Evaluating Clinical Placement Performance in Allied Health Student-Led Healthcare Services: A Modified Delphi Study

BackgroundUniversity-affiliated student-led health care services have emerged in response to the challenges faced by universities in securing quality clinical placements for health care students. Evidence of the health care benefits and challenges of student-led health care services is growing, while evidence of clinical placement performance remains variable and not generalizable. Though there have been previous attempts to develop a framework for evaluation of clinical placement performance, concerns have been raised about the applicability of these frameworks across the various placement settings. Additionally, the perspectives of all key stakeholders on the critical areas of clinical placement performance have yet to be considered.ObjectiveThis study’s objective is to gather information on areas of measurement related to student learning outcomes, experience of placement, and costs of placement and then develop consensus on which of those areas need to be included in a framework for evaluation of clinical placement performance within the context of student-led health care services. The aim of this paper is to outline a protocol for a modified Delphi study designed to gain consensus on what is important to measure when evaluating an allied health clinical placement.MethodsWe will recruit up to 30 experts to a heterogeneous expert panel in a modified Delphi study. Experts will consist of those with firsthand experience either coordinating, supervising, or undertaking clinical placement. Purposive sampling will be used to ensure maximum variation in expert panel member characteristics. Experts’ opinions will be sought on measuring student learning outcomes, student experience, and cost of clinical placement, and other areas of clinical placement performance that are considered important. Three rounds will be conducted to establish consensus on what is important to measure when evaluating clinical placement. Each round is anticipated to yield both quantitative data (eg, percentage of agreement) and qualitative data (eg, free-text responses). In each round, quantitative data will be analyzed descriptively and used to determine consensus, which will be defined as ≥70% agreement. Qualitative responses will be analyzed thematically and used to inform the subsequent round. Findings of each round will be presented, both consensus data and qualitative responses in each subsequent round, to inform expert panel members and to elicit further rankings on areas of measurement yet to achieve consensus.ResultsData analysis is currently underway, with a planned publication in 2024.ConclusionsThe modified Delphi approach, supported by existing research and its ability to gain consensus through multiround expert engagement, provides an appropriate methodology to inform the development of a framework for the evaluation of clinical placement performance in allied health service.International Registered Report Identifier (IRRID)DERR1-10.2196/44020

Purpose: This study investigated factors that influence psychiatric clinical learning for diploma nursing students in western Kenya.
 Methodology: Cross-sectional research design was used with both qualitative and quantitative approaches in data collection. Study participants consisted of diploma nursing students on psychiatric clinical placement. Ten institutions that place their students at Kakamega County Referral Hospital for psychiatric experience were sampled. A total of 178 students, 10 lecturers and 3 psychiatric nurses participated in the study. Qualitative data was collected using interview guides; while quantitative data was collected using structured questionnaires. Descriptive statistics were used to analyse quantitative data while qualitative data was analysed thematically. The relationship between variables was set at a statistical significance of p-value < 0.05. Quantitative data was coded and entered the Statistical Package for Social Sciences version 25.0. Continuous variables were summarized using the Odds Ratio to measure the association between variables and presented in tables and figures to provide a pictorial description of the sample.
 Findings: The results showed that most students were theoretically prepared to participate in psychiatric clinical learning (67.8% - OR: 1.4: 95% p=0.3). Also, it was supported by the students having a positive attitude (66.1% - OR: 1.2; p=0.5) and being motivated (64.5% - OR: 1.5; p=0.2) towards clinical placement. However, according to key informants’ findings, most students were not well prepared in practical skills for clinical placement at the psychiatric unit, which was due to inadequate or lack of simulative laboratory for practice at the college level. Nursing students were well prepared theoretically to engage in psychiatric clinical learning placement at Kakamega County Referral Hospital. It also, established that positive attitude and motivation from the nursing students towards clinical placement at the psychiatric unit promoted clinical learning experience and performance thereafter. However, most of the psychiatric nursing students were not well prepared with practical skills to handle mentally-ill patients
 Conclusion: This study revealed that Kenya Registered Community Health Nurse diploma students were well prepared theoretically to engage in psychiatric clinical learning placement.
 Recommendation: Medical colleges in Kenya should emphasise skill-based training on human anatomy and behaviour through simulation. Trainers should be required to lead the nursing students through skill-based training. Medical college management should make available practical based resources to trainers and students to promote a skill-based learning approach.
 Unique contribution to theory, practice and policy Practical skills should be given priority at the college level when preparing students for clinical placement for a holistic clinical learning experience. Positive attitude and motivation from the nursing students towards clinical placement at the psychiatric unit promoted clinical learning experience and performance thereafter.

The variables that contribute to positive and negative experiences of clinical education amongst student physiotherapists are well established. Multiple stakeholders are invested in the ongoing success of physiotherapy clinical placements given workforce challenges within the profession and the emerging relationship between clinical placements and new-graduate recruitment. However, little is known about the relationship between clinical placement experiences and the career decisions of new-graduate physiotherapists. To explore the influence of clinical placement experiences on new-graduate physiotherapists' career intentions and decision making. A qualitative study which used a general inductive approach. New-graduate physiotherapists (n = 18) were recruited through a snowball sampling approach and participated in semi-structured interviews. Ethical approval was obtained from The University of Queensland. Four overarching themes were generated; (1) clinical placements impact career decisions, (2) placements as a trial for future employment to identify professional preferences, (3) feeling valued as a team member, and (4) clinical educators' shape placement experiences. Clinical placements play a significant role in directing new-graduate physiotherapists' careers, with clinical placement viewed as an opportunity to explore one's career options. A complex interplay of clinical and nonclinical variables was acknowledged by new-graduates, with positive experiences during clinical placements considered to increase new-graduate physiotherapist intentions to work in similar settings or contexts. Factors that contributed to positive experiences included accessible mentorship from clinical educators with regular feedback, and opportunities for the students' contribution and clinical capacity to be acknowledged and valued. Recommendations are made for creating supportive workplace environments for clinical education and include prioritizing supportive mentorship. Clinical placement providers intending to recruit new-graduates who have attended their workplace as students may benefit from implementing strategies that assist students to feel supported as valued members of the team. Additionally, the findings of this study may guide education providers when considering the training delivered to new and existing clinical placement sites with the aim of providing supported student learning environments.

A first clinical placement for nursing students is a challenging period involving translation of theoretical knowledge and development of an identity within the healthcare setting; it is often a time of emotional vulnerability. It can be a pivotal moment for ambivalent nursing students to decide whether to continue their professional training. To date, student expectations prior to their first clinical placement have been explored in advance of the experience or gathered following the placement experience. However, there is a significant gap in understanding how nursing students' perspectives about their first clinical placement might change or remain consistent following their placement experiences. Thus, the study aimed to explore first-year nursing students' emotional responses towards and perceptions of their preparedness for their first clinical placement and to examine whether initial perceptions remain consistent or change during the placement experience. The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews (n = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing students. Data were analysed thematically. Three main themes emerged: (1) adjusting and managing a raft of feelings, encapsulating participants' feelings about learning in a new environment and progressing from academia to clinical practice; (2) sinking or swimming, comprising students' expectations before their first clinical placement and how these perceptions are altered through their clinical placement experience; and (3) navigating placement, describing relationships between healthcare staff, patients, and peers. This unique study of first-year postgraduate entry-to-practice nursing students' perspectives of their first clinical placement adds to the extant knowledge. By examining student experience prior to and during their first clinical placement experience, it is possible to explore the consistency and change in students' narratives over the course of an impactful experience. Researching the narratives of nursing students embarking on their first clinical placement provides tertiary education institutions with insights into preparing students for this critical experience.

Objective: The aims of this study are to assess nursing student satisfaction with their Northern Territory clinical placement; describe the characteristics of these students; and examine the relationship between student placements and future rural/remote work intentions. Background: Positive clinical placement experiences in a rural or remote setting can encourage student nurses to consider working in rural and remote locations after graduation. Study design and methods: The study is a cross-sectional survey of nursing students, and a review of placement data. Participants were studying a pre-registration Bachelor of Nursing course from a variety of Australian universities who undertook a clinical placement of usually four or more weeks in the Northern Territory from 2017-2019. The main outcome measures are overall satisfaction with their placement, and consideration of living and working in a rural or remote location after graduating. Logistic regression analyses examined the relationship between student placements and future rural or remote work intentions. Results: One hundred and sixty three undergraduate nursing students responded to the online survey. The majority (70%) of placements were undertaken in remote or very remote (18%) locations. Satisfaction with the placement was very high (94%), and 88% agreed/strongly agreed that the placement had encouraged them to consider working in a rural or remote setting. Satisfaction with educational resources and prior interest in working remotely were associated with overall placement satisfaction (p<0.10). Overall satisfaction with the placement and prior consideration of working regionally, rurally, or remotely were significantly associated with feeling encouraged to consider working rurally or remotely (p<0.05). Conclusion: This study supported the logical pathway of providing a satisfying clinical nursing placement in the Northern Territory to contribute to a higher likelihood of the student considering working in a remote or rural setting after graduation. Providing satisfying remote clinical placements is a strategy for growing a nursing workforce for remote and rural settings. Implications for research, policy and practice: Ongoing investment in remote clinical nursing placements is needed to ensure nursing students are satisfied with their placement. In particular, the educational resources and support during the placement need to be of high quality. Actively recruiting students who had a prior interest in working in a regional, rural or remote setting will likely lead to high satisfaction with the placement and contribute to an interest in working in a rural or remote setting post-graduation. What is already known about this topic? Recruitment of student nurses and preparation for working in the rural and remote sector are important for improving population healthcare outcomes for populations who live there. Previous studies of nursing, allied health and medical students indicate that exposure to positive placement experiences in regional, rural or remote locations increases the likelihood of students returning to those locations after completing their study. What this paper adds Data from this study come predominately from remote clinical placements. Satisfaction with clinical placements in remote locations in the Northern Territory of Australia, and prior interest in working remotely, are associated with considering working in a regional, rural or remote location. Satisfaction with educational resources is associated with overall placement satisfaction.

Clinical placements are integral to any health professional education program, allowing students to integrate theoretical knowledge and skills acquired in campus-based learning into authentic, real-world healthcare settings. Limited empirical knowledge exists about the determinants of clinical performance. Contemporary thought is that clinical performance is determined by multiple cognitive, environmental, psychological and social factors. Accordingly, we examined which individual differences and self-regulatory factors are credible determinants of undergraduate physiotherapy student performance within clinical placements. Utilising a measurement burst design, we captured weekly self-reported survey data amongst two cohorts (2019 and 2020) of final year, undergraduate students as they progressed through four 5-week physiotherapy clinical placements. In total, 97 of the 181 consenting students met the data inclusion criteria by completing more than three surveys in a minimum of two clinical placements. For these students, we collated their clinical placement results and utilised multilevel structural equation modelling to examine intra-individual dynamics of diverse psychosocial factors and their association with clinical performance data. Study findings supported stable individual differences, contextual experiences, and self-regulatory factors as meaningful determinants of physiotherapy entry-level performance. Knowledge of salient psychosocial determinants associated with clinical performance can inform curriculum design. Doing so includes practical strategies for early identification of students who may struggle in clinical placement settings, and ways to foster salient student skills and abilities before and during placements to optimise clinical placement performance outcomes.

P32 - An Interprofessional approach to clinical facilitation of midwifery and medical students in the Birth Suite

ObjectiveClinical placement is an essential aspect of student training in professional postgraduate psychology. However, students can be exposed to risk during clinical placement. Further, anecdotal evidence suggests that barriers may hinder formal reporting of adverse events occurring during placement. The objective of this study was to investigate the incidence and nature of psychology students' exposure to risk during clinical placement. This study also sought to explore key stakeholders' perceptions of risks to students engaging in placement.MethodA sequential explanatory mixed‐method design was utilised. The quantitative element of the study involved a questionnaire capturing the experiences of 70 students currently undertaking clinical psychology placement in healthcare services within Australia. This was followed by qualitative semi‐structured interviews with 10 industry‐based stakeholders associated with clinical placements across seven Australian universities.ResultsPreliminary evidence indicates that psychology students can experience adverse events while on clinical placement, and that industry‐based stakeholders can also encounter professional risk resulting from student contact. Low uptake of formal incident reports among students was demonstrated. The quality of risk‐related training was shown to vary across the industry, indicating a need for streamlined training approaches to risk management. Finally, strategies to support students and supervisors were raised.ConclusionsNovice students may be inadequately prepared for the risks arising in unpredictable clinical placement milieu. They may also be unaware of their rights and avenues for reporting. Further support and resources designed to equip health services and universities for student exposure to risk during placement is warranted.

Clinical experience is recognised as the core of nursing education. Quality clinical placements across a variety of venues are vital to the development of capable and competent professionals. However there is evidence, both anecdotal and empirical, suggesting that students’ clinical placement experiences are fraught with problems. The quality improvement project described in this paper aimed to improve the clinical learning experience of nursing students by strengthening communication and partnerships between the university and the two local health services. To achieve this goal, clinicians’ perceptions of the problems related to clinical placements and their recommendations for improvement were explored. Focus groups, brainstorming sessions, personal interviews and surveys were used to collect qualitative and quantitative data. Problems and priority issues were identified as more than five hundred clinicians expressed their concerns, claims and issues.Key findings from the project are described under five themes: communication breakdown between the university and clinicians; mentorship; preparation for clinical placements; clinical competence; and graduates’ readiness for practice.Utilising a quality improvement framework this project promoted vigorous debate and dialogue between university and health service partners. The nature and extent of the problems surrounding clinical placements were examined, high priority issues targeted for improvement, and the subsequent results measured through feedback from clinicians and students. The success of this project, although impressive in the early stages, will depend upon ongoing communication and evaluation to ensure sustainability of the improvements made.

To explore the perceptions of nursing students regarding the treatment of men in nursing during their clinical placement. Negative placement experiences of men who are nursing students is a risk factor for student attrition. Hence, exploring gender disparity in treatment during placement from both men and women studying nursing will contribute to improving student experience and reducing attrition. Survey capturing both quantitative and qualitative data. Nursing students were surveyed between July and September 2021 across 16 Schools of Nursing in Australia. In addition to the Clinical Learning Environment Inventory (CLEI-19), an open-ended question explored if men received different treatment during clinical placement. Those who expressed difference in treatment of men were less satisfied with their clinical learning experience (p < .001). Of the 486 (39.6%) who responded to the open-ended question, 152 (31%) indicated a difference in the treatment of men, reporting that men received: (a) better (39%); (b) different, not exclusively better or worse (19%); and (c) worse (42%) treatment from either the clinical facilitator or ward staff. While both men and women perceived gender differences in the treatment of men during placement, men were more likely to report worse treatment. Despite the advances achieved in recruiting men in nursing, negative experiences during clinical placement are characterised by stereotypes, prejudice and discrimination, adversely impact retention. Nurse educators need to recognise specific support students require during placement regardless of gender. Our findings reinforce the adverse impacts of inequitable treatment on both men and women nursing students on learning, clinical performance, morale and ultimately on retention in the nursing workforce. Addressing gender stereotyping and discrimination in the undergraduate nursing program is an important step in promoting diversity and inclusivity in the nursing workforce.

The role of technology in assessment, documentation, and tracking of clinical competencies in radiography education

IntroductionAlthough clinical nursing placement is an indispensable component of student nurses' education, data on students' first clinical experiences is scarce in developing countries.ObjectivesThe study aim is to uncover nursing students' first-time clinical placement experience and identify related influencing factors in Jordan.Methods: Focus group discussions (n=4) were used.ResultsThe results showed that the transition from learning with mannequins to practicing on real patients in the clinical placement involved both effective learnings through hands-on practice to dealing with clinical challenges. Students perception of nursing ranged from positive comments such as “humanistic” and “nursing almost medicine” to negative images such as “nursing is all about bedside care” and “nursing has poor social status.”ConclusionStudents' experience in their first clinical placement is multifaceted, and incorporation of student's perspective in the first clinical placement is a crucial component of educational planning.

Objective: To present and discuss options for upskilling registered nurse supervisors to ultimately improve the quality and consistency of nursing student placements. Background: Many studies have examined clinical learning in nursing, with evidence that student learning and registered nurse clinical supervision experiences can be improved. An independent review of nursing education in Australia confirmed gaps in the preparation and support of supervising registered nurses that may negatively impact students’ learning. Study design and methods: This paper discusses contemporary insights around 1) the current situation in Australian nursing student clinical placements regarding learning, 2) registered nurse clinical supervisor experiences and 3) professional options for recognising role excellence, offered by Australian and international nursing and healthcare specialities. Discussion: Nursing students’ placement experiences are at times sub-optimal. One way to improve learning experiences could be to offer clinical supervisors professional development programs. Now is the time to consider a certification process to recognise excellence in registered nurses’ education capabilities and to better support students’ clinical learning. Conclusion: Upskilling registered nurses for clinical supervision may be assisted through formal and informal education programs specific to the professional nursing context in Australia. Implications for research policy and practice: Upskilling registered nurse clinical supervisors should be a priority on the national agenda of improving students’ clinical learning experiences. This commentary provides contemporary insights to the current situation regarding Australian students’ clinical placement and supervisor experiences. The ways that some nursing specialities recognise excellence in practice are discussed as options for improving clinical supervision. What is already known about the topic? Nursing students’ clinical placements need improvement; students continue to report less than optimal experiences. There are no requirements in Australia for registered nurse clinical supervisors to undertake assessment of capability for the role. National and international processes exist to recognise supervisor capabilities and role excellence. What this paper adds: Options for recognising capability and practice excellence in nursing clinical supervision. A discussion around clinical supervisors engaging with formal and informal education and processes that recognise excellence in role capabilities.

ABSTRACTAustralia is currently experiencing a nursing shortage, and the speciality of mental health has been particularly hard hit as it is plagued by student disinterest and difficulty recruiting and retaining nurses. There is also evidence to suggest that when students are on their mental health nursing placement, they experience a lack of learning opportunity, incivility, bullying and are often ignored by nursing staff. Positive experiences during undergraduate mental health clinical placements have been associated with a desire to work in mental health nursing upon graduation. Ensuring students have a positive placement experience, which provides opportunity to link theory and skills, is a priority for sustaining the mental health nursing workforce. This study reports on the mental health placement experiences of a cohort of Victorian undergraduate nursing students enrolled in a Bachelor of Nursing course. Cross‐sectional study with thematic analysis of free‐text responses and descriptive statistics of placement satisfaction survey (Placement Evaluation Tool: Nursing Student) of data collected between May 2023 and August 2024. Overall n = 264 (26.8%) students were satisfied with their placement (8/10); however, experiences pertaining to constructive feedback, supervision, learning support and feeling valued were rated lower. Additionally, n = 103 (39%) free‐text responses on student experience of mental health placement were analysed using thematic analysis, where three themes emerged. Students described placement experiences that were often fraught with incivility and conflict, in addition to being unable to meet learning opportunities. Students were critical of community mental health placements where they were not provided adequate opportunity to engage with consumers or engage in mental health practice. Students reported that the experiences they had on clinical placement significantly influenced their desire to work with both the health service and in mental health. Health services need to address toxic workplace culture, not only for students but for their own staff, and recognise that students are often scrutinising a service for future employment. Despite evidence dating back decades to identify the importance of positive clinical placement experience on recruitment, there remain significant issues in some health services where students are seen as burdensome, and not the answer to the dwindling workforce. Payments by education providers for clinical placement services have been in operation in Victoria, Australia, since 2015; however, it is not necessarily directed to support student placement experience. Health services must be more proactive in identifying their capabilities around supporting undergraduate nursing students, the professional development of staff to provide quality supervision and the suitability and quality of the placement experience they offer.

This article presents findings from a study that sought to explore the extent to which clinical placements have an impact on nursing students' decisions regarding their first staff nurse post. Within the UK, nursing is facing a recruitment crisis with particular difficulty recruiting to areas such as primary care and care of older people. Transitioning into a new role is challenging in any occupation, but it is a particular problem in nursing where the realities of professional practice often differ from students' perception of the staff nurse role as shaped by their clinical placements. This pilot study aimed to explore the influence of practice placements on final-year adult nursing students' career decisions. Qualitative and quantitative data were collected in a single phase using a questionnaire distributed to nursing students on the final day of their course. A total of 35 completed questionnaires were returned (response rate 57%). Half of the participants entered the course with preconceived preferences for clinical specialisms. However, only five participants (14%) applied for first-destination posts in that specialism. The overall importance of placements in career choice increased across the three years of the programme. Although placements in all three years are important, the experiences in year 3 are pivotal, with 74% ranking these as 'significantly influential' in their decision-making process. Analysis of the data obtained from the free-text responses from the questionnaire suggested that working environment; the level of support provided by mentors and clinical staff; the opportunity to make a difference to patients' lives and the variety of placements, were key influences on nursing students' decision regarding their first staff nurse post. This study highlights the key role of practice placements in the career choices of student nurses, particularly during the final year of their programme. It shows that students are likely to apply for posts in the placement area they found to be most supportive and developmental.