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Nurse Education in Practice (2006) 6, 207–213
NurseEducation
www.elsevierhealth.com/journals/nepr
in Practice
An evaluation of the first year of acollaborative tertiary–industry curriculumas measured by students’ perception oftheir clinical learning environment
Amanda Henderson a,*, Heather Beattie b, Mary Boyde c,Kim Storrie c, Belinda Lloyd d
a Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland 4101, Australiab School of Nursing, Faculty of Health Sciences, University of Queensland, Queensland, Australiac Princess Alexandra Hospital/UQ, Ipswich Road, Woolloongabba, Queensland 4101, Australiad School of Population Health, Faculty of Health Sciences, University of Queensland, Herston, Australia
Accepted 8 January 2006
SummaryBackground: In response to the limitations identified through the transfer of nursingeducation to the tertiary setting this paper reports on an evaluation of a collabora-tive tertiary/industry programme established in response to recommendations aris-ing from the National Review of Nursing Education – ‘Our duty of care’.Aim: This study compared first year undergraduate student nurses’ perceptions ofthe psycho-social characteristics of their clinical learning environment as part ofa tertiary–industry collaborative model with other first year undergraduate nursingstudents placed in a similar clinical learning environment as a block placement, sep-arate from their home tertiary institution.Method: A survey design using the Clinical Learning Environment Inventory devel-oped to assess student nurses’ perception of the psycho-social aspects of the clinicallearning environment was used to collect the data.Findings: When the personalization score for the first year students of the tertiary–industry collaborative model is compared to other first year students’ experience inthe clinical area there is a significant difference in personalization scores.
KEYWORDSClinical;Learning;Environment;First year students;Satisfaction
1d
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471-5953/$ - see front matter �c 2006 Elsevier Ltd. All rights reserved.oi:10.1016/j.nepr.2006.01.002
* Corresponding author. Tel.: +617 3240 2780; fax: +617 3240 7356.E-mail addresses: [email protected], [email protected], [email protected],
208 A. Henderson et al.
Discussion: Personalization, which refers to student’s perception of concern fortheir welfare and learning opportunities, is worthy of consideration, as it is oftenthese perceptions that influence interest and commitment to learning in the under-graduate nursing program.
�c 2006 Elsevier Ltd. All rights reserved.
Background
Nursing is a practice based discipline. However,during the last two decades in Australia pre-registration nursing education has been transferredto the tertiary sector to produce a more appropri-ately educated, flexible and career orientated Reg-istered Nurse (Reid, 1994). In Australia, thisseparation of the tertiary and industry sector haspresented challenges in relation to the appropriateorganization of theory and practice in the develop-ment on nursing curricula. In common with globaltrends, Australia has also suffered from a criticalshortage of registered nurses and the Australiangovernment responded to this health care crisisby initiating an Inquiry into Nursing by the SenateCommunity Affairs Committee and a National Re-view of Nursing Education. The National Review(Heath, 2002) incorporated the submissions to theSenate Inquiry and the recommendations made bythis Inquiry in their report, in addition to theirown commissioned research, the extensive interna-tional literature and reviews on nursing education(Turner et al., in press).
The final report made 36 recommendationsrelating to one or more of the following seventhemes:
� Health care is a national issue.� Health care provision must be effective andefficient.� Nursing is a profession.� Future development should build on currentexpertise and promote continuous improve-ment, planning and quality.� Nursing is a practice discipline.� Nursing should be inclusive.� Partnerships are essential for quality practiceand education (Heath, 2002).
In response to these recommendations the Uni-versity of Queensland and Queensland Health,Southern Zone collaborated to develop a strategi-cally planned programme that was informed fromthe issues that relate to both the academic andindustry areas.
Program initiatives
Initiatives of the programme are aimed at improv-ing graduate outcomes and transition to profes-sional practice and address the issue of studentsbeing ‘work ready’. This has been addressedthrough an emersion in clinical practice achievedthrough an increase in clinical hours, early and con-sistent clinical practicum, and students being geo-graphically located in the clinical venue for fourout of five days, important considerations for ade-quate induction into the clinical area (Field, 2004;Papp et al., 2003; Turner et al., in press).
The innovative curriculum
The key features of the curriculum design andimplementation are:
� Integrated problem-based learning approach.� Multi-professional learning.� Addressing areas of special health care needs.� Innovative model of clinical practice.� Partnership with health care provider.� Flexible entry and exit points (Turner et al., inpress).
Innovation in the curriculum included a clinicallyoriented program that involved secondment of cli-nicians already employed by the industry partner asconjoint appointments to facilitate problem-basedlearning sessions, clinical laboratory sessions andclinical placement experiences. Problem-basedlearning sessions, clinical laboratory sessions andclinical placement experiences account for fourof the five contact days per week required of thestudents.
A key advantage of the clinically orientated pro-gram located in the clinical facility includes theease of involvement of expert clinicians, for exam-ple, the Clinical Nurse Consultant Continence Advi-sor who assists the introduction of continenceevidence into practice. Contemporary practice issupported through ready access to clinical stan-dards and guidelines based in current literature,
An evaluation of the first year of a collaborative tertiary–industry curriculum 209
and also technical infrastructure, from the industrypractice partner. These are readily accessible dur-ing clinical skills sessions in the laboratory. Thestandards and guidelines are regularly updatedand reviewed by expert clinicians employed in theindustry. These may be Clinical Nurse Consultants,clinicians who provide expert advice to the clinicalareas or Nurse Unit Managers who are responsiblefor the management and provision of services inhighly specialized areas. This strategy ensures thateducation and service appropriately inform andsupport each other (Henderson et al., 2005).
The advantages of Clinical Lecturers being sec-onded from the industry is their ability to facilitatea seamless link from theory to practice. The use ofa joint appointment model further recognizes thatthe expertise and knowledge to develop clinicalskills in undergraduates rests with nurse clinicians(Turner et al., in press). This is possible throughthe clinical lecturers’ local knowledge of the prac-tice environment, and a well established rapport,based on trust, between clinical lecturers and clini-cians as the lecturers have previously worked as amember of the extended clinical team. Integrationof the students into the clinical area is assistedthrough a comprehensive orientation by the clini-cal lecturers both to the organization and specificclinical unit. Accordingly, clinical lecturers super-vise students during their practicum. The value ofclinical lecturers in the clinical environment istheir familiarity of the curriculum, in particular,this assists the identification of the learning trig-gers raised in problem-based learning tutorials thatassists in the seamless transition of theory to clin-ical practice.
Clinical lecturers collaborate and negotiate fre-quently with clinicians to ensure a positive learningenvironment for students. They proactively supportthe learning environments in collaboration withuniversity staff, nurse unit managers and ‘buddy’registered nurses, that is, those registered nurseswho work alongside the students during their clini-cal experience. Because of their familiarity withthe structures within the industry, clinical lecturersare readily able to mediate and address issues atthe most appropriate stage in the organization opti-mizing competent skill development in the clinicallearning environment (Forrester et al., 2005).
A comprehensive communication plan involvingkey stakeholders was developed and implementedby the university staff, senior nursing team and clin-ical lecturers. This strategy, an important requisitefor acceptance of the new program, however, often‘implicit’, incorporated the following activities: anorientation for clinical staff re: the buddying pro-cess and expectations of students in each ward;
hospital wide communication regarding an over-view of the program through the regular nursingnewsletter; feedback to all levels of staff bothexecutive and clinical lecturers throughout the hos-pital during the semester; and clinical lecturersmaking themselves available to both tertiary insti-tution and the industry staff (Hogard et al., 2005).
Addressing these areas in the new partnershipwas perceived as most important as clinical experi-ence provides students with the opportunity toexperience nursing in the real world and ideally en-ables students to put theory into practice (Elliot,2002). Close links to the clinical environment arecrucial to develop practical skills (Dunn and Hans-ford, 1997). This was important as the clinicalpractice component of undergraduate nursing cur-ricula is most often criticised and has been the sub-ject of 50% of all research reports commissionedsubsequent to the Reid review in 1994 (Turneret al., in press). It has even been suggested thatthe success of the nursing program is largely relianton the effectiveness of the clinical experience(Pearcey and Elliott, 2004). Furthermore, thesearrangements are advantageous as students feelthat they are being taught current practice (Nehlset al., 1997).
Aim
The aim of this study was to compare first yearundergraduate student nurses’ perceptions ofthe psycho-social characteristics of their clinicallearning environment as part of a tertiary–indus-try collaborative model with other first yearundergraduate nursing students placed in a similarclinical learning environment, but rather, as ablock placement separate from their hometertiary institution.
Method
A survey design using the Clinical Learning Environ-ment Inventory (Chan, 2001, 2003) was distributedto all students at the one health care facility at thecompletion of their clinical practicum in the firstyear of the Bachelor of Nursing program.
The clinical practicum for tertiary–industry col-laborative model students comprised 30 shifts overthe duration of one academic year. The clinicalpracticum for the students undertaking standardfacilitation under a block placement comprised10 continuous shifts, except for week-ends, overa two week period.
210 A. Henderson et al.
Ethical considerations
The feedback was collected as part of routine qual-ity assurance that is warranted when new initiativesare introduced into the organization. The collectionof information conformed to the NHMRC (2003):Anonymity was maintained, there was no infringe-ment of privacy, no burden was imposed on staffor patients as there was no departure from routinepractice. It did not meet the criteria for requiringethical approval from the hospital ethics commit-tee as there was no randomization intervention. Ap-proval was granted at the local level. Students wereasked to provide feedback about their clinical envi-ronment through completion of the survey. Nocoercion for participation took place.
Tool
The Clinical Learning Environment Inventory wasspecifically developed to assist researchers to as-sess student nurses’ perception of the psycho-so-cial aspects of the clinical learning environment(Chan, 2001, 2002, 2003). This tool acknowledgesthat learning takes place in a dynamic environmentwhere patient care is nurses’ core business.
The tool identifies a number of factors recog-nized by students, namely, individualization, inno-vation, involvement, personalization and taskorientation that are highly desirable if learning isto be effectively facilitated (Chan, 2003).
The scale descriptors are as follows:Individualization: Extent to which students are al-
lowed to make decisions and are treateddifferently according to ability or interest,
Innovation: Extent to which clinical teacher/clini-cian plans new, interesting and productiveward experiences, teaching techniques,learning activities and patient allocation,
Involvement: Extent to which students participateactively and attentively in hospital wardactivities,
Personalization: Emphasis on opportunities forindividual student to interact with clinicalteacher/clinician and on concern for stu-dent’s personal welfare,
Task orientation: Extent to which ward activitiesare clear and well organised,
Satisfaction: An outcome measure that reflectsthe level of students’ enjoyment.
Sample
Potential participants were all first year undergrad-uate students studying a Bachelor of Nursing at a
University in South East Queensland undertakingtheir clinical practicum during 2004. For the pur-poses of the following analyses, a full sample of64 respondents was included. In terms of clinicalplacement models selected for analysis, the sampleconsisted of 33 in a block placement under a stan-dard facilitation model category and 31 respon-dents who experienced their clinical placement aspart of a tertiary–industry collaborative model.
Scoring of items
The items have been scored differently to themethod used by Chan (2001, 2002, 2003) whereitem non-response was given a score of 3 on a scaleof one to five (1 = Strongly Disagree, 2 = Disagree,3 = No Response, 4 = Agree, 5 = Strongly Agree).This process has not been applied in the followinganalyses due to concerns regarding the validity ofassigning non-response a valid value within an over-all score. It is not necessarily appropriate toassume that non-response is due to the respon-dent’s desire to answer an item with a responseof ‘‘unsure’’ – respondents may have missed theitem, may object to some component of the itemor may not have responded due to a range of otherreasons. Accordingly, each variable has beenscored using a four point scale where 1 = ‘‘StronglyDisagree’’, 2 = ‘‘Disagree’’, 3 = ‘‘Agree’’ and 4 =‘‘Strongly Agree’’. Where non-response has oc-curred, the item was excluded.
Validation of scales
As small variations were made in the CLEI the inter-nal reliability of all subscales were calculated forthe revised survey. Revised scores are as follows:
Scale Cronbach alpha coefficient
Individualization 0.68Student involvement 0.62Satisfaction 0.88Innovation 0.61Personalization 0.68Task orientation 0.72
Results
Analysis of variance has been utilised here as a sta-tistical tool in order to understand the comparativeeffectiveness of clinical placement model as part ofa collaborative tertiary–industry curriculum whencompared to clinical placements as a block period
An evaluation of the first year of a collaborative tertiary–industry curriculum 211
quite distinct from university lectures. The clinicalplacement models considered are investigated interms of the scales that form part of the clinicallearning environment inventory (CLEI) developedby Chan (2001, 2002, 2003), including individualiza-tion, student involvement, satisfaction, innovation,personalization and task orientation. The varianceof scores between the first year students of the col-laborative tertiary–industry curriculum and blockplacement used by other first year students is com-pared for each of the six scales (Table 1).
There is actually no significant difference be-tween the individualization, student involvement,satisfaction, innovation or task orientation scoresfrom first year students of the collaborative ter-tiary–industry curriculum when compared to firstyear students of other placement models as dis-played in Table 1. While satisfaction scale scoresfor the tertiary–industry collaborative model werehigher than the scores recorded for the blockplacement, (Table 1), this is not significantly dif-ferent. However, when the personalization scorefor the first year students of the tertiary–industrycollaborative model is compared to the first yeargroup then the difference is significant (P =0.001), as displayed in Table 1.
Discussion
Individualization
As identified in the results the individualizationscore was lower for the tertiary–industry collabo-rative curriculum, however, this score was viewedas consistent with the intent of the curriculum.This is because the individualization score refersto the degree of independent decision-making. Asthe students in the tertiary–industry collaborationmodel commence their clinical placement at thebeginning of their program, from week four, it isnot the intent nor the expectation that they makeindependent decisions. Interestingly this score was
Table 1 CLEI Scale Scores for the tertiary-collaboration mfirst year nursing students
Model Individualization Studentinvolvement
Standard facilitationduring block placement
19.18 (33) 18.27 (33)
Tertiary–industrycollaboration model
18.79 (29) 17.93 (28)
p-Value 0.509 0.582
not significantly different with other first year stu-dents. The intent, therefore, for first year studentsinvolvement in decision-making would appear to beconsistent across different curricula.
Student involvement
Student involvement refers to the degree thatstudents are attentively involved in ward activi-ties. This is potentially directly related to theknowledge base of the students and thereforethe degree to which the students can becomereasonably involved because of the theoreticalbackground able to inform their involvement.The year one students of the tertiary–industrycollaborative model were consistent with yearone students from other curricula. This highlightsthat curricula are probably fairly consistent inrecognizing that learning is undertaken in a fairlystaged approach and accordingly complexity ofclinical activities are associated with level oftheoretical content.
Satisfaction
Of particular interest was the students’ satisfac-tion of the tertiary–industry collaborative modelwith their clinical experience. Consistent withother first year students, satisfaction is noticeablyquite high – possibly related to the enthusiasmwith the commencement of their course. Interest-ingly the students in the first year of the collabora-tive tertiary–industry model were higher again.This result is not significant, however, with largernumbers of students entering the program and ableto respond in the future this may become moresignificant.
Innovation
Innovation was much the same with the tertiary–industry collaborative model when compared withother first year students. Arguably while innovationpertains to presentation of interesting things in a
odel and standard facilitation during block placement of
Satisfaction Innovation Personali-zation
Taskorientation
23.78 (32) 19.54 (28) 19.01 (30) 22.06 (33)
24.93 (28) 19.07 (28) 20.77 (31) 22.00 (28)
0.214 0.471 0.001 0.926
212 A. Henderson et al.
new format this is more readily able to be achievedonce students’ scope of practice increases.
Personalization
Personalization in the new tertiary–industry col-laborative model was significant when comparedto other first year students’ experience in the clin-ical area. Personalization which refers to student’sperception of concern for their welfare and learn-ing opportunities is important, as it is often theseperceptions that influence interest and commit-ment. Of particular interest is that personalizationhas commenced at a significantly higher level inthis collaborative model. This bodes well for stu-dent interest and commitment in the programwhich may partially explain the high satisfactionlevels already reported by these students.
Task orientation
Task orientation was high; indicating the success-fulness of the organization in clearly specifyingthe scope of practice of these students and ade-quately preparing staff.
Implications for practice
Through fostering student alignment with the orga-nization this program has been instrumental indeveloping the most influential aspect of studentlearning, namely, personalization. Personalizationhas been identified by students as the most impor-tant subscale for learning in the clinical context(Chan, 2004). Personalization assists learningthrough enhancing student assimilation into theenvironment (Henderson et al., 2006). The impor-tance of this positive socialisation is continuallyreinforced by student reports about the impact ofgood communication and positive interactions withstaff (Dunn and Hansford, 1997; Pearcey and Elli-ott, 2004). Accordingly, lack of acceptance im-pedes student learning. Implications for practiceinvolve students being incorporated as part of theteam.
Conclusion
There would seem to be similar trends in this modelwith other contemporary models in relation to theopportunities for students to undertake activitiescommensurate with their year level. The most sali-ent feature of this model is the level of personali-
zation as reported by students in their clinicallearning environment. This collaboration modelhas been in operation for just one year. This eval-uation after the first year, however, suggests thatclose collaboration between the industry and ter-tiary sectors has assisted in a high mutual regardbetween staff and students. This potentially bodeswell for future progress of these students as a sup-portive environment is a key factor to student suc-cess. Replication of this study in future years of theprogram will provide data for further evaluation ofthe outcomes of the tertiary–industry collabora-tive model.
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