Collaboration in Undergraduate Students’ Simulated Clinical Practice

by Nancy McNamara MHSc (hons), BN, RCompN, CATE Rebecca Giles BSW, RSW, PGDip Ed, DPGCert Prof Sup, CATE

Background

• Inter-professional Education (IPE) (Oandanson & Reeves, 2005)

• Communication (TJC, 2012)

• Work-ready health workforce (Leonard, Shuhaibar & Chen, 2010; McNamara, 2015)

Clinical Context

• Within a simulated clinical practice programme for second semester nurses

Day 1 Day 2 Day 3 Day 4

Patient admission-The unconscious / bedridden patient-All admission documentation… -Basic nursing careDebrief

A day in the ward-Patient Manual Handling/ -Medications Debrief

A day in the ward-Collaborative care-Referrals. Collaborative Meeting

Patient Discharge -Discharge decision and process -Documentation audit. -Summary/presentation

Workshop 1 Workshop 2 Workshop 3 Workshop 4

-Admission process-Professional documentation-Introduction to Medication Management

-Time Management-Mobility Aids/documentation -Medication Management cont’d

-Collaborative care…referral system-Fluid balance

-Discharge Process-Evaluation

Collaborative Meeting

• Social work, occupational therapy and nursing students

• Collaborative team: Doctor, nutritionist, physiotherapist, spouse or family advocate

Study Aim

• To gain an understanding of the inter-professional learning experiences of undergraduate nursing, social work and occupational therapy students in a simulated collaborative team meeting.

Method/Methodology

• Self selecting students: questionnaire (5 questions), focus group

• Thematic analysis of data

• Theoretical Framework; Kolb’s experiential learning theory

Population and Participation

• Of the 72 participants (54 nursing students, 8 occupational therapy students and 10 social work students) n=48 responded to the questionnaire.

• n=9 took part in the focus group..

Questionnaire Results

• Q1: Describe what it was like for you attending a collaborative meeting

with the other disciplines

Great experience or opportunity Good learning No response Scary and nervous

11

29

3 2

Describe what it was like for you attending a MDT meeting with the other disciplines

Student Learning

Shared Perspectives Clearer Understanding of Roles Insight into Reality Deeper Cultural Awareness

Aspects of the Meeting

Shared Patient Focus

Professional Role Recognition

Different Perspectives

0 2 4 6 8 10 12 14 16 18

14

12

18

Favourite Aspects of the Meeting

Enhanced Learning

More Fully Prepared More Student Representatives DisciplineSpecific Meeting Processes 0

1

2

3

4

5

6

7

8

9

10

Overall Findings

• Overall questionnaire and focus group themes:

• Professional role clarification and awareness• Preparedness• Safety• Realism

Professional Role Clarification and Awareness

• Professional identity

• Role negotiation

• Professional boundaries

• Professional competition

Professional Role Clarification and Awareness

• Students had an opportunity to consider and define their own professional roles and see how their roles were perceived by the team.

• “… I found it interesting that the majority of the people in our meeting had no idea what we actually did and were quite surprised at what we could offer…”

• “…Good opportunity to reflect on the scope and role”

Role Negotiation and Professional Boundaries

• A process of role negotiation occurred as students realised that more than one discipline could access the same service or provide the same support for the patient.

• “…Clarified my boundaries, like what I am supposed to do and not to step on somebody’s feet”

• “…so Ok you do that in your role as well, so I’ll do the placement enquiry”

Professional Competitionics

• Sense of competing for team dominance based on experience

• “…as a first year it would not have been as helpful….especially when you are with other professions who are second and third years. That’s got to be daunting…”

• “ stressed beforehand ….because we thought we were going to be up against third year nursing students…..having never done this before we thought we would be at a loss…”

Preparedness

• Patient scenario briefing and expectations for professional input

• Preparation for collaborative clinical practice

Patient Scenario Briefing and Expectations for Professional Input

• Some students had less preparation than others. This was predominantly around patient scenario briefing, meeting objectives and expectations for professional input.

• “…everyone could be informed of what to expect…more information beforehand”

• “…not sure exactly what was expected of me”

Preparation for Collaborative Practice

• Practice for practice

• “…Getting to know how they work and seeing how other health professionals work with nurses”

• “…We knew about MDTs but being able to put the theory into action and practice working with the others was really useful”

Safety

• Safe supportive environment

• Culturally appropriate meeting processes

Safety

• Patient advocacy, interventions and team processes did not impact patient outcomes

• “…it was nice just practising and knowing that nothing was going to come of it or get damaged by what you do and say”

• “…I think it was a good confidence builder doing it in the simulated situation as opposed to first time having to do it out in the field work situation”

Safety

• Culturally appropriate meeting processes

• “…Kai-Awhina attendance and input, • “…meetings were appropriately culturally sensitive and focussed ”

Realism

• Considering the reality

• Matching the reality

Considering the Reality

• Students considered the reality of the professional collaborative environment.

• “…really enjoyed meeting people from other classes who I could be working with in future”

• “…showed me what it would be like in a real situation…. makes you think about the rehab of your patient beyond hospital”

Matching the RealityClinical Meeting Processes

• The patient’s/family voice:

• “…the client’s voice needs to be heard as equally loudly if not more than ours”

• “…everybody’s coming with a solution but that’s not the way a social worker works with a client……we talk to the client, only then solutions are coming, but in our meeting everybody came with solutions”

Limitations

• Disciplines were not individually identified • The study did not identify demographics such as age,

gender or ethnicity• Meeting preparation and debriefing was done

independently within disciplines. • A larger and equal sample may have altered

outcomes.

Recommendations

• For future research:• Participant groups, gender and ethnicity are identified

• Students receive the same briefing information and are aware of the objectives for each of the disciplines

• Students clearly understand what and how they are expected to contribute to the meeting.

• Collaborative meeting with undergraduate students continues

In Conclusion

• This research has provided some insight into the inter-professional learning experiences of undergraduate nursing, social work and occupational therapy students.

• All student participants concurred that the simulated collaborative meeting was a useful learning experience.

Thank you