Nursing students' perceptions of community pediatric experiences.

Over the last decade health care delivery has shifted from hospitals to the community resulting in a significant reduction of hospital-based clinical placements for nursing students to practice and learn. Studies have emerged describing this problem and outlining the ways in which Colleges and Universities have attempted to deal with the acute shortage of clinical areas in nursing and other health care programs. Several studies describe the development of community-based clinical experiences, and some of these examinated students' perceptions. One finding appears to be constant: student perceptions of community experiences have an effect on their settings both to contend with the shortage of hospital-based placements and to prepare students for future practice.

The Impact of a Simulated Clinical Experience on CEGEP Nursing Students’ Perceptions of Self-Efficacy and Achievement

Abstract : Providing high-quality clinical experiences to prepare students for the complexities of the current health-care system has become a challenge for nurse educators. Additionally, there are concerns that the current model of clinical practice is suboptimal. Consequently, nursing programs have explored the partial replacement of traditional in-hospital clinical experiences with a simulated clinical experience. Despite research demonstrating numerous benefits to students following participation in simulation activities, insufficient research conducted within Québec exists to convince the governing bodies (Ordre des infirmières et des infirmiers du Québec, OIIQ; Ministère de L’Éducation supérieur, de la Recherche, de la Science et de la Technologie) to fully embrace simulation as part of nurse training. The purpose of this study was to examine the use of a simulated clinical experience (SCE) as a viable, partial pedagogical substitute for traditional clinical experience by examining the effects of a SCE on CEGEP nursing students’ perceptions of self-efficacy (confidence), and their ability to achieve course objectives. The findings will contribute new information to the current body of research in simulation. The specific case of obstetrical practice was examined. Based on two sections of the Nursing III-Health and Illness (180-30K-AB) course, the sample was comprised of 65 students (thirty-one students from section 0001 and thirty-four students from section 0002) whose mean age was 24.8 years. With two sections of the course available, the opportunity for comparison was possible. A triangulation mixed method design was used. An adapted version of Ravert’s (2004) Nursing Skills for Evaluation tool was utilized to collect data regarding students’ perceptions of confidence related to the nursing skills required for care of mothers and their newborns. Students’ performance and achievement of course objectives was measured through an Objective Structured Clinical Examination (OSCE) consisting of three marked stations designed to test the theoretical and clinical aspects of course content. The OSCE was administered at the end of the semester following completion of the traditional clinical experience. Students’ qualitative comments on the post -test survey, along with journal entries served to support the quantitative scale evaluation. Two of the twelve days (15 hours) allocated for obstetrical clinical experience were replaced by a SCE (17%) over the course of the semester. Students participated in various simulation activities developed to address a range of cognitive, psychomotor and critical thinking skills. Scenarios incorporating the use of human patient simulators, and designed using the Jeffries Framework (2005), exposed students to the care of families and infants during the perinatal period to both reflect and build upon class and course content in achievement of course objectives and program competencies. Active participation in all simulation activities exposed students to Bandura’s four main sources of experience (mastery experiences, vicarious experiences, social persuasion, and physiologic/emotional responses) to enhance the development of students’ self-efficacy. Results of the pre-test and post-test summative scores revealed a statistically significant increase in student confidence in performing skills related to maternal and newborn care (p < .0001) following participation in the SCE. Confidence pre-test and post-test scores were not affected by the students’ section. Skills related to the care of the post-partum mother following vaginal or Caesarean section delivery showed the greatest change in confidence ratings. OSCE results showed a mean total class score (both sections) of 57.4 (70.0 %) with normal distribution. Mean scores were 56.5 (68.9%) for section 0001 and 58.3 (71.1%) for section 0002. Total scores were similar between sections (p =0.342) based on pairwise comparison. Analysis of OSCE scores as compared to students’ final course grade revealed similar distributions. Finally, qualitative analysis identified how students’ perceived the SCE. Students cited gains in knowledge, development of psychomotor skills and improved clinical judgement following participation in simulation activities. These were attributed to the « hands on » practice obtained from working in small groups, a safe and authentic learning environment and one in which students could make mistakes and correct errors as having the greatest impact on learning through simulation.

Les Perceptions des Étudiants en Soins Infirmiers Pédiatriques en Milieu Communautaire

Over the last decade health care delivery has shifted from hospitals to the community resulting in a significant reduction of hospital-based clinical placements for nursing students to practice and learn. Studies have emerged describing this problem and outlining the ways in which Colleges and Universities have attempted to deal with the acute shortage of clinical areas in nursing and other health care programs. Several studies describe the development of community-based clinical experiences, and some of these examined students’ perceptions. One finding appears to be constant: student perceptions of community experiences have an effect on their learning outcomes. There is an increasing need to teach nursing students in community settings both to contend with the shortage of hospital-based placements and to prepare students for future practice. Pediatric hospitals are no longer able to provide as many clinical placements as they once did. This has created a problem for college nursing departments. Over the past five years, John Abbott College’s pediatric nursing teachers have attempted to deal with this problem in numerous ways; however, students and faculty were dissatisfied with the solutions as there was a lack of development of the pediatric community clinical component. The purpose of this study is to explore nursing students’ perceptions of pediatric community experiences both prior to the start of the clinical rotation and following the experience. Student perceptions of nursing in community settings are an important element in the level of student satisfaction and ultimately their learning in pediatric clinical settings. In order to explore the John Abbott College’s nursing students’ perceptions, data was collected from a small segment of the population. Students’ perceptions were explored quantitatively through the use of questionnaires using a Likert scale administered both prior to the clinical experience and following the experience; and qualitatively, using content analysis of reflective journals and focus group discussions. The results of the study demonstrated that prior to the community rotations; students did not know what the experience would involve. They felt apprehensive due to being inadequately prepared for the experience and questioned the actual learning they would acquire from a community setting. Following the pediatric community experience, students perceived benefits to their learning particularly in the development of their abilities to communicate with children, and to recognize and apply principles of growth and development to children of different age groups and with different health needs. In addition, students perceived an increase in their self- confidence when teaching children. They also developed an appreciation of the role of the nurse in health promotion for individuals’ in community settings. Furthermore, students described an increase in their awareness of resources that are available in the community. Overall, students were satisfied with their pediatric community clinical experience. The results of this study indicate that adequate student preparation is required prior to the community clinical experience. This preparation would include a clear description of the clinical objectives and associated learning activities, as well as an explicit explanation of the evaluation process. Finally, it is recommended that the pediatric nursing teachers continue to search for community clinical areas that can enhance student learning in pediatrics. This study contributes to the literature on community experiences for nursing students since it explored students’ perceptions before and after the community clinical rotation.

The influence of nursing student characteristics on performance in the Quebec licensing exam.

This study examines whether certain academic, demographic or psychosocial characteristics of students can be indicators of future success on the Provincial Nursing Licensing exam. A cohort of 42 third year Nursing students was the study sample. Data were collected using a self-reporting questionnaire, academic marks, and graduate interviews. Academic variables that were studied included: first year nursing marks, college biology marks, final year nursing marks, and literacy level. Demographic variables that were studied included : age, gender, socioeconomic status and level of life responsabilities, academic motivation (hours spent studying) and hours worked at unrelated employment. Lastly, psychosocial variables that were studied included: test taking anxiety, stress and overall confidence level in terms of success on the upcoming exam. A comparison was then undertaken between the two groups-students that passed and students that failed the Licensing exam on their first sitting-with respect to specific student characteristics. The conceptual framework for this study is based on Leinbach and Jenkin's model of the correlation of milestones to momentum points in the educational experience. Results of this study suggest that exam anxiety and content review in the months that follow graduation seem to affect exam performance. Also, certain demographic characteristics such as age and financial strain seemed to be good indicators of future success.||Résumé : Cette étude tente d'établir si certaines caractéristiques liées aux études ainsi que des caractéristiques démographiques ou psychosociales des étudiantes et des étudiants peuvent être indicatives du succès futur à l'examen professionnel provincial d'admission à la profession infirmière. Une cohorte de 42 étudiantes et étudiants de troisième année en sciences infirmières formait l'échantillon de l'étude. Les données ont été recueillies au moyen d'un questionnaire d'autoévaluation, des résultats scolaires et d'entrevues avec les infirmières et infirmiers gradués. Les variables liées aux études examinées ont été les résultats de la première année d'études en sciences infirmières, les résultats en biologie au collégial, les résultats de la dernière année d'études en sciences infirmières et le niveau de littératie. Les variables démographiques étudiées ont été l'âge, le sexe, le statut socioéconomique, le niveau de responsabilités sociales, la motivation dans les études (les heures passées à étudier) et les heures consacrées à un travail non lié aux études. Enfin, les variables psychosociales examinées ont été l'anxiété devant l'examen, le stress et le niveau général de confiance quant à la réussite de l'examen à venir. Une comparaison des deux groupes d'étudiantes et d'étudiants, soit ceux qui ont réussi l'examen et ceux qui l'ont échoué à leur première tentative, a ensuite été faite en tenant compte des caractéristiques particulières à chacun. Le cadre conceptuel de cette étude repose sur le modèle de la corrélation entre les jalons (milestones) et les accomplissements (momentum points) dans l'expérience des études de Leinbach and Jenkin. Les résultats de cette étude laissent entendre que l'anxiété devant l'examen et la révision de la matière dans les mois suivant l'obtention du diplôme semblent avoir un effet sur le rendement à l'examen. Aussi, certaines caractéristiques démographiques comme l'âge et les difficultés financières semblaient être indicatifs du succès futur.

Designing and evaluating an instructional exercise as a supplement to the Fluids & Electrolytes lecture

First year nursing students repeatedly have difficulty recalling, understanding, and applying knowledge from the Fluids & Electrolytes (F&E) class. Although the traditional teaching method of lecturing is appropriate in a situation of knowledge acquisition, this situation refers to a broader context. An alternate teaching method is needed to increase students' understanding of the previously acquired knowledge and its application. This research concerns gaming as a tool for teaching with the focus on process as well as product. An instructional exercise, in the Jeopardy format, is designed to incorporate understanding (through problem-solving), group collaboration, and metacognition. Constructivist philosophy is combined with Instructional Design to construct an exercise that focuses not only on knowledge recall, but also emphasizes thinking, understanding, and the reflective nature of the exercise. The focus of this research is to design and evaluate an exercise as a supplemental teaching method to the lecture presentation of the F&E class.

How are Canadian universities training and supporting undergraduate medical, physiotherapy and occupational students for global health experiences in international low-resource settings?

Abstract : OBJECTIVES : Canadian medical (MD), physiotherapy (PT) and occupational therapy (OT) students increasingly show an interest in global health experiences (GHEs). As certain moral hazards can occur as a result of student GHEs, a growing consensus exists that universities must have an established selection process, in-depth pre-departure training (PDT), adequate onsite supervision and formal debriefing for their students. This study aimed at identifying current practices in Canadian MD, PT and OT programs and discussing areas for improvement by comparing them with recommendations found in the literature. METHODS : Canadian MD, PT and OT programs (n = 45) were invited to answer an online survey about their current practices for GHE support and training. The survey included 24 close-ended questions and 18 open-ended questions. Descriptive statistics and a thematic analysis were performed on the data and results were discussed with recommendations found in the literature. RESULTS : Twenty-three programs responded to the survey. Student selection processes varied across universities; examples included using academic performance, interviews and motivation letters. All but 1 MD program had mandatory PDT; content and teaching formats varied, as did training duration (2-38 hours). All but 1 MD program had onsite supervision; local clinicians were frequently involved. Debriefing, although not systematic, covered similar content; debriefing was variable in duration (1-8 hours). CONCLUSIONS : Many current practices are encouraging but areas for improvement exist. Integrating global health content into the regular curriculum with advanced study option in global health for students participating in GHEs could help universities standardize support and training.