The Role of the Clinical Skills Laboratory in Preparing Students for the Real World of PracticeCatherine E. HoughtonOctober 2007Supervisor: Dr. Dympna Casey

Aim of the PresentationExploration of previous researchAim of the research in progressInterpretivismCase study designChallenges

Changes in Nurse Educationemphasis on theory/decreased emphasis in skills learningIn clinical setting:More rapid patient turnoverIncreased high dependency patientsShortage of qualified practitioners

physical structure supporting the new academic structure

How does the CSL facilitate this statement?

During the course of their education, students are expected to acquire knowledge, incorporate critical thinking and psychomotor skills, develop self-confidence in their abilities, and then transfer this knowledge to the clinical setting (Childs and Sepples, 2006)

The Function of the CSLSimulated LearningSimulated ModelsStandardised PatientsComputer-based Simulation

Audio Visual Recording

Skills assessment (i.e. OSCE)

Simulated Models

Low-fidelityModerate fidelityHigh Fidelity

Standardised PatientsCoached to present a patient problem accurately

Increased levels of judgement, performance and communication skills Same outcome as real patients ? Reliability of SP feedback

Computer based Simulation

Higher Satisfaction and self-efficacy

? Improve ability to demonstrate skill Penfield Virtual Hospital Authentic World

Audio-Visual RecordingBenefits Immediate Analysis and FeedbackRecognise own mistakesDistracting, anxiety, behaviour modification

OSCE (Objective Structured Clinical Examination)Positive Feedback and reflection Motivation to learnDependent on assessors subjectivityCause of Anxiety

Benefits of CSL TeachingGain confidenceMotivation to learn Student Satisfaction Safe environment to practice skills Patient Safety Communication Skills Interprofessional LearningImprovement on traditional methods

Disadvantages of CSL TeachingStudent Anxiety

Comparison with reality of clinical settingNeeds context? Learning opportunities in clinical area? Learn non-evidence based methods

Methodological Issues

Methodological IssuesCriticism of the primarily positivist approach

? use of OSCE to determine the effectiveness of CSL teaching

Level of education

Research AimsTo analyse the teaching strategies used in Irish Clinical Skills LaboratoriesTo investigate the factors which influence how student nurses use their learned skills in the practice setting. To examine student nurses perceptions of the methods used to teach clinical skills in the laboratory.To explore qualified clinical and CSL staffs perceptions of undergraduate clinical skills teaching.

Research ProcessPhase 1 Visit all the 13 Nursing Centres Criteria for Selection of 4 Sites Gain AccessPhase 2 Pilot phasePhase 3Data Collectionobservation, interviews, documentary sourcesPhase 4 Cross-case/Within Case Analysis

Interpretivist ParadigmNature of the world as it exists

Subjectivity

Multiple realities

Emic and Etic perspective

Multiple Case Study ResearchNatural context

Emic Perspective

Flexibility

Exploratory

Embedded

Instrumental

Multiple

ChallengesGaining Access

Ethical Issues

Semesters/Timetables

Thank YouCatherine Houghton

catherine.houghton@nuigalway.ie

Department of Nursing and Midwifery StudiesAras MoyolaNUI GalwayIreland

*******Yoo and Yoo (2003) quasi-experimental, skills: mouth care, back care, change of position, urinary catheterisation and enemas, control group=40, experimental group= 36Johnsson et al (2006): bed to chair transfer only, control group=36, intervention group=35.McGraw and OConnor (1999) no statistical difference in student satisfaction or OSCE performance, therefore SPs are a feasible alternative to practicing in clinical area. Nestel et al (2003) : will they try to be nice to students and tell them what they want to hear*Jeffries compared an interactive CD-ROM against a traditional lecture/ video demonstration on medication administration. No statistically significant difference in competency levels. Limited by small convenience sample (c=19, I=23). Also highlighted the Halo effect.Madorin and Iwasiw is limited by date 1999, and although control and experimental group,total sample=23!

**Alinier (2003) lecturers (n=39) also had the same opinions. Limited by small sample size; student sample = 30.Henrichs et al (2002)? Overcome subjectivity.. Dependent on the structure of the assessment.Anxiety: the anxiety of performing skills in the clinical area must also be considered)*The previous slides have highlighted some of the specific advantages in relation to Simulation, AV recording and OSCE, but in general CSL research.Highlight Morgan as an Irish study which found that CSL teaching allowed students to feel better prepared for practice (phenomenology, n=6).

das et al: medical students and young interns-highlight importance of seeking perceptions of those who have completed training.*HARRISON (2004), increases student numbers, changing health care system with higher turnover; higher acuity, are the same practice opportunities availible?Morgan (2006) example-quicker methods of taking BP, IM injection sites etc**Point 3: does this really allow us to explore whether CSL teaching prepares students for practice?Point 4: a lot of studies focused on different stages such as postgraduate studies. There is a need to focus on the undergraduate programme in a complete form******