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Enhancing Clinical Nursing Skill Acquisition in 1 st Year BNSG: Evaluation of a Real-Life Model of Learning. Report on 2007 ACU Teaching Development Grant Project By Sandra Simpson Jean Mukasa Stephen Guinea Jo Cameron Michelle Campbell With great thanks to Dr Frances McInerney.
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Enhancing Clinical Nursing Skill Acquisition in 1st Year BNSG: Evaluation of a Real-Life Model of Learning Report on 2007 ACU Teaching Development Grant Project By Sandra Simpson Jean Mukasa Stephen Guinea Jo Cameron Michelle Campbell With great thanks to Dr Frances McInerney
Background – Rationale for Project • Long-standing recognition of the need to provide nursing students with preparatory experiences prior to entering practice settings e.g. hospitals • Simulation models developed since mid-1980s and into the 21st century • Recent increased need to enhance the laboratory setting due to increased acuity of patients • Simultaneous increase in pressures around accessing sufficient hospital clinical placements • These needs identified formally in 2006 Department of Health Services (DHS) ‘Prepare Nurses for the Future’ Report.
Benefits of Laboratory-Focused Learning • Safe learning environment for acquisition and practice of skills • Less pressure from clinical and service-driven issues/priorities • Greater control over learning encounters that can be more specifically matched to novice students’ learning objectives
Challenges of Laboratory Focused Learning • Creating realistic, credible scenarios that reflect the clinical situation and • Enable student preparedness for the workplace • Enhance appropriate and skilled nursing care provision • Sustain student valuing of subsequent learning encounters • Innovations like Sim Man® have been designed to address some of these issues and enhance the authenticity of the clinical learning environment. • Simulators: • Can be programmed to meet a variety of needs/ scenarios • Allow for a controlled clinical practice environment • Enable the acquisition and development of clinical skills
The Human touch BUT SIMULATORS • Are not human • Are not the clinical environment • Have limited application for skills such as communication • Bouley & Medway (1999) and others note that such innovations cannot replace ‘real’ clinical experience • Because of this, these skills are usually practised on peers in the laboratory setting • Student peer groups generally do not exhibit the characteristics of the ‘average’ clinical client by either age or health status
Specific Student Needs in Relation to the Project • Skills development and practice that are difficult to develop via interaction with simulators or peers, e.g.: • Communication skills • Therapeutic relationship skills • Interview techniques • Taking a health history • Client education • Vital signs: Temperature, Blood pressure, pulse, and respiratory rate. • The above skills are of general relevance, but of particular importance for the International student cohort owing to specific challenges of English as a second language (ESL).
Project Proposal • AIMS • To enhance clinical nursing skills development • To bridge the gap between simulated laboratory learning and clinical experience • To capture and assess real-life situations in the laboratory environment that more closely reflect clinical reality • To enhance students’ confidence and competence to initiate beginning learning practice • To reduce students’ culture shock on first entering the clinical environment
Project Outline • To enable students to practice taking a health history and vital signs on a group of well, older volunteers living in the community in the nursing laboratory environment • To compare their views on this learning strategy with the views of a similar student group undertaking the same laboratory-based learning activities, but practising their skills on their peers.
The Project • STUDENT SAMPLE • First year BN students (N = 100) enrolled in ‘Contexts of Nursing’ units at ACU Melbourne • ‘CLIENT’(Volunteer) SAMPLE • Volunteer group (N = 20) of independent, healthy older individuals residing in the Melbourne community • Convenience sample accessed via snowballing – word of mouth • Volunteers recruited via family and friends of faculty and community groups • Telephone call used to provide overview and assure of confidentiality
The Project • Two Cohorts: • The students were prepared with lectures addressing relevant content, student pre-reading, and opportunities for students to practice skills on each other prior to the practical class. • Group 1 (N = 60) practised health history taking and vital signs on each other • Group 2 (N = 40) practised health history taking and vital signs on community volunteers (ratio of 2 students per volunteer). • Class learning objectives provided • Classes consisted of 16 students per class with 8 volunteers (2:1 ratio) • Classes of 100 minutes’ duration
Evaluation Strategies • Summative questionnaire administered to both student cohorts following laboratory session • 17-item questionnaire – 4 response options from ‘Strongly Agree’ to ‘Strongly Disagree’ • Questionnaire invited qualitative comments from students on their experience • Lecturer observation of interactive sessions • Informal feedback from students • Informal feedback from volunteers
Results • The following data indicates that students took value from laboratory time irrespective of working with peers or older volunteers • The data has been analysed using frequencies only • Trends from this data suggest that volunteers may value-add in the areas of enhancing communication, establishing rapport, and preparation for clinical practice • While all students were positive about their laboratory practical sessions, those experiencing classes with volunteers were more enthusiastic about recommending this technique for others.
Qualitative Findings • Nearly 50% of students who completed a written response from the peer group (Group 1) expressed the wish to practise with volunteers, e.g. • ‘…practising on fellow students didn’t prepare me for clinical placement’ • ‘…interacting with strangers would have been of benefit’ • ‘…please have volunteers in all classes!’ • ‘I don’t feel interviewing class mates helped me at all. People give silly answers…’ • ‘…it would build confidence if vital signs & interviews are done with unfamiliar persons’
Qualitative Findings • Group 2 (students with volunteers) written responses were overwhelmingly positive, e.g.: • ‘It was good to be able to practice on people not from my class, with a varied age & past health history’ • ‘I was able to become comfortable with taking vital signs from strangers in a familiar environment, so it was less intimidating’ • ‘ …the use of people from the community was great because it meant we had to deal with the situation at hand & behave in a professional manner when we often joke around with fellow students’
Qualitative Findings • ‘...this experience helped me to realise that people don’t bite, even if you’re asking them awkward questions!’ • ‘I did find it helpful to practice on a complete stranger rather than just family members. I think it made me more confident on clinicals ’
Strengths and Limitations • Sample • Initially had hoped to access older adults from RSL, Church groups, University of the 3rdAge etc however largely unable to do so. • Cohort consisted of younger adults than acute care cohort (70% > 65 years) • Owing to above, cohort less likely to experience health issues common to in-patient community • Cohort generally educated and familiar with nursing via their relationship to faculty • Overall number of volunteers meant that some were asked to repeat being assessed which proved tiring for some.
Strengths and Limitations • Evaluation method • Pre- and post-questionnaires would have identified attitudes and changes more accurately. Participants had to retrospectively identify their pre-education states. • Costs • Minimal for the University, involving food primarily • Volunteers met using own time and transport costs • Staff time was increased relating to preparation and facilitation of groups
Strengths/Limitations/Future Directions • Preparation • Students – provide them with ‘tips’ for ice-breaking & initiating conversations with strangers • Volunteers – practice-run with Faculty member prior to student interaction • Endeavour to ‘match’ students with volunteers – while some volunteer personalities proved challenging, this reflected some of the unpredictability and spontaneity of the clinical setting
Future directions • A larger study to explore factors influencing student laboratory experience is warranted • Need to plan for greater lead-in time to - complete ethics clearance - access older adult volunteers from community organizations, - communicate with school to increase cooperation
Reflections • Project exciting for all involved – students, volunteers and faculty • Students enjoyed learning • Students were quite nervous but relaxed into the interview process • Student/volunteer interactions overwhelmingly took place in a pleasant and positive environment • Thank-you morning / afternoon tea essential! • Many volunteers expressed the desire to participate/contribute in a similar process again
References Australian Nursing Council. (2000). ANC national nursing competency standards for the registered and enrolled nurse. Canberra: ANC. Australian Nursing Council. (2002). Code ofEthics for Nurses in Australia. Canberra: ANC Australian Nursing Council. (2003). Code of professional conduct for nurses in Australia. Canberra: ANC. Chau, J.P.C., Chang, A.M. et. Al (2001). Effects of using video-taped vignettes on enhancing students’ critical thinking ability in a baccalaureate nursing programme. Journal of Advanced Nursing, 36 (1). 112-119. du Bouley C. & Medway, C. (1999). The clinical skills resource: a review of current practice. Medical Education, 33. 185-191.
References Egan, G. (2002). The Skilled Helper: A Problem-Management and Opportunity- Development Approach to Helping (7th Ed.). Australia: Brookes/Cole. Levett-Jones, T. & Bourgeois, S. (2007). The Clinical Placement: An Essential guide for nursing education. Sydney: Elsevier. Parr, M.B. & Sweeney, N. (2006). Use of Human Patient Simulation in an Undergraduate Critical Care Course. Critical Care Nursing Quarterly, 29 (3). 188-198. Stein-Parbury, J. (2006). Patient and Person: Interpersonal Skills in Nursing. (3rd ed.). Sydney: Elsevier. The Victorian Government Department of Human Services. (2006). Prepare Nurses for the Future Report-Phase 1 2005. Victoria: Nurse Policy Branch. White, R. & Ewan, C. (1994). Clinical Teaching in Nursing. London: Chapman & Hall.
