The development of service users in the provision of verbal feedback to student nurses in a clinical simulation environment

Nomenclature of real patients in health professional education by role and engagement: a narrative literature review

Research problem

Real patients living with a disease and engaged in the education of healthcare professionals are referred to by different terms. To address this, A.Towle proposed a draft taxonomy.

Objective

Our objective is to extract from the literature the definitions given for the following terms: (1) patient educator, (2) patient instructor, (3) patient mentor, (4) partner patient, (5) patient teacher, (6) Volunteer Patient in order to clearly identify their roles and level of engagement.

Methods

The literature search was carried out in Medline, CINAHL, PsychInfo and Eric by adding medical education or healthcare professional to our previously identified keywords to ensure that it is indeed literature dealing with real patients' involvement in the education of healthcare professionals.

Results

Certain terms refer to real and simulated patients. Roles are more or less well described but may refer to multiple terms. The notion of engagement is discussed, but not specifically.

Conclusion

Explicitly defining the terms used according to the task descriptions and level of engagement would help contribute to Towle's taxonomy. Real patients would thus feel more legitimately involved in health professional education.

Involving patients in undergraduate health professions education: What's in it for them?

OBJECTIVES

Patients have become more involved in research, policy, and health professions education. They are involved in teaching students competencies required for person-centred care, but patient benefits have not received proper attention. This exploratory study identifies how patient involvement in health professions education help patients to practice self-management and shared decision-making.

METHODS

Individual interviews were conducted with patients (hereafter 'experts by experience') (N = 11) who participated in the Patient As a Person Module, organised for students of health professions in The Netherlands. Additionally, one of their healthcare professionals (N = 10) and family members (N = 9) were interviewed. Directed content analysis was used.

RESULTS

Participants reported that sharing lived experiences helped experts by experience to reflect on their preferences regarding health and healthcare, accept their changed selves, and obtain a renewed sense of purpose. They reported gaining insight into the perspectives of healthcare professionals, which yielded more equal healthcare professional-patient relationships.

CONCLUSIONS

Sharing their lived experiences with health and health care with students could help patients in practising effective self-management and participate in shared decision-making.

PRACTICE IMPLICATIONS

Approaching patient involvement in health professions education from both the perspectives of students and experts by experience, as opposed to students alone, optimises its societal impact.

Interaction with an ostomy patient in a laboratory setting: Expectations and experiences of first-year nursing students

BACKGROUND

Interacting with real patients is an important component of nursing education in all learning settings.

OBJECTIVES

This study aimed to determine the expectations and experiences of first-year nursing students' interaction with a real patient with an ostomy in the clinical skill laboratory.

METHOD

The phenomenological qualitative study was carried out with 17 first-year undergraduate nursing students. Data was collected via focus group interviews during pre- and post-nursing students and real patient with an ostomy interaction. Semi-structured questions were used during the focus group interviews. The data were analyzed by inductive content analysis method.

RESULTS

The findings are presented under two contexts: expectations of first-year nursing students related to interaction with an ostomy patient and experiences of first-year nursing students related to interaction with an ostomy patient. The two contexts were divided into five main themes: Emotions regarding interaction with a real patient with an ostomy, providing ostomy care to a real patient with an ostomy, predictions for living with an ostomy, effects of interaction with a real patient with an ostomy, and real patient engagement in nursing education.

CONCLUSIONS

In consequence of the research, the first-year nursing students were enthusiastic about the interaction with the real patient. The most important contribution to interaction with a patient was breaking down the prejudices of students concerning being a patient and having an illness. Real patients should engage in varied learning environments in nursing education, particularly via patients with different illnesses and health conditions.

Interpreting the value of feedback: Older adult voices in nursing education

As patients, older adults are often involved informally with the teaching of nursing students in clinical environments. This involvement is recognised as valuable; however, the role of the patient is often passive. In recent years there has been recognition of the value that real people's lives, and health experiences can bring to student education, so much so that many programs now incorporate real patients into the formal education of students. In this educational initiative, older adults, from a Residential Aged Care Campus (RACC), participated as simulated patients in scenario based clinical learning activities, providing feedback to nursing students on the carative aspects of the learning activities. The aim of this study was to contribute toward the body of knowledge in engaging older adults in simulated clinical activities, specifically in the provision of feedback to nursing students. A qualitative interpretive methodology was applied to capture the older adults' experiences of providing feedback as simulated patients. This included the collection of data through participant observation, recording of field notes, collection of a written feedback form and semi-structured interviews with the participants. Thematic analysis was undertaken to identify emergent themes in the data. Findings from this study have emphasised the value of including the patient voice in nursing education. The provision of feedback by older adults during direct care interactions supports and nurtures student awareness of the patient and the caring process of nursing. Unique to this study, was the finding that although the participants received no formal training in the delivery of feedback, all utilised a clear process recognised within the literature. A recommendation linked to this finding is that a feedback training program would be of benefit in reducing some of the feelings of uncertainty expressed by the older adults when giving feedback and better equipping them to deliver constructive feedback.

Patient involvement in health professionals' education: a meta-narrative review

More than 100 years ago, Osler inspired educators to consider health professions education (HPE) as intricately reliant on patients. Since that time, patient involvement in HPE has taken on many different meanings. The result is a disparate body of literature that is challenging to search, making it difficult to determine how to continue to build knowledge in the field. To address this problem, we conducted a review of the literature on patient involvement in HPE using a meta-narrative approach. The aim of the review was to synthesize how questions of patient involvement in HPE have been considered across various research traditions and over time. In this paper, we focus on three scholarly communities concerned with various interpretations of patient involvement in HPE-patient as teachers, real patients as standardized patients, and bedside learning. Focus on these three research communities served as a way to draw out various meta-narratives in which patients are thought of in particular ways, specific rationales for involvement are offered, and different research traditions are put to use in the field. Attending to the intersections between these meta-narratives, we focus on the potentially incommensurate ways in which "active" patient engagement is considered within the broader field and the possible implications. We end by reflecting on these tensions and what they might mean for the future of patient involvement, specifically patient involvement as part of future iterations of competency based education.

O ESTUDO DE CASO COMO MÉTODO DE PESQUISA EM ENFERMAGEM: UMA REVISÃO INTEGRATIVA

RESUMO Objetivo: analisar a aplicação do estudo de caso como método de pesquisa pela enfermagem nas publicações científicas nacionais e internacionais. Método: revisão integrativa de literatura realizada nas bases bibliográficas eletrônicas PubMed, CINAHL, LILACS e SciELO, utilizando os descritores estudo de caso, pesquisa e enfermagem. Foram incluídos artigos originais disponíveis na íntegra no formato on-line, nos idiomas português, inglês ou espanhol, no recorte temporal de 2010 a 2015. Resultados: foram encontrados 624 estudos, dos quais 50 atenderam ao objetivo. Os autores Yin e Stake foram os pesquisadores cujos referenciais metodológicos de estudo de caso se destacaram no contexto da pesquisa na área da enfermagem. A aplicação do método abrangeu os diferentes campos de atuação da profissão: educação, assistência/cuidado e gestão/administração. Conclusão: o estudo de caso como método de pesquisa mostrou-se uma importante metodologia que pode ser amplamente utilizada pela enfermagem nos seus diversos campos de atuação ao buscar compreender fenômenos relacionados a indivíduos, grupos ou organizações.

How patient educators help students to learn: An exploratory study

INTRODUCTION

Benefits of the active involvement of patients in educating health professionals are well-recognized but little is known about how patient educators facilitate student learning.

METHOD

This exploratory qualitative study investigated the teaching practices and experiences that prepared patient educators for their roles in a longitudinal interprofessional Health Mentors program. Semi-structured interviews were conducted with eleven experienced health mentors. Responses were coded and analyzed for themes related to teaching goals, methods, and prior experiences.

RESULTS

Mentors used a rich variety of teaching methods to teach patient-centeredness and interprofessionalism, categorized as: telling my story, stimulating reflection, sharing perspectives, and problem-solving. As educators they drew on a variety of prior experiences with teaching, facilitation or public speaking and long-term interactions with the health-care system.

CONCLUSIONS

Patient educators use diverse teaching methods, drawing on both individualistic and social perspectives on learning. A peer-support model of training and support would help maintain the authenticity of patients as educators. The study highlights inadequacies of current learning theories to explain how patients help students learn.

The role of service-user feedback in undergraduate nursing courses

There is an increasing expectation that service users should contribute in a meaningful way to student nurse education courses. This article describes how service-user feedback on undergraduate student nurses' performance during practice learning opportunities (PLOs) gives an insight into the qualities service users value in student nurses. At Cardiff University, the new Bachelor of Nursing course, launched in September 2012, took into account the Nursing and Midwifery (NMC) standards for preregistration, implementing a mechanism for service users to feed back on students' clinical performance. To facilitate this service, user/carer feedback pages were inserted into the students' bound clinical practice portfolio. A large sample of the clinical portfolios (n=100) from one cohort across adult, child and mental health nursing fields were examined at the end of year 1, year 2 and again at the end of year 3, and service users' comments collated. In considering the words used by service users, the authors propose that they reflected the six fundamental values-or 6Cs-of care, compassion, competence, communication, courage and commitment that underpin the delivery of excellent care. Conclusions drawn from the feedback were that students exhibited the caring and professional qualities that service users value, and indeed showed the dignity and respect for patients and people that the profession demands.

The association of positive and negative feedback with clinical performance, self-evaluation and practice contribution of nursing students

BACKGROUND

Providing consistent and high-quality feedback is a crucial component of clinical instruction. Such feedback can improve the students' ability to reflect themselves more accurately. However, giving feedback, especially negative is intricate.

OBJECTIVES

To evaluate the level of feedback provided to nursing students during clinical practice and investigate their association with related outcomes, such us clinical performance, self-evaluation of achievements and contribution of the practice to the professional skills.

DESIGN

Cross-sectional study.

SETTINGS AND PARTICIPANTS

124 third-year nursing students during their "Emergency Nursing" (EN) clinical practice were instructed, criticized and graded by three teachers from the university staff.

METHODS

Following their clinical practice the students filled-out a questionnaire, in which they evaluated the feedback provided by their teachers, the contribution of the practice to their professional skills and their personal performance. Additionally, the teachers' grades of students' achievements were collected. Accuracy of students' self-evaluation was calculated as the arithmetical difference between the students' grades and the teachers' grades.

RESULTS

The mean grades of positive and negative feedback were 74.5/100 and 70.7/100, respectively. Higher-quality positive feedback was associated with higher teachers' grade (p=0.027) and with "very high" evaluation of the contribution of the practice (p=0.022). Higher-quality positive feedback was associated with student's over-self-evaluation (p=0.02), whereas higher-quality negative feedback was associated with more accurate self-evaluation (p=0.015).

CONCLUSIONS

High-quality positive feedback is associated with higher grades, higher contribution of the clinical practice to the student and over-self-evaluation whereas high-quality negative feedback is related to an accurate self evaluation of the students' performance. Teachers should pay more attention to administering high-quality positive and negative feedback.