n2839 research report on deu cycle 1
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/TRANSCRIPT
Research Report on Completion of the First Cycle of the Action Research
Prepared by:
Willem Fourie & Bev McClelland
Supported by the AKO Aotearoa National Project Fund
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ACKNOWLEDGEMENTS
We would like to express our appreciation to the participating Bachelor of Nursing students for taking
the time to complete questionnaires and for participating in the focus groups. Your views and
experiences were very useful. We wish to express our sincere appreciation to the staff of both DEUs
and to the Action Group for not only participating in the research but for making the implementation of
the first cycle a great success. We wish to acknowledge the generous sponsorship by AKO Aotearoa
through their National Project Fund. Finally we would like to thank the respective nurse leaders of the
two organisations, Denise Kivell and Debbie Penlington, for their continued support and encouragement
to this project.
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Table of Contents ACKNOWLEDGEMENTS ................................................................................................................................. 2
BACKGROUND ............................................................................................................................................... 4
METHODOLOGY ............................................................................................................................................ 6
CNDU Governance Group ......................................................................................................................... 7
Action Group ............................................................................................................................................. 7
Research Management Team ................................................................................................................... 7
Data Collection .......................................................................................................................................... 8
Data Analysis ............................................................................................................................................. 8
DISCUSSION AND FINDINGS .......................................................................................................................... 9
The DEU Prior to Implementation ............................................................................................................ 9
Understanding, being Informed and Prepared. .................................................................................... 9
The implementation of the DEU ............................................................................................................... 9
Orientation Day ..................................................................................................................................... 9
The Initial Days on the DEU ................................................................................................................. 11
The Role of the Clinical Liaison Nurse ................................................................................................. 13
The Role of the Academic Liaison Nurse ............................................................................................. 17
Teamwork ........................................................................................................................................... 22
Support................................................................................................................................................ 25
Students Learning Needs .................................................................................................................... 28
RECOMMENDATIONS ................................................................................................................................. 46
REFERENCES ................................................................................................................................................ 47
Appendix 1: Tables with Qualitative Comments ......................................................................................... 48
Appendix 2: Participant Information Sheet ................................................................................................ 61
Appendix 3: Questionnaire Midway through Placement ........................................................................... 64
Appendix 4: Questionnaire on Completion of Placement .......................................................................... 73
Appendix 5: Consent Students .................................................................................................................... 80
Appendix 6: Consent Staff........................................................................................................................... 81
Appendix 7: Focus Group Questions ........................................................................................................... 82
Appendix 8: Ethics Approval Letter ............................................................................................................. 83
Appendix 9: CMDHB Approval Letter ......................................................................................................... 84
Appendix 9: CMDHB Approval Letter ......................................................................................................... 84
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Research Report on Completion of the First Cycle of the Action Research
BACKGROUND
There has been much debate in the literature about models and roles that best support nursing student
placements. A recent white paper for the US Department of Labor offered pioneering solutions
currently in development which include amongst others the development of Dedicated Education Units
(Joynt & Kimball, 2008). DEUs have been pioneered in Australia and have been the primary model for
clinical nursing experience in Adelaide since 1999. The KPMG (2001) report on undergraduate nursing
education in New Zealand identified that “DEUs are a good example of a model in which student work
shifts alongside registered nurses but do so in a collaborative and supportive environment in which
clinicians and educators work together” (p.88).
Students in DEUs have reported feeling supported by a clinical facilitator who is dedicated to them and
their learning needs (Nehls et al., 1997). The use of staff within a unit who are clinically current and
familiar with the environment impacts greatly on the students’ experiences (Baird et al., 1994). The
nurses in a DEU reported feelings of personal and professional satisfaction by being given time to
support students (Henderson, 2006). Melander and Roberts (1994) added that improvements have
been reported in the teaching and preceptoring skills of the facilitator, evidencing their professional
development.
In New Zealand it was decided by both Christchurch Polytechnic Institute of Technology (CPIT) and
Christchurch District Health Board (CDHB) that a DEU model would be piloted in 2007. CPIT therefore
became the first New Zealand Nursing School to establish a DEU and from their evaluation, benefits to
students, the CDHB and CPIT were identified. Benefits included better quality placements, an increase
in clinical placements as well as better alignment between theory and practice while the DHB and CPIT
staff enjoyed more work satisfaction and a closer relationship in nursing education. Students also
reported better communication, better access to staff and more consistent assessment practices.
This project is about initiating a culture change amongst clinicians in relation to student education. Both
Manukau Institute of Technology (MIT) and Counties Manukau District Health Board (CMDHB) are
committed to improving student learning and will continue to work together to ensure the best possible
outcomes by establishing more DEUs following this project.
The DEU project was implemented in a multicultural environment and in a region that has the fastest
growing population in New Zealand, particularly youth and elderly populations. At CMDHB, 52% of staff
(69 ethnicities) have been trained overseas which adds to the complexity of nursing education. CMDHB
serves a diverse range of clients making up 11% (464700) of the New Zealand population. This diversity
presents unique challenges in relation to retention and success of students. Not only is the DHB one of
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the largest in the country but the population growth in its region is unique as reflected in the graph
below. Figure 1: Population Growth
(Source: Shaping our Future Health System: MOH p 20)
To implement this project it was necessary to understand the context and limitations of current
practices in the clinical education of nurses and to understand DEUs as a strategy to providing superior
clinical education. To achieve this an extensive literature search using databases such as EBSCOhost and
CINAHL was carried out. A visit to the University of South Australia where DEUs have been used
successfully over the past 10 years and a visit to CPIT where the first DEU in New Zealand were
undertaken. Funding was sought and approved by AKO Aotearoa and the implementation of the DEUs
commenced in February 2009. Action research was used to ensure a scientific and robust process for the
implementation of the DEUs.
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METHODOLOGY
Action research is an appropriate method for the establishment of the DEUs as it is a systematic inquiry
to effect positive educational changes in the clinical learning environment. According to Kemmis and
McTaggart (1988) it is a collective and collaborative process which in this case lends itself to MIT and
CMDHB working collaboratively on an initiative that would be beneficial to both organisations. Action
research enhances the lives of learners as well as the lives of teachers. It encourages continuous
learning and reflection which are critical for the practice of nursing. More specifically, practical action
research emphasises the ‘how to’ approach necessary for this project (Mills, 2003).
Stephen Kemmis’s model of action research was used, and involved a series of cycles as a basis for
further planning (Kemmis & McTaggart 1988). The essential characteristics of this model include
reconnaissance, planning, action, reflection, monitoring and evaluation (Mills, 2003).
Action Research Cycle 1
Phase 1 (July 2008 – November 2008). Reconnaissance
Phase 2 (November 2008 – February 2009). First Action Plan
Phase 3 (February 2009 – May 2009). Implementation of Plan
Phase 4 (February 2009 – June 2009). Reflection, Monitoring & Evaluation
Proposed Action Research Cycle 2
Phase 1 (June 2009 – July 2009). Second Action Plan
Phase 2 (July 2009 – November 2009). Implementation of Plan
Phase 3 (July 2009 – December 2009). Reflection, Monitoring & Evaluation
Phase 4 (December 2009). Final Report
The following objectives have been identified for this project:
• Document the process of implementing the DEUs • Evaluate the model’s potential ability to support undergraduate nursing students within CMDHB • Make recommendations to the CNDU on completion of the project as to the model’s suitability
for use as an ongoing undergraduate nursing clinical education • Build research capacity through team research between MIT and CMDHB.
For this project Wards 6 and 24 at Middlemore Hospital were selected as DEUs based on their capacity
and commitment to support the clinical learning of nursing students.
The following structures have been created to develop, oversee and manage the project.
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CNDU Governance Group
The project is overseen by a governance group consisting of key MIT and CMDHB personnel. The role of
the Governance Group is to develop roles/processes/ evaluation criteria; oversee day-to-day
implementation and report to the Collaborative Nursing Development Unit (CNDU).
Action Group
The Action Group facilitated by the MIT Clinical Coordinator met weekly and were primarily concerned
with:
Co-ordinating day-to-day operational issues within the two DEUs
Monitoring student/staff satisfaction
Facilitating staff communication
Providing feedback and support to pilot areas
Participating in the action research.
Research Management Team
A Research Management Team was formed to oversee the action research and its various cycles by
liaising closely with the Action Group, the Governance Group and Rose Whittle from CPIT.
Figure 2: Conceptual Model
DEUAction
ResearchCNDU
Governance Group
Action Group
Charge Nurse
CLN
ALN
Staff
Clinical Coordinators
Students
Research Management
Team
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Data Collection
This report integrates the findings of both qualitative and quantitative data emerging from the following
sources:
Student interviews
Staff interview
Action Group interview
Journals
Minutes
Midway questionnaires
End point questionnaires
Data Analysis
A total of five focus groups was conducted with students, staff and action group members. The
interviews were audiotaped and transcribed by an independent transcriber. The interview transcripts
were sent to all participants for checking and correction. Interviews, reflective journals and meeting
minutes were thematically analysed, independently by both researchers. The researchers met,
reviewed and discussed their analysis to identify commonalities and explore points of difference. A
matrix was developed to group data and emerging themes in a logical manner. The matrix also served
to identify effective practice and areas for review.
Two sets of questionnaires were distributed to students in the DEUs, one at the midway point and the
second on completion of the placement. The first round of questionnaires consisted of 21 questions
using both Likert scales and open-ended questions. Using the same format the second round of
questionnaires consisted of 16 questions. A total of 26 questionnaires (13 from each DEU) were
returned after the first round and nine after the second round. Only one questionnaire was returned
from Ward 24 which resulted in the inability to make comparisons to this ward. The population for the
second round excluded BN semester two students as they spent only two weeks in the DEUs and could
not meaningfully contribute to the data required from the second questionnaire. The responses to
closed-ended questions were captured on an Excel spreadsheet and descriptively analysed and
presented as bar graphs. The open-ended questions were captured verbatim and grouped under each
relevant question using a word document. These verbatim responses were thematically analysed.
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DISCUSSION AND FINDINGS
The DEU Prior to Implementation
Understanding, being Informed and Prepared.
Understanding, being informed and prepared relates to the activities preparing staff and students for
the implementation of the DEU including the workshops and planning day and excluding the orientation
and initial days on the DEUs as they will be discussed separately.
The data suggests that students were informed about the DEU at different times and in different ways.
Some found out about the DEUs well ahead of time while others had less time to consider it. Some
students had the opportunity to request to be placed in a DEU while others were allocated to a DEU.
One participant stated “I first learnt about the DEU when we were preparing for our clinical to make
requests, so it wasn’t clear to me what a DEU was” while another commented “one of our lecturers, the
one responsible for placement explained a bit about the DEU”.
From the Action Group interview there were perceptions about staff readiness for the DEU that related
to being too quick, not feeling informed enough about how it would work and staff not being well
prepared. “I thought it came up too fast. I wasn’t really informed or had enough time to be informed
from the point of how this was going to work. Preparation for the staff I think was pretty much a shock
to them really.” This was further emphasised by the following statement by the same participant: “All in
all I thought the preparations; the commencement for it was[sic] too fast. I would have liked to have a
little bit more time.”
The implementation of the DEU
The implementation of the DEU started with the orientation day, initial days on the DEU and continued
until the completion of the placement by students in the DEUs.
Orientation Day
The orientation day for each DEU was held separately at Middlemore Hospital on 11 February 2009,
following which students commenced their placements on 16 February. The orientation day was seen
as an essential event, however all participants in the orientation day should be well briefed about the
DEU prior to the orientation day so that the content of the day could focus on the orientation itself.
Students valued the orientation to the physical environment, becoming familiar with people and getting
to know the ward routine.
I think that was the most important component of this whole programme, was just
that induction. The rest of it was almost just a build-on. Having that day where you
could just find out simple things like where the toilet is, where I put my bag, routine of
the ward and all that sort of stuff was just so helpful.
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The orientation day made students feel accepted and expected and they valued the fact that staff were
prepared for them and that they were welcoming. “They were expecting us and prepared for us. They
said they are looking forward to seeing us and things like that. That was really welcoming and I think
they were well prepared for us”
The orientation day provided an excellent opportunity for students to ask questions in a safe
environment, conducive to communication. Students reported that the orientation allayed their anxiety
about the clinical placement.
I think it was easy to get over the anxiety, because you know you have that whole
orientation. People made you feel welcome in the first place. People made you feel like
you could communicate back to them and you wouldn’t be dismissed. You have that
open feeling of ok well I can just ask anyone.
Orientation not only prepared students but it also prepared staff and created the opportunity to clarify
expectations.
I felt the students were much better prepared, because of that day. There was a chance
to say some things to the students that we didn’t normally get to say like these are the
ward staff’s expectations of students, these are the sorts of patients you are going to
be looking after and the sorts of things you may come across.
However, some students reported that expectations were not always clear and related this to
miscommunication and misunderstanding of what they had to do in the DEU.
Student valued the support from the Charge Nurse Manager (CNM) at orientation. The Charge Nurse
Manager is a key player in the success of the DEU and her approach and attitude towards the DEU made
a big difference to both students and staff.
We were very warmly welcomed by the Charge Nurse who really set the tone for the
day. She has a real presence and leadership skills. She is strongly supportive of the
programme and is helping to raise the profile of the DEU in the hospital generally.
I feel more confident to start my shift as I was oriented very well and it was easier for
me to work because I am more familiar around the area. I met a few people even
before the start of my duty on the orientation w/c makes me more at ease.
Some student participants reported that not all staff knew about the DEU, in fact they reported that
only nurses seemed to know about it. Regarding doctors, one student reported that “I don’t think that
the doctors really embraced the DEU as a concept and we were obviously more bodies to look for charts,
because I felt that is what they really used me for a lot.”
The questionnaires to students generated quantitative and qualitative data which will be discussed
where appropriate.
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Figure 3: How do you rate your orientation to the area?
Eighty eight percent of students rated their orientation as either excellent (38%) or very good (50%).
From the open-ended questions it is clear that the orientation was well received as reflected in the
following statement: “Fantastic – we had a lot of small orientations to help us learn the layout in small
time frames, so we weren’t overwhelmed” and “I know the ward well within a short period of time.”
The Initial Days on the DEU
The initial days on the DEU were important and played a crucial role in students settling down and
feeling part of the unit. Thoughtful gestures gave students a sense of belonging “I think the notice
board with our names, welcoming us was also quite nice. The handover room had another board with
our names welcoming us to the ward. That was quite nice as well.” Another student participant said “It
makes you feel part of the team, makes you feel welcome and acknowledged. It is just nice to see that ok
you are part of something.” During the first few days students reported experiencing a supportive
environment where people were approachable and reliable. The role of the preceptor during the first
few days could make a positive difference for students as reflected in the following comment. “In my
case in that first week I got a good preceptor, because she was able to orientate me regarding what was
happening in the ward. Before we started the shift she explained to me what are the procedures and the
protocols.”
However, in contrast, BN semester two students reported feeling less welcome than other students.
Due to the structure of the programme, BN semester two students joined the DEU units approximately
two months after the orientation day.
62%
23%15%
0%
15%
77%
8%0%
38%
50%
12%
0%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Excellent Very Good Poor Very Poor
Re
spo
nse
Fre
qu
en
cy
Response
Orientation Rating
Ward 6
Ward 24
Total
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Figure 4: How do you rate your welcome to the area?
Twenty-four percent of all students rated their welcome as poor of which 31% related to Ward 6 and
17% to Ward 24. None felt that it was very poor and 36% felt it was excellent. From the open-ended
questions, students reported that “most nurses were friendly and welcoming making me feel at ease.”
In contrast, BN semester two students reported feeling less welcome compared to others. “Don’t really
get welcomed on my first day. Just went with my preceptor.”
31%
38%
31%
0%
42% 42%
17%
0%
36%
40%
24%
0%0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Excellent Very Good Poor Very Poor
Re
spo
nse
Fre
qu
en
cy
Response
Welcome Rating
Ward 6
Ward 24
Total
13
Figure 5: How do you rate the preparation of ward staff for the DEU?
Twenty-eight percent of the students rated the preparation of ward staff for the DEU as poor however
none rated the preparation as very poor. From the open-ended questions students stated that “staff
were prepared, but perhaps not for the quantity of students arriving.” However some students felt that
“some may not have been informed of what was happening with DEU students. Some are not as
forthcoming as others.” There appear to be conflicting experiences in regard to the preparation of ward
staff for the DEU.
The Role of the Clinical Liaison Nurse
Initially the CLN was not clear on the role and experienced a lack of feedback from staff which made it
difficult to adjust to the role. Timely feedback from staff is crucial to the role.
As a CLN it was a very challenging role to start with. As the weeks went slowly I was
fitting into the role and starting to get what I am supposed to be doing. I could see
there were times where I had quite a lot of students with me and at times I didn’t really
know what to do with them.
The CLN was described as the first point of contact, an advocate, a middle person or catalyst, a bridge
and problem solver. “She was the ‘go to’ person for the students and the nurses. They would consult
with her if there were things they were not sure about whether something was in our scope of practice.”
15%
54%
31%
0%
17%
58%
25%
0%
16%
56%
28%
0%0%
10%
20%
30%
40%
50%
60%
70%
Excellent Very Good Poor Very Poor
Re
spo
nse
Fre
qu
en
cy
Response
Preparation of Ward Staff
Ward 6
Ward 24
Total
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Another participant suggested: “To be a good CLN one needs to have problem solving skills, a quick
thinker and solve issues fairly without letting anyone down and often communication is the key.”
The CLN was also described as supporting students by checking on them, someone who is dedicated and
who took the load off other staff. The CLN was seen as someone who is helpful, available, always there
for students. “She is always there for us all the time.” Students did however suggest that both the CLN
and ALN should be more available during afternoon shifts. “You do kind of feel the difference between
your week of morning shifts and your week of afternoon shifts, mainly because of that support which is
not there.” They felt the afternoon shifts provided more time for teaching and learning. “That is when
we have more time in the afternoon shift for us students to ask questions, because we get more free
time.” While many students valued the availability of the CLN, students in BN semester two felt that the
CLN was not always available to them, particularly on the first day in the unit. “For an hour and a half I
really didn’t know what was happening. There was no approach from [CLN] to say welcome on board,
this is what is going to be expected of you and we will be having handover.”
The CLN was also valued as a person who holds a lot of knowledge and experience of the ward. “It was
good to have someone who had worked in that ward. It made it easier, because she knew many things
about that ward, so that helped a lot.” Her organisational and time management skills were also valued
however some of the data suggested that CLNs faced challenges in relation to organisation and time
management and often had to take work home late at night or over weekends, doing rosters or
attending to progress notes for students.
I have got 2 children, 2 ½ plus 4 ½ at home and also doing post-grad [sic] studies…so I
hardly have any free time. I am enjoying this new role but I foresee this role to be a full
time role between Mon [sic] to Friday in the future. It is indeed a busy role and I feel I could
offer a lot to the students.
CLNs were also valued for the education sessions they planned with other team members such as
dieticians, occupational therapists and infection control nurses. Because the CLN is supernumerary and
focused on the students learning, the CLN worked at a pace that students could cope with. “We are not
rushed by the nurses, because they don’t have time for us, because we have the CLN that is there for us
and she would take her time and she will talk us through it.” Having more time to work with students
resulted in the CLN identifying struggling students at an early stage which meant that additional support
could be provided for these students. “When she is getting feedback from us and she knows which
student who is behind, needs help and she can spend more time with that student.” However, the
supernumerary role of the CLN came into question as participants reported that the CLN was also taking
on a case load as reflected in the following two quotes. “Right now with our CLN she seems to be
juggling a lot of things and we are just something else that is put on top” and “she is having to take a full
patient load and continue with her CLN responsibilities.”
The CLN helped to overcome cultural barriers.
Well I believe I had a student whose cultural background made it difficult for her to ask
for as much help as she should have been asking for. I would offer help, but she was
15
too proud to say I am struggling and I need a hand. Yet she was a bit more open with
you wasn’t she? She was a bit more open with the CLN.
Figure 6: How do you rate the preparation of the Clinical Liaison Nurse for the DEU?
Ninety-six percent of students rated the preparation of the CLN as either excellent (60%) or very good
(36%). Students thought “the CLN was prepared for the role and was also very supportive” and they
saw her as “helpful, punctual, dedicated, hardworking in planning education seminars/teaching sessions
for us which have been very helpful and much appreciated to help understand.”
Midway through the student placement students were asked about their understanding of the CLN role,
the results are reflected in the following graph.
75%
25%
0% 0%
46% 46%
8%
0%
60%
36%
4%0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Excellent Very Good Poor Very Poor
Re
spo
nse
Fre
qu
en
cy
Response
Preparation of CLN
Ward 6
Ward 24
Total
16
Figure 7: Did you understand the role of the Clinical Liaison Nurse (CLN)?
Ninety-six percent of the students understood the role of the CLN at the midway point in their
placement. Students were again asked the same question on completion of their placement and at this
point 100% of the students indicated that they understood the role. This finding is restricted to Ward 6
as insufficient questionnaires were returned from Ward 24 to make comparisons.
92%
8%
100%
0%
96%
4%
0%
20%
40%
60%
80%
100%
120%
Yes No
Re
spo
nse
Fre
qu
en
cy
Response
Understand the role of the Clinical Liaison Nurse (CLN)
Ward 6
Ward 24
Total
17
Figure 8: Did you understand the role of the Clinical Liaison Nurse (CLN)?
The Role of the Academic Liaison Nurse
The ALN has to build rapport with the DEU staff and the CLN in order to be effective as the ALN is not
part of the usual ward staff and represents another organisation, the ALN therefore has to work at
getting to know the staff and becoming accepted by them. “There are also a few groups of staff in
*name removed+ who I will have to get alongside in order to work effectively” In addition, the ALN
needed to establish a working partnership with the CLN to support her in dealing with students’ learning
needs. “I realise she (CLN) will need a lot of support in the CLN role and encouragement too – not just the
students.”
From the data the availability of the ALN and the ability to provide an immediate response when needed
were valued by staff and students. Availability and presence on the unit allowed for many on the spot
teachable moments which otherwise would not have been possible. Students described the ALN as
being present and able to give instant correction if needed while also pointing them to the right
resources. “I felt like we were just so supported, that you were definitely on the path to success. You
would be caught and put back on the right road at any stage you wandered off into the wrong path.” At
the same time one of the ALNs reported that as a result of her presence in the unit there was less need
for students to contact her by cellphone as would otherwise be the case. “My cellphone usage has
decreased! This is real evidence that students have daily access to me so don’t need to text as much as
they previously did.” Students suggested that both CLN and ALN should be more available on afternoon
shifts as explained in the section on the role of the CLN. One of the ALNs however needed to cover
students in other nearby wards (non-DEU) which may have impacted on her availability to work with
students and the CLN.
100%
0%
92%
8%
0%
20%
40%
60%
80%
100%
120%
Yes No
Understanding the role of the CLN: Ward 6
End of placement
Midway through placement
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She [ALN] pops in or pops out. Maybe that is the problem, because she has that feeling that
she is burdening us. I know when she came in one day I was doing the drugs, “oh she is
busy I can’t see her”. Again I was expecting some dedicated time, so that we knew [sic]
everyday and we talked about this when we had the introduction to this, that there would
be set times for one-to-one with [ALN]. It’s not like that, it’s just ad hoc. I think sometimes
that is the issue, because the preceptors have got us doing some learning and she comes in
and takes us away.
An important part of the ALN role is to link theory and practice as they understand the curriculum and
assessments and what was covered in class.
She understands the curriculum and I think that is the great difference between [CLN] and
[ALN] is that [ALN] really understands what marks we have to have and what we have to
achieve while we are in the clinical. She also kind of brings us up to a more professional
level, feeling supported.
However, some students felt that there could have been a better match between what was covered in
class and what was happening in the unit. This appeared to be more a timing issue rather than a lack of
linking theory with practice.
The ALNs felt supported by the CLN who provided clinical examples of students’ progress. The CLN role
assisted the ALN in getting feedback on students. “The CLN role has helped me immensely with giving
me clinical examples of students’ progress and not [sic] progress.” Good communication between the
CLN and ALN is essential in order to coordinate, share information, and organise students. Students
reported that the CLN and ALN had lots of meetings (formal and informal) and that they would catch up
for 10 minutes here and there or at a planned meeting. “I have never for one moment think [sic] that
‘Oh gosh I wish they would talk to one another’. They always seem to be on the same page.” In contrast,
some participants reported a lack in communication between the ALN and CLN such as changes in
student rosters.
Critical to the success of the ALN role is the sense of belonging and not feeling like an outsider in the
unit. “Previously I was a visitor to the hospital, I always felt like an outsider. I wasn’t one of the ward
staff and I wasn’t one of the students, so for me the DEU has meant I have a real sense of belonging
somewhere.” While the sense of belonging is influenced by the attitude of everyone working in the
DEU, the role of the Charge Nurse Manager (CNM) in making the ALN feel welcome and accepted is
most important and valued. “ [The CNM] was extremely welcoming – telling me I didn’t need to ask her
if it was ok for visitors – “it’s your ward now. Just a little phrase but very reassuring” Being accepted
and developing a sense of belonging is not a one-way relationship and ALNs could do a lot to facilitate or
enhance their acceptance in the unit. “To ensure that I am accepted as one of the team I answer
phones, wipe discharge beds, check IV a/b’s + help an RN.”
While the ALNs developed a sense of belonging in the unit they began to feel disconnected from their
semester team back at the Institute and felt disappointed about a perceived lack of support and
understanding by their teaching peers. “My team members tell me they feel “left out”. At times I feel
19
left out!! Kind of feels we are damned if we do, damned if we don’t!” Another participant commented
“It is disappointing to think that our ALNs feel undermined in this respect by colleagues.” Peers also
perceived DEU students as being advantaged over others which added to the ALNs feelings of
disconnection with the team. Over time the relationship with peers improved and one ALN reported
“My team members (BN3 team) have stopped telling me that they feel DEU students are advantaged. A
good thing!”
Figure 9: How do you rate the preparation of the Academic Liaison Nurse for the DEU?
Twenty-three percent of students in Ward 24 felt that the preparation of the ALN was poor compared to
8% in Ward 6. 75% of Ward 6 students felt the preparation of the ALN was excellent, compared to 46%
in Ward 24.
Students reported that the ALN was well prepared as reflected in the following statement: “Very well
prepared. Always there to support our clinical experience with academic knowledge.” However, some
BN semester two students felt: “I did not feel there was any preparation, she visited us ad hoc and this
was not productive as we could not plan or be prepared for her visits.” This perceived lack of
preparation of the ALN by BN Semester two participants appeared to be in relation to their
understanding of the role and the fact that the ALN was also supervising students in other wards.
75%
17%
8%
0%
46%
31%
23%
0%
60%
24%
16%
0%0%
10%
20%
30%
40%
50%
60%
70%
80%
Excellent Very Good Poor Very Poor
Re
spo
nse
Fre
qu
en
cy
Response
Preparation of ALN
Ward 6
Ward 24
Total
20
Figure 10: Did you understand the role of the Academic Liaison Nurse (ALN)?
Ninety-six percent of students indicated that they understood the role of the ALN at the midway point in
the placement. Students were again asked the same question on completion of their placement and at
this point 100% of the students indicated that they understood the role. However, this finding is
restricted to Ward 6 as insufficient questionnaires were returned from Ward 24 to make comparisons.
92%
8%
100%
0%
96%
4%
0%
20%
40%
60%
80%
100%
120%
Yes No
Re
spo
nse
Fre
qu
en
cy
Response
Understand the role of the Academic Liaison Nurse (ALN)
Ward 6
Ward 24
Total
21
Figure 11: Did you understand the role of the Academic Liaison Nurse (ALN)?
Figure 12: To what extent is there an overlap between the roles of the CLN and ALN?
100%
0%
92%
8%
0%
20%
40%
60%
80%
100%
120%
Yes No
Understanding the role of the ALN: Ward 6
End of placement
Midway through placement
50%
8%
25%
17%
8%
38%
31%
23%
28%24%
28%
20%
0%
10%
20%
30%
40%
50%
60%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Extent of overlap between CLN and ALN roles
Ward 6
Ward 24
Total
22
Fifty-two percent of students felt that there was either full (28%) or substantial (24%) overlap between
the roles of ALN and CLN. This finding is acceptable as some overlap is desirable and despite the
perceived overlap most students clearly understood the roles of the CLN’s and ALN’s
Teamwork
Students reported that they contributed to the team and that they were able to support staff in return.
“The fact that I can actually help and not just be there and get their support, but I can actually support
them back in some ways was good.” Being part of the team was seen as everyone getting something
out of the situation, in other words, a win-win situation for all involved. “It’s a knock-on effect as well
because you get something from the nurses and you give something to someone else. Everyone gets
something out of the situation.” Staff reported that students were very much a part of the team. “You
could actually see the students actually blending in, becoming part of the team like they actually belong
there.”
There was strong evidence that the CLN, ALN and CNM made a good team and that they worked well
together. The role of the CNM in promoting teamwork is not to be underestimated as reflected by an
ALN. “She [CNM] would always check with me every week, she would say “how are your students?” and
we would just have a half hour conversation and just talk about the students.”
I also like the way the charge nurse makes sure that all the students work, for example
everyday we have meetings where the doctors rounds are discussed and she makes sure all
the students are happy with preceptors. That makes us feel like we are part of the team.
Support from preceptors was valued and they were perceived as better informed about students.
Generally the preceptors coped really well. I think they were a bit better informed than
usual about what were the expectations of our BN2, BN3 and BN6 students. They were a
bit more aware of the different levels. They seemed to have more understanding of the
students’ assignments, because they have to do care studies.
I reckon if you have a really good day with your preceptor you learn heaps. Like one of
them said to me you know you are so enthusiastic and it’s really good for me that you are
asking questions, because I learn as well.
Data suggested that non-preceptoring staff supported students and that students perceived them as
interested in their learning and that they cared about them. “But sometimes even though they are not
our preceptors the other nurses are willing to help.” The level of support in the DEU was such that if a
preceptor relationship did not work out it did not matter much. “The preceptor to student didn’t always
work, but you have so much support it didn’t really matter if it didn’t work.” There were also reports
that the multidisciplinary team members included students in learning opportunities. “They actually
went out of their way sometimes if they were doing something and there were some students around.
They took us with them and showed us what they were doing.” Teamwork was also seen as more
23
structured compared to non-DEU wards “the structure is really good, for example there is a special nurse
doing their roster and all those sorts of things.” With students included in the team, the level of
commitment, by staff, to student learning increased as reflected in the following quotation.
Before this programme for me personally I don’t care whether I get the students or
whatever, because I am so busy. I don’t have a student, “oh that is my blessing”. But now it
is different, that is my role and I have to fulfill it.
A positive effect of teamwork was the building of students’ confidence and the development of trust in
students by staff. “I think it gives them more confidence, like trusting them to make a phone call to the
doctor.”
Figure 13: To what extent were your responsibilities within the health care team explained?
Forty-six percent of students felt that their responsibilities within the health care team was either
partially (42%) or not at all (4%) explained.
54%
8%
38%
0%
23% 23%
46%
8%
38%
15%
42%
4%
0%
10%
20%
30%
40%
50%
60%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Explanation of own responsibilities within health care team
Ward 6
Ward 24
Total
24
Figure 14: To what extent did the organisation of care reflect a commitment to teamwork?
Seventy-seven percent of the students reported that the organisation of care reflected a commitment to
teamwork and 31% felt this was done fully and 46% felt it was substantial.
Figure 15: To what extent did the organisation of care enable you to function as a member of the health care team?
46%
23%31%
0%
15%
69%
15%
0%
31%
46%
23%
0%0%
10%
20%
30%
40%
50%
60%
70%
80%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Organisation of care reflected a commitment to teamwork
Ward 6
Ward 24
Total
54%
23% 23%
0%
23%
62%
15%
0%
38%42%
19%
0%0%
10%
20%
30%
40%
50%
60%
70%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Functioning as a member of the health care team
Ward 6
Ward 24
Total
25
Eighty percent of the students reported that the organisation of care enabled them to function as a
member of the health care team. Students state that “the team worked well; especially being a part of
the multidisciplinary team was a wonderful experience.”
Support
Peer Learning and Peer Support
The DEUs are unique in that students of different levels were in clinical at the same time, creating the
opportunity for peer learning and peer support. “I felt I was part of this team with the students, because
while you may not be comfortable to ask a nurse you can ask from [sic] a student.” This participant went
on to say “It helps when you have your peers to support you.” Less experienced students valued learning
from more experienced students as they find them easy to approach and ask questions.
It was so helpful to have BN6 students, because they are more knowledgeable than us
and more experienced than us. Sometimes it was easy to go and ask them some of the
things that we are not familiar about in the ward.
Besides learning from each others experiences, students felt that their peers were accessible and
available to them as they were always around, checking on each other’s welfare. “She [fellow student]
is always around and if you’re just doing something she will come and ask if you are okay or if you need
help.” This participant went on to say. “I think it is good to have someone at an upper level than you
are, because you know you can go and ask them things that you don’t know.”
Peer teaching and learning was encouraged and observed by staff as students took initiative in
establishing their own support groups. “The second year showed the third year how to set up an
infusion. She just went through the process and I [preceptor] just stood back and listened to her.”
Through peer support and learning, students developed assertiveness. “Just knowing I guess that each
of us have the support of one another helped us kind of stand up to those issues that were hard.”
Student saw peer learning as two way learning, a way of refreshing your own knowledge. “It’s like
refreshing your own knowledge. I think it is a great thing teaching someone else, because it’s both way
learning. It’s not just you telling someone else, but it’s yourself as well.” In addition it enables students
to identify others in need. “It is interesting that the group [fellow students] have identified the
struggling students for themselves.”
Students have identified the need for more time to provide support to one another and that this may be
structured by the DEU.
26
Figure 16: To what extent did you make use of the opportunity for peer learning and support from other students?
Ninety-two percent of students made either fully (54%) or substantially (38%) use of peer and student
support at the midway point of their placements. Students were asked the same question on
completion of their placement and at this point 88% indicated that they fully use peer and student
support and the remaining 13% used it substantially. This finding is restricted to Ward 6 as insufficient
questionnaires were returned from Ward 24 to make comparisons.
46%
38%
8% 8%
62%
38%
0% 0%
54%
38%
4% 4%
0%
10%
20%
30%
40%
50%
60%
70%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Making use of peer and student support
Ward 6
Ward 24
Total
27
Figure 17: To what extent did you make use of the opportunity for peer learning and support from other students?
Student felt the tutorials were very useful as reflected in the following statement: “Attended tutorials
where students were able to talk about their experiences and share info. Very good and beneficial
sessions.” They went on to say “there was a huge support given by senior students especially those in BN
6.”
Additional Support
The support by the CNM was very visible and her interest in the students was highly valued.
We would find the charge nurse coming frequently to us and asking how we are going,
what our progress was, and what our problems were. She was really eager to help us. I
thought that was really good, because in my previous placement I hardly spoke to the
charge nurse, so it was really good. I felt really supported.
The support from other staff was also valued, they were seen as willing, dedicated, interested, and
looking out for learning opportunities for students. “From the nurses to health care assistants, everyone
in the ward, I think the fact they knew we were students I think the support was really good.” However,
students reported variability in the support from preceptors and felt that some preceptors required
more information about the students and how to provide constructive feedback. A preceptor day was
suggested as a possible solution to this issue.
88%
13%
0% 0%
46%38%
8% 8%
0%10%20%30%40%50%60%70%80%90%
100%
Use of peer learning and support by students: Ward 6
End of placement
Midway through placement
28
Students Learning Needs
The data from both staff and students suggested that there were too many students at certain times,
resulting in too many bodies for the physical space and for the available equipment. This was not seen
as a major problem with the DEU concept but rather a practical issue of accommodating so many people
in one space. This was particularly the case during the early afternoons when morning and afternoon
shifts overlapped and when all three levels of students were allocated to the DEUs. “I think sometimes
for the staff we are just too much for them. For us it is about six on the morning and sometimes six in the
afternoon.” A staff member suggested “We don’t find it as stressful as before, even though we are
having two or three students to one nurse, it is not as stressful as how we used to look at it before the
DEU started.” Participants offered possible solutions such as the use of the whanau room or arranging
study sessions during these peak hours.
Students were growing in confidence as a result of being in a DEU and they started taking on
responsibility for their own learning. Students became more committed to learning. “Everyone is so
focused on teaching you, so you are more interested in making your own learning. I think it has been
really good and one of the best experiences I have had on the ward.” A staff member remarked “They
had their own small timetable set so at this hour I am doing this, at this [sic] hour I am doing this [sic].
That actually worked quite well.” Because of the support in place it was possible to identify students in
need at an early stage as reflected in the following statements. “But with this system there is no room
for the students to escape.” “It highlighted the ones that were slow.”
While the DEUs enhanced the students’ learning experiences, the workload of the unit impacted at
times, on students’ learning needs as students felt they did everything instead of focusing on their
learning. “We end up helping everyone and sometimes I think we need some time to actually focus on
them and really focus on the care and not with everyone else as well.” By attending too many patients
students got mixed up and confused when questioned by the ALN or CLN. “My lecturer would ask
about the medications for my focus patient and then I wouldn’t be able to remember, because I get
mixed up with everyone else.”
Student learning was also influenced by inconsistency in feedback and some preceptors were not as
confident as others in providing feedback.
Sometimes you work with a nurse and you just go and do your thing and there is no
feedback or communication and sometimes someone you have got someone else who
takes the time to say this I what you have done and can you give me the rationale and
this is what you can do to improve. That is more helpful, so you find you would rather
be with this person and you feel short changed when with the other nurse. I think it
should be consistent throughout, so there should be a way at looking at it so nurses
operate in a uniform manner. Another participant stated “We are coming to our last
two weeks now and I have looked at some of our ongoing assessments and we need
constructive criticism.”
29
From the data is was clear that BN semester two students needed more CLN and ALN contact and a
more structured approach to their learning within the DEU. The expectations of BN semester two
students were not always clear.
There would be some kind of plan of action for our [BN semester two] education while we
were there. I will be honest with you [CLN] has never stopped and said “how’s it going?,
have you done this yet?, have you done that?, have you done an assessment?”
There was also a general need for more clarification of student scopes of practice and tasks.
There was this whole grey area over administration of medicine through an IV line and
they kept pulling up information of the Counties Manukau District Health Board
website and saying look you can, its right here. We can’t, we are not allowed to.
Access to information
Access to the intranet and the internet via computers impacted on student learning with some students
feeling that they had good access even though they had to ask staff to log them on while others were
very critical about this. Staff felt that student access would enhance their performance.
I think from an education perspective it would have been great for students to have I
don’t know whether they have it before they come in or after they come in computer
access. It proved really hard for us. I think it would be good if a preceptor can say “go
could you quickly go and look up this and look up that.”
30
Figure 18: To what extent were you able to access electronic information within the area e.g. policies, procedures, forms?
Twenty-seven percent at the midway point of the placement felt that they only had partial access to
electronic information while 4% felt they had no access at all. When asked again on completion of the
placement 43% felt they had only partial access and 14% felt they had no access at all to electronic
information. This finding is restricted to Ward 6 as insufficient questionnaires were returned from Ward
24 to make comparisons.
31%
38%
31%
0%
38%
31%
23%
8%
35% 35%
27%
4%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Access to electronic information
Ward 6
Ward 24
Total
31
Figure 19: To what extent were you able to access electronic information within the area e.g. policies, procedures, forms?
While students felt that Southnet was very useful, they had issues with gaining access as reflected in the
following statement: “Only problem was that sometimes we needed to ask staff to log in for us to access
electronic info.”
29%
14%
43%
14%
31%
38%
31%
0%0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Fully Substantially Partially Not at all
Access to electronic information
End of placement
Midway through placement
32
Figure 20: To what extent were you able to access written information within the area e.g. policies, procedures, forms?
Fifteen percent of the students felt they only had partial access to written information on the DEU at the
midway point of their placements. When asked again on completion of the placement 19% answered
the question in the negative of which 12.5% felt they had no access to written information. This finding
is restricted to Ward 6 as insufficient questionnaires were returned from Ward 24 to make comparisons.
54%
38%
8%
0%
46%
31%
23%
0%
50%
35%
15%
0%0%
10%
20%
30%
40%
50%
60%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Access to written information
Ward 6
Ward 24
Total
33
Figure 21: To what extent were you able to access written information within the area e.g. policies, procedures, forms?
A series of questions were put to students to gauge how the DEU was meeting their learning needs.
Figure 22: To what extent did staff enable you to contribute to patient assessments?
50.0%
37.5%
0.0%
12.5%
53.8%
38.5%
7.7%
0.0%0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Access to written information: Ward 6
End of placement
Midway through placement
42%
33%
25%
0%
31%
38%
23%
8%
36% 36%
24%
4%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Contribution to patient assessment
Ward 6
Ward 24
Total
34
At the midway point in the placement 24% of students felt that staff only partially enabled them to
contribute to patient assessments and 4% felt that it was not occurring at all. Students were asked the
same question on completion of their placement and at this point 50% indicated that they fully
contributed to patient assessment and 50% felt they did so substantially. This finding is restricted to
Ward 6 as insufficient questionnaires were returned from Ward 24 to make comparisons.
Figure 23: To what extent did staff enable you to contribute to patient assessments?
50% 50%
0% 0%
42%
33%
25%
0%0%
10%
20%
30%
40%
50%
60%
Fully
Sub
stan
tial
ly
Par
tial
ly
No
t at
all
Contribution to patient assessment: Ward 6
End of placement
Midway through placement
35
Figure 24: To what extent did staff enable you to contribute to care plans?
Midway through their placement 19% of students felt that staff only partially enabled them to
contribute to care plans and 4% felt that it was not occurring at all. Students were asked the same
question on completion of their placement and at this point 37.5% indicated that they fully contributed
to care planning and 62.5% felt they did so substantially. This finding is restricted to Ward 6 as
insufficient questionnaires were returned from Ward 24 to make comparisons.
38% 38%
23%
0%
31%
46%
15%
8%
35%
42%
19%
4%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Contribution to care plans
Ward 6
Ward 24
Total
36
Figure 25: To what extent did staff enable you to contribute to care plans?
Figure 26: To what extent did staff enable you to contribute to nursing interventions?
Midway through their placements 20% of students felt that staff only partially enabled them to
contribute to nursing interventions. Students were asked the same question on completion of their
37.5%
62.5%
0.0% 0.0%
38.5%
38.5%
23.1%
0.0%0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Fully
Sub
stan
tial
ly
Par
tial
ly
No
t at
all
Contribution to care planning: Ward 6
End of placement
Midway through placement
42% 42%
17%
0%
31%
46%
23%
0%
36%
44%
20%
0%0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Contribution to nursing intervention
Ward 6
Ward 24
Total
37
placement and at this point 50% indicated that they fully contributed to nursing intervention and 50%
felt they did so substantially. This finding is restricted to Ward 6 as insufficient questionnaires were
returned from Ward 24 to make comparisons.
Figure 27: To what extent did staff enable you to contribute to nursing interventions?
Figure 28: To what extent did staff enable you to contribute to the evaluation of care?
Midway through their placements 28% of students felt that staff only partially enabled them to
contribute to the evaluation of care and 8% felt that was not occurring at all. Students were asked the
50.0% 50.0%
0.0% 0.0%
41.7% 41.7%
16.7%
0.0%0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Fully
Sub
stan
tial
ly
Par
tial
ly
No
t at
all
Contribution to nursing intervention: Ward 6
End of placement
Midway through placement
25%
42%
17% 17%
31% 31%
38%
0%
28%
36%
28%
8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Contribution to evaluation of care
Ward 6
Ward 24
Total
38
same question on completion of their placement and at this point 38% indicated that they fully
contributed to the evaluation of care and 62% felt they did so substantially. This finding is restricted to
Ward 6 as insufficient questionnaires were returned from Ward 24 to make comparisons.
Figure 29: To what extent did staff enable you to contribute to the evaluation of care?
Figure 30: Was time set aside to discuss your individual learning outcomes and responsibilities with the ALN?
38%
62%
0% 0%
25.0%
41.7%
16.7% 16.7%
0%
10%
20%
30%
40%
50%
60%
70%
Fully
Sub
stan
tial
ly
Par
tial
ly
No
t at
all
Contribution to the evaluation of care: Ward 6
End of placement
Midway through placement
77%
23%
73%
27%
75%
25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Yes No
Re
spo
nse
Fre
qu
en
cy
Response
Time set aside to discuss learning outcomes with ALN
Ward 6
Ward 24
Total
39
Twenty-five percent of students felt there was no time set aside to discuss learning outcomes with the
ALN.
Figure 31: Was time set aside to discuss your individual learning outcomes and responsibilities with the CLN?
Thirty percent of the students felt that there was not enough time set aside to discuss their learning
needs with the CLN. Students reported that “both ALN and CLN were dedicated and helpful and ensure
my learning progress goes well” While this appears to be working well, students felt there was “not
enough time set for both.”
77%
23%
60%
40%
70%
30%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Yes No
Re
spo
nse
Fre
qu
en
cy
Response
Time set aside to discuss learning outcomes with CLN
Ward 6
Ward 24
Total
40
Figure 32: To what extent did this clinical experience enable you to achieve your learning outcomes?
At the midway point in their placements 92% percent of students felt that the clinical experience
enabled them to achieve their learning outcomes either fully (42%) or substantially (50%). Students
were asked the same question on completion of their placement and at this point 75% indicated that
the clinical experience enabled them to fully achieve their learning outcomes and 25% felt it did so
substantially. This finding is restricted to Ward 6 as insufficient questionnaires were returned from
Ward 24 to make comparisons.
64%
27%
9%
0%
23%
69%
8%0%
42%
50%
8%
0%0%
10%
20%
30%
40%
50%
60%
70%
80%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Achievement of learning outcomes
Ward 6
Ward 24
Total
41
Figure 33: To what extent did this clinical experience enable you to achieve your learning outcomes?
Figure 34: To what extent did this clinical experience enable you to achieve the prescribed competencies?
75%
25%
0% 0%
64%
27%
9%
0%0%
10%
20%
30%
40%
50%
60%
70%
80%
Fully Substantially Partially Not at all
Achievement of learning outcomes: Ward 6
On completion of placement
Midway through placement
64%
27%
9%
0%
38%
62%
0% 0%
50%46%
4%0%
0%
10%
20%
30%
40%
50%
60%
70%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Achievement of prescribed competencies
Ward 6
Ward 24
Total
42
Midway through their placements 96% of students felt that the clinical experience enabled them to
achieve the prescribed competencies either fully (50%) or substantially (46%). Students were asked the
same question on completion of their placement and at this point 62.5% indicated that the clinical
experience enabled them to fully achieve the prescribed competencies and 37.5% felt it did so
substantially. This finding is restricted to Ward 6 as insufficient questionnaires were returned from
Ward 24 to make comparisons.
Figure 35: To what extent did this clinical experience enable you to achieve the prescribed competencies?
BN semester 2 students felt that “2 weeks of placement is short to achieve learning outcome.” This
constraint is related to the structure of the curriculum and not the DEU.
62.5%
37.5%
0.0% 0.0%
63.6%
27.3%
9.1%0.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Fully
Sub
stan
tial
ly
Par
tial
ly
No
t at
all
Achievement of competencies : Ward 6
On completion of placement
Midway through placement
43
Figure 36: To what extent did the DEU environment enable you to practise in a culturally safe manner?
Midway through their placements 38% of students in Ward 6 reported that the DEU environment only
partially enabled them to practise in a culturally safe manner compared to 8% in Ward 24. Students
were asked the same question on completion of their placement and at this point only 13% felt that the
environment only enabled them to partially practise in a culturally safe manner. This finding is
restricted to Ward 6 as insufficient questionnaires were returned from Ward 24 to make comparisons.
46%
15%
38%
0%
31%
62%
8%
0%
38% 38%
23%
0%0%
10%
20%
30%
40%
50%
60%
70%
Fully Substantially Partially Not at all
Re
spo
nse
Fre
qu
en
cy
Response
Practising in a culturally safe manner
Ward 6
Ward 24
Total
44
Figure 37: To what extent did the DEU environment enable you to practise in a culturally safe manner?
The questionnaires provided students with the opportunity to comment on how the DEU compared with
their previous experiences in the preceptor model. A student reported the difference as: “More support
from CLN + ALN, felt more like I was part of the team. More opportunities to observe procedures + be
with other nurses outside the main ward. More students on the ward so I had more peer support.” They
also felt that the “DEU is concentrated on the attainment of the competencies of the student while
previous experience of the preceptor model is just a matter of compliance with the academic
requirements.”
The questionnaire also explored things that were most valuable to their learning needs. Numerous
students reported positively about their DEU experience as reflected in the following comments:
“I have really enjoyed being part of the DEU and feel that it is definitely the best way for students to
learn in the future.”
“I’ve had a great experience so far that it contributing to the nurse that I will become. A very helpful and
positive experience personally.”
“The ability to use other [students] for peer learning. The willingness of staff to facilitate learning
outcomes.”
63%
25%
13%
0%
46.2%
15.4%
38.5%
0.0%0%
10%
20%
30%
40%
50%
60%
70%
Practising in a culturally safe manner: Ward 6
End of placement
Midway through placement
45
“Teaching sessions from different health care workers eg physios, pacific health care supporters,
infection control etc.” The multidisciplinary approach to learning was most valuable to the students’
learning needs and is unique to the DEU.
46
RECOMMENDATIONS
From the results of this study the researchers recommend the following considerations for the second
cycle of the action research project:
Students should be informed about the DEU in a timely and consistent manner prior to the
orientation day and commencement of the DEU
The process in allocating students to the DEU should be fair and transparent
A process should be developed to inform all multidisciplinary team members, including
preceptors about the DEU model
Ensure that MIT semester teams and DEU processes are aligned and supportive of the ALN and
the students allocated to the DEU
During the orientation day further clarification is required on:
the learning outcomes and student scopes of practice
roles and responsibilities of ward staff and team members. Where possible DEU staff
could be introduced to students to talk about their roles and expectations
Generate a list of frequently asked unit questions and answers, that would assist future students
to adapt to their clinical environment
Provide new staff with orientation to the DEU model as soon as possible
Ensure the supernumerary status of the CLNs and ALNs is maintained while students are present
on the units
Consider additional availability of the ALNs and CLNs on afternoon shifts
Further develop the partnership between CLN, ALN, preceptor and student to more closely link
theory and practice and to maximise the unique learning opportunities in the unit
Consider how the number of students in a physical space such as the duty room could be
reduced during handover without compromising the students’ learning
The placement period of BN semester 2 students should be more structured to maximise the
limited time in the DEU. Both students and DEU staff need to be clear on what they should
achieve during their placement
Consider better ways for students to access electronic information
Consistency with feedback from preceptors and nurses and, preceptors should be allocated time
to give constructive feedback to students
Consider developing students’ ability to receive and deliver constructive feedback.
47
REFERENCES
Baird, S., C., Bopp, A., Kruckenberg, K., K., Langenberg, A., S., & Matheis-Kraft, C. (1994). An
innovative model for clinical teaching. Nurse Educator, 19(30), 23-25.
Henderson, A., Twentyman, M., Heel, A., & Lloyd, B. (2006) Student’s perceptions of the psycho-
social clinical learning environment: an evaluation of placement models. Nurse Education
Today, 26(7), 564-571.
Joynt, J., & Kimball, B. (2008). Blowing open the bottleneck: Designing new approaches to increase
nurse education capacity. Oregon Healthcare Workforce Institute. White Paper.
Kemmis, S., & McTaggart, R., (1988). The action research planner. 3rd ed. Deakin University: Victoria.
KPMG Consulting. (2001). Strategic review of undergraduate nursing education: Report to Nursing Council of New Zealand. Wellington, New Zealand: Author
Melander, S., & Roberts, C. (1994). Clinical teaching associate model: creating effective BSN
student/faculty/staff nurse triad. Journal of Nursing Education, 33(9), 411-416.
Mills, G. E., (2003). Action research: A guide for the teacher researcher. 2nd ed. Merrill Prentice Hall:
New Jersey.
Nehls, N., Rather, M., & Guyette, M. (1997). The preceptor model of clinical instruction: the lived
experiences of students, preceptors and faculty- of-record. Journal of Nursing Education,
36(5), 220-227.
Ranse, K., & Grelish, L. (2007). Nursing students’ perceptions of learning in the clinical setting of the
Dedicated Education Unit. Journal of Advanced Nursing, 58(2), 171-179.
48
Appendix 1: Tables with Qualitative Comments
Table 1: How do you rate your orientation to the area?
Ward BN Comment
6 Had a day of orientation which prepared me adequately for the ward.
6 I have to ask which one is my preceptor. However she was very organised maybe she wasn’t told! (just thoughts or views).
6 Orientation was very clear and staff welcome to help identify some areas in the ward.
6 3 Fantastic – We had a lot of small orientations to help us learn the layout in small time frames, so we weren’t overwhelmed.
6 The CLN did a great job showing and telling us about everything about the ward.
6 2 The orientation was fantastic. Gave a good indication of what the DEU was all about.
24 Friendly open, easy to approach staff.
24 2 Need more orientation about the routine of each shift.
24 The area was well oriented.
24 I had routine of ward and PM shift. I had chance to supervision of basic nursing care and course about roles of health care team members.
24 3 The Clinical Liaison Nurse showed all around, where everything was in the ward on orientation.
24 3 Within the 1st
week we were shown everything around the ward.
24 2 Had been given orientation 3 times, which was fine by me, were more knowledgeable and I felt more confident.
24 3 I know the ward well within short period of time.
24 2 It was quite fast but suppose it was not what I expected in orientation in the area on my first day. I put my bag in a little office with everyone else’s stuff squashed on the table. People just staring but I just smiled and did whatever until my preceptor came at 3 pm when I started at 1pm.
24 2 We were shown around the ward and the major points of interest (ie storage room, med room etc) were pointed out.
24 2 Referring to the critical orientation with [Clinical Coordinator] this was very good, but there was no orientation of the ward on our first day.
49
Table 2: How do you rate your welcome to the area?
Ward BN Comment
6 Most nurses were friendly and welcoming making me feel at ease
6 Excellent staff were good. Welcoming environment
6 Must be past experiences they weren’t introduced! Just a personal viewpoint
6 Some staff don’t look happy or not welcoming to students
6 3 Because we had induction day – I felt very welcome on my first day
6 The orientation day really helped I knew where I was going, the staff knew we were coming
and they were really welcoming
6 2 Don’t really get welcomed on my first day. Just went with my preceptor
24 Friendly staff, all willing to help and orientate us
24 A warm welcome was given
24 They put the welcome sheet on the announcement board and introduce me to all the staff
24 3 We had a tour all around the ward on orientation day
24 3 Most of the nurses were welcoming
24 2 It was warm, inviting, my preceptors were great at teaching and educating me
24 3 Warm welcome to a friendly ward/environment
24 2 I introduced myself and explained who I was. Then I asked who would be my preceptor –
staff was unsure. I just went to a colleague student and helped do the medication orders
with the RN present
24 2 Although there was a note near the front entrance of the ward say “welcome to BN2
students” there was no formal introduction to any of the staff until 2 hrs later when we
attended handover.
50
Table 3: How do you rate the preparation of ward staff for the DEU?
Ward BN Comment
6 Most of them were open and communicated well. Some however, did not say much which
was not very helpful to student’s learning
6 Staff were more than prepared and willing
6 However the preceptor I had was awesome and helpful. She works smarter not harder
(Maybe because she was an MIT graduate! Complement!)
6 3 I think the staff were prepared, but perhaps not for the quantity of students arriving
6 2 Clinical liaison nurse and academic liaison nurse was very good and helpful. Ward staff
weren’t that prepared
24 At times I felt some may not have been informed of what was happening with DEU students.
Some are not as forthcoming as others.
24 Having said that some staff are not welcoming and shows dislikes of students
24 The ward staff were more cooperative and helpful
24 3 The staff for the DEU were very helpful specially the Clinical Liaison and Academic Liaison.
24 3 It was okay
24 2 Very good most of the staff were aware of us even though they could have easily mixed us
from BN3 and BN2
24 3 Well planned and prepared
24 2 Only the staff on the DEU programme knew about the DEU whereas the rest did not know
what was expected of us. I was buddied up with 4 different preceptors 1 Sen Enrolled N, a
new grad (1yr) RN and a RN of many years of experience. I took upon myself to do my own
learning.
24 2 All the staff on duty were aware of who we were are, what we were therefore and why
24 2 I did not see any preparation, it would have been beneficial if there had been plans drawn up
as to what our objectives were in relation to the DEU
51
Table 4: How do you rate the preparation of the Clinical Liaison Nurse for the DEU?
Ward BN Comment
6 Very helpful especially at the start of the clinical experience. Ensured that we learnt how to
do things the right way and supported us throughout
6 Very helpful and dedicated working with students
6 Clinical liaison’s always prepared for the next week and students know what to expect
6 3 I think the CLN was prepared for the role and was also very supportive
6 She has been wonderful, her clinical expertise really helped me
6 2 Was very good
24 Helpful, punctual, dedicated, hardworking in planning education seminars/teaching sessions
for us which have been very helpful and much appreciated to help understand
24 Good, supportive, caring
24 3 She’s well organised and each week she arranges education day with different people who
contribute to the ward. It’s really helpful to us
24 3 The CLN was very supportive, she makes sure that the students are comfortable and if we
have any concerns
24 2 She was prepared with copies for us and keep us informed of any education presentations
24 3 Well prepared and very dedicated and helpful
24 2 At the beginning of placement, I am not sure if she was to approach me, so I approached her
and asked some stuff. She was my preceptor for 1 day but from the second wk I know she is
good in her role. I think she was also busy with the BN 3 students
24 2 Again no preparation was made except the buddy system with RN. We attend workshops
along with other staff from the ward, but I don’t think this was prepared for students
52
Table 5: How do you rate the preparation of the Academic Liaison Nurse for the DEU?
Ward BN Comment
6 2 Don’t really understand her role but ALN role is probably more prominent in BN3
6 Very well prepared. Always there to support our clinical experience with academic
knowledge
6 Good communication with students, excellent work
6 Academic liaison were always helpful and always there when needed
6 3 I think the ALN was very prepared for their role, and I felt very supported by her
6 She has done a wonderful job. It was a great help having her in the wd, if I had any doubt
about anything I always went to her.
6 2 Was very good
24 Very helpful and punctual. The ALN I have found informative and very passionate about our
learning
24 The Academic Liaison Nurse was very supportive, co-operative, knowledgeable, caring
24 3 She’s really helpful and explains us things if we are unsure of anything. She visits us
everyday during clinicals
24 3 It was helpful, and she always made sure we were happy with everything
24 2 Very thorough and patient
24 3 Well prepared and very dedicated and helpful
24 2 I did not get much help from her. She is a lovely person. I rarely saw her just passing by
quickly. I would have preferred a set time to sit down and discuss some of my concerns with
the learning and requirements for assignments?
24 2 I did not feel there was any preparation, she visited us adhoc and this was not productive as
we could not plan or be prepared for her visits
53
Table 6: To what extent is there an overlap between the roles of the CLN and ALN?
Ward BN Comment
6 They both had experience and knowledge in each others fields. This made it easier for us
because if you talked to one, you would get the amount of info from both sides
6 CLN & ALN were doing a good job when we want to know something
6 Both were supportive as they both could help in academic and clinical situations
6 3 I feel that I approached the CLN and ALN for different reasons
24 CLN and ALN have their own area of responsibility however there is excellent relationship
between the two roles
24 3 The CLN and ALN both supported my learning in every way
24 2 I did not see any overlapping. The ALN just came and went. I am unsure of what the content
of her role involves. The CLN was more involved with BN3 students. This is not a negative
feedback.
2 There didn’t seem to be any cohesiveness between them
Table 7: To what extent were your responsibilities within the healthcare team explained?
Ward BN Comment
6 Just after 1-2 wks of placement most of the nurses knew what our scope of practice was and
the learning outcomes they helped me to achieve them
24 We kind of have to explain what we can and cant do
24 Preceptors usually take the students as HCA and not students need learning and guidance
24 3 I had a good role of taking care of couple of patients myself and ensuring their healthcare
24 2 The preceptors were very thorough and explained everything well
24 2 I just read the expectations on the handouts given at the DEU orientation day early in the year.
The DEU programme information.
24 2 Our responsibilities were not clearly explained and again it was mainly determined by the
preceptor on each shift.
24 2 Never, I was asked what they were
54
Table 8: To what extent did the organisation of care reflect a commitment to teamwork and enable
you to function as a member of the health care team?
Ward BN Comment
6 Team nursing was practised. All patients were everyone’s responsibility even the students
24 Very helpful to be appointed pts as you feel more part of the team. Also encouragement to participate in MDT’s
24 3 Some nurses (preceptors) does not work with the students. They don’t teach much and the enrol nurses do much anyway
24 3 Most of the team was co-operative
24 2 The team worked well; especially being a part of the multi-disciplinary team was a wonderful experience
24 2 I was always willing to assist in whatever nursing care was needed to any patient. I asked if there was anything I could do if I wasn’t needed or busy on my side. I assisted on the other side.
24 2 There were many disputes during handover, especially afterwards about the practice of care by various nurses
Table 9: To what extent did you make use of the opportunity for peer learning and support from other
students?
Ward BN Comment
6 Attended tutorials where students were able to talk about their experiences and share info. Very good and beneficial sessions
6 3 We often spoke to other students to do peer focussed learning
6 We had meeting every wk where students discussed about 1 patient and it was really helpful
24 With other levels of students knowledge it is easier to relate to them. Also to help other students below with things they need to know
24 There was a huge support given by senior students especially those in BN 6
24 We share knowledge between BN6 and BN 3 students
24 3 I always shared my experiences with my peers as I learn a lot from them too
24 2 By asking lots of questions? Attending and participating in the pharmacy, stroke, skin integrity workshops and presentations
24 2 I asked questions and read as much of what I needed to complete my assignment. My preceptors were approachable so I could ask them anything. My student colleagues BN3 were most helpful too. I used my time in the ward to understand the nursing process in a inpatient setting. The experience was great.
24 2 The BN3 students were always very willing to help or answer questions and where possible allowed us to be fully involved with tasks
24 2 I was always asking questions and volunteering myself, the BN3 students were very supportive when requiring help with assignments
24 2 Managed to ask questions from peers and seniors during break time and when the ward was quiet
55
Table 10: To what extent were you able to access electronic information within the area e.g. policies,
procedures, forms?
Ward BN Comment
6 Only problem was that sometime we needed to ask staff to log in for us to access electronic info
6 Haven’t done any within policies & procedures apart from patient notes.
6 Southnet is very useful
6 Had to ask nurses to log on for us
6 3 Although we didn’t have passwords to computer systems all of the RN’s were helpful in gaining access
6 The staff were very helpful in finding any information that I needed
24 Southnet is a very useful tool
24 I can’t get onto the Internet because I don’t have ID and password. But we can get on to Southnet to get the CMDHB information
24 3 We had good access to the Internet and Southnet which helped our learning
24 2 Forms were available so that was easy. Reading patient notes and photocopied – no patient ID’s. Observer data entered by RN for patient.
24 2 Because I asked I was told
Table 11: Was time set aside to discuss your individual learning outcomes and responsibilities with the
ALN and CLN:
Ward BN Comment
6 They were always keen to discuss our outcomes at any time. Always made time for us at least once a week
6 We did have a session on Tuesday with XXXXX, about half an hour where we could discuss patient s that we had worked with
6 3 On a weekly basis
6 They were so great that if forgot about my appointment they came looking for me.
6 2 Didn’t bother me too much though as I was just there to observe and didn’t have any specific objectives
24 At times, times was set out but not continually
24 I wrote down my personal learning outcomes and showed to ALN and CLN
24 3 Yes, ALN takes out time for individual feedback on clinical area and relate things from practical to theory
24 3 Both of them ensured best of learning
24 2 CLN such a busy person + may have got BN3 confused with us BN2 and thought she has discussed learning outcomes
24 3 Both ALN and CLN were dedicated and helpful and ensure my learning progress goes well
24 2 If this DEU programme is to continue it is important to be given some time to welcome students to the programme, establish and understanding of the programme with the preceptors involved.
24 2 A plan of objectives and goals would have benefited, basically we went ahead and did our own thing
24 2 Not enough time set for both
Table 12: To what extent did this clinical experience enable you to: Achieve your learning outcomes;
Achieve the prescribed competencies?
56
Ward BN Comment
6 Everything in the clinical area including staff, Clinical Liaison Nurse and Academic Liaison Nurse were helpful
6 However is a lot to learn & to absorbed, maybe when the DEU system is effectively implemented.
6 What were the learning outcomes?? What were the prescribed competencies??
6 3 At all times during my placement – I Felt fully supported
24 2 2 weeks of placement is short to achieve learning outcome
24 3 Like what we are taught in lecture we get to see in practical in the ward for example different diseases and things.
24 3 I had many different opportunities to learn different things
24 2 Depending on which RN was our preceptor determined how much we were able to do on the ward. Some preceptors were more inclined to allow us to do tasks, some preferred for us to just watch and follow them
24 2 Through being proactive and keen to learn I was able to achieve
Table 13: To what extent did the DEU environment enable you to practice in a culturally safe manner?
Ward BN Comment
6 Potentially maybe because it’s a new project. However culturally safe manner was implemented at all/most times
6 Very supportive DEU staff, so felt safe in the ward and nurses were helpful to
24 By having a cultural safety teaching session
24 3 Having different patients from different culture and working with nurses from different cultures helped my learning
24 2 XXXX the Maori nurse liaison had taken us for cultural safety workshop which was valuable and should be often repeated.
24 2 The ward pt was mainly European and they were lovely and caring. The staff were of cultural diversity, but that was good. The 2
nd last week there were 3 different cultures pt. I asked
where they were from. I greeted a PI patient, cultural safety was respected I felt.
57
Table 14: Comparison with previous experience of preceptor model
Ward BN Comment
6 More support from CLN + ALN, felt more like I was part of the team. More opportunities to observe procedures + be with other nurses outside the main ward. More students on the ward so I had more peer support.
6 DEU makes us work hard and be focussed
6 To be honest I haven’t seen the DEU previous experience of the preceptor model but I assume is not as same and sophisticated as the new DEU, otherwise I wont be writing all these.
6 Staff are very thorough and competent. Very welcoming staff
6 DEU is concentrated on the attainment of the competencies of the student while previous experience of the preceptor model is just a matter of compliance with the academic requirements.
6 Preceptors this year – they knew about the DEU so everyone tried to support the students
6 3 I have really enjoyed being part of the Ward 6 team – cause I really felt like I was a valued member of the team – on previous placement I didn’t have that
6 DEU had a better learning environment esp with CLN and ALN being present in the ward most of the time. The DEU staff were more welcoming towards the students, it didn’t feel I was a burden for them.
6 2 DEU experience helped me a lot with regards to the participation and support of Clinical Liaison Nurse and Academic Liaison Nurse and other students
24 Knowledge, experience, helpfulness
24 Compare to my previous experience, DEU experience is giving me time, authority as a student to function in a way the student nurse should be. Not too much pressure for the students
24 No previous experience of the preceptor model
24 Each shift I can know who’s my preceptor and she would discuss the patient and time management of the care with me. Compare with my previous experience in surgical ward. I needed to find a preceptor each shift because my name was not on the roster
24 3 More attention given more support and better learning opportunity
24 2 Preceptor would understand and know your learning outcomes and ensure time was planned in to achieve them
24 2 To become more involved with the preceptor in DEU than the previous model
58
Table 15: Additional comments
Ward BN Comment
6 This is an excellent program which I think should not end up with us but to continue. It is excellent.
6 Analyse the comments at areas mentioned above but the DEU is a very good education system introduced. Will fruit effectively in the near future!
6 No comment
6 DEU should be strengthened for the benefit of the students because it supports the students in their clinical experience and it should be shared to other students to experience the process being implemented in the pilot areas
6 DEU is a great way of supporting students and encouraging student to learn and gain confidence because there is a lot of people to support
6 3 I have really enjoyed being part of the DEU and feel that it is definitely the best way for students to learn in the future
6 2 I feel more confident to start my shift as I was oriented very well and it was easier for me to work because I am more familiar around the area. I met a few people even before the start of my duty on the orientation w/c makes me more at ease
6 I think it a great idea to have DEU. I feel the CLN did a great job getting other health professionals to talk to us, it gave me a good understanding about their roles.
24 Ive had a great experience so far that it contributing to the nurse that I will become. A very helpful and positive experience personally.
24 During my first 2 days at the placement, I was assigned to a enrolled nurse, who did not help me achieve my goals of my placement. However, this was highlighted to the Academic Liaison Nurse, who made the necessary arrangement for a new preceptor. At once my preceptor told me not to use the Dianamap but to take manual BP. She said students are not allowed to use the Dianamap but I did not use it further in my placement.
24 3 The nurses should be more into it but they don’t seem to teach students much. Some nurses are even rude to students.
24 3 My experience in the DEU is good so far, but it would be helpful if some of the nurses had a better attitude towards student learning.
24 2 I think there were too many students in 1 ward which would have easily confused both staff and patients. So the ration should be a lot lower.
24 3 Is there any opportunity for students to rotate around different wards?
24 2 My personal learning about nursing in an inpatient setting was a great experience. But it would have been better of orientation was done on the first day at placement. Define the roles and expectations and the outcomes required at completion of the DEU programme. It may be just the same if it was not a DEU programme. Privileged to be part of the DEU but could not see the difference to the other students in a ward placement not in DEU. Just wanted to add on why our shifts starts at 1pm and the preceptor starts at 3pm
24 2 I feel that at the end of the clinical experience a type of debrief of our time on the ward would have been valuable. Input and comment from the staff that we worked with would enable us to be aware of areas that we did well in and be able to make changes in those that we were not so competent in
24 2 I believe having a planned itinerary of practices and experiences would enhance the students learning. An opportunity to debrief with the Charge nurse and the CLN and ALN would also be of benefit
2 There should be written plan / guidelines as to what students must achieve at the end of their clinical experience including being able to learn practical things which has not been taught in class so that when the student goes back to class and are introduced to a new topic/concept they will get more understanding because they’re already done the practical aspect
59
Table 16: List two things that were most valuable to your learning needs
Ward BN Comment
6 3 The ability to use other for peer learning The willingness of staff to facilitate learning outcomes
6 3 To work in a DEU ward as provided good support and a very organised environment to learn in
6 3 The ALN, CLN both were very beneficial in guiding our learning and the ward’s nurse were very helpful and helped us to meet our goals every week and the support by everyone was fantastic because I think its DEU so they make sure that students learn
6 3 Communication with nurses and patients Relating patients diagnoses to medications
6 3 Understanding the relationship between theory and practice, putting theory into practice through the help of the medical staff (nurses, doctors etc) in ward 6 Knowing the policies and procedures with the ward
6 3 Teaching sessions from different health care workers eg physios, pacific health care supporters, infection control etc
6 All nurses being very supportive and easy to approach Having the CLN and ALN within the ward so that I could always ask them things that I didn’t know
6 6 Guidance and support form ALN and CLN Peer support learning
24 3 Several educational seminars organised by DEU. Received a lot of attention in my clinical learning from DEU team esp ALN & CLN
Table 17: List two things that you would like to see changed in the DEU
Ward BN Comment
6 3 Having too many students in one space affects students learning needs. Eg not enough preceptors for each student nurse
6 3 Internet access so that we can review stuff, find out information etc. for educational use
6 3 More access to resources eg textbooks
6 3 I think reorientation for the other members of the medical staff in ward 6 should be conducted as it has been observed the other nurses are not aware regarding the practice
6 3 Reduce the number of students in the ward
6 There were few nurses who did not really understand that as students we needed to achieve our learning outcomes and not be there just to do obs for them
6 6 Internet access on the ward More communication from preceptors
24 3 It will be even more beneficial if students are allowed to rotate among different wards so that we can learn other medical ward settings
60
Table 18: Comparison between DEU and old model.
Ward BN Comment
6 3 Enables the student from the very beginning to feel a part of the team
6 3 DEU has made things easy for both students and staff. Both students and staff are more organised than other wards within Middlemore. That makes so much easy
6 3 DEU model seems to be more supportive as I received a lot of support from the CLN and ALN and other nurses. They made me feel like I was a part of the team
6 With DEU all the staff knew that we were suppose to be there and they were very welcoming
6 6 Students benefit more from having different preceptors. Greater support from ALN and CLN as they are available for more hours. Students learning needs are prioritised instead of doing routine tasks like vital signs, bed making etc.
61
Appendix 2: Participant Information Sheet
PARTICIPATION INFORMATION
Title of Project: Dedicated Education Unit (DEU) - Pilot
Principal Investigators: Willem Fourie & Bev McClelland
INVITATION TO PARTICIPATE:
You are invited to take part in the above study. Please take the time to read this document. Your
participation is voluntary and you can decline without penalty of any kind. You may also withdraw from
the research without giving reasons and without being penalised.
ABOUT THE STUDY
The study is a joint initiative between MIT and Counties Manukau District Health Board (CMDHB) and is
aimed at establishing two Dedicated Education Units at Middlemore Hospital in 2009 with the view of
establishing more units across CMDHB services thereafter. DEUs have been introduced in response to
the success factors identified for quality clinical learning and have proven to be sustainable through
their placement of a greater number of students at any one time in a clinical learning context dedicated
to excellence (Henderson et al., 2006).
A DEU is a collaborative model of clinical teaching & learning that:
Facilitates a closer working relationship between clinical staff and MIT to prepare graduates to meet service needs.
Provides consistent clinical support for students and staff. Focuses on the learning needs of students. Encourages and values peer teaching.
All staff in a DEU are strongly focussed on teaching and learning and both staff and students are assisted
and supported by an appointed Clinical Liaison Nurse and Academic Liaison Nurse.
OBJECTIVES OF THE STUDY
The objectives of this project is to pilot DEUs in two identified wards at CMDHB to:
62
Document through research the process of trialling DEU pilot sites
Evaluate the model’s potential ability to support undergraduate nursing students within CMDHB
Make recommendations to the Collaborative Nursing Development Unit (CNDU) on completion of
the project as to the model’s suitability for use as an ongoing undergraduate nursing clinical
education.
Build research capacity through team research between MIT and CMDHB.
PARTICIPANTS IN THIS STUDY:
All staff and students of MIT and CMDHB in Wards 6 and 24 will be invited by one of the principal
investigators to participate. While participation is voluntary there are no exclusion criteria.
The study is likely to involve:
BN students allocated to Wards 6 and 24
2 Clinical Liaison Nurses
2, Academic Liaison Nurses
8 Registered nurses working in the DEU
All project team members not already working in the wards
HOW WILL THIS INVOLVE ME? You may be asked to participate in either individual or focus group interviews. Your interview will be
audio taped. You can ask for the tape recording to be stopped at any time, or for parts, or all of the
tape to be erased. In the case of focus groups it is important to understand that while you could
withdraw from the study at any time it may not be possible to remove your information from the tapes.
Focus groups by nature cannot guarantee anonymity but care will be taken to ensure confidentiality and
that no identifying information is used in any report or presentation. The tapes will be transcribed and
you will not be identifiable in any transcriptions or subsequent research reports or publications. You
may also be asked to complete an anonymous questionnaire to evaluate the DEU. Consent will be
implied by your completing and returning your questionnaire. You may be asked to keep a journal/diary
of your experience in which case your written consent will be asked before the journal diary could be
analysed. Again no identifying information will be used in any report or presentation. You have the
right to request a copy of the research report and to check that no information that could identify you
has been included. Data for the study will be collected during each action research cycle and will come
from the following sources:
Documents such as minutes, duty rosters, action plans, reports and clinical placement evaluations
Focus groups
Individual interviews
Questionnaires
Journals/diaries
63
BENEFITS & RISKS:
The establishment of a DEU will increase the quality of the clinical learning and increase the number of
nursing students supervised in an area at any one time, which in turn will contribute to an increase in
the number of graduates available to the CMDHB workforce. Students will experience a quality learning
experience which will better prepare them for their role and enhance their retention on the programme.
Student’s sense of belonging to CMDHB will be enhanced. Collaboration between service and education
will be further developed increasing the concept of ‘joint responsibility’ for preparing the future
workforce. The DEU environment will encourage collegial relationships between students, nursing staff
and lecturers. The Clinical Liaison Nurse role is an additional career opportunity for RNs and will
contribute to personal professional advancement and succession planning. Students from different
levels of the Bachelor of nursing (BN) could be accommodated in one area with less confusion. The
model is transferable to other nursing schools
FURTHER INFORMATION:
For further information about this research project please contact the researchers directly at:
Dr Willem Fourie: Department of Nursing and Health Studies, Private Bag 94006, Manukau City,
Auckland. Tel (09) 968 8606 ext 8606. Email: [email protected]
Ms B McClelland: Nurse Leader Education and Professional Development CMDHB Tel 021 512 314
Email: [email protected]
You may also contact Dr Helen Anderson of the Manukau Institute of Technology Ethics Committee, for
any ethical concerns regarding this research at: Manukau Institute of Technology, Private Bag 94006,
Manukau City, Auckland. Tel 027 568 8754 Email: [email protected]
APPROVED BY THE MANUKAU INSTITUTE OF TECHNOLOGY ETHICS COMMITTEE on 11 November
2008, for a period of 3 years, until November 2011. Reference E08/NHS/21
64
Appendix 3: Questionnaire Midway through Placement
STUDENT FEEDBACK ON DEU
Title of Project: Dedicated Education Unit (DEU) - Pilot
Principal Investigators: Willem Fourie & Bev McClelland
Purpose
This student evaluation tool was designed to provide comprehensive feedback on the effectiveness of
communication within the DEU, the teaching and learning opportunities available and the
appropriateness of the environment for student learning.
The evaluation tool is anonymous and will be completed by students. Completed questionnaires will be
treated as confidential and will only be accessible to Willem Fourie and Bev McClelland. Feedback will
be collated and returned to the Research Management Team for analysis and interpretation. This
evaluation tool will assist in the ongoing monitoring and evaluation of each DEU to ensure a quality
clinical experience is available for students.
FURTHER INFORMATION:
For further information about this research project please contact the researchers directly at:
Dr Willem Fourie: Department of Nursing and Health Studies, Private Bag
94006, Manukau City, Auckland. Tel (09) 968 8606 ext 8606. Email:
[email protected] Ms B McClelland: Nurse Leader - Professional Development CMDHB Tel 021 512 314 Email: [email protected] You may also contact Dr Helen Anderson of the Manukau Institute of Technology Ethics Committee, for
any ethical concerns regarding this research at: Manukau Institute of Technology, Private Bag 94006,
Manukau City, Auckland. Tel 027 568 8754 Email: [email protected]
APPROVED BY THE MANUKAU INSTITUTE OF TECHNOLOGY ETHICS COMMITTEE on 11 November
2008, for a period of 3 years, until November 2011. Reference E08/NHS/21
65
Midway Questionnaire
DEU: Ward 6; 24 (circle the one applicable) BN Semester: 2; 3; 6 (circle the one applicable)
Based on your experience, please answer the following questions. Your feedback will help us
ensure students’ clinical experience continues to be positive and valuable. The majority of
questions require you to circle the most appropriate response or mark Yes or No. Space is
provided for you to write any comments you believe are relevant or important. DO NOT write
your name on the questionnaire.
PLEASE INDICATE YOUR RESPONSE AFTER EACH QUESTION by circling the appropriate number
1 =Excellent 2 = Very Good 3 = Poor 4 = Very Poor
1. How do you rate your welcome to the area? 1 2 3 4
Comments:
2. How do you rate your orientation to the area? 1 2 3 4
Comments:
66
3. How do you rate the preparation of ward staff for the DEU? 1 2 3 4
Comments:
4. How do you rate the preparation of the Academic Liaison Nurse
for the DEU? 1 2 3 4
Comments:
5. How do you rate the preparation of the Clinical Liaison Nurse for
the DEU? 1 2 3 4
Comments:
6. Was time set aside to discuss your individual learning outcomes
and responsibilities with the:
6.1 Academic Liaison Nurse (ALN) Yes No
6.2 Clinical Liaison Nurse (CLN) Yes No
Comments:
67
Please use the scale below to answer questions 7 - 16
1 = Fully 2 =Substantially 3 = Partially 4 = Not at all
7. To what extent did this clinical experience enable you to:
7.1 Achieve your learning outcomes 1 2 3 4
7.2 Achieve the prescribed competencies 1 2 3 4
Comments:
8. To what extent did the DEU environment support your learning? 1 2 3 4
Comments:
9. To what extent were your lines of communication in the area
clearly defined and explained to you? 1 2 3 4
Comments:
10. Information
10.1 To what extent were you able to access written
information within the area e.g. policies, procedures,
forms?
1 2 3 4
68
10.2 To what extent were you able to access electronic
information within the area e.g. policies, procedures, forms? 1 2 3 4
Comments:
11 To what extent were your responsibilities within the healthcare
team explained? 1 2 3 4
Comments:
12 To what extent did staff enable you to contribute to all or any
of the following activities with patients:
12.1 patient assessment 1 2 3 4
12.2 care planning 1 2 3 4
12.3 nursing intervention 1 2 3 4
12.4 evaluation of care 1 2 3 4
Comments:
13 To what extent did the organisation of care
13.1 reflect a commitment to teamwork 1 2 3 4
69
13.2 enable you to function as a member of the health care
team 1 2 3 4
70
Comments:
14 To what extent did the DEU environment enable you to practice
in a culturally safe manner? 1 2 3 4
Comments:
15 To what extent is there an overlap between the roles of the CLN
and ALN? 1 2 3 4
Comments:
16 To what extent did you make use of the opportunity for peer
learning and support from other students? 1 2 3 4
Comments:
71
17 Did you understand the role of the Clinical Liaison Nurse
(CLN)?
18 Did you understand the role of the Academic Liaison Nurse (ALN)
19 Were the roles of different people in the area explained to you?
If any roles were not explained please indicate which they were
20. General Comments:
If you are in a position to compare the DEU experience with a previous experience of the
preceptor model, please highlight the main differences from your perspective.
21. If there is anything else you would like to comment on about any of the areas discussed
above, or about the DEU. We would appreciate your feedback.
Please return the completed questionnaire to Sheona Watson or place it in the suggestion box
at A-block reception. Thank you for taking the time to share your perceptions, they will be
collated with those of other students.
YES NO
YES NO
YES NO
72
73
Appendix 4: Questionnaire on Completion of Placement
STUDENT FEEDBACK ON DEU
Title of Project: Dedicated Education Unit (DEU) - Pilot
Principal Investigators: Willem Fourie & Bev McClelland
Purpose
This student evaluation tool was designed to provide comprehensive feedback on the effectiveness of
communication within the DEU, the teaching and learning opportunities available and the
appropriateness of the environment for student learning.
The evaluation tool is anonymous and will be completed by students. Completed questionnaires will be
treated as confidential and will only be accessible to Willem Fourie and Bev McClelland. Feedback will
be collated and returned to the Research Management Team for analysis and interpretation. This
evaluation tool will assist in the ongoing monitoring and evaluation of each DEU to ensure a quality
clinical experience is available for students.
FURTHER INFORMATION:
For further information about this research project please contact the researchers directly at:
Dr Willem Fourie: Department of Nursing and Health Studies, Private Bag 94006, Manukau City, Auckland. Tel (09) 968 8606 ext 8606. Email: [email protected] Ms B McClelland: Nurse Leader - Professional Development CMDHB Tel 021 512 314 Email: [email protected] You may also contact Dr Helen Anderson of the Manukau Institute of Technology Ethics Committee, for
any ethical concerns regarding this research at: Manukau Institute of Technology, Private Bag 94006,
Manukau City, Auckland. Tel 027 568 8754 Email: [email protected]
APPROVED BY THE MANUKAU INSTITUTE OF TECHNOLOGY ETHICS COMMITTEE on 11 November
2008, for a period of 3 years, until November 2011. Reference E08/NHS/21
74
Questionnaire on completion of the DEU placement
Some questions are the same as the questions you answered in the first questionnaire, this is
necessary to compare students’ experiences of placements. A ref number is included for this
purpose. Based on your experience, please answer the following questions. Your feedback will
help us ensure students’ clinical experience continues to be positive and valuable. The majority
of questions require you to circle the most appropriate response or mark Yes or No. Space is
provided for you to write any comments you believe are relevant or important. DO NOT write
your name on the questionnaire.
PLEASE INDICATE YOUR RESPONSE AFTER EACH QUESTION by circling the appropriate number
DEU: Ward 6; 24 (circle the one applicable)
BN Semester: 3; 6 (circle the one applicable)
1 =Excellent 2 = Very Good 3 = Poor 4 = Very Poor
1. (ref 6) How well was your individual learning outcomes and
responsibilities addressed by the:
1.1 Academic Liaison Nurse (ALN) 1 2 3 4
1.2 Clinical Liaison Nurse (CLN) 1 2 3 4
Comments:
75
Please use the scale below to answer questions 2 - 11
1 = Fully 2 =Substantially 3 = Partially 5 = Not at all
2. (Ref 7) On completion of the placement to what extent did
this clinical experience enable you to:
2.1 Achieve your learning outcomes 1 2 3 4
2.2 Achieve the prescribed competencies 1 2 3 4
Comments:
11. (Ref 8) To what extent did the DEU environment support your
learning? 1 2 3 4
Comments:
12. (Ref 9) On completion of the placement to what extent did you
feel comfortable with the lines of communication in the area? 1 2 3 4
Comments:
13. (Ref 10) Information
13.1 To what extent were you able to access written 1 2 3 4
76
information within the area e.g. policies, procedures,
forms?
13.2 To what extent were you able to access electronic
information within the area e.g. policies, procedures, forms? 1 2 3 4
Comments:
14 (Ref 11) To what extent did you take on your responsibilities
within the healthcare team? 1 2 3 4
Comments:
15 (Ref 12) To what extent did staff enable you to contribute to all
or any of the following activities with patients:
15.1 patient assessment 1 2 3 4
15.2 care planning 1 2 3 4
15.3 nursing intervention 1 2 3 4
15.4 evaluation of care 1 2 3 4
Comments:
77
16 (Ref 13) To what extent did the organisation of care
16.1 reflect a commitment to teamwork 1 2 3 4
16.2 enable you to function as a member of the health care
team 1 2 3 4
Comments:
17 (Ref 14) To what extent did the DEU environment enable you to
practice in a culturally safe manner? 1 2 3 4
Comments:
18 (Ref 15)To what extent is there an overlap between the roles of
the CLN and ALN? 1 2 3 4
Comments:
19 (ref 16) To what extent did you make use of the opportunity for
peer learning and support from other students? 1 2 3 4
Comments:
78
20 (Ref 17) Did you understand the role of the Clinical Liaison
Nurse (CLN)?
21 (Ref 18) Did you understand the role of the Academic Liaison Nurse (ALN)
If any roles were not explained please indicate which they were
22. Reflecting on your DEU experience please outline two things that was most valuable to you
in meeting your learning needs
23. Reflecting on your DEU experience please outline things that you would like to see changed
to ensure your learning needs are better met.
24. Please comment on how the DEU model compares to the traditional preceptor model used
elsewhere in Middlemore Hospital (Answer this question only if you have previously
experienced the traditional preceptor model)
YES NO
YES NO
79
Please return the completed questionnaire to Sheona Watson or place it in the suggestion box
at A-block reception. Thank you for taking the time to share your perceptions, they will be
collated with those of other students.
80
Appendix 5: Consent Students
CONSENT TO PARTICIPATION IN RESEARCH
Students
Title of Project: Dedicated Education Unit (DEU) - Pilot
Researchers: Willem Fourie & Bev McClelland
I have been given a verbal and written explanation of this research project and I understand that explanation. I
have had an opportunity to ask questions and have them answered. I understand that I may withdraw myself or
any information I have provided from this project (before data collection is completed), without having to give
reasons and without penalty of any sort. I consent to participate in this research through focus groups and/or the
completion of evaluation forms. I understand that I will not be identified in any transcriptions or subsequent
research reports or publications. I understand that the research findings may be presented at a suitable
conference and that they may be published in an appropriate journal. I understand that taking part in this study is
voluntary and will not affect my studies at MIT or my clinical experience at CMDHB. I understand that the consent
form and data will be stored separately in a locked cabinet at MIT and will be kept for a period of 6 years. I have
had time to consider whether to take part. I know whom to contact if I have any questions about the study.
I agree to take part in this research.
Signed:
Name:
(please print clearly)
Date:
I would like to receive a copy of the research findings: [ ]
This consent form will be held for a period of six years
APPROVED BY THE MANUKAU INSTITUTE OF TECHNOLOGY ETHICS COMMITTEE on 11 November 2008, for a
period of 3 years, until November 2011. Reference E08/NHS/21
81
Appendix 6: Consent Staff
CONSENT TO PARTICIPATION IN RESEARCH
Staff – CMDHB/MIT
Title of Project: Dedicated Education Unit (DEU) - Pilot
Researchers: Willem Fourie & Bev McClelland
I have been given a verbal and written explanation of this research project and I understand that explanation. I
have had an opportunity to ask questions and have them answered. I understand that I may withdraw myself or
any information I have provided from this project (before data collection is completed), without having to give
reasons and without penalty of any sort. I consent to my journal/diary being analysed. I consent to participate in
this research through focus groups / individual interviews and/or the completion of evaluation forms. I
understand that I will not be identified in any transcriptions or subsequent research reports or publications. I
understand that the research findings may be presented at a suitable conference and that they may be published
in an appropriate journal. I understand that the consent form and data will be stored separately in a locked cabinet
at MIT and will be kept for a period of 6 years. I understand that taking part in this study is voluntary and will not
affect my employment at MIT/CMDHB. I have had time to consider whether to take part. I know whom to contact
if I have any questions about the study.
I agree to take part in this research.
Signed:
Name:
(please print clearly)
Date:
I would like to receive a copy of the research findings: [ ]
This consent form will be held for a period of six years
APPROVED BY THE MANUKAU INSTITUTE OF TECHNOLOGY ETHICS COMMITTEE on 11 November 2008, for a
period of 3 years, until November 2011. Reference E08/NHS/21
82
Appendix 7: Focus Group Questions
Focus Group – Students [Note: Similar questions were used for staff and the Action Group members]
Questions:
The preparation of the unit, staff and students
o Tell us about your preparation before arriving in the DEU unit
o Tell us about your preparation upon arrival at the DEU, the first day and first week
o What are your impressions of the preparation of students in the unit
o What are your impressions of the preparation of staff in the unit
Tell us about the role of the CLN, how do see it?
Tell us about the role of the ALN, how do see it?
Tell us about the support for your learning within the unit
Tell us about the team and how you fit in it?
Can you identify any improved clinical educational processes and why do you think they are
improved?
What are your views and experience of peer learning and support within the unit?
Can you identify any educational issues and how they could possibly be resolved?
Tell us how you experienced the communication and liaison between MIT and CMDHB
What re-planning is necessary?
83
Appendix 8: Ethics Approval Letter
84
Appendix 9: CMDHB Approval Letter
Research Officer First Floor, Room 132
Clinical Support Building Middlemore Hospital
12 January 2009 Bev McClelland Education and Professional Development Middlemore Hospital Auckland 1640 Dear Ms McClelland Thank you for the information you supplied to the Clinical Board regarding your research proposal:
EO8 / NHS / 21 Dedicated Education Unit (DEU ) - Pilot
I am pleased to inform you that the Clinical Board Executive has approved this research with you as CMDHB investigator. We wish you well in your project and require an update on how it is progressing. A copy of the progress report that is required by the Ethics Committee is sufficient, and should be submitted to the Research Officer by 12 January 2010. Please note failure to submit the progress report may result in the withdrawal of ethical approval. Yours Sincerely, Alison Robertson Research Officer Cc Willem Fourie