Placement Periods Research Articles

Nurturing ethical insight: exploring nursing students’ journey to ethical competence

BackgroundEthical competence is a key competence in nursing and the development of the competence is a central part in nursing education. During clinical studies, nursing students face ethical problems that require them to apply and develop their ethical knowledge and skills. Little is known about how ethical competence evolves during students’ initial clinical placements. This study explored the development of ethical competence in first-year nursing students during their first clinical placements in nursing homes.MethodsThis exploratory-descriptive qualitative study used focus group interviews to collect data and a phenomenological hermeneutical method for analysis. Twenty-eight first-year nursing students participated in six focus groups. The data were collected between March and April 2024 at Oslo Metropolitan University in Norway.ResultsThe naïve reading of the data involved an awareness of the students applying their prior knowledge, modifying their prior knowledge and developing skills that allowed them to manoeuvre ethical practices that, in some cases, appeared excellent and, in other cases, grim. The structural analysis identified three themes: (i) ethical competence forges in practice, (ii) ethical competence evolves at the intersection of knowledge and skills and (iii) ethical competence unfolds through meaningful discussions. A comprehensive understanding of the data was formulated as ‘Being on a journey towards ethical competence’. This presents a metaphor illustrating that nursing students embark on a journey towards ethical competence; from their point of departure, their clinical experiences forge the essential waypoints along their path, knowledge and skills fuelling their navigation in rugged terrain towards their destination.ConclusionsNursing students’ ethical competence evolved in intricate ways during their initial clinical period. Being informed bystanders or participants in the care of nursing home residents in situations of ethical tension may be a unique position enabling students to evaluate care options differently from those immersed in the ward culture. The findings indicate that organised professional development in nursing homes needs to focus on more reflexively driven ways of supervising students in their first clinical study period. Educational institutions need to continue and further develop reflection-based learning activities and meeting points with students and their peers during their clinical placement periods.

Suomenoppijoiden toimijuus kotoutumiskoulutuksen yksilöllisissä ratkaisuissa

This article examines migrants’ agency related to the individualised and flexible practices available in Integration Training in Finland, with a focus on migrants’ Finnish language learning. The research focused on migrants who have not been studied before, namely those entering training after it had already started. The data consist of background information and interviews of 17 migrants who studied in Integration Training in 2018–2020. The interviews were analysed using qualitative content analysis. The results show that the same practice can support the learner agency of some participants but limit the agency of others. The possibility to make choices about one’s own education varies, and choices are often related to beliefs about language proficiency. In the classroom and during work placement periods, some participants reported having had multiple chances to grasp affordances and use Finnish, others only a few. In summary, the individualised practices available in Integration Training appear to impact participants’ language learning variably, and participants’ wishes do not always align with the available practices.

Fostering Adaptability in the Future Nursing Workforce Through the Transformation of Nursing Education During the COVID-19 Pandemic

This is a reflective report on the challenges experienced at an Australian nursing school, in which there was full continuation of degree delivery throughout the national lockdown period in mid-2020 due to the COVID-19 pandemic. The authors describe the significant modifications to teaching methods and reflect on how this experience influenced learning, yet also helped develop essential nursing qualities among students. Anecdotal evidence is drawn from the authors’ academic roles as clinical education specialists, positions which involve teaching at the university as well as clinical supervision during students’ work integrated learning clinical placement periods. This unique perspective allows for insight into the impact of the pandemic on transference of student knowledge and skills to patient care in health facilities. There were indications that these modifications to teaching during the pandemic have, in some respects, impeded learning, yet have provided the benefit of fostering adaptability and resilience in these future nurses. Further analysis of modified nursing education in the context of a pandemic is needed to determine implications for the future nursing workforce, and strategies needed to address these. The authors recommend optimising this momentum of adaptability as an opportunity for innovation in tertiary nursing education for better preparedness of future nurses.

Extended School Placement in Initial Teacher Education: Factors Impacting Professional Learning, Agency and Sense of Belonging

<p style="text-align: justify;">School placement plays a critical and complex role in student teacher development as well as in their professional dispositions and career attitudes. It is where theory and practice meet, teaching skills are developed, professional relationships formed and future careers envisioned. This mixed methods study explores student teachers’ experiences with and perspectives about new models of extended school placements developed in Ireland following significant policy and programme reform. Data was collected through interviews and questionnaires with one of the first cohorts to experience a reconceptualised initial teacher education programme, including extended school placement periods in a variety of school settings. This paper will explore student teachers’ perspectives regarding the value of the extended placement and factors influencing their professional learning, agency and sense of belonging. Overall, our findings confirm the pedagogical benefits of the extended placement in two different school settings for student teachers’ professional learning. However, they also highlight how a number of factors, including the existence (or absence) of school support structures, school culture, peer networks, paid or unpaid additional workload and financial pressures impacted on student teachers’ capabilities to develop their skills and professional agency, their sense of belonging and, in some cases, their physical and mental health.</p>

Registered Nurses’ Supervision of Nursing Students During Practical Skill Learning: A Qualitative Exploratory Study

ABSTRACT Nursing education relies on nurses to supervise students in practical skill learning during their clinical placement periods, yet literature is sparse regarding what this supervision actually entails. The study aimed to explore the learning actions that characterised nurses’ and students’ interaction during supervision of peripheral vein cannulation attempts on patients in hospital, and how these learning actions influenced the students’ practise. In this study, 38 video-recorded attempts of the practical skill peripheral vein cannulation conducted of nine nursing students were analysed. Of the 38 attempts, 10 were successful. In successful and failed attempts both, students and nurses primarily engaged in learning actions that informed, reminded, or corrected the students; students and nurses rarely engaged in learning actions characterised by reflection and discussion. A surface approach to learning was insufficient for most students to successfully insert a vein cannula during their clinical placement.

Development and Validation of the Stent Tracking Algorithm Registry for Monitoring and Retrieving Forgotten Ureteral Stents

Purpose: Forgotten ureteral stents are associated with safety issues, increased cost, and medicolegal disputes. Tracking ureteral stents is cumbersome because of the variety in placement periods. We developed and validated an electronic medical record (EMR) system-based algorithm for monitoring patients with ureteral stent placements. Materials and Methods: The Stent Tracking Algorithm Registry (STAR) is automatically activated once the physician enters the stent placement or replacement billing code into the EMR billing system. At 120 days, an overdue notification is generated and sent to the attending physician through an EMR pop-up dashboard and e-mail. The model is automatically deactivated when the stent of the corresponding laterality is removed. To validate the feasibility of STAR, we performed a retrospective review of 2194 patients who received stent placements between November 2006 and September 2019. Results: Among 2194 patients, STAR retrospectively identified 354 (16.1%) patients suspected of harboring forgotten ureteral stents. A total of 12 (0.5%) patients actually had forgotten ureteral stents and were contacted for removal. A total of 124 (5.7%) patients were identified because of the omission of the stent removal billing code, whereas 209 (9.5%) patients were identified because of being lost to follow-up after referral to another health care facility or death. There were no cases in which STAR identified patients whose stents were removed or replaced at an appropriate time frame. Conclusions: STAR provides an efficient interface with which to prevent the occurrence of forgotten ureteral stents. This model can be integrated into any EMR system that utilizes coding algorithms.

Stress and burnout: exploring postgraduate physiotherapy students\u2019 experiences and coping strategies

Background and purposeThe impact of stress and burnout in students is an emerging topic. When students perceive that they are unable to cope with stressors, there is increased potential for burnout. To maximise students’ higher educational institution outcomes, students must be able to effectively cope with stressful demands. Research suggests physiotherapy students, in particular, suffer from a high risk of stress and burnout, however limited research exists on postgraduate, pre-registration, physiotherapy students. The purpose of this study was to determine perceived stress, burnout and associated coping strategies across three timepoints in the first year of a postgraduate, pre-registration physiotherapy program.MethodsA qualitative and quantitative survey design was utilised at one Australian Higher Education Institution. The 51-item self-administered questionnaire consisted of demographics, the Coping Self Efficacy (CSE) Scale and Maslach Burnout Inventory – General Survey for Students (MBI-GS (S)), and open-ended questions. The questionnaire was administered at three timepoints (T) in the program: T1 at the start of semester 1, T2 before the first placement in semester 2 and T3 after 10-weeks of placement. Data were analysed using descriptive, statistical and thematical analysis.SubjectsAll first year Doctor of Physiotherapy students.ResultsA response rate of 62% (n = 38) was achieved. There were no differences in stress and burnout scores between sexes, nor differences in stress and burnout over time. Highest median CSE scores were seen at T1, with highest median MBI-GS (S) cynicism scores at T2, exhaustion (EX) at T1 and T2, and professional efficacy at T1 and T2. The greatest mean CSE changes were seen from T1-T2 and T1–3, and PE greatest changes from T2-T3 and T1-T3. No strong correlation was found between stress and burnout. Curriculum coursework was a frequently reported stressor, along with clinical placement and transition periods. Coping strategies utilized by students were both positive and maladaptive. Positive strategies included sporting activities, baking, listening to music, and social connections, whereas maladaptive strategies included alcohol consumption, excessive eating, and gaming.ConclusionStudent consistently identified periods of stress and burnout, with curriculum coursework in particular being a trigger. Findings acknowledge the need for further investigation on sources of perceived stress, burnout, and coping mechanisms to optimise student welfare and enhance Higher Education Institution outcomes.

Sustainable architecture: trends in higher professional architectures’ education

In the article we tried to investigate theoretical ideas concerning actual students’ reasons for education in the field of architecture in frame of the second level of higher professional education system. We present the results of survey that we conducted last year. We collected data about students’ reasons to enrol for architectures’ and others master programmes and their expectations of programmes’ content, programmes’ volume, curriculum structure, placement periods. We analysed the teaching methods, structure and trends in architecture’s master programmes that was legally introduced by government standards. As a result, we concluded that the changes of education standards mostly meet expectations of master programmes contenders. However, the contenders will succeed in higher school only if their motivation is enough strong and appropriate.

From school to work: Coherence between learning in school and learning in workplaces for apprentices in the Media graphics programme in Norway

A key challenge in vocational education and training (VET) programmes is the lack of coherence between the school-based and the enterprise-based parts of learning. This study explores the conditions that are important for the perception of coherence between learning in school and workplaces by interviewing apprentices enrolled in the Media graphics programme in Norway. In addition to the views of apprentices, the study also includes the perspectives of other participants in the vocational education system, such as media teachers and instructors in the workplaces and apprenticeship training office. The interview data revealed that the media education in school had facilitated the students’ learning primarily by allowing them to work on authentic media productions. Despite this, however, some of the apprentices experi-enced a lack of coherence between learning in school and learning in enterprises, mainly because there were few opportunities to specialise in their chosen vocation in school, and limited cooperation between schools and workplaces about placement periods.

The effect of speech-language pathology students on clinician time use and activity

Purpose: This prospective study investigated the impact of supervising students on public health speech-language pathologists’ (SLPs) time and patient activity levels in order to broaden evidence in the profession.Method: Thirty-four SLPs supervising students collected data profiling their time use and activity during the first, middle and penultimate placement week. They also collected data for a week when not supervising students. Pre- and post-placement surveys were used to supplement quantitative data with additional information such as clinician and student experience levels.Result: Overall clinical time (face-to-face and indirect) and the number of patients seen neither increased nor decreased during student placements. However, clinicians’ use of time altered across placement periods. For example, SLP time delivering clinical services decreased but time observing students providing clinical services increased as the placement progressed. Some differences in time spent in non-clinical activities (e.g. student teaching and SLP administration) were found. Comparing data from placements with varying supervision models or student competence level showed few significant differences in time use, activity or productivity.Conclusion: There was no significant difference in overall clinical time used, nor patient activity or productivity whether clinicians were supervising students or not. Further research is required within SLP services.

Using action research to build mentor capacity to improve orientation and quality of nursing students' aged care placements: what to do when the phone rings.

To describe whether an action research approach can be used to build capacity of residential aged care facility staff to support undergraduate nursing students' clinical placements in residential aged care facilities, using development of an orientation programme as an exemplar. Aged care facilities are unpopular sites for nursing students' clinical placements. A contributing factor is the limited capacity of staff to provide students with a positive placement experience. Strategies to build mentor capability to shape student placements and support learning and teaching are critical if nursing students are to have positive placements that attract them to aged care after graduation, an imperative given the increasing care needs of the ageing population worldwide. Action research approach employing mixed-methods data collection (primarily qualitative with a quantitative component). Aged care facility staff (n=32) formed a mentor group at each of two Tasmanian facilities and met regularly to support undergraduate nursing students (n=40) during placements. Group members planned, enacted, reviewed and reflected on orientation procedures to welcome students, familiarise them with the facility and prepare them for their placement. Data comprised transcripts from these and parallel student meetings, and orientation data from student questionnaires from two successive placement periods (2011/2012). Problems were identified in the orientation processes for the initial student placements. Mentors implemented a revised orientation programme. Evaluation demonstrated improved programme outcomes for students regarding knowledge of facility operations, their responsibilities and emergency procedures. Action research provides an effective approach to engage aged care facility staff to build their capacity to support clinical placements. Building capacity in the aged care workforce is vital to provide appropriate care for residents with increasing care needs.

Geochemistry of arsenic in low sulfide-high carbonate coal waste rock, Elk Valley, British Columbia, Canada.

This study investigated the geochemistry of arsenic (As) in low sulfide-high carbonate coal waste rock of the Elk Valley, British Columbia, Canada. Its abundance and mineralogical associations in waste rock of different placement periods were determined in addition to its mobilization into porewater and rock-drain effluent. The mean (5.34mg/kg; 95% confidence interval: 4.95-5.73mg/kg) As concentration in the waste rock was typical of sedimentary rock. Electron microprobe and As K-edge X-ray absorption near-edge spectroscopic analyses showed the As is predominantly associated with primary pyrites in both source and freshly blasted waste rock. However, in aged waste rock the As is associated with both primary pyrites and secondary Fe oxyhydroxides. Oxidation of pyrite in waste rock dumps was reflected by the presence of high concentrations of SO42- in porewater and oxidation rims of Fe oxyhydroxides around pyrite grains. Acid released from pyrite oxidation to Fe oxyhydroxides is neutralized by carbonate mineral dissolution that buffers the pH in the waste rock to circumneutral values. Adsorption of As onto secondary Fe oxyhydroxides provides an internal geochemical control on As release during pyrite oxidation and porewater flushing from the dump, resulting in the low As concentrations observed in porewater (median: 9.91μg/L) and rock-drain effluent (median: 0.31μg/L). Secondary Fe oxyhydroxides act as a long-term sink for As under present day hydrologic settings in waste rock dumps in the Elk Valley.

A frailty model for recurrent events during alternating restraint and non-restraint time periods.

We consider recurrent events of the same type that occur during alternating restraint and non-restraint time periods. This research is motivated by a study on juvenile recidivism, where the probationers were followed for re-offenses during alternating placement periods and free-time periods. During the placement periods, the probationers were under a restricted environment with direct supervision of the probation officers. During the free-time periods, the probationers were released to home and not under direct supervision. Although re-offenses can occur during both types of time periods, the intensities of the re-offenses are very different. Thus, these two types of time periods should be modeled differently. The same data structure also arises in many biomedical settings, as exemplified by tumor metastases during chemotherapy and chemo-free periods. In this paper, we propose a joint modeling framework that explicitly accounts for the different types of time periods, as well as the within-subject dependence during the same type and between different types of time periods. The estimation procedure is implemented in SAS and is easily accessible to practical investigators. We evaluate the proposed method through simulation studies under several realistic scenarios and demonstrate the feasibility of the proposed method by applying it to the juvenile recidivism dataset. Copyright © 2016 John Wiley & Sons, Ltd.

Placement supervision of pedagogue students in Denmark: the role of university colleges and early childhood centres

The article examines Danish pedagogue students’ supervision during their placement periods in early childhood settings. Throughout the long history of Danish pedagogue education, discourses relating to the placement element have been located either within a ‘work’ paradigm or a ‘scholastic’ paradigm. These two understandings of the function of placements are analysed and related to the current aim of integrating them. The supervisory roles of both the university college and the early childhood centre are critically examined, with a specific focus on the mentoring role of pedagogues in the centres. Many attend short-term courses, and some enrol for a diploma course. Challenges for the future include the need for more investment and engagement from local authorities, centre directors and university colleges.

Mentoring practices in workplace-based professional preparation: a critical analysis of policy developments in the Italian context

In recent years, the issue of early childhood staff professionalisation has been taking an increasingly prominent position in policy-making and academic debates at the international level. Despite this growing interest, studies investigating the content and delivery of professional preparation programmes for early childhood practitioners are still quite rare in European literature. Against this background, the article will describe and critically analyse the characterising features of the university degree for the professional preparation of pre-school teachers in Italy, with a special focus on workplace-based training. In particular, the theoretical underpinnings and shared understandings related to the implementation of mentoring practices within the university course will be explored by drawing on the data collected from documentary sources and interviews with local experts. Findings highlight that the main strengths of mentoring practices within such a programme are: (a) the extended placement periods in early childhood education and care (ECEC) settings which allow prospective teachers to live the culture of practice; (b) the critically reflective component of tutoring practices, which combines theoretical and experiential learning; (c) the strong partnerships built at the local level between ECEC services and universities, which generates reciprocal influences between academic research and educational practices and thus sustains pedagogical innovation. At the same time, the fact that the mentoring role of placement tutors in ECEC institutions is not adequately supported in terms of competence development and workload allocation might potentially undermine the benefits of workplace-based training for students. In addition, the contextualisation of our analysis within the broader landscape of national policy developments in the field of ECEC staff professionalisation revealed that the increased academisation of pre-school teachers professional preparation might lead – in the long term – to a risk of ‘schoolification’ of pedagogical practices enacted within ECEC services. In regards to these issues, the article will raise questions for further consideration and debate.

In-Service Teachers’ Learning Through Integrating Theory and Practice

Vocational education aims to prepare competent workforce for the needs of continuously changing work life. A competent employee does not only carry out routine tasks but is also required to have the ability to act in the communities of practice in his field and develop his way of working. The challenge of Finnish school-based vocational education has been in creating such learning environments that promote learning professional knowledge demanded by work life. The challenge has required vocational teachers to develop their competences in collaboration with employers. The research covers the role of Finnish vocational teachers’ authentic work placement periods in developing competences from the viewpoint of sociocultural learning. During the work placement period, a teacher furthers his or her competences by working in goal-oriented and planned ways in the work communities of enterprises or in the public sector of their fields. The purpose of the present qualitative case study is to increase the understanding of the role of authentic work placement periods in vocational teachers’ competence. Experiences of teachers representing different subjects were studied during their work placement periods. The results show that work placement period supports the development of teachers’ competences and provides prerequisites for work-based vocational education.

Effects of task precision demands on behavioral and physiological changes during a repetitive asymmetric lifting activity.

This study investigated the effects of task precision demands on behavioral and physiological changes during repetitive asymmetric lifting. Repetitive lifting encountered in manual material handling leads to muscle fatigue and is a documented risk factor for low back disorder. A total of 17 healthy volunteers performed repetitive asymmetric lifting for 60 min (10 lifts/min). Task precision demands were imposed by varying the entry width onto the destination conveyor. Physiological changes were assessed using near-infrared spectroscopy obtained from the erector spinae muscles. Three-dimensional spine kinematics and moment responses were quantified to understand behavioral changes during the lifting activity. Task precision demands showed no effect on erector spinae muscle oxygenation levels. Behavioral changes associated with repetitive lifting included increases in the overall lift duration, peak forward bending motion, and three-dimensional movement velocities of the spine, along with a decrease in the lateral bending moment. Relative to low precision demands, high precision demands resulted in 20% longer placement periods, which, in turn, resulted in a 12% increase in the time-integrated twisting postures and a 10% increase in the time-integrated lateral bending moments during load placement. The elevated risk of low back injury when lifting under greater precision demands is likely due to the sustained spine twisting and the sustained lateral bending moment on the spine in the final phase of these lifts. Understanding behavioral changes to repetitive asymmetric lifting, especially for tasks requiring greater precision can be used to support injury prevention efforts.

Abstract 116: Is There Gender Disparity in the Use of Drug Eluting Stents after Acute Myocardial Infarction?

Background: Women are less likely than men to have cardiac catheterization and percutaneous coronary intervention (PCI) after acute myocardial infarction (AMI). It is unclear whether such gender disparity extends to the implantation of the type of coronary stent (bare metal stent (BMS) versus drug eluting stent (DES)) after AMI. Methods: We examined coronary stent implantation by type within 30 days of AMI in 33,748 patients admitted to non-federal hospitals in New Jersey using a statewide database. Data from 2003 through 2009 in the Myocardial Infarction Data Acquisition System (MIDAS) were used to identify patients with first episode of AMI and single type (BMS versus DES) of coronary stent implantation after the AMI. Multivariate logistic regression was used to analyze the differences by gender after adjustment for age, race, insurance, site of MI, pre-or post discharge stent implantation, and co-morbidities. Results: Coronary stent implantations after AMI were stratified by placement periods into: at index of AMI admission, n=16,719; within 2 days, n=22,019; within one week, n=31,618; and within 30 days of index AMI, n=33,748. In 2003, the use of BMS in women declined from 76% (386 of 507) to 68% (986 of 1454) from index AMI to 30 days, and in men from 79% (930 of 1181) to 70% (2017 of 2863). The use of DES in women increased from 24% (121 of 507) at index AMI to 32% (468 of 1454) at 30 days, and in men from 21% (251 of 1181) to 30% (846 of 2863). After adjustment for covariates, in 2003, women were more likely to receive DES than men within 2 days of the index AMI [Odds Ratio (OR): 1.37; 95% Confidence Interval (CI): (1.10, 1.70); p = 0.005], within 1 week of index AMI [OR: 1.21; CI (1.03,1.41); p= 0.02], within 30 days of index AMI [OR: 1.20; CI (1.03, 1.39); p = 0.02)]. In 2004 through 2009, both men and women had higher proportion of DES than BMS implantation after AMI. However, there was no significant gender difference in stent type for these years, except in 2006 when DES implants (received within 1 week and 30 days of index AMI) were significantly more frequent in women compared to men. Conclusion: Although women are less likely to receive PCI compared to men after AMI, there is generally no gender difference in the proportion of DES versus BMS received in contemporary years.

A discourse analysis of trainee teacher identity in online discussion forums

Teacher education involves an identity transformation for trainees from being a student to being a teacher. This discourse analysis examined the online discussion board communications of a cohort of trainee teachers to better understand the situated identities of the trainees and how they were presented online. Their discussion board posts were the primary method of communication during placement periods and, as such, provided insight into how the trainees situated their identities in terms of being a student or being a teacher. During the analysis, the community boundaries, language and culture were explored along with the tutor’s power and role in the identity transformation process. This involved looking at the lexis used by the students, the use of pronouns to refer to themselves and others such as teachers and pupils, the types of messages allowed in the community and the effect of the tutor’s messages on their communication. The research found that the trainees felt comfortable with teaching but did not feel like teachers during the course. Tutors and school teachers need to develop an awareness of the dual nature of trainees’ identities and help promote the transition from student to teacher. In the beginning of the course, trainees should be familiarised with teacher vocabulary and practical concepts in addition to pedagogical theory. Towards the end of the course, trainee identity as teachers could be promoted through the use of authentic assessments that mirror real teacher tasks and requirements.

Collaboration to Change the Landscape of Nursing: A Journey between Urban and Remote Practice Settings

University Health Network (UHN) became a demonstration site to test a health human resource planning model to foster inter-organizational collaboration, knowledge transfer and exchange of nurses between an urban academic health science centre and a remote region in northern Ontario. Funding support was provided by the Ontario Ministry of Health and Long-Term Care. The partnership between UHN, Weeneebayko Health Ahtuskaywin (WHA) and James Bay General Hospital (JBGH) addressed retention, recruitment, professional practice development, planning and succession planning objectives. The primary goal of this partnership was to supply the staffing needs of WHA/JBGH with UHN nurses at a decreased cost for four- to six-week placement periods. This resulted in a marked decrease in agency use by approximately 40% in the WHA site during the months UHN nurses were practicing in the north, with an overall agency cost savings of $165,000 reported in the pilot year. The project also served as a recruitment and retention strategy for all organizations. It provided an opportunity to practice in new clinical settings and to engage in knowledge transfer experiences and professional development initiatives between remote and urban practice environments. In the pilot year, 37 nurses (30 from UHN and 7 from WHA) participated. They returned to their respective organizations re-energized by the different "landscape" of practice experience and toward the nursing profession itself.