The Role of the Clinical Skills Laboratory in Preparing Students for the Real World of Practice

1. The Role of the Clinical Skills Laboratory in Preparing Students for the Real World of Practice Catherine E. Houghton October 2007 Supervisor: Dr. Dympna Casey

2. Aim of the Presentation • Exploration of previous research • Aim of the research in progress • Interpretivism • Case study design • Challenges

3. Changes in Nurse Education • emphasis on theory/decreased emphasis in skills learning • In clinical setting: • More rapid patient turnover • Increased high dependency patients • Shortage of qualified practitioners • “physical structure” supporting the new “academic structure”

4. How does the CSL facilitate this statement? During the course of their education, students are expected to acquire knowledge, incorporate critical thinking and psychomotor skills, develop self-confidence in their abilities, and then transfer this knowledge to the clinical setting (Childs and Sepples, 2006)

5. The Function of the CSL • Simulated Learning • Simulated Models • Standardised Patients • Computer-based Simulation • Audio Visual Recording • Skills assessment (i.e. OSCE)

6. Simulated Models • Low-fidelity • Moderate fidelity • High Fidelity

7. Standardised Patients • Coached to present a patient problem accurately • Increased levels of judgement, performance and communication skills • Same outcome as real patients • ? Reliability of SP feedback

8. Computer based Simulation • Higher Satisfactionand self-efficacy • ? Improve ability to demonstrate skill • Penfield Virtual Hospital • Authentic World

9. Audio-Visual Recording • Benefits • Immediate Analysis and Feedback • Recognise own mistakes • Distracting, anxiety, behaviourmodification

10. OSCE (Objective Structured Clinical Examination) • Positive • Feedback and reflection • Motivation to learn • Dependent on assessors’ subjectivity • Cause of Anxiety

11. Benefits of CSL Teaching • Gain confidence • Motivation to learn • Student Satisfaction • Safe environment to practice skills • Patient Safety • Communication Skills • Interprofessional Learning • Improvement on traditional methods

12. Disadvantages of CSL Teaching • Student Anxiety • Comparison with reality of clinical setting • Needs context • ? Learning opportunities in clinical area • ? Learn non-evidence based methods

13. Qualitative Quantitative Triangulation Total Nursing Research 9 18 1 28 Medical Research 1 15 1 17 Medical & Nursing Research 1 1 1 3 Other Health Professionals 0 2 0 2 Total 11 25 3 50 Methodological Issues

14. Methodological Issues • Criticism of the primarily positivist approach • ? use of OSCE to determine the effectiveness of CSL teaching • Level of education

15. Research Aims • To analyse the teaching strategies used in Irish Clinical Skills Laboratories • To investigate the factors which influence how student nurses use their learned skills in the practice setting. • To examine student nurses’ perceptions of the methods used to teach clinical skills in the laboratory. • To explore qualified clinical and CSL staff’s perceptions of undergraduate clinical skills teaching.

16. Research Process Phase 1 Visit all the 13 Nursing Centres Criteria for Selection of 4 Sites Gain Access Phase 2 Pilot phase Phase 3 Data Collection observation, interviews, documentary sources Phase 4 Cross-case/Within Case Analysis

17. Interpretivist Paradigm • Nature of the world as it exists • Subjectivity • Multiple realities • Emic and Etic perspective

18. Natural context Emic Perspective Flexibility Exploratory Embedded Instrumental Multiple Multiple Case Study Research

19. Challenges • Gaining Access • Ethical Issues • Semesters/Timetables

20. Thank You Catherine Houghton catherine.houghton@nuigalway.ie Department of Nursing and Midwifery Studies Aras Moyola NUI Galway Ireland