Partnering to educate: Dedicated education units

A current focus of the healthcare industry is centered on addressing the nursing shortage. In the midst of a nursing faculty shortage the Institute of Medicine (2010) recently released a report that calls for increasing the number of baccalaureate prepared nurses to 80% of the workforce by 2020. Therefore, nursing schools are faced with graduating more nurses to meet the demand. Yet, admission to schools of nursing are often limited because of clinical placement sites. The Dedicated Education Unit (DEU) model has been recently introduced to address the challenge of increasing the enrollment of nursing students in spite of a nationwide shortage of nursing faculty. Dedicated Education Units are clinical sites in hospitals where staff nurses serve as preceptors for students in all levels of their nursing education. This model is designed to improve practice education to better prepare students for actual practice while decreasing the number of faculty required at clinical sites. The purpose of this article is to discuss the implications of this model for nursing education, our experience with the DEU model, and issues of deliberation.     

University COVID -19 Surveillance Testing Center: Challenges and Opportunities for Schools of Nursing

As the impact of the COVID-19 pandemic became clear, it was evident that higher education schools and Universities, including schools of nursing were facing enormous challenges to create a safe environment for educational instruction to continue. Clinical education in particular was affected as clinical sites were increasingly unable to accommodate student clinical rotations due to crushing volumes and overwhelming care needs of COVID patients. This article outlines the innovative efforts of one university that set up a robust surveillance testing program that required and provided weekly COVID-19 testing of all students, faculty and staff that were on-campus. The testing center is nurse led and nurse managed, providing a clinical experience for over 50 nursing students each semester, allowing them to accrue community clinical hours so that they can progress through their nursing program. Clinical quality and patient experience outcomes are shared, and lessons learned described.     

Public schools as a clinical setting for RN students.

The challenge to select meaningful clinical sites for RN students is a problem for educators. The significance of the public schools as an initial clinical site, the contribution of RNs to school health programs, student responses, and adaptations to the school setting are presented. Outcomes of the experience will interest nurse educators attempting to provide a professional education for RN to BSN students and provide a service to the community.     

Institutional collaboration and competition in community-based education

We sought to determine whether competition for community-based training sites exists among health professions schools, and to examine faculty and senior administrators' perspectives on institutional collaboration for community-based education. Eight academic health centers (AHCs) in the USA were selected by objective criteria for their significant community involvement. Chief executive officers, vice chancellors, deans, and the individuals responsible for community-based education, research and community service responded to written surveys. The overall response rate was 79% (n = 91). Responses were subjected to quantitative and qualitative analyses. Leaders of community-based education reported that "competition for community-based training sites" is a barrier to community involvement. "Competition for community-based training sites"was positively related to 'call for increasing percentage of graduates to enter primary care careers' (0.30, p < 0.01) and negative related to "collaboration exists between the community and your school/AHC" ( - 0.28, p < 0.05). Respondents reported that a moderate level of collaboration across schools exists. While medical school respondents reported having collaborative relationships with other health professions schools and with the community, nursing respondents reported medicine's performance at a significantly lower level. Public health and nursing faculty reported that they are competing with medical schools for sites they had traditionally used for their students. Competition for sites is an unintended outcome of the increased emphasis on community-based education in health professions curricula. We recommend AHCs form joint committees across schools to effectively address community-based sites as a limited resource, and to consider a wider range of community-based organizations as training partners.     

Pre-service midwifery education in sub-Saharan Africa: A scoping review

BackgroundIn response to a global call for more midwives, maternal health stakeholders have called for increased investment in midwifery pre-service education. Given the already long list of challenges and the increasing burden on health care systems due to the COVID-19 pandemic, the need to prioritize investment is acute, particularly in sub-Saharan Africa. An important first step is to examine the current evidence.MethodsWe conducted a scoping review of the peer-reviewed literature about pre-service midwifery education in sub-Saharan Africa. A search of studies published between 2015 and 2021 in French or English was conducted using six databases (PubMed, CINAHL, Embase, Scopus, Web of Science and African Index Medicus).ResultsThe search yielded 3061 citations, of which 72 were included. Most were a mix of qualitative and quantitative cross-sectional, country-specific studies. Organized by pre-service educational domain, the literature reflected a misalignment between international standards for midwifery education and what schools and clinical sites and the larger administrative systems where they operate, reliably provide. Inadequate infrastructure, teaching capacity in school and clinical settings and clinical site environment were factors that commonly impede learning. Literature related to faculty development and deployment were limited.ConclusionSchools, faculty and clinical sites are overwhelmed yet recommendations by key stakeholders for change are substantive and complex. Efforts are needed to help schools map their current status by pre-service education domain and prioritize where scarce resources should be directed. These results can inform research and investments in pre-service midwifery education in sub-Saharan Africa.     

Institutional collaboration and competition in community-based education

We sought to determine whether competition for community-based training sites exists among health professions schools, and to examine faculty and senior administrators' perspectives on institutional collaboration for community-based education. Eight academic health centers (AHCs) in the USA were selected by objective criteria for their significant community involvement. Chief executive officers, vice chancellors, deans, and the individuals responsible for community-based education, research and community service responded to written surveys. The overall response rate was 79% (n?=?91). Responses were subjected to quantitative and qualitative analyses. Leaders of community-based education reported that ‘competition for community-based training sites’ is a barrier to community involvement. ‘Competition for community-based training sites’ was positively related to ‘call for increasing percentage of graduates to enter primary care careers’ (0.30, p?<?0.01) and negative related to ‘collaboration exists between the community and your school/AHC’ (???0.28, p?<?0.05). Respondents reported that a moderate level of collaboration across schools exists. While medical school respondents reported having collaborative relationships with other health professions schools and with the community, nursing respondents reported medicine's performance at a significantly lower level. Public health and nursing faculty reported that they are competing with medical schools for sites they had traditionally used for their students. Competition for sites is an unintended outcome of the increased emphasis on community-based education in health professions curricula. We recommend AHCs form joint committees across schools to effectively address community-based sites as a limited resource, and to consider a wider range of community-based organizations as training partners.     

Finding common ground in public health nursing education and practice

Preparation of the public health nursing (PHN) workforce requires public health nurses from academia and practice to collaborate. However, a shortage of PHN clinical sites may lead to competition between schools of nursing for student placements. The Henry Street Consortium, a group of 5 baccalaureate schools of nursing and 13 local health departments in the state of Minnesota, developed a model for collaboration between PHN education and practice. This paper describes the development process--the forming, storming, norming, and performing stages--experienced by the Henry Street Consortium members. The consortium developed a set of entry-level core PHN competencies that are utilized by both education and practice. It developed menus of learning opportunities that were used to design population-based PHN clinical experiences. In addition, the consortium created a model for training and sustaining a preceptor network. The members of the Henry Street Consortium collaborated rather than competed, used consensus for decision making, and respected and accepted different points of view. This collaboration significantly impacted how schools of nursing and local health departments work together. The consortium's ability to retain its relevance, energy, and momentum for both academic and agency partners sustains the collaboration.     

Clinical site selection by students through use of an internet database

Use of the Internet in nursing education has greatly expanded during the past decade and will continue to be a force in the future. The authors describe the development and maintenance of an Internet Web site created to assist in the placement of individual students on particular clinical sites for their Capstone Practicum course in a baccalaureate school of nursing. Issues related to development, maintenance, and use of the program are included. Recommendations include possible application in other schools of nursing as well as other disciplines.     

Paying for nursing student clinical placements,ethical considerations

Ethics is foundational to nursing practice, including the practice of nursing education. Many schools of nursing are struggling to find adequate clinical placements for students; the root causes of this shortage are complex. Although it has not historically been the practice, some schools of nursing are considering offering clinical agencies payment for this valuable resource.Given the importance of clinical experience in nursing education, relationships between schools of nursing and clinical agencies are crucial. This paper explores some of the advantages and disadvantages that may present if schools of nursing pay clinical agencies to host nursing students, specifically pre-licensure students. Prior to establishing such relationships, schools of nursing and clinical agencies should carefully consider this decision. Questions informed by the American Nurses Association Code of Ethics and the National League for Nursing Ethical Principles for Nursing Education are provided as examples.     

Partnering with schools: a win-win experience

In many states, budget cuts have influenced school systems to question whether school nurses are necessary. Consequently, many schools no longer have a nurse to coordinate school health services. Creighton University School of Nursing saw this situation as an opportunity. Using schools as clinical sites for nursing students has resulted in positive outcomes for all involved. Competencies successfully demonstrated by nursing students have included understanding concepts of health and illness, identification of strategies to promote and protect the school-age population, and the ability to provide population-focused prevention within the community. Faculty think the school population is healthier and school personnel have increased knowledge of health promotion and protection strategies for school-age children as a result of the school health project. The education provided serves to promote the well-being of students, families, and the community and prepares them to make health-related choices. The project has also resulted in health benefits for the community.     

A survey of rural medical education strategies throughout the medical education continuum in Canada

In many countries the sustainability of rural health care systems is being challenged by a shortage of rural physicians and difficulties in recruiting and retaining physicians in rural practice. Research does suggest that specific medical education strategies can be introduced to enhance rural physician recruitment and retention initiatives. The purpose of this paper is to summarize the current strategies of Canadian rural medical education programs. A survey of all Canadian medical schools was undertaken to profile specific programs and activities at the undergraduate, postgraduate, and continuing medical education/continuing professional development (CME/CPD) levels. The majority of medical schools reported either mandatory or elective rural medicine placement/learning experiences during undergraduate medical education, as well as Rural Family Medicine streams or programs as components of postgraduate medical education. The majority of medical schools reported that they provide clinical traineeships to enhance clinical competencies in rural medicine as well as CME outreach programming, including the use of telehealth or distance learning technologies. Canadian medical schools all have substantial programs covering the full range of approaches found in the literature to help recruit and retain rural physicians. Not surprisingly, the most extensive programs are found in medical schools that have a specific rural mandate.     

Clinical nursing and midwifery education in the pandemic age

The COVID-19 pandemic has disrupted clinical nursing and midwifery education. This disruption has long-term implications for the nursing and midwifery workforce and for future healthcare responses to pandemics. Solutions may include enhanced partnerships between schools of nursing and midwifery and health service providers and including schools of nursing and midwifery in preparedness planning. These suggestions notwithstanding, we call upon national and international nursing and midwifery bodies to study how to further the clinical education of nurses and midwives during pandemics and other times of crisis.     

Cost-effectiveness and pain medicine

The specialty of pain medicine, as noted by Lippe,“… justifies itself as a unique medical specialty by virtue of a distinct body of knowledge and a well-defined scope of practice. In common with other medical specialties, it is founded on an infrastructure of scientific research, education, and clinical practice [1].“ The traditional methods of education for healthcare providers, such as medical schools, nursing schools, physical therapy schools, and clinical psychology programs, do not prepare their students adequately for the delivery of evaluation and treatment services to patients experiencing pain. Also apparent, as evidenced by the dearth of medical literature, is that the traditional methods of educating pain specialists do not adequately prepare students for an effective approach to the realities of healthcare economics in their respective fields.The result of a lack of significant education in the economics of pain medicine can be financially devastating to a new practitioner who is practicing “good” medicine yet not meeting the financial obligations incipient in the operation of a multidisciplinary pain center or even a solo practice. One important concept in the study of healthcare economics is the issue of cost-effectiveness [2].     

The Community Preceptor Crisis: Recruiting and Retaining Community-Based Faculty to Teach Medical Students—A Shared Perspective From the Alliance for Clinical Education

Issue: Community-based instruction is invaluable to medical students, as it provides “real-world” opportunities for observing and following patients over time while refining history taking, physical examination, differential diagnosis, and patient management skills. Community-based ambulatory settings can be more conducive to practicing these skills than highly specialized, academically based practice sites. The Association of American Medical Colleges and other national medical education organizations have expressed concern about recruitment and retention of preceptors to provide high-quality educational experiences in community-based practice sites. These concerns stem from constraints imposed by documentation in electronic health records; perceptions that student mentoring is burdensome resulting in decreased clinical productivity; and competition between allopathic, osteopathic, and international medical schools for finite resources for medical student experiences. Evidence: In this Alliance for Clinical Education position statement, we provide a consensus summary of representatives from national medical education organizations in 8 specialties that offer clinical clerkships. We describe the current challenges in providing medical students with adequate community-based instruction and propose potential solutions. Implications: Our recommendations are designed to assist clerkship directors and medical school leaders overcome current challenges and ensure high-quality, community-based clinical learning opportunities for all students. They include suggesting ways to orient community clinic sites for students, explaining how students can add value to the preceptor's practice, focusing on educator skills development, recognizing preceptors who excel in their role as educators, and suggesting forms of compensation.     

Using experienced clinicians to facilitate clinical education

Dedicated education units (DEUs) teach nursing students how to provide professional, competent, and safe nursing care using staff nurses as educators and reduce the number of adjunct clinical faculty required by schools of nursing. The authors describe a collaborative clinical partnership between a pediatric healthcare system and a school of nursing to pilot the use of a DEU for one-on-one clinical education of students with expert pediatric nurses.     

The availability of education on death and dying: A survey of U.S. nursing schools

A stratified random sample of 226 U.S. nursing schools was surveyed to determine the extent and nature of current death education training for nursing students. Of the 205 responding schools, 5 percent reported offering a required death and dying course, while an additional 39.5 percent indicated that a death and dying course was available for their students on an elective basis. The authors challenge the current pedagogical approach toward death education in U.S. nursing schools. They propose the need for the development of a model that would formally link a death education course, or courses, with the clinical phase of training. It is hypothesized that such an approach would enhance the nursing students' recognition and management of their feelings regarding death and dying and therefore result in more effective means of relating to terminally ill patients.     

Shifting the clinical teaching paradigm in undergraduate nursing education to address the nursing faculty shortage

To address the faculty shortage problem, schools of nursing are reexamining how they provide clinical education to undergraduate students to find ways to use faculty resources more efficiently and to maintain student enrollment. We describe a unique clinical teaching model implemented at the New York University College of Nursing. The new model currently being evaluated shifts from the traditional clinical education model, in which all clinical education is in a hospital or agency setting, to a model that substitutes high-fidelity human patient simulation for up to half of the clinical education experience. This article describes the clinical teaching model and its effects on nurse faculty capacity.     

Hope Theory: A Framework for Understanding Suicidal Action

Abstract

A stratified random sample of 226 U.S. nursing schools was surveyed to determine the extent and nature of current death education training for nursing students. Of the 205 responding schools, 5 percent reported offering a required death and dying course, while an additional 39.5 percent indicated that a death and dying course was available for their students on an elective basis. The authors challenge the current pedagogical approach toward death education in U.S. nursing schools. They propose the need for the development of a model that would formally link a death education course, or courses, with the clinical phase of training. It is hypothesized that such an approach would enhance the nursing students' recognition and management of their feelings regarding death and dying and therefore result in more effective means of relating to terminally ill patients.