Research placements: are they a suitable alternative for student nurses?

COVID-19 has affected those undertaking courses in higher education, especially programmes in health care with clinical placements. Many student nurses were unable to undertake their planned clinical placements and had to adjust to self-directed learning and an increase in simulated learning. As a suitable alternative to clinical placements, a research placement for two second-year BSc adult nursing students was trialled, and this article presents an account from one placement. The academic team devised specific questions for students to consider for their research electives and provided a template for their written work with the aim of writing up a weekly report to reflect their learning. In particular, the students had to identify how their learning related to the UK Nursing and Midwifery Council code of conduct. The research placement was successful and shows great potential, offering students tangible opportunities to seek out the evidence for themselves and use it to inform their clinical practice.

The COVID-19 e-lective: using innovation to manage disrupted medical student clinical placements.

BACKGROUND: The COVID-19 pandemic changed the way we work, spend, live, and learn. The impact was felt in the health sector where hospitals cancelled elective surgery, put on hold outpatient services, and implemented new social distancing procedures and telehealth systems, to enable hospitals to increase bed capacity. For medical students, these factors meant significant disruption to their clinical placements, remote delivery of their education, cessation of international and interstate placements, complicated by significant travel restrictions and border closures. There were concerns that final year students might be unable to graduate that year due to this lack of clinical exposure. INNOVATION: As a result of this disruption in late March 2020 we developed an innovative 6 week 'COVID-19 e-lective' rotation, consisting of online modules, virtual clinical tutorials and a COVID project totalling the equivalent of 200 h of work. RESULTS: An evaluation was undertaken that found it to be remarkably successful in meeting the students' learning needs and alleviating concerns about disrupted placements. It was also conducted during 2021 for all Year 4 students to help expand clinical placement opportunities. OUTCOMES: This paper describes the e-lective, its innovations, its challenges, and its evaluation findings, for others to learn from.

Impact of the COVID-19 pandemic on student experiences during rural placements in Australia: findings from a national multi-centre survey.

BACKGROUND: The aim of this national study was to explore the learning experiences of Australia's medical students who trained rurally during the COVID-19 pandemic in 2020. METHODS: A cross-sectional, national multi-centre survey was conducted in 2020, through the Federation of Rural Australian Medical Educators (FRAME). Participants were medical students who had completed an extended Rural Clinical School (RCS) training placement (≥ 12 months). A bespoke set of COVID-19 impact questions were incorporated into the annual FRAME survey, to capture COVID-19-related student experiences in 2020. Pre-pandemic (2019 FRAME survey data) comparisons were also explored. RESULTS: FRAME survey data were obtained from 464 students in 2020 (51.7% response rate), compared with available data from 668 students in 2019 (75.6% response rate). Most students expressed concern regarding the pandemic's impact on the quality of their learning (80%) or missed clinical learning (58%); however, students reported being well-supported by the various learning and support strategies implemented by the RCSs across Australia. Notably, comparisons to pre-pandemic (2019) participants of the general RCS experience found higher levels of student support (strongly agree 58.9% vs 42.4%, p < 0.001) and wellbeing (strongly agree 49.6% vs 42.4%, p = 0.008) amongst the 2020 participants. Students with more than one year of RCS experience compared to one RCS year felt better supported with clinical skills learning opportunities (p = 0.015) and less affected by COVID-19 in their exam performance (p = 0.009). CONCLUSIONS: This study has provided evidence of both the level of concern relating to learning quality as well as the positive impact of the various learning and support strategies implemented by the RCSs during the pandemic in 2020. RCSs should further evaluate the strategies implemented to identify those that are worth sustaining into the post-pandemic period.

The Challenges of Visualisation During Delivery and Assessment of Clinical Teaching Under COVID-19: A Reflective Account of Problem Solving.

Whilst the in-person clinical immersion of students in their final years of medical programmes was relatively protected from the impact of COVID-19, the ability to deliver in-person clinical teaching was restricted or heavily altered for early-year students. Our challenge as a 3-year BSc (Hons) in Medicine programme at the University of St Andrew's School of Medicine was to continue to immerse and engage students in their clinical training when in-person access to the authentic environment was impossible, restricted, or completely altered from the original image held by students.In this chapter, we aim to discuss the problems faced, the solutions considered within the contextual restraints and then reflect on the successes and failures of the approaches we took in aiding students to visualise themselves in the clinical environment, or when using altered delivery modes that introduced radically different optics on the learning experience.Whilst there were some limits on what could be practically achieved (specifically remote learning of "hands-on" clinical skills requiring specialist models or equipment), either sole- or hybrid-use of virtual platforms to provide both real-time and student-led mixed-media visualisations provided effective means to ensure appropriate delivery and assessment throughout varying levels of restrictions. In some cases, this mirrored adaptations in the clinical environment (e.g. virtual consultations).Whilst online delivery of teaching and assessment provided some mitigation of COVID-19 impact upon teaching, given the nature of a medical curriculum these cannot offset the lack of hands-on practical experience students require. However, some adaptations made by necessity (e.g. teleconsultations) have mirrored the advances in patient care and have arguably better-equipped students. The full positive and negative impacts of the pandemic on medical education remain to be seen.

Supporting the learning experience of health‐related profession students during clinical placements with technology: A systematic review

High quality clinical education is a fundamental component of undergraduate health‐related professions programmes. Technological interventions offer potential to support and enhance student learning experiences during clinical placements, i.e. away from the university setting. This review aims to systematically explore, evaluate and summarise the range of technological strategies within the literature regarding support of the student learning experience during clinical placements. A systematic review was conducted using defined search terms, educational and medical subject headings (MeSH). Relevant databases were searched alongside hand searching of citations and grey literature. Experimental studies with technological strategies designed to support student learning during clinical placements were included. A modified version of Kirkpatrick's levels (Barr et al., Effective interprofessional education: Assumption, argument and evidence. Blackwell, 2005) was used to evaluate strategies. Twenty‐one papers met inclusion criteria. Heterogeneity existed in terms of strategies and their usage e.g. whether synchronous or asynchronous;targeting individual students or groups A wide range of technological strategies may be employed to support the student learning experience during placements. However, none were identified as being of high quality therefore further research is required to provide stronger evidence to support their use. Consideration should be given to the underlying purpose of the strategy as well as the potential barriers for implementation e.g. acceptability and connectivity. Students should be clearly informed of strategy purpose and requirements, with opportunities to practice prior to placements. Review findings may provide insight to assist educators to develop future support strategies for students on clinical placements during challenging circumstances such as the COVID‐19 pandemic.Context and implicationsRationale for this studyThis systematic review aimed to establish and describe technological methods that are currently being used during clinical placements to support the learning experience of undergraduate students of health‐related professions.Why the new findings matterThe findings indicate that a broad range of technological strategies may be utilised to support the student learning experience during placements, with numerous learner benefits including improved clinical knowledge, increased reflection upon practice, increased peer and staff support, and reduced sense of isolation during placements.Implications for educatorsEducators should clearly explain the strategy purpose and requirements of the student should be clearly explained, with opportunities provided for students prior to placements to practice its use. Balance is required in terms of (a) encouraging student engagement without over burdening the student and (b) moderator involvement to facilitate student engagement without stifling contributions. When selecting a technological support strategy, consideration should be given to (a) potential technological difficulties, such as accessing platforms and (b) acceptability of the strategy for use within a clinical context.

Administering interactive simulations to supplement traditional clinical placements

This chapter aims to enhance the ability of healthcare educators to identify learner skill levels, develop and implement an appropriate simulation or scenario-based learning technique, and provide optimal feedback to refine clinical reasoning and decision-making development of the learner. The concept of problem-based learning is outlined and applied to the creation of virtual patient cases to augment clinical experiences for healthcare students amidst the COVID-19 pandemic. Through the use of appropriately targeted learning objectives, case design, and feedback strategies, students will be able to continue their professional and academic development in a post-pandemic landscape. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The impact of the COVID-19 pandemic on nursing simulation use and the influence of simulation use on future admissions

Nursing simulations have been used for over 100 years to better prepare nursing students and equip them with the medical and social skills necessary to provide high quality patient care. The use of simulation in nursing programs has helped students better their clinical skills, increase their confidence with patients, and practice with rare and difficult medical and social scenarios. With states approving up to 50% replacement of clinical hours with simulation hours, many schools have taken this opportunity to provide their students with the technology. With the onset of the COVID pandemic, clinical placements were suspended, and nursing programs turned to virtual simulations. The California Board of Nursing (BON) increased their approval to 75% replacement of clinical hours (AB2288) and, based on the results of this study, the vast majority of California nursing programs increased their percent of simulation use by 100% on average. Simulation was used to replace a higher percent of clinical hours than ever before.This explanatory sequential mixed methods study included a survey, followed by an interview to understand how simulation use changed as a result of the COVID pandemic and explore ways in which simulation technology can impact nursing school admissions for the future. For the quantitative portion, surveys were sent to simulation leaders at 128 of the 149 nursing programs in California, and 43 completed the survey (a 34% response rate). The survey revealed that 90% of programs increased their simulation use overall during the pandemic, 92% of respondents stated that the increase was necessary to address a scarcity of clinical placements, and the percent of clinical hours replaced by simulation during the pandemic rose from an average of 16% to 40%. After the pandemic, 68% of respondents predicted that they would use more simulation than they did before the pandemic, which suggests that schools have increased their buy-in to the benefits of the technology. Lastly, 31% of respondents stated that they were able to increase admission offers in 2020 because of increased simulation use.From the survey data collected, I interviewed simulation leaders of 5 nursing programs at which simulation impacted enrollment in the past, currently or had a predicted impact on future enrollment. Interviews were conducted virtually and further confirmed that increasing simulation use for the replacement of clinical hours could allow the enrollment of more students. If each student requires fewer clinical placement hours because a higher percent of these hours can be replaced by simulation, then the available clinical placement hours can be spread across more students. However, all interview respondents stated the next biggest barrier of increasing enrollment, insufficient number of faculty, would stifle any hopes of enrolling more students.Program leaders reported highly positive perceptions of the effectiveness of simulation on student NCLEX scores as well as their clinical competence. Respondents noted that the top three motivators for increasing simulation use before the pandemic was to practice clinical skills, expose students to rare scenarios and assess students' clinical skills. During the pandemic, the top three motivators shifted;an overwhelmingly high percent of respondents (92%) stated that the top reason for increasing simulation was to address the scarcity of clinical placements.Although most nursing programs have increased their simulation substantially, there are still programs that are nowhere near the maximum allowable usage. The Diffusion of Innovation theory categorizes schools that have not fully integrated the innovation as being in the implementation stage. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The impact of COVID-19 upon student radiographers and clinical training in Latin America.

INTRODUCTION: This study aimed to identify the impact of the COVID-19 pandemic upon radiography education across Latin American countries. METHODS: A survey containing 20 questions was circulated to radiography students, across 13 universities in 11 countries of Latin America using Google Forms. The survey contained open and closed questions. Answers were analysed with descriptive statistics and the methodology of interpretative phenomenological analysis for the open answers. RESULTS: Of the 1310 responses only 23.9% (n = 313) of students reported attending clinical placements and from this cohort only 8.9% (n = 28) became infected with COVID-19. In response to how the pandemic had impacted upon the students' academic progression, the most common topic in the open answers was "Concerns about the lack of clinical training", mentioned by 629 students. Students in middle and later years of their radiography education expressed the greatest concern about future clinical placements. Almost all radiography students (95.2%/n = 1247) indicated that their main concerns regarding COVID-19 infection while undertaking clinical placements was in relation to the risk of infecting their families as most students stated they cohabited with relatives (86.6%/n = 1134). CONCLUSION: Compared to European findings co-habitation trends increased anxiety related to infection and impacted their mental health. Students expressed concern about the quality of education they were receiving during the pandemic and access to resources to facilitate on-line learning was inadequate. Socio-economic and internet connectivity factors specific to Latin America were identified and these issues need to be addressed if on-line education is required in the future. IMPLICATIONS FOR PRACTICE: The COVID-19 pandemic has impacted Latin America and this study identifies the implications for radiography students related to their clinical and academic training and highlights factors which require consideration to support radiography students as the pandemic continues.

Supporting the well-being of nursing students and student midwives during the COVID-19 pandemic.

Throughout the coronavirus disease 2019 (COVID-19) pandemic the Queen's University Belfast Connections (QUB Connections) project has provided online well-being support to nursing students and student midwives. The project, which was co-designed and led by students and academic staff, provided an online well-being service for students who took on front-line roles during the early part of the pandemic and for those who had to pause their studies. Insights gained from responses to an evaluation of the support sessions suggested that some students felt stigmatised, frightened, lost, isolated and abandoned during this period, but that QUB Connections gave them a sense of 'being held' and 'attended to' in a time of uncertainty. The evaluation findings are a reminder of the need to continue to help nursing and midwifery students and newly qualified staff develop self-care and support mechanisms. QUB Connections is now embedded in the university's school of nursing and midwifery pre-registration programmes to support students and those new to nursing and midwifery practice.

Impact of the COVID-19 pandemic on medical student placements in rural Queensland: A survey study.

OBJECTIVE: The COVID-19 pandemic has adversely impacted medical students' learning experiences. Students in one Australian Rural Clinical School were surveyed to investigate the impact of disruptions to clinical placements and satisfaction with educational changes implemented as a result of the pandemic. DESIGN: Cross-sectional survey. SETTING: The University of Queensland Rural Clinical School. METHODS: Students undertaking one or two years of study at the participating Rural Clinical School in November 2020. MAIN OUTCOME MEASURE: A 20-item anonymised survey with questions on personal health and safety, quality of clinical training experience, response to changes in learning and student environment, and progression to completion of the medical degree. RESULTS: The survey was completed by 124 students (76% response rate). Students were satisfied with the changes made to their learning to accommodate the disruptions to health service delivery and placements. Final year students were more satisfied with their learning experiences compared to their third-year counterparts. CONCLUSIONS: The Rural Clinical School implemented a range of academic and psychological support strategies which appear to have helped with mitigating mental health concerns experienced by students completing rural placements, who are already prone to experiencing social isolation. Strengthening communication between the academic and health service sectors can improve the quality of learning for medical students on placements.

Nursing students' clinical placement experiences during the Covid-19 pandemic: A phenomenological study.

AIM: This study explored the clinical placement experiences of nursing students during the Covid-19 pandemic. BACKGROUND: The health emergency caused by Covid-19 required a rapid reorganisation of care settings. This reorganisation entailed revisiting the clinical placements settings and learning programs of Italian nursing faculties. Some Italian universities wanted to seize the health emergency as a learning opportunity enabling the nursing student to acquire additional knowledge and skills. DESIGN: We conducted a descriptive qualitative study employing a phenomenological approach. The study population was second and third-year nursing students. The students did their clinical placement in 5 Northern Italy hospitals, mainly in infectious diseases wards, intensive care and sub-intensive care units, emergency department, short-stay surgical units and internal medicine wards. In these departments, the inpatient wards were entirely converted into Covid-19 units. Ethical approval was obtained from the local ethics committee. METHODS: Semi-structured, open-ended interviews were conducted in March-April 2021 and analysed following a phenomenological approach. RESULTS: Twenty-one nursing students in their 2nd and 3rd academic year participated. Their average age was 24 years. 81% were female and 19% were male. Three main themes were generated: (i) Learning which surpasses technicalities; (ii) Confronting dignity issues; (iii) Feeling treated as an equal in the workspace. Students had to learn how to lower their fear and self-manage the emotional burden to be a caring presence for the patients who were intensely suffering from the disease and isolation. Attending a clinical practice placement in Covid-19 wards led them to focus on human dignity issues: participants realised how dignity was questioned and how they could become patients' advocates. Students also described that they felt part of the team, with their student role almost fading. CONCLUSIONS: This study describes that the most unpredictable public health emergency, such as Covid-19, can provide learning opportunities in the practice environment for nursing students. Students described feeling useful and capitalising on new competencies. Designing educational activities for nursing students concerning pandemic emergencies may be strategic for dealing with similar situations in the future.

Establishment of an innovative telehealth speech and language therapy placement as a rapid response to covid-19: Sharing the learning

The aim of this evaluation was to explore practice educators' and speech and language therapy (SLT) students' experiences of a rapid response telehealth placement in response to the COVID-19 pandemic in order to inform quality improvement. In March 2020, public health restrictions were imposed across Ireland in efforts to 'flatten the curve' in response to the COVID-19 pandemic. All placements were cancelled. According to an Irish Association of Speech and Language Therapists survey in April 2020, 47% of SLTs were redeployed to swabbing and contact tracing roles, and many remain redeployed seven months later. This redeployment, along with strict public health measures in clinical sites, significantly reduced the availability of clinical placements. A rapid response was required to enable students to develop clinical competencies. Although telehealth has been used to deliver speech and language therapy in other countries, it had not been used routinely in service provision in Ireland. In this article, we outline how we built on existing partnerships with practice educators, both on- and off-site, to design a much-needed telehealth placement. We explored educators' and students' experiences using an online focus group and online survey respectively. The evaluations of practice educators were positive in that despite their initial apprehension, they reported that this placement provided valuable learning opportunities for students while also providing benefits for clients. They also reported some technological and sustainability challenges. The students also evaluated this placement positively with 83.3% of respondents rating the placement as 'excellent 'and 16.7% rating it as 'good'. All stakeholders valued this learning experience. © 2021 Coventry University. All rights reserved.

Rising to the challenge of covid-19: Pivoting to online and project-based physiotherapy student placements in contemporary professional settings

Online and project-based student placements in sport and corporate settings were incorporated within the Macquarie University Doctor of Physiotherapy following the restriction of face-to-face delivery during the COVID-19 pandemic. This study explores student and educator perceptions of these placements, and analyses student performance results to provide future recommendations. The mixed-methods design included a student survey, semi-structured educator interviews and quantitative analysis of student assessment performance comparing 2020 to 2018/2019 cohorts. Quantitative survey data were described, with proportional differences between groups analysed. Open-ended survey responses and interview transcripts were thematically analysed, and integration of all results was performed. Themes derived from 24 student surveys highlighted that the learning experiences and skills required for online and project-based placements were varied and valuable. Analysis of 176 students' performance showed differences between performance and applicability of assessment items in 2020 placements in comparison to previous years, although all students met performance requirements. Analysis of eight educator interviews identified that online and project-based placements changed experiences for all stakeholders and highlighted the need for enhanced educator and student communication and organisation for the placement to be successful. Online and project-based placements were considered a better reflection of contemporary work practices, producing valuable deliverables to the business. Three final integrated themes were identified regarding online and project-based elements of placements: Learning experiences of students differed, skills for students and educators differed, and placements were representative of real-world work. A hybrid approach that incorporates both online and onsite placement time and includes a project-based component is recommended for future placements. Project-based and online elements provide genuine and valuable learning opportunities for physiotherapy students in preparation for real-world work. © 2021 Coventry University. All rights reserved.

And if we had to do it all over again, would we send medical students to the emergency departments during a pandemic? Lessons learned from the COVID-19 outbreak.

The COVID-19 pandemic has led to increased staffing needs in emergency departments. The question quickly arose as to whether it was appropriate to offer medical students the opportunity to assist this staff. The dilemma stems in part from the potential impact on their psychological well-being as well as their academic and clinical performances. We sought to determine the level of anxiety of medical students during the COVID-19 outbreak, and whether it was higher among the students who chose to return to the clinical setting, especially in first-line units (i.e., emergency departments and resuscitation units). In May 2020, 1180/1502 (78.5%) undergraduate medical students at Strasbourg Medical School (France) completed a questionnaire assessing their anxiety and clinical experience. A 2018 cohort of undergraduate medical students served as the baseline. The 2020 COVID cohort had higher rates of anxiety than the 2018 cohort. This difference was specifically observed in the students who chose not to return to the clinical setting during the crisis (N = 684, 59%). At linear regression, the main factors associated with anxiety were gender (p < 0.005) and perceived clinical activity personal conditions (p < 0.001). Employment site, including COVID first-line units, was not correlated with anxiety. Working in the clinical setting during the COVID-19 outbreak is not a risk factor for anxiety in medical students. Instead, it is an active coping strategy, suggesting that there are no barriers to allowing students to return to clinical settings during a pandemic, including first-line units, in terms of their psychological well-being.

Clinical placements for undergraduate diagnostic radiography students amidst the COVID-19 pandemic in Singapore: Preparation, challenges and strategies for safe resumption.

INTRODUCTION: The COVID-19 pandemic resulted in the suspension of clinical training for undergraduate radiography students in Singapore. Coordinated preparation plans and strategies between the university and hospitals were needed to safely resume clinical placements within national and hospitals' risk control measures against COVID-19 transmission. METHODS: Singapore Institute of Technology (SIT) and the Radiology Department of Singapore General Hospital (SGH) had collaborated to meet requirements for safe resumption of clinical placements. SIT prepared students by emphasising compliance to all risk measures, addressing concerns of risk transmission, meeting learning objectives, and reassessing infection control competencies. In tandem, SGH prepared an orientation programme and used technology for open communication among faculty, clinical educators and students which included monitoring of well-being and rapid dissemination of updates. Of note, SGH reorganised operating procedures and physical spaces to meet national standards of safe physical distancing, restricted movement between treatment areas and teams, and rosters to remain committed to the supervision and education of students. RESULTS: Clinical placements resumed 3 months following suspension. Clinical educators faced the challenge of the need for balance between increasing clinical load and student supervision. A solution was frequent engagement and support by faculty, with educators and students via video conferencing platforms. Students' well-being was frequently checked. There was less variation in cases which simulation training made up for some of the learning objectives. CONCLUSION: Adaptation and commitment to continue active and quality clinical education while ensuring students' safety were vital during a pandemic. Clinical training within stringent precautionary measures may shape the era of the new norm.

Clinical nursing and midwifery education in the pandemic age.

The COVID-19 pandemic has disrupted clinical nursing and midwifery education. This disruption has long-term implications for the nursing and midwifery workforce and for future healthcare responses to pandemics. Solutions may include enhanced partnerships between schools of nursing and midwifery and health service providers and including schools of nursing and midwifery in preparedness planning. These suggestions notwithstanding, we call upon national and international nursing and midwifery bodies to study how to further the clinical education of nurses and midwives during pandemics and other times of crisis.