Vol.7, No.1 April 2001
Editorial | Contents
Promoting Excellence in Clinical Learning Environments: Technical Support in the Nursing Laboratory
Refereed Paper
Authors
Denise Ellis, RN, Cardiothoracic Cert.,
BN (GU)
Masters of Nursing (Research) Student,
Griffith University, Queensland.
Anne Symons, RN, BHlthSc(Nursing) (SCU)
Technical Officer, School of Nursing,
McAuley Campus, Australian Catholic University.
Abstract
The university nursing laboratory provides a safe and controlled on-campus environment for nursing practice. Technical staff employed in nursing laboratories use specialist skills and expertise to resource class room clinical scenarios, and a talent to invent, devise and imagine to overcome the challenge of rendering simulations as authentically as possible, to provide optimum delivery of teaching and learning activities. Although the nursing laboratory aims to provide a predictable environment, creative resourcing strategies need to be employed to overcome its limitations of artificiality. Curricula, students' skill levels, physical design of laboratories, their intended purpose, and resource constraints must all be considered for technical staff to support teaching requirements.
Introduction
The university nursing laboratory provides a safe and controlled on-campus environment for nursing practice. Technical staff employed in nursing laboratories use specialist skills and expertise to resource class room clinical scenarios, and a talent to invent, devise and imagine to overcome the challenge of rendering simulations as authentically as possible, to provide optimum delivery of teaching and learning activities. Although the nursing laboratory aims to provide a predictable environment, creative resourcing strategies need to be employed to overcome its limitations of artificiality. Curricula, students' skill levels, physical design of laboratories, their intended purpose, and resource constraints must all be considered for technical staff to support teaching requirements.
The Nursing Laboratory Environment
The nursing laboratory in Australian universities simulates a hospital ward and is the place where students learn clinical skills in a safe and directed environment. Nursing laboratories allow students to explore how to perform various clinical procedures (eg handwashing, hygiene, IV preparation, medication administration, oral and parenteral, cardiorespiratory resuscitation, wound care) with manikins or models before providing nursing cares to actual patients. According to, "[t]he nursing laboratory is used to enable students to apply theory to practice, develop a repertoire of psychomotor and interpersonal skills and to develop a sense of direction and confidence" (p89). It is a setting rich with potential where theory based practice can be promoted . The environment where students learn is believed by educationalists and nursing scholars to be a key concept in student learning, both for its educational merit and for nursing practice .
Nursing laboratory design and resourcing is often driven by curriculum and budgetary constraint. A structured programme directs students’ enterprises towards achieving mastery in simulated clinical situations escalating in complexity, while enabling control of the complexity and content of nursing skills presented. Students test clinical skills and problem solving, consider their impact and efficacy, to become competent and confident in their practice.
Simulations of Clinical Scenarios
Geographical and conceptual variations of the hospital ward setting exist within universities to meet curriculum requirements. A range of settings are accommodated, from intensive care units, through to nursing homes, and district community services settings. Technical staff use written course materials provided by subject coordinators to develop laboratory resourcing and clinical scenarios pertinent to educational outcomes. Formal resource statements document for technical, academic and sessional staff, the equipment, consumables and scenario resource requirements, as well as risk assessment interventions and controls.
Mannequins frequently form the basis of clinical scenarios. Hospital (whole body) training mannequins are used in most nursing laboratories in place of patients. The mannequins, intended for basic nursing care procedures, and made of rigid plastic, are constructed to resemble normal movements and positions of the human body. It is suggested that where possible, practice of psychomotor activities should take place on whole body mannequins to promote the concept of holism. Often, however, budgetary constraints see the use of partial models. Cost-effective solutions have been sought and implemented when such constraints disallow model acquisition (eg fetal facsimile. Similarly the use of appropriate clinical scenarios contextualises the clinical activity attempted. Technical staff ensure that simulations are as authentic as possible, and reflect information from the various sources of theory relevant to practice. This is done by liaising with academic staff, clinical agencies, practitioners, external suppliers and where appropriate by reference to the literature. The aim is to provide a wide range of relevant resources to assist student learning, as such resources may or may not be available in the clinical setting. Resource limitations, influenced by geographic location and facility equipment funding, stimulate technical staff to construct innovative and realistic learning opportunities, to meet specified learning needs.
Integration of theory and practice
Most universities actively incorporate clinicians’ involvement in laboratory-based teaching. Such clinicians are a valuable conduit for students to gain insight into nursing arenas prior to undertaking undergraduate clinical placements. This bridging strategy between educational and clinical service areas may effectively address theory-practice discontinuity.
The concept of a theory practice gap is well documented with ) approaching the debate from different viewpoints. All emphasise the need to close the gap. The theory-practice gap as defined by Greenwood (1996, p.14) is "a term used to represent the perceived discrepancy between the ideals of nursing taught in universities and the realities of practice as experienced in clinical units". The implications of "the gap" are particularly relevant to undergraduate teaching support. By recognising the type of theory practice relationship that may be sustained in the nursing laboratory, and directing resources and simulations accordingly, technical staff can effectively assist student learners to integrate theory with practice. Such direction by technical staff aims to integrate an applied science approach using current healthcare equipment, practice and research based theory.
Profile of Technical Staff
Informal feedback suggests the majority of technical staff supporting schools of nursing in Queensland universities are Registered Nurses, although technical staff supporting nursing laboratories bring to the role a broad range of experience from a variety of disciplines. A recent survey of Australia's nursing workforce reports that 90% of employed nurses work as clinicians. Technical staff are one of many diverse practice groups combining to represent the remaining 10% of employed nurses. Most universities employ one or two technical staff in the nursing laboratory. These staff mostly work autonomously, in isolation from academic or general staff activities, such is the nature of the role. For this reason, many technical staff across Australia have formed State wide nursing laboratory networks to share practice and support each other.
Technical Staff Networking
Statewide nursing laboratory groups meet formally once or twice a year, hosted by each university on a rotational basis. The Queensland Nursing Laboratory Group (QNLG) is a nursing laboratory network formed in 1997 from the efforts of a group of dedicated technical staff at universities in metropolitan Brisbane. The network has grown to become an active State-wide association, developing interstate and international contacts, and participating in national conferences. QNLG provides opportunities to share expertise and communicate with similar staff in a manner that is both inclusive, informative, and empowering. It has significantly contributed to the lessening of the isolation of these positions.
Internet Networking
A notable characteristic of QNLG is its geographical spread, from Townsville in far north Queensland, to Lismore and Armidale in northern New South Wales. For all members to gain ready access to collated expertise of identified ‘resident experts,’ a creative solution was sought. One of the most efficient and effective contemporary mechanisms for reaching a wide audience, gathering and disseminating information is the internet. Thus a website seemed the obvious choice: instant access irrespective of distance, and the establishment of a "visible' presence for the QNLG. The QNLG website was launched in mid-1999.
QNLG Website design
Important considerations in designing this site were the computing abilities and resources of the QNLG members. Initially, few had internet access, some had no email facilities. Most had some knowledge of computing techniques. With this in mind, the site layout was designed to be straightforward and easy to follow. Site navigation and concepts were tested by people with similar experience in using a computer or internet use. This quality testing provided fast feedback on ensuring web usability and clarity.
An important principle for any website design is not whether it suits those devising it, but whether it suits those who visit the site. In keeping with Nielsen’s guidelines, the website was designed where possible to keep the use of graphics to a minimum to facilitate downloads. Not all users have the ‘latest and greatest’ in computing hardware and internet access. QNLG website users work in busy interrupted environments. Speedy access to technical information and networking contacts is required. The majority of the website is textbased information delivery, with many short pages hyper-linked.
Conclusion
Collating the hard-won expertise of QNLG associates proved to be a forcing function for developing a website. An added benefit in establishing this was the greater recognition accorded, of the diversity of the work involved in the technical role in nursing laboratories. Queensland technical nursing laboratory staff have produced a representative body which has become well established within nursing faculties, technical service departments and with similar interstate organisations. QNLG participates in interstate conferences, and networks with international contacts which have emerged since the website was formed. A national technical staff conference (TechTrain2000) saw discussions towards beginning a national nursing laboratory network.
The role of technical staff supporting Australian nursing laboratories explored in this paper is diverse. Technical staff explore many innovative simulation practices, mindful of the nursing laboratory environment, integration of theory and practice, and symbiotic working relationships with academic colleagues to continue ‘promoting excellence in clinical learning environments’.
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