The effectiveness of clinical education models for undergraduate nursing programs: A systematic review

Highlights

• Clinical nurse education is a major part of all undergraduate nursing programs.

• The evidence of clinical education models for nursing programs is notably weak.

• The clinical facilitator model is preferable to the preceptor model.

• Clinical Education Unit (CEU) model is preferable to standard facilitation model.

Abstract

Clinical nurse education is a major part of all undergraduate programs preparing nurses for competent professional practice. While research mostly evaluated specific clinical education models, few studies compared different type of models and limited attention has been given to the effect on student learning outcomes. This systematic review aimed to examine the effectiveness of clinical education models for undergraduate nursing programs. This systematic review utilised the Joanna Briggs Institute systematic review approach (JBI, 2014). A web-based literature search was conducted to identify research studies published from 2002 to 2015 using a three-step search strategy. All selected papers were assessed by at least two independent reviewers for inclusion criteria, methodological validity, and data extraction in the review. This systematic review included nine studies including two pre-post-test studies with a control group totalling 1893 participants including 1286 nursing students. The evidence regarding the effectiveness of clinical education models for undergraduate nursing programs is notably weak; however this review found limited evidence that the clinical facilitator model is preferable to the preceptor model and the Clinical Education Unit (CEU) model provided greater engagement and an enhanced learning environment compared with the standard facilitation model.

Introduction

Globally, nurse educators are seeking better ways to prepare nurses for practice in constantly changing health services. In Australia, as in many other countries around the world, nurse education has moved the hospital-based apprenticeship training to university-based education, enabling the acquisition a bachelor degree as a minimum preparation for beginning professional nursing practice. In the years since, a variety of clinical nursing education models have been used to develop students' clinical practice knowledge, skills and attitudes (Budgen and Gamroth, 2008, Hall-Lord et al., 2013). Several studies found that the clinical education model and setting are the most influential in the development of nursing competencies and professional socialisation (Jokelainen et al., 2011, Kim et al., 2013). Clinical placements may also influence students' confidence for clinical practice, improving the sense of teamwork, and organizational skills and preparedness to qualify to enter the profession (Dobrowolska et al., 2015). In nursing education, classroom, simulation and practice based laboratories experiences make essential contributions to students’ learning development (Budgen and Gamroth, 2008, Jeppesen et al., 2017), however experience in actual clinical practice settings is an irreplaceable component of preparing students for competent professional practice (Croxon and Maginnis, 2009, Paton et al., 2009, Vitale, 2014).

In most countries, clinical nursing staff acting as preceptors or facilitators have had a key role in developing students’ learning in clinical practice despite some international disparities in their role and responsibilities (Budgen and Gamroth, 2008, Löfmark et al., 2012, Mamhidir et al., 2014). In a review, Budgen and Gamroth (2008) identified ten basic model types: faculty-supervised practicum, preceptorship, education unit, joint appointment, secondment, affiliate position, internship, co-operative education, work–study and undergraduate nurse employment, however this review is limited to exploring model types, key features, benefits and limitations. It is evident that clinical education models include significant variations in roles and responsibilities among students, faculty and clinicians in relation to supervision; teaching, learning and evaluation; and differences in the nature of relationships between clinical and academic organisations (Brown et al., 2005, Budgen and Gamroth, 2008, Hall-Lord et al., 2013). All clinical education models showed inherent benefits and limitations, however potential student learning outcomes could be maximized if available models are property evaluated using systematic research. In addition, a comprehensive understanding of current clinical education models enables nurse educators and educational institutions to select and implement most effective models in terms of improving student learning outcomes. However, research studies most often evaluated specific clinical models (Hall-Lord et al., 2013); few studies compared models (Courtney-Pratt et al., 2012, Kim et al., 2013). Despite a wealth of evidence evaluating variety of clinical placement models in nursing education, there is no high quality evidence from well-designed systematic reviews to inform the effectiveness of these models. This review project was conducted by a team of nurse academics led by a systematic review expert of Education in Nursing, Midwifery and Health Science Research Group, University of South Australia (UniSA, 2015).