Practice Makes Perfect: Vancouver, BC November 5, 2007 harwood@twu

1. Pedagogy, Capacity and Sustainability:A national perspective on the use of innovative clinical placements Practice Makes Perfect: Vancouver, BC November 5, 2007 harwood@twu.ca

2. Research Program • Pilot Study: Parish and Rural Settings as Clinical Placements (2001) • Phase I: Innovative Clinical Placements: A Descriptive Study (2002 – 2004) • “Keeping the Vision”: Sustaining Social Consciousness following International Learning Experiences (2004 – 2006) • Phase II:A National Survey of the Use of Innovative Clinical Placements (2005 – 2007)

3. Background Pressures on availability of clinical nursing placements Theory & practice (praxis) come together in the clinical learning settings Study Purpose To determine utilization rate & other factors r.t. learning & clinical education within Innovative Clinical Placements (ICPs) in Canadian Undergraduate Nursing Programs

4. Definitions: • Innovative Clinical Placements Less structured clinical environments, often multidisciplinary; typically outside or varying from the main health care delivery system • Traditional Clinical Placements Structured clinical environments, typically within the main health care system

5. Study Design Survey • Online format • 3 sections: General; Program Information; Teaching/learning perspectives Focus Group • Validate & extend survey findings

6. Data Collection:Nov 2005 – Nov 2006 Survey Sample 90 programs met inclusion criteria. Data were obtained from 147 respondents in 74 nursing programs Focus Group 10 participants Data Analysis Procedures Descriptive Analyses of Survey Data Content Analysis of Narrative Responses

7. Overview of Findings • ICP’s are widely utilized in Canadian nursing education (71 out of the 74 programs) • Pedagogy: Rich student learning in ICP’s • ICP’s often require additional administrative time and coordination, as compared to traditional settings • Concerns over Capacity & Sustainability of ICPs

8. Use of ICPs • 72% report that use of ICPs has ↑over past 5 years • 52% of CPCs indicate that > ½ of community placements were in ICPs • A majority of programs report use of ICPs exceeds > 100 hrs/student over student’s program

10. Pedagogy: Nature of Student Learning • Nurse Educators agreed or agreed strongly that ICPs are more effective for promoting student learning of: • Community Development (93%) • Social Determinants of Health (92%) • Social Justice & Equity (89%) • Poverty (89%) • Culture & Diversity (84%) * Based on responses from 71 nurse educators that used ICPs.

11. Pedagogy: Nature of Student Learning Nurse educators agreed or strongly agreed that students in ICPs demonstrated: • More initiative toward engaging in clinical learning opportunities (70%) • More creativity in clinical decision-making (77%) • More critical thinking by identifying nursing assessments & interventions (63%) • Stronger professional relationships with the communities of ICPs (82%) * Based on responses from 71 nurse educators that used ICPs.

12. Pedagogical Outcomes in ICP’s “ICPs have a huge effect on students, often opening their eyes to a part of society unknown to them. ICPs sensitize students to the health needs of marginalized populations.”

13. PedagogyStrategies to Promote Learning • Structure of Learning Activities • Unanimous re: importance of clarity of course & clinical placement objectives • Links to existing curriculum important • Models of Clinical Supervision • Most common approach reported by CPC (50%) & NE (43%) is some supervision with contact q 2 – 3 days via email, phone or on-campus contact, limited on-site visits

14. PedagogyStrategies to Promote Learning Narrative responses – NE described concepts of: • “Right fit” b/w student & ICP • Student attributes for successful learning • Creative approach to learning • Flexible & open minded • Demonstrate initiative in independent learning • Understanding that clinical is not limited to traditional settings

15. PedagogyStrategies to Promote Learning “Students gain a > understanding of the issues of the community at large… promotes a more global way of thinking…forced to examine own strengths & ability to work & communicate on other people’s terms & territory…they gain an appreciation for the diverse factors that affect the health of the population.”

16. SustainabilityAdministrative Issues • Labour and Time intensive to negotiate & coordinate • Multiple parties involved in each ICP negotiation • Communication issues • Unique needs to be accommodated/communicated all parties • Educational & service agency administrative support seen necessary for creative process in developing ICPs • Existing partnerships facilitate process

17. SustainabilityAdministrative Issues • Agency Related Issues • Differing agency requirements • Appropriate mentors • Staff turnover, burnout • Faculty Related Challenges • Educational Institution Related Challenges • Student Related Factors

18. Sustainability “The numbers of agencies & individual students can be overwhelming to the CPC when looking at the numbers of agencies, students, preceptors & faculty persons involved. Each one involves different players, policies, procedures & communication factors…….. A challenge indeed!”

19. Discussion: Capacity & Sustainability of ICPs • Building Capacity: • Underutilized areas • Making the professional practice role understood • Target Population Groups • Maximizing Learning • Ensuring Sustainability • Fostering Partnerships

20. Recommendations • Develop strategies to ↑capacity & facilitate sustainability of ICPs: • Articulate the role of the nursing in non-traditional settings. • Identify under-utilized areas and population groups • Administrative support (such as funding, release time) should account for the extra time req’d to negotiate ICPs. • Establish partnerships b/w academic & host agencies to facilitate administration of ICPs & foster student learning.

21. Recommendations • Recognize valuable pedagogy & continue to develop the use of ICPs • Conduct research with agency stakeholders to gain insight into the issues they face hosting students

22. Conclusion “…Life altering experiences for students.” “Students usually have the greatest personal & professional growth in these sites.”

23. Publications • Reimer Kirkham, S., Van Hofwegen, L., & Hoe Harwood, C. (2005). Narratives of Social Justice: Student Learning in Innovative Clinical Placements. International Journal of Nursing Education Scholarship. 2(1), article 28. Available: http://www.bepress.com/ijnes/vol2/iss1/art28 • Van Hofwegen, L., Reimer Kirkham, S., & Hoe Harwood, C. (2005). Accessing the strength of rural health settings: Implications for undergraduate nursing education. International Journal of Nursing Education Scholarship. 2(1), article 27. Available: http://www.bepress.com/ijnes/vol2/iss1/art27

24. Publications • Reimer Kirkham, S., Hoe Harwood, C., & Van Hofwegen, L. (2005). Capturing the vision: Undergraduate nursing students in innovative clinical settings. Nurse Educator,30(6):263-270. • Reimer Kirkham, S., Hoe Harwood, C., Terblanche, L., Van Hofwegen, L. & Sawatzky, R. (2007) The Use of Clinical Placements in Nursing Education: A National Survey. Trinity Western University, Langley, B.C. Available at: http://www.twunursing.ca/web/Research/survey.html

25. Innovative Clinical Placements Research Team Sheryl Reimer Kirkham, RN PhD Catherine Hoe Harwood, RN MScN Lynn Van Hofwegen, RN, MSN, NP Landa Terblanche, RN PhD Rick Sawatzky, RN PhD Funding: Western Region Canadian Association Schools of Nursing (WRCASN) 2005 - 2007 Dept. of Nursing, Trinity Western University Langley, British Columbia