Preceptors´ experiences of student supervision in the emergency medical services: A qualitative interview study

Assessment during clinical education among nursing students using two different assessment instruments

BACKGROUND

Assessment of undergraduate students using assessment instruments in the clinical setting is known to be complex. The aim of this study was therefore to examine whether two different assessment instruments, containing learning objectives (LO`s) with similar content, results in similar assessments by the clinical supervisors and to explore clinical supervisors' experiences of assessment regarding the two different assessment instruments.

METHOD

A mixed-methods approach was used. Four simulated care encounter scenarios were evaluated by 50 supervisors using two different assessment instruments. 28 follow-up interviews were conducted. Descriptive statistics and logistic binary regression were used for quantitative data analysis, along with qualitative thematic analysis of interview data.

RESULT

While significant differences were observed within the assessment instruments, the differences were consistent between the two instruments, indicating that the quality of the assessment instruments were considered equivalent. Supervisors noted that the relationship between the students and supervisors could introduce subjectivity in the assessments and that working in groups of supervisors could be advantageous. In terms of formative assessments, the Likert scale was considered a useful tool for evaluating learning objectives. However, supervisors had different views on grading scales and the need for clear definitions. The supervisors concluded that a complicated assessment instrument led to limited very-day usage and did not facilitate formative feedback. Furthermore, supervisors discussed how their experiences influenced the use of the assessment instruments, which resulted in different descriptions of the experience. These differences led to a discussion of the need of supervisor teams to enhance the validity of assessments.

CONCLUSION

The findings showed that there were no significant differences in pass/fail gradings using the two different assessment instruments. The quantitative data suggests that supervisors struggled with subjectivity, phrasing, and definitions of the LO´s and the scales used in both instruments. This resulted in arbitrary assessments that were time-consuming and resulted in limited usage in the day-to-day assessment. To mitigate the subjectivity, supervisors suggested working in teams and conducting multiple assessments over time to increase assessment validity.

Supporting health professional educators in the workplace: A scoping review

PURPOSE

Clinical educators frequently request additional support for educating pre-qualification health professions students despite having access to professional development programs to build education knowledge and skills. The breadth of 'additional support' options remains unclear. The aim of this review is to explore what is known about support options for health professional educators in the workplace through the lens of learning organisations.

MATERIALS AND METHODS

A scoping review was conducted searching Ovid Medline, CINAHL, ProQuest and PsycINFO electronic databases from 1 January 2005 up to 21 October 2020 for studies that identified support strategies for clinical educators of pre-qualification students in the workplace. Relevant data were charted, summarised thematically and synthesised with reference to support type and implementation level.

RESULTS

Fifty relevant records related to medicine, nursing and allied health clinical education were included. Twelve support themes and five cross-cutting support categories were identified across four implementation levels of healthcare systems.

CONCLUSIONS

A diversity of support for clinical educators beyond professional development was identified. Future research combined with leadership and commitment from the healthcare and education sectors is needed to better understand the applicability, efficacy and resourcing of any newly integrated support to ensure it is sustainable and improves clinical educator capability.

Undergraduate nursing students' mentoring experiences in the clinical practicum: The United Arab Emirates (UAE) perspective

AIM

This study explored undergraduate nursing students' mentoring experiences during their final clinical practicum as they prepared to enter the workforce.

METHODS

We used a qualitative case study design with data collected in two focus group discussions involving 19 students. Data were analysed using inductive thematic analysis.

RESULTS

Students' descriptions of their mentoring experiences fell under three themes: 'great experience', 'being treated like part of the family', and 'gaining confidence and skills'. Students described their mentors as having critical roles in providing feedback and learning opportunities to interns. Students also reported that ungraded initial assessment, friendlier workplaces, and mentors with patience were required to strengthen their professional learning at the workplace.

CONCLUSION

These results suggest that prompt and constructive feedback, warmer workplace environments, and passionate mentors' involvement may help enhance students' mentoring experiences during their clinical practicum.

IMPLICATIONS FOR NURSING MANAGEMENT

Management and academia should work jointly to develop mentorship programs to achieve better student outcomes. Doing this will lead to role clarity, higher levels of satisfaction, and increased productivity. Management needs to consider compensating mentors for their time in student learning and select experienced nurses willing to mentor others to promote enjoyable relationships and effective mentoring engagements. Management needs to find creative ways to build mentoring into appraisals, for at present, it is considered a voluntary activity for educating the next generation of nurses. Management should ensure adequate training and ongoing support for mentors and mentees in clinical mentoring.

Developing new possibilities for interprofessional learning- students' experience of learning together in the ambulance service

BACKGROUND

It is known that setting and context matters, and contextual factors influence interprofessional education (IPE). Activities developed in a new setting should therefore be evaluated to determine students' experiences and learning. IPE in the ambulance service may present a new setting for interprofessional learning (IPL).

AIM

The aim of this study was to explore undergraduate students' experiences of collaboration and learning together during their clinical rotation in the ambulance service.

STUDY DESIGN AND METHOD

A mixed convergent parallel design was used to describe nursing and medical students' experiences of collaboration and learning together during their clinical rotation in the ambulance service during autumn 2019. Two group interviews with nursing students (n = 20; response rate 80%) were conducted and the medical students (n = 40; response rate 72.5%) answered a self-assessment questionnaire regarding their IPE. The group discussions were analysed using an inductive thematic analysis and descriptive statistics were used to describe the medical students' self-assessed experiences and competencies in interprofessional collaboration.

RESULTS

In the context of the ambulance service, some of the challenges included, the team vary daily, a context that can be unpredictable, and the team being required to make decisions in various situations with limited support. The context presented good opportunities to learn together, since they faced a broad variety of situations and had opportunities to follow patients through the chain of care.

CONCLUSION

The students' experiences show that the ambulance service offers possibilities for IPL. The ambulance service enhanced the students' learning in an unfamiliar environment, encouraging them to develop collaborative learning strategies and situational leadership regardless of established hierarchical structures and stereotypes that are sometimes present in other parts of the health care service.

ETHICAL APPROVAL

By the Swedish Ethical Review Authority. No: 2019-03595.

Nurse preceptors' experience-based strategies for supporting learning in the ambulance service-A combined focus group and dyadic interview study

Ambulance service organizations worldwide report about an expanding professional role, responsibilities and scope of practice for ambulance clinicians, resulting in discussions concerning educational design and desired professional competencies. To face the contemporary demands in ambulance care, non-technical skills are advocated and clinical practice considered fundamental for the development of these abilities. However, there is very little research concerning educational strategies for supporting the desired competencies for novice registered nurses in the ambulance service.

AIM

To describe and explore nurse preceptors' experience-based strategies for supporting registered nurses learning in the ambulance service.

DESIGN

The study had an inductive and data-driven approach, guided by phenomenological epistemology.

METHODS

Twenty-seven Swedish nurse preceptors were interviewed in three focus groups and four dyadic interviews between October 2019 and April 2020. The data were analysed with reflexive thematic analysis.

FINDINGS

The nurse preceptors use several learning strategies, focusing on a socialization process and a clinical competence process, intertwined during clinical practice to support the development of a situated professional identity and a clinical decision-making competence. Supportive structures facilitate a progressive learning strategy when addressing desired skills and cognitive abilities in teamwork processes and clinical judgement.

CONCLUSION

Supporting novice clinicians, prior to and during clinical practice in the ambulance service, should include medical assessment skills, situation awareness and processes for effective teamwork. Further, novice clinicians need to develop complex cognitive abilities to deal with the dynamic nature of decision-making in ambulance care.

IMPACT

The study findings show contextual strategies, previously not described and desired competencies when supporting learning for registered nurses in the ambulance service. A theoretical grounding in episteme, techne, phronesis and situation awareness may guide educators at universities, managers in the ambulance service, preceptors and novice clinicians worldwide in the planning and performance of teaching and learning in the ambulance service.

Starting ambulance care professionals and critical incidents: a qualitative study on experiences, consequences and coping strategies

BACKGROUND

Ambulance care professionals are regularly confronted with critical incidents that increase risks for mental health disorders. To minimize these risks, it is important that ambulance care professionals adequately cope with critical incidents. Especially from the perspective of starting ambulance care professionals it is unknown which coping styles they use when experiencing a critical incident and how they are trained to cope with critical incidents. The aim of this study was to gain insight in (a) what starting ambulance care professionals describe as critical incidents, (b) how they experience these critical incidents and their consequences, (c) how they cope with these incidents, and (d) how they are trained and guided to cope with these incidents.

METHODS

A qualitative design with individual, semi-structured interviews was used. The data was analyzed by using inductive thematic analysis.

RESULTS

Twenty-two starting ambulance care professionals were interviewed of which, 11 were male. The age ranged from 23 to 31 years, with 11 participants being 27 years or younger. Three key-themes emerged that make an incident critical: (1) emotional connection versus emotional detachment, (2) feeling loss of control, and (3) incomprehension. All participants experienced several short to middle term physical, psychological and social consequences after encountering a critical incident. Starting ambulance care professionals applied different coping strategies during different phases of the ambulance care process: a mix of depersonification, focus on the medical task, support from colleagues and their own network, seeking confirmation, and distraction. Most starting ambulance care professionals don't actively remember they received education about coping with critical incidents during their initial educational program. During and after traineeships, the workplace preceptor has a crucial role for starting ambulance care professionals to learn them how to cope with critical incidents.

CONCLUSIONS

Three key-themes interact to make an incident more critical for starting ambulance care professionals. To cope with these critical incidents, starting ambulance care professionals use a variety of coping strategies. These results can be used to develop training and coaching for starting ambulance care professionals so they can adequately cope with critical incidents.

Evaluation of Emergency First Response's Competency in Undergraduate College Students: Enhancing Sustainable Medical Education in the Community for Work Occupational Safety

Worldwide, people’s quality of health has been decreasing due to bad eating habits that have generated an increase in diseases such as diabetes, hypertension, overweight, as well as an increase in hours of the daily workday and stress. This situation can generate sudden illness and work accidents where the need to have knowledge in emergency first response (EFR) is necessary for all. Unfortunately, workshops and courses to certify EFR individuals are usually taught only to healthcare professionals. Therefore, to address this need a EFR project has been developed at the Tecnológico de Monterrey (TEC) which consists of a multidisciplinary challenge to train, certify, and evaluate students’ competency as “emergency first responders” in medical emergencies and healthcare awareness. This EFR project has been performed for one week, every year since 2015, and constitutes a joint venture among academic departments, faculty, and industrial/government institutions, which work together in multidisciplinary projects, providing a source of innovative proposals. The EFR project at TEC has provided instruction and certification for 966 students between 2015 to 2019 and this study has analyzed results considering a sample size of 197 participants. The combination of exam evaluation, medical emergency skills verification, and project proposal results indicate that most students reach skill levels between 2 and 3 in EFR competency after successfully completing the program, regardless of their year of study or the undergraduate program they are enrolled on. This evaluation emphasizes the compromise of the institution and its students in preparation for new living under sanitary conditions for pandemic conditions such as COVID-19.

Effects of multiepisode case-based learning (CBL) on problem-solving ability and learning motivation of nursing students in an emergency care course

BACKGROUND

Meeting the learning needs and developing the thinking skills of nursing students in caring for injured patients with complex, emergency, and unpredictable conditions is essential.

PURPOSE

The present study aimed to compare the effects of case-based learning (CBL) with multi-episode case studies and lecture-based learning (LBL) on the perceived problem-solving ability and learning motivation of undergraduate nursing students in an emergency care course.

METHODS

This study was conducted with a quasi-experimental, within-subjects, pretest-posttest design. Forty-three third-year undergraduate nursing students (as a single cohort) enrolled in the fall semester were selected using convenience sampling. The theoretical course of emergency nursing was taught to them using the LBL method (control group) during the first six weeks of the semester and then using the CBL method (intervention group) during the second six weeks of the semester through multi-episode cases in five steps. Outcomes including perceived problem-solving ability and learning motivation were measured using the Problem-Solving Inventory (PSI) and the Instructional Materials Motivation Scale (IMMS).

RESULTS

There was a significant difference (P < 0.001) between the changes in the total mean score of perceived problem-solving ability and its subscales on the three measurement points, i.e. before lectures (pre-test), after lectures (mid-term test) and after CBL (final test). There was a significant difference between the LBL and CBL groups in terms of the students' total learning motivation score (t = 16.91, P = 0.000) and all its subscales after the CBL intervention.

CONCLUSION

The study suggests that the CBL method applied through multi-episode cases is an effective approach to improving the perceived problem-solving ability and learning motivation of nursing students.