Nurses as educators: creating teachable moments in practice

Effective workplace teaching is increasingly important in healthcare, with all staff being potential educators. The introduction of new roles and the need to create capacity for increased numbers of students can make it difficult to create a good learning experience. Despite the richness of clinical practice as a learning environment, creating capacity for teaching can be challenging. This article explores the possibilities for identifying and creating teachable moments in busy clinical environments and suggests a developmental model for incorporating these learning opportunities. Teachable moments linked directly to optimal patient care can potentially influence and shape a positive learning culture in clinical environments

Student Perceptions of the Clinical Education Environment

This Masters Project surveyed nursing clinical students at a University School of Nursing in the Pacific Northwest using a recently developed tool, the Student Evaluation of Clinical Education Environment (SECEE, version 3). Use of the SECEE (version 3) helped identify differences in student perceptions of various clinical learning environments. Results of nonparametric statistics were non-significant due to the small sample size; however there appeared to be consistent preference by students for clinicals at Magnet designated facilities. Additionally, higher instructor facilitation scores were also noted among students assigned to the university main campus (n = 31, M = 45.19, SD = 9.39) compared to students assigned to the distance campus (n = 9, M = 36.89, SD = 20.63). The findings have implications for nursing education, specifically the potential benefit of student learning at Magnet designated facilities and the importance of adequate support and engagement between university faculty and students in distance learning environments

Improving the clinical learning environment: A collaborative workshop for students, residents, and faculty

The AAMC Graduation Questionnaire (AAMC GQ) surveys the students at the completion of their training. Results from this survey show that students report mistreatment and unprofessional behavior during their training. The results of this survey, both locally and nationally, motivated faculty in the school of medicine to develop a workshop that would introduce the learning climate to students, and allow the students to interact with faculty to understand mistreatment and professionalism in the learning environment. In this presentation, we will highlight the need for educating students about the learning climate, professionalism and mistreatment; provide attendees with the definition of mistreatment; and illustrate the ambiguity involved in defining incidents of mistreatment. A need has been identified, both due to the results of the AAMC GQ survey and by the hundreds of peer-reviewed articles on the topic of professionalism in medical education, and this workshop was an attempt to fill that need at VCU

Students' Perception of the Psycho-Social Clinical Learning Environment: An Evaluation of Placement Models

Nursing is a practice based discipline. A supportive environment has been identified as important for the transfer of learning in the clinical context. The aim of the paper was to assess undergraduate nurses' perceptions of the psychosocial characteristics of clinical learning environments within three different clinical placement models. Three hundred and eight-nine undergraduate nursing students rated their perceptions of the psycho-social learning environment using a Clinical Learning Environment Inventory. There were 16 respondents in the Preceptor model category, 269 respondents in the Facilitation model category and 114 respondents in the clinical education unit model across 25 different clinical areas in one tertiary facility. The most positive social climate was associated with the preceptor model. On all subscales the median score was rated higher than the two other models. When clinical education units were compared with the standard facilitation model the median score was rated higher in all of the subscales in the Clinical Learning Environment Inventory. These results suggest that while preceptoring is an effective clinical placement strategy that provides psycho-social support for students, clinical education units that are more sustainable through their placement of greater numbers of students, can provide greater psycho-social support for students than traditional models

Do they practice what we teach? Follow-up evaluation of a Schema Therapy training programme

This study evaluated a three-day Schema Therapy training programme for trainee clinical psychologists. The training used an experiential model of learning, which was intended to encourage the transfer of knowledge and techniques from the learning environment into clinical practice. Using a mixed-methods approach, the training programme was evaluated in terms of: (1) self-reported changes in knowledge, confidence and willingness to use Schema Therapy-informed techniques; (2) whether the training was integrated into clinical practice; and (3) the perceived barriers/facilitators to achieving practice integration. Participants – 17 of the 19 trainee clinical psychologists enrolled on the Schema Therapy training programme – completed assessments immediately pre- and post-training. Participants were subsequently followed-up for reassessment three months after the training. Group- and individual-level analyses showed that most participants reported training-related gains in knowledge and confidence; these were largely sustained at follow-up, and were associated with post-training practice integration of Schema Therapy concepts and techniques. Analysis of qualitative data identified factors moderating use of training in practice. Findings of the study have implications for future delivery and evaluation of training in cognitive-behavioural therapies

Peer review : organisational learning for nurses : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University

Organisational learning as it relates to the development of a peer review system within a clinical area of nursing practice is the focus of this study. Sixteen Public Health Nurses, with the manager of their service, and three key managers from the employing Crown Health Enterprise in provincial New Zealand, took part with the researcher in this praxis-oriented participatory action research process. A framework of the learning organisation was created to direct the research inquiry and evaluate data in relation to the developing peer review system. Through the use of critically reflexive discussions in an ongoing spiral of planning, implementing, observing, and assessing, this study illuminates the growth of the learning organisation and the building of a peer review system. within a cost-conscious healthcare service delivery environment. The account of the research process includes factors facilitative of, and critical to, the learning organisation. Use of many direct quotes from participants creates a context against which to visualise problems and constraints faced by the research group, and offers the reader a decision trail with which to resolve issues of credibility. Use of the peer process, it is suggested, will generate vital information about organisational performance, which will enable nurses to assume legitimate control of clinical nursing workplaces. Conclusions derived from this study suggest that peer review and the learning organisation are important tools for both assuring the quality of clinical nursing performance and securing organisational goals

Professional Learning in Massive Open Online Courses

This study explores the role of Massive Open Online Courses (MOOCs) in supporting and enabling professional learning, or learning for work. The research examines how professionals self-regulate their learning in MOOCs. The study is informed by contemporary theories of professional learning, that argue that conventional forms of learning are no longer effective in knowledge intensive domains. As work roles evolve and learning for work becomes continual and personalised, self-regulation is becoming a critical element of professional learning. Yet, established forms of professional learning generally have not taken advantage of the affordances of social, semantic technologies to support self-regulated learning. MOOCs present a potentially useful approach to professional learning that may be designed to encourage self-regulated learning. The study is contextualised within ‘Fundamentals of clinical trials', a MOOC for health professionals designed and run by the Harvard Medical School, Harvard School of Public Health, and Harvard Catalyst, the Harvard Clinical and Translational Science Center, and offered by edX. The research design builds on the authors' previous studies in the areas of Technology Enhanced Learning and Professional Learning and in particular, research which explored the learning behaviours of education professionals in the Change 11 MOOC. The previous studies demonstrated a link between individual learners SRL profile and their goal setting behaviour in the Change 11 MOOC as well as uncovering other factors which influenced their engagement with the MOOC environment. The present study extends the original study by further focusing on specific aspects of self-regulation identified by the Change11 studies and our parallel studies of self-regulated learning in knowledge workers. The analysis of learner behaviour in the Fundamentals of Clinical Trials is complemented by additional exploration of the design considerations of the MOOC, to determine the extent to which course design can support or inhibit self-regulation of learning. The study poses three research questions: How are Massive Open Online Courses currently designed to support self-regulated learning? What self-regulated learning strategies and behaviours do professionals adopt? and How can MOOCs be designed to encourage professionals to self-regulate their learning? Validated methods and instruments from the original study will be adapted and employed. The research is unique in providing evidence around two critical aspects of MOOCs that are not well understood: the skills and dispositions necessary for self-regulated learning in MOOC environments, and how MOOCs can be designed to encourage the development and emergence of SRL behaviours

Discovering which experiences physiotherapy students identify as learning facilitators in practical laboratories: An action research project

Purpose: Students enrolled in courses that focus on patient contact participate in practical laboratories to learn clinical skills but this can be challenging in a pre-clinical environment. A simulated case based format using role play in small groups is commonly undertaken. Students may find it difficult to actively engage in learning and effective role playing without prior clinical experience. The aim of this study was to discover what type of experiences facilitated student learning in practical laboratory sessions. Method: Design: Action research study. Participants: Thirty two undergraduate second year physiotherapy students who were engaging in practical laboratories. Data collection and analysis: Teacher observations, minute papers and semi structured interviews were conducted over a nine week teaching period to gain the student perspective on what facilitated their learning. Data from these three sources were categorised and coded. A concept mapping technique was then used to represent the construct of learning facilitators identified, from which the final survey was developed. Results: Learning facilitators identified by students were categorised under three key units: those provided by the teacher, those initiated by the students themselves and material resources. Concept mapping revealed three emergent themes: provide multiple opportunities for learning that address all learning styles, formative learning support and resources to consolidate learning. Students rated timely feedback from the teacher while they practiced the required skills and behaviours as the highest valued learning facilitator (strongly agreed 78.6%, agreed 21.4%) followed by watching the teacher modelling the skill or behaviour required (strongly agreed 67.9%, agreed 25.0%). Students also reported that using a peer feedback checklist constructed by the teacher clarified their expectations of engaging in observation and feedback (strongly agreed 32.1%, agreed 50.0%) and guided their performance in the skills and behaviours expected (strongly agreed 35.7%, agreed 53.6%). Conclusions: Students at a pre-clinical level can identify which experiences facilitate their learning in practical laboratories, if given the opportunity. While these students place the highest value on teacher feedback they can actively engage in peer learning if given constructive guidance on the skills and behaviours required. Discovering what students identify as facilitating their learning in practical laboratories can guide successful evaluation of laboratory teaching plans to modify and create new learning opportunities and resources. This has the potential to improve student satisfaction and achievement of intended learning outcomes

Barriers to Practical Learning in the Field: A Qualitative Study of Iranian Nursing Students' Experiences

Background: Clinical training is an integral part of nursing education; however, some studies have shown that it is not always efficient. Objectives: This study aimed to find out the factors that can impede nursing students’ clinical learning. Materials and Methods: In this qualitative study, data were collected via reflective journal writing. Purposeful sampling was used, and 12 senior nursing students were recruited to the study. The data were analyzed using a content analysis method. Results: Three main categories were derived, including inappropriate communication, ineffective role models, and theory-practice gaps. Students perceived that inappropriate communication between instructors, staff members, and students had the greatest impact on student learning. The competence of clinical instructors and staff is an important factor affecting students’ training. The clinical learning environment does not always integrate theory and practice together. Conclusions: Nursing students did not experience effective clinical learning. Having expert instructors and supportive communication are important factors in creating a clinical learning environment