INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for...

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INNOVATIVE CLINICAL INNOVATIVE CLINICAL PLACEMENTS: PLACEMENTS: A NATIONAL PERSPECTIVE A NATIONAL PERSPECTIVE Change, Chaos & Courage: Change, Chaos & Courage: Educating for Nursing Educating for Nursing Excellence Excellence University of Calgary University of Calgary August 25 & 26, 2008 August 25 & 26, 2008
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Page 1: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

INNOVATIVE CLINICAL INNOVATIVE CLINICAL PLACEMENTS: PLACEMENTS:

A NATIONAL PERSPECTIVEA NATIONAL PERSPECTIVE

Change, Chaos & Courage: Change, Chaos & Courage:

Educating for Nursing ExcellenceEducating for Nursing Excellence

University of CalgaryUniversity of Calgary

August 25 & 26, 2008August 25 & 26, 2008

Page 2: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Innovative Clinical Placements Innovative Clinical Placements Research TeamResearch Team

Sheryl Reimer Kirkham, RN PhDSheryl Reimer Kirkham, RN PhD

Catherine Hoe Harwood, RN MScNCatherine Hoe Harwood, RN MScN

Rick Sawatzky, RN PhDRick Sawatzky, RN PhD

Landa Terblanche, RN PhDLanda Terblanche, RN PhD

Lynn Van Hofwegen, RN, MSN, NP Lynn Van Hofwegen, RN, MSN, NP

* Less active role due to relocation to California* Less active role due to relocation to California

Page 3: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

FundingFunding

• Western Region Canadian Association Western Region Canadian Association Schools of Nursing (WRCASN) Schools of Nursing (WRCASN) 2005 - 20072005 - 2007

Page 4: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

BackgroundBackground pressures nationally on availability pressures nationally on availability

of clinical nursing placementsof clinical nursing placements

Changed health care environment – fewer Changed health care environment – fewer inpatient beds, early discharge & cut backs in inpatient beds, early discharge & cut backs in traditional public health programs traditional public health programs

Theory & practice (praxis) come together Theory & practice (praxis) come together within the clinical learning settingswithin the clinical learning settings

Page 5: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Background Background (cont)(cont)

TWU Nursing entered placement TWU Nursing entered placement negotiations on the cusp of growing negotiations on the cusp of growing shortage of clinical placementsshortage of clinical placements

Challenges negotiating community clinical Challenges negotiating community clinical placements led, of necessity, to non-placements led, of necessity, to non-traditional community practice placementstraditional community practice placements

Page 6: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

ICP Research ProgramICP Research Program

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

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

• ““Keeping the Vision”: Sustaining Social Keeping the Vision”: Sustaining Social Consciousness following International Consciousness following International Learning ExperiencesLearning Experiences

(2004 – 2006)(2004 – 2006)

Page 7: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

ICP Research ProgramICP Research Program

• Phase IIPhase II: : The Use of Innovative The Use of Innovative

Clinical Placements in Nursing Education: Clinical Placements in Nursing Education: National Survey (2005 – 2007)National Survey (2005 – 2007)

• Pilot Study Phase III: Pilot Study Phase III: Innovative Clinical Innovative Clinical Placements in Nursing Education: A Pilot Placements in Nursing Education: A Pilot Study with Host Agencies Study with Host Agencies (2008)

Page 8: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

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

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

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

within the main health care systemwithin the main health care system

Page 9: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Study PurposeStudy Purpose

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

Page 10: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Study Design Study Design Survey

Questions derived from Phase I study findings Online format 3 sections: General; Program Information;

Teaching/learning perspectives

Focus Group Focus Group

Validate & extend survey findings

Page 11: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

ObjectivesObjectivesa)a) describe the describe the useuse of innovative clinical settings in of innovative clinical settings in

Canada (prevalence, type).Canada (prevalence, type).b) elicit the perspectives of nurse educators b) elicit the perspectives of nurse educators

regarding the regarding the nature of student learningnature of student learning in in these sites; these sites;

c) describe variables related to c) describe variables related to administrative administrative mattersmatters regarding the use of ICPs; regarding the use of ICPs;

d) describe d) describe strengths and weaknessesstrengths and weaknesses of clinical of clinical placements in these sites; andplacements in these sites; and

e) identify ethical, legal, and academic e) identify ethical, legal, and academic issuesissues associated with the utilization of these settings. associated with the utilization of these settings.

Page 12: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Survey SampleSurvey SampleConvenience sample from all Canadian baccalaureate Convenience sample from all Canadian baccalaureate

undergraduate nursing programsundergraduate nursing programs

Potential respondents nominated by deans/directors of Potential respondents nominated by deans/directors of nursing programsnursing programs

Inclusion Criteria:Inclusion Criteria:• Clinical Placement Coordinator (CPC) for program &/orClinical Placement Coordinator (CPC) for program &/or• Nurse Educator (NE) teaching in any of:Nurse Educator (NE) teaching in any of:

• Sr level community health course (or equiv)Sr level community health course (or equiv)• Other undergrad courses using ICPsOther undergrad courses using ICPs• Undergrad preceptorships in ICPsUndergrad preceptorships in ICPs

Page 13: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Data CollectionData CollectionDec 2005 – Nov 2006Dec 2005 – Nov 2006

Survey Sample Survey Sample 90 programs met inclusion criteria90 programs met inclusion criteria

Data were obtained from:Data were obtained from:147 eligible respondents 147 eligible respondents

74 nursing programs represented 74 nursing programs represented 40 programs represented by 2 or more respondents40 programs represented by 2 or more respondents

Nov 06 Focus Group – 10 participants Nov 06 Focus Group – 10 participants

Page 14: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Focus Group Focus Group

• Profile: Profile: • 3 administrators of Nsg programs, 3 administrators of Nsg programs, • 4 Ns educators4 Ns educators• 1 CPC1 CPC• 2 Joint roles (combination of above roles)2 Joint roles (combination of above roles)

• Broad representation of national sceneBroad representation of national scene

Page 15: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Data Analysis ProceduresData Analysis Procedures

Descriptive Statistical Analyses of Descriptive Statistical Analyses of Survey AnswersSurvey Answers

Content Analysis of Narrative responses Content Analysis of Narrative responses using NVivousing NVivo™™

Page 16: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Overview of FindingsOverview of FindingsFindings included:Findings included:

a)a) ICP’s are widely used in Canadian nursing educationICP’s are widely used in Canadian nursing education

b)b) Pedagogy: Rich student learning typically occurs in Pedagogy: Rich student learning typically occurs in these settings these settings

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

d)d) Concerns over capacity & sustainability of ICPsConcerns over capacity & sustainability of ICPs

Page 17: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Findings:Findings: Use of ICPs Use of ICPs

• 96% of CPCs reported their program(s) 96% of CPCs reported their program(s) used ICPsused ICPs

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

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

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

Page 18: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

ICP sites used in nursing programs*

24%

46%

54%

59%

66%

68%

74%

84%

84%

0 20 40 60

Other

Parish

International

Impoverished Inner City

Corrections/Forensics

Aboriginal First Nations Settings

Rural

Schools

Community Support groups

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

Page 19: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Average # of hrs that Nursing Students Spent in ICPs in Undergraduate Program

29%

1%

9%

8%

17%

16%

19%

0% 5% 10% 15% 20% 25% 30% 35%

Don't Know

< 10 hours

10 – 50 hours

51 – 100 hours

101 – 150 hours

151 – 200 hours

> 200 hours

as reported by CPCs(N = 75, no response = 9)

Page 20: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Courses that use ICPs

80%

58%

54%

29%

25%

18%

13%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Community Health

Mental Health / Psychiatric Nursing

Preceptorships

Pediatrics

Maternal-child / Perinatal

Gerontological Nursing

Palliative Care

as reported by CPCs(N = 76, no response = 8)

Page 21: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Findings: Use of ICPsFindings: Use of ICPs • Size of programSize of program

• The extent of ICP use in undergraduate programs was similar for The extent of ICP use in undergraduate programs was similar for programs of difference sizesprograms of difference sizes..

• Graduate ProgramsGraduate Programs • Nursing programs offering graduate degree(s) used ICPs more Nursing programs offering graduate degree(s) used ICPs more

extensively in undergrad programs than programs without graduate extensively in undergrad programs than programs without graduate degrees.degrees.

• PartnershipsPartnerships • Nursing programs that had more partnerships with community Nursing programs that had more partnerships with community

agencies reported more extensive use ICPs.agencies reported more extensive use ICPs.• Level of student Level of student

• 32% of CPCs reported that their programs used ICPs for entry level 32% of CPCs reported that their programs used ICPs for entry level studentsstudents (N=75, 9 = no response)(N=75, 9 = no response)

(Above conclusions are based on chi-square analyses of contingency tables)(Above conclusions are based on chi-square analyses of contingency tables)

Page 22: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Overview of FindingsOverview of Findings

a)a) Use of ICPsUse of ICPs

b)b) Pedagogy: Rich student learning Pedagogy: Rich student learning typically occurs in these settings typically occurs in these settings

c) ICPs often require additional administrative time & coordination, as compared to TCPs

d) Concerns over capacity & sustainability of ICPs

Page 23: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Pedagogy: Pedagogy: Nature of Student LearningNature of Student Learning

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

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

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

Page 24: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

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

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

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

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

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

Pedagogy: Pedagogy: Nature of Student LearningNature of Student Learning

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

Page 25: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Pedagogical Outcomes in ICPsPedagogical Outcomes in ICPs

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

Page 26: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

PedagogyPedagogy Strategies to Promote Learning Strategies to Promote Learning

• Structure of the Learning ActivitiesStructure of the Learning Activities• NE unanimous re: importance of clarity of course & clinical NE unanimous re: importance of clarity of course & clinical

placement objectives placement objectives

• Links to existing curriculum importantLinks to existing curriculum important

• Models of Clinical SupervisionModels of Clinical Supervision• Most common approach reported by CPC (50%) & NE (43%) Most common approach reported by CPC (50%) & NE (43%)

is is some supervisionsome supervision with contact q 2 – 3 days via email, with contact q 2 – 3 days via email, phone or on-campus contact, limited on-site visitsphone or on-campus contact, limited on-site visits

Page 27: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

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

• Creative approach to learningCreative approach to learning

• Flexible & open mindedFlexible & open minded

• Demonstrate initiative in independent learningDemonstrate initiative in independent learning

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

PedagogyPedagogyStrategies to Promote LearningStrategies to Promote Learning

Page 28: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

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

PedagogyPedagogyStrategies to Promote LearningStrategies to Promote Learning

Page 29: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Overview of FindingsOverview of Findings

a)a) Use of ICPsUse of ICPs

b)b) Student learningStudent learning

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

d)d) Capacity & sustainability of ICPsCapacity & sustainability of ICPs

Page 30: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Administrative IssuesAdministrative Issues

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

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

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

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

• Existing partnerships facilitate processExisting partnerships facilitate process

Page 31: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Administrative Issues: Administrative Issues: Barriers to Use of ICPsBarriers to Use of ICPs

69% of CPCs & 58% of NE respondents 69% of CPCs & 58% of NE respondents

Reported various barriers existReported various barriers existi) Faculty Factors:i) Faculty Factors:

• Skill level req’d of facultySkill level req’d of faculty

•↑↑WorkloadWorkload • Shortages of suitable faculty – eg. experience, Shortages of suitable faculty – eg. experience,

demographicdemographic• Resistance – need “buy in”Resistance – need “buy in”

Page 32: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Faculty & Educational Institution Faculty & Educational Institution BarriersBarriers

““There is a perception that a community There is a perception that a community based experience is ‘less than’ an based experience is ‘less than’ an acute care experience. This is acute care experience. This is propagated by some faculty, as well as propagated by some faculty, as well as nurses, in acute care settings”.nurses, in acute care settings”.

Page 33: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Administrative Issues: Administrative Issues: Barriers to Use of ICPsBarriers to Use of ICPs

ii) Educational Institution factorsii) Educational Institution factors• Competition b/w different professions/programs for spacesCompetition b/w different professions/programs for spaces

• > Costs of clinical faculty supervising students/site or > Costs of clinical faculty supervising students/site or covering multiple placementscovering multiple placements

• Geographic factors – keep some students closer to home Geographic factors – keep some students closer to home

iii) Student related factors (as reported by NE)iii) Student related factors (as reported by NE)

• Typically additional costs/scheduling impactTypically additional costs/scheduling impact

• Access to technology, transportation, accommodationAccess to technology, transportation, accommodation

• Impact on family or work commitmentsImpact on family or work commitments

Page 34: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Administrative Issues: Administrative Issues: Barriers to Use of ICPsBarriers to Use of ICPs

iv) Agency factorsiv) Agency factors & constraints & constraints• Staff issues – shortages/schedules impact placements, Staff issues – shortages/schedules impact placements,

downsizing, retirement of most experienced staffdownsizing, retirement of most experienced staff

• Space/equipment limitationsSpace/equipment limitations

• Consistency of strong clinical instructor keyConsistency of strong clinical instructor key

• Protectiveness of staff re: clientele, confidentiality issuesProtectiveness of staff re: clientele, confidentiality issues

• Agency criteria Agency criteria ↑↑constraints on student assignments to setting eg. desire strong students only, criminal record desire strong students only, criminal record checks, refusal of junior studentschecks, refusal of junior students

Page 35: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Administrative IssuesAdministrative Issues

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

we are looking at the numbers of agencies, we are looking at the numbers of agencies, students, preceptors and faculty persons students, preceptors and faculty persons

involved. Each one involves different players, involved. Each one involves different players, policies, procedures and communication policies, procedures and communication

factors……..factors……..

A challenge indeed!”A challenge indeed!”

Page 36: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Overview of FindingsOverview of Findings

a)a) Use of ICPsUse of ICPs

b)b) Student learningStudent learning

c) ICPs often require additional administrative time and coordination

dd)) Concerns over capacity & & sustainability of ICPs

Page 37: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Capacity & Sustainability of ICPsCapacity & Sustainability of ICPs

• Capacity: Capacity: • Widespread use by programsWidespread use by programs

• Sustainability: Burn-out FactorSustainability: Burn-out Factor• Can’t expect CPC & NE to negotiate & utilize ICPs Can’t expect CPC & NE to negotiate & utilize ICPs

under the same formula as used in traditional sitesunder the same formula as used in traditional sites• Agency fatigueAgency fatigue

• Importance of partnerships to success Importance of partnerships to success

Page 38: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

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

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

• Maximizing LearningMaximizing Learning

• Ensuring SustainabilityEnsuring Sustainability

• Fostering PartnershipsFostering Partnerships

Page 39: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Discussion Discussion

• TerminologyTerminology• Since ICP’s widely used > 10 yrs – they’ve Since ICP’s widely used > 10 yrs – they’ve

become the “mainstream” become the “mainstream” • Need to adopt consistent terminology Need to adopt consistent terminology

Page 40: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

LimitationsLimitations

• Administrator, student & agency stakeholder Administrator, student & agency stakeholder perspectives not sought on surveyperspectives not sought on survey

• Impact of Nursing program collaborations on Impact of Nursing program collaborations on datadata

• Language constraints Language constraints → Incomplete data re: → Incomplete data re: French language based programsFrench language based programs

Page 41: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

RecommendationsRecommendations1. Nursing programs should continue to 1. Nursing programs should continue to

develop the use of ICPs develop the use of ICPs 2. Strategies be developed to 2. Strategies be developed to ↑ ↑ capacity & to capacity & to

facilitate sustainability of ICPs.facilitate sustainability of ICPs.3. Administrative support (such as funding, 3. Administrative support (such as funding,

release time) should account for the extra release time) should account for the extra time req’d to negotiate ICPs. Includes: time req’d to negotiate ICPs. Includes:

• encouraging innovation to develop new encouraging innovation to develop new clinical sites, & the clinical sites, & the

• purposeful building of understanding among purposeful building of understanding among faculty regarding the value of ICPs. faculty regarding the value of ICPs.

Page 42: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Recommendations (cont’d)Recommendations (cont’d)

4. Partnerships b/w academic & host agencies 4. Partnerships b/w academic & host agencies should be established to facilitate administration should be established to facilitate administration of ICPs & foster student learning.of ICPs & foster student learning.

5. The role of the nurse in non-traditional sites 5. The role of the nurse in non-traditional sites should be articulated. should be articulated.

6. Research should be conducted with agency 6. Research should be conducted with agency stakeholders to gain insight into the issues they stakeholders to gain insight into the issues they face hosting students face hosting students

Page 43: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Research DisseminationResearch Dissemination• Reimer Kirkham, S., Van Hofwegen, L., & Hoe Reimer Kirkham, S., Van Hofwegen, L., & Hoe

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

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

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

Page 44: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

Research DisseminationResearch Dissemination

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

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

Page 45: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

ConclusionConclusion

““Using non-traditional settings Using non-traditional settings enables the student to perceive enables the student to perceive nursing as it truly should be – nursing as it truly should be – reaching across the continuum to reaching across the continuum to nurse people at all stages of their nurse people at all stages of their life, not only in an illness setting.”life, not only in an illness setting.”

Page 46: INNOVATIVE CLINICAL PLACEMENTS: A NATIONAL PERSPECTIVE Change, Chaos & Courage: Educating for Nursing Excellence University of Calgary August 25 & 26,

ConclusionConclusion

“…Life altering experiences for students.”

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