Outlining the development of an online structured framework to help student nurses achieve assessment learning outcomes during practice placements
Christine Stevens, BSc, RN, OND, Cert ED, Cert Health Promotion, is senior lecturer; Carol Clark, MSc Health Promotion, RN (Part 15), RN, RM, HV, Cert Ed, is senior lecturer, both at Faculty of Health and Social Care, University of the West of England; Angela Young, PGDipHE, BSc, RGN, DN, RNT, is practice education facilitator, Bristol PCT; Kerri Thomas, DipHE, RN, BSc Health and Social Care, is practice education facilitator, Weston Area Health NHS Trust; Donna Hassell, RGN, Dip Community Health Studies(DN), is practice education facilitator, South Gloucestershire PCT.
Stevens, C. et al (2009) Developing activities to help student nurses achieve learning outcomes in practice placements. Nursing Times; 105: 21, early online publication.
This article describes a collaborative project between practice staff and academics to help and support students and mentors when providing evidence that learning outcomes have been achieved in practice placements.
Keywords: Online structured framework, Practice placements, Student support, Learning outcomes
- This article has been double-blind peer-reviewed
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- Nurses can use a web-based facility such as the library of activities to identify their learning needs and guide them towards achievement of their learning outcomes.
- Learning outcomes can be achieved in bite-sized portions and, once completed, evidence that they have been achieved can be downloaded and added to a student nurse’s portfolio of evidence.
- By using online structured learning, nurses make it easier for mentors to identify valid evidence that they have achieved competencies.
Nursing practice and education were separated in the late 1990s – this has often made it more difficult for nurses to produce evidence of achievement in practice.
Mentors have expressed concern about how best to support student nurses and how to gather evidence that they are achieving in practice.
Mentors have found the academic jargon used in the assessment documentation difficult to understand.
The government’s modernisation agenda and the NHS Plan (DH, 2000) support the call for an improvement in clinical placements.
In 1999, Fitness for Practice (UKCC, 1999) recommended the improvement of clinical placements and highlighted the need to take into consideration the context of modern healthcare delivery. The government’s modernisation agenda and The NHS Plan (Department of Health, 2000) supported this, to ensure student nurses gained the relevant knowledge and skills to provide the care patients need. Placements in Focus: Guidance for education in practice for health care professions (DH and English National Board for Nursing, Midwifery and Health Visiting, 2001) also highlighted the need to enhance the quality of practice placements.
To ensure that student nurses gain the knowledge and skills they require, the School of Health and Social Care at the University of the West of England (UWE) has adopted an outcome-based competency approach to programmes. Here, we explain how a competency-based clinical assessment document was developed, which now forms part of student nurses’ personal professional portfolio.
In response to the separation of nursing practice and education, academic tutors at the School of Health and Social Care were allocated to placement areas and became link tutors.
Their role was to support and facilitate students and mentors in practice, enhancing the learning environment and undertaking educational audits (Cave, 2005).
However, there was criticism of this development. It was felt that educators’ clinical role was unclear and undervalued and that heavy workloads left insufficient time for support and facilitation duties.
During 2000–2001, the link tutor role was replaced by clinical education facilitators (CEF), who were appointed jointly by the university and healthcare trusts to address these issues. The CEFs produced a resource file for mentors to assist them in supporting students in clinical placements. However, this was found not to be accessible to all mentors because of the sheer number of placements and lack of resource files. Previously, the academic link tutors had developed an online ‘library of activities’, which was a resource aimed at students. Although library and the resource filehad been produced independently, it became clear that a collaborative project would be more productive and effective for both students and mentors.
During this collaborative venture, the CEFs became practice education facilitators (PEFs), which is how we refer to them in this article.
Feedback from students and mentors
After the new system was introduced, concerns were raised about students’ experience while on clinical placement. Common threads were highlighted as a result of feedback from mentors and students.
Mentors reported that students were unprepared and unaware of possible learning opportunities available to them. Students felt that learning opportunities had changed considerably, and many felt isolated, lonely and reported not feeling welcome in the clinical setting (Twentyman et al, 2006). They also said inadequate staffing or heavy workloads meant that mentors were not always accessible.
Wilkes (2006) said that competing demands on mentors could affect their ability to support students. Another factor influencing the students’ experience was the move from small, local colleges of nursing to higher education institutions (HEIs). In some instances, students were given hospital or community placements up to 50km from the university, which increased their sense of isolation.
Anecdotal evidence from mentor workshops and one-to-one support sessions suggested that many found the competencies difficult to assess. Also, mentors sometimes found it difficult to interpret the academic language of the learning outcomes in the context of actual clinical practice.This was especially true in areas where students were spending time in a placement with a variety of professionals. In the primary care setting, for example, where students worked alongside health visitors, district nurses, treatment room nurses and/or practice nurses, the same learning outcome had to be matched to the various clinical learning opportunities.
The difficulty in establishing parity of student evidence between mentors was apparent in both literature and anecdotally. These factors signalled the need to develop support for both students and mentors.
Library of activities
In an attempt to address the issues of parity of information and learning opportunities, in 2001 Christine Stevens and Carol Clark developed a website of information for students. This detailed specific learning opportunities and gave information about practice placements and suggestions on how to fulfil the competencies in these areas. There was a clear need to make the documentation more user friendly, so a ‘library of activities’ was set up. This online, structured framework helps students to identify their learning needs and guides them towards achieving their learning outcomes, and helps mentors to identify valid evidence and suggests ways to support students in achieving learning outcomes.
Establishing the PEF
To improve student support in the practice area, the PEF role was established in 2002. It was refined following the Student Learning in Practice Project (University of the West of England et al, 2002), which reported on practice education across the Avon, Gloucestershire and Wiltshire area. The project identified the positive impact of the CEF (now PEF) role on practice education and the difficulty link lecturers experienced in meeting their practice obligations at the time. This problem was experienced by other HEI providers of pre-registration nursing courses because of the large increases in student numbers.
The key responsibilities of the PEF role were to:
- Develop and increase the capacity of the clinical placements;
- Be a resource to mentors, ensuring their mentorship/assessment skills were annually updated via the four-year development cycle (UWE et al, 2004);
- Develop and enhance the learning environment, acting as a conduit between practice and UWE, and endeavouring to bridge the theory practice gap for students;
- Troubleshoot problems and support mentors faced with challenging student behaviour;
- Develop strategies to support mentors and students to achieve learning outcomes for a particular placement module.
At this time, there was an increase in student numbers across the region and many practice areas were at student capacity level.
To support students more efficiently, PEFs were looking for material to assist mentors in their role. They used action plans to help mentors through the formative and summative stages of assessment. Action planning appeared to be related to particular competencies, and anecdotal evidence suggested there was a varied interpretation of these competencies.
It was discovered that both the HEIs and PEFs were trying to address similar issues – PEFs for the mentors and the academics for the students. Joint meetings were held and they decided to amalgamate their work into the already established library of activities.
This partnership was found to have a positive effect on student learning. The library offers a user-friendly approach by providing guidance and a clearer understanding of what can be used as evidence for the achievement of the competencies.
Implications for nurses
Wilkes (2006) suggested that student-mentor relationships can be hampered by multiple demands and limited resources. Potentially, the library of activities can help address a part of this problem by providing a resource that benefits both students and mentors, helping them to achieve learning outcomes in bite-size portions. Once completed, evidence to show that learning outcomes have been achieved can be downloaded from the internet and added to a student’s portfolio of evidence.
The library of activities is aimed primarily at the student as an independent learner who is required to provide evidence of their achievement of learning outcomes. Therefore, all activities are student led, using a learner-focused approach. For example, as part of the professional and ethical practice domain, there is an outcome on the use of the NMC code (NMC, 2008).
It is hoped that students will become more active in their learning with the provision of a self-directed learning environment that enables them to work at a pace that meets their needs (Cooze and Barbour, 2007). This student-centred approach promotes a constructivist mode of thinking (one in which individual learners construct knowledge for themselves).
Using a web-based facility means that activities can be interactive as well as informative and supportive in suggesting how to achieve competencies. A communication crossword, for example, demonstrates the student’s knowledge of communication.
The library of activities is adaptable and still evolving; currently it includes puzzles, podcasts and quizzes, all of which are designed with the purpose of engaging the student.
The activities are standardised by the NMC code (NMC, 2008) and are in line with Fitness for Practice details (UKCC, 1999) and the NHS Knowledge and Skills Framework (DH, 2003).
The library reflects the university’s philosophy of promoting evidence-based practice and blended learning in its educational structure for students.
The results of evaluation to date from informal question-and-answer sessions are good. Many mentors are using the library activities and, as these activities become more interactive, students are enjoying completing them.
The library is increasing the parity and equity of the student learning experience. The collaboration of experts from practice and academia is proving to be extremely successful in further developing the content of the library.
Cave, I. (2005) Nurse teachers in higher education – without clinical competence, do they have a future? NurseEducation Today; 25: 8, 646–651.
Cooze, M., Barbour, M. (2007) Learning styles: a focus upon e-learning practices and their implications for successful instructional design. Journal of Applied Educational Technology, 4: 1, 7–20.
Department of Health (2003) The NHS Knowledge and Skills Framework. London: DH.
Department of Health (2000) The NHS Plan. London: DH.
Department of Health/English National Board for Nursing, Midwifery and Health Visiting (2001) Placements in Focus: Guidance for education in practice for health care professions. London: DH.
NMC (2008) The code: standards of conduct, performance and ethics for nurses and midwives. London: NMC.
Twentyman, M., et al (2006) Enhancing support for nursing students in the clinical setting. Nursing Times; 102: 14, 35–37.
UKCC Commission for Nursing and Midwifery Education (1999) Fitness for Practice. London: UKCC.
University of the West of England and Avon, Gloucestershire and Wiltshire SHA, Workforce DevelopmentConfederation (2004) Improving Your Skills as a Mentor Through a 4 year Development Cycle. Bristol: UWE.
University of the West of England and Avon, Gloucestershire and Wiltshire SHA, Workforce DevelopmentConfederation (2002) Student Learning in Practice (SLIP) Project: The Way Forward. Bristol: UWE.
Wilkes, Z. (2006) The student-mentor relationship: a review of the literature. Nursing Standard; 20: 37, 42–47.