Preparing nursing students to be community health practitioners

Clinical placement models for undergraduate health professions students: a scoping review

BACKGROUND

Clinical learning is fundamental to undergraduate health professions students. There are several calls for the transformation of health professions education, which have direct implications on clinical learning. Clinical placement models provide structure to clinical learning. Therefore, this scoping review could contribute to supporting curriculum transformation to enhance learning in the clinical environments for undergraduate health professions students.

OBJECTIVES

This scoping review identified the characteristics of research evidence related to mapping the purpose, methodologies used, outcomes, and specific recommendations associated with clinical placement models in undergraduate health professions education.

DESIGN

A scoping review method was used in this study. A search string developed from the title of the review was used to search online databases to identify research published between January 2000 and March 2020.

RESULTS

Forty-eight articles reporting on ten clinical placement models were included in this review. The majority of these articles originated from Australia and predominantly report on nursing. The aims of these articles aligned with the evaluation of the implementation of a clinical placement model. Seven categories of outcomes of the clinical placement models are reported namely, relationships, influence, environment, facilitation, inputs, knowledge scores, and student perceptions.

CONCLUSIONS

As clinical learning is fundamental to undergraduate health professions education, clinical placement models should prioritise the development of competence among undergraduate students. Insights into outcomes reported in literature could guide educators in fostering optimal learning in students who may then be able to influence community health outcomes positively.

New nurses and community maternal care education: A qualitative study

There is ongoing focus in Indonesia to lower the maternal mortality rate. One strategy has been increasing numbers of health care practitioners, including nurses, in the community. While much is known about transition experiences of new registered nurses, little is known about the adequacy of educational preparation of new nurses in Indonesia to provide maternal care in community settings. This qualitative descriptive study explored new diploma prepared nurses' perceptions of their educational preparation for providing community maternal care. Semi-structured interviews were conducted with five new nurses working in community health care centres in Gowa District, South Sulawesi, Indonesia. Thematic analysis was used to analyse data. Three key themes emerged: Practice context, Professional role delineation, and Education programs. Nurses reported encountering a range of aspects of maternal care, and community expectations of their skills and knowledge. These were particularly necessary in rural areas. Educational preparation was found to be insufficient for the activities that graduates were engaged in. There is a need for more research into maternal care content in undergraduate nursing programs in Indonesia to ensure optimal maternal care in community settings.

Potential and challenges for learning during acute medical/surgical placement for intellectual disability, mental health and midwifery students

In Ireland nursing and midwifery degree programmes involve four pathways to registration. Three of which, intellectual disability and mental health nursing and midwifery require students to undertake acute medical/surgical placements offering learning opportunities caring for patients with complex needs in settings beyond their core discipline. This paper focuses on findings from a descriptive qualitative study exploring intellectual disability and mental health nursing and midwifery students experiences of such placements. Data analysis identified three themes: Getting ready, Navigating the way and Getting through. Feelings of stress and uncertainty are described by participants when moving from familiarity within a chosen discipline to an unfamiliar environment. Findings have influenced specific placement structures with local health service partners. While our study focuses on an Irish context, findings have relevance for student education in other jurisdictions. Enhancing preparation and support for students undertaking unfamiliar placements needs to be a constant endeavour. Such foundations will foster valuable experiences where students can feel part of a team, gain confidence, enhance skills and transfer meaningful learning to their core practice discipline. Further research is needed to explore the views of preceptors, ward managers and Clinical Placement Coordinators.

Enhancing undergraduate community placements: a critical review of current literature

In the face of the UK-wide policy shift to increased home care, inspiring and enabling the next generation of community nurses is more urgent than ever. The quality of the pre-registration practice learning experience is highly influential on career choices at the point of qualification. Given that 50% of learning by pre-registration students takes place in practice, mentors have a crucial role to play in preparing the next generation of nurses to work in the community. This article discusses the findings of a systematic and critical literature review of pre-registration placements that was funded by the Queen's Nursing Institute Scotland. The review found that students' experiences of learning in community settings are variable, and perceptions of students and mentors are misaligned in terms of what a quality placement should look like. Although there is no clear definition of what constitutes a community placement and there is some underuse of learning environments in areas such as general practice nursing, there are also a number of examples of new and imaginative placements. While these innovations provide 'whole experience' placements, they are currently lacking robust evaluation, despite their potential usefulness on a larger scale. Mentors have the opportunity to provide students with a range of learning opportunities that increase preparedness for working in the community, allowing final year students in particular greater influence over their learning experience. Students undertaking community practice learning, where they have a managed level of autonomy, are more likely to feel confident to take on community nursing roles.

Helping community-based students on a final consolidation placement make the transition to registered practice

The pressure of role transition on new nurse registrants has affected recruitment and retention, which, along with an ageing workforce, has resulted in a global shortage of nurses that is now reaching crisis point. This article examines and discusses what can be done to attract and prepare the future workforce in the community, focusing on helping students to make the transition to registered practice that begins during their final consolidation of practice placement. There is currently limited evidence on the effectiveness of how community placement teams prepare finalist students for registered practice and this could be seen as an opportunity lost given the urgent need to recruit more registered nurses to work in primary care. Recommendations for enhancing this crucial stage of the student journey are made, and a case for the need to know more from students about how they experience their final practice placement when allocated to a community setting is presented.

The role of the sign-off mentor in the community setting

In an move to identify nursing as an all-graduate profession, the Nursi Midwifery Council standards identified that future nurses need to be equipped with the skills and knowledge to lead and deliver high-quality care. Inorder to have these skills within the changing context of health care, students need to experience care delivery across a range of community, hospital and other settings. Students have to undertake a final clinical placement of 12 weeks at the end of their programme, commonly called a consolidation placement, and are allocated a sign-off mentor to confirm they meet the requirements for entry to the register. Placement capacity within primary care settings continues to be a challenge alongside the need for providing a sign-off mentor. This article discusses some of the challenges and opportunities of the role of the sign-off mentor and the potential impact for encouraging newly qualified recruitment in this area.