A collaborative approach to developing “learning synergy” in primary health care

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Summary

Supporting and enhancing clinical learning for pre registration nursing students continues to be a challenge for nurse educators. The drive of recent and contemporary nurse education policy in the United Kingdom (UK) has re-emphasised the need for nurse educators to be instrumental in the support and development of clinical learning [United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC), 1999. Fitness for Practice (The Peach Report). UKCC, London; Department of Health, 1999. Making a Difference. Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare, DOH, HMSO]. This paper presents a preliminary study of an action research project, identifying how nurse educators can facilitate new ways of learning in practice. Predominantly, a first person inquiry approach is adopted, supplemented by qualitative approaches, reflecting the journey of the author in relation to her role as nurse educator in practice. This was enriched by engaging with students and mentors from the author’s clinical link area, who had participated in a new initiative to develop small tutorial groups designed for students undertaking their primary health care placement, within year two of a Fitness for Practice programme within the UK.

Students’ and mentors’ experiences and stories, were appraised using qualitative and self-reflexive techniques. The role of the nurse educator in clinical practice is demonstrated, as is the importance of successful collaboration between educators and practitioners to establish high quality learning environments for students.

Introduction

Supporting and facilitating student learning within the nursing practice arena is a constant challenge faced by nurse educationalists (Lee, 1996, Cahill, 1996, Humphreys et al., 2000, Pegram and Robinson, 2002). The problem of integrating theory and practice has always created much debate (Dale, 1994, Rafferty et al., 1996, Rolfe, 1998, Landers, 2000) but the challenges for nurse educators remain; how to transform theoretical knowledge and information into effective nursing practice, and how to appreciate practice so that it can inform new knowledge and theory development, resulting in dynamic client care. This is also hampered within the university setting by the emphasis on large group teaching. Current nursing curricula are often overcrowded, sometimes promoting the transmission of information rather than reflective and critical active learning. This was indicated by Spouse (2001) who concluded that nurse education has ‘derived from behaviourist approaches to learning, where students often learnt from their peers and through a system of trial and error’. Clinical practice experience is often relied upon to make the theoretical component come alive, helping students to make sense of it all by offering meaningful experiences so that theoretical knowledge can be practically applied. The challenge lies with nurse educators to make these links more meaningful, so the goal of transferring theory into practice (that in turn informs theory development), is effectively achieved.

Section snippets

Background

The need to establish closer links between education and clinical practice settings has long been recognised as being essential if student nurses experiences are to be positive and successful (Wilson-Barnett et al., 1995, Philips et al., 1996, Duffy and Watson, 2001, Maslin-Prothero and Owen, 2001). This rationale was further reinforced in Strategy For Nursing (Department of Health (DOH), 1999) which highlighted the need for robust partnerships between education and service providers for the

Context of this study

Recent and contemporary nurse education policy, particularly since the Peach Report (United Kingdom Central Council (UKCC), 1999), has led to ongoing refocusing of pre registration nurse education in the United Kingdom (UK). Whilst theoretical components of the curricula continue to be delivered via Higher Education, the report recommended the need for robust collaborative and partnership working to ensure that experiences gained by students in clinical areas are of high quality. Indeed, in the

Approach to the study

Initially, the primary purpose of the study was to use self-reflexive means to explore critically a personal journey through collaborative work, between nurse teachers, students and mentors. To achieve this, a first person inquiry approach (Marshall, 2001, Torbert, 2001) was used as a vehicle to question and appraise the inquirer’s personal experiences and practice during the implementation of the initiative. This was an evolutionary process, enhanced by sharing, questioning and appraising

Ethical appreciation

Colleagues who agreed to share their stories and experiences were predominantly students and mentors who had participated in the initiative from the author’s link area. As the inquirer’s journey evolved, multiple points of view were sought from other colleagues – sometimes in an informal, everyday manner that was subject to self-reflexivity (Torbert, 2001). This self-reflexivity included careful consideration of ethical implications, for example gaining permission, seeking informed consent, not

Supporting learning in clinical practice

In relation to the initiative, one of the main themes to emerge was the value that students placed on actually having contact with a lecturer in the practice setting. Many discussions with students highlighted the positive aspects of having contact with a familiar person who would be available to offer advice and support. Even though some expressed initial anxiety about having to present an aspect of their community profile, in general they felt that discussion with peers, mentors and lecturers

Importance of feedback to enhance competency

A major goal of the initiative was to enable students to participate in a group assessment process to obtain feedback in a formative manner, so that synergy from combining the elements of both theory and practice could be successfully achieved. The idea of students presenting an aspect of their community study was to link to the intended learning outcomes of the module and encourage them to participate in thinking – not only about their own strengths and weaknesses, but to offer feedback to

Conclusion

The facilitation of small tutorial groups in practice can provide valuable opportunities for mentors as well as students. Opportunities for discussion and thought with other practitioners is essential – ensuring favourable learning environments and establishing good working relationships – providing an avenue for both personal and professional development. In today’s culture, diversity of practice continues to grow at pace, with the reality being that not all students will share the same

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