Collaborative Process to Enhance Student Learning and Clinical Nursing Research
AEJNE Volume 6 - No.1
June, 2000.
Marie Heartfield
Lecturer, Faculty of Nursing
University of South Australia
Holbrooks Road, Underdale 5032.
Colleen Smith
Senior Lecturer
University of South Australia.
Division of Health Sciences
School of Nursing and Midwifery
City East Campus
North Terrace Adelaide
South Australia 5000.
Abstract
This paper describes a strategy to encourage the conduct of clinically relevant research and improve the preparedness and percentage of nursing students ready for entry into the Bachelor of Nursing Honours at the University of South Australia. The project involved nurse academics, and registered nurse clinicians working with final year undergraduate student nurses to identify ideas for clinical research whilst concurrently exploring the expectations, opportunities and requirements of an honours degree. Evaluation of the program indicated that students valued the opportunity to discuss research ideas, honours programs and career directions with academic staff and other enthusiastic students. They also found the supportive small group environment particularly helpful in extending their learning about clinical research and mentoring relationships. Clinicians acknowledged the value of collaboration and communication about current research interests and activities.
Introduction
Less than 0.1 per cent of graduates in nursing go on to honours and those that do generally do not research clinical topics (Nursing Education in Australian Universities, 1994). At the same time there is a growing gap between the knowledge and skills of new graduates in nursing and the knowledge and skills of experienced clinical nurses. New graduates know a lot about nursing theory and understand the role of nursing research in the development of nursing practice. Experienced clinical nurses know a lot about clinical nursing and understand the place of nursing research in the development of nursing practice, but for a number of reasons infrequently have the time or other resources to undertake research. Furthermore, undergraduate students of nursing take units in research methods, but generally do not know how to apply their knowledge to practical problems that clinical nurses think are important. The paper reports on an educational strategy designed to improve the preparedness and percentage of honour students enrolling in the Honours program in the School of Nursing at the University of South Australia. Furthermore the prevalence of clinical research for honours students is explored through the program called the Pre-Honours Program.
Nursing Research
Nursing research is fast becoming a highly valued skill, seen as essential for the pro-active, lifelong learner and critical thinker, particularly in the currently defined dynamic environments of evidence based-health care (Muir 1998; Sander 1998; Smith 1997). Furthermore with the current emphasis on evidence based practice and the need for nurses to be accountable to the public for their actions, the role of clinical research in establishing best practice is of paramount importance. It is however recognised that few nursing graduates go on to the research training of honours, and those that do generally do not research clinical topics. For research activity to be valued it needs to be seen as useful to individual practitioners as well as have an appreciable impact on nursing practice. There is very little in the available Australian and international literature to suggest that graduate nurses are provided with adequate opportunities to re-dress this suggested imbalance and there is often discrepancy between espoused needs of nursing as a discipline and clinical nursing expectations. Instead, continuing education and professional development for new graduate nurses in Australia consist of either obtaining a position within a Graduate Nurse Program, seen by most new graduates as the key to Registered Nurse employment, or enrolling in an honours year. There is insufficient evidence that explores whether completion of an honours degree results in nurses pursuing a research or academic pathway or returning to clinical practice. Research training in medicine for example is seen as separate to clinical training whereby a research investigator requires several years of dedicated scientific training (Schwinn, Delong and Shafer 1998) To pursue a research direction in medicine is often through post graduation fellowships gained through an early commitment to research. Calls are however now being made to integrate learning and research into the everyday work of medicine as 'only then will the necessary knowledge and skills diffuse through' to the clinical environment (Pearson and Jones 1997).
A Pre-Honours Program
Traditional research education for nurses is offered across Australia in the form of a fourth often full time post registration year at University. Eligibility to register as an nurse is also a pre-requisite for honours programs in nursing, whilst some universities in Australia also require up to a minimum of one year post registration nursing experience prior to commencing an honours program. In response to the above issues a two part Pre-Honours Program involving academics, students and clinical nurses in mentoring relationships to explore clinical research topics was developed. The aim of the Pre- Honours program was to prepare students to undertake the Bachelor of Nursing Honours and assist them to identify and refine their research interests into a research hypothesis/question or problem statement pertinent to clinical practice.
Expressions of interest were sought from students near completion of the undergraduate program who met or were likely to meet the criteria for enrolment in an honours degree. Eligibility was based on credit grade averages for previous subjects. As the Pre-Honours Program was a pilot program and involved a component of clinical mentorship, only ten places were made available. Following numerous inquiries and expression of interest seven students were selected to undertake the program. Five of these participated fully through to the completion of the program.
Part One - Mentorship between Nurse Clinicians and Students
In the final semester of the undergraduate nursing program all students undertake a six-week clinical practicum. During this placement students are mentored by experienced Registered Nurses and expected to demonstrate achievement of the Australian Nursing Council Competencies, necessary for registration. The competencies require that each nurse recognise the value of research in contributing to developments in nursing and improved standards of care. In addition to the usual clinical placement, the Pre-Honours Program students were allocated to clinicians that had previously expressed an interest in fostering clinical research. These clinicians, in conjunction with the nurse academics, acted as mentors and worked with the students in helping them identify ideas suitable for clinical research. Fostering a research culture in nursing is important and development of research knowledge and skills involves a process of participation and learning. For clinical research mentorship to be effective, collaboration needs to extend in a feedback loop between the University, the clinician, the student and back to inform curriculum development and teaching strategies (Mann, Byrnes and Clare 1997; Usher, Nolan, Reser, Owens, Tollefson 1999).
Part Two - Workshops
Following the period of clinical placement six workshops were conducted with speakers addressing issues related to conducting clinical research and the demands of Honours programs as experienced by supervisors and previous honours students. Clinicians also participated though presenting reports on clinical research projects. A learning package provided information on the Bachelor of Nursing Honours and a number of handouts covering new and extension material on critical analysis and writing techniques, developing research interests to research questions and research codes of good practice. In recognising the need for both academic research development and clinical experience a combined Graduate Nurse Program, that is, a hospital based clinical consolidation program and a University based honours program, was offered by for the first time in 1999. This combined program offered students the opportunity to be employed by a hospital in a Graduate Nurse program with the provision of unpaid time release to participate in the University Honours program. The program was favourably considered by the hospitals that were striving to create a research culture within their organisations. Having honours students undertaking a graduate nurse program was seen by these organisations as a way of enhancing this culture. Applicants for this program had to go through a combined hospital and University employment process, so some resources on application and interview techniques were also provided.
Evaluation of the Pre-Honours Program
This project was evaluated though information gained from a series of questionnaires and two focus group discussions. The questionnaires sought responses to questions focused on studentís satisfaction and learning about the expectations and skills necessary to undertake an honours program and the development of a clinical research topic. Though an initial program had been developed the small number of the participants and staff flexibility meant student suggestions and requests could be continuously incorporated in the program. Therefore satisfaction with the program was high. A follow up questionnaire to ascertain participants current work and study status, the usefulness of the Pre-Honours program and current research topic was distributed five months after completion of the Pre-Honours Program and responded to by all participants. Two focus group discussions were taped with the participants during the second part of the Pre-Honours Program, one in week two and the other at the completion in week six. The first discussion focused on the studentís experiences with clinical nurses in relation to research awareness, attitudes and practices and research topic identification. The second discussion sought student comments on the factors that were most influential on their decisions about enrolling in an honours program. The semi-structured focus group discussions provided an opportunity for participants to raise any questions relevant to the project.
Challenges - Choosing Clinical or Research Pathways
The Pre-Honours program was seen as very useful in clarifying the requirements of an honours program and helping students refine their research interests. However it appears that a more pressing need for students and one that the program did assist with, though not to the benefits of increasing enrolments, was that of assisting participants in deciding whether or not to enrol in an honours program. Evaluation six months after completion of the Pre-Honours program indicates that participants viewed their learning and experience from the Pre-Honours program positively and would recommend participation to other students. However 40% of participants had chosen not to enrol in an honours program either because they preferred to focus on clinical skill consolidation or full time employment. Another 40% of participants had withdrawn from their enrolment in the honours program citing perceptions of being overburdened with the combined demands from the hospital, the University Honours Program and/or personal circumstances. Though the Pre-Honours Program had incorporated discussion of the pressures of honours studies this did not appear to influence student attrition rates. It is anticipated that the separate evaluation of the combined Graduate Nurse program may further inform understanding of these matters.
For the clinicians who participated in the Pre-Honours Program the demands and immediacy of clinical work meant that research was often marginalised from other more imminently important aspects of nursing practice. The clinicians involved in the program had communicated a commitment to fostering research in the clinical setting, yet day to day events meant that planned meetings or opportunities to discuss ideas were often limited. Recognising and managing this in itself was a challenging learning exercise for the participating students but this factor did detract from the anticipated level of research collaboration between the clinicians and students. Problems were also encountered in gaining organisational approval for clinical staff to participate in sessions at the university with paid attendance in work time not achieved. This did impact on the cliniciansí ability to commit their time to the program. For the studentís this situation prompted them to explore the impact of workplace forces on research participation and work to understand how a balance between these elements might be achieved. The constraints on opportunities to increase research awareness and participation of clinicians resulted in only one clinician contributing to the workshops.
Competition between Universities for Students
Competitive promotion and marketing of nursing honours programs by the other Universities, saw all seven participants in the Pre-Honours Program receive personal invitations to attend information sessions at other universities. The students attended these sessions and were keen to use the Pre-Honours program to openly discuss with academic members of the project team the different programs and offers. Some nursing graduates, who had not participated in the Pre-Honours Program, did enrol in honours programs at other universities. Interestingly none of the students who participated in the Pre-Honours Program enrolled in honours at another university.
Student participation
Despite limited success in increasing student enrollment numbers in our honours program, the students in the program demonstrated their commitment by undertaking the Pre-Honours Program in addition to their other full time university commitments. They reported finding the opportunity to work through relevant professional issues in a small group of great benefit and believed this assisted them in the successful transition from university student to registered nurse in full time employment. They commented on the opportunity to discuss detailed information about the honours program both with school staff and other enthusiastic students, the supportive environment of small group discussions about nursing research and the learning about clinical research and mentoring relationships as important. These students did however describe feeling under some pressure to identify a research topic and to make their decision about enrolling in honours. For some students deciding on enrolling in an honours degree was perceived as having to decide between a clinical practice or research pathway and their involvement in the program had bought forward their need to make this decision.
Outcomes
As a pilot program this project did not contribute significantly to the enrolment statistics for the School of Nursing Honours Program. Personal outcomes for the students were rated highly with consistent acknowledgment of the value of the program in assisting their transition from an undergraduate program to the workplace. Early and continued promotion of honours programs and appropriate support services to assist with student decision making may be of value not only in recruiting honours students but reducing the attrition rate. Though potential honours students probably only make up a small percentage of the undergraduate student cohort, they do have the potential to contribute greatly to the research performance and culture of the School and the profession, and for this reason warrant the investment of university resources. Working with a small group of enthusiastic and committed students at a pivotal time in their professional lives was also fulfilling and rewarding for the academic staff.
Previous practices to encourage potential honours students such as recognition of academic achievement by the Head of School and promotion of the Honours program in each year of the undergraduate program will continue. Potential honours students are also invited to meet with key researchers and potential supervisors from the School of Nursing and the Centre for Research into Nursing and Health Care. However new opportunities to assist potential honours students with their decision making will be provided through the development of an elective subject in the third year of the undergraduate program. This subject will explore the experiences of previous honours students, expectations of honours supervisors, discussion of clinical research benefits and constraints and exploration of clinical research ideas. Increased opportunities have also been made available to incorporate honours students in research activities currently being conducted in the School. Most importantly all participants in the pilot program agreed that research must continue to be promoted as a legitimate professional pathway during all liaison opportunities between the University and nursing industry partners in particular with nurses who are involved in clinical practice.
Conclusion
The Pre-Honours Program aimed to foster a research culture by bringing together undergraduate students and nurse clinicians through a shared interest in clinical research. The potential honours students had the time and motivation to undertake the research whilst nurse clinicians had the knowledge and insight of relevant clinical research topics. Through a process of participatory learning students became more informed about the honours program and acquired topics for clinical research. Clinicians and academics also aimed to provide role modelling and learning in an environment which valued research and foster a research ethos. The current lack of research that focuses on clinical topics is problematic for nursing. Given the need for professional accountability and the potential for legal ramifications from inefficient practices, nurses require the knowledge and skills to conduct research that provides evidence for practice. This Pre-Honours Program was one example of how academic staff at the University of South Australia addressed this issue.
References
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