Training Ward Research Articles

Pattern of Hepatitis A Virus Epidemiology in Nursing Students and Adherence to Preventive Measures at Two Training Wards of a University Hospital.

BackgroundNursing students can be exposed to patients with hepatitis A virus (HAV) and can represent a vehicle of transmission both for health personnel, patients and relatives.ObjectivesThe aim of this study was to assess the risk of HAV infection in nursing students during their internship.Patients and MethodsA seroprevalence survey on HAV infection was performed on nursing students at the Cagliari university-hospital, together with the assessment of the compliance to preventive measures to decrease the risk of infection during their internship. Blood specimens were obtained from 253 students. All serum samples were tested for anti-HAV antibodies (IgG) by the enzyme-linked immunosorbent assay (ELISA). Compliance to preventive measures was recorded by trained personnel.ResultsOverall HAV seropositivity in nursing students (mean age 24, range 17 - 45 years) was 3%. Compliance to preventive measures was not uniform (6% - 76%) and extremely low in some specific measures targeted to decrease the oral-fecal transmission.ConclusionsThe high proportion of susceptible nursing students can contribute to an increase in the risk of nosocomial transmission, especially when specific preventive measures are not completely applied. Nursing education packages, before starting medical internship, should be implemented in order to increase their compliance to preventive measures, especially in wards at higher risk. Vaccination should be considered in wards at higher risk.

Impact of Interprofessional Education for Medical and Nursing Students using Simulation Training and a Training Ward: A German Pilot Study

Background: Interprofessional teamwork has become increasingly important to provide patient centered care. Physicians and nurses as two major professions are needed to be adequately qualified. Interprofessional Education (IPE) is an eligible approach. Nevertheless, there is a lack of the impact for both professions. Therefore, we implemented and evaluated simulation training and a collaborative working sequence on a training ward. The aim was to analyze the course structure and assess learning effects to evaluate the suitability for IPE. Methods: A mixed methods study with a sequential explanatory design was conducted. A total of five medical and five nursing students were involved. Students completed questionnaire based interviews after IPE lectures. Two group discussions were conducted to specify and expand quantitative evaluation results. For descriptive statistics, we used the software package SPSS. Both group discussions were analyzed by a qualitative content analysis using the software MAXQDA. Results: Students rated IPE predominantly positive. The learning contents broadness and the links between theory and practice. Students identified six core learning effects: (1) Realization of the importance for collaborative working; (2) Gaining knowledge about the roles of both professions; (3) Realization, that interprofessional care facilitates work; (4) Practicing communication between physicians and nurses; (5) Improving collaborative communication with the patient; and (6) Understanding chances and challenges of joint decision making. Nevertheless, students suggested improvements, e.g., the scenarios of the simulation training should be expanded. Conclusion: The results provide clear evidence that IPE by simulation training and a training ward is feasible and well accepted by students in a German medical school. Results can be used to adapt IPE lectures and to implement them for a larger number of students. The next step is to generalize findings and to sustainably implement IPE in both curricula.

Does gender matter? Differences between students at an interprofessional training ward

Studies on graduates’ transitions from education into clinical work highlight inequalities concerning how women and men experience their professional learning and development. This study explores how female and male students from different programs within the health care education system (i.e. medicine, nursing, occupational therapy, and physiotherapy programmes) experience an interprofessional training ward (IPTW) as a part of their professional identity formation. Students from the medicine, nursing, physiotherapy, and occupational therapy programmes collaborate in teams during two weeks at one of three IPTWs at the medical school, Linköping University. They together take the responsibility for diagnosis, treatment, and rehabilitation of the patients, albeit with professional supervisors as support. During 2010 to 2011, 454 (93%) of the 488 students who practiced at the IPTWs answered a questionnaire on their experiences of the IPTW. The students stated that the IPTW had positively influenced their professional development. The female and male medical students were significantly less positive than other female and male students, respectively, concerning the value of IPTW. The male students from all programmes were slightly, but significantly, less positive than all the female students. These findings show that students “do gender” as an integral part of the educational practice. It is important to scrutinise the IPTW as an educational practice, influencing students’ preparation for future work. Gender should be discussed not only during the IPTW rotation but also in general during the curriculum for all healthcare programmes.

A collaborative approach to training ward nurses in acute care skills in resource limited settings: the nursing intensive care skills training (nicts) project

Early recognition and prevention of deterioration of ward patients can improve patient outcomes and reduce critical care admissions [1]. In low and middle income countries (LMICs), with often minimal access to critical care therapies, the benefit may be even greater. However training to assist ward nurses develop acute care skills remains limited in such settings. As part of the NICST portfolio of acute care training, the Sri Lankan nursing faculty sought assistance to deliver a 2 day course for ward nurses [2].

Evaluation, outcomes and education

Evaluation, outcomes and education

Teaching teamwork: an evaluation of an interprofessional training ward placement for health care students.

The establishment of interprofessional teamwork training in the preprofessional health care curriculum is a major challenge for teaching faculties. Interprofessional clinical placements offer an opportunity for teamwork education, as students in various professions can work and learn together. In this sequential, mixed-method study, focus group and survey techniques were used to evaluate students’ educational experiences after 2-week ward-based interprofessional clinical placements. Forty-five senior nursing, medicine, and other health care students cared for patients in hospital wards under professional supervision, with nursing-medicine student “teams” leading care. Thirty-six students attended nine exit focus groups. Five central themes that emerged about training were student autonomy and workload, understanding of other professional roles, communication and shared knowledge, interprofessional teamwork/collaboration, and the “inner circle”, or being part of the unit team. The learning environment was described as positive. In a postplacement satisfaction survey (n=38), students likewise rated the educational experience highly. In practicing teamwork and collaboration, students were able to rehearse their future professional role. We suggest that interprofessional clinical placements be regarded as an essential learning experience for senior preprofessional students. More work is needed to fully understand the effect of this interactive program on students’ clinical learning and preparation for practice.

Measuring students perceptions of interprofessional clinical placements: Development of the Interprofessional Clinical Placement Learning Environment Inventory

Pre-professional healthcare courses, including nursing, are increasingly focused on interprofessional learning and experimentation with clinical education in ‘training wards’. This involves students from at least two disciplines who, under supervision, are responsible for patients' care. There is no consensus on how students' clinical learning experiences in this context are evaluated. We report the development and testing of the Interprofessional Clinical Placement Learning Environment Inventory (ICPLEI) in the Australian context. A question set was developed to measure student's perceptions of key variables in an interprofessional clinical learning environment: orientation, supervision, roles, learning and autonomy. An expert nursing panel rated items for a Content Validity Index of .93. Reliability was tested with 38 students. After a 2-week interprofessional ward placement nursing, medical and allied health students (n = 38) rated their learning environment highly, with median responses 4 or 5 of five (mean total 83%). The scale was reliable with a Cronbach alpha of .80 and moderate item-to-total correlations for 22/26 items. The Interprofessional Clinical Placement Learning Environment Inventory is a reliable, feasible, fast to complete tool, suitable for use with pre-registration healthcare students in this setting. Further testing of the tool's psychometric properties is recommended.

An Australian hospital-based student training ward delivering safe, client-centred care while developing students’ interprofessional practice capabilities

Royal Perth Hospital, in partnership with Curtin University, established the first interprofessional student training ward in Australia, based on best practice from Europe. Evaluation of the student and client experience was undertaken. Feedback from all stakeholders was obtained regularly as a key element of the quality improvement process. An interprofessional practice program was established with six beds within a general medical ward. This provided the setting for 2- to 3-week clinical placements for students from medicine, nursing, physiotherapy, occupational therapy, social work, pharmacy, dietetics and medical imaging. Following an initial trial, the training ward began with 79 students completing a placement. An interprofessional capability framework focused on the delivery of high quality client care and effective teamwork underpins this learning experience. Quantitative outcome data showed not only an improvement in students’ attitudes towards interprofessional collaboration but also acquisition of a high level of interprofessional practice capabilities. Qualitative outcome data from students and clients was overwhelmingly positive. Suggestions for improvement were identified. This innovative learning environment facilitated the development of the students’ knowledge, skills and attitudes required for interprofessional, client centred collaborative practice. Staff reported a high level of compliance with clinical safety and quality.

Students' experiences of collaboration during and after an interprofessional training ward course: a mixed methods study

The objective of this study was to obtain a deeper understanding of how students experience and perceive interprofessional collaboration connected to their learning activities during and after an interprofessional clinical course.

One site fits all? A student ward as a learning practice for interprofessional development

Interprofessional training wards (IPTWs), aiming to enhance interprofessional collaboration, have been implemented in medical education and evaluated over the last decade. The Faculty of Health Sciences, Linköping University has, in collaboration with the local health provider, arranged such training wards since 1996, involving students from the medical, nursing, physiotherapy, and occupational therapy programs. Working together across professional boundaries is seen as a necessity in the future to achieve sustainable and safe healthcare. Therefore, educators need to arrange learning contexts which enhance students’ interprofessional learning. This article shows aspects of how the arrangement of an IPTW can influence the students’ collaboration and learning. Data from open-ended questions from a questionnaire survey, during autumn term 2010 and spring term 2011 at an IPTW, was analyzed qualitatively using a theoretical framework of practice theory. The theoretical lens gave a picture of how architectures of the IPTW create a clash between the “expected” professional responsibilities and the “unexpected” responsibilities of caring work. Also revealed was how the proximity between students opens up contexts for negotiations and boundary work. The value of using a theoretical framework of professional learning in practice within the frames of healthcare education is discussed.

Capturing students' learning experiences and academic emotions at an interprofessional training ward

An important goal for interprofessional education (IPE) in clinical settings is to support healthcare students in collaboratively developing their understanding of interprofessional teamwork. The aim of this study was to investigate students' learning experiences and academic emotions as they occur in actual context in relation to collaborative and trialogical activities during a clinical IPE course. The contextual activity sampling system methodology was used to collect data via mobile phones. Thirty-seven healthcare students (medical, nursing, physiotherapy and occupational therapy) reported their experiences, learning activities and academic emotions several times a day via their mobile phones during their 2-week course at an interprofessional training ward (IPTW). The results provided understanding of the students' experiences of their academic emotions and how they created new knowledge collaboratively. These collaborative knowledge creation activities occurred mostly when students from different professions were collaborating as a team (e.g. discussing patient care or participating in a ward round) and were also significantly related to optimal experiences, i.e. “flow” (high challenge in combination with high competence). In conclusion, these results emphasize the importance of collaboration among students during IPTW courses. Our results might help to optimize the design of IPE learning activities in clinical healthcare contexts.

Introducing and adapting a novel method for investigating learning experiences in clinical learning environments

The Contextual Activity Sampling System (CASS) is a novel methodology designed for collecting data of on-going learning experiences through frequent sampling by using mobile phones. This paper describes how it for the first time has been introduced to clinical learning environments. The purposes of this study were to cross-culturally adapt the CASS tool and questionnaire for use in clinical learning environments, investigate whether the methodology is suitable for collecting data and how it is experienced by students. A study was carried out with 51 students who reported about their activities and experiences five times a day during a 2-week course on an interprofessional training ward. Interviews were conducted after the course. The study showed that CASS provided a range of detailed and interesting qualitative and quantitative data, which we would not have been able to collect using traditional methods such as post-course questionnaires or interviews. Moreover, the participants reported that CASS worked well, was easy to use, helped them structure their days and reflect on their learning activities. This methodology proved to be a fruitful way of collecting information about experiences, which could be useful for not only researchers but also students, teachers and course designers.

A review of undergraduate interprofessional simulation-based education (IPSE)

Interprofessional simulation-based education (IPSE) is becoming an increasingly popular educational strategy worldwide within undergraduate healthcare curricular. The purpose of the literature review was to examine qualitative, quantitative and mixed/multi-method research studies featuring undergraduate IPSE. A literature review was conducted using CINAHL, MEDLINE, and PsycINFO databases from January 1999 to September 2011 and pre-set criteria. The criteria used to screen all 120 abstracts included: (a) the article pertained to both simulation and undergraduate IPE and (b) the article reported a research study. Eighteen articles which met the pre-set criteria were included in the literature review. All studies featured outcome measures; many were purposely designed and lacked psychometric development and evaluation. Key IPSE drivers included capacity planning, preparedness for disaster management and improving patient care through the evaluation of teambuilding, teamwork skills or communicating within inter-disciplinary teams. Studies evaluated/explored either student or teacher perspectives of learning within the context of IPSE or both. The IPSE learning processes varied considerably in relation to duration, fidelity and professions involved. The scenarios ranged from managing adults admitted to hospital settings, mass casualty/mock disaster patient management to the use of training wards. The majority of the articles identified common IPSE outcomes relating to increased confidence, knowledge, leadership, teamwork, and communication skills. Based on the findings of this review, the authors suggest that further multi-site, longitudinal research studies are required to provide evidence of the transferability of skills developed during IPSE and their overall impact on both undergraduate education and healthcare.

Konsequenzen aus der Evaluation eines chirurgischen PJ-Logbuchs

The current training programme for final year medical students does not meet the requirements of surgery and is obviously not able to encourage young physicians to become surgeons. After finishing the surgical trimester, the motivation to become a doctor decreases considerably more strongly than after any other specialty during the final year programme. This emphasises the urgent need for a consequent redesign involving modern educational programmes. The present article represents a systematic analysis of 70 logbooks used by final year medical students, which accompanied them during the surgical trimester from August 2008 to December 2009 at the Department of Surgery at the University of Greifswald, Germany. This analysis was subsequently compared to an evaluation of the same students as to how valuable the logbook was for their surgical education by means of an anonymous questionnaire. The results indicate that the general quality of education during the surgical trimester was evaluated to be high, but that the use of a logbook in the current mode did not contribute to enhance medical/surgical training programmes. Although most of the requested examinations and procedures were carried out by at least 70 % of the students, less than half of them had the impression that the use of this specific logbook improved their education. The students ask for a more intense interaction with the tutor/mentor and request differentiated discussions about their personal stronger and weaker spots, as well as more bedside teaching, e. g., the terms of training ward rounds with the consultant surgeon. Besides, they demand more supervised practical skill training in contrast to the often commonly practiced "learning by doing". The logbook is a powerful and effective educational tool able to structure and examine medical training and skills. But the present evaluation of the surgical logbook indicates that there is a need to adapt the current version to student's and institution's requirements. Otherwise it will only be seen as a purely labour intensive obligation, which will consequently lead to frustration and will not enrich the surgical training programme within the final year of medical school.

Preparation for becoming members of health care teams: findings from a 5-year evaluation of a student interprofessional training ward

Setting. An orthopaedic interprofessional training ward manned by students at a University Hospital.Objective. To assess to what extent students from different undergraduate programmes evaluated the effects of a 2-week rotation at the ward on their professional roles and the value of teamwork within health care.Method. A questionnaire was filled in by 841 students by the end of a 2-week rotation at the ward over 5 years. Questions concerned students’ estimate of how the rotation had strengthened their insight into their own future professional role, into other students’ professional roles and into the value of teamwork within health care. Differences between the different student categories and possible associations between the different estimates were statistically analysed.Results. Students from all programmes reported that the rotation at the student ward had dramatically strengthened their insight about their own future professional role as well as the roles of the other professions and the value of teamwork within health care.Conclusion. Health care is a complicated system based on cooperation and professionalism. We suggest that interprofessional training of students from all professions within health care should be a part of their education as a worthwhile preparation for their future professional work and to ensure high-quality health care.

The team builder: The role of nurses facilitating interprofessional student teams at a Swedish clinical training ward

Interprofessional education (IPE) is an educational strategy attracting increased interest as a method to train future health care professionals. One example of IPE is the clinical training ward, where students from different health care professions practice together. At these wards the students work in teams with the support of facilitators. The professional composition of the team of facilitators usually corresponds to that of the students. However, previous studies have revealed that nurse facilitators are often in the majority, responsible for student nurses’ profession specific facilitation as well as interprofessional team orientated facilitation. The objective of this study was to describe how nurses act when facilitating interprofessional student teams at a clinical training ward. The research design was ethnography and data were collected through participant observations and interviews. The analysis revealed the four strategies used when facilitating teams of interprofessional students to enhance collaborative work and professional understanding. The nurse facilitator as a team builder is a new and exciting role for nurses taking on the responsibility of facilitating interprofessional student teams. Future research needs to explore how facilitating nurses balance profession specific and team oriented facilitating within the environment of an interprofessional learning context.

Learning through participating on an interprofessional training ward

Learning in clinical education can be understood as a process of becoming a legitimate participant in the relevant context. Interprofessional training wards (IPTWs) are designed to give students from educational programmes in health and social care a realistic experience of collaboration for the purpose of developing teamwork skills. IPTWs have been found to be appreciated by the students and to influence students' understanding of each other's professions. The aim of this study was to describe and analyse the students' learning on an interprofessional training ward in care for older persons through focusing on the students' ways of participating in the communities of practice on the ward. A case study design was chosen. Multiple data sources were used. The findings show that the students engaged as active participants in the care. At the same time there was sometimes a discrepancy between on the one hand expectations and goals, on the other hand actual participation. There were difficulties in making the training relevant for all the student groups involved. The findings indicate that in the planning of interprofessional education the choice of setting and learning situations is crucial with regard to the learning that will occur.

Students’ learning experiences from interprofessional collaboration on a training ward in municipal care

AbstractOne way to offer students pursuing health and social care programmes realistic experiences of teamwork is interprofessional training wards where students from different educational programmes learn teamwork by working together. In the present study, a training ward in municipal care for older people was evaluated. Students from occupational therapy, nursing and social work programmes worked together on the ward for 3 weeks to learn with, from and about each other. The aim of the study was to compare students’ attitudes towards practice on a training ward before and after and to evaluate goal fulfilment after 3 weeks’ interprofessional education on a training ward. An attitude questionnaire was distributed to all students before and after their time on the ward, supplemented with a retrospective goal‐fulfilment questionnaire afterwards. The results show that the collaborative, social experience the training ward offers was appreciated by the students and in most respects, met the learning goals set up for the course. The most important learning experience was working together in a real‐life setting. However, there are some issues to take into consideration when planning and developing training wards. The setting needs to be realistic and relevant in relation to future roles for all of the student groups involved. The value and purpose of engaging together in basic patient care needs to be the subject of further investigation. When it comes to fostering competent team‐workers, training wards seem to be one way forward. But to fully understand the challenges and difficulties involved in planning these wards, the learning achieved must be understood in the context of the setting as a whole, in all its aspects.

Learning about each other: Students' conceptions before and after interprofessional education on a training ward

In interprofessional work the striving of the members of each profession to establish their own positive in-group identity can be a source of conflict and have a negative effect on care. To counteract this, interprofessional training wards (IPTWs) have been developed in Sweden. The aim of the present study was to investigate similarities and differences in how student nurses, student occupational therapists and student social workers perceived their own and the other two professions before and after clinical education on an IPTW. Sixteen students were interviewed before and after the training on an IPTW in municipal care for older people in Sweden. A coding scheme developed in an earlier study was used in the analysis of the interviews. The findings indicate that there are changes in the students' stereotyped views, enhancing understanding of each other's professions after three weeks' clinical education on the IPTW. In some areas, however, there are still discrepancies between the description of own profession and the others' understanding of this profession that need to be confronted. In interprofessional training during education in social and health care there needs to be a balance between on the one hand the particular professional identity, on the other the shared identity implied by membership of the health-care team focusing on a common goal.

Interprofessional Learning in Practice: The Student Experience

Interprofessional learning and the development of teamworking skills are recognised as essential for patient care and are also a government priority for undergraduate education. Sixteen occupational therapy students worked on an interprofessional training ward as part of their practice placement and three of them participated in an evaluation using the nominal group technique. Despite this small number, the evaluation identifies the value of this learning experience in giving the students an opportunity to appreciate the importance of interpersonal skills; to learn about other team members' roles; and to experience the challenges of working on a busy rehabilitation ward for older people.