ENHANCING CLINICAL NURSING SKILL ACQUISITION IN 1ST YEAR BNSG:

EVALUATION OF A REAL-LIFE MODEL OF LEARNING

Report on 2007 ACU Teaching Development

Grant ProjectBy Sandra Simpson

Jean MukasaStephen Guinea

Jo CameronMichelle 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.

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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

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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

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THE HUMAN TOUCHBUT 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

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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).

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COMMUNICATION AND HEALTH HISTORY M

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BLOOD PRESSURE MEASUREMENT May 8, 2023

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LECTURER FACILITATION OF CLASSM

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LECTURER FACILITATION OF CLASSM

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LECTURER FACILITATION OF CLASSM

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PREAMBLE FOR STUDENTSM

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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

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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.

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THE PROJECT STUDENT SAMPLE

First year BN students (N = 100) enrolled in ‘Contexts of Nursing’ units at ACU Melbourne

‘CLIENT’(Volunteer) SAMPLEVolunteer 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

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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 otherGroup 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

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EVALUATION STRATEGIES

Summative questionnaire administered to both student cohorts following laboratory session17-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

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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.

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RESULTS (%)M

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RESULTS (%)M

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RESULTS (%)M

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RESULTS (%)M

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RESULTS (%)M

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RESULTS (%)M

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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’

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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’

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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 ’

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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.

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STRENGTHS AND LIMITATIONS

Evaluation methodPre- and post-questionnaires would have

identified attitudes and changes more accurately. Participants had to retrospectively identify their pre-education states.

CostsMinimal for the University, involving food

primarilyVolunteers met using own time and

transport costsStaff time was increased relating to

preparation and facilitation of groups

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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

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FUTURE DIRECTIONSA 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

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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

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REFERENCESAustralian Nursing Council. (2000). ANC national nursing competency standards for the

registered and enrolled nurse. Canberra: ANC. Australian Nursing Council. (2002). Code of Ethics 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.

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REFERENCESEgan, 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. 

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COMMUNICATION AND HEALTH HISTORYM

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VOLUNTEERS- MALE AND FEMALEM

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STUDENTS AND VOLUNTEERSM

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