Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning

Which actions contribute to the development of an interprofessional learning and working culture in nursing homes? A realist action study

OBJECTIVE

Insights about what actions contributed to the development of an interprofessional learning and working culture were lacking for nursing homes. This study aimed to provide insight into the context and actions that trigger mechanisms for the development of an interprofessional learning and working culture in nursing homes.

STUDY DESIGN

Realist evaluation action research was conducted from 2019 to 2023.

SETTING AND PARTICIPANTS

11 teams in 6 Dutch nursing homes.

PRIMARY AND SECONDARY OUTCOME MEASURES

Questionnaires, focus group interviews and observations were used to identify actions, context factors and mechanisms. We used retroductive analysis to discuss how actions were related to the development of the culture. Actions were evaluated in terms of context and manner in which they contribute to the development.

RESULTS

21 actions were identified and clustered into two themes. Theme 1: improving person-centred care. Actions activated the mechanisms of critical reflective behaviour and collective ownership in a context of, among other things, clear roles and tasks, a stable and competent team, the presence of case managers and facilitating organisational factors such as time for reflection. Theme 2: getting to know and understand each other's expertise. Actions activated respectful relationships, collective ownership of goals and feeling appreciated for your work in a context of, among other things, team members who meet regularly and management supporting interprofessional working.

CONCLUSIONS

This research sheds light on how and in what manner-specific actions contribute to the development of an interprofessional learning and working culture in nursing homes. Depending on the context, the actions triggered the following mechanisms: critical reflective behaviour, collective ownership of goals, respectful/caring relationships and feeling appreciated for your work. These mechanisms are the underlying drivers of an interprofessional learning and working culture. This study provides valuable guidance for fostering collaborative and effective interprofessional dynamics in nursing homes.

Evaluation of an interprofessional educational program in nursing home practice: a mixed methods multiple-case study

Research has shown that interprofessional collaboration (IPC) and education (IPE) may potentially lead to better care for residents in nursing homes, but their implementation is challenging. This study evaluates the implementation of a co-designed IPE program and investigates what and how healthcare students learn and what factors influence their learning. A mixed-methods approach was used to evaluate three cases, with student participation in the IPE (n = 72). The study comprised pre- and posttests, focus groups, and interviews (n = 54). The results indicate that students developed their interprofessional skills and person-centered practice, as confirmed by both the students and educators in the interviews. Additionally, the findings suggest that others also learned from the program. The study emphasizes the influence of workplace learning culture, resources, organizational infrastructure for IPC, and educators' embeddedness in the care organization on learning outcomes. The findings suggest that IPE is stimulated and accelerated by existing IPC and can stimulate or accelerate existing IPC. As the enabling factors are interrelated, addressing them simultaneously on all organizational levels may result in the faster development of an IPE-ready organization.

Experiences of Using a Digital Guidance and Assessment Tool (the Technology-Optimized Practice Process in Nursing Application) During Clinical Practice in a Nursing Home: Focus Group Study Among Nursing Students

BACKGROUND

Nursing students' learning during clinical practice is largely influenced by the quality of the guidance they receive from their nurse preceptors. Students that have attended placement in nursing home settings have called for more time with nurse preceptors and an opportunity for more help from the nurses for reflection and developing critical thinking skills. To strengthen students' guidance and assessment and enhance students' learning in the practice setting, it has also been recommended to improve the collaboration between faculties and nurse preceptors.

OBJECTIVE

This study explores first-year nursing students' experiences of using the Technology-Optimized Practice Process in Nursing (TOPP-N) application in 4 nursing homes in Norway. TOPP-N was developed to support guidance and assessment in clinical practice in nursing education.

METHODS

Four focus groups were conducted with 19 nursing students from 2 university campuses in Norway. The data collection and directed content analysis were based on DeLone and McLean's information system success model.

RESULTS

Some participants had difficulties learning to use the TOPP-N tool, particularly those who had not attended the 1-hour digital course. Furthermore, participants remarked that the content of the TOPP-N guidance module could be better adjusted to the current clinical placement, level of education, and individual achievements to be more usable. Despite this, most participants liked the TOPP-N application's concept. Using the TOPP-N mobile app for guidance and assessment was found to be very flexible. The frequency and ways of using the application varied among the participants. Most participants perceived that the use of TOPP-N facilitated awareness of learning objectives and enabled continuous reflection and feedback from nurse preceptors. However, the findings indicate that the TOPP-N application's perceived usefulness was highly dependent on the preparedness and use of the app among nurse preceptors (or absence thereof).

CONCLUSIONS

This study offers information about critical success factors perceived by nursing students related to the use of the TOPP-N application. To develop similar learning management systems that are usable and efficient, developers should focus on personalizing the content, clarifying procedures for use, and enhancing the training and motivation of users, that is, students, nurse preceptors, and educators.

Learning community participation: A valuable opportunity for transferring actions and behaviors within the nursing learning and working context?

AIM/OBJECTIVE

Indicating how community participation transfers to application within the nursing learning and working context.

BACKGROUND

Preparing nurses to drive advances in health care requires the integration of working and learning. Learning communities are therefore recommended to connect students, educational programs and health care organizations.

DESIGN

A multiple case study with three hospital learning communities was conducted during the 2019-2020 academic year, partly during the COVID-19 pandemic.

METHODS

The main data were collected by conducting three group interviews and 21 individual interviews with members. A hybrid thematic analysis approach was used.

RESULTS

Seven themes originated from the analysis: learning community features, learning community preconditions, learning community needs, impetus, application, research context and meaningfulness. Individual members applied acquired knowledge, skills and attitudes later or in other situations. Depending on the case, collective application manifested as inventing, consulting or reusing, but this seemed less sustainable in the research context at the time.

CONCLUSIONS

Application within the nursing learning and working context occurs and is sustained at the individual level even when there are no organized learning community sessions in times of crisis. Framing and facilitators' support can be used to encourage collective application.

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.

Kickstart in nursing home-Nursing students experiences of a model for active and collaborative learning in clinical placement

AIMS AND OBJECTIVES

To explore students' experiences from a pilot project testing out a model for active, collaborative learning in first-year placement at a nursing home.

BACKGROUND

There is a need for innovative learning activities and projects to improve clinical education in nursing homes. Active, collaborative approaches in placement learning may enhance students learning outcome.

DESIGN

The study had a qualitative and explorative design, in which the experiences of students participating in the pilot were investigated through paired interviews at the end of their placement.

METHODS

Twenty-two students participated in the study, and data from paired interviews were analysed using qualitative content analysis. COREQ reporting guidelines were used.

RESULTS

Three themes emerged from the analysis: (1) The learning cell as facilitator for learning; (2) Discovering learning possibilities in nursing homes and (3) Applying tools and resources for learning.

CONCLUSIONS

The model could reduce tension and anxiety while helping the students focus on learning options and use their environment more actively for learning. Working with a learning partner seems to increase student learning through common planning, feedback and reflection. The study emphasises the importance of facilitating active learning through the scaffolding structures and configuration of the students' learning space.

RELEVANCE TO CLINICAL PRACTICE

This study indicates the potential for introducing active and collaborative pedagogical models in clinical placement. The model can promote nursing homes as a conducive learning arena for nursing students and help prepare students for a future work role in a rapidly changing health care field.

PATIENT OR PUBLIC CONTRIBUTION

The result of the research is shared and discussed with stakeholders prior to finalising the article.

Understanding students' participation in physiotherapy and nursing work settings

Students' health profession education includes learning at the workplace through placements. For students, participating in daily work activities in interaction with supervisors, co-workers and peers is a valuable practice to learn the expertise that is needed to become a health care professional. To contribute to the understanding of HPE-students' workplace learning, the focus of this study is to identify affordances and characterise student's participation during placements. We applied a research design based on observations. Three student-physiotherapists and four student-nurses were shadowed during two of their placement days. A categorisation of affordances is provided, in terms of students' participation in activities, direct interactions and indirect interactions. Students' daily participation in placements is discussed through unique combinations and sequences of the identified affordances reflecting changing patterns over time, and differences in the degree of presence or absence of supervisors, co-workers and peers.

“A life without a supervisor is like a seed that never grows”: Students’ Experiences of Undergraduate Nursing Research Supervision

Background: Undergraduate research is an inquiry or investigation conducted by students who develop an original intellectual or creative contribution to the discipline. However, little is known within the Philippine context that explores undergraduate nursing research experience and supervision.Purpose: This study illustrated the students’ lived experiences of undergraduate research supervision using transcendental phenomenology.Methods: This study made use of transcendental phenomenology. Thirty students enrolled full-time in a nursing research course during the academic year (AY) 2019-2020, and AY 2020-2021 were purposively sampled. These students completed their research projects as required for the nursing research course and were supervised by a mentor. Each participant underwent an in-depth one-on-one interview, of which the responses were transcribed and analyzed based on the modified Stevick-Colaizzi-Keen method.Findings: From the thirty-nine significant statements carefully reviewed and clustered into meaning units, three themes emerged, namely (a) re-capturing tripartite challenges in doing research, (b) re-cultivating quintessential requisites in doing research, and (c) re-envisioning the future ahead. These themes provided textural and structural descriptions that intuitively integrate into the essence of the lived experience of being supervised in undergraduate research.Conclusion: Undergraduate research supervision resonates with the mutual exchange of novel ideas in a dialogical encounter, collective learning, and participatory-in-action where sciencing and caring thinking is imbued to develop critical thinking, inquisitiveness, and caring intuitiveness.

How to establish workplace learning in long-term care: results from a World Café dialogue

Background

As long-term care continues to change, the traditional way of learning for work purposes is no longer sufficient. Long-term care organisations need to become ‘learning organisations’ and facilitate workplace learning for nursing staff teams. Therefore, insight is needed into what conditions are important for establishing workplace learning. The aim and objective of this article is to gain insight into necessary individual, team and organisational conditions for nursing staff to enhance workplace learning in long-term care settings.

Methods

This study is a qualitative explorative study. A World Café method was used to host group dialogues in which participants (n = 42) discussed certain questions. Group dialogues were held for the nursing home and community care setting separately due to organisational differences. Nursing staff, experts in workplace learning, educational staff, client representatives and experts in the field of work and organisation in healthcare organisations were invited to a Dutch long-term care organisation to discuss questions of interest. Data were analysed using theme-based content analysis.

Results

Overall themes concerning individual, team and organisational conditions for workplace learning included: facilitating characteristics (e.g. to be given time and room for [team] development); behavioural characteristics (e.g. an open attitude); context and culture (e.g. feeling safe); cooperation and communication (e.g. giving/receiving feedback); and knowledge and skills (e.g. acquiring knowledge from each other). No major differences were found between settings.

Conclusions

By assessing the themes at the individual, team and organisational level regarding nursing staff, the current workplace learning situation, and its possible improvements, can be detected.

Simulation as a joint learning activity in clinical placement-interaction between first-year nursing students and qualified nurses

AIMS

The purpose of the study was to explore students' experiences from joint simulation training with qualified nurses that took place in students´ first-year placement at a nursing home.

BACKGROUND

Nursing students' clinical placement in nursing homes has been pictured as inadequate, boring and irrelevant. There is a need for innovative learning designs that include increased collaboration between the educational institution and clinical placement site to support student learning in practice. Simulation training is highlighted as a learning activity that enhances practical skills and reflection.

DESIGN

The study had a qualitative evaluation design to explore and capture students' experiences and provide an understanding of the impact of the joint simulation activity during placement.

METHODS

Three retrospective focus group interviews were conducted with a total of twenty nursing students. Written reflective notes from sixteen of the students were included in the study. The data were analysed by means of a thematic content analysis. COREQ reporting guidelines were used.

RESULTS

Four themes were identified as follows: (a) anxiety and arrangements, (b) realistic scenarios-real nurses, (c) debriefing and reflection and (d) the aftereffect of the simulation training for the clinical placement.

CONCLUSIONS

The joint simulation training gave the students an opportunity to actively participate in a complex clinical learning situation together with qualified nurses and within a safe environment. This learning activity provoked feelings and stress within the students. However, it also enriched the students' learning experience and strengthened the outcome of the clinical placement through an improved relationship between the students and qualified nurses.

RELEVANCE TO CLINICAL PRACTICE

Creating collaborative learning activities between nursing homes and universities, such as joint simulation, can increase relevance and enhance learning and student satisfaction in their clinical placement. It can also promote nursing homes as interesting learning arena and future workplace for nursing students.

Learning from nursing students' experiences and perceptions of their clinical placements in nursing homes: An integrative literature review

OBJECTIVES

This paper aims to investigate pre-registration nursing students' experiences and perceptions of their clinical placements in nursing homes in order to develop recommendations for nurse educators. Evidence indicates that nursing students do not view nursing home placements as favourably as acute hospital placements. Therefore, nurse educators are challenged to facilitate a change in students' perceptions towards working in the nursing home environment.

DESIGN

An integrative literature review allowed for the analysis and synthesis of the data relating to students' experiences and perceptions of nursing home practice, from studies with diverse research designs.

METHODS

An electronic database search of CINAHL (Ebsco), Pubmed, British Nursing Database (BND), ERIC and social service abstracts, published from 2008 to April 2020 in English was completed. Papers were included using pre-allocated criteria and 649 qualified for closer examination. After exclusion, 21 papers underwent final analysis and synthesis using NIVIO 12.

RESULTS

Five main themes were derived from the literature; i) the importance of effective supervision; ii) students' experiences and perceptions of the learning environment; iii) understanding the roles of care staff, iv) comprehensive orientation to the learning environment, and v) curriculum preparation. From these five categories, two synthesised themes were developed: nursing home placement encounters and enhancing learning opportunities.

CONCLUSIONS

Increasing the visibility of caring for older people in the curriculum is urgent in order to address nursing students' perceived misconceptions about placements in nursing homes. The development of standalone older people pathways, delivered by experienced and knowledgeable faculty, as well as the provision of compulsory clinical placements in settings exclusive to nursing older people and supervised by registered nurses are recommended. Failing to resolve this immediate problem will result in a further shortage of nurses who are adequately prepared to meet future nursing needs.

The potential for learning within hospital learning communities: the interplay between nursing practice and education to support research ability

Objectives Nurses must contribute to the development of professional practice and thereby improve quality of care by using their research abilities. Therefore, learning communities comprised of nurses, students and teachers were created in a hospital. Methods A qualitative descriptive methodology was used. Three learning communities were purposefully selected, and members were asked open-ended questions about their learning and activities in multiple data collection sessions. Data were analyzed by means of an inductive process. Results Both individually and collectively, members learned about research in general, research terminology and methods. They learned about asking questions and critical thinking, and, specifically through collective learning, they learned about the differences between education practices. Activities were carried out primarily to continue personal learning. Conclusions Learning within the learning communities was mainly research-oriented and therefore potentially suitable for enhancing research ability. Implications are offered to support the formulation of community activities.

First generation immigrant and native nurses enacting good care in a nursing home

BACKGROUND

Several studies have investigated the experiences of first-generation immigrant nurses in new workplaces. Yet, little is known about how native nurses and newcomers collaborate in their care for aging residents in European nursing homes.

OBJECTIVE

To gain a deeper understanding of interactions between first-generation immigrant nurses and native nurses in their care for aging residents in a Dutch nursing home.

METHODS

Ethnography, including 105 h of shadowing immigrant and native nurses, 8 semi-structured interviews with 4 immigrant and 4 established nurses, and 2 focus group discussions with 8 immigrant and 6 established nurses in a Dutch nursing home. Data were analyzed by a post-positivist grounded theory coding approach.

ETHICAL CONSIDERATION

The Medical Ethical Review Committee of the Leiden University Medical Center approved this study.

RESULTS

The interactions between established staff and newcomers were influenced by norms, rules and regulations, policies and protocols. In daily practice and institutional structure, we observed both opportunities and challenges. The strict time schedules and the requisite standards of care were opportunities related to nurses' expectations. Residents' needs were sometimes challenging and inhibited newcomers' active participation. However, sometimes new practices were developed where nurses created common ground, tinkered, and formed an inclusive playing field to enact good care.

CONCLUSION/ DISCUSSION

This study shows that despite obstacles, there was room to make small changes in the rules of the game of nursing. These moments of tinkering may be sufficient to establish a stable, inclusive workforce for first-generation immigrants and give room to the evolvement of hybrid professional identities.

IMPLICATIONS

The findings of this Dutch study are relevant for nursing ethics related to "good care" and nurses in other cultural contexts on how the integration of immigrant nurses in European countries in general could be facilitated.

Care home nursing: Co-creating curricular content with student nurses

BACKGROUND

Meeting the complex care needs of an ageing population is a global issue and long term care settings, such as care homes, play an essential role. However, there is a crisis in the recruitment of registered nurses within care homes. Higher educational institutions have a critical part to play in addressing the crisis in recruitment in care homes and it is argued that student nurses can have a significant role to play in co-creating curricular content responsive to population need.

OBJECTIVE

To co-create curricular content on care home nursing with student nurses.

DESIGN

Co-creation through collaborative enquiry and a three stage thematic analysis.

SETTING

Undergraduate, preregistration nursing programme in a university in the United Kingdom.

PARTICIPANTS

Student nurses from Years One to Four undertaking a Bachelor in Nursing with Honours degree.

METHODS

Six focus groups and two one to one interviews.

RESULTS

Findings revealed predominantly negative attitudes towards care home nursing. Teaching and practice placements appeared to play a minor role in shaping students' attitudes but rather, gave the unspoken message that for the acquisition of necessary knowledge and skills, care homes were less important than other settings. Most students were initially averse to care home nursing as a career choice. During focus groups/interviews, views shifted from seeing care homes as places where you 'lose clinical skills' to places where there is 'a lot of responsibility', and also a potentially rewarding career choice. From this attitudinal shift, students made suggestions for developing better curricular content and more positive learning opportunities.

CONCLUSIONS

A co-creative framework can create a space for mutual learning between students and staff about challenges and opportunities for equipping nurses to meet the needs of ageing populations. Student nurses are open to learning about care home nursing as part of their education and keen to have a more positive exposure.