Pedagogy, Capacity and Pedagogy, Capacity and Sustainability:Sustainability:

A national perspective on the use of A national perspective on the use of innovative clinical placementsinnovative clinical placements

Practice Makes Perfect:Practice Makes Perfect:

Vancouver, BCVancouver, BC

November 5, 2007November 5, 2007

harwood@twu.ca

Research ProgramResearch Program

• Pilot Study:Pilot Study: Parish and Rural Settings as Parish and Rural Settings as Clinical Placements Clinical Placements (2001)(2001)

• Phase I:Phase I: Innovative Clinical Placements: A Innovative Clinical Placements: A Descriptive Study Descriptive Study (2002 – 2004)(2002 – 2004)

• ““Keeping the Vision”: Sustaining Social Keeping the Vision”: Sustaining Social Consciousness following International Learning Consciousness following International Learning Experiences Experiences (2004 – 2006)(2004 – 2006)

• Phase IIPhase II:: A National Survey A National Survey

of the Use of Innovative Clinical of the Use of Innovative Clinical Placements Placements (2005 – 2007)(2005 – 2007)

BackgroundBackground

Pressures on availability of clinical nursing Pressures on availability of clinical nursing placementsplacements

Theory & practice (praxis) come together in the Theory & practice (praxis) come together in the clinical learning settingsclinical learning settings

Study PurposeStudy Purpose

To determine utilization rate & other factors r.t. To determine utilization rate & other factors r.t. learning & clinical education within Innovative learning & clinical education within Innovative Clinical Placements (ICPs) in Canadian Clinical Placements (ICPs) in Canadian Undergraduate Nursing ProgramsUndergraduate Nursing Programs

Definitions:Definitions:• Innovative Clinical PlacementsInnovative Clinical Placements Less structured clinical environments, often Less structured clinical environments, often

multidisciplinary; typically outside or multidisciplinary; typically outside or varying from the main health care delivery varying from the main health care delivery systemsystem

• Traditional Clinical PlacementsTraditional Clinical Placements Structured clinical environments, typically Structured clinical environments, typically

within the main health care systemwithin the main health care system

Study DesignStudy DesignSurvey Survey • Online format • 3 sections: General; Program Information;

Teaching/learning perspectives

Focus Group• Validate & extend survey findings

Data Collection:Data Collection:Nov 2005 – Nov 2006Nov 2005 – Nov 2006

Survey SampleSurvey Sample90 programs met inclusion criteria.90 programs met inclusion criteria.

Data were obtained from 147 respondents in Data were obtained from 147 respondents in 74 nursing programs74 nursing programs

Focus Group Focus Group 10 participants 10 participants

Data Analysis ProceduresData Analysis ProceduresDescriptive Analyses of Survey DataDescriptive Analyses of Survey Data

Content Analysis of Narrative ResponsesContent Analysis of Narrative Responses

Overview of FindingsOverview of Findingsa)a) ICP’s are widely utilized in Canadian nursing ICP’s are widely utilized in Canadian nursing

education (71 out of the 74 programs)education (71 out of the 74 programs)

b)b) Pedagogy: Rich student learning in Pedagogy: Rich student learning in ICP’s ICP’s

c)c) ICP’s often require additional administrative ICP’s often require additional administrative time and coordination, as compared to time and coordination, as compared to traditional settingstraditional settings

d)d) Concerns over Capacity & Concerns over Capacity & Sustainability of ICPsSustainability of ICPs

Use of ICPsUse of ICPs

• 72% report that use of ICPs has 72% report that use of ICPs has ↑↑over over past 5 yearspast 5 years

• 52% of CPCs indicate that 52% of CPCs indicate that > ½> ½ of of community placements were in ICPscommunity placements were in ICPs

• A majority of programs report use of A majority of programs report use of ICPs exceeds ICPs exceeds > 100 hrs/student> 100 hrs/student over over student’s programstudent’s program

ICP sites used in nursing programs*

24%

46%

54%

59%

66%

68%

74%

84%

84%

0 20 40 60

Other

Parish

International

Impoverished Inner City

Corrections/Forensics

Aboriginal First Nations Settings

Rural

Schools

Community Support groups

Number of nursing programs * N = 68 nursing programs that used ICPs (data about the use of ICP sites was not available for 3 additional nursing programs).

Pedagogy: Pedagogy: Nature of Student LearningNature of Student Learning

• Nurse Educators Nurse Educators agreed or agreed stronglyagreed or agreed strongly that ICPs that ICPs are are moremore effective effective for promoting student learning of: for promoting student learning of:

• Community Development (93%)Community Development (93%)• Social Determinants of Health (92%)Social Determinants of Health (92%)• Social Justice & Equity (89%)Social Justice & Equity (89%)• Poverty (89%)Poverty (89%)• Culture & DiversityCulture & Diversity (84%) (84%)

* Based on responses from 71 nurse educators that used ICPs.

Nurse educators Nurse educators agreed or strongly agreed agreed or strongly agreed that that students in ICPs demonstrated:students in ICPs demonstrated:

• More More initiativeinitiative toward engaging in clinical learning toward engaging in clinical learning opportunities (70%)opportunities (70%)

• More More creativitycreativity in clinical decision-making (77%) in clinical decision-making (77%)• More More critical thinkingcritical thinking by identifying nursing by identifying nursing

assessments & interventions (63%)assessments & interventions (63%)• Stronger professional relationships with the Stronger professional relationships with the

communitiescommunities of ICPs (82%) of ICPs (82%)

Pedagogy: Pedagogy: Nature of Student LearningNature of Student Learning

* Based on responses from 71 nurse educators that used ICPs.

Pedagogical Outcomes in ICP’sPedagogical Outcomes in ICP’s

““ICPs have a huge effect on ICPs have a huge effect on students, often opening their eyes students, often opening their eyes to a part of society unknown to to a part of society unknown to them. ICPs sensitize students to the them. ICPs sensitize students to the health needs of marginalized health needs of marginalized populations.”populations.”

PedagogyPedagogyStrategies to Promote LearningStrategies to Promote Learning

• Structure of Learning ActivitiesStructure of Learning Activities• Unanimous re: importance of clarity of course & clinical Unanimous re: importance of clarity of course & clinical

placement objectives placement objectives • Links to existing curriculum importantLinks to existing curriculum important

• Models of Clinical SupervisionModels of Clinical Supervision• Most common approach reported by CPC (50%) & NE Most common approach reported by CPC (50%) & NE

(43%) is (43%) is some supervisionsome supervision with contact q 2 – 3 days via with contact q 2 – 3 days via email, phone or on-campus contact, limited on-site visitsemail, phone or on-campus contact, limited on-site visits

Narrative responses – NE described concepts of:Narrative responses – NE described concepts of:• ““Right fit” b/w student & ICP Right fit” b/w student & ICP • Student attributes for successful learningStudent attributes for successful learning

• Creative approach to learningCreative approach to learning

• Flexible & open mindedFlexible & open minded

• Demonstrate initiative in independent learningDemonstrate initiative in independent learning

• Understanding that clinical is not limited to traditional Understanding that clinical is not limited to traditional settingssettings

PedagogyPedagogyStrategies to Promote LearningStrategies to Promote Learning

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

PedagogyPedagogyStrategies to Promote LearningStrategies to Promote Learning

SustainabilitySustainabilityAdministrative IssuesAdministrative Issues

• Labour and Time intensive to negotiate & Labour and Time intensive to negotiate & coordinatecoordinate

• Multiple parties involved in each ICP Multiple parties involved in each ICP negotiationnegotiation• Communication issuesCommunication issues

• Unique needs to be accommodated/communicated all partiesUnique needs to be accommodated/communicated all parties

• Educational & service agency administrative support seen Educational & service agency administrative support seen necessary for creative process in developing ICPs necessary for creative process in developing ICPs

• Existing partnerships facilitate processExisting partnerships facilitate process

• Agency Related IssuesAgency Related Issues• Differing agency requirementsDiffering agency requirements• Appropriate mentors Appropriate mentors • Staff turnover, burnoutStaff turnover, burnout

• Faculty Related ChallengesFaculty Related Challenges

• Educational Institution Related ChallengesEducational Institution Related Challenges

• Student Related FactorsStudent Related Factors

SustainabilitySustainabilityAdministrative IssuesAdministrative Issues

““The numbers of agencies & individual The numbers of agencies & individual students can be overwhelming to the CPC when students can be overwhelming to the CPC when

looking at the numbers of agencies, students, looking at the numbers of agencies, students, preceptors & faculty persons involved. Each preceptors & faculty persons involved. Each

one involves different players, policies, one involves different players, policies, procedures & communication factors……..procedures & communication factors……..

A challenge indeed!”A challenge indeed!”

SustainabilitySustainability

Discussion: Discussion: Capacity & Sustainability of ICPsCapacity & Sustainability of ICPs

• Building Capacity:Building Capacity:• Underutilized areasUnderutilized areas• Making the professional practice role understoodMaking the professional practice role understood• Target Population GroupsTarget Population Groups

• Maximizing LearningMaximizing Learning

• Ensuring SustainabilityEnsuring Sustainability

• Fostering PartnershipsFostering Partnerships

RecommendationsRecommendations

1.1. Develop strategies to Develop strategies to ↑↑ capacity & facilitate capacity & facilitate sustainability of ICPs:sustainability of ICPs:

a)a) Articulate the role of the nursing in non-traditional Articulate the role of the nursing in non-traditional settings.settings.

b)b) Identify under-utilized areas and population groupsIdentify under-utilized areas and population groups

c)c) Administrative support (such as funding, release Administrative support (such as funding, release time) should account for the extra time req’d to time) should account for the extra time req’d to negotiate ICPs. negotiate ICPs.

d)d) Establish partnerships b/w academic & host Establish partnerships b/w academic & host agencies to facilitate administration of ICPs & agencies to facilitate administration of ICPs & foster student learning.foster student learning.

RecommendationsRecommendations

2.2. Recognize valuable pedagogy & continue Recognize valuable pedagogy & continue to develop the use of ICPs to develop the use of ICPs

3.3. Conduct research with agency Conduct research with agency stakeholders to gain insight into the issues stakeholders to gain insight into the issues they face hosting students they face hosting students

ConclusionConclusion

“…Life altering experiences for students.”

“Students usually have the greatest personal & professional growth in these sites.”

Publications Publications • Reimer Kirkham, S., Van Hofwegen, L., & Hoe Reimer Kirkham, S., Van Hofwegen, L., & Hoe

Harwood, C. (2005). Narratives of Social Justice: Harwood, C. (2005). Narratives of Social Justice: Student Learning in Innovative Clinical Placements. Student Learning in Innovative Clinical Placements. International Journal of Nursing Education International Journal of Nursing Education Scholarship.Scholarship. 2(1), article 28. Available: 2(1), article 28. Available: http://www.bepress.com/ijnes/vol2/iss1/art28

• Van Hofwegen, L., Reimer Kirkham, S., & Hoe Van Hofwegen, L., Reimer Kirkham, S., & Hoe Harwood, C. (2005). Accessing the strength of rural Harwood, C. (2005). Accessing the strength of rural health settings: Implications for undergraduate nursing health settings: Implications for undergraduate nursing education. education. International Journal of Nursing International Journal of Nursing Education Scholarship.Education Scholarship. 2(1), article 27. Available: 2(1), article 27. Available:

http://www.bepress.com/ijnes/vol2/iss1/art27

PublicationsPublications

• Reimer Kirkham, S., Hoe Harwood, C., & Van Reimer Kirkham, S., Hoe Harwood, C., & Van Hofwegen, L. (2005). Capturing the vision: Hofwegen, L. (2005). Capturing the vision: Undergraduate nursing students in innovative clinical Undergraduate nursing students in innovative clinical settings. settings. Nurse Educator,Nurse Educator, 3030(6):263-270.(6):263-270.

• Reimer Kirkham, S., Hoe Harwood, C., Terblanche, Reimer Kirkham, S., Hoe Harwood, C., Terblanche, L., Van Hofwegen, L. & Sawatzky, R. (2007) The L., Van Hofwegen, L. & Sawatzky, R. (2007) The Use of Clinical Placements in Nursing Education: A Use of Clinical Placements in Nursing Education: A National Survey. Trinity Western University, National Survey. Trinity Western University, Langley, B.C. Available at: Langley, B.C. Available at: http://www.twunursing.ca/web/Research/survey.html

Innovative Clinical Placements Innovative Clinical Placements Research TeamResearch Team

Sheryl Reimer Kirkham, RN PhDSheryl Reimer Kirkham, RN PhDCatherine Hoe Harwood, RN MScNCatherine Hoe Harwood, RN MScNLynn Van Hofwegen, RN, MSN, NPLynn Van Hofwegen, RN, MSN, NPLanda Terblanche, RN PhDLanda Terblanche, RN PhDRick Sawatzky, RN PhD Rick Sawatzky, RN PhD

Funding: Western Region Canadian Association Funding: Western Region Canadian Association Schools of Nursing (WRCASN) 2005 - 2007Schools of Nursing (WRCASN) 2005 - 2007

Dept. of Nursing, Trinity Western University Dept. of Nursing, Trinity Western University Langley, British ColumbiaLangley, British Columbia