Who am I now? The experience of being a post-registration children's student nurse in the first clinical placement

Role transition from staff nurse to post-registration student is not a well researched area of nursing. Two previous Irish studies have been reported of the experiences of post-registration midwifery students [McCrea, H., Thompson, K., Carswell, L., Whittington, D., 1994. Student midwives' learning experience on the wards. Journal of Clinical Nursing 3, 97-102; Begley, C., 1997. Midwives in the making: a longitudinal study of the experiences of student midwives during their two-year training in Ireland. Unpublished PhD Thesis, School of Nursing and Midwifery, Trinity College, Dublin.] but there is limited research into post-registration children's student nurses experiences. A broadly phenomenological approach was employed to interpret what it means to be a post-registration children's student nurse during the first clinical placement. Data was collected from a purposive sample of six students, using unstructured tape recorded interviews. Thematic content analysis was utilised to produce an interpretation of nurses' experience within the first clinical placement. The findings reflect the participants' role confusion when changing from being a staff nurse in one discipline of nursing to being a post-registration student in another. They find previous experience is not recognised and that students originating from different disciplines in nursing have different experiences within the first placement. Coping mechanisms are discussed along with preparation for and supports available in the clinical area.     

Problems in the supervision and assessment of student nurses: can clinical placement be improved?

The assessment and supervision of student nurses during clinical placement remains a complex activity. The student needs to be assessed thoroughly to identify his or her strengths and weaknesses. Further, this assessment should be conducted in circumstances which allow the student to be at his or her best. There are many which continue to impact upon clinical supervisors although documented over the last five to ten years. This paper addresses how assessment and student supervision are still influenced by extraneous factors. Its major suggestion is for universities to place a greater emphasis on all aspects of the clinical placement component within nursing courses.     

The student experience of clinical supervision across health disciplines – Perspectives and remedies to enhance clinical placement

Effective clinical practice supervision for health students is essential prior to commencing their respective professions. Students require adequate preparation before their clinical practice event with an experienced clinical supervisor able to impart professional ‘know how’ and skills to students. The purpose of this study was to describe final year health students' perspectives and experiences of clinical supervision, and to develop an interprofessional model of clinical supervision. Focus groups and semi-structured interviews were conducted with undergraduate health students across a range of disciplines. Some students provided email comments. Qualitative data was analysed thematically using NVivo (V11). Six key themes and their various sub-themes (refer Table 1) were identified: (1) undergraduate learning valued by the CP provider; (2) effective connections (communications) between student, CS, CP provider and university; (3) undergraduate student learning not being valued; (4) ineffective connections; (5) mitigating factors for students; and (6) the impact of increasing student numbers. Undergraduate health student clinical placement requires careful educational preparation, structuring and adequate support for both the student undergoing the practice event and for the clinical supervisor stewarding the undergraduate health professional. A prospective plan to ensure an excellent experience is required (Fig. 1).     

One site fits all? A student ward as a learning practice for interprofessional development

Abstract

Interprofessional training wards (IPTWs), aiming to enhance interprofessional collaboration, have been implemented in medical education and evaluated over the last decade. The Faculty of Health Sciences, Linköping University has, in collaboration with the local health provider, arranged such training wards since 1996, involving students from the medical, nursing, physiotherapy, and occupational therapy programs. Working together across professional boundaries is seen as a necessity in the future to achieve sustainable and safe healthcare. Therefore, educators need to arrange learning contexts which enhance students’ interprofessional learning. This article shows aspects of how the arrangement of an IPTW can influence the students’ collaboration and learning. Data from open-ended questions from a questionnaire survey, during autumn term 2010 and spring term 2011 at an IPTW, was analyzed qualitatively using a theoretical framework of practice theory. The theoretical lens gave a picture of how architectures of the IPTW create a clash between the “expected” professional responsibilities and the “unexpected” responsibilities of caring work. Also revealed was how the proximity between students opens up contexts for negotiations and boundary work. The value of using a theoretical framework of professional learning in practice within the frames of healthcare education is discussed.     

Reflections on the practice of facilitating group‐based antenatal education: Should a midwife wear a uniform in the hospital setting?

Wisanskoonwong P, Fahy K, Hastie C. International Journal of Nursing Practice 2011; 17 : 628–635 Reflections on the practice of facilitating group‐based antenatal education: Should a midwife wear a uniform in the hospital setting? The first author of this paper, a Thai midwife, conducted a feminist action research project aimed at collaboratively developing a model for group‐based antenatal education in Thailand. Should a midwife wear a uniform when facilitating midwife‐led group‐based antenatal education sessions in the hospital setting? This paper reports on a single example of reflection in and on midwifery practice that aimed to answer the guiding question. The practice and reflection occurred over a number of months at the beginning of the feminist action research project. The midwife should wear normal clothes when facilitating group‐based antenatal education as a symbol of equality in power relationships within the group. When power relationships between women and the midwife are equalized, women are more able to take responsibility for their health as they are less likely to defer to the ‘expert’. Reflection in and on practice is a powerful tool to allow the midwife to understand and change her own practice as required to meet those goals. Self‐change is a critical first step because there can be no change in the way maternity care is provided without each midwife being willing to be self‐aware and open to appropriate self‐change.     

How effective is the computer-based clinical practice guideline?

CONTEXT: The primary prevention of coronary artery disease in patients with diabetes could have a large impact on health care costs and outcomes. Guidelines for improving diabetic health indices are common, but significant challenges exist in implementing them. GENERAL QUESTION: How does integrating an evidence-based guideline into an electronic medical record affect patient care? SPECIFIC RESEARCH CHALLENGE: How can we implement the new guideline-enhanced medical record in a controlled manner and measure its impact on physician satisfaction, diabetes process measures, and the risk for cardiovascular disease? PROPOSED APPROACH: All patients in the University of Washington system have an electronic Web-based medical record. Patients with diabetes will be randomly assigned to a guideline-enhanced or standard electronic medical record. The electronic medical record allows measurement of most clinical process measures and outcomes. Physician satisfaction will be measured by survey. POTENTIAL DIFFICULTIES: Contamination may occur when guideline recommendations are applied to control patients as physicians gain experience with the guideline-enhanced record.     

Can the study of ethics enhance nursing practice?

AIM: The aim of this paper is to suggest that the study of ethics and ethical theories can enhance nursing practice. DISCUSSION: Knowledge of ethical theories can be of practical use to nurses in at least three ways. First, it can help nurses uncover to what extent a problem is an ethical one. The questions faced in practice can be empirical, formal or philosophical. Very often, a practical decision requires us to tackle all three types. In the example of a 'Do not attempt resuscitation' order, deciding on whether such an order is appropriate requires us to answer empirical questions such as how likely any attempt is to achieve success. It also requires us to answer formal questions such as whether the law permits such an order in the present circumstance. Finally, it requires us to answer ethical/philosophical questions, such as how we should weigh up quality of life against quantity. Second, it can enable practitioners to develop skills and tools to tackle ethical/philosophical questions. In this paper I describe two such tools: Socratic questioning and Aristotelian dialectic. Third, it can help practitioners to develop the soundness of their ethical values and beliefs. All ethical reasoning requires us to use our values and beliefs, and attending to them enhances the quality of our reasoning. CONCLUSION: The study of ethics can enhance nursing practice.     

Case-based learning in cross-professional groups – the development of a pre-registration interprofessional learning programme

This paper describes the development and evaluation of an interprofessional learning (IPL) programme at the pre-registration level. The principal aim of the study was to investigate whether case-based learning in cross-professional groups is a feasible and an effective way to conduct interprofessional education (IPE). Student volunteers from five different health professional training programmes were allocated to two groups: an intervention group and a control group. Interprofessional attitudes of all students were measured at the beginning and at the end of the study. Group members fed back their views about their learning experience after the 9-week long intervention. The study reports significant effects of the intervention on students' attitudes to different health professions. For example, students in the intervention group tended to view each profession as more ‘caring’ when compared to the control group. Student feedback was positive, with the main message to integrate the programme in the timetable and to introduce an opportunity for IPE in future years. The initial findings reported in this paper show that this is a feasible and an effective way to deliver IPE across the wide range of professions in the study and that the learning programme was viewed positively by the students who took part.     

“Collaborative-ready” students: Exploring factors that influence collaboration during a longitudinal interprofessional education practice experience

A goal of interprofessional education (IPE) is to prepare “collaborative-ready” healthcare professionals to ultimately improve health outcomes. The objective of our study was to explore student-reported factors that influence collaboration within our longitudinal IPE experience. Twenty-five first-year pharmacy students and 50 first-year medical students enrolled in IPE courses were invited to participate in three focus groups. Focus group responses were audio-recorded, transcribed verbatim, and applied to a qualitative thematic analysis. Eighteen students participated with six students in each group. Compared to the medical students, the pharmacy students were younger (22 vs. 26 years), had earned only a high school diploma, and had less healthcare experience. Emergent themes that students reported revealed various factors that can facilitate and inhibit collaboration among student participants. These findings can inform curricular redesign to focus on: clarifying provider roles, requiring ongoing preceptor development, enhancing course orientation, and coordinating student schedules to better prepare “collaborative-ready” students.     

Does implementation of a paediatric asthma clinical practice guideline worksheet change clinical practice?

Background

Despite the development of evidence-based practice guidelines in many countries for asthma treatment in children, there is limited evidence that using such guidelines improves patient care.

Aims

Our aim was to evaluate whether the implementation of an evidence-based asthma clinical practice guideline (CPG) worksheet changes clinical practice.

Methods

The study was a before and after study of the implementation of a paediatric asthma CPG in a tertiary paediatric emergency department (ED). All children aged 2–16 years who had a diagnosis of asthma were included. Clinical data were obtained by retrospective chart review for time periods before (May to September 2003) and after (May to September 2005) the introduction of the CPG worksheet. Primary outcomes were: use of spacers for salbutamol instead of nebulisers, use of ipratropium and use of corticosteroids. Secondary outcomes were use of an ED action plan, ordering chest X-rays (CXR) and admission rate.

Results

Before implementation, 240 children presented with asthma and after implementation, 286 children presented. The two groups had similar ages, asthma severity, admission respiratory rate (RR) and oxygen saturation. Following implementation there was an increase in spacer use from 17 to 26% [+9%; 95% confidence interval (CI): 2–16%; p?=?0.015] and a reduction in ipratropium use from 58 to 44% (?13%; 95% CI: ?22 to ?5%; p?=?0.0029). The proportion of patients treated with corticosteroids did not change. The number of patients with an ED action plan increased. The number of CXR ordered decreased and the hospital admission rate decreased.

Conclusions

The study demonstrates that implementation of an asthma CPG worksheet in a tertiary paediatric ED resulted in modest changes in clinical practice, mainly by increasing clinician adherence to the guidelines.     

Developing interprofessional education in the pre-registration curricula: mission impossible?

Interprofessional education has long been cited in health and social care policy as a remedy to improve many of the problems faced by the National Health Service (NHS) around co-ordination and collaboration of staff. More recently, this form of education has been acknowledged as having a key role in delivering the government’s modernisation agenda to produce a more ‘flexible’ workforce. Given the large number of logistical problems connected to developing interprofessional education before registration, this type of activity more often occurs after registration. It is interesting, therefore, to note that pre-registration interprofessional education has recently been hailed by NHS policy as a primary method for enhancing collaboration. However, these policy documents have both contributed to the conceptual confusion in this area and also overlooked the range of factors (educational, organisational and cultural) connected with implementing and sustaining this type of education in the pre-registration sector. In posing the question, ‘pre-registration interprofessional education: mission impossible?’ this paper examines the cultural, organisational and educational factors that affect the development of this activity. It also considers attempts to build an evidence-base for interprofessional education. This paper finally outlines how the implementation of interprofessional practice-based placements can be an achievable goal for the pre-registration curricula.