Research on the Frontlines of Healthcare

Student nurse dyads create a community of learning: proposing a holistic clinical education theory

AIMS

This paper is a report of a qualitative study of students' experiences of cooperative learning in the clinical setting.

BACKGROUND

Although cooperative learning is often used successfully in the classroom, it has not been documented in the clinical setting with sophomore nursing students being paired with other sophomore nursing students.

METHODS

Using a grounded theory methodology a sample of 64 participants (32 student nurse dyads, eight clinical groups, in two different acute care institutions) were observed on their first day in the clinical setting while working as cooperative partners. Interviews were also conducted with students, patients and staff preceptors. Data were collected in the fall of 2008, spring and fall of 2009 and the spring of 2010 using semi-structured interviews and reflective surveys. Data were analysed using the constant comparative method.

RESULTS/FINDINGS

A holistic clinical education theory for student nurses was identified from the data. This theory includes a reciprocal relationship among five categories relevant to a community of learning: supportive clinical experience; improved transition into practice; enhanced socialization into the profession; increased accountability and responsibility; and emergence of self-confidence as a beginning student nurse.

CONCLUSION

The use of student dyads creates a supportive learning environment while students were able to meet the clinical learning objectives. Cooperative learning in the clinical setting creates a community of learning while instilling very early in the education process the importance of teamwork. This approach to clinical instruction eases the transition from the classroom to the clinical learning environment, and improves patient outcomes.

Enhancing research interest and collaboration in the interdisciplinary context of emergency care

The interdisciplinary context of the emergency department encompasses diverse clinical presentations requiring teamwork by doctors, nurses and allied health workers to achieve optimal patient care. This interdisciplinary focus is extended by adding a research perspective. This project sought to systematically examine the current research capacity of emergency department staff at a major Australian tertiary urban hospital and to derive information about further research-related needs with a view to enhancing research capacity. The mixed method project utilized a department-wide staff survey followed by focus groups and individual interviews. Adequate response rates to the two phases were achieved (n = 67, n = 17 respectively). Not surprisingly, 89% of participants reported that they needed help with developing their research skills. Clinicians reported little or no experience with (i) finding literature (35%) and critical review (50%), (ii) research skills and techniques, both qualitative (72%) and quantitative (63%), and (iii) research output: publishing (68%), writing & presenting (34%). Data from focus groups and individual interviews yielded themes around developing research skills, communication, meaningfulness, team work and interdisciplinary strategies, forming part of the Dimensional Enhancing Research Capacity (DERC) model. This project highlighted not only interdisciplinary needs for research but also the way that research may additionally assist with building interprofessional linkage.

[Organization of clinical emergency units. Mission and environmental factors determine the organizational concept]

AIM

Mission and organization of emergency units were analysed to understand the underlying principles and concepts.

METHODS

The recent literature (2000-2007) on organizational structures and functional concepts of clinical emergency units was reviewed. An organizational portfolio based on the criteria specialization (presence of medical specialists on the emergency unit) and integration (integration of the emergency unit into the hospital structure) was established. The resulting organizational archetypes were comparatively assessed based on established efficiency criteria (efficiency of resource utilization, process efficiency, market efficiency).

RESULTS

Clinical emergency units differ with regard to autonomy (within the hospital structure), range of services and service depth (horizontal and vertical integration). The "specialization"-"integration"-portfolio enabled the definition of typical organizational patterns (so-called archetypes): profit centres primarily driven by economic objectives, service centres operating on the basis of agreements with the hospital board, functional clinical units integrated into medical specialty units (e.g., surgery, gynaecology) and modular organizations characterized by small emergency teams that would call specialists immediately after triage and initial diagnostic.

CONCLUSIONS

There is no "one fits all" concept for the organization of clinical emergency units. Instead, a number of well characterized organizational concepts are available enabling a rational choice based on a hospital's mission and demand.