collaboration in undergraduate students’ simulated clinical practice by nancy mcnamara mhsc...
TRANSCRIPT
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Collaboration in Undergraduate Students’ Simulated Clinical Practice
by Nancy McNamara MHSc (hons), BN, RCompN, CATE Rebecca Giles BSW, RSW, PGDip Ed, DPGCert Prof Sup, CATE
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Background
• Inter-professional Education (IPE) (Oandanson & Reeves, 2005)
• Communication (TJC, 2012)
• Work-ready health workforce (Leonard, Shuhaibar & Chen, 2010; McNamara, 2015)
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Clinical Context
• Within a simulated clinical practice programme for second semester nurses
Day 1 Day 2 Day 3 Day 4
Patient admission-The unconscious / bedridden patient-All admission documentation… -Basic nursing careDebrief
A day in the ward-Patient Manual Handling/ -Medications Debrief
A day in the ward-Collaborative care-Referrals. Collaborative Meeting
Patient Discharge -Discharge decision and process -Documentation audit. -Summary/presentation
Workshop 1 Workshop 2 Workshop 3 Workshop 4
-Admission process-Professional documentation-Introduction to Medication Management
-Time Management-Mobility Aids/documentation -Medication Management cont’d
-Collaborative care…referral system-Fluid balance
-Discharge Process-Evaluation
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Collaborative Meeting
• Social work, occupational therapy and nursing students
• Collaborative team: Doctor, nutritionist, physiotherapist, spouse or family advocate
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Study Aim
• To gain an understanding of the inter-professional learning experiences of undergraduate nursing, social work and occupational therapy students in a simulated collaborative team meeting.
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Method/Methodology
• Self selecting students: questionnaire (5 questions), focus group
• Thematic analysis of data
• Theoretical Framework; Kolb’s experiential learning theory
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Population and Participation
• Of the 72 participants (54 nursing students, 8 occupational therapy students and 10 social work students) n=48 responded to the questionnaire.
• n=9 took part in the focus group..
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Questionnaire Results
• Q1: Describe what it was like for you attending a collaborative meeting
with the other disciplines
Great experience or opportunity Good learning No response Scary and nervous
11
29
3 2
Describe what it was like for you attending a MDT meeting with the other disciplines
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Student Learning
Shared Perspectives Clearer Understanding of Roles Insight into Reality Deeper Cultural Awareness
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Aspects of the Meeting
Shared Patient Focus
Professional Role Recognition
Different Perspectives
0 2 4 6 8 10 12 14 16 18
14
12
18
Favourite Aspects of the Meeting
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Enhanced Learning
More Fully Prepared More Student Representatives DisciplineSpecific Meeting Processes 0
1
2
3
4
5
6
7
8
9
10
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Overall Findings
• Overall questionnaire and focus group themes:
• Professional role clarification and awareness• Preparedness• Safety• Realism
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Professional Role Clarification and Awareness
• Professional identity
• Role negotiation
• Professional boundaries
• Professional competition
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Professional Role Clarification and Awareness
• Students had an opportunity to consider and define their own professional roles and see how their roles were perceived by the team.
• “… I found it interesting that the majority of the people in our meeting had no idea what we actually did and were quite surprised at what we could offer…”
• “…Good opportunity to reflect on the scope and role”
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Role Negotiation and Professional Boundaries
• A process of role negotiation occurred as students realised that more than one discipline could access the same service or provide the same support for the patient.
• “…Clarified my boundaries, like what I am supposed to do and not to step on somebody’s feet”
• “…so Ok you do that in your role as well, so I’ll do the placement enquiry”
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Professional Competitionics
• Sense of competing for team dominance based on experience
• “…as a first year it would not have been as helpful….especially when you are with other professions who are second and third years. That’s got to be daunting…”
• “ stressed beforehand ….because we thought we were going to be up against third year nursing students…..having never done this before we thought we would be at a loss…”
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Preparedness
• Patient scenario briefing and expectations for professional input
• Preparation for collaborative clinical practice
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Patient Scenario Briefing and Expectations for Professional Input
• Some students had less preparation than others. This was predominantly around patient scenario briefing, meeting objectives and expectations for professional input.
• “…everyone could be informed of what to expect…more information beforehand”
• “…not sure exactly what was expected of me”
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Preparation for Collaborative Practice
• Practice for practice
• “…Getting to know how they work and seeing how other health professionals work with nurses”
• “…We knew about MDTs but being able to put the theory into action and practice working with the others was really useful”
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Safety
• Safe supportive environment
• Culturally appropriate meeting processes
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Safety
• Patient advocacy, interventions and team processes did not impact patient outcomes
• “…it was nice just practising and knowing that nothing was going to come of it or get damaged by what you do and say”
• “…I think it was a good confidence builder doing it in the simulated situation as opposed to first time having to do it out in the field work situation”
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Safety
• Culturally appropriate meeting processes
• “…Kai-Awhina attendance and input, • “…meetings were appropriately culturally sensitive and focussed ”
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Realism
• Considering the reality
• Matching the reality
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Considering the Reality
• Students considered the reality of the professional collaborative environment.
• “…really enjoyed meeting people from other classes who I could be working with in future”
• “…showed me what it would be like in a real situation…. makes you think about the rehab of your patient beyond hospital”
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Matching the RealityClinical Meeting Processes
• The patient’s/family voice:
• “…the client’s voice needs to be heard as equally loudly if not more than ours”
• “…everybody’s coming with a solution but that’s not the way a social worker works with a client……we talk to the client, only then solutions are coming, but in our meeting everybody came with solutions”
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Limitations
• Disciplines were not individually identified • The study did not identify demographics such as age,
gender or ethnicity• Meeting preparation and debriefing was done
independently within disciplines. • A larger and equal sample may have altered
outcomes.
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Recommendations
• For future research:• Participant groups, gender and ethnicity are identified
• Students receive the same briefing information and are aware of the objectives for each of the disciplines
• Students clearly understand what and how they are expected to contribute to the meeting.
• Collaborative meeting with undergraduate students continues
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In Conclusion
• This research has provided some insight into the inter-professional learning experiences of undergraduate nursing, social work and occupational therapy students.
• All student participants concurred that the simulated collaborative meeting was a useful learning experience.
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Thank you