The sum of all parts: an Australian experience in improving clinical partnerships

Developing a theory of change model for a learning and innovation network: A qualitative study

AIM

The aim of this study is to further develop a preliminary framework into a model that can translate mechanisms into output and impact, based on the views of those working in practice and the relations between the mechanisms: a model that can inform practitioners and organizations on what has to be in place to shape a learning and innovating environment in nursing.

BACKGROUND

A Learning and Innovation Network (LIN) is a network of healthcare professionals, students and education representatives who come together to be part of a nursing community to integrate education, research and practice to contribute to quality of care. In a previous study a preliminary framework was developed through a concept analysis based on publications. The preliminary framework describes input, throughput and output factors in a linear model that does not explain what the components entail in practice and how the components work together.

DESIGN

Focus groups.

METHODS

We designed a Theory of Change (ToC) in four phases. This was based on a focus group interview with lecturer practitioners (Phase 1); a first concept ToC based on thematic analysis of the focus group interview (Phase 2); three paired interviews where the ToC was presented to other lecturer practitioners to complement and verify the ToC model (Phase 3); and adjustment of the model based on the feedback of phase 3 (Phase 4).

RESULTS

The developed ToC model describes important preconditions that have to be in place to start a LIN: a shared vision, a facilitating support system and a diversity of participants who are open to change. It describes the mechanisms by which a wide range of activities can lead to an improvement of the quality of care through collaboration between practice, education and research by working, learning, performing practice based research and implementing new methods together.

CONCLUSION

This study gives a comprehensive overview of the concept of the 'Learning and Innovation Network' (LIN); how the activities in the LIN can lead to impact; and under what conditions. Previously published findings supported elements of the ToC model. The overarching ToC model and the detailed appendix offer a theoretical and practice-based model for practitioners, managers and policy makers.

Enabling Factors for the Implementation of Competency-Based Curricula in Colleges and Schools of Pharmacy

OBJECTIVES

To review the implementation drivers of competency-based pharmacy education (CBPE) and provide recommendations for enablers.

FINDINGS

Competency-based education is an emerging model in the health professions, focusing on time-variable competency development and achievement compared with a time-bound, course-based, traditional model. CBPE is an outcomes-based organized framework of competencies enabling pharmacists to meet health care and societal needs. However, challenges need to be recognized and overcome for the successful implementation of CBPE. Competency drivers include defining the competencies and roles of stakeholders, developing transparent learning trajectories and aligned assessments, and establishing lifetime development programs for stakeholders. Organization drivers include developing support systems for stakeholders; facilitating connections between all educational experiences; and having transparent assessment plans, policies, and procedures that align with core CBPE precepts, including the sustainability of time-variability. Leadership drivers include establishing growth mindset and facilitating a culture of connection between workplace and educational environments, program advocacy by institutional leaders, accepting failures as part of the process, shifting the organizational culture away from learner differentiation toward competence, and maintaining sufficient administrative capability to support CBPE.

SUMMARY

The successful implementation of CBPE involves enabling the competency, organization, and leadership drivers that will lead to program success. More research is needed in the areas of creation, implementation, and assessment of CBPE to determine success in this model. We have reviewed and provided recommendations to enable the drivers of successful implementation of CBPE.

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.

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.

Midwifery Student Evaluation of Practice: The MidSTEP tool - Perceptions of clinical learning experiences

BACKGROUND

Little emphasis has been given to the standardised measurement of midwifery students' perceptions of their clinical learning experiences.

AIM

To develop a tool that evaluates students' perceptions of their clinical learning experiences according to environment and impact of preceptors on professional development.

METHODS

A cross-sectional design was used. Tool development had three phases: item generation; expert review to assess clarity, apparent internal consistency and content validity; and psychometric testing. All Bachelor of Midwifery students at one university in Australia were invited to complete the online survey. Psychometric testing included dimensionality, internal consistency and test-retest reliability.

RESULTS

A 74% (n=279) response rate was achieved. Factor analysis revealed the Clinical Learning Environment Scale and Impact of the Midwifery Preceptor Scale accounting for 53.6% and 71.5% of variance respectively. Both scales were reliable (Cronbach's alpha=.92 and .94) and valid. Overall, students positively rated the clinical learning environment and preceptors' abilities to foster their sense of identity as a midwife. Students were less satisfied with preceptors' understanding of the academic program.

DISCUSSION

The new tool consists of two scales that reliably measure midwifery students' perceptions of how the clinical learning environment develops their skills and reflects a midwifery philosophy. Preceptors had a positive influence on students' skills and professional development.

CONCLUSIONS

The Midwifery Student Evaluation of Practice tool is the first valid and reliable measure of students' perceptions of their clinical learning experiences. Students' feedback provides valuable information to educators and preceptors on how best to optimise clinical learning.

Benefits and Challenges of Partner Site Engagement with Community-Based Dental Education Programs: The Partner Sites' Perspectives

The aim of this qualitative study was to examine the perspectives of key personnel at partner sites providing community learning experiences to dental students to gain more understanding of the effects that community-based programs have on the sites themselves. Fourteen semi-structured interviews were conducted in 2015 with individuals from nine extramural sites. Interviewees had a range of roles from clinicians to CEOs, with six also reporting they were faculty preceptors. Three of the researchers developed a coding scheme focused on the benefits and challenges that community sites experience from participating in a community-based dental education (CBDE) program. Each coder then reviewed the interview transcripts independently before final group discussions and recoding to agreement. The main themes related to benefits were recruiting future dentists, staying current with clinical developments, sites' indirectly improving their missions by exposing students to broader roles of oral health providers, raising awareness regarding the need for dentistry in community settings, and nurturing a positive workplace environment. The main themes related to challenges were balancing education and training for students with clinical demands, communication with the university, and managing distinctive clinical and professional characteristics of students. This study's participants reported that the main benefit of CBDE for partner sites was dentist recruitment. The study also provided insights for both partner sites and dental schools to consider when developing and maintaining these partnerships.

Nurses' experiences of supervising nursing students who demonstrate unsafe practices in clinical placements: a systematic review protocol

This review explores the experiences of nurses who have supervised nursing students on clinical placement who demonstrate unsafe practices. The primary objective is to identify and synthesize the best available evidence on the experiences of nurses supervising students who demonstrate unsafe practices in clinical placements. The secondary objective is to explore why nurses award pass grades to students who demonstrate unsafe performance in clinical placements. The review question is "what is the experience of nurses supervising nursing students who demonstrate unsafe practices in clinical placements?"