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Producing a competent workforce

Universities are finding clinical practice can be improved within its walls, writes Annie May.

Clinical placements are essential for undergraduate nursing students in developing the required skills to join the workforce. However, with nurses and healthcare facilities experiencing increased demand, workforce shortages and budgetary restraints, there is increasing competition for these placements.

Faced with these challenges, Charles Sturt University piloted a campus based interdisciplinary screening program to improve and extend the range of clinical skills for its health care students, with particular focus on exposing them to interprofessional collaboration.

In a recent study, published in the Australian Journal of Advanced Nursing evaluating the effectiveness of this model, it was found that all students felt the clinic was worthwhile, giving them the opportunity to practice complex clinical skills in a supportive, interprofessional, low stress environment.

Such programs can provide the ideal environment for undergraduate health care students, say the authors.

Traditionally, clinical skills are acquired within university laboratories and ward simulations, with consolidation and expansion of these skills obtained through clinical rotation in health care facilities.

However, in recent times the feasibility of the model has been questioned. With facilities constrained by time and resource issues, accessing appropriate quality placements can be a challenge.

“These problems are exacerbated in rural Australia with less placement opportunities available and the tyranny of distance conspiring against efforts to benefit students of diverse and clinically challenging placement opportunities,” says Paul Warner, one of the study’s authors and lecturer in nursing at CSU.

The program used an established community cardiovascular risk screening clinic conducted by CSU. Established in 2002, the clinic invited community members to take part in a range of cardiovascular tests to provide them with a cardiovascular risk profile.

Profiling helps identify individuals at risk of CVD and provides those with previously diagnosed disease updated information on the progress of their illness.

Academics and laboratory staff from across the disciplines of nursing and podiatry are involved in data collection, interpretation and research.

As the program grew the university decided to involve its undergraduate nursing and podiatry students. Nurses attending the clinic did so as part of their tutorial time in one of their medical or surgical subjects.

Groups of up to five students from the two disciplines were assigned to a clinic day and allocated a skills station, overseen by either an academic or laboratory staff. At the end of each clinic day, students attended a debriefing session and important clinical findings were discussed.

“Although there is a need to acquire discipline specific knowledge for these students, there is recognition of the increasing importance of interprofessional practice and collaboration within clinical teams,” says Warner.

Previous research has suggested up to 70 per cent of adverse outcomes may be due to the lack of interdisciplinary communication and collaboration.

“Interdisciplinary collaboration has been shown to improve job satisfaction, improve the quality of patient care, assist with treatment goal settings and provides a more effective resolution mechanism when conflict over treatment occurs,” says Warner.

In its evaluation, the study found students particularly liked the opportunity to learn from each other and expand their scope of knowledge. As a result they felt much more likely to collaborate with other professions once graduated, it says.

The podiatry students taught the nursing students the theory and practice of ankle brachial index measurement, abnormal results of which significantly increase the risk of developing CVD, while the nursing students reciprocated with the rationale for and the interpretation of ECGs where the presence and frequency of some cardiac arrhythmias including atrial fibrillation and voltage changes may also be suggestive of CVD.

Establishing a research culture in its students was also an important aim of the project.

The authors noted that, at the undergraduate level, research is usually taught as a standalone subject. While fulfilling the requirements of registering authorities, evidence shows in order to develop a research culture among students, it needs to be embedded in the curriculum across all subjects.

“Introducing students to the clinic was ideal in demonstrating both the reason for clinical research as well as how easily research may be undertaken and the potential of research to modify clinical practice and support evidence based practice.”

Part of the study looked at the value of this clinical experience to skill acquisition. Nursing students were given a test to assess their knowledge of blood pressure, including the definition of hypertension, normal values and procedural accuracy.

Students were given the same test after four half days attendance at the clinic over four weeks. All students demonstrated improved procedural performance and accuracy of measurement.

“A university based community screening program provides an ideal environment for undergraduate health care students to engage in interdisciplinary collaboration, allowing them to interact across professional boundaries, while expanding their scope of practice.”

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