Clinical Placement Hours Research Articles

Clinical placement education during the coronavirus disease 2019 pandemic shapes new nurses: A qualitative study

BackgroundMany newly qualified nurses experience transition challenges because they feel unprepared for the reality of the nursing profession owing to the theory-practice gap. Transition challenges amongst newly qualified nurses have profound consequences for the nursing profession and patient care. A detailed and nuanced understanding of the complexity in transition-related challenges during extraordinary conditions like the coronavirus disease 2019 pandemic is needed for newly qualified nurses to remain in the nursing profession. ObjectiveThis study explored the experience of newly qualified nurses entering the nursing profession who had their clinical placement education missed, shortened, or substituted since they had to serve as health care assistants during the coronavirus disease 2019 pandemic. DesignAn exploratory and descriptive study design was used. SettingsWorkplaces for newly qualified nurses. ParticipantsA purposive sample of 10 newly qualified Norwegian nurses working in various clinical placement nursing settings were included. MethodsData were collected in April and May 2022 via individual interviews conducted via Zoom. Thematic analysis was applied to identify themes. Triangulation was employed to ensure trustworthiness. FindingsThree major themes emerged: relational aspects of nursing, practical aspects of nursing, and inadequacies in the pedagogical plan of teaching and learning. The themes indicate that the limited or suspended clinical placement education during the pandemic affected the competence of newly qualified nurses. ConclusionsDuring the coronavirus disease 2019 pandemic, clinical placement education for student nurses was limited or suspended owing to safety concerns. The short clinical placement durations affected the competence of newly qualified nurses, as they lacked exposure to real-world patient care scenarios as in non-pandemic times. Furthermore, our findings indicate that newly qualified nurses’ clinical placement experiences provide important knowledge and insight for educators in terms of education and support for future student nurses going into situations with short clinical placement hours. The conclusion highlights the implications of the findings and recommendations and the need for further support and education for newly qualified nurses after the pandemic. Study registration detailsThe study was approved by the Norwegian Social Data Service (project number 396247). The registration date was 2021–11–04. Tweetable abstractTransition-related challenges became more prominent during the coronavirus disease 2019 pandemic than during non-pandemic times.

Students' perceptions of a UK physiotherapy student-led clinic.

Student-led clinics (SLCs) are a mode of delivery whereby students take responsibility for the delivery of a health service or intervention. SLCs for physiotherapy have a wide range of uses, including enhancement of learning, replacement of clinical placement hours and serving population and community needs. Evidence is emerging globally as to the outcomes of SLCs in physiotherapy, but little exists in the United Kingdom (UK) context. The purpose of this study was to explore student perceptions of running, leading and participating in a UK physiotherapy student-led neurological rehabilitation clinic. A qualitative design using a focus group. Four themes were identified relating to students' perceptions of SLCs associated with the learning environment, self-development, enhanced clinical skill development and reflections on experience at the SLC. The findings of this study suggest that physiotherapy SLCs in a UK context can contribute positively to student experience and skill development, particularly in relation to the learning environment, development of clinical skills, leadership and autonomy. Some aspects related to, for example, student induction and preparation could be further developed. Further research should explore if these findings are applicable in other countries where SLCs are less established. Further research in the UK and globally related to SLC models in different courses and across varying stages is required. Exploration of the SLC as a viable form of clinical placement experience is also warranted.

Overcoming the monster! Perceptions of physiotherapy students regarding the use of stroke master plots for building therapeutic relationships; a vignette study

BackgroundNarrative master plots identify illness stories which are recognisable within clinical settings. Responses to different master plots by physiotherapy students can lack empathy and need to be understood further. One narrative master plot for people with stroke that has not been well studied is called ‘overcoming the monster’. Research is needed to understand physiotherapy students’ reactions to this master plot.ObjectiveTo examine the responses of physiotherapy students to three variations of the master plot called ‘overcoming the monster’ generated from patients who have had a stroke.MethodsA qualitative narrative vignette study was undertaken. A university in the West Midlands (England) was used to access physiotherapy students on the pre-registration programs. A purposive sample of students volunteered to complete a single vignette questionnaire at one time point. The vignette provided three unique examples of the master plot overcoming the monster as told by people with stroke. Students responded to each by asking specific questions that captured demographic information and questions that captured reactions to the different versions of the master plot. Categorical-content narrative analysis was undertaken.ResultsThirty-two first year (BSc) students, thirty-nine first year (pre-registration) MSc students and nineteen third year (BSc) students participated in this study. Neither first year groups had undertaken any clinical placement hours. All third-year students had finished the required clinical placement hours for the physiotherapy course. Students consistently demonstrated empathy towards this master plot. Students often valued the variant of the story which illustrated how difficulties following stroke could be experienced as an ‘adventure’. Students also valued and were motivated by the story variant that considered a family member as a source of motivation and encouragement. The story variant which focused on the shortcomings of the health care system was more often related to by the final year BSc students and MSc students. However, first year students, particularly BSc students, reported being more emotionally affected by the vignette.ConclusionAll variants of the master plot overcoming the monster appeared to generate empathetic responses. This is important because it highlights the value of students’ understanding the patients’ story and challenges or ‘monsters’ faced. Therapeutic relationships will benefit from training physiotherapy students on the importance of listening and exploring challenges people with stroke face.

Paramedic student encounters with patients during clinical placements: A multi-institutional cohort study.

ObjectiveParamedic students in the US are required to complete clinical placements to gain supervised experience with real patient encounters. Given wide variation in clinical placement practices, an evidence‐based approach is needed to guide programs in setting realistic and attainable goals for students. This study's goal was to describe patient encounters and hours logged by paramedic students during clinical placements.MethodsA retrospective review of prospectively collected quality assurance data entered by US paramedic students between 2010 and 2014 was conducted. De‐identified electronic records entered in the Field Internship Student Data Acquisition Project (FISDAP) Skill Tracker database were included from consenting paramedic students whose records were audited and approved by instructors. Descriptive statistics were calculated.ResultsA total of 10,645 students encountered 2,239,027 patients; most encounters occurred in hospital settings (n = 1,311,967, 59%). The median total number of patient encounters per paramedic student was 206 (142–269) and the median total clinical placement hours per student was 626 (504–752). The median number of team leads per student was 56 (30–84). Students encountered a median of 22 (12–31) pediatric patients, ages 0–12 years, and 181 (126–238) adolescent or adult patients. For pediatric patient encounters, the most common clinical impressions were respiratory distress, other medical complaints, and extremity trauma. Among adult patient encounters, the most common clinical impressions included other medical, trauma, and cardiac conditions.ConclusionsUS paramedic students experienced a variable range of patient encounter types and volumes. The findings of this study offer an evidence base from which programs can set realistic and attainable clinical placement requirements.

Beyond simulation — Extracurricular volunteering in nursing education: A focus group

BackgroundA reduction in clinical placement hours has seen alternative teaching methods being explored in nursing education in Australia. The use of simulated patients in academic laboratories is highly utilised, however, may still be limiting learning opportunities. ObjectiveThe objective of this research was to describe the learning experiences of nursing students who participated in supervised extracurricular, volunteering opportunities during their nursing studies. DesignA descriptive qualitative design was used to discover and understand learning experiences of a volunteering encounter, described from the nursing student perspective. SettingThe Pit Stop men’s health check program is a collaboration of local health organisations, volunteering their time to provide free health checks at a farming Field Day event in regional Victoria, Australia. ParticipantsTwelve second year undergraduate nursing students volunteered at the 2019 Pit Stop event, over a four day period and outside their normal study requirements. Seven volunteers then participated in post event research, sharing experiences and providing feedback. MethodsOne semi-structured focus group interview was conducted at University campus, using reflective and open ended questioning. Interviews were audio recorded and transcribed. Thematic analysis identified common themes. ResultsStudents unanimously recommended the real life learning experiences and reported an increased confidence and competence in basic communication and clinical skills, not always provided in the simulated environment of the academic laboratory. Their motivation to attend was driven by wanting more real life contact with patients, having time to practice skills and experience diversity within their practice. Students also recommended future volunteering ideas that would potentially provide additional learning opportunities. ConclusionsExperiential learning such as simulation is highly valued in current nursing education, however, students still crave the real life learning experiences from working with human patients. With limited clinical exposure currently offered to students within nursing education programs, additional opportunities such as supervised volunteering may be worth considering when preparing confident and competent nurse graduates.

Recognition for registered nurses supporting students on clinical placement: a grounded theory study

Objective: This study examined registered nurses’ perspectives of being supportive of nursing students and providing them with learning opportunities when on clinical placements. Background: In Australia, as part of their three-year Bachelors degree, undergraduate nursing students undertake a minimum of 800 hours of clinical placement. During these clinical placement hours, nursing students are supervised by registered nurses who are required to be supportive of the students and provide them with learning opportunities. Study design and methods: This study used a grounded theory approach. In this qualitative study there were fifteen registered nurse participants. Thirteen participants were female participants and two were male. Participants were individually interviewed. Transcripts from these in–depth interviews were analysed using constant comparative analysis. Results: The major category, an added extra, emerged from this study. An added extra is about registered nurses’ perception that having a student is an added extra to their daily duties. The major category an added extra is informed by three emergent themes. The first theme was time, the second theme was workload and the third theme was wanting recognition. Discussion: Registered nurses perceived that their workloads tend not to be taken into consideration when they have nursing students. The literature suggests that nursing students often miss out on learning opportunities when they are on clinical placement because registered nurses do not have additional time to effectively support students’ clinical learning. Conclusion: Participants in this study believed being supportive of nursing students and providing them with learning opportunities was an added extra to their daily nursing duties. Findings revealed registered nurses want to be recognised for the extra time and effort they dedicate to students’ learning.

Simulation can offer a sustainable contribution to clinical education in osteopathy

BackgroundClinical education forms a substantial component of health professional education. Increased cohorts in Australian osteopathic education have led to consideration of alternatives to traditional placements to ensure adequate clinical exposure and learning opportunities. Simulated learning offers a new avenue for sustainable clinical education. The aim of the study was to explore whether directed observation of simulated scenarios, as part replacement of clinical hours, could provide an equivalent learning experience as measured by performance in an objective structured clinical examination (OSCE).MethodsThe year 3 osteopathy cohort were invited to participate in replacement of 50% of their clinical placement hours with online facilitated, video-based simulation exercises (intervention). Competency was assessed by an OSCE at the end of the teaching period. Inferential statistics were used to explore any differences between the control and intervention groups as a post-test control design.ResultsThe funding model allowed ten learners to participate in the intervention, with sixty-six in the control group. Only one OSCE item was significantly different between groups, that being technique selection (p = 0.038, d = 0.72) in favour of the intervention group, although this may be a type 1 error. Grade point average was moderately positively correlated with the manual therapy technique station total score (r = 0.35, p < 0.01) and a trivial relationship with the treatment reasoning station total score (r = 0.17, p = 0.132).ConclusionsThe current study provides support for further investigation into part replacement of clinical placements with directed observation of simulated scenarios in osteopathy.

Placement replacement: A conceptual framework for designing simulated clinical placement in occupational therapy.

Simulation is increasingly used to supplement clinical placement in preregistration health professional programs. However, there are no conceptual frameworks to guide the design of these learning experiences when replacing a clinical placement. In the present study, the conceptual framework for simulated clinical placements (CF-SCP) is presented. Evolving from an iterative process of synthesizing learning and simulation theory, findings from the empirical literature, and the perspectives and ideas from experts in occupational therapy practice, education and simulation-based learning, the CF-SCP aligns principles and processes of workplace and simulation learning. The application of the CF-SCP is described in the context of a 1 week full-time SCP. The CF-SCP provides a structure for organizing, understanding, and applying the principles and processes to design a simulated placement to be a "placement replacement" experience. Articulating a conceptual framework for the design of simulated placement experiences to replace actual clinical placement hours in the allied health sector is important if these experiences are to be tested for validity, efficacy, and transferability to a range of occupational therapy practice areas and other health disciplines.

Effectiveness and cost-effectiveness of embedded simulation in occupational therapy clinical practice education: study protocol for a randomised controlled trial

BackgroundClinical placements are a critical component of the training for health professionals such as occupational therapists. However, with growing student enrolments in professional education courses and workload pressures on practitioners, it is increasingly difficult to find sufficient, suitable placements that satisfy program accreditation requirements. The professional accrediting body for occupational therapy in Australia allows up to 200 of the mandatory 1000 clinical placement hours to be completed via simulation activities, but evidence of effectiveness and efficiency for student learning outcomes is lacking. Increasingly placement providers charge a fee to host students, leading educators to consider whether providing an internal program might be a feasible alternative for a portion of placement hours. Economic analysis of the incremental costs and benefits of providing a traditional versus simulated placement is required to inform decision-making.Methods/designThis study is a pragmatic, non-inferiority, single-blind, multicentre, two-group randomised controlled trial (RCT) with an embedded economic analysis. The RCT will compare a block of 40 hours of simulated placement (intervention) with a 40-hour block of traditional placement (comparator), with a focus on student learning outcomes and delivery costs. Six universities will instigate the educational intervention within their respective occupational therapy courses, randomly assigning their cohort of students (1:1 allocation) to the simulated or traditional clinical placements. The primary outcome is achievement of professional behaviours (e.g. communication, clinical reasoning) as assessed by a post-placement written examination. Secondary outcomes include proportions passing the placement assessed using the Student Practice Evaluation Form-Revised, changes in student confidence pre-/post-placement, student and educator evaluation of the placement experience and cost-effectiveness of simulated versus traditional clinical placements. Comprehensive cost data will be collected for both the simulated and traditional placement programs at each site for economic evaluation.DiscussionUse of simulation in health-related fields like occupational therapy is common, but these activities usually relate to brief opportunities for isolated skill development. The simulated clinical placement evaluated in this trial is less common because it encapsulates a 5-day block of integrated activities, designed and delivered in a manner intended to emulate best-practice placement experiences. The planned study is rare due to inclusion of an economic analysis that aims to provide valuable information about the relationship between costs and outcomes across participating sites.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12616001339448. Registered 26 September 2016.

Teaching and supporting nursing students on clinical placements: Doing the right thing

ProblemPre registration nursing students do not always feel supported by Registered Nurses during their clinical placements. To help develop and refine clinical skills, in order to deliver safe, competent nursing care, nursing students rely on Registered Nurses to teach and support them in their clinical learning. BackgroundPre-registration nursing students in Australia must undertake a minimum of 800 clinical placement hours as part of their undergraduate nursing education. Registered Nurses are required to provide professional development and to teach and support students during these clinical placements. Little is known about Registered Nurses’ understanding of this nursing standard requirement. AimTo explore Registered Nurses’ understanding of the nursing standard requirement to provide professional development to pre-registration nursing students during their clinical placements. MethodsA Grounded Theory study was used involving in-depth semi-structured individual interviews to gather data from fifteen Registered Nurse participants. Constant comparative analysis was used to analyse the data and it was from this data analysis that the substantive theory emerged. FindingsThe substantive theory developed as a result of this research is titled, Doing the Right Thing. The core category, the right thing to do, is informed by four elements; sense of responsibility, an added extra, choice, and nursing standard. ConclusionRegistered Nurses are motivated to teach and support nursing students on clinical placements because they believe it is the right thing to do.

Assessment of Correlates of Stigma in Mental Health Nursing Practice Among Nursing Students in Two Universities in Nairobi- Kenya

Mental health and psychiatric nurses are considered important and integral members of the multidisciplinary mental health care team offering 90% of mental health services in Kenya. Stigma towards mental health nursing practice has led to acute shortage in mental health nursing workforce and consequently poor quality of mental health care. Aim : to assess the correlates of stigma towards mental health nursing practice among Bachelor of Science Nursing students. Research Method : Cross-sectional study was conducted among 90 Undergraduate nursing students at the Universities of Nairobi and Eastern Africa-Baraton. Only students who had completed and passed both theory and clinical experience in mental health nursing course were selected for the study. A structured questionnaire and focus group discussion were used. Ethical approval was sought form the UON/KNH ERC. Data Analysis : The SPSS version 22 was used to analyze the quantitative data whereas the qualitative data from the focus group discussion were analyzed using deductive approach. The correlates were tested using chi-square test and at a P-Value of ≤ 0.05. The final data presented using frequency distribution tables, pie charts, graphs. Findings : Stigma in mental health nursing practice stands at 85.6% (N=87). Marital status significantly correlated with stigma towards mental health nursing practice p=0.04 (χ2 = 7.731). Belief that mental illness is due to demonic possession, shorter clinical placement, a motivation by the course lecturers and poor environment of practice correlated significantly with stigma towards mental health nursing practice. Recommendations : Improve minimum clinical placement hours, over emphasize on psychopathology of mental disorders, encourage thorough orientation of students in clinical area upon arrival. Dissemination : Results will be delivered in scientific conferences, the schools of nursing and to policy makers in mental health care to guide policy development.

Student self-reported communication skills, knowledge and confidence across standardised patient, virtual and traditional clinical learning environments.

BackgroundAdvanced communication skills are vital for allied health professionals, yet students often have limited opportunities in which to develop them. The option of increasing clinical placement hours is unsustainable in a climate of constrained budgets, limited placement availability and increasing student numbers. Consequently, many educators are considering the potentials of alternative training methods, such as simulation. Simulations provide safe, repeatable and standardised learning environments in which students can practice a variety of clinical skills. This study investigated students’ self-rated communication skill, knowledge, confidence and empathy across simulated and traditional learning environments.MethodUndergraduate speech pathology students were randomly allocated to one of three communication partners with whom they engaged conversationally for up to 30 min: a patient in a nursing home (n = 21); an elderly trained patient actor (n = 22); or a virtual patient (n = 19). One week prior to, and again following the conversational interaction, participants completed measures of self-reported communication skill, knowledge and confidence (developed by the authors based on the Four Habit Coding Scheme), as well as the Jefferson Scale of Empathy – Health Professionals (student version).ResultsAll three groups reported significantly higher communication knowledge, skills and confidence post-placement (Median d = .58), while the degree of change did not vary as a function of group membership (Median η2 < .01). In addition, only students interacting with a nursing home resident reported higher empathy after the placement. Students reported that conversing with the virtual patient was more challenging than conversing with a nursing home patient or actor, and students appeared to derive the same benefit from the experience.ConclusionsParticipants self-reported higher communication skill, knowledge and confidence, though not empathy, following a brief placement in a virtual, standardised or traditional learning environment. The self-reported increases were consistent across the three placement types. It is proposed that the findings from this study provide support for the integration of more sustainable, standardised, virtual patient-based placement models into allied health training programs for the training of communication skills.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0577-5) contains supplementary material, which is available to authorized users.

The Relationship Between Simulation in Nursing Education and Medication Safety

This experimental study examined whether the use of clinical simulation in nursing education could help reduce medication errors. Fifty-four student volunteers were randomly assigned to an experimental (treatment) group (24 students) or a clinical control group (30 students). The treatment replaced some early-term clinical placement hours with a simulated clinical experience. The control group had all normally scheduled clinical hours. Treatment occurred prior to opportunities for medication administration.

The meaningfulness and appropriateness of using human patient simulation manikins as a teaching and learning strategy in undergraduate nursing education: a systematic review.

Review question/objective Objective The aim of this review is to identify the best available evidence on the meaningfulness and appropriateness of integrating human patient simulation manikins (HPSMs) into undergraduate nursing education. Review Questions This review will systematically examine the evidence to answer the following questions: 1. What are the perspectives and experiences of students and academics on the appropriateness and meaningfulness of the use of HPSMs in undergraduate nursing education? 2. What teaching and learning practices with HPSM are considered appropriate and meaningful by students and academics? Inclusion criteria Types of participants The review will consider studies that include undergraduate nursing students and academics who are involved in undergraduate education. Studies that consider other allied health care professionals will be excluded unless data for undergraduate nursing students are included and analysed separately. Types of intervention(s)/phenomena of interest The review will consider as phenomena of interest the experiences, values, opinions, beliefs and interpretations of undergraduate nursing students and academics using HPSM for teaching and learning purposes.

The experience of spinal cord injury: using Frank's narrative types to enhance physiotherapy undergraduates’ understanding

Objectives To consider physiotherapy students’ responses to three illness narratives common in rugby players who have suffered a spinal cord injury (SCI). Design A narrative vignette was provided to first and third year students reading for a Batchelor of Science degree in physiotherapy. Setting A university in the West Midlands during a year cohort meeting. Participants Seventy-seven first year students and 45 third year students took part in the study. All students were attending the university at the time of the study. None of the first year students had completed any clinical placement hours, and all of the third year students had completed the required number of clinical hours for a physiotherapy degree. Main outcome measures The narrative vignette consisted of nine questions relating to the vignette. Thematic content analysis was applied to the results. Results The role of experience appeared to influence students’ responses. The third year students’ reactions to each narrative appeared more consistent and unified as a medical voice. This appeared to support their preference for an ideal type of story and patient. Problems with each narrative were identified, although often not critiqued. Conclusions Students need more time to consider different illness narratives in order to accept and understand them.

Students’ and facilitators’ perceptions of simulation in practice learning

In the United Kingdom (UK), there have been concerns about nursing students' clinical competence at registration; whether simulation can enhance practice learning is under consideration. This paper presents results from an evaluative study of students' and facilitators' perceptions of simulation and its application to clinical practice. A project was conducted, involving 267 pre-registration nursing students; 179 students, in eight sub-groups, experienced a simulation programme and a further 88 undertook their usual clinical placements. Facilitator and student data were collected through questionnaires and were entered into SPSS v13 and analysed using descriptive statistics. Chi-square was used to examine associations where appropriate. Facilitators and students evaluated the simulation programmes very positively. Students perceived that simulation increased their ability and confidence in their clinical placements and they did not feel disadvantaged by the reduced clinical placement hours. At the end of their placements, most simulation group students were confident about their skills and many made comments about how the experience had increased their confidence. There was no significant difference between the perceived confidence of simulation and comparison group students at the end of placement. In conclusion, undertaking simulated learning during a clinical placement appears to be at least as effective as learning during practice placement without simulation.