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

Clinical learning experiences of healthcare professional students in a student-led clinical learning environment (SLCLE) - A mixed methods evaluation

AIM

To evaluate healthcare professional (HCP) students clinical learning experiences' whilst undertaking placements in a student-led clinical learning environment (SLCLE) and any changes in self-reported ratings of confidence.

BACKGROUND

The English NHS Long Term Workforce Plan (2023) highlights the need to expand domestic education of HCPs to meet workforce shortages. The demand for quality clinical placements to support the preparation of HCP students remains a challenge globally. A creative solution has been the development of student-led learning clinical environments in healthcare settings. SLCLEs provide high-quality learning experience, increase clinical placement capacity whilst maintaining patient care standards. A multisite NHS Trust adopted this model as evidence suggests HCP students will be better prepared on qualification to adopt registered practitioner professional responsibilities. This model has been integrated across three hospital sites within a large teaching hospital, providing care for a diverse population and designed to accommodate students from a range of HCP disciplines and higher educational institutions.

DESIGN

A mixed methods convergent design.

METHODS

An online survey was administered to SLCLE allocated nursing and allied health profession (AHP) undergraduate and graduate-entry first, second and third-year students (n=132). Face to face focus groups/individual interviews were undertaken with a purposive sample of student participants (n=80) to evaluate their experiences of clinical learning in SLCLEs. Survey data were analysed using descriptive statistics and paired t-tests, interviews using framework method.

RESULTS

Undergraduate and graduate-entry students from four UK universities completed the survey (n=132), 103 students (78 %) responded. Most were year 2 students (n=43/42 %), pursuing nursing programmes (n=82/80 %). Most considered the SLCLE met their expectations (n=76/74 %), reported increased confidence post-placement (n=84/82 %), felt supported by staff (n=80/78 %), peers (n=93/90 %) and clinical educators (n=93/90 %). Self-reported confidence scores post-SLCLE were significantly higher than pre-SLCLE. On-line pre-placement information was infrequently accessed yet identified as an omission. Four themes were identified: (i) preconceptions and initial anxiety; (ii) empowerment, growth and a unique learning experience; (iii) collaborative inter-professional learning and support; and (iv) insights and anticipations.

CONCLUSIONS

The SLCLE allocation enhanced students' confidence and knowledge. Support from clinical educators, ward staff and doctors was perceived as invaluable for creating a positive learning culture. Peer support and opportunities to lead care delivery contributed to students' professional development. The format and method for providing pre-placement information needs review as do strategies for avoiding delays in completing assessment documentation. Overall, the SLCLE experience offers much potential as a nurturing and effective learning environment for HCP students.

Research in action-developing and evaluating a student research placement experience

BACKGROUND

Evidence based practice is essential in the provision of high-quality contemporary nursing practice. Yet nursing students often lack an understanding of the research process because applied research experience is rarely facilitated in undergraduate nursing programmes. Students research knowledge is mostly gained via classroom based theoretical teaching; however, it is a challenging subject to teach and is often evaluated poorly by students who find the subject uninteresting and difficult to apply to their clinical practice.

AIM

The aim of the study was to explore the experiences of student nurses after undertaking a nurse led primary research study placement.

METHODS

The study explores the students' experiences of a research placement using a phenomenological approach with the data collection method of drawings and narration which were then subject to Interpretive Phenomenological Analysis as a data analysis method.

SETTINGS

This study was undertaken with 18 nursing students who were enrolled in a United Kingdom university, who had recently participated in a nurse-led research study exploring the use of sensors to detect atrial fibrillation in members of the public in a supermarket.

RESULTS

The following themes were developed by the researchers: Practice makes perfect, Enhancing communication, Research attitude, Making a difference, Increased confidence, Enhanced skills, Researcher collaborations, The views of others.

CONCLUSIONS

Students valued the research placement; the experience provided insight into the conduct of research in primary health and allowed students to learn about research in an experiential way which proved to be more effective than usual classroom methods. Students' communication skills were enhanced, through interacting with the public in a different way, who were keen to engage with them because of their student status.

Clinical learning opportunity in public academic hospitals: A concept analysis

BACKGROUND

Clinical learning opportunities (CLO) are vital educational encounters occurring in various clinical areas to provide the student nurses with clinical knowledge and experiences to develop their competencies for professional practice. However, CLO is a broad concept with varied characteristics that allow ambiguity, limiting its understanding and use. Its ambiguous nature leads to uncertainties and poor development of the required clinical attributes of successful theory to practice integration, higher-order thinking skills (HOTS) and clinical competencies.

AIM

The aim of the study was to explore and describe the conceptual meaning of CLO, have a clear understanding and insight into the concept and identify the antecedents and consequences for pragmatic purposes.

SETTING

The study took place in a public academic hospital in Gauteng.

METHODS

The eight steps of concept analysis by Walker and Avant were followed. Multiple data sources not limited to nursing were explored and critically analysed for the definitions, characteristics, nature and uses of CLO from different fields of study.

RESULTS

The defining attributes of CLO were identified, namely the context, antecedents, processes, consequences and outcomes. The context within which CLO occurs was dynamic, multidimensional, real-life healthcare settings; antecedents included planning of clinical placement, provision of learning outcomes and consideration of the cognitive level of the students. Engagement and active participation in collaborative, problem-based learning activities, community-based research and the use of emerging technologies were the processes identified. The outcomes were autonomous, confident, competent professional nurses with critical thinking, clinical reasoning, judgement, critical decision making and problem-solving skills.

CONCLUSION

A theoretical and operational definition of CLO was developed. The findings and results of concept analysis identified and specified the defining attributes of clinical learning opportunity. The findings can assist nurse educators, Clinical Education and Teaching Unit (CETU) personnel and operational managers to enhance CLO for student nurses to achieve their clinical learning goals and outcomes. The evaluation tools that may be adopted to assess the acquired clinical skills were also identified.

CONTRIBUTION

An increase in the existing body of knowledge in nursing education, considering that enhancing the CLO exposes students to various clinical experiences contributing to their development of clinical competencies to solve complex problems. The strategies to enhance the CLO will be developed, which may also provide vital information for policy development. Conceptualisation of the findings to nursing practice and quality patient care will be integrated into relevant literature.

The experience of baccalaureate clinical nursing faculty transitioning to emergency remote clinical teaching during the COVID-19 pandemic: Lessons for the future

BACKGROUND

Experiential clinical learning in undergraduate nursing education allows for fusion of nursing knowledge with practice to ensure the development of competent graduate nurses. The global COVID-19 pandemic necessitated an abrupt transition from in-person clinical educational experiences to emergency remote clinical teaching.

OBJECTIVES

The purpose of this study was to describe the experiences of baccalaureate nursing clinical faculty who transitioned from in-person clinical to emergency remote clinical teaching during the COVID-19 pandemic in spring 2020.

DESIGN

A qualitative descriptive design was used.

SETTING

The study took place in the United States.

PARTICIPANTS

Nineteen baccalaureate nursing clinical faculty participated in the study.

METHODS

Participants engaged in semi-structured, in-depth, online interviews.

RESULTS

Five themes emerged from the data: transition, collaboration and support, the joy of teaching, authentic professional experience, and the overarching primary theme, stress of the moment.

CONCLUSIONS

The transition to emergency remote clinical teaching during the COVID-19 pandemic caused stress and anxiety. However, there were important lessons learned about how to best support students and faculty while providing a robust online learning experience. Understanding the experiences of clinical nursing faculty during this abrupt transition can support recommendations for best practices in the future.