Block versus integrated clinical placement - which model best facilitates learning in nursing?

Transcription

1 Block versus integrated clinical placement - which model best facilitates learning in nursing? Investigators/Presenters Professor Melanie Birks Mrs Tracy Bagley Co-investigators Dr Tanya Park Assoc Prof Jane Mills

2 Background Integrated models may narrow the theory-practice gap giving students continuity and consistency in clinical practice (Kevin et al., 2010) Hauer et al. s (2012) comparison of block and integrated placements in medicine found that the latter provided greater opportunities for growth into the professional role Walters et al. (2012) concluded that longitudinal integrated clerkships are now recognised as representing credible and effective pedagogical alternatives to traditional block rotations in medical education (p. 1028). In nursing, block placements are widely used based on arguments of consolidation, efficiency and cost-effectiveness There is little evidence to support the efficacy of one model over another

3 Research aims This study aims to: examine current models of block, integrated and mixed approaches to clinical nursing education identify specific factors that contribute to or detract from learning with each approach increase the efficiency and cost-effectiveness of clinical placements improve the clinical placement experience for students in pre-service nursing programs

4 Study design Descriptive exploratory study Focus group interviews using tutorial-type activities 12 institutions approached to participate 4 sessions/22 participants Data gathered via partial audio recording and tutorial materials Demographic information collected via survey for descriptive presentation Interview data and materials subjected to thematic analysis

5 Preliminary results Demographics Strengths and weaknesses of each approach Factors that contribute to or detract from learning

6 Demographics Age Gender Range years Male 9% Mean Female 91% Mode of enrolment Enrolment status Part time 41% On campus 23% Full time 54.5% Off campus/mixed 45% Not stated 4.5% Not stated 32%

7 Issue Block Integrated Consolidation of learning Continuity of learning Ability to apply theory to practice Learning opportunities Staff/facilitator motivation Familiarity with staff/facility Opportunities for shiftwork Study/life balance Ability to maintain employment Managing course commitments Preventing fatigue/burnout Establishing confidence in buddy Facility preference Opportunity for orientation Greater variety/staff diversity Less financial burden

8 The best placement

9 That s what makes it good, when you do have that RN who understands and supports your learning. Our first one was a good mentor, so having someone there that trusts you shows you the right tools and explains things to you makes your experience a lot better. we had a very supportive facilitator, who really did stand up for us and went into bat for us to ensure that we got the placement we needed and deserved. The best thing that happened to me was I had a nurse who said, okay, you write the plan, I'm following you today, you're running the shift.

10 I had a nurse, well my CNC actually, go home, do research for me and come back the next day with information for me that I had requested and she hadn't had the answer for. That makes you feel really good as well, because they follow up on what they say... They're furthering your education. They also don t want to give you the wrong information either. So that s really nice to have that. I wasn t even referred to as a student. I was referred to as a colleague. It made you feel so good when they introduced me, I wasn t introduced as this is the student, is she allowed to participate? It's this is my colleague, she would like to ask some questions, is that okay? Yep. Awesome. Then they wanted my feedback, they wanted my knowledge, they wanted to know what I thought, my opinion

11 The worst placement

12 I don t think I've done a placement yet where I haven't cried. I still went through every single day of that placement, every single day I fought through tears getting there. By the end, we were sitting in the car park counting down the minutes until we had to walk on that ward for handover. I was allocated to a placement where they didn't always have students. So I showed up. They didn't know I was coming and the two ladies said oh I'm not having a student and the other one said well I'm not having a student. So I stood [and said] well maybe I will go somewhere else. But for them to say that in front of me, they could have been a bit more professional.

13 On my last placement, we were walking in to start the shift and one of us heard one of the nurses saying at the nurses' station to all the other nurses oh great, here come the students and the rest started laughing. So straightaway, before we'd even begun, before they even got to know us or even gave us a chance, we'd already had that label on us, that oh, we're in the way, we're just such a burden, when really, we're there to help. the bullying that we got, we were crying, we were walking off halfway through a shift. In the end [the facilitator] actually told us to pack our bags and go to the library and do assignments and research because it was safer for us to come off that ward.

14 I've been abused. I've actually been physically handled and taken off a ward because I picked up a RN with a medication error and he wanted me to sign the medication form and it had no other signatures on it, it had nothing, and I wasn t going to do it because also, I wasn t the one who drew up the medication. He also wanted me to give an S8, without another RN present and I refused to do that because I wasn t in the room when it was drawn up. I didn t sign off the charts. I didn t know what it was, and when I questioned him on it, I was actually physically pulled out of the room and abused and I was taken into the drug room and in front of everyone I even had a patient afterwards, because I went back onto those patients, and they said I am so sorry you had to go through that. I think I'm generally pretty quick, but she was rushing me so much that my hands were shaking and I couldn t think about the meds I was giving. You know what she did to calm me down, she said stop shaking!. She whacked me on the arm like that and I thought well that s not helping.

15 Discussion/Conclusions Advantages and disadvantages to each approach Various other factors contribute to and detract from learning Efficiency and cost-effectiveness are secondary considerations Placement model is inconsequential in the absence of positive facilitation, staff attitudes and culture Numerous implications for education, practice and research

16 References Hauer, K, Hirsh, D, Ma, I, Hansen, L, Ogur, B, Poncelet, A,... O Brien, B. (2012). The role of rote: learning in longitudinal integrated and traditional block clerkships. Medical Education, 46(7), doi: /j x Kevin, J, Callaghan, A, Driver, C, Ellis, J, & Jacobs, B. (2010). A possible alternative model of clinical experience for student nurses. Journal for Nurses in Professional Development, 26(5), E5-E9. Norris, T, Schaad, D, DeWitt, D, Ogur, B, & Hunt, D. (2009). Longitudinal integrated clerkships for medical students: an innovation adopted by medical schools in Australia, Canada, South Africa, and the United States. Academic Medicine, 84(7), Walters, L, Greenhill, J, Richards, J, Ward, H, Campbell, N, Ash, J, & Schuwirth, L. (2012). Outcomes of longitudinal integrated clinical placements for students, clinicians and society. Medical Education, 46(11), doi: /j x