Evaluating Hub and Spoke models of practice learning in Scotland, UK: a multiple case study approach

How excellent can centres of excellence be? The impact of prevalence on service quality

Centres of Excellence (CEs) are thought to provide better quality services for their speciality than Generic Services (GS). However, clinical test theory suggests this may arise from differences in the prevalence of these specialities' conditions in their referral populations, which affects the services' ability to detect diagnoses accurately, even with similar diagnostic sensitivities and specificities. Furthermore, GS' insensitivity to rarer diagnoses is necessary to avoid serious overdiagnosis despite using skills equivalent to CEs. Good GS can perform as well as CEs for disorders of 15% to 20% or greater prevalence in their referral populations, depending on the Minimal Clinically Important Difference (MCID) decided for their diagnoses' positive predictive values or degree of bias. CEs are necessary for rare disorders and have a role in determining MCIDs and the sensitivity and specificity of new measures. Sensitivity, specificity, positive & negative predictive values, and true diagnostic prevalence should be routine outcome measures.

Health professionals' education related to people with intellectual and developmental disabilities: A scoping review

BACKGROUND

People with intellectual and developmental disabilities are among the most underserved in an inequitable healthcare system.

METHODS

Using Arksey and O'Malley's methodology and a social determinants of health framework, we conducted a scoping review of literature on the state of practice in education of healthcare professionals in the health and healthcare needs of this population.

RESULTS

Searches found 4948 articles, with 182 included in the final review. Themes identified included gaps of not being informed by workforce needs, continued use of the medical model of care, not addressing intersectionality with racial/ethnic and other discriminations, and lack of involvement of the population in developing/evaluating programs and promising trends of development of competency-based interprofessional programs with experiential learning.

CONCLUSION

We provide recommendations for best practices in a concerted effort to educate a healthcare workforce equipped with the knowledge and skills to address the health needs of this population.

Student nurse education and preparation for palliative care: A scoping review

BACKGROUND

The World Health Organisation and palliative care stakeholders recommend that healthcare workers are educated in palliative care. Provision of high-quality palliative care is fundamental to nursing practice. However, caring for palliative care patients and meeting family needs is challenging without appropriate knowledge and experience. Palliative care education and clinical skill development for undergraduate student nurses is a priority to ensure graduate nurses are equipped with the knowledge and skill to deliver safe and competent care.

METHODS

A scoping review guided by Arksey and O'Malley's framework was used to identify undergraduate student nurses' palliative care education and preparation. A comprehensive literature search of five electronic databases and grey literature were conducted from January 2002 to December 2021. The aim was to review the empirical evidence and ascertain how undergraduate student nurses' palliative care education is organised, facilitated, delivered and evaluated. Screening was performed independently by two reviewers against eligibility criteria with meetings to discuss included papers and form a consensus. Data was extracted and related to palliative care undergraduate student nurses' education, educational model, methodology, key findings, and recommendations. Analysed and summarised data was mapped onto the four key review questions (educational models utilised, methods used to assess effectiveness, facilitators/barriers and gaps in the literature).

RESULTS

34 papers met the criteria for this review. The review highlights that undergraduate nursing palliative care education is more evident in high income countries. Limited and diverse published research existing in low- and middle-income countries. Educational models utilised were theoretical and experiential learning and educational process, early integration and multiple learning methods which were highlighted as facilitating factors. However, crowded curricula, lack of palliative care clinical placement expertise, difficulty providing clinical placement, timing and delivery of palliative care and difficulty responding to simulated environments (manikins) were perceived barriers. Nevertheless, palliative care education can increase knowledge, positive attitude, self-confidence and adequate preparation of undergraduate student nurses.

CONCLUSION

This review highlights that there is limited research regarding the timing and delivery of palliative care principles and practice in undergraduate student nurse education. Early integration of palliative care education impacts upon students perceived preparedness for practice and positively influences their attitudes to palliative care provision.

A systematic scoping review of undergraduate nursing hub-and-spoke placement models

BACKGROUND

While nursing education has been forecast to continue to grow, placement capacity is now the key factor precluding growth in supply.

AIMS

To provide a comprehensive understanding of hub-and-spoke placements and their ability to increase placement capacity.

METHOD

A systematic scoping review and narrative synthesis were used (Arksey and O'Malley, 2005). PRISMA checklist and ENTREQ reporting guidelines were followed.

FINDINGS

The search returned 418 results. After a first and second screen 11 papers were included. Results suggest that hub-and-spoke models were generally evaluated favourably by nursing students, with a range of benefits reported. However, many of the studies included in the review were small and of low quality.

CONCLUSION

Given the exponential increase in applications to study nursing, hub-and-spoke placements appear to have the potential to better meet these increased demands, while also providing a number of benefits.

Learning in and across communities of practice: health professions education students' learning from boundary crossing

Learning to adapt to new contexts is crucial in health professions education (HPE). Boundaries between and within contexts challenge continuity in students' learning processes. Little is known about how HPE students can make these "boundary experiences" productive for learning. We investigated how and what nursing students learn from boundary experiences while they are simultaneously growing into a community of practice (CoP). Using a boundary-crossing lens, experiences of discontinuity were identified in pre-placement and post-placement interviews and diary fragments with 14 nursing students during their placement in an academic hospital. We found that students experience discontinuity as a result of different approaches to nursing care and to learning, both between (academic and clinical) settings and within a setting. When students feel safe enough, they can convert boundary experiences into meaningful learning situations, such as critical discussions with staff. Successfully overcoming boundary experiences improves students' understanding of healthcare and professional development and helps them to develop a personal approach to learning. Students critically address boundary experiences when they are motivated to learn and when they perceive a violation of ethical standards but not when they are concerned that it will affect their assessment. Objects designed to bridge theory and practice can generate additional barriers. This study adds to the HPE literature by demonstrating the learning potential of boundaries and to the broader literature by showing how responses to boundary experiences are intertwined with the process of growing into a CoP. The findings can be used to design future boundary objects.

Nursing students' experiences of educational discrimination: a qualitative study

Background

Although the need for justice and the elimination of injustice (or discrimination) is now a universally accepted principle, discrimination is still an unpleasant experience for many nursing students. This study aimed to explain the experiences of nursing students of educational discrimination and find out the main factors that cause this feeling.

Methods

This is a qualitative study conducted in the nursing faculty of Shahr-e-Kord and the Iran university of medical science (IUMS) in Iran. Twelve nursing students were selected by purposeful sampling method and data were collected through face-to-face and in-depth interviews with semi-structured questions. All interviews were analyzed according to the content analysis method.

Results

Three main themes and ten subcategories appeared. Extracted themes include: "inappropriate behavior of nursing professors (or instructors) " with 3 subcategories (1- discriminatory behavior by nursing professors (or instructors), 2- lack of sufficient self-confidence in nursing professors and transferring it to the student, and 3- the educator role in motivating or eliminating motivation); "Strict rules" with 3 subcategories (1- inequality in implementation of rights and rules among students of different disciplines, 2- differences in compliance with laws and regulations, and 3- nurses are being strictly monitored), and " Lack of nursing professional independence " with 4 subcategories (1- lack of authority, 2- lack of supportive organizations for nurses, 3- lack of proper social status of nursing in society, and 4- the high authority and power of physicians over other disciplines).

Conclusions

In our study, it was shown that nursing students feel the most discrimination in front of medical students. Feelings of discrimination reduce self-confidence in nursing students. Therefore, nursing educators and professors must think of a solution, or at least they should not cause this feeling in them through inappropriate behavior and discriminatory speech and words.

Clinical placement models for undergraduate health professions students: a scoping review

BACKGROUND

Clinical learning is fundamental to undergraduate health professions students. There are several calls for the transformation of health professions education, which have direct implications on clinical learning. Clinical placement models provide structure to clinical learning. Therefore, this scoping review could contribute to supporting curriculum transformation to enhance learning in the clinical environments for undergraduate health professions students.

OBJECTIVES

This scoping review identified the characteristics of research evidence related to mapping the purpose, methodologies used, outcomes, and specific recommendations associated with clinical placement models in undergraduate health professions education.

DESIGN

A scoping review method was used in this study. A search string developed from the title of the review was used to search online databases to identify research published between January 2000 and March 2020.

RESULTS

Forty-eight articles reporting on ten clinical placement models were included in this review. The majority of these articles originated from Australia and predominantly report on nursing. The aims of these articles aligned with the evaluation of the implementation of a clinical placement model. Seven categories of outcomes of the clinical placement models are reported namely, relationships, influence, environment, facilitation, inputs, knowledge scores, and student perceptions.

CONCLUSIONS

As clinical learning is fundamental to undergraduate health professions education, clinical placement models should prioritise the development of competence among undergraduate students. Insights into outcomes reported in literature could guide educators in fostering optimal learning in students who may then be able to influence community health outcomes positively.

Characteristics and processes of the dedicated education unit practice education model for undergraduate nursing students: a scoping review

OBJECTIVE

The objective was to review literature related to the dedicated education unit practice education model for undergraduate nursing students, and identify common characteristics and processes for implementing and sustaining this model.

INTRODUCTION

Although practice education is central to undergraduate nursing education, evidence-informed practices for learning in the clinical setting remain elusive. Changes to health care over the past decades related to the role and scope of practice for nurses, gradual shifts to community- and population-based care delivery, and expectations for interprofessional practice require forward-looking education models. The dedicated education unit model was developed in 1997 as a potential solution to globally recognized challenges in nursing education amidst discourses of nursing resource scarcity. Despite more than two decades of innovation and expansion, there is still limited understanding of the effectiveness of the dedicated education unit as a solution to those challenges, or for the anticipated benefits for students and patients, through enhanced evidence-informed health care. This analysis of the characteristics and processes of the model is timely for evaluating and sustaining implementation of the dedicated education unit across nursing practice and education settings.

INCLUSION CRITERIA

English-only publications related to the dedicated education unit practice education model for undergraduate nursing students in baccalaureate and associate degree programs using qualitative, quantitative, or mixed methods research, and quality improvement, program evaluation, and opinion publications were included.

METHODS

Using selected keywords including "dedicated education unit," we searched CINAHL, Google Scholar, MEDLINE, Academic Premier Search, ERIC, Cochrane Database of Systematic Reviews, JBI EBP Database, and ProQuest Dissertations and Theses. Two independent reviewers screened titles and abstracts against inclusion criteria. We reviewed reference lists for gray literature and additional references. Data were extracted from the included articles and categorized for characteristics and processes. Eighty-two publications from January 1997 to May 2020 were included. The findings were presented descriptively with tables and figures to support the data.

RESULTS

Dedicated education unit models were based on five characteristics and four processes. Characteristics of the dedicated education unit model included effective academic-practice partnership, adaptability to diverse contexts, unit culture of educational excellence, responsive and supportive unit leadership, and clarity of roles and responsibilities. Processes included building nurse and faculty capacity, facilitating student learning, communicating regularly at systems and unit levels, and evaluating and sustaining the model.

CONCLUSIONS

Evidence demonstrated that the dedicated education unit practice education model is well-established. However, there were existing gaps in this evidence, specifically evaluation and economic analyses. There was also limited attention to long-term sustainability of the model. The common characteristics and processes identified in this review may be used to support planning, implementation, and evaluation, including development and validation of evaluation tools. Although administrative infrastructure was noted as central to the dedicated education unit strategy, it was rarely acknowledged as part of management and thus also requires further study.

The relationship between clinical placement duration and students' satisfaction with the quality of supervision and learning environment: A mediation analysis

Multiple factors that influence the learning experience of nursing students while they are in clinical training have been identified, such as the clinical learning environment, the supervision provided by supervisors, and the level of cooperation with the nurse teacher. The objective was to examine whether the relationship between the clinical placement duration and overall satisfaction with clinical training is mediated by the supervisory relationship and learning environment. A secondary analysis was conducted using the data from a cross-sectional study conducted in 17 higher educational institutions in nine European countries with the Clinical Learning Environment, Supervision and Nurse Teacher scale (n = 1903 pre-registration nursing students). Satisfaction with the supervisor and a good learning environment mediated the relationship between clinical placement duration and overall satisfaction as perceived by the students. Nursing students with longer clinical placement durations were more satisfied with clinical training as a result of both their satisfaction with their supervisor and their perceptions of good learning environment. The optimal duration a nursing student should remain in the different practice settings is approximately 7 weeks.

Nurses and undergraduate student nurses' experiences in collaborative clinical placement programs in acute hospitals: An integrative literature review

OBJECTIVES

To identify, and critically review student, nurse clinician and clinical facilitator/educator experiences of collaborative clinical placement models in acute hospitals.

DESIGN

An integrative review that followed Whittemore and Knafl's (2005) framework.

DATA SOURCES

Studies published between 2009 and 2019 were identified via a comprehensive search of the following databases: CINAHL, OVID Medline, EMBASE, EMCARE, PsychINFO, Johanna Briggs Institute, ERIC and SCOPUS.

REVIEW METHODS

The initial search located 2309 Articles. After screening and checking for eligibility 14 articles were critically appraised using the Critical Appraisal Skills Program checklist for qualitative papers, the McMaster's Critical Review Form for quantitative papers and MMAT Appraisal tool for mixed method papers. The papers were then analysed thematically.

RESULTS

Thirteen studies met the inclusion criteria for the review (four quantitative, six mixed method, three qualitative). We identified an overarching central theme of sense of belonging and acceptance along with the following four sub themes: familiarity and continuity, confidence and competence, preparedness and lastly supervising relationships and faculty support.

CONCLUSION

This review indicates collaborative clinical placement programs have a positive impact on the student experience. Further research is needed regarding experiences of clinical nurses, health organisation leaders and Faculty to better understand what will improve support of students in collaborative clinical placement programs as there were few research findings found related to these non-student participant groups. Exploring student placement experiences that include both traditional and Collaborative models would provide greater insight into the value of these programs.

Clinical placements in intellectual disability nurse education: A scoping review

Intellectual disability undergraduate nurse education is provided in partnership between third level institutes and healthcare providers. The changing healthcare landscape has resulted in a reduction of the number of clinical placement's available to students, as persons with intellectual disabilities previously supported in institutional settings are now supported to live more independently and included within their community. This review aims to identify the range and efficacy of clinical placement's currently utilised within intellectual disability undergraduate nurse education. A scoping review framework was utilised to present a broad understanding and knowledge synthesis of the available literature. A systematic search strategy detected relevant papers across eight electronic databases. A total of 451 non-duplicate papers were identified. The review methods yielded ten papers for inclusion. Of these papers, nine were from the United Kingdom (UK) and one from Australia. Findings indicate that there is limited published literature on this topic and a notable absence of literature from Ireland, which is one of only two countries that have direct entry intellectual disability undergraduate nurse education. This review highlights the need to explore alternative placement options not traditionally considered/available to undergraduate nursing students and that further research is needed in this area.

A mapping review of models of practice education in allied health and social care professions

Introduction

Practice education is fundamental to pre-registration learning for many health and social care professions, yet finding sufficient opportunities for students is challenging. One-to-one student–educator pairings are common, and while different models could increase placement opportunities, the associated terminology is inconsistent and an overview of advantages, challenges and available evidence is missing. This mapping review identifies, categorises and critically considers the evidence for different models of practice education used by health and social care professions.

Method

Papers from 2008 onwards reporting on practice education approaches in allied health or social care profession courses were identified in three databases. Data was extracted, methodological quality categorised and a typology of practice education models developed.

Findings

Fifty-three papers were reviewed and developed into a typology of 14 models. Mapping indicated issues with a lack of high-quality research and limitations in available outcome indicators. Pre-requisites for the effective operation of different models include preparation, communication and allowing sufficient time for new ways of working.

Conclusions

Practice education discourse is characterised by varied terminology and practices. Various models for structuring practice education exist, though the evidence for their effectiveness and impact on capacity is limited. Using consistent language and considering wider impacts and outcomes is recommended in future study.

'How families live …' - the views and experiences of parent-carers who provide family placements to intellectual disability nursing students

AIM

We aimed to learn about the value of family placements from the perspective of parent-carers who provide them to nurse students via a Scottish university Family Placement Scheme.

METHOD

Qualitative interviews were conducted with seven parent-carers who provided a family placement over two academic years. Descriptive data was analysed, organized into themes and subject to content analysis: parents' descriptions of caring; their perceived value of family placements; and their views and experiences of participation in intellectual disability nurse education.

RESULTS

Family placements are beneficial to nurse students and families with children with an intellectual disability. Description of wider aspects of caring was provided, offering insight into learning experiences of students on placement.

CONCLUSION

This model of learning provides opportunities for students to appreciate the reality of caring for a relative with an intellectual disability at home. Students develop their practice skills for working in partnership with family carers.

Students' perspectives of using the hub and spoke model to support and develop learning in practice

The hub and spoke model is one approach to nursing students' practice learning, which involves a base practice placement (hub), from which the student's learning is complemented by additional activities (spokes). This model has been integrated into Edinburgh Napier University's undergraduate nursing programmes since 2011, and it is considered to enhance practice learning.

AIM

To explore the characteristics of the hub and spoke model that support nursing students' learning and enable them to improve their understanding of a person-centred approach to care.

METHOD

The study involved nursing students from two fields of practice - child health and mental health. A mixed methods approach was used, using a questionnaire and three focus groups.

FINDINGS

A total of 24 students completed the questionnaire, while 27 students participated in the focus groups. The questionnaire results indicated that participants were able to undertake spoke activities in their practice, which enabled them to understand communities' issues and to better understand their learning competencies. Three themes emerged from the focus groups that encapsulated participants' experience of hub and spoke learning in practice: value for learning, making connections, and organisations and systems.

CONCLUSION

There were several positive effects on nursing students' practice learning as a result of the hub and spoke model approach to practice learning. Students valued the option of undertaking a 'different' placement experience that offered them the opportunity to view connections to the wider patient healthcare journey and understand the influence of the community on patients' health and well-being.

Needing to Belong: First Practice Placement Experiences of Children's Nursing Students

This study examines first year children's nursing students' anxieties before their first practice placement and their support needs during that time. Strategies to address needs are highlighted. A questionnaire was completed by children's nursing students (n = 21) before their initial practice placement to establish their expectations and concerns. A subgroup (n = 5) took part in a focus group following placement to establish consensus around the support that helped and what could help future students prepare for first placement. The resultant data indicated the importance of students having a sense of belonging to their practice placement, trusting website information, induction days, and the involvement of a more senior student in their preparation, in addition to facilitative mentors. Using similar methodology to that used with students, a subgroup of professional staff took part in two focus groups (FG1 n = 5, FG2 n = 4) to establish consensus around support initiatives using areas identified by students as priorities that could better facilitate this initial practice placement. Although commonalities existed within both students and professionals, some differences were highlighted. A student's first practice placement is of utmost importance in affirming their choice to study nursing. Academic and clinical staff play a crucial part in this decision-making.

Student experience of hub and spoke model of placement allocation - An evaluative study

An evaluative project was undertaken at the University of Wolverhampton centring on the Hub and Spoke model utilised for organisation of placement allocation across the BNurs programme for all fields of nursing. Student experience was of particular interest throughout the evaluation with the research team focusing on the views, feelings and experiences of student nurses in relation to the hub and spoke model applied for practice. A qualitative approach was adopted, initially using Survey Monkey to collect student views through a series of open questions, and further enhanced by focus groups. These were transcribed and together with the data from the surveys, data was categorized and themed. Themes were analysed and conclusions drawn. The hub and spoke method for placements was found to enhance student understanding of the whole patient journey which offered students a wide breadth of experience and development of transferable skills such as communication and adaptability. A sense of increased belonging was highlighted by students which encouraged the development of strong effective relationships positively affecting their learning. Some less positive aspects were apparent revolving around personality difficulties and organisational problems, in particular relating to spoke placements. The purpose of spoke placements was not always apparent and sometimes there was a lack of appropriate student placement experiences provided by spoke mentors. Overall the hub and spoke model for organising placement was found to be beneficial and enhanced the student's experience, satisfaction and learning, which in turn had a positive effect on practice.

The context, influences and challenges for undergraduate nurse clinical education: Continuing the dialogue

INTRODUCTION

Approaches to clinical education are highly diverse and becoming increasingly complex to sustain in complex milieu

OBJECTIVE

To identify the influences and challenges of providing nurse clinical education in the undergraduate setting and to illustrate emerging solutions.

METHOD

A discursive exploration into the broad and varied body of evidence including peer reviewed and grey literature.

DISCUSSION

Internationally, enabling undergraduate clinical learning opportunities faces a range of challenges. These can be illustrated under two broad themes: (1) legacies from the past and the inherent features of nurse education and (2) challenges of the present, including, population changes, workforce changes, and the disconnection between the health and education sectors. Responses to these challenges are triggering the emergence of novel approaches, such as collaborative models.

CONCLUSION(S)

Ongoing challenges in providing accessible, effective and quality clinical learning experiences are apparent.

Undergraduate student nurses' perceptions of two practice learning models: a focus group study

BACKGROUND

Phase 1 of this study examined student, mentor and clinical manager's perceptions of a 'Hub and Spoke' practice learning model in year 1 of an undergraduate nursing programme. Findings from Phase 1 suggested that the model had significant educational merit in orientating students to clinical learning and emphasising the primacy of the mentor relationship in developing and supporting students. Following the students through year 2 of their programme, wherein they experienced a 'rotational' practice learning model, which provided an opportunity to explore student perceptions of both models.

AIMS

To explore undergraduate nurses' perceptions of two experienced practice learning models: hub and spoke model, and the classical rotational model. In a previous study the hub and spoke model appeared to develop 1st year students' sense of belongingness, continuity and quality of practice learning, there for it was important to understand what students reported about these issues when recounting their 2nd year experience in the clinical setting that was organised according to a classical rotational model.

DESIGN

Qualitative approach utilising focus groups.

PARTICIPANTS

10 under-graduate student nurses at the end of 2nd year.

METHODS

Focus group interviews.

RESULTS

Students responded in ways that indicate they believed the experiences of year 1 had raised their faith in their ability to cope with the practice learning and educational demands of nursing. They saw themselves as being better prepared for year 2 as a result of their exposure to hubs and spokes. The study has identified traits of resilience, continued belongingness and self-confidence in orientation to learning in clinical practice in hub and spoke experienced students.

CONCLUSIONS

The student nurses found the hub and spoke model valid in 1st year, whilst stating that for 2nd year the rotational model can be valid. This supports earlier findings that student nurses require a structured and supportive 1st year learning environment to enable development of resilience for subsequent years.

Swimming without the water: a critical perspective on mental health experience for adult nursing students

Adult nurses and adult field nursing students come into contact with a diverse range of other patient groups in their practice but perhaps none more so than those who have co-existing mental health issues. Consequently adult field student nurses must be equipped with the requisite knowledge and skills to competently care for their patients who also experience mental health problems. Given the pressure on placements many education providers have developed alternatives to direct mental health experiences. The authors review their own experience of some of the modalities that higher education institutes (HEI) use to instruct their students in this field. They argue that, ideally, there is no substitute for the practical experience of placements in the mental health sector, particularly if these include contact with mental health nursing. The paper concludes with some recommendations for nursing education and our professional body that could help equip adult field nursing students with the necessary experience and skills of mental health to support them into their future careers.