Academic Outcome Measures of a Dedicated Education Unit Over Time: Help or Hinder?

Characteristics and processes of the dedicated education unit practice education model for undergraduate nursing students: a scoping review

OBJECTIVE

The objective was to review literature related to the dedicated education unit practice education model for undergraduate nursing students, and identify common characteristics and processes for implementing and sustaining this model.

INTRODUCTION

Although practice education is central to undergraduate nursing education, evidence-informed practices for learning in the clinical setting remain elusive. Changes to health care over the past decades related to the role and scope of practice for nurses, gradual shifts to community- and population-based care delivery, and expectations for interprofessional practice require forward-looking education models. The dedicated education unit model was developed in 1997 as a potential solution to globally recognized challenges in nursing education amidst discourses of nursing resource scarcity. Despite more than two decades of innovation and expansion, there is still limited understanding of the effectiveness of the dedicated education unit as a solution to those challenges, or for the anticipated benefits for students and patients, through enhanced evidence-informed health care. This analysis of the characteristics and processes of the model is timely for evaluating and sustaining implementation of the dedicated education unit across nursing practice and education settings.

INCLUSION CRITERIA

English-only publications related to the dedicated education unit practice education model for undergraduate nursing students in baccalaureate and associate degree programs using qualitative, quantitative, or mixed methods research, and quality improvement, program evaluation, and opinion publications were included.

METHODS

Using selected keywords including "dedicated education unit," we searched CINAHL, Google Scholar, MEDLINE, Academic Premier Search, ERIC, Cochrane Database of Systematic Reviews, JBI EBP Database, and ProQuest Dissertations and Theses. Two independent reviewers screened titles and abstracts against inclusion criteria. We reviewed reference lists for gray literature and additional references. Data were extracted from the included articles and categorized for characteristics and processes. Eighty-two publications from January 1997 to May 2020 were included. The findings were presented descriptively with tables and figures to support the data.

RESULTS

Dedicated education unit models were based on five characteristics and four processes. Characteristics of the dedicated education unit model included effective academic-practice partnership, adaptability to diverse contexts, unit culture of educational excellence, responsive and supportive unit leadership, and clarity of roles and responsibilities. Processes included building nurse and faculty capacity, facilitating student learning, communicating regularly at systems and unit levels, and evaluating and sustaining the model.

CONCLUSIONS

Evidence demonstrated that the dedicated education unit practice education model is well-established. However, there were existing gaps in this evidence, specifically evaluation and economic analyses. There was also limited attention to long-term sustainability of the model. The common characteristics and processes identified in this review may be used to support planning, implementation, and evaluation, including development and validation of evaluation tools. Although administrative infrastructure was noted as central to the dedicated education unit strategy, it was rarely acknowledged as part of management and thus also requires further study.

The Impact of Dedicated Education Model on Nursing Students' Outcomes: An Integrative Review

BACKGROUND

Dedicated education units (DEUs) provide an approach to clinical redesign in nursing education. However, the evidence supporting the application of the DEU model has not been systematically reviewed to assess the impact of this model on students' learning outcomes.

PURPOSE

This integrative review analyzed the evidence on the relationship between the DEU model and nursing students' learning outcomes.

METHODS

Electronic databases were searched for articles published between 1998 and 2019. Search terms used were dedicated education unit, academic collaboration, academic-practice partnership, and outcomes. A total of 24 articles informed this review.

RESULTS

Four categories emerged: clinical self-efficacy and confidence, teamwork and collaboration, knowledge and competency, and students' satisfaction.

CONCLUSION

The main findings support a positive relationship between the DEU model and students' learning outcomes. Research is still needed to investigate the impact of DEU models on students' problem-solving and clinical judgment.

A mixed-methods assessment of the transition to a dedicated educational unit: nursing students' perceptions and achievements

BACKGROUND

In 2019, our nursing school shifted clinical instruction from the traditional model to the Dedicated Educational Unit (DEU).

OBJECTIVES

To evaluate the DEU learning atmosphere, instruction quality, clinical instructor's performance and students' grades.

METHODS

A sample of 45 nursing students completed the CLES-T; 10 of them participated in a focus group. Students' grades in the DEU and traditional models were compared.

RESULTS

Students (77.6%) ranked the DEU outcomes as "good"-"excellent;" "nursing care on the unit" and the "clinical faculty's ability to integrate theory and practice" were the highest and lowest ranked categories, respectively. The focus group revealed dichotomous opinions regarding the unit atmosphere and the professional performance of the nurse manager and staff. Students in the DEU framework attained higher grades than did their counterparts.

CONCLUSIONS

Clinical instructors need specific training; the clinical staff and nurse managers should be informed about the unit atmosphere's impact on students' future professional decisions.

Peer learning and collaborative placement models in health care: a systematic review and qualitative synthesis of the literature

AIMS

To summarise the international empirical literature to provide a comprehensive overview of peer learning and collaborative practice placement models in health care and to synthesise their benefits and challenges.

BACKGROUND

Practical placements for students are in high demand due to the need for an increased nursing, midwifery and health professional workforce, thus collaborative placement models are an attractive solution to potentially increase placement capacity and enhance the student learning experience.

DESIGN

A systematic search of the literature and qualitative data synthesis using the PRISMA checklist and ENTREQ guidelines.

REVIEW METHODS

MEDLINE and CINAHL searched in March 2020. Quality appraisal of studies conducted. Collaborative models and empirical findings summarised. Reported benefits, challenges and implementation recommendations synthesised. Two tables developed for data representation.

RESULTS

172 studies were identified by the search strategy. Of these, 47 articles were included for appraisal and synthesis. 30 articles employed qualitative, seven quantitative and ten mixed-methods approaches. Research took place in eight countries. The majority of studies employed focus groups, interviews as well as questionnaire design. The total participant sample was 3462 consisting of students and educators.

CONCLUSIONS

This review confirmed that any peer learning is beneficial in supporting students' confidence and team working skills. It is especially helpful when pairing first year with third-year students. The latter can demonstrate their clinical skills and prepare for working in practice. Simultaneously, expert-led learning is important for role modelling and for the recognition of acquired skills. Evidence on the optimal placement experience is inconclusive; however, it can be concluded that any form of collaborative placement model requires careful planning and continuous preparation for staff and students.

RELEVANCE TO CLINICAL PRACTICE

Decision makers should consider implementing at least some form of peer learning to assist students with peer support, and ideally work towards a collaborative learning environment.

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.

Dedicated education units: Redirecting for success

This process paper describes the evolution and growth of Dedicated Education Units through an academic-practice partnership at a college of nursing and urban medical center. This collaboration marked a period of rapid expansion from a single unit pilot dedicated education unit to five within a six-year timeframe. During the expansion from the pilot phase to creation of the dedicated units, it was determined that success in one unit did not translate to success in others. Using Tuckman's Group Development Theory as a lens for analysis of barriers and facilitators, suggested oversight and monitoring parameters were identified and include: (1) a dedicated clinical faculty coordinator is a necessity; (2) clearly defined dedicated education unit vision and goals need to be articulated to all; (3) a unit must commit to providing dedicated education unit clinical experiences only; (4) designated resources are needed for attending to staff and student scheduling requirements; (6) established and barrier-free clinical instructor educational support for nurse educator transition; (7) an objective evaluation plan with established benchmarks, (8) a need to evaluate the coordinator role as partnerships expand to multiple units, and (9) awareness of potential storming among new and experienced dedicated education units.

The effectiveness of partnership models in clinical nursing education - A scoping review

OBJECTIVES

To examine the effectiveness of partnership models in clinical nursing education with regards to cost effectiveness; student employability, work-readiness, confidence, and competence; and stakeholders' satisfaction.

DESIGN

Scoping review.

DATA SOURCES

Research studies published in English were searched electronically through EbscoHost (CINAHL and ERIC), Scopus, Medline (via Ovid), ProQuest Central, and Web of Science databases. Criteria were developed to guide the selection of original studies published in English before 2019 for review.

REVIEW METHODS

Arksey and Malley's framework (2005) and relevant enhancements guided the conduct of the review. An informal appraisal of selected studies was applied.

RESULTS

Two theses and 31 articles with a variation in methodologies, methods, sample sizes, research populations and quality of evidence were included for review. Four themes were identified: (i) Description of partnership models in clinical education, (ii) length of model implementation prior to evaluation, (iii) positive qualitative findings, and (iv) quantitative findings limited by data collection periods and methods.

CONCLUSIONS

Shared among the reviewed studies is stakeholder view of the positive impacts of partnership models on the clinical learning environment, and the increased level of support and individualised instruction for students. However, the use of not fully validated survey instruments and the lack of description about the implementation period before evaluation in many reviewed studies limit the interpretation of quantifiable effect of the partnership models. This review identifies a lack of attention on student employability, work-readiness, cost evaluation, patient perspective, and partnership models in low-income countries. Future research to address these knowledge gaps using high quality data collection methods and rigorous research design is warranted.

The Influence of the Dedicated Education Unit Clinical Model on Standardized Test Scores

ABSTRACT

While the dedicated education unit (DEU) clinical model is being increasingly integrated into prelicensure nursing programs, a lack of research investigating objective measures of this model is evident. Standardized test scores were compared between students who had a DEU experience and those completing the same rotation in a traditional model. Although no statistically significant differences were noted, some scores were higher for students in the DEU model. Findings suggest the DEU does not negatively impact scores, making it a valid alternative to the traditional model. Further research is needed as few studies have investigated objective outcomes for the DEU model.

Collaborative learning in practice: A systematic review and narrative synthesis of the research evidence in nurse education

Collaborative Learning in Practice is a model of placement learning for student nurses that is currently being implemented in the United Kingdom, apparently originating in Amsterdam. Potential benefits are reported to be increased placement capacity, reduced burdens on mentors as practice assessors, improvements in qualified nurses' job satisfaction, recruitment and retention, and better-developed preparedness for registrant practice amongst student nurses. We conducted a thorough, rigorous systematic review between October and December 2018 of the literature on Collaborative Learning in Practice to discover whether there was a research evidence base for these claims. We found nothing published in English in peer reviewed journals. We found 14 related papers, although these were about the Dedicated Education Unit concept, and we have conducted a narrative synthesis of them. Key findings support the assertions related to Collaborative Learning in Practice, albeit in different models of placement learning. Further research is necessary with Collaborative Learning in Practice stakeholders including staff and students, and regarding patient care metrics, to demonstrate benefits or otherwise and until that research takes place potential gains remain unproven.

Dedicated Education Units: A Unique Evaluation

Background

Traditional models of clinical nursing education do not deliver the most effective learning experiences to undergraduate nursing students. An innovative way to clinically prepare nursing students is the use of dedicated education units (DEUs). This model utilizes staff nurses to provide supervision and hands-on teaching to students.

Objective

The purpose of this project was to evaluate an evidence-based change from a traditional model of clinical instruction to a DEU.

Methods

DEUs were implemented on three adult medical–surgical units. Two unpaired identical pre-DEU and post-DEU questionnaires were used to evaluate the practice change in both nursing students and staff nurse mentors.

Results

A total of 41 students and 22 nurses participated in the project. Students reported feeling comfortable, engaged, and satisfied in their clinical experiences on the DEU. Nurses' responses revealed the DEU to be a rewarding experience and found satisfaction in their role.

Conclusions

The paradigm shift from traditional to DEU models has enhanced the quality of learning experiences for students and improved the professional environment for nurses at large academic medical institutions located in central Ohio.

Implications for Nursing

Implications for future inquiry include standardizing educational training/orientation programs for DEU staff nurse mentors.

Student and Preceptor Advancement in a Dedicated Education Site: Innovation in Clinical Education for Advanced Practice Nurses

In the 1990s, dedicated education units transformed undergraduate preceptorships, but graduate preceptorships remain static. The dyadic nurse practitioner preceptorship model supports an environment where faculty, students, and preceptors may overlook nuances that affect the teaching-learning process. This article describes an innovative clinical education model, Student and Preceptor Advancement in a Dedicated Education Site, designed to improve preceptorships for advanced practice nurses. The focus is on adaptations made to facilitate use in advanced practice nursing programs.

In pursuit of an optimal model of undergraduate nurse clinical education: An integrative review

Clinical learning experiences are an essential part of nurse education programs. Numerous approaches to clinical education and student supervision exist. The aim of this integrative review was to explore how studies have compared or contrasted different models of undergraduate nurse clinical education. A search of eight databases was undertaken to identify peer-reviewed literature published between 2006 and 2015. Eighteen studies met the inclusion criteria. A diverse range of methodologies and data collection methods were represented, which primarily explored student experiences or perceptions. The main models of undergraduate nurse clinical education identified were: traditional or clinical facilitator model; the preceptorship or mentoring model; and the collaborative education unit model in addition to several novel alternatives. Various limitations and strengths were identified for each model with no single optimal model evident. Thematic synthesis identified four common elements across the models: the centrality of relationships; the need for consistency and continuity; the potential for variety of models; and the viability/sustainability of the model. The results indicate that effective implementation and key elements within a model may be more important than the overarching concept of any given model. Further research is warranted to achieve an agreed taxonomy and relate model elements to professional competence.