Enhancing learning opportunities in clinical leadership' Adele Callaghan RN, BN, Grad Cert Periop',

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Enhancing learning opportunities in clinical
leadership. Adele Callaghan RN, BN, Grad Cert
Periop., Post Grad Dip Management, Post Grad Dip
Ed, MEd.Lecturer Nursing
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• Clinical leadership is central to building a
  sustainable, highly educated perioperative
  nursing workforce.

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• This study explored the impact of a perioperative
  clinical experience on undergraduate nursing
  students.

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The Aim of the study

• Explore student nurses perceptions of a
  perioperative clinical practicum.
• To describe each students individual
  interpretation of the experience.

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Background

• Current undergraduate nursing courses have a
  generalist focus and are challenged to secure
  enough generalist clinical placements for their
  students.

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• A wealth of learning opportunities exists in the
  perioperative environment (Latz and Nordbye 2004
  Australian College of Operating Room Nurses
  2006).

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• While the environment can be highly technical,
  Webb (2003) contends that peri-operative nurses
  are nurses first and that patient care is
  paramount.

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• Researchers have argued that the speciality of
  perioperative nursing is an important area for
  educating nursing students as the environment has
  a high potential to dehumanise patients and
  nurses (Mc Namara 2006 ).

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• The assignment of undergraduate student nurses to
  the environment is not just aimed at the student
  observing a particular surgical procedure rather
  they learn about the full range of patient care
  (McGarvey, Chambers et al. 2000 Sigsby 2004).

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• The role of clinicians in preceptoring and
  mentoring students is critical in role modelling
  quality care (Andrews and Chilton 2000 Bartlett,
  Simonite et al. 2000).
• Students value positive relationships with
  clinicians that enable them to feel accepted
  within the team environment (Hart and Rotem 1995
  Sykes 1997 Clare, Brown et al. 2003).

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Overall research design

• Qualitative design, informed by hermeneutic
  phenomenology, to the study described the
  individual experiences of undergraduate nurses in
  the perioperative environment and enabled the
  presentation of meaning and context (Omery 1983
  Jasper 1994).
• The aim was to capture what was perceived as
  happening, as it was lived and interpreted by the
  students (Munhall 1988).

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Theoretical Framework

• The theoretical framework sets out to provide the
  researcher with assumptions about the nature of
  the data which are collected and a process of
  analysis and interpretation in the light of the
  theoretical framework.

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The lens of the participant

• The way the participants view the world and
  consequently interpret their experiences was
  based upon Benners (1984) model of skill
  acquisition and Blooms (1964) Taxonomy of the
  cognitive domain.

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• Blooms (1964) cognitive domain reflects Benners
  (1984) aspects of performance progression.
• Benners (1984) stages of skill acquisition and
  Blooms (1964) description of learning served as
  a conceptual framework that was utilised to
  synthesise the interpretive framework from the
  data collected.
• Blooms (1964) cognitive domain and Benners
  levels of skills performance provided a matrix
  for data interpretation (Fig.1.)

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Participants

• Participants in this study were third year
  undergraduate nursing students.
• Six students participated
• Ethics approval was given from the Universitys
  Human Research Ethics Committee.

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Data Collection

• One to two hour in-depth individual interviews
  were completed with each student and they were
  asked two broad open-ended questions

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Data Collection

• One to two hour in-depth individual interviews
  were completed with each student and they were
  asked two broad open-ended questions
• What comes to mind when you think about your
  perioperative experience?
• Could you describe in your own words your
  perioperative experience?

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Data analysis

• After completing six interviews data saturation
  was achieved as no new information emerged.
• Consistent with the work of Banonis (1989), the
  process of analysis aimed to ensure that the
  uniqueness of each participants experience.

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• The transcripts were read and reread and coded
  into categories.
• The initial codes were verified by an independent
  researcher and were sent to the participants for
  confirmation that their meanings had been
  captured.
• The expansion of categories were reviewed and
  re-reviewed.

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TRUSTWORTHINESS/RIGOUR

• Trustworthiness or interpretive rigor was
  achieved by accurately representing
  understandings of events and actions within the
  framework or world-view of the people engaged
  (Grbich 1999 Rice and Ezzy 1999).

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TRUSTWORTHINESS/RIGOUR

• Credibility was established via prolonged
  engagement with subject matter to provide scope
  and member checks to validate the reported
  findings.

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TRUSTWORTHINESS/RIGOUR

• Dependability was achieved through the auditing
  process (Koch 1994).

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TRUSTWORTHINESS/RIGOUR

• The entire research process was extensively
  documented to enable an audit trail to exist
  contributing to confirmability (Lincoln and Guba
  1985).

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Findings

• Data analysis of students experience of a
  preoperative placement resulted in the emergence
  of three major themes
• Nursing care,
• Skill acquisition and
• The specialist environment.

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• Having insight into a significant aspect of a
  patients surgical journey enabled each
  participant to approach nursing with more
  understanding of the surgical experience.
• I think people other students who have not
  experienced this perioperative placement have
  missed out on a very important chunk of nursing.
  Even if they are not going to work in that area
  it gives you a better understanding of what the
  patient has been throughYou know what it is
  like. R6

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Patient Care

• One thing I did notice was that every patient
  was anxiousone woman who had previous surgery.
  She was still conscious. She had an epidural for
  her surgerythey anaesthetist and nurse were
  communicating with her the whole time through the
  procedure R5
• Surgery is the time that the patient is most
  vulnerable. Theyre completely in the power of
  everyone around them at the time. They can die if
  you didnt do your jobwhen the person is not
  able to speak they the patient are completely
  vulnerable R4
• I saw a young surgeon who was definitely on a
  power trip. The scrub nurse, who was older and
  experienced, handled him and the situation really
  wellShe did not let him compromise the sterile
  field R6

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Skill Acquisition

• Thats true autonomy referring to the role of
  the PACU nurse. Thats the best autonomy I have
  seen with nursing. They have to know their stuff.
  Any situation can happen. You have surgeons
  visiting but they re not hanging outthey PACU
  nurses have to know all the different body
  functions and all the different haemodynamics,
  airway, monitoring and pain management. Just
  setting everything up. They are very good. They
  are good nurses... R4
• I now believe I can give patients reassurance
  about their procedure without giving them false
  reassurance because of my personal experience in
  the operating suite. Good clinical experience,
  quality of learning and working close to surgeons
  has given me a better understanding of the
  perioperative process R1
• I was more concerned with surgical conscience,
  infection control and seeing what the instrument
  nurses were doing R3
• I liked anaesthetics but I also found that
  everything was a bit repetitive. This role was
  the most repetitive. After we intubated the
  patient I was boredI really didnt like the
  recovery role because it felt like a production
  line R6

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Specialist Learning Environment

• she was a scrub and scout circulating nurse
  nurse. Things really started to improve because
  she was a really good nurse. She showed me around
  and explained things to me. There was so much to
  learn. She made me want to have a go. Everything
  just got better I started to understand things
  better because everything was explained to me. I
  started to identify the instruments and the
  equipment. I began to have more understanding of
  the procedures as well R1
• I said I would like to see heart surgery. She
  Clinical Educator took every length possible to
  get me into see heart surgery. It was really
  fascinating. It was one of the most special
  situations to actually witness R4
• She perioperative preceptor appeared to get on
  well with the surgeons. They seemed to respect
  her and her opinions. She stood up for the
  patient and was a good advocateI had lots of
  hands on and good teaching with her... R6

Sally fictitious name of mentor appeared to get
on well with the surgeons. They seemed to respect
her and her opinions. She stood up for the
patient and was a good advocateI had lots of
hands on and good teaching with Sally. R1
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My favourite The team

• We had an emergency AAA repair. I was pushed
  away by the nurse I stood against the wallI
  felt like crying. The anaesthetist noticed me and
  asked me to come and hold the patients hand. He
  encouraged me to participate and he explained
  things along the wayHe let me give the IV
  morphineThey the nurse set me up on a nice
  stool so I could look right down on the whole
  surgery. The surgeon was explaining
  everything R1
• Multidisciplinary team support was described by
  each participant in various ways. Despite the
  diversity of all the roles in the perioperative
  environment, participants saw each role
  co-dependent to each other rather than
  independent from each other.

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Recommendations

• Academic and clinical leaders should work
  together to clearly identify responsibilities and
  articulate learning requirements and outcomes for
  students in the perioperative environment.

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Recommendations

• Clinical leaders need to acknowledge the
  generalist aspects of their practice in order to
  contextualise broader learnings within a
  specialist environment.

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Recommendations

• Universities and clinical leaders should work
  together to develop an understanding of the
  relationship between specialist aspects of the
  perioperative environment and learning objectives
  for the undergraduate.

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Recommendations

• The novice lens needs to be acknowledged by
  clinical leaders when facilitating learning.

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Recommendations

• Clinical leaders should be encouraged to
  mentor/preceptor students to facilitate learning
  and encourage positive role modelling in a
  specialist environment.

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Recommendations

• A focus of specialist placements should be on
  maximising multidisciplinary/interprofessional
  opportunities for clinical learning using a
  clinical leadership model.

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Conclusion

• The specialist nature of perioperative nursing is
  highlighted and the type of learning appropriate
  for the preparation of generalist nurses in this
  clinical setting are identified. The analysis of
  the data enables educationalist and clinical
  leaders to formulate appropriate experience based
  learning programs in specialist environments with
  a student centred focus. These findings can be
  translated to undergraduate nurses not only in
  the perioperative setting but other specialist
  clinical environments. Clearly, all clinical
  learning environments require appropriate aspects
  of clinical leadership to be modelled for the
  undergraduate nurse.

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Thank You