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An evaluation of nursing student placement in the Beaconsfield Multi-Purpose Service AEJNE Volume 5 - No.1 August, 1999. P J Martyr BA(Hons), Heather Noble Dianne Milner Abstract One of the pressing concerns in rural health nursing education is effective student preparation for rural area work. This study will describe the results of a survey taken of nursing students who underwent their community health practicum at the Beaconsfield Multi Purpose Service (MPS) in Beaconsfield, Tasmania. Four of the five students placed responded to a 14-point questionnaire, which was designed to evaluate how useful the experience was for them, and how much they had learned about primary health care in the rural community setting. The results were highly satisfactory, and indicate that MPS placement may be a valuable option for other institutions which favour rural student placements. Introduction The philosophy of the multi-purpose service (MPS) enables small communities to develop innovative and realistic methods of providing appropriate and integrated health and aged care (Hardwick, 1997). As such, it draws on primary health care principles of community-based health promotion, which makes it an ideal training ground for future rural health nurses. A joint Commonwealth/State Multi-Purpose Services Task Force was established in March 1991 following the acknowledgment from the Australian Health Minister's Conference of the problems with relation to health and community service provision in rural and remote communities. The Multi-Purpose Service initiative recommended the establishment of 17 MPS pilot projects in Australia, which will be assessed progressively over a 3 year period. The MPS at Beaconsfield, Tasmania, is the first in the state, which has a relatively large rural population and industry base. Previously the Beaconsfield District Hospital, the MPS will incorporate acute beds, nursing home and hostel placements, respite and palliative care, as well as a post-natal bed. Four additional hostel beds will also be offered in the community, as Self Contained Units (SCUs). Many community services are also available, with some of these being delivered into the client's own home and others through the MPS. A needs analysis was conducted in 1992 to help identify the main health needs of the community. Some of the services identified as needed were: an extendedDay Care Centre, public outpatient physiotherapy, community social worker and a respite booking program. All of these recommendations have been put into place in the past 12 to 18 months. The MPS is a relatively new phenomenon, and yet has already attracted the interest of nursing researchers. Reid and Solomon (1992) predicted the impact of the MPS on rural health policy in Australia, while Mensink (1995) evaluated the impact of the MPS on Western Australia's largely urbanised hospital system, describing it as a bonus for rural areas. Briskman and Patterson (1996) examined the development of the MPS in the Mallee Track area in Victoria, while Hardwick (1997), Sheehan (1997) and Arch et al (1997) have examined the importance of community involvement in the development of MPS facilities in rural and remote area health care. Most of these studies are based on the Victorian experience, and few relate to the problems of educating futute nurses for MPS work, although Duffy et al (1997) describe a staff development workshop program for MPS staff which had positive results. Spencer (1997) has identified many pressing areas of need in rural health nurse education, and anticipates valuable results from a greater attention to their training: improved retention rates, greater recruitment into rural areas, and a decreased sense of isolation. In particular, Spencer notes the importance of placing the students in rural area health services for their practicum. Background to this study With this in mind, the researchers undertook an evaluation of five students who had been placed at the Beaconsfield MPS as part of their core Year 3 unit Community Health, run by the Tasmanian School of Nursing. This unit takes a primary health care approach to nursing in various community and mental health nursing settings, and adopts an experiential learning approach, with observation and practice forming the basis of student learning. Their learning occurs in the clinical area as well as the university setting, and emerges out of interaction with lecturers, preceptors, other health care workers as well as patients/clients in the clinical areas. Students undertake 240 hours of supervised clinical experience, of which 120 hours is in the Community Health module, and 120 hours in the Mental Health module. The two modules together comprise a one-semester unit. Students undertaking the Community Health Module of the nursing degree at the University of Tasmania are placed throughout the state in various community settings to gain community experience and to consolidate their understanding of the concept of primary health care. Heather Noble's faculty practice at the Beaconsfield MPS contributed to her awareness of the service as a possible venue for students to gain experience in community and rural health. This prompted her to approach the Beaconsfield MPS about student placement. Only one student at a time is assigned to this location, and arrangements for the experience are carried out by the clinical nurse consultant of the facility in consultation with the academic module coordinator. Dianne Milner was invited to organise the placement for the nursing students, and initially visualised the student placement as focussed on theCommunity Nursing Service. It became apparent, however, that exposing students to a broader experience of the many MPS Services meant that they could be involved in the adoption of primary health care principles across the entire service. With each student, a learning program is structured around their placement period, including as many of the services as possible. The student has a designated Registered Nurse preceptor, and all service providers involved in the student's clinical placement are given a copy of her/his program and a copy of the Assessor Evaluation Form (which incorporates the Australian Nursing Council competencies). This provides feedback for the preceptor, who correlates all the information and completes the Assessor form, which is forwarded to the student at the completion of the placement. The study At the conclusion of the placements for 1997, Noble, Milner and Martyr met to design a survey which would reveal any developments in students' knowledge and perceptions of primary health care and rural nursing. It was also designed to identify any problem areas which could be addressed in future placements. A fourteen-question survey was the end product, combining multiple-choice answers with an attached section in which students could expand upon their answer. The first three questions dealt with the quality of the student's preparation for the MPS experience, followed by six questions which evaluated the experience of working at the MPS. The remaining five questions offered students the chance to suggest changes or improvements to the teaching program, and to evaluate their overall experience of rural nursing. The limitations of the study are that the sample was very small, being determined by the five students who undertook the clinical placement at Beaconsfield; not all the students returned the surveys; and not all students made comments when invited, restricting themselves to multiple-choice answers. Even allowing for these limitations, the results show a pleasing level of student learning and discovery, and a productive placement experience. Results Four of the five students completed the surveys and returned them. Their comments were overwhelmingly positive. Responses to the first three questions showed that, although students had been exposed in class to the principles and objectives of a Multi Purpose Service before they went to Beaconsfield, they did not feel that they were really prepared for the MPS beforehand. All four read and understood the package given to them on the Beaconsfield MPS at the outset of the program, and all four felt that they were as a result well-informed on the concepts, philosophy, and objectives of the Multi Purpose Service. Their experiences at the Beaconsfield MPS seem to have been positive. All four replied that they were made to feel welcome in all areas of the MPS, and comments included: Staff very friendly from D.O.N. to kitchen staff & community people. Not made to feel like a "bloody student" who made more work for staff. Everyone from the cleaning staff to the administration levels were very welcoming, supportive & friendly. Only one student identified one area in the MPS where there was a sense of being unwelcome. All four commented that they found the MPS gave them a realistic view of holistic health care: I was exposed to many non-nursing roles, but I found this most informative. It is important for one to know/be aware of services/products in order to "sell" them effectively. It was beneficial learning about & seeing the different services in action, gaining an understanding about their roles & functions. Lots of "non-nursing" but nurses are not the be all and end all of an MPS. Good to see how other disciplines fit into total picture. Only one of the four felt that she had not had enough time with her preceptor, which indicates a high level of support from the Beaconsfield MPS for the students, tempered with the following comments: Sometimes I felt a bit isolated, but never alone. I knew my preceptor was there for me, but I did not interpret this as she was always very busy. She was very approachable and I could have gone to her at anytime. Sometimes I would have liked to have debriefed though. Maybe a "beginner" would require more time with preceptor. I am not a "beginner" so was able to feel comfortable with little contact with preceptor. For myself, my introduction to my preceptor perhaps should have occurred a little sooner than it did.
Students felt that their assessment was fair, with the following comments: Yes - I didn't have enough time to correct it properly as I was working full time when I did the placement (my choice though) so I am pleased with my effort. Extremely - in theory. My preceptor visited to speak to all who had contact with me & I agree with this. Unfortunately many failed with the feedback required and I feel that this was a downfall in an accurate assessment of me. I feel that this lead to an unfair and unnecessary load placed on my preceptor at the time she had to complete my assessment. Importantly, all four were happy to have input into their assessment from assessors other than their preceptor, such as the social worker and community co-ordinator. All four also said that working at the MPS had consolidated their understanding of primary health care principles: Good experience for a "hospital based" nurse such as myself - I enjoy Primary Health Care & the BMPS is PHC in action. I could see the theory actually working in the community. When asked how they would improve the teaching program at Beaconsfield, the results were gratifying: I feel that my preceptor and the staff of the BMPS went out of their way to accommodate me and therefore I am unable to see much room for improvement. I thank all those involved in my placement. It was a wonderful learning experience. The programme designed for me was comprehensive allowing me the opportunity to access all the different services - it was very much appreciated. The results from the last three questions are particularly significant. When asked if they would like to work full-time or part-time at a Multi Purpose Service, based on their experiences at Beaconsfield, students responded: Yes, I would thoroughly enjoy it. It is certainly an area that I would be willing to work, but I would like more experience in a bigger hospital first. Yes, I loved the rural area and that is where I eventually plan to work. Would definitely like to work in Community Nursing - no interest in the hospital itself ... I would apply for Community. When asked if this experience had developed their interest in rural nursing as a career option: Yes, I was already set on this option & my visit to the BMPS confirmed my choice. My choice was based on dreams. My placement confirmed that my dreams were not unrealistic. Yes, but again I believe I need more experience & chance to consolidate skills. Definitely, I was interested before but placement has reinforced interest & allowed me to see that this is something I can do. Finally, their overall comments on the Beaconsfield placement were very positive: A wonderful experience. I had a wonderful time at BMPS, although it was mostly observational in format, the experience certainly involved me in a MPS Thank you to all those involved in my placement. I highly recommend a placement at BMPS. Very impressed with placement. Would recommend it to other students (& have done so already). Good to find a placement so obviously interested in and geared towards students. Discussion Several key themes emerge from this data which had a significant impact on the nature of the student experience: the willingness of the staff to accommodate students, and the students' ability to see theoretical principles at work. Some of the respondents felt they needed more time and more experience before making a career decision, but for the most part, the placement had confirmed pre-existing interest in community and rural health nursing. It would be useful to survey this year's students on placement at the Beaconsfield MPS to see if a comparable result emerges. Another profitable study would be a concurrent examination of staff attitudes to student placement at the MPS, with a view to maintaining the high level of staff cooperation in this exercise, and to producing data which may help other MPSs to adapt to student placements.
Conclusion These responses from students indicate the placement is valuable for both students and staff of the Beaconsfield MPS and TSON. Students have been able to experience and observe the many services offered by the MPS. It has also been a way of promoting and marketing the BMPS. Staff involved from both agencies have been able to undertake collaborative work in research and publications. Above all, student placement at as MPS has proved valuable in introducing students to practical applications of primary health care, and to the work of rural health nurses, which may improve recruitment and retainment in the rural health workforce in later years.
List of References Arch, M. Kulyuru, M. Milyika, P. 1997. Nganampa Health Council Multi Purpose Service. Paper presented at the 4th National Rural Health Conference, 9th February 1997, Perth, Western Australia.(PDF format) Briskman, L; Patterson, D. 1996. Tracking health: development of a model for health service delivery to the Mallee Track area. Community Quarterly, 40: 34-39. Duffy, E. Wainer, J. Hall, R. Hovel, J. Strasser, R. 1997. Multi Purpose Service staff development in rural Victoria. Paper presented at the 4th National Rural Health Conference, 9th February 1997, Perth, Western Australia (PDF format) Hardwick, A. 1997. We are special! A survey of pastoral, mining and Aboriginal communities for Laverton/Leonora Multi-Purpose Service. Paper presented at the 4th National Rural Health Conference, 9th February 1997, Perth, Western Australia. (PDF format) Mensink, K. 1995. MPS: rural bonus. Australian Nursing Journal, 3 (4): 16-18 Reid, M. Solomon, S. 1992. Improving Australia's Rural Health and Aged Care Services, National Health Strategy Background Paper No 11, Melbourne. Sheehan, G. 1997. A rural reincarnation - the birth of an MPS. Paper presented at the 4th National Rural Health Conference, 9th February 1997, Perth, Western Australia. Spencer, J. 1997. Education for rural nurses. In: Siegloff, L (ed). 1997. Rural Nursing in the Australian Context. Royal College of NursingProfessional Development Series No 7: 59-76.
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© 1997 Peter Cleasby | pcleasby@csu.edu.au | ISSN 1322-8676 |