Empowering the Professionalization of Nurses through Mentorship (EmpNURS)

Empowering the Professionalization of Nurses through Mentorship (EmpNURS) Final Report Public Part 510111-LLP-1-2010-1-FI-ERASMUS-ECUE

Project information Project acronym: Project title: Project number: Sub-programme or KA: Project website: EmpNURS Empowering the Professionalization of Nurses through Mentorship 510111-LLP-1-2010-1-ERASMUS-ECUE Erasmus / Co-operation between Universities and Enterprises www.empnurs.eu Reporting period: From 01/10/2010 To 30/09/2013 Report version: 1 Date of preparation: 11/11/2013 Beneficiary organisation: Turku University of Applied Sciences (TUAS) Project coordinator: Dr. Mr Mikko Saarikoski Project coordinator organisation: Turku University of Applied Sciences (TUAS) Project coordinator telephone number: +358 50 598 5510 Project coordinator email address: mikko.saarikoski@turkuamk.fi This project has been funded with support from the European Commission. This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein. 2008 Copyright Education, Audiovisual & Culture Executive Agency. The document may be freely copied and distributed provided that no modifications are made, that the source is acknowledged and that this copyright notice is included. 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 2 / 16

Executive Summary The EmpNURS project is for benefiting nurse educators and student and qualified nurses in enabling them to experience a learning supervision model. The end-users of the project are qualified nurses, student nurses and academics working in a clinical practice. The consortium consists of 11 full partner organisations. Seven of these are higher education institutions (HEI) and four are teaching hospitals working at close cooperation together. Involving countries are: Czech Republic (CZ), Finland (FI), Hungary (HU), Lithuania (LT), Romania (RO), the Netherlands (NL) and United Kingdom (UK). Design of the EmpNURS project: (1) Basic exploration of clinical practice in four teaching hospitals in Brno, Budapest, Iasi and Kaunas, (2) Planning the Mentorship training course for clinical staff nurses, (3) Piloting the Mentorship programme (4 pilots), (4) Evaluation of the pilot process using qualitative and quantitative methods and (5) Dissemination of the results. Contextual planning of the Mentorship training course has been done by three partners (NL, LT and UK) during the autumn 2011. The measurements of the influences of EmpNURS project were been undertaken using both quantitative and qualitative methods. In particular the evaluation will assess the increased cooperation between health care services and education, and the impact upon the professional empowerment of nurses especially in joining HEIs and hospital organisations. Continuous management (FI) has been operated mostly using by virtual working platform Optima. Almost all communication and documentation (also reporting and supporting documents) during the process has been taken place there. All delegates of the EmpNURS network use it actively. Exploration of current supervisory practices (FI) has been carried out by quantitative web-based-survey (study1) in CZ, HU, LT and RO in spring 2011. Differences between the old and new EU countries were remarkable. The quality assurance of the EmpNURS is carried out so that it is consistent by internal and external evaluation. All partners reflect all activities and products. Responsibility of the contextual aims of the project (e.g. empowerment process among nurses) is on partners who carry out the Mentorship pilots. The common level quality assurance as the role of external evaluation - has been carried out by two experienced delegates of the network who do not join the Mentorship pilots but rather have long lasting experience parallel development process in the UK. The anticipated project outcomes are: improved supervision skills of qualified nurses; a homogeneous range of Mentorship models; enhanced integration of education and practice organizations and promote congruity of European nurse education. The EmpNURS seeks permanent cultural influences. The preliminary results of the actual evaluation report shows positive responses from student-mentors as well as student nurses. 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 3 / 16

Table of Contents 1. PROJECT OBJECTIVES... 5 2. PROJECT APPROACH... 6 3. PROJECT OUTCOMES & RESULTS... 8 4. PARTNERSHIPS... 12 5. PLANS FOR THE FUTURE... 13 6. CONTRIBUTION TO EU POLICIES... 14 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 4 / 16

1. Project Objectives The EmpNURS project was for benefiting nurse educators and student and qualified nurses in enabling them to experience a learning supervision model. It both supported and promoted nursing as a profession and its practice by empowering present and future practitioners. Nursing profession contributes strongly with other professions to delivery of patient care. Targets (=end-users) of the project were qualified nurses, student nurses and academics working in a clinical practice. The specific aims were: to improve the quality of nurse education by advancing a new supervision culture of student nurses during their clinical practice to increase the readiness of health care staff to act as supervisors and mentors for student nurses during their clinical placements to pilot a Mentorship model developed by the project partner organisations in the collaborating hospitals and universities of 4 moderately new EU countries to evaluate the preliminary Mentorship model in relation to changes in current practice and future developments Benefits to nursing profession: The EmpNURS consortium consisted of 11 full partner organisations. Seven of these organisations were higher education institutions (HEI) and four teaching hospitals working in close cooperation together. Organisations are locating in Czech Republic (CZ), Finland (FI), Hungary (HU), Lithuania (LT), Romania (RO), the Netherlands (NL) and United Kingdom (UK). The Mentorship programmes included training courses for clinical staff nurses and implementations with students occurred in Brno (CZ), Budapest (HU), Kaunas (LT) and Iasi (RO). There were working pairs: a delegate from HEI and from hospital, which operated the local Mentorship pilots. The Mentorship programme enhanced empowerment of nursing profession in these four local areas and the main beneficiaries were the clinical nurses who joined the programme. Each Mentorship pilot met the cultural, professional and organizational needs of the participating partners. Impacts: The project sought to improve the supervision skills of qualified nurses and to develop a homogeneous Mentorship model. The project advanced congruity of mentorship practices in the four joined HEIs and their teaching hospitals. The pilots promoted permanent cultural exchange in these organizations. According the qualitative data collected during the pilots (e.g. learning diaries and portfolios), the project got clear evidence that strong empowerment development process started among the clinical nurses who joined the programme. During the workshop meetings hospital visits the students joined the pilots have given extremely positive feedback from their experiences as mentee. Successful Closing Seminar (the 6 th September 2013) with over 100 delegates from eight European countries gave evidence that project s message has been received among nurse educators widely in Europe. 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 5 / 16

2. Project Approach Design of the EmpNURS project: 1. Basic exploration of clinical practice in four teaching hospitals in Brno, Budapest, Iasi and Kaunas 2. Planning the Mentorship programme (including training course for clinical staff nurses and experiments among students) 3. Piloting the Mentorship programme (4 pilots) 4. Evaluation of the pilot process using quantitative and qualitative methods 5. Dissemination of the results Methodologies: The measurements of the influences of EmpNURS project were undertaken by using both quantitative and qualitative methods. In particular the evaluation assessed the increased cooperation between health care services and education, and the impact upon the professional empowerment of nurses especially in joined higher education institutions (HEI) and hospital organizations. Basic exploration (study 1) of current practices of student supervision in clinical practice was carried out during the spring 2011. The empirical study explored students (N=418) experiences during their clinical placements. The study gave a common picture of current practices in four teaching hospitals in CZ, HU, LT and RO before the project interventions. Completely same survey (study 2, spring and autumn 2012) was carried out among students who had taken part to the pilots (N=58). These research results were compared with the results got from the basic exploration in study 1. Remarkable structural changes in supervision practices had occurred. The research instrument used in the survey was the Clinical Learning Environment and Supervision (CLES+T) evaluation scale. It is a validated research instrument, which can be used as a part of the total quality assessment of nurse education. The CLES+T scale has been validated within a wide European study earlier (Warne et al. 2010. An exploration of the clinical learning experience of nursing students in nine European countries. Nurse Education Today 30; 809-815). The questionnaire was translated into the needed four languages of the study participants. A contact person in each university-hospital working pair sent the electronic questionnaire s web-link using e-mail to the students at the end of their clinical placement. The results of the explorative study were used in the planning of the contents of Mentorship programme. The local Mentorship pilots produced also rich and multidimensional qualitative data collected from the student-mentors, the course teachers, the student nurses and ward-managers. These kind of qualitative materials were learning diaries, self-evaluation documents and group interviews. These kinds of methods are valid when evaluating changes and development on experimental level of individuals. In qualitative analysis the open coding method (Strauss & Corpin 1990; Morgan 1997) was used. Process of all pilots outcomes was evaluated. 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 6 / 16

Evaluation strategy: The quality assurance of the EmpNURS has been based mainly on internal evaluation. The project s design the close cooperation between clinical staff nurses and students - has offered a lot of external views for project partners in HEIs and hospitals. External feedback and comments has been got also via many dissemination events (meetings and conferences). All partners have reflected inputs, activities and products together. Responsibility of the contextual aims of the project (e.g. empowerment process among nurses) was on partners who carried out the Mentorship pilots. The products of these pilots acted as internal evaluation inputs. The workshops and projects own reporting periods acted as interim evaluation milestones. The common level quality assurance as the role of external evaluation - has been carried out by two experienced members of the network who did not joined the Mentorship pilots but rather have a long experience parallel development process in the Salford University (UK). Because the evaluators were a part of the network they had a possibility to monitor the process in all action steps and forums of the project (e.g. in meetings and virtual working platform Optima). The role and approach of the evaluators (membership in network and contextual interest) maybe influenced that the process evaluation got lesser interest (e.g. timetables or some adjustments in the plan). Dissemination and exploitation strategy: The dissemination and exploitation actions were mandated to two project partners. These partners were GYEMSZI from Budapest, Hungary, and Gr. T. Popa Medical University from Iasi, Romania. The project emphasised to reach stakeholders in all administrative levels in four joining countries who can create the national frame for the Mentorship programme. The key recipients in this process are local decision makers and practical actors in health care services. The project has used public media (TV and radio spots, public newspapers), EmpNURS web-sites, personal contacts and professional forums (journals, conferences, meetings, flyers and posters). EmpNURS network has contacted also professional organisations like European Federation of Nurse Educators FINE. The basic dissemination level of EmpNURS which has been described in the plan has been achieved because the Mentorship programme has been established its role as crucial method of clinical teaching in HEIs and hospitals joined the project. It has also become a permanent action model. The partners have started to disseminate and exploitate the project results in other hospitals and HEIs in their countries. Still, there has been notable differences between the Network countries, how Dissemination has progressed. E.g. in Romania, the process has been active; new training programmes have started and local EmpNURS beneficiary has got the direct link to the Parliament of the country. Some law suggestions have already been made to develop the nurse education system in Romania. The important operative tool in dissemination of EmpNURS results is Mentorship programme package as open access format available for all interested via Internet. It has been produced as open-access publication via Turku University of Applied 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 7 / 16

Sciences Publications together with the project network. It has been published on the 6th of September 2013 (Closing Seminar). At the end of reporting phase, 220 uploads from the web-site have been occurred. The EmpNURS Mentorship Programme Handbooks are available on the project s website www.empnurs.eu (the lowest link in the Homepage s left frame): Handbooks for Mentoship Course. From there the site-visitors can download and print if needed the electronic volumes. Fundamentally, this electronic publication has been located permanently in the TUAS s electronic publications data-base as Open-access publication. (http://julkaisut.turkuamk.fi/empnurs_start_here.pdf). The volumes and their ISBN numbers in that starting page act as straight links to the final material. The publication can be find also with a common Google searching using terms EmpNURS + publication ; 3 from 5 first searching hits link to this publication. 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 8 / 16

3. Project Outcomes & Results EmpNURS project produced Mentorship programme that contained four training courses for staff-nurse mentors and four local pilots for students in Brno, Budapest, Iasi and Kaunas. 51 mentors were trained and 58 student-nurses got mentorship experience in their clinical practice. According the main results, the project progressed by the plan; focus of supervision moved from group supervision to individual supervision and supervising staff was mainly clinical staff nurses instead when earlier supervisors were assistant doctors or ward-managers. Working role of clinical nurses strengthened and became more independent. This transition can be interpreted as empowerment development. Project outcomes and results that are presented in this report by each work packages: Management Continuous management (FI) has been operated mostly using by virtual working platform Optima. This solution was chosen because platform like Optima acts also as an archive of all project documentation. Nearly all communication and documentation (also reporting and supporting documents) during the project has been taken place there. All delegates of the EmpNURS network have used it actively. At the end of the EmpNURS there are 20 active members who have leaved approx. 2200 messages during the project s lifespan. Number of documents in the forum is approx. 1200 and they have been opened approx. 23 000 times. Usage of personal e-mails as communication tools has been minimal. Optima serves execution of all deliverables (N=23) of the project. Project websites (www.empnurs.eu) has been established in the beginning of 2011. In October 2013 there have been over 7300 visitors (the calculator accepts one IP-number only once). The project network kept six workshop meetings (three for HEI and hospital partners, three only for HEI partners) and two extra meetings for targeted small groups (pilot leaders). Kick-off meeting was held in Turku (FI) in November 2010. Turku University of Applied Sciences coordinated this Final Report. Exploration of current practices Exploration of current supervisory practices (FI) has been carried out by quantitative web-based-survey (study 1) in CZ, HU, LT and RO in spring 2011. The CLES+T evaluation scale has been translated into 4 languages, analysis has been made and reported. The students total satisfaction correlated most strongly with the supervisory model; most satisfied students had an experience of individualised supervision. Planning the training course for mentors Mentorship training course is crucial part of Mentorship programme which is the most important product of the EmpNURS project. The course were planned by two partners (Windesheim University of Applied Sciences, NL and University of Health Sciences, LT) and assisted by experienced internal evaluator. The wide literature review gave clear evidence and foundation for the structure of Mentorship training course in EmpNURS pilots in four countries (CZ, HU, LT and RO). The country specific modifications were taken into account if needed. The Mentorship course 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 9 / 16

structure is five days in total: 4 full days for the theory and learning, then all participants undertake their practice experience with students followed by 1 day to evaluate, assess learning and evaluate experience. There are four different type course materials: Introduction for Mentorship programme implementation, package for teachers, package for student-mentors and package for student-nurses. Additionally there are evaluation tools which will be used for collecting quality feedback from the coming participants. In the pilots the English language original material was translated for needed languages by course teacher and studentmentors. Execution of Mentorship pilot Mentorship training courses and pilots took their places in different time periods from spring to autumn 2012 in all participating cities. Every participating hospital kept info briefing about the Mentorship programme and course for clinical staff nurses. The numbers of voluntary student-mentors and student-nurses fitted together. All pilots, excluding Budapest Rehabilitation Hospital, were capable to offer the Mentorship programme as a part of professional advancement (without extra salary). In Budapest the student-mentors got a little extra salary during the pilot. Together with participating universities and their teaching hospitals the Mentorship programme reached total 51 student-mentors and 58 student-nurses. These values are a little bit lower than expected in the project plan. In the original project plan an idea about the common social media (e.g. Facebook) forum had been presented. However there were two main reasons why this did not success: pilots did not timely overlap with each other and secondly the English language skills of participating students were not good enough. Synthesis of the Mentorship model The lead of making the synthesis was mandated to Masaryk University, Brno (CZ). For the synthesis the leading partner collected experiences and used draft materials from all four pilots. According the guidelines the pilot leaders summarized their experiences of their own, student-mentors experiences, student-nurses experiences and ward-managers experiences. The synthesis made in Brno was used as a base for final material for Mentorship programme. The material can be found from: http://julkaisut.turkuamk.fi/empnurs_start_here.pdf. The material presents the good practices developed. The extra meeting between pilot leaders and material constructors had a crucial role in summarizing the main finding of the project. Dissemination and exploitation Lead partner in dissemination action has been Gr T Popa University of Medicine and Pharmacy in Iasi (RO). Members of the network have reported 90 dissemination acts during the project s life span. They have served different valorization arenas: internal and customer arenas, arena of developers and researchers, administration arena and public media. Dissemination act summary includes media spots, websites, short articles, national meetings, project workshops, submitted papers, international conferences (NET2011/Cambridge, UK; CLES+T symposium 2012 / Stockholm, SE; FINE2012 / Cardiff, UK; NETNEP2012 / Baltimore, US and The Eden Conference in Oslo, NO) and national network presentations, discussions and contacting people. The project has delivered EmpNURS Closing Seminar flyers (500 pieces) and project abstracts (300). Public audience dissemination has used mainly web-based tools. 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 10 / 16

EmpNURS project has been demonstrated as a good project example in Finnish LLP promoter CIMO website: http://www.cimo.fi/ohjelmat/erasmus/kokemuksia/kokemus6 Quality assurance of the project Evaluation took place along the project using both quantitative and qualitative methods. The modified Clinical Learning Evaluation Scale (CLES) has been used as quantitative evaluation tool in basic exploration (study 1) and evaluation after project interventions (study 2 after the pilots). This valid research instrument gave evident information about development of supervisory practices during students clinical placements. According the measurements the role of clinical staff nurses as mentors has increased during the process and traditional actors (ward manager and nurse teacher) roles have changed more indirect enabling better learning conditions for students learning. Qualitative data like project diaries and students portfolios offered a perspective to their empowerment development during the national pilots. Also student-mentors training and evaluation sessions offered clear evidence for interpretation that also their professional empowerment had increased during their experimental roles when acting as mentors. Nearly all trained mentors who have taken part to process have committed to new (or potential coming ones) mentorship experiments in future as well. Achieving the aims of the project has been ensured by WP8. However the procedural continuation of the project has been ensured by good management. In this task careful obeying the Project Handbook and good co-operation with the Agency has enabled the fluent project progress in currant time and financial frames. 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 11 / 16

4. Partnerships Partnership in EmpNURS project worked well and all partners of the project endured through the project s lifespan. Only in one partner occurred personnel changes. Every joining organisation had something usable issues in their own practices which they shared with the other project partners. There were no silent or sleeping partners and this could be seen also in statistics of virtual working platform Optima and project group meetings as well. The project had three hospitals which acted as associated partner in the EmpNURS. These contacts were used especially during the workshops when the primary partners met clinical and student nurses when visiting the hospitals. EmpNURS got one unplanned partner when the plans for Closing Seminar were under the work. The role of Semmelweis University (new associated partner in HU) was important because they enabled successful seminar with big audience in Budapest (over 100 delegates). Second link to Semmelweis University came from local pilot in Budapest. The students in the pilot came mainly from the University besides GYEMSZI. Few professional associations were faced during the project and importance of that kind of organizations became clear to project consortium when widening the professional empowerment of nursing. The emergent transnational dialogue was rich in both personal and professional meaning and purpose, and partners gained from personal and professional friendships and collaborative futures. Although there were partners from both old and new developing EU countries, the project spirit was excellent and there were not any serious confrontations between different cultures. Originally English language skills were in quite different levels among the partners. When finishing the project, the language skills and cultural understanding have increased in all partners and network members. These kinds of contacts have established a base for professional growth and empowerment inside the nursing profession in EU. In overall many cultural prejudice and bias were won during the project. 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 12 / 16

5. Plans for the Future Role of nursing profession is increasing in past Eastern Europe. Even the training system has moved to universities, its status is still partly dominated by medical profession on educational and practical fields. It is important that nursing based lecturers should act as trainers in departments where nurses are trained; nurses must train nurses. Without that kind of attitude the independent status of profession cannot be increased. Also in clinical practice is important that supervisors of students are nursing based staff not physicians. In the pilots of EmpNURS this aim was achieved but still in many new EU countries the situation is similar like it was before in the piloting hospitals of EmpNURS. This is one of the biggest reasons why the results of EmpNURS must be disseminated effectively also in other new EU countries. This work has already started in the countries that joined the EmpNURS project. New experiments of produced Mentorship programme have started in two of HEI-hospital pairs already during the project (Brno, CZ and Iasi, RO). So in two partner pairs there are on-going new local consortiums where the Mentorship programme is replicated. Similar plans are in agenda also in Kaunas, LT and Budapest, HU. In overall it is important that Mentorship programme has been established its permanent role in all university-hospital pairs that joined the EmpNURS project. In the final phase of the project there are over 150 new mentors in the joined teaching hospitals. The original aim of the project was 80 trained new mentors. In two partner countries in Czech Republic and Romania real lobbying activities of EmpNURS has been started. Local university partner in Brno has presented the results of EmpNURS to local and national authorities of health care. One network member in Iasi, Romania has been Parliament member since 2012 and has started the process to change the national educational law that nurses can act as studentmentor in clinical practice. At this moment the situation is unclear and often the supervisors are physicians, not nurses. Interpretation in this matter in EmpNURS has been that supervision of student-nurse in clinical practice is not teaching, rather being guiding and helping in practical issues. There have been promising discussions with the colleagues from other potential countries where the Mentorship programme should be needed. These countries are e.g. Estonia, Germany, Latvia and Russia. 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 13 / 16

6. Contribution to EU policies One aspect of the project was to promote the principles relating to European education policy. The project offered new skills for clinical nurses who can act as supervisors and mentors for student nurses in the future. This is a part of modernisation development within European nursing education that seeks congruence, and in so doing promote an empowered and better educated nursing profession in collective level. In individual level the project offered nurses the skills, knowledge and competencies which enable them to work in new ways. For a single nurse her/his experience in EmpNURS can act as an impulse to work abroad. The EmpNURS enhanced integration of education and practice organizations and promote congruity of European nurse education in co-operation between HEIs and health care service organizations. Empowered profession is a profit to both parties. In a big picture the competent and empowered health care staff guarantees in its part the high quality of health care services in the EU. In doing so it also benefits the growth and competitiveness of Europe. 510111-LLP-1-2010-1-FI-ERASMUS-ECUE 14 / 16

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