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Student learning in community experience: SLICE project

06 December 2019

Zoe Clark, Cameron Cox, Mary Brady and Jayne Price gathered children’s nursing students’ experiences of community practice placements to develop the best possible online resource.

Authors

Contact Zoe Clark at [email protected]

Conflict of interest

This project was funded by a teaching enhancement fund. There are no financial and personal relationships with other people or organisations that could inappropriately influence this work.


Research summary

  • The Student Learning in Community Experience (SLiCE) project was established to develop, in tandem with students, a website accessible from any computer or mobile device to support learning in community placements.
  • A qualitative study using the principles of action research was used to gather children’s nursing students’ experiences in community practice placements and their opinions regarding a draft website to assist in the development of the final website.
  • Final-year children’s nursing students (n=48) from pre-registration programmes at both bachelor’s degree (BSc) and postgraduate diploma (PGDip) were invited to participate in focus groups. In all, 17 children’s nursing students participated in two focus groups (n=8, n=9).
  • They were shown the content of the website and asked to draw upon their experience in community practice placements to evaluate and guide the development of the website.
  • Responses were analysed and themes identified.

Abstract

Current and previous groups of third-year children’s nursing students in a UK higher education institution through placement evaluation and verbal feedback have suggested that community placements caused anxiety as they struggled to identify learning opportunities. They felt they were missing opportunities to gain essential skills as outlined within the Practice Assessment Document (PAD), and further found it difficult to understand the structure of community placements. Responding to such feedback, we developed a community placement workbook to guide students’ learning in community settings. This workbook was difficult to navigate in Word document format, and furthermore students did not want to carry this around with them in practice. Therefore a website format was developed as a means of supporting and guiding student learning and development within these community placements. A qualitative study using the principles of action research was used to gather children’s nursing students’ experiences in community practice placements and their opinions to assist in the development of the final website. The focus groups revealed that the facilitation of their independent acquisition of knowledge, website design and mentor information would be crucial inclusions for this resource.

Key Words: Children’s nursing, community, placement, support


Introduction

Following an evaluation from third-year children’s nursing students’ community experiences, the results provided strong evidence to suggest they felt they had not received adequate support to fully achieve the required essential skills. Equally, there is a degree of apprehension from first-year nursing students (on the same course) being placed in community settings. Furthermore, students may face stresses in community-based placements that are not encountered in hospital-based settings (Baglin and Rugg, 2010). On the other hand it is important to dispel the myths surrounding community practice such as lack of opportunities to develop knowledge, skills and competences (Shelton and Harrison, 2010). Alternatively, Murphy et al (2012) suggest more emphasis could be placed on employing strategies that maximise learning opportunities available to pre-registration nurses in community practice. However, this area remains relatively unexplored (Baglin and Rugg, 2010).

Findings from the children’s nursing students’ community placement evaluations across all three year groups, led to adjustments in the support being offered and, the development of a Community Booklet aimed at enhancing student learning and practice. Informal discussion and evaluation during preparation for practice seminars suggested students found the booklet difficult to navigate as a PDF, or Word document, preferring a technology-enhanced approach. Consequently, we established the Student Learning in Community Experience (SLiCE) project to develop a website accessible to students from any PC or mobile device to support learning in community placements. When evidence-based information is required to ensure high standards of care, mobile information and communication technologies can be useful devices for clinical nursing practice and education (Beauregard and Ponsoni, 2017). Following a successful bid to the faculty of health and social care, we received teaching enhancement funding for the project.


Background

The Department of Health (DH) stated that Health Education England needed to ensure all nursing students enrolled on a degree program have 50% experience in community placements (DH, 2015). The NMC also supports the need for nursing students to gain community experience during their training (NMC, 2018). Brooks and Rojahn (2011) highlighted the importance of meeting the learning needs of nursing students during their community practice in order to foster a workforce that recognises how community care is essential to delivering good quality health care across the board. Furthermore, Hewitt-Taylor and Farasat (2013) suggest developing the nursing students’ skills in caring for children and young people and their families in the community is a high priority. Moreover, Ridley (2015) note the changing face of health care requires more nurses to prepare for a career in the community. Therefore, educational providers and clinical leaders must work together to prepare the next generation of nurses to work in new and integrated health and social care teams (Dickson et al, 2015).

Within the university which is the focus of this paper, community practice consists of nursing students being placed in school-nursing, health-visiting and children’s community nursing teams. Within these placements they have the opportunity to undertake outreach in other areas of the community to enhance their learning and practice experience. Learning the skills and expertise of school nurses and health visitors and acquiring knowledge of public health practice can be of great benefit to nursing students (Shaw-Flach and Hoy, 2016). In contrast to acute settings, registered nurses working in the community often work autonomously managing their time, making decisions without consulting other team members and being more accountable for their own practice (Wright, 2005). Students may not have encountered this style and pace of working before (Carr et al, 2016). The observational nature of these placements together with the need to acquire practical skills to consolidate their learning (Dickson et al, 2015) in unfamiliar environments (clinics, schools, person’s own home) can be daunting and result in anxiety (Carr et al, 2016).

However, community placements have many learning opportunities including, leadership, management, assessment, communication, multi-agency working and negotiation (Perrin and Scott, 2016). Students have the opportunity to be more informed about local areas and accessibility to the different health and social care services available to the children young people and families (Wright, 2005).

As education providers, we created a website for children’s nursing students to use alongside their mentors to enhance learning opportunities and develop their community practice skills. The website followed the same format for the three main community placement areas, health visiting, school nursing and community children’s nursing, with a number of key features. For example: the history of the three areas of practice, the role of the health visitor, school nurse and community children’s nurse, and a guide to the differing roles within the respected teams. This was to provide structure and act as a quick reference for students to use before and/or during their placement. Key information included roles and services, useful literature and online information, points for reflection and discussion, and tips for getting the most out of your placement.

Edwards et al (2008) reported very positive outcomes when utilising an interactive website for nursing students to enhance their knowledge and experiences in the care of the elderly. Their study found students were excited and keen to develop their knowledge further. Moreover, the need for educators to assist students to maximise their learning opportunities, evaluate strengths and limitations and develop their knowledge for improvement was highlighted by Levett-Jones and Bourgeois (2011). Additionally, strong evidence exists to support the use of online learning for nursing students (Quinn and Hughes, 2013). However, to date there is limited research examining the potential value of developing websites to support children’s nursing students’ in practice. This study aims to investigate this and redress gaps in knowledge and guide nurse educators in their preparation of students for future nursing community practice.

Aims

The aim of the SLiCE project was to develop a website in tandem with children’s nursing students’ that would enhance their experience of child related community practice placements.


Method

An action research approach (Ellis, 2019) was used to examine the children’s nursing students’ thoughts regarding a draft website which aimed to enhance the students experience when in community placements. This method was selected since the research was intended to be driven by the children’s nursing students’ who would be affected by it. Action research is designed to implement change in problem solving or improvement by involving those who will be affected by the change throughout the cyclical process (Burnard et al, 2011). Cronin et al (2015) described this as a five-staged cycle (figure 1).

Fig 1 Action research cycle

Cronin et al, 2015

Cronin et al’s (2015) cycle consists of five stages which facilitated the development, implementation and evaluation of the resource:

  1. Identify a problem or issue
    Informal and formal evaluations of the children’s nursing program revealed the need to develop support for community placements.
     
  2. Fact finding and analysis
    Focus groups were used to gain children’s nursing students’ perspectives on the draft format of the website. The general aim of the focus groups was to efficiently gain a wealth of information relating to the ideas of the children’s nursing students’ regarding website content, structure and overall presentation (Ellis, 2019) which could be used to guide the completion of the website.
     
  3. Plan action/s
    The community website was developed in full guided by the findings from the focus group
     
  4. Implement action/s
    Subsequently the community website was completed and implemented, this was made available to all pre-registration student nurses via the virtual learning environment.
     
  5. Evaluate action(s)
    Feedback was sort from the children’s nursing students and this was used to continue to develop content. This feedback has also created an opportunity to increase the content and reach of the website to include all fields of nursing.

Recruitment and participants:

Purposive sampling was used to invite final year children’s nursing students (n=48) from pre-registration programmes at both bachelor’s degree (BSc) and postgraduate diploma (PGDip) to participate in the focus groups. Postgraduate children’s nursing offers a shortened two year programme leading to qualified status as a children’s nurse. Both groups had experienced a variety of community practice placements which was recognised as an essential precursor for capturing their reflections on how the website could have potentially improved their experiences of community practice placements.

Data was collected by the lead researchers ZC and CC using focus groups. Focus groups have been used successfully within industry and the health service (Ellis, 2019) to generate data from participants closely aligned with the study topic, which was viewed as appropriate for this participative action research study. The invitation to participate in the focus groups was sent to each student by email from an independent lecturer to minimise the potential for coercion. Ethical approval was granted from the Education Faculty Research Ethics Committee prior to sending out the invitations. The timings, date and room allocation were given in the initial email with a follow-up email being sent two weeks later. Altogether 17 children’s nursing students agreed to participate in two focus groups (n=8, n=9); both groups had a mix of BSc and PgDip students. In line with current research guidance (Krueger and Casey, 2015) the size of the focus groups was limited to no more than 10 students to generate sufficient discussion without deterioration into an unmanageable group where the discussion may deviate and become distracted.

Within each focus group students were shown the content of the website by the lead researchers (figure 2). Then students were asked to spend five minutes considering the website and thinking about the following question: ‘Please consider your experiences within the community setting including any challenges or barriers to your learning and use this to consider the website and its development.’ The researchers asked the students to draw upon their experience in community practice placements to evaluate and guide the development of the website. Paper was provided around the room for students to scribe their thoughts; the researchers also used flip chart paper to scribe during the discussions. Students were also asked to consider the benefits, further improvements and overall thoughts regarding a community website to support them when in practice placement (Foth et al, 2016).


Data analysis

Analysis of the data was carried out by the lead researchers which identified patterns and the frequency of information indicated by the student participants. The use of the collection of data on paper enabled the areas of concern in community practice placements to be highlighted and for the lead researchers to identify themes (Moule and Goodman, 2014), enabling analysis of what the participants had said to make a contribution to the future development of the website (Parahoo, 2006). The responses of each focus group was considered individually and then the data from both groups was combined under themes. Additionally, this on-going analysis underwent further analysis by another member of the research team (MB) to help ensure validity and reliability.

Findings

Three themes were identified:

  1. Independent acquisition of knowledge,
  2. Design of the website
  3. Mentor involvement.

Theme 1: Independent acquisition of knowledge

The students appreciated that at times their mentors would be involved in documentation activities, which excluded them and could generate boredom as they felt redundant. At such times, they saw being able to access ‘their website’ as opportunistic, motivational and beneficial to enhancing their knowledge. Indeed, there was a palpable sense of ownership as they suggested ideas including length of placements, overall website presentation and content, clearly relishing the opportunity to contribute to the ‘student voice’. Senior students voiced regret at having not been able to experience this resource, acknowledging the potential benefits to learning:

‘I wish I’d had this for my placement’
 

In addition, students stated that this website had the potential to foster proactive learning by helping students develop ownership of their learning by becoming more self-directed. Also, it equipped them with the skills to distinguish between reputable websites that had an evidence based academic underpinning as appose to those with more superficial information.

‘Very good for students to have a head start when beginning placement’

‘Helps younger students develop their skills in self-directed study’

‘Links to respected and reliable sites, good for references’
 

Students also made suggestions for links to websites that would be invaluable to future students:

‘Add Birth to five link’
 

Theme 2: Design of the website

Although students could use the non-contact time with mentors to reflect on their own learning, some students felt bored and needed additional guidance that enhanced their specific learning style. They commented that online access to the website should be an easily accessible point of reference that provided:

‘A broader knowledge of services available’

‘Be a central location for everything you need’

‘Gain knowledge of the roles of different professionals’

The students continued noting that the design of the website was easy to use with a clear and logical structure. The use of images, as can be seen in figure 2, was praised by students who felt it was motivational to “see” other students in the pictures.

‘The website was motivational with pictures’

As the website has several sections including health visiting, school nursing and community children’s nursing, the students suggested colour coding the site to make it clearer. The students also showed concern for their student colleagues who they thought could find the website difficult to read if they had a learning need, for example dyslexia.

‘Could be difficult to read for dyslexic students’

However, in line with current university guidance, the background was blue with white writing which is recommended by the British Dyslexia Association (2018). Other students commented that the website could include interactive games and quizzes to facilitate their learning about the community and client care.

Overall, the students felt the website looked professional and they would be keen to use this in practice while mentors are completing tasks which the students cannot involve themselves.

‘Website looks professional’

‘Could access while mentor is doing notes’

 

Theme 3: Mentor involvement

The students were cognisant that there was also potential value in the website for their mentors too.

‘Informative for both students and mentors’

‘Guidance and instructions for mentors on the use of the website’

The students commented that the provision of guidance for mentors regarding how the student experience could be enhanced would be beneficial. Suggestions included the type of additional ‘outreach’ learning opportunities that the students could access when the mentors were involved in documenting confidential/sensitive client data. However, the students were keen to note that these ‘outreach’ experiences should enhance their practice experience.


Discussion

Overall, the students reported positive comments around the development of the community website. Historically, students have voiced feelings of boredom and inertia in community practice as well as lack of autonomy to direct their own learning was also evident from the focus groups. According to Brooks and Rojahn (2011), nursing students across nurse education programmes have felt this sense of disengagement due to clinical staff having increasingly heavy administration tasks to perform daily as part of the community roles. The children’s nursing students in this study were keen to develop their own ideas relating to outreach in community practice and develop some autonomy over their learning objectives. It was an encouraging finding that the website had the possibility to be motivational and the potential to enhance the students’ developing autonomy. With healthcare moving rapidly into the community (Ridley, 2015), it was rewarding to see that this study demonstrated that the website fostered feelings of empowerment, motivation and engagement with community practice placements. Engaging in E-Learning is now commonplace in the healthcare sector and meets the learning needs of the current generation (Page et al, 2017). Embracing technology to create an interactive and dynamic website clearly gave children’s nursing students a feeling of autonomy in their learning.

Undoubtedly, the students involved in the focus groups voiced a growing sense of ownership as they participated in the collaborative development of this website by suggesting improvements such as links to sites that they had found useful. In addition, they reinforced the value of interactive components for their learning that developed their knowledge with the use of quizzes and games. They were also mindful of the needs of fellow students and sought to ensure that the website would be accessible for those with learning needs such as dyslexia.

Allowing an interactive nature to the website was essential for the children’s nursing students, since they felt that being able to contribute to the content and guide the future development of the website would help improve motivation within community practice placements for future students and mentors alike. With the NMC (2018) continuing to value the inclusion of community experience as part of a children’s nursing student degree programme, the development of innovative support is essential to drive and sustain motivation. The Higher Education Funding Council for England’s e-learning strategy (2009) proposed that technology can be utilised positively to change existing processes within teaching and learning in higher education. The results of this study confirmed that the children’s nursing students’ welcomed a platform to support them that was functional on a PC, laptop, tablet or mobile phone device.

The students commented that their involvement with the website was essential since it would help improve motivation within community placements. Clearly the students were able to indicate the types of information that they felt was important (such as a Birth to five link and other reputable websites). Following evaluation of the website as part of the action research cycle, the feedback from the focus groups was integrated to complete this process. Access has been given to all pre-registration children’s nursing students’ and evaluation of the website by students and practice mentors is the next step in the action research cycle.

 

Strengths and limitations

The main strengths of the study were that the two lead researchers had established backgrounds in school nursing and health visiting and had been able to develop the initial website using their in-depth knowledge and skills. The participants voiced ownership over the design of the website.

The main limitations of the study were time constraints in that the participants were in their final year and busy focussing on assignments, their practice placements and seeking their first post as a registered nurse. The study size was small and limited to year 3 students, feedback has been sourced from all years on the completed website and moving forward the website will be formally evaluated by all years, which will aim to increase participation numbers.

 

Implications for practice

The findings from this study highlight the potential benefits of utilising technology enhanced learning to support children’s nursing students in community practice placements. With an overwhelmingly positive response from the children’s nursing students, there is scope to further develop the website to include community areas such as specialist schools, specialist health-visiting practice and child and adolescent mental health services. Interestingly, thought has been given to expanding this website to include other fields of nursing for example including a section on district nursing, sexual health clinic placements and hospice care for both adult and child.

The NHS is a forever changing and evolving organisation. Students, as the future staff providing care, need to participate in developing their knowledge appropriate to the needs of this service. The use of a versatile, flexible and dynamic platform such as this community placement website will empower students and enable adaptations to be included so that the information remains current.

Future research now revolves around gaining the expert knowledge from the mentors in community practice placements to explore the usefulness of the website from their perspective and to encourage partnership working in the further development of the website to increase the current content.


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Figure 2


Image credit | iStock

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