Examining the role of the practitioner-teacher in nursing

Clinical education facilitators: a literature review

AIMS AND OBJECTIVES

The aim of this literature review, set within an Irish context, is to present a broad overview of former and existing clinical support personnel, explore the concept of facilitation and examine what is known about the role of the clinical education facilitator.

BACKGROUND

The importance of providing a supportive clinical environment to enhance clinical teaching and learning is strongly portrayed in the literature. While the past two decades have borne witness to various clinical support personnel, the literature identifies conflicting demands that these personnel face. No suggestions are advanced as to how to overcome these difficulties, which inevitably influence the quality and quantity of their clinical teaching role. An identifiable gap exists over who has prime responsibility for clinical teaching. It is timely that alternative possibilities for organizing clinical teaching are investigated. A new post emerging in practice settings is that of the clinical education facilitator who is meant to be the key linchpin in clinical areas for reducing the theory-practice gap.

METHOD

Relevant literature for this review was sourced using the computerized databases CINAHL, Medline and Synergy. Manual searching of relevant nursing journals and sourcing of secondary references extended the search. Government reports and other relevant documents were obtained through pertinent websites.

RESULTS

Papers that explicitly examined the concept of facilitation and explored the posts of clinical education facilitators were included; six research papers were accessed and reviewed. In addition seven non-empirical papers were included.

CONCLUSIONS

It is clear that considerable lack of role clarity resides over what constitutes clinical facilitation and the role of the clinical facilitator. Thus, it is paramount to strengthen this support role with Irish empirical evidence.

RELEVANCE TO CLINICAL PRACTICE

A major advantage in having a ward-based clinical education facilitator is the benefit of having access to someone who can concentrate solely on clinical education and support with attempts to narrow the theory-practice divide.

Value and vulnerability: reflections on joint appointments

For more than 20 years, joint appointments between nursing education and nursing service have been recommended as a strategy to foster excellence in nursing education and nursing practice, bridge the theory-practice gap, and promote clinically relevant research. This article discusses the termination of a joint-appointment initiative after research that had demonstrated its success in terms of benefits to both agencies and satisfaction for the incumbents in the positions. It presents the value and vulnerability of joint academic-clinical agency joint appointments based on critical analysis of the academic literature juxtaposed with our research and subsequent experience with four joint appointments between a faculty of nursing and a home-care agency. Top-level administrative support and understanding of the potential of such positions are crucial for the nurses involved, and the positions themselves become vulnerable in times of change and fiscal restraint.

Joint appointments: another dimension to building bridges

For many years nurse education has been under close scrutiny, with particular focus on the links between what is taught in the classroom and what is practised. Since the onset of the United Kingdom Central Council for Nursing and Midwifery's Project 2000: A new preparation for practice, concerns have been raised over the potential for an even greater gap between theory and practice. Within this concept, the development of joint appointments between education and service providers has been an issue of much debate within the nursing profession in recent years. This paper explores the complexity of the role and shares the writer's personal experiences as a joint appointee between University College Worcester and Worcester Royal Infirmary NHS Trust. The issues discussed demonstrate how by supporting nurses in their development of practice, research, policy and teaching, joint appointments can contribute directly and indirectly to providing a first class nursing service for patients.

The roles of Australian chairs in clinical nursing

Australian chairs in clinical nursing have been established in order to achieve more effective partnerships between academia and the health care sector in education, research and quality of nursing care. The aim of this study was to describe the goals, obstacles, supports and outcomes of such appointments. The study explored the perceptions of a purposive sample of Australian professors holding clinical chairs, stratified to ensure representation of both the geographical and clinical specialty diversity of the population. Eight professors were interviewed using semi-structured telephone interviews. The interviews covered three phases: role establishment, current foci and future developments. Qualitative analysis for common themes and areas of divergence was conducted with concurrent analysis providing the opportunity to seek confirmation for emerging themes. The participants highlighted the diversity of arrangements between university and health sector partners in establishing their respective roles. Clear communication was crucial to successful partnership arrangements. All roles included components of education, research and politics but the relative contribution of each of these areas depended to a large extent on the priorities of the employing partners. The participants felt the need to secure sustainable income sources and consolidate outcomes to ensure the continued viability of their positions. Clinical professorial nursing appointments provide one means of addressing perceived gaps in the links between the university and health care sectors, academia and clinicians, thus enhancing nursing education, research and politics. Through emphasizing common purpose and mutual respect, these positions can illuminate the crucial role nursing plays in Australian health care delivery.

Learning on clinical placement: the experience of six Australian student nurses

Concerns about the adequacy of clinical education in nursing courses in Australia have escalated since the transfer of pre-registration nursing education into the tertiary sector. This descriptive, interpretative study, informed by the tradition of critical social science, sought to understand the clinical learning experiences of undergraduate nursing students. At the same time, it fostered an active participation of students in their own learning. Daily post-clinical conferences with the students were taped and transcribed verbatim to provide data for the study. Additional data was collected from informal discussions and observations of the students during the placement. Analysis revealed three main categories, which reflected the students' experiences. These included: (1) I don't belong; (2) doing and practising: progress at last; and (3) transitions in thinking. Feeling part of the team was closely linked to the opportunity to learn, emphasizing the important role not only of educators but also clinicians in undergraduate learning on clinical placement. Though the findings reflect age-long problems associated with student learning in the clinical field, it serves to remind all nurses of the importance they play in the learning process. This study reflects the importance of effective communication between the health and education sectors and the need to concentrate on strategies which will strengthen this bond.

Lecturer practitioner: a concept analysis

The concept of the lecturer practitioner arose in one health authority in Britain in the late 1980s. Since its inception there, the concept has been widely adopted across the country suggesting that there is a perceived need for this role. However, there is much confusion over what a lecturer practitioner is, since each post is multifaceted, complex and unique. Rodgers' (1993) evolutionary concept analysis is used in an attempt to clarify and to identify those elements that are common to this concept. Through a review of all the available literature on this concept, the attributes, antecedents and consequences are identified and their implications discussed. Rodgers' evolutionary method is described and critiqued throughout the paper and is shown to be a suitable method for clarifying a complex concept.

Lecturer practitioners: a literature review

Much of the existing literature on lecturer practitioners to date is comprised of the perspectives of individuals within the role and how they function in their specific setting. It is surprisingly difficult from this work, however, to define the role of lecturer practitioner. The authors were commissioned by a regional health authority to undertake a study of lecturer practitioners within that region. In the process of undertaking this study, a literature review was carried out. Whilst the authors found an abundance of literature surrounding the theory and practice gap, and the development of the lecturer practitioner role as one possible solution, they were not able to find a comprehensive review of the multifaceted aspects of the lecturer practitioner role. This paper is an attempt to provide such a review, and will address the following aspects: the need for lecturer practitioners; their origin within nursing and midwifery education; the development of the lecturer practitioner role; the debate surrounding academic and clinical credibility; and finally, the current situation for lecturer practitioners.

Seeking balance to dialectic tensions in teaching through philosophic inquiry

PURPOSE

To propose a plausible means of cultural criticism of nursing's educational environment for preparing new nurses by exploring epistemological tensions and their consequences from the perspective of educators.

DESIGN

Naturalistic, qualitative, philosophic.

METHOD

Six nurse educators teaching in a university-based traditional BSN program were interviewed in one southeastern state of the United States about their experience as creative, innovative teachers during 1991.

FINDINGS

Three major themes were reflections of the positivist work culture of teaching, reconciliation of tensions, and repercussions from personal choices. Educators reconcile dialectic tension by suppression, subordination, or equilibrium and are influenced by their sense of tension and willingness to be risk takers.

CONCLUSIONS

Philosophical conflicts are inherent in nursing when commitments to empirical knowledge and personal meaning are both valued. A plausible means for moving beyond this tension is to increase awareness of the dynamics and consequences that occur when perspectives seem contradictory. Schools of nursing socialize future nurses. Calling into question the context in which the professional nursing culture is transmitted and reproduced is necessary if nurses of the future are to be in the forefront of changing health care.