An innovative model of supportive clinical teaching and learning for undergraduate nursing students: The cluster model

Korean Nursing Students' Experiences of Virtual Simulation Programs Replacing In-Person Mental Health Nursing Practicum during the COVID-19 Pandemic

This qualitative study explored the experiences of nursing students whose clinical practice in mental health nursing had been substituted with virtual simulation programs due to the COVID-19 pandemic. The participants were ten nursing students who had undergone a virtual simulation program-centered practice, replacing the traditional clinical practice in mental health nursing and previous clinical practice in mental health nursing. The data were collected through in-depth individual interviews from January to February 2021. Following Braun and Clarke's method, the thematic analysis identified five themes and ten sub-themes. The five themes included the following: (1) lack of vibrancy in the actual clinical setting, (2) limited direct and indirect practical experience, (3) performing diverse roles in a virtual setting, (4) learner-directed practicum, and (5) sense of relief due to a safe virtual practicum environment. The participants recognized the limitations of the practice, particularly regarding communication with patients with mental disorders in the virtual simulation program. However, their perception of nursing underwent a positive change through the indirect clinical practice experience. Accordingly, it is necessary to develop a platform for the mental health nursing practicum that can easily interact with clients and to establish a hybrid practice that combines the clinical practice and virtual simulation practice.

Clinical learning environment for nursing students in operating rooms: Development of an evaluation scale

Aim

To develop a measurement tool to evaluate the clinical learning environment for nursing students in operating rooms.

Background

In this study, a scale for evaluating the clinical learning environment for nursing students in operating rooms was developed and subjected to reliability and validity tests.

Design

A cross-sectional, methodological study.

Methods

Qualitative interviews, the Delphi method, a literature review and pilot testing were employed to develop the scale. A purposive sampling method was used to select September 2021 through May 2022; a total of 227 nursing students with internship experience in operating rooms at several teaching hospitals in North China were selected to evaluate the reliability and validity of the scale.

Results

The 32-item, four-dimensional evaluation scale was developed through two rounds of consultation with 17 experts. The reliability and validity test showed that the overall Cronbach's alpha was 0.984 and 0.96. The split-half reliability for the total scale was 0.937, indicating good reliability.

Conclusion

The proposed scale has high reliability and validity in evaluating the clinical learning environment of nursing students in operating rooms and improving clinical nursing education.

A supportive clinical learning environment for undergraduate students in health sciences: An integrative review

BACKGROUND

The clinical learning environment is a platform where theory and practice should be integrated in a safe environment. However, many students experience the clinical learning environment as "stress provoking", because this environment is not always supportive.

OBJECTIVE

The aim of the article is to report on a study that synthesized the evidence on strategies for providing a supportive clinical learning environment for undergraduate students in health sciences.

DESIGN

The integrative review followed the methodology of Whittemore and Knafl (2005).

DATA SOURCES AND REVIEW METHODS

We searched MEDLINE with Full Text, CINAHL with Full Text, Academic Search Ultimate, PsycINFO, Health Source: Nursing/Academic Edition, ERIC, Africa-Wide Information, OpenDissertations, CAB Abstracts, MasterFILE Premier, SocINDEX with Full Text, SPORTDiscus with Full Text and PsycARTICLES. Other data sources included grey literature and reference lists. The filtering process, quality appraisal and data extraction were carried out by at least two independent reviewers. Thematic analysis was used to analyse the data.

RESULTS

The search yielded 500 studies, of which nine studies met the inclusion criteria. The generated data culminated in a clinical learning environment mindmap that highlights, firstly, a network of carefully selected supporters who may have specific clinical responsibilities while supporting undergraduate students in clinical learning. Secondly, the relationship between the student, student supporter and clinical staff should create a sense of belonging, self-efficacy and self-directedness. This relationship is influenced by the roster, the ratio of students to student supporters, and appropriate learning opportunities. Thirdly, higher education institutions and healthcare providers should support students and student supporters through formal partnerships.

CONCLUSIONS

The synthesis of the evidence provided new insights regarding creating and maintaining supportive clinical learning environment strategies for undergraduate students in health sciences. These strategies may be implemented in innovative ways to provide students with the best clinical learning opportunities.

Comparison of the effectiveness of the electronic portfolio and online discussion forum methods in teaching professional belonging and ethical behaviors to nursing students: a randomized controlled trial

BACKGROUND

Nursing is a profession that has had many ethical aspects and understanding professional belonging and ethics as a deep and complex process is one of the basic concepts in this field. This study aimed to compare the effectiveness of training professional belonging and ethical behaviors in two methods: electronic portfolio and online discussion forum in nursing students.

METHODS

This study is a single-blinded randomized-controlled trial (RCT) with two parallel intervention groups and a third control group. The sample size was 90 selected by block randomization method. The educational contents of professional belonging and ethical behaviors were presented to the participants in two ways: electronic portfolio and online discussion forum. Demographic information form, professional belonging questionnaire, and ethical behaviors questionnaire were applied to collect data. Data were analyzed using SPSS version 24 software. Respectively mean, standard deviation and repeated measured, analysis of variance tests was used in descriptive and analytic statistic. (P value < 0.05).

RESULTS

Comparison of the mean score of professional belonging and ethical behavior in the three stages of pretest, immediately after the test and four weeks after the test in all three groups was significant (P < 0.001). The control group had a higher mean score of professional belonging immediately after the test (108.18 ± 48.9) compared to the other two groups. Also, the online discussion forum group had a higher mean score on ethical behavior in four weeks after the test (104.2 ± 0.8) compared to the other two groups.

CONCLUSION

Training based on two methods of the electronic portfolio and online discussion forum increases and enhances the level of ethical behaviors in students. Therefore, the implementation of such methods of training can be useful in improving, promoting, and learning ethical behaviors in nursing students. On the other hand, training based on the two methods had a negative impact on professional belonging. Therefore, it is suggested that future studies be conducted with a greater focus on areas of professional belonging.

TRIAL REGISTRATION

This research has been registered in Iranian Clinical Trial Registration Center (IRCT) with registration number "IRCT20180612040063N1" and registration date "16/07/2018".

Facilitators and barriers influencing utilization of services provided by community midwives in district Thatta, Pakistan: a qualitative exploratory study

BACKGROUND

To address the issue of high maternal mortality, the Government of Pakistan initiated a community midwifery program in 2006 to provide skilled birth attendance to women living in rural areas. Despite a large investment in the community midwifery program, research evidence from rural districts of Pakistan suggests that the utilization of maternal and newborn services through community midwives is very low. This exploratory study aimed to understand the facilitators and barriers influencing community midwives' services utilization in district Thatta.

METHODS

A qualitative study was conducted in the rural district Thatta, Pakistan. Key-informant interviews (KIIs) were conducted with district officials of the Health department (Thatta), Maternal and Newborn Child Health Program, and Midwifery Association of Pakistan (MAP). In-depth Interviews (IDIs) were conducted with midwifery students who were currently enrolled in the midwifery program of the district; trained community midwives providing services in district Thatta, and trained community midwives not continuing their profession. IDIs were also conducted with community women to explore their views about the scope of midwifery practice and the factors influencing the utilization of community midwives' services in district Thatta, Pakistan. Data were analyzed using qualitative thematic analysis.

RESULTS

A total of 25 interviews (KIIs = 5; IDIs = 20) were conducted. Two overarching themes were identified: (I) community midwives' skills and competencies; and (II) ownership and supportive supervision. The major hindering factors for community midwives' service utilization included deficiencies in community midwives' training particularly in clinical hands-on training, lack of ownership of community midwifery program, and lack of service structure by the CMWs regulatory body.

CONCLUSION

The study has identified serious gaps in the CMWs program at the level of training and supervision of midwives in Pakistan. The study has also identified factors related to the training of CMWs that could facilitate the program in the context of Pakistan and similar settings.

The Learning Environment of Student Nurses During Clinical Placement: A Qualitative Case Study of a Student-Dense Ward

Introduction

Ensuring the quality of clinical placements has long been a challenge in nursing education. This is partly due to a growing aging population requiring health services, and an increased need for nursing workforce. Both in Norway and internationally, there is a rise in the use of student-dense models, wherein several students are placed together on the same ward at the same time where the supervision of the students is the collective responsibility of the nurses.

Objective

The aim of this study was to explore factors that promote or inhibit learning in a student-dense ward when used as a model for clinical placement in hospitals. We examined how clinical placement is experienced in a student-dense ward, as well as how learning is facilitated.

Methods

A qualitative case study design was used to capture the learning environment on the student-dense ward in a comprehensive way. We used focus group interviews, in-depth interviews, and observations with students and employees at a major hospital in Norway.

Results

Our findings showed that the orientation days and the teaching activities in student-dense wards, the feedback students receive, the clinical facilitator's role and the student community were factors that had particular importance for good learning environments in this placement model.

Conclusions

To ensure the quality of clinical placements, more attention should be paid to these factors in the planning, organization, and facilitation of new and existing student-dense wards. It is paramount to provide students with thorough written feedback and to secure the clinical facilitators with enough time to conduct student supervision when organizing clinical placement as student-dense wards.

Learning Experience of Chinese Nursing Students during Clinical Practicum: A Descriptive Qualitative Study

The change in clinical environment can have a significant impact on nursing students’ clinical learning and as a consequence, to their competency. Students’ learning experiences could provide important insights for improving the existing approach towards clinical education. This descriptive qualitative study aimed to explore nursing students’ clinical learning experience. Focus group interviews were conducted with 20 final year nursing students studying a bachelor nursing programme at a self-financing tertiary institution in Hong Kong. Thematic analysis was conducted. 16 female and four male students were recruited. Six themes were identified: Anxiety towards clinical practicum, expectations of roles and responsibilities in practicum, ward environment, adequacy of support, learning attitude, and practicum arrangement. The findings suggest that nursing students are more discontented with their clinical training than before. Nursing faculty must look for possible ways to improve the clinical learning environment.

A preceptorship model to facilitate clinical nursing education in health training institutions in Botswana

Background

Despite the wide use of preceptorship, there is evidence that preceptorship and the role of preceptor in clinical nursing education are not clearly understood or supported.

Objectives

To develop a preceptorship model to facilitate clinical nursing education in Botswana.

Method

The model development in this study followed the steps of theory generation as described by Chinn and Kramer. These four steps are concept analysis, relationship statements, description and critical reflection of the model.

Results

Four main themes emerged from the empirical study that formed the basis for key concepts and model development. The model has six components, namely, agent, recipient, context, procedure, dynamics and terminus. The description of the model is based on Chinn and Kramer.

Conclusion

The need for a preceptorship model to facilitate preceptorship cannot be overemphasised in this regard. This model will guide the planning and implementation of preceptorship procedures by different stakeholders to improve its effectiveness in clinical nursing education.

Effective academic-practice partnership models in nursing students' clinical placement: A systematic literature review

OBJECTIVES

This systematic review examines the effectiveness of academic-practice partnership models which include clinical faculty and clinical mentor roles in improving nursing students' clinical learning when compared with traditional models.

REVIEW METHODS

PubMed, CINAHL, PsycINFO and Cochrane Library were searched to locate Randomized Control Trials and quasi-experimental studies published from 1999 to 2020. The Joanna Briggs Institute critical appraisal tools were used to ensure methodological quality.

RESULTS

Fourteen studies were included in the review. The Collaborative Teaching Model and the Dedicated Education Unit model were tested in randomized controlled trials. Dedicated Education Unit, Dedicated Education Centre, Clinical Education Units, Education Partnership model, Collaborative educational-practice model and Collaborative clinical practicum model were evaluated in four experimental studies and ten quasi-experimental studies. Studies did not include patient participation, and staff and faculty had anecdotal presence.

CONCLUSION

There is limited evidence on the effectiveness of academic-practice partnership models. However, the complementary roles of clinical faculty and clinical mentor, in addition to education and health institutions managers commitment could successfully facilitate students' clinical learning.

The relationship between the undergraduate clinical learning environment and work readiness in new graduate nurses: A pre-post survey study

BACKGROUND

Due to projected nurse shortages, it is necessary that undergraduate programs optimise work readiness outcomes in new graduate nurses. Research that quantitatively evaluates characteristics of clinical nursing programs that predict increased work readiness is required.

OBJECTIVES

To explore the relationship between the undergraduate clinical learning environment and nurse perceptions of work readiness prior to and following, commencement as a new graduate nurse.

DESIGN

A pre-post follow-up study. Undergraduates were surveyed at the end of their Bachelor's degree (baseline) and at 8-10 weeks after commencement as a graduate nurse (Time 1).

SETTING

A multi-site, metropolitan private hospital in Victoria, Australia.

PARTICIPANTS

Nursing graduates who completed a university fellowship program (n = 26), or were undertaking their graduate year and had completed placement blocks within (n = 18) or outside (n = 31) the healthcare organisation.

METHODS

Participants self-completed the Clinical Learning Environment Inventory (CLEI) and Work Readiness Scale for Graduate Nurses (WRS-GN) at baseline and Time 1. Multiple regression analyses were performed.

RESULTS

CLEI scores significantly predicted work readiness outcomes (all p-values<.05), accounting for 16-36% and 17-28% of the variance of WRS-GN scores at baseline and Time 1, respectively. After adjusting for clustering due to clinical placement groups, CLEI Individualisation (p = .023) and Valuing Nurses Work (p = .01) predicted improved Time 1 WRS-GN Organisational Acumen. CLEI Innovative and Adaptive Culture scores predicted poorer Time 1 Organisational Acumen (p = .001).

CONCLUSIONS

Learning environments that offered high levels of individualised attention and valued nurses' work appeared to facilitate post-graduation engagement and identification with nursing practice. However, highly innovative and adaptive education may detract from optimal work readiness. Findings revealed that while important, the clinical learning environment only accounted for a small-to-moderate degree of nursing graduates' work readiness. To facilitate robust evidence-based improvement of clinical nursing education, future research should attempt to empirically establish the value of additional facilitators of work readiness.

Nursing and midwifery students' experiences and perception of their clinical learning environment in Malawi: a mixed-method study

Background

The clinical learning environment is an important part of the nursing and midwifery training as it helps students to integrate theory into clinical practice. However, not all clinical learning environments foster positive learning. This study aimed to assess the student nurses and midwives' experiences and perception of the clinical learning environment in Malawi.

Methods

A concurrent triangulation mixed methods research design was used to collect data from nursing and midwifery students. Quantitative data were collected using a Clinical Learning Environment Inventory, while qualitative data were collected using focus group discussions. The Clinical Learning Environment Inventory has six subscales of satisfaction, involvement, individualisation, innovation, task orientation and personalisation. The focus group interview guide had questions about clinical learning, supervision, assessment, communication and resources. Quantitative data were analysed by independent t-test and multivariate linear regression and qualitative data were thematically analysed.

Results

A total of 126 participants completed the questionnaire and 30 students participated in three focus group discussions. Satisfaction subscale had the highest mean score (M = 26.93, SD = 4.82) while individualisation had the lowest mean score (M = 18.01, SD =3.50). Multiple linear regression analysis showed a statistically significant association between satisfaction with clinical learning environment and personalization (β = 0.50, p = < 0.001), and task orientation (β =0.16 p = < 0.05). Teaching and learning resources, hostile environment, poor relationship with a qualified staff, absence of clinical supervisors, and lack of resources were some of the challenges faced by students in their clinical learning environment.

Conclusion

Although satisfaction with clinical learning environment subscale had the highest mean score, nursing and midwifery students encountered multifaceted challenges such as lack of resources, poor relationship with staff and a lack of support from clinical teachers that negatively impacted on their clinical learning experiences. Training institutions and hospitals need to work together to find means of addressing the challenges by among others providing resources to students during clinical placement.

Nursing students' perceptions of and experiences coping with stress in clinical practice

Objectives Clinical practice is a major component of nursing education wherein significant learning takes place. Nursing students experience stress in clinical practice which can have a negative impact on their learning. Guided by Lazarus and Folkman's theory of stress and coping, this study explored nursing students' perceptions of and experiences with coping with stress in clinical practice. Methods Semi-structured interviews were conducted with ten undergraduate nursing students. Qualitative content analysis was used to analyze the data. Results The themes of: Learning about self, Knowing self, Value of social support, and Relationships with clinical instructors reflect participants' descriptions of coping with stress. Students cognitive and behavioral strategies, including reflection, help them understand their stress and decide how to reduce its effects. Conclusions Supportive and respectful relationships are essential for a student to learn and cope effectively with stressful situations. Implications for improving the clinical instructor's role to enhance students' coping with stress in clinical practice are discussed.

“Share Your Tools”—A Utility Study of a Norwegian Wildland-Fire Collaboration Exercise

Based on the assumption that crisis collaboration exercises lead to better team-integration and more efficient problem solving, the aim of this study is to test whether there is a relationship between exercise participation and perceived levels of learning and utility. Online survey data was collected from participants in a 2018 two-day, full-scale, wildland-fire collaboration exercise in southeastern Norway. The instrument of choice was the collaboration, learning, and utility (CLU) scale. Findings indicate a strong covariation between participation in Norwegian wildland-fire collaboration exercises and the perceived level of learning, with a medium to small covariation between perceived learning and utility. The results indicate the importance of giving clear instructions, focus on collaboration, and sufficient forms of discussion during and after the exercise in order to gain learning. However, learning had a limited impact on utility. The study indicates joint evaluations, improvising, and testing of new and alternative strategies across sectors are important when exercises are constructed. The data was retrieved from a questionnaire, observations and interviews can add more and comprehensive insight into the studied phenomenon.

Elements of group dynamics that influence learning in small groups in undergraduate students: A scoping review

BACKGROUND

Learning in small groups is a frequent activity in undergraduate programs to enrich learning, as well as in nursing programs during clinical experiences. Being in a small group adds elements of group dynamics that influence learning. Research into the influence of these elements on learning in small groups is not clear in the literature. This makes it challenging for educators to promote the optimal environment for learning.

OBJECTIVE

To explore the literature on elements of group dynamics that influence learning in small groups among undergraduate students.

DESIGN AND DATA SOURCES

A scoping review was performed, inspired by the five-stage approach of Arksey and O'Malley and the methodology outlined by the Joanna Briggs Institute. Various databases were used including CINAHL, ERIC, psycINFO, PubMed and Science Direct.

REVIEW METHOD

Our research question was: What are the elements of group dynamics that influence learning in small groups among undergraduate students? At least two authors analyzed the relevant studies and data were extracted to describe the elements of group dynamics that influence learning in small groups among undergraduate students.

RESULTS

Thirty papers were included in our review. Five elements emerged: engagement, openness, support, quality of communication and style of dominant behavior.

CONCLUSIONS

The results suggested the utilization of these elements in establishing a group dynamic favorable for learning in small groups. Since little research has been done into group dynamics in nursing education, it was useful to explore this concept in other disciplines. Further research is needed with a focus on clinical education for nursing students.

Learning experience of nursing students in a clinical partnership model: An exploratory qualitative analysis

BACKGROUND

Clinical teaching models are crucial for nursing students' learning experiences as students learn and socialise in a complex clinical context. An innovative clinical partnership model, employing hospital-based clinical teachers to provide supervision and university teachers to liaise with students, has been developed to facilitate clinical teaching and enhance learning experiences.

OBJECTIVES

The study aims to explore nursing students' learning experiences under this clinical partnership model.

DESIGN

An exploratory qualitative study using focus group interviews.

PARTICIPANTS

Twenty-eight pre-registration nursing students at undergraduate and postgraduate level participated in this study.

METHODS

Students formed four groups with each consisting of six to eight students. Semi-structured interviews were conducted to explore students' experiences and perceptions of clinical learning in the clinical partnership model. The data analysis was guided by an inductive approach using content analysis.

RESULTS

The narrative data relates to the clinical learning environment and experience. Nursing students found the clinical partnership model provided a conducive learning context facilitating their adaption to the new environment and integration with the healthcare team. Though students spent time developing mutual understanding with their clinical teachers, they were satisfied with the ample opportunities to practise and learn from their teachers. They appreciated the fact that teachers enriched their learning through bridging the theory-practice gap and acting as role models.

CONCLUSION

The clinical partnership model enriches students' learning experiences. It provides a student-centred learning approach and supportive clinical environment which engages nursing students in learning.

Translation and validation of a Vietnamese version of the modified Clinical Learning Environment Inventory (V-CLEI)

The quality of students' experiences in an education environment directly affect learning outcomes. In an applied profession such as nursing, students undertake work-integrated learning in unpredictable health settings where multiple influences interact. Understanding students' perspectives with a valid instrument is the first step in improving learning environments and maximizing learning outcomes. It is important that language and cultural nuances are accounted for when instruments are translated. This paper reports translation and psychometric properties of the Vietnamese language version (V-CLEI) of the modified English language Clinical Learning Environment Inventory (CLEI) (Newton et al., 2010). The V-CLEI was tested with a convenience sample of 209 Vietnamese nursing students to assess clinical learning experiences in hospitals in central Vietnam. The internal consistency, test-retest reliability, content validity and factor structure of the V-CLEI were examined. Results indicate that the V-CLEI is unlikely to be valid and reliable in the Vietnamese context and revision is required. This study informs research, particularly the different cultural dimensions considered when translating and adapting instruments.

Clinical learning experiences of nursing students using an innovative clinical partnership model: A non-randomized controlled trial

BACKGROUND

Clinical practicum is a major learning component for pre-registration nursing students. Various clinical practicum models have been used to facilitate students' clinical learning experiences, employing both university-based and hospital-based clinical teachers. Considering the strengths and limitations of these clinical practicum models, along with nursing workforce shortages, we developed and tested an innovative clinical partnership model (CPM) in Hong Kong.

OBJECTIVE

To evaluate an innovative CPM among nursing students actual and preferred clinical learning environment, compared with a conventional facilitation model (CFM).

DESIGN

A non-randomized controlled trial examining students' clinical experiences, comparing the CPM (supervised by hospital clinical teacher) with the CFM (supervised by university clinical teacher).

SETTING

One university in Hong Kong.

PARTICIPANTS

Pre-registration nursing students (N = 331), including bachelor of nursing (n = 246 year three-BN) and masters-entry nursing (n = 85 year one-MNSP).

METHODS

Students were assigned to either the CPM (n = 48 BN plus n = 85 MNSP students) or the CFM (n = 198 BN students) for their clinical practice experiences in an acute medical-surgical ward. Clinical teachers supervised between 6 and 8 students at a time, during these clinical practicums (duration = 4-6 weeks). At the end of the clinical practicum, students were invited to complete the Clinical Learning Environment Inventory (CLEI). Analysis of covariance was used to compare groups; adjusted for age, gender and prior work experience.

RESULTS

A total of 259 students (mean age = 22 years, 76% female, 81% prior work experience) completed the CLEI (78% response rate). Students had higher scores on preferred versus actual experiences, in all domains of the CLEI. CPM student experiences indicated a higher preferred task orientation (p = 0.004), while CFM student experiences indicated a higher actual (p < 0.001) and preferred individualization (p = 0.005). No significant differences were noted in the other domains.

CONCLUSIONS

The CPM draws on the strengths of existing clinical learning models and provides complementary methods to facilitate clinical learning for pre-registration nursing students. Additional studies examining this CPM with longer duration of clinical practicum are recommended.

The impact of timetable changes on student achievement and learning experiences

BACKGROUND

Many pre-registration nursing programs in Australia use distributive models of clinical placement whereby students attend placement on regular days each week of the teaching semester. The use of this model offers practical advantages by increasing the placement offerings, but reduces the weekdays available for students to attend on-campus classes. The impact of introducing this model on the delivery of on-campus classes has not been examined.

OBJECTIVES

The aim of this study was to explore the impact of delivering classes using a condensed weekly timetable on the academic achievement, learning experiences and approaches to learning of pre-registration Bachelor of Nursing Science students at an Australian regional university.

METHODS

This was a mixed methods study, including Likert-type and free text responses. Second-year students studying Human Pathophysiology and Pharmacology were invited to complete a questionnaire about their learning practices and experiences; student grades were obtained from official university records.

RESULTS

The academic achievement of students learning under the condensed class schedule was approximately 7.5% lower than that achieved by cohorts prior to the timetable changes. This resulted in an additional 9% of the cohort failing the subject compared to previous cohorts. Many students reported that they did not prepare adequately for classes and that their learning experiences were negatively impacted by the condensed class timetable.

CONCLUSIONS

The incorporation of a distributed model for clinical placements required major changes to the delivery of on-campus coursework classes and added to the semester workload for some Nursing Science students. These changes coincided with lower academic achievement by students learning Human Pathophysiology and Pharmacology and poorer quality learning experiences. The development of students' awareness of how they study and the effectiveness of their study practices may help them to develop self-regulated learning skills which will assist them to succeed in diverse learning environments and workplaces.

Learner : preceptor ratios for practice-based learning across health disciplines: a systematic review

CONTEXT

Practice-based learning is a cornerstone of developing clinical and professional competence in health disciplines. Practice-based learning systems have many interacting components, but a key facet is the number of learners per preceptor. Different learner : preceptor ratios may have unique benefits and pose unique challenges for participants. This is the first comprehensive systematic review of the topic. Our research questions were: What are the benefits and challenges of each learner : preceptor ratio in practice-based learning from the perspectives of the learners, preceptors, patients and stakeholder organisations (i.e. the placing and health care delivery organisations)? Are any ratios superior to others with respect to these characteristics and perspectives?

METHODS

Qualitative systematic review of published English-language literature since literature database inception, including multiple health disciplines.

RESULTS

Seventy-three articles were included in this review. Eight learner : preceptor ratio arrangements were identified involving nursing, physiotherapy, occupational therapy, pharmacy, dietetics, speech and language therapy, and medicine. Each arrangement offers unique benefits and challenges from the perspectives of learners, preceptors, programmes and health care delivery organisations. Patient perspectives were absent. Despite important advantages of each ratio for learners, preceptors and organisations, some of which may be profession specific, the 2 : 1 and 2+ : 2+ learner : preceptor ratios appear to be most likely to successfully balance the needs of all stakeholders.

CONCLUSIONS

Regardless of the learner : preceptor ratio chosen for its expected benefits, our results illuminate challenges that can be anticipated and managed. Patient perspectives should be incorporated into future studies of learner : preceptor ratios.

Student participation in clinical handover-an integrative review

AIM AND OBJECTIVES

To examine the literature exploring the current understanding of student nurse participation in clinical handover whilst they are enrolled in an undergraduate preregistration course.

BACKGROUND

The importance of handing over the care of a patient to ensure continuity and safety of care is well-recognised. Effective preparation of student nurses to competently perform this critical task requires the use of appropriate teaching strategies to support this learning, within undergraduate preregistration nursing programs.

DESIGN

An integrative literature review.

METHOD

An integrative literature review was conducted to establish what is known about student nurse participation in relation to clinical handover. This resulted in 18 articles for inclusion in the literature review. An analysis was then undertaken of these 18 articles to extract key themes.

RESULTS

Learning and teaching strategies need to address a variety of methods of the clinical handover process including verbal and written handovers. Participating in clinical handover prior to being given the responsibility of patient care prepares students for the workplace. Key themes identified within the literature included: learning strategies, limitations and challenges involved in putting theory into practice, handover structure and issues regarding confidentiality.

CONCLUSION

Simulation and clinical practice are commonly used to prepare students for this role during their undergraduate education. The use of simulation and structured handover techniques prior to clinical placement increases student confidence to engage in clinical handovers during their clinical placements.

RELEVANCE TO CLINICAL PRACTICE

This article raises the awareness of both clinical staff and educators as to the need for student nurses to develop their skills in clinical handover practice and suggests strategies to prepare student nurses to conduct clinical handover competently in the clinical setting.

Swedish student nurses' perception of peer learning as an educational model during clinical practice in a hospital setting-an evaluation study

BACKGROUND

Peer learning, a collaborative learning model has no tradition in clinical education for undergraduate student nurses in Sweden, and little is reported of the student experience. An increasing number of students have led to a pressing need for preceptors and clinical placements thus, highlighting the need for a supportive educational model. The objectives for the current study were to explore how student nurses' evaluated peer learning as an educational model during clinical practice in a hospital setting, and to compare perceptions among student nurses from year one and three.

METHODS

A questionnaire developed for the purpose of this study was developed and responded to by 62 (year one) and 73 (year three) student nurses. Data were collected between 2011 and 2013. The questionnaire contained six open- ended and eight closed questions on a four point Likert-scale. Written responses were analysed by content analysis and the closed questions by using descriptive statistics. Mann-Whitney U-test was used to examine differences in relation to students from year one and three.

RESULTS

The peer learning experience was evaluated in a positive way. Statistical significance differences were shown for two out of eight closed questions. The peer learning activities were evaluated as supportive and relevant for learning. Three categories emerged from the content analysis: "a feeling of safety", "a sense of competition" and "the learning experience".

CONCLUSION

A feeling of safety seems to be connected to students' perception of increased learning and independence. However, the sense of negative competition needs to be addressed when students are prepared for the teaching and learning activities in the peer learning model. Finally, what needs to be further investigated is what challenges and opportunities the peer learning model presents to preceptors.

Nursing students' perceptions of clinical supervision: the contributions of preceptors, head preceptors and clinical lecturers

AIM

The aims of the study were 1) to investigate to what extent nursing students were satisfied with the supervision provided by facilitators (preceptor, head preceptor, and clinical lecturer), 2) to compare nursing students' ratings of facilitators' contribution to supervision as supportive and challenging, and 3) to examine relationships between facilitators' supportive and challenging behavior in supervision and nursing students' perception of fulfillment of expected learning outcomes in clinical education.

BACKGROUND

Although there are many studies on support of students in clinical education, few have addressed this from the students' point of view or made comparisons between different facilitators.

METHODS

A cross-sectional survey study was conducted during April to November 2010, where 107 nursing students, from a university in central Sweden, answered a questionnaire about supervision immediately after their period of clinical education.

RESULTS

Supportive behavior in supervision was rated higher by students for all facilitator groups as compared with challenging behavior. The students rated preceptors and clinical lecturers as more supportive than head preceptors and clinical lecturers as providing more challenges than the two other facilitator groups. Supportive and challenging behavior in supervision explained 39% of the variance in students' overall learning outcomes. However, the regression coefficient was only significant for students' ratings of supportive behavior for the preceptor.

CONCLUSIONS

Nursing students were satisfied with facilitators' supervision and by their contribution to fulfillment of overall learning outcomes. Comparisons showed that preceptors in a higher degree were perceived as supportive while clinical lecturers were perceived as more important as challengers for critical thinking, reflection and exchange of experiences between students. The model of supervision seems to be promising, but the roles across facilitators need to be made clearer, especially the head preceptor's role, which seemed to be the most unclear role in this model.

Facilitator versus preceptor: which offers the best support to undergraduate nursing students?

INTRODUCTION

There is an abundance of literature regarding factors that influence student learning within the clinical environment. Within this discourse, there is a paucity of research on the impact of supervision models on the learning support needs of students. This paper presents the results of research that focused on nursing students' perceptions about the effectiveness of the support they received during their work integrated learning (WIL) experience.

BACKGROUND

The majority of students placed within health care facilities are in groups. The group model incorporates a facilitator who supervises the students who are placed across a number of wards. At the ward level students are then assigned a Registered Nurse (RN) who is their mentor. This occurs on a shift by shift basis. Another model of clinical supervision involves preceptorship. This approach is via a one-on-one supervision of students. Within the preceptorship model, students are supervised by a RN who is responsible for supporting them during their WIL experience and for completing their assessment.

METHODS

This study compared two models of clinical supervision to better understand the learning support needs as perceived by undergraduate nursing students during their WIL experience. Survey method using a self reporting online questionnaire developed by the researchers was used to collect data.

RESULTS

159 undergraduate nursing students enrolled in a Bachelor level programme of study completed the on-line survey. When comparing the two models of supervision, students supervised within the facilitator model were statistically more likely to be challenged to reflect, think, build on existing skills and knowledge and to problem-solve issues. Notably, all factors integral to RN education. Overall, students considered the quality of support to be the most important facet of supervision.

CONCLUSIONS

The findings of this study demonstrate that the facilitator model is the better approach for the development of critical thinking, but both models enable the development of a student's professional identity and the development of their role within nursing. This highlights the significance of clinical experiences during undergraduate nursing education.

Implementation of the Clinical Facilitation Model within an Australian rural setting: the role of the Clinical Facilitator

Education providers globally use various models for undergraduate nurse clinical education. This paper presents the major findings of a research project conducted by a rural university in Australia that aimed to explore the Clinical Facilitation Model of undergraduate nursing education from a rural perspective. In particular how the Clinical Facilitators enacted their role within the rural environment and to identify any barriers to the provision of effective clinical learning during facilitated clinical experience within this context. This qualitative study used a phenomenological approach to explore the experiences of Clinical Facilitators. Individual in-depth interviews were conducted with eight Clinical Facilitators. Data was analysed using thematic analysis and several themes emerged from the study. This paper will report two of the major findings which are based on how Clinical Facilitators enacted their role within the rural environment. Whilst this study has a rural focus the findings will add to the limited body of knowledge internationally regarding the Clinical Facilitation model used as a result of balancing educational needs of the student with the care needs of the patients in the current health policy climate. The findings will be useful for informing undergraduate curricula, and will assist faculty and health services in planning and implementation of models of clinical education that meet the needs of the student and that are specific to the rural environment. In addition, the findings will provide insight into strategies that the rural Clinical Facilitator can utilise to assist in fulfilling their teaching role.