Clinical Facilitation in Nursing: Does it meet re-entry and refresher students' expectations?

Author: Helen Louise Hughes

Hughes, Helen Louise, 2015 Clinical Facilitation in Nursing: Does it meet re-entry and refresher students' expectations?, Flinders University, School of Medicine

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The aim of this study was to explore how effectively three models of clinical facilitation used to support students undertaking either a Re-entry or Refresher nursing program met their expectations. Re-entry (RE) and Refresher (RF) nursing programs are intended to prepare currently, or previously registered nurses to return to practice, and have been conducted by two teaching hospitals in South Australia since 2001. The three clinical support models used are 1) the Program Clinical Facilitator - Primary Hospital model, 2) the Program Clinical Facilitator - Off site model, and 3) the Local Facilitator - Remote Hospital model. The model used for each student is determined only by their clinical placement location. Examining the appropriateness of using clinical facilitation as a model to support RE/RF students is valuable for four reasons. First and foremost, using a clinical placement support model designed for undergraduate nursing students, for either qualified, or previously qualified nurses' needs to be questioned. Secondly, whilst RF programs are not regulated per se as students are registered nurses, RE students are no longer registered, and therefore programs require accreditation by appropriate regulatory bodies. This distinction is important in the context of role responsibilities for clinical support and assessments, and for emphasising the importance of quality assurance processes in monitoring assessment of competence. Thirdly, in times of economic and fiscal restraint it is valuable to explore the validity of using a clinical support model, which some argue, is not economically sustainable (Mannix et al. 2006; Sanderson & Lea 2012), and exhibits major flawes (Andrews & Ford 2013). Lastly, and in support of the former points, the RE/RF student is considered a valuable human resource in times of workforce shortages (Durand & Randhawa 2002; National Nursing and Nursing Education Taskforce 2005; Asselin, Osterman & Cullen 2006; Elwin 2007; Long & West 2007; McMurtrie et al. 2014), thereby justifying research into this student cohort and development of a broader, and deeper understanding of concepts related to RE/RF students, in particular their clinical learning needs and support preferences. In this exploratory study, a three stage qualitative interpretative approach was used to maximise both the richness of the data, and capture the diverse expectations and experiences of the clinical support students expected and received. A purposive sampling method was used to recruit study participants. A short demographic questionnaire and three focus groups were used to collect data. Two focus groups were conducted with students enrolled in a RE/RF program delivered in 2011. Focus group one explored students' expectations of the support they anticipate needing from the clinical facilitator, and focus group two reflected on how their experience matched their expectations. A third focus group explored the concepts raised by the student participants with clinical facilitators who provide support to RE/RF students while on placement. Data from all three focus groups was examined using a three stage thematic analysis approach. Analysis indicated RE/RF students expected the clinical facilitator role may include activities grouped into four themes: a) guide their learning; b) facilitate clinical assimilation; c) provide advocacy and; 4) support. Focus group two and three reviewed these themes and identified whether students' expectations were met. This study's finding highlighted four main points and provides direction for further research. Firstly the finding suggests RE/RF students were self-directed in achieving their learning and relied less than they expected on the clinical facilitator for their learning. Secondly, RE/RF students expected the clinical facilitator would play a role in their clinical assimilation and role transition; however, this was not the case for all students, particularly at satellite hospitals. Thirdly, the expectation that clinical facilitators would advocate on their behalf, both as an individual and learner was also not met in every situation. And Lastly, RE/RF students' expectations and needs being met were influenced by availability and accessibility of the clinical facilitator. Given these findings, and in recognition of the need to support the reintegration of RE/RF students into the workforce, further research exploring this student cohorts' learning needs and support preferences would seem appropriate.

Keywords: clinical facilitation,nursing re-entry program,nursing refresher program,clinical supervision,clinical support models in nursing

Subject: Nursing thesis

Thesis type: Masters
Completed: 2015
School: School of Medicine
Supervisor: Associate Professor Linda Sweet PhD