International Journal of Practice-based Learning in Health and Social Care

Some is not everything? Designing an instrument that measures the clinical learning environment holistically

Lizemari Hugo-van Dyk — 2024-06-28

This article describes the development as well as face and content validation of an instrument for measuring the clinical learning environment of professional healthcare students. A methodological research design was used to develop the instrument and a Delphi technique was used to determine face and content validity. The research was conducted systematically in two phases to construct the instrument, and to establish face and content validity. Phase 1 comprised a general literature overview to identify existing instruments. The retrieved instruments were thematically analysed into the four themes of atmosphere, teamwork, workload and learning opportunities, and then the first version instrument was drafted. In Phase 2, the first version instrument was evaluated for face and content validity. Thirty-six healthcare professional experts responded in the consensus Delphi study, and consensus was reached after three rounds. A consensus Delphi study confirmed the face and content validity of 62 items. The second version of the new instrument was determined. A new holistic clinical learning environment measuring instrument, based on existing instruments, was developed to promote quality student placements.

Promoting the Wellbeing of Physiotherapy Students on Placement:

Jenna Rhodes — 2024-06-28

The current healthcare workforce crisis in the United Kingdom has highlighted the need to equip graduates with the skills to maintain their personal wellbeing whilst working in increasingly pressurised environments. The Placement Wellbeing Project (PWP) is an intervention designed to support the wellbeing of physiotherapy students during studies, while on placement and as they enter the workforce.

This action research project used a single group, repeated measures design. Ethical approval was gained from the [redacted] ethics committee. On recruitment, participants were given the Placement Wellbeing Toolkit [toolkit link available but redacted as not anonymous to author or organisation] and took part in a pre-placement peer group discussion and a post-placement de-briefing session. Outcomes were measured using the Placement Coping Scale (PCS) and the General Self-Efficacy Scale.

Significant improvements were observed in the total PCS score (Friedman's test χ2(2) = 19.75, p = 0.000) and all individual items of the PCS from baseline to post-placement. Post hoc analysis detected significant improvements between baseline and pre-placement total PCS scores (p = 0.005). Total GSE scores improved significantly from baseline to final measure (Wilcoxon sum-rank test Z = 2.105, p =.035).

To develop a resilient future workforce we need to ensure that students are well prepared for challenges and supported to maintain their wellbeing on placement. The results of this study indicate that physiotherapy students may benefit from interventions to develop positive coping strategies for placement.

An Exploration of the Impact of the COVID-19 Pandemic on Allied Health Students; Practice Placement Experiences

Garret Tan — 2024-06-28

The COVID-19 pandemic was an unexpected event, significantly impacting global populations. Due to its sudden occurrence, it has affected pillars of world stability, namely, healthcare. Not only has it stretched healthcare systems beyond their capacity, but it has disrupted its daily protocols and activities. As a result, adaptations to tackle this pandemic have been implemented, putting healthcare education, specifically, practice placements as a lesser priority; affecting students in a myriad of ways. Nevertheless, guidance has now been provided to allow clinical placements to continue. However, these changes have potentially limited students in their learning, posing the question of clinical sufficiency and competency. Hence, this qualitative study aims to understand the specific changes to Trusts and how students adapted to fulfil their module criteria and learning outcomes. A convenience sample of physiotherapy and occupational therapy students was recruited; from it, 18 interviews were then conducted. Transcriptions, coding and thematic analysis identified four main themes of learning opportunities, organisational changes, adaptations and mental wellbeing, thus providing clarity regarding how students successfully completed and met their placement learning outcomes despite organisational changes. However, as a result of these changes, mental and physical wellbeing has also been affected. The findings did shed light on which changes were helpful and which needed modification. Hence, future research was suggested to gain a more holistic understanding of the needs of students and other effective coping mechanisms, providing a more balanced placement experience during these uncertain times.

The Effect of Self-esteem on Stress and Coping Mechanisms among Nursing Students during Clinical Training in Palestinian Universities

Mutaz Dreidi — 2024-06-28

Nursing students are exposed to a variety of stressors during their clinical training. The impact of stress must be considered as an important factor that may have negative impact on clinical performance and patient care. The purpose of this study was to identify the relationship between self-esteem and stress and coping mechanisms among nursing students during clinical practice. A descriptive-correlational study was used in the study; a self-reported questionnaire was used to collect the data. A convenience sample of 300 baccalaureate-nursing students from Palestinian universities and had clinical training in governmental and/or private hospitals participated in the study. The most common type of stressors perceived was stress from taking care of patients (Mean= 9.8), followed by stress from instructors and nursing staff (Mean= 8). Problem solving was the most prevalent coping strategy used by the participants (Mean= 14.2), followed by staying optimistic (Mean= 9). The results showed that avoidance, and transference have significant positive correlations with all stressors (p < 0.05), while self-esteem has significant negative correlation with all stressors. The findings of this study revealed that nursing students experienced mild to moderate stress, and the most prevalent form of stresses experienced was stress from taking care of patients, followed by stress from instructors and nursing staff. Students commonly used problem solving followed by staying optimistic to cope with their stress, and they found these methods to be effective.

Examining SLP student perceptions of reflective practice. How do students compare on the reflective practice questionnaire?

Kate Cook — 2024-06-28

Reflective practice (RP) activities are regularly employed as part of clinical education programs for SLP. Studies examining SLP student perception of RP, suggest that in general RP activities are valued and learning occurs (Dunne et al., 2019; Tillard et al., 2018). However, it is not known whether perceptions of RP activities change as clinical placement experience increases. The impact of RP activities on outcomes such as: confidence; communication; job satisfaction; stress; uncertainty; and desire for improvement also has not been examined.

Aims: 1. To determine perceptions of reflective capacity and outcomes of engaging in RP in three groups of SLP students (following their second, fourth or sixth clinical placement experience) utilizing a validated and reliable instrument. 2. To examine patterns of perceptions of reflective capacity and outcomes of engaging in RP across SLP students utilizing Hierarchical clustering (Manhattan distance).

70 SLP students completed The Reflective Practice Questionnaire (RPQ) (Priddis & Rogers, 2018; Rogers et al., 2019).

The majority of SLP students perceived they had high levels of reflective capacity. In general, as SLP student clinical placement experience increased so did perception of RP abilities and subscales associated with outcomes of engaging in RP. A significant positive effect for three subscales of the RPQ (communication confidence, confidence general and job satisfaction) was found as clinical placement experience increased. Three groupings were identified as a result of Hierarchical clustering.

This study provides quantitative data to support the teaching and use of RP activities with students across clinical programs.

Evaluating the impact of a 2-week Peer Enhanced E-Placement (PEEP) on pre-registration physiotherapy students’ attitudes, self-perceived confidence, and competence in delivering telerehabilitation.

Christie Robinson — 2024-06-28

The COVID-19 pandemic brought about rapid digital transformation of physiotherapy practice and education. Previous studies have suggested a lack of knowledge, beliefs, and clinical acceptance of telerehabilitation as barriers to implementation and sustainability of telerehabilitation. Providing pre-registration specific teaching and practical experience of telerehabilitation may improve physiotherapy student confidence and competence in delivering telerehabilitation and support clinical acceptance of telerehabilitation in practice.

A 2-week Peer Enhanced E-Placement (PEEP) was developed and evaluated to explore its impact on third year physiotherapy student attitudes, and perceived competence and confidence in delivering telerehabilitation. Students completed a Likert scale questionnaire, immediately pre and post the PEEP placement, rating their perceived confidence and competence in four key areas of telerehabilitation: assessment, intervention, communication, and problem solving. In addition, students participated in group discussions to explore the impact of the PEEP on their attitudes towards telerehabilitation.

59 students completed the PEEP, 49 (mean age 25±6.6 years, 41% male) completed both the pre and post placement questionnaire. 55 students participated in group discussions (n=8). Following the PEEP, self-perceived confidence and competence increased in all four key areas assessed. Analysis of the group discussions identified three core themes: Prior experience and assumptions of telerehabilitation, Opportunities and barriers, and Experience of the PEEP.

Participation in a 2-week PEEP had a positive impact on physiotherapy student confidence and perceived competence in delivering telerehabilitation. Student attitudes towards telerehabilitation generally improved, with increased acceptance and recognition of its clinical value for physiotherapy practice. Students’ concerns echoed those of clinicians identified in prior research related to the opportunities and barriers facing telerehabilitation. The intensive structure of the PEEP, peer interaction and simulation appeared to positively impact on outcomes related to confidence and acceptance of telerehabilitation.

Further research is required to understand and evaluate the effectiveness of pre-registration telerehabilitation training as a means of preparing students for practice and supporting sustainability of telerehabilitation in the post-COVID era.

Perspectives of Nursing Students toward High-Fidelity Simulation Learning During COVID-19 Pandemic

Ghada Abu Shosha — 2024-06-28

While evidence of the impact of simulation in nursing education is growing, COVID-19 pandemic may carry further evaluation beyond the existing perception.

To explore Jordanian nursing students' perspectives toward utilizing high-fidelity simulation learning as alternative clinical bedside training during COVID-19 pandemic.

A qualitative thematic analysis approach was employed through direct focus group discussions. Transcripts were thematically analyzed using Marshall and Rossman's (1999) process.

Thirty-five nursing students joined seven focus group discussions. Two major themes emerged from data analysis as follow: "Restored factual training environment", and "Proficiency devoid from self-confidence". Students articulated the implication of using HFS on their knowledge, practical skills, communication, and team working. However, a criticism on HFS inability to promote self-confidence was addressed.

Despite the effectiveness of HFS in nursing education, it was viewed as incompetent for building sufficient confidence required for direct interaction with contagious patients in real settings.

Career motivation of 1st year nursing and midwifery students

Dr Mark Wareing — 2024-06-28

This paper presents findings from a cross-sectional study into the motivational factors of students who chose nursing and midwifery as a career.

189 students from the University of Bedfordshire (UoB) and 223 students from Canterbury Christ Church University (CCCU) completed a questionnaire at the start of their studies in 2018. The findings are generated from the first stage of the Placement, Impact, Experience and Destination (PIED) study into student belongingness on placement and the influence of practice on the first career destination of newly qualified nurses and midwives.

An in-class questionnaire was administered to 1^st year pre-registration adult, child and mental health nursing and midwifery students to identify the intrinsic and extrinsic factors that influenced their motivation to choose nursing or midwifery as a career.

A mix methods study design was adopted for the PIED study where participants completed a survey that collected quantitative and qualitative data and administered during the course induction period.

Motivation scores were found to be high in both cohorts, with students at both sites endorsing intrinsic motivational factors over extrinsic at statistically significant levels. The strongest intrinsic factors appeared to be a desire to help and care for people and play a useful role in society, whereas the strongest extrinsic factors were career stability and the ability to work in different regions and countries.

The study suggests that the influence of family and friends continues to exert a strong intrinsic motivational influence on the career choices of students, particularly those under the age of 25. Identifying the motivational factors of first year nursing and midwifery students presents employers with an opportunity to tailor strategies to recruit apprentices, enable placement partners to enculturate prospective employees into the workforce and understand the relationship between extrinsic factors and practice learning to successfully recruit graduates.

Editorial: ‘Onward and upward’

Helen Buchanan — 2024-06-28

Front Matter

2024-06-28