Role of the clinical facilitator

This article looks at and considers, in the light of current developments within nurse education, the role of the clinical facilitator, emphasising that within a changing educational environment such a role is both essential and feasible.The authors conclude that all trained staff within the clinical area (especially where learners are employed) should accept their individual roles as facilitators, and in this context recognise their own and the students' self-worth.     

Student views of interprofessional education facilitator competencies: A cross-sectional study

ABSTRACT

Research attention has been paid to providing evidence on undergraduate/pre-licensure health sciences students’ interprofessional education competency requirements, placements, and attainment. Although interprofessional facilitator training has been identified as critical to interprofessional learner outcomes, scant research has examined student perceptions of valued facilitator competencies. This short report investigates students’ views of important attributes for interprofessional facilitation using a cross-sectional observation-survey design. A survey was conducted in a pre-licensure sample of n = 343 students (response rate 68%) from four health professions (nursing, midwifery, physical therapy, and occupational therapy). After completing a semester-long interprofessional education course, students completed a survey vis-à-vis rating the importance of interprofessional facilitator competency with regard to 25 abilities, 12 teacher profiles, and 10 characteristics. Taken together, results indicate the need for a multifaceted view of interprofessional facilitator competencies. Our findings will inform training targeted to specific facilitator competencies, as needed for optimizing the delivery of interprofessional education.     

Rural palliative care needs: a survey of primary care professionals in Powys, Wales

The county of Powys in rural Wales has a population of about 125,000 people and no district general hospitals. In 1999, 12 Macmillan general practitioner clinical facilitators were appointed as part of a pilot project aiming to provide a coordinated framework for the commissioning of specialist cancer and palliative care services, extended clinical care to cancer and non-cancer patients, and an educational intervention to raise the standards of generalist palliative care. A survey of facilitators, general practitioners, district nurses and community hospital nurses was undertaken early in the project. Palliative care formed a small but significant part of respondents' workload. Specialist palliative care services were seen as helpful but distant from the patients. Pain and symptom control were seen to be problematic in patients with diagnoses other than cancer. Services that provided 24-hour nursing care at home were thought to be in need of development by most respondents.     

Exploring the views of nurse prescribing among Macmillan nurses

Nurse prescribing is a key government initiative which aims to enhance patient care. The aim of this study was to investigate the prescribing practice of specialist nurses working in cancer and palliative care and to explore the benefits of and barriers to uptake of nurse prescribing training. A national postal survey of 2252 Macmillan nurses was undertaken using a structured questionnaire with open-ended questions. Data were analyzed using thematic content analysis for 1575 respondents (70% response rate). Only 13% (203) had undergone prescribing training and of these 105 provided responses to the open questions concerning training and of the 87% (1372) who had not undergone the training, 423 provided details on barriers to nurse prescribing training. The data presented in this paper draw from this data. The findings indicate that those who prescribed gave the prospect of improving care as the main reason for undertaking nurse prescribing training. The main reasons why these specialist nurses did not undertake training were: resource issues particularly with respect to backfill while training, lack of medical support and mentorship, concerns about the relevance of prescribing as a nursing role and prioritizing other courses. If nurse prescribing is to be more widely available for cancer and palliative care patients it is important in both primary and secondary care to address the resource and support issues.     

Provider/client views: health-care needs of the rural elderly.

Health-care providers perceived the following issues as influencing service use among rural elderly: financial restraints, eligibility requirements, values, geographic location, coordination of services, transportation, knowledge of normal aging, and family education. The elderly cited the following as influencing their acceptance of services: self-perceptions, fear of dependence, lifetime skills, finances, and maintaining dignity. More research is necessary to determine the "true" needs of older adults in rural areas so that service provision can effectively be modified to meet existing and future needs.     

Development of diabetes attitude scale for health-care professionals

This article describes the development of a diabetes attitude scale (DAS) that was designed to measure the attitudes of health-care professionals (HCPs). The DAS was developed through the efforts of a national panel of diabetes experts. The panel developed a 60-item scale that was pilot tested and reduced to a 50-item scale. The 50-item scale was then mailed to a national sample of HCPs with an interest in diabetes. The surveys were returned by 633 nurses, 322 dietitians, 116 physicians, and 67 others totaling 1138 returns (a return rate of 54%). The returned surveys were analyzed, and a 31-item DAS composed of 8 subscales resulted. Evidence for the reliability and validity of the 31-item DAS along with the instrument itself are included in this study.     

Pediatric palliative care online: the views of health care professionals

The purpose of the study was to evaluate the role of an online resource for dying children, their family members, and health care providers from the perspective of pediatric palliative care experts. Semistructured interviews with 12 leaders in pediatric palliative care in North America were conducted, exploring their perceptions and attitudes towards various aspects of Web-based resources for dying children and their care providers. Informants felt that an online resource may allow for a different form of expression, a connection between people undergoing a rare event, and an increase in education and support. Major challenges, such as accessibility, monitoring, and remaining current, would be ongoing. Other key themes included access, information, and anonymity. The data suggest that developing Web-based resources for dying young patients and their families may have merit. Should this take place, a feasibility study will be necessary to further determine the value of such a Web site for these vulnerable populations.     

Ability and attitudes to mathematics of post-registration health-care professionals

A small study was conducted to investigate the mathematical abilities and attitudes to mathematics teaching of a sample of students embarking upon post-registration courses in health care. Mathematical ability showed a number of deficiencies of some concern. Expressed attitudes to mathematics teaching led to a discussion of the nature of mathematics teaching and some recommendations for remedial action.     

The views of primary health care professionals about the management of breast problems in clinical practice

Rationale, aims and objectives To identify primary health care professionals’ views about patients presenting with breast problems, and their approaches to clinical management. Methods Qualitative study using practice‐based semi‐structured group discussions with primary health care professionals. All practices were involved in a study evaluating the effect of the national breast symptom management guidelines on clinical practice. Discussion groups were conducted in the practices; 15 of the 34 study practices were audio‐taped. Groups comprised the partners and practice nurses at each practice. All members of each group were well known to one another. There was good attendance by all doctors, with 75% of male partners and 90% of female partners present at the meetings. Of the practice nurses, 51% attended. In all, 86 professionals attended the meetings. Results A number of themes arose consistently from the discussions. Participants were concerned about the possible consequences of errors in diagnosis and about difficulties concerning the ‘management of uncertainty’. Doctors were influenced especially by adverse past experiences. Other difficult situations included referral decisions and the management of risk factors in isolation from clinical presentation. Outside influences on presentation and management, such as the media, were also noted. Conclusions The management of breast disease is perceived as a complex issue by health professionals. The patient and doctor contextual factors described must be taken into account in discussions about what constitutes appropriate clinical management and in the development and implementation of clinical guidelines to improve management.     

Exploring the Doctor of Nursing Practice project facilitator/mentor role

BackgroundThe Doctor of Nursing Practice (DNP) facilitator/mentor is a collaborative member of the project team, yet little has been reported about this role. This qualitative study explored the experiences of DNP project facilitators.MethodsFocus groups were conducted using a purposeful sample of project facilitators. Focus group questions were developed using Gitlin, Lyons, and Kolodner's five-stage model of collaboration. Data were transcribed and content analyzed using Kruger and Casey methods.ResultsThree focus groups included 21 facilitators who were affiliated with an academic health system. Six themes emerged: (a) exploring student interest, (b) establishing a collaborative fit, (c) connecting with key stakeholders, (d) overcoming barriers, (e) role clarity, and (f) interaction.ConclusionDNP project facilitators have an important role not only in students’ formation, but also in contributing to the academic–practice partnership. The importance of the facilitator role as the student progresses through their DNP project cannot be overstated.     

Clinical nurse specialist: a facilitator for clinical research

The role of the clinical nurse specialist is continuing to expand to include participation in clinical research. There is, however, a lack of clinical researchers available to conduct nursing research. A clinical nurse specialist with a joint appointment between a clinical and an academic setting can facilitate clinical research through collaboration. Such collaborative efforts can result in improved patient care and nursing practice. This article describes several major collaborative models used to join the academic and practice settings and discusses their strengths and weaknesses. It also describes in detail a collaborative approach in which the clinical nurse specialist play a more pivotal role by acting as a facilitator for the collaboration. We discuss the formation of the collaborative team, the roles of the participants, and the research plan of the team. Suggestions for implementing this model in other settings are offered.     

Language translation of outcome measurement tools: views of health professionals

Assessing the outcome and effectiveness of treatment is extremely important in nursing practice and it is vital that outcome measures are available to non-English speakers. We investigated health professionals' views on translating outcome measures for use in nursing practice. Semi-structured interviews were conducted with a purposive sample of 10 health professionals. Content analysis of data identified the following two broad themes: meeting need and cultural consideration. Specific palliative care issues were also identified. Low literacy levels among ethnically diverse communities and the need to ensure cultural equivalence were perceived as major challenges for palliative nursing practitioners when translating outcome measures. Given increasing cultural diversity within the UK, health professionals considered clinical tool translation worthwhile because it helps to address inequalities in health-care provision for ethnically diverse communities. A consideration of the cultural context is needed when interpreting responses on translated outcome measure. However, translations into appropriate languages can help overcome communicant barriers and minimize the need for family members to act as interpreters for patients with palliative care needs.     

Regulation and legislation of the dying process: views of health care professionals

Because of radical changes that have been effected by medical advances in the process of dying, it is now frequently necessary for patients to make an explicit decision on whether to, forego life-prolonging medical therapies. We report physicians' and nurses' perceptions of the need for, feasibility of, and value of regulations and legislation to govern the dying process. In-depth, semistructured interviews were conducted with a sample of 20 physicians and 20 nurses at a large teaching hospital. There was little unanimity in their attitudes toward whether it is advisable or feasible to devise adequate legal safeguards for physicians and nurses who assist patients to hasten their deaths. Some believed such regulations were needed, but others believed they would seriously compromise good patient care. There was also disagreement as to who should develop guiedlines. There was, however, clear opposition among most participants to the involvement of lawyers in the process of clarifying the content of regulations and legislation on the dying process.     

GP views of nurse-led telephone referral for paediatric assessment

Following the introduction of a new nurse-led telephone referral service to a dedicated paediatric emergency assessment unit (PEAU), a study was conducted to determine the views of general practitioners (GPs) who use the service. The PEAU operates between 10 am and 10 pm on weekdays and between 10 am and 6 pm at weekends. The unit has four beds and treatment and stabilization areas, plus associated services in a dedicated area of a regional child health unit. The design utilized a faxed questionnaire over a 1-month period to all consenting GPs using the PEAU with a postal questionnaire follow-up. Non-parametric Likert scores and qualitative data were used to determine levels of satisfaction with the service and the subsequent management of the referred children. Sixty-nine GPs referred 80 children to the PEAU via the service over a period of 1 month. All consented to participate and were sent a faxed questionnaire, which generated 39 (57%) responses. A follow-up questionnaire sent to the 39 respondents achieved a return of 25 (64%) responses. Thirty-four GPs agreed that referral via the dedicated nurse service was easier than the previous senior house officer referral system. Of the 25 GP respondents to the follow-up postal survey, the majority (17) agreed that the follow-up morning after discharge telephone call to parents by the PEAU nurses was helpful. Four GPs indicated that the 24-hour open access system, offered by the nursing staff, in which a parent may attend PEAU with a discharged child causing concern without a previous appointment, does not always work. This study has shown that a nurse-led telephone referral system to a PEAU for GPs and the subsequent management of the children has been favourably received.     

An evaluation of the role of the clinical education facilitator

Aims and objectives. The objective of the study was to identify whether clinical education facilitators made a difference to the learning experiences of nurses in a large teaching hospital. Background. Strategies for enabling continuous professional development are well established in healthcare organizations as key components of approaches to lifelong learning. The benefits of continuous professional development include the maintenance of high standards of care, the improvement and development of services, ensuring the competency of all nursing staff and guaranteeing the accountability of nurses for their actions. The role of clinical education facilitator is relatively new and little evaluation of this role has been undertaken. Conclusions. This study highlights important issues to be considered in developing a ‘learning culture’ in a hospital organization, through the adoption of such roles as clinical education facilitators. Whilst the roles have had an important function in the active coordination of learning activities in the hospital, there is little evidence of the role directly impacting on the learning culture of clinical settings. Learning mechanisms have been identified. The results of this evaluation can be subjected to further testing through ongoing evaluation of the outcomes arising from the learning mechanisms in place. Given the emphasis on work‐based learning and continuing professional development in health care, then this ongoing evaluation can yield important information about future directions for nurse education. Relevance to clinical practice. The study highlights the importance of supported learning in the workplace. However, more importantly, it identifies the need for a culture of professional practice to be developed in order to sustain learning in practice. Classroom‐based learning alone, cannot create a culture of development in nursing and there is thus a need for models of work‐based learning to be integrated into practice environments.     

An action research project to evaluate the clinical practice facilitator role for junior nurses in an acute hospital setting

It has been well documented that newly qualified nurses require support in developing confidence and professional competence. Although preceptorship models have gone some way in addressing this need, innovative and flexible models of facilitation and development are also required to respond to local demands. In the project reported here a number of supernumerary clinical practice facilitators (CPFs) were appointed to support both healthcare assistants and newly qualified registered nurses to enhance their competence and clinical skills. It was anticipated that they might also encourage awareness of other professional issues, such as evidence-based practice, as well as having a positive influence on the clinical learning environment and staff morale. This article describes how an action research approach was used to establish the CPF role in a variety of clinical areas across a large inner-city National Health Service Trust. It outlines the evaluation undertaken and the further contribution that such roles could provide.     

Australian clinical facilitator professional development needs: A cross-sectional study

BackgroundRegistered Nurses are recruited from clinical positions to work as clinical facilitators, supervising nursing students' clinical learning. Few studies have reported on the capabilities of the group, nor offered clinical facilitators validated tools to support their professional development.ObjectiveTo test the validated Capabilities of Nurse Educator (CONE) questionnaire with expert clinical facilitators. To use the modified CONE to investigate the Australian clinical facilitator capability for the role.DesignCross-sectional survey design.ParticipantsA purposive sample of 235 Australian clinical facilitators.MethodFace validity testing was completed with five members of the target group. The modified CONE was emailed to the 235 Australian nurses with a link for the CONE to complete online. Appropriate statistical analysis was applied to the aggregate data.ResultsAll 93 items and six subscales remained in the modified CONE following minor rewording, of some items. Eight-one (n = 81) participants responded. Clinical facilitators are committed to supporting students to learn, and to their own life-long learning, however the survey results identified gaps in leadership and research capabilities.ConclusionThe modified CONE is suitable for use with clinical facilitators as both a self-assessment tool and for understanding group professional development needs. The results of this study will be beneficial in the design of future professional development for clinicians working with students in clinical settings.     

Macmillan nurse facilitators for palliative care: evaluation of a pilot project

AIM: to describe and evaluate the implementation of two Macmillan nurse facilitator posts. METHOD: a case study design was adopted with data collection in two main phases. A range of data collection techniques were used, including interview, questionnaire and observation. Various sampling strategies were adopted for the different data collection methods. The use of multiple sources of data supported the triangulation of evidence in order to increase the strength and rigour of the analysis. FINDINGS: two Macmillan nurse facilitator posts were set up with the overall aims of enhancing the quality of palliative care to patients in the community by mobilising the existing skills and supporting the development of new competencies by community nurses. The Macmillan nurse facilitators have been active in three areas directly linked to community nurses' clinical practice: educational programmes, establishment of a palliative resource nurse network and support of clinical guidelines in nursing and primary care teams. The model of peer facilitation whereby the Macmillan nurse facilitators continue to work as district nurses for part of the week has been highly valued by community nurses. CONCLUSIONS: the single most important factor identified in facilitating successful implementation of these posts has been the 'dual role' nature of the posts. This has been key to acceptance of the posts by a generic workforce. The posts provide an effective model for supporting and enhancing the palliative clinical skills and knowledge of generic community-based staff.