n2839 Research Report on Deu Cycle 1

Research Report on Completion of the First Cycle of the Action Research

Prepared by:

Willem Fourie & Bev McClelland

Supported by the AKO Aotearoa National Project Fund

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ACKNOWLEDGEMENTS

We would like to express our appreciation to the participating Bachelor of Nursing students for taking

the time to complete questionnaires and for participating in the focus groups. Your views and

experiences were very useful. We wish to express our sincere appreciation to the staff of both DEUs

and to the Action Group for not only participating in the research but for making the implementation of

the first cycle a great success. We wish to acknowledge the generous sponsorship by AKO Aotearoa

through their National Project Fund. Finally we would like to thank the respective nurse leaders of the

two organisations, Denise Kivell and Debbie Penlington, for their continued support and encouragement

to this project.

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Table of Contents ACKNOWLEDGEMENTS ................................................................................................................................. 2

BACKGROUND ............................................................................................................................................... 4

METHODOLOGY ............................................................................................................................................ 6

CNDU Governance Group ......................................................................................................................... 7

Action Group ............................................................................................................................................. 7

Research Management Team ................................................................................................................... 7

Data Collection .......................................................................................................................................... 8

Data Analysis ............................................................................................................................................. 8

DISCUSSION AND FINDINGS .......................................................................................................................... 9

The DEU Prior to Implementation ............................................................................................................ 9

Understanding, being Informed and Prepared. .................................................................................... 9

The implementation of the DEU ............................................................................................................... 9

Orientation Day ..................................................................................................................................... 9

The Initial Days on the DEU ................................................................................................................. 11

The Role of the Clinical Liaison Nurse ................................................................................................. 13

The Role of the Academic Liaison Nurse ............................................................................................. 17

Teamwork ........................................................................................................................................... 22

Support................................................................................................................................................ 25

Students Learning Needs .................................................................................................................... 28

RECOMMENDATIONS ................................................................................................................................. 46

REFERENCES ................................................................................................................................................ 47

Appendix 1: Tables with Qualitative Comments ......................................................................................... 48

Appendix 2: Participant Information Sheet ................................................................................................ 61

Appendix 3: Questionnaire Midway through Placement ........................................................................... 64

Appendix 4: Questionnaire on Completion of Placement .......................................................................... 73

Appendix 5: Consent Students .................................................................................................................... 80

Appendix 6: Consent Staff........................................................................................................................... 81

Appendix 7: Focus Group Questions ........................................................................................................... 82

Appendix 8: Ethics Approval Letter ............................................................................................................. 83

Appendix 9: CMDHB Approval Letter ......................................................................................................... 84

Appendix 9: CMDHB Approval Letter ......................................................................................................... 84

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Research Report on Completion of the First Cycle of the Action Research

BACKGROUND

There has been much debate in the literature about models and roles that best support nursing student

placements. A recent white paper for the US Department of Labor offered pioneering solutions

currently in development which include amongst others the development of Dedicated Education Units

(Joynt & Kimball, 2008). DEUs have been pioneered in Australia and have been the primary model for

clinical nursing experience in Adelaide since 1999. The KPMG (2001) report on undergraduate nursing

education in New Zealand identified that “DEUs are a good example of a model in which student work

shifts alongside registered nurses but do so in a collaborative and supportive environment in which

clinicians and educators work together” (p.88).

Students in DEUs have reported feeling supported by a clinical facilitator who is dedicated to them and

their learning needs (Nehls et al., 1997). The use of staff within a unit who are clinically current and

familiar with the environment impacts greatly on the students’ experiences (Baird et al., 1994). The

nurses in a DEU reported feelings of personal and professional satisfaction by being given time to

support students (Henderson, 2006). Melander and Roberts (1994) added that improvements have

been reported in the teaching and preceptoring skills of the facilitator, evidencing their professional

development.

In New Zealand it was decided by both Christchurch Polytechnic Institute of Technology (CPIT) and

Christchurch District Health Board (CDHB) that a DEU model would be piloted in 2007. CPIT therefore

became the first New Zealand Nursing School to establish a DEU and from their evaluation, benefits to

students, the CDHB and CPIT were identified. Benefits included better quality placements, an increase

in clinical placements as well as better alignment between theory and practice while the DHB and CPIT

staff enjoyed more work satisfaction and a closer relationship in nursing education. Students also

reported better communication, better access to staff and more consistent assessment practices.

This project is about initiating a culture change amongst clinicians in relation to student education. Both

Manukau Institute of Technology (MIT) and Counties Manukau District Health Board (CMDHB) are

committed to improving student learning and will continue to work together to ensure the best possible

outcomes by establishing more DEUs following this project.

The DEU project was implemented in a multicultural environment and in a region that has the fastest

growing population in New Zealand, particularly youth and elderly populations. At CMDHB, 52% of staff

(69 ethnicities) have been trained overseas which adds to the complexity of nursing education. CMDHB

serves a diverse range of clients making up 11% (464700) of the New Zealand population. This diversity

presents unique challenges in relation to retention and success of students. Not only is the DHB one of

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the largest in the country but the population growth in its region is unique as reflected in the graph

below. Figure 1: Population Growth

(Source: Shaping our Future Health System: MOH p 20)

To implement this project it was necessary to understand the context and limitations of current

practices in the clinical education of nurses and to understand DEUs as a strategy to providing superior

clinical education. To achieve this an extensive literature search using databases such as EBSCOhost and

CINAHL was carried out. A visit to the University of South Australia where DEUs have been used

successfully over the past 10 years and a visit to CPIT where the first DEU in New Zealand were

undertaken. Funding was sought and approved by AKO Aotearoa and the implementation of the DEUs

commenced in February 2009. Action research was used to ensure a scientific and robust process for the

implementation of the DEUs.

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METHODOLOGY

Action research is an appropriate method for the establishment of the DEUs as it is a systematic inquiry

to effect positive educational changes in the clinical learning environment. According to Kemmis and

McTaggart (1988) it is a collective and collaborative process which in this case lends itself to MIT and

CMDHB working collaboratively on an initiative that would be beneficial to both organisations. Action

research enhances the lives of learners as well as the lives of teachers. It encourages continuous

learning and reflection which are critical for the practice of nursing. More specifically, practical action

research emphasises the ‘how to’ approach necessary for this project (Mills, 2003).

Stephen Kemmis’s model of action research was used, and involved a series of cycles as a basis for

further planning (Kemmis & McTaggart 1988). The essential characteristics of this model include

reconnaissance, planning, action, reflection, monitoring and evaluation (Mills, 2003).

Action Research Cycle 1

Phase 1 (July 2008 – November 2008). Reconnaissance

Phase 2 (November 2008 – February 2009). First Action Plan

Phase 3 (February 2009 – May 2009). Implementation of Plan

Phase 4 (February 2009 – June 2009). Reflection, Monitoring & Evaluation

Proposed Action Research Cycle 2

Phase 1 (June 2009 – July 2009). Second Action Plan

Phase 2 (July 2009 – November 2009). Implementation of Plan

Phase 3 (July 2009 – December 2009). Reflection, Monitoring & Evaluation

Phase 4 (December 2009). Final Report

The following objectives have been identified for this project:

• Document the process of implementing the DEUs • Evaluate the model’s potential ability to support undergraduate nursing students within CMDHB • Make recommendations to the CNDU on completion of the project as to the model’s suitability

for use as an ongoing undergraduate nursing clinical education • Build research capacity through team research between MIT and CMDHB.

For this project Wards 6 and 24 at Middlemore Hospital were selected as DEUs based on their capacity

and commitment to support the clinical learning of nursing students.

The following structures have been created to develop, oversee and manage the project.

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CNDU Governance Group

The project is overseen by a governance group consisting of key MIT and CMDHB personnel. The role of

the Governance Group is to develop roles/processes/ evaluation criteria; oversee day-to-day

implementation and report to the Collaborative Nursing Development Unit (CNDU).

Action Group

The Action Group facilitated by the MIT Clinical Coordinator met weekly and were primarily concerned

with:

Co-ordinating day-to-day operational issues within the two DEUs

Monitoring student/staff satisfaction

Facilitating staff communication

Providing feedback and support to pilot areas

Participating in the action research.

Research Management Team

A Research Management Team was formed to oversee the action research and its various cycles by

liaising closely with the Action Group, the Governance Group and Rose Whittle from CPIT.

Figure 2: Conceptual Model

DEUAction

ResearchCNDU

Governance Group

Action Group

Charge Nurse

CLN

ALN

Staff

Clinical Coordinators

Students

Research Management

Team

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Data Collection

This report integrates the findings of both qualitative and quantitative data emerging from the following

sources:

Student interviews

Staff interview

Action Group interview

Journals

Minutes

Midway questionnaires

End point questionnaires

Data Analysis

A total of five focus groups was conducted with students, staff and action group members. The

interviews were audiotaped and transcribed by an independent transcriber. The interview transcripts

were sent to all participants for checking and correction. Interviews, reflective journals and meeting

minutes were thematically analysed, independently by both researchers. The researchers met,

reviewed and discussed their analysis to identify commonalities and explore points of difference. A

matrix was developed to group data and emerging themes in a logical manner. The matrix also served

to identify effective practice and areas for review.

Two sets of questionnaires were distributed to students in the DEUs, one at the midway point and the

second on completion of the placement. The first round of questionnaires consisted of 21 questions

using both Likert scales and open-ended questions. Using the same format the second round of

questionnaires consisted of 16 questions. A total of 26 questionnaires (13 from each DEU) were

returned after the first round and nine after the second round. Only one questionnaire was returned

from Ward 24 which resulted in the inability to make comparisons to this ward. The population for the

second round excluded BN semester two students as they spent only two weeks in the DEUs and could

not meaningfully contribute to the data required from the second questionnaire. The responses to

closed-ended questions were captured on an Excel spreadsheet and descriptively analysed and

presented as bar graphs. The open-ended questions were captured verbatim and grouped under each

relevant question using a word document. These verbatim responses were thematically analysed.

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DISCUSSION AND FINDINGS

The DEU Prior to Implementation

Understanding, being Informed and Prepared.

Understanding, being informed and prepared relates to the activities preparing staff and students for

the implementation of the DEU including the workshops and planning day and excluding the orientation

and initial days on the DEUs as they will be discussed separately.

The data suggests that students were informed about the DEU at different times and in different ways.

Some found out about the DEUs well ahead of time while others had less time to consider it. Some

students had the opportunity to request to be placed in a DEU while others were allocated to a DEU.

One participant stated “I first learnt about the DEU when we were preparing for our clinical to make

requests, so it wasn’t clear to me what a DEU was” while another commented “one of our lecturers, the

one responsible for placement explained a bit about the DEU”.

From the Action Group interview there were perceptions about staff readiness for the DEU that related

to being too quick, not feeling informed enough about how it would work and staff not being well

prepared. “I thought it came up too fast. I wasn’t really informed or had enough time to be informed

from the point of how this was going to work. Preparation for the staff I think was pretty much a shock

to them really.” This was further emphasised by the following statement by the same participant: “All in

all I thought the preparations; the commencement for it was[sic] too fast. I would have liked to have a

little bit more time.”

The implementation of the DEU

The implementation of the DEU started with the orientation day, initial days on the DEU and continued

until the completion of the placement by students in the DEUs.

Orientation Day

The orientation day for each DEU was held separately at Middlemore Hospital on 11 February 2009,

following which students commenced their placements on 16 February. The orientation day was seen

as an essential event, however all participants in the orientation day should be well briefed about the

DEU prior to the orientation day so that the content of the day could focus on the orientation itself.

Students valued the orientation to the physical environment, becoming familiar with people and getting

to know the ward routine.

I think that was the most important component of this whole programme, was just

that induction. The rest of it was almost just a build-on. Having that day where you

could just find out simple things like where the toilet is, where I put my bag, routine of

the ward and all that sort of stuff was just so helpful.

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The orientation day made students feel accepted and expected and they valued the fact that staff were

prepared for them and that they were welcoming. “They were expecting us and prepared for us. They

said they are looking forward to seeing us and things like that. That was really welcoming and I think

they were well prepared for us”

The orientation day provided an excellent opportunity for students to ask questions in a safe

environment, conducive to communication. Students reported that the orientation allayed their anxiety

about the clinical placement.

I think it was easy to get over the anxiety, because you know you have that whole

orientation. People made you feel welcome in the first place. People made you feel like

you could communicate back to them and you wouldn’t be dismissed. You have that

open feeling of ok well I can just ask anyone.

Orientation not only prepared students but it also prepared staff and created the opportunity to clarify

expectations.

I felt the students were much better prepared, because of that day. There was a chance

to say some things to the students that we didn’t normally get to say like these are the

ward staff’s expectations of students, these are the sorts of patients you are going to

be looking after and the sorts of things you may come across.

However, some students reported that expectations were not always clear and related this to

miscommunication and misunderstanding of what they had to do in the DEU.

Student valued the support from the Charge Nurse Manager (CNM) at orientation. The Charge Nurse

Manager is a key player in the success of the DEU and her approach and attitude towards the DEU made

a big difference to both students and staff.

We were very warmly welcomed by the Charge Nurse who really set the tone for the

day. She has a real presence and leadership skills. She is strongly supportive of the

programme and is helping to raise the profile of the DEU in the hospital generally.

I feel more confident to start my shift as I was oriented very well and it was easier for

me to work because I am more familiar around the area. I met a few people even

before the start of my duty on the orientation w/c makes me more at ease.

Some student participants reported that not all staff knew about the DEU, in fact they reported that

only nurses seemed to know about it. Regarding doctors, one student reported that “I don’t think that

the doctors really embraced the DEU as a concept and we were obviously more bodies to look for charts,

because I felt that is what they really used me for a lot.”

The questionnaires to students generated quantitative and qualitative data which will be discussed

where appropriate.

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Figure 3: How do you rate your orientation to the area?

Eighty eight percent of students rated their orientation as either excellent (38%) or very good (50%).

From the open-ended questions it is clear that the orientation was well received as reflected in the

following statement: “Fantastic – we had a lot of small orientations to help us learn the layout in small

time frames, so we weren’t overwhelmed” and “I know the ward well within a short period of time.”

The Initial Days on the DEU

The initial days on the DEU were important and played a crucial role in students settling down and

feeling part of the unit. Thoughtful gestures gave students a sense of belonging “I think the notice

board with our names, welcoming us was also quite nice. The handover room had another board with

our names welcoming us to the ward. That was quite nice as well.” Another student participant said “It

makes you feel part of the team, makes you feel welcome and acknowledged. It is just nice to see that ok

you are part of something.” During the first few days students reported experiencing a supportive

environment where people were approachable and reliable. The role of the preceptor during the first

few days could make a positive difference for students as reflected in the following comment. “In my

case in that first week I got a good preceptor, because she was able to orientate me regarding what was

happening in the ward. Before we started the shift she explained to me what are the procedures and the

protocols.”

However, in contrast, BN semester two students reported feeling less welcome than other students.

Due to the structure of the programme, BN semester two students joined the DEU units approximately

two months after the orientation day.

62%

23%15%

0%

15%

77%

8%0%

38%

50%

12%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Excellent Very Good Poor Very Poor

Re

spo

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Response

Orientation Rating

Ward 6

Ward 24

Total

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Figure 4: How do you rate your welcome to the area?

Twenty-four percent of all students rated their welcome as poor of which 31% related to Ward 6 and

17% to Ward 24. None felt that it was very poor and 36% felt it was excellent. From the open-ended

questions, students reported that “most nurses were friendly and welcoming making me feel at ease.”

In contrast, BN semester two students reported feeling less welcome compared to others. “Don’t really

get welcomed on my first day. Just went with my preceptor.”

31%

38%

31%

0%

42% 42%

17%

0%

36%

40%

24%

0%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


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Response

Welcome Rating

Ward 6

Ward 24

Total

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Figure 5: How do you rate the preparation of ward staff for the DEU?

Twenty-eight percent of the students rated the preparation of ward staff for the DEU as poor however

none rated the preparation as very poor. From the open-ended questions students stated that “staff

were prepared, but perhaps not for the quantity of students arriving.” However some students felt that

“some may not have been informed of what was happening with DEU students. Some are not as

forthcoming as others.” There appear to be conflicting experiences in regard to the preparation of ward

staff for the DEU.

The Role of the Clinical Liaison Nurse

Initially the CLN was not clear on the role and experienced a lack of feedback from staff which made it

difficult to adjust to the role. Timely feedback from staff is crucial to the role.

As a CLN it was a very challenging role to start with. As the weeks went slowly I was

fitting into the role and starting to get what I am supposed to be doing. I could see

there were times where I had quite a lot of students with me and at times I didn’t really

know what to do with them.

The CLN was described as the first point of contact, an advocate, a middle person or catalyst, a bridge

and problem solver. “She was the ‘go to’ person for the students and the nurses. They would consult

with her if there were things they were not sure about whether something was in our scope of practice.”

15%

54%

31%

0%

17%

58%

25%

0%

16%

56%

28%

0%0%

10%

20%

30%

40%

50%

60%

70%


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Response

Preparation of Ward Staff

Ward 6

Ward 24

Total

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Another participant suggested: “To be a good CLN one needs to have problem solving skills, a quick

thinker and solve issues fairly without letting anyone down and often communication is the key.”

The CLN was also described as supporting students by checking on them, someone who is dedicated and

who took the load off other staff. The CLN was seen as someone who is helpful, available, always there

for students. “She is always there for us all the time.” Students did however suggest that both the CLN

and ALN should be more available during afternoon shifts. “You do kind of feel the difference between

your week of morning shifts and your week of afternoon shifts, mainly because of that support which is

not there.” They felt the afternoon shifts provided more time for teaching and learning. “That is when

we have more time in the afternoon shift for us students to ask questions, because we get more free

time.” While many students valued the availability of the CLN, students in BN semester two felt that the

CLN was not always available to them, particularly on the first day in the unit. “For an hour and a half I

really didn’t know what was happening. There was no approach from [CLN] to say welcome on board,

this is what is going to be expected of you and we will be having handover.”

The CLN was also valued as a person who holds a lot of knowledge and experience of the ward. “It was

good to have someone who had worked in that ward. It made it easier, because she knew many things

about that ward, so that helped a lot.” Her organisational and time management skills were also valued

however some of the data suggested that CLNs faced challenges in relation to organisation and time

management and often had to take work home late at night or over weekends, doing rosters or

attending to progress notes for students.

I have got 2 children, 2 ½ plus 4 ½ at home and also doing post-grad [sic] studies…so I

hardly have any free time. I am enjoying this new role but I foresee this role to be a full

time role between Mon [sic] to Friday in the future. It is indeed a busy role and I feel I could

offer a lot to the students.

CLNs were also valued for the education sessions they planned with other team members such as

dieticians, occupational therapists and infection control nurses. Because the CLN is supernumerary and

focused on the students learning, the CLN worked at a pace that students could cope with. “We are not

rushed by the nurses, because they don’t have time for us, because we have the CLN that is there for us

and she would take her time and she will talk us through it.” Having more time to work with students

resulted in the CLN identifying struggling students at an early stage which meant that additional support

could be provided for these students. “When she is getting feedback from us and she knows which

student who is behind, needs help and she can spend more time with that student.” However, the

supernumerary role of the CLN came into question as participants reported that the CLN was also taking

on a case load as reflected in the following two quotes. “Right now with our CLN she seems to be

juggling a lot of things and we are just something else that is put on top” and “she is having to take a full

patient load and continue with her CLN responsibilities.”

The CLN helped to overcome cultural barriers.

Well I believe I had a student whose cultural background made it difficult for her to ask

for as much help as she should have been asking for. I would offer help, but she was

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too proud to say I am struggling and I need a hand. Yet she was a bit more open with

you wasn’t she? She was a bit more open with the CLN.

Figure 6: How do you rate the preparation of the Clinical Liaison Nurse for the DEU?

Ninety-six percent of students rated the preparation of the CLN as either excellent (60%) or very good

(36%). Students thought “the CLN was prepared for the role and was also very supportive” and they

saw her as “helpful, punctual, dedicated, hardworking in planning education seminars/teaching sessions

for us which have been very helpful and much appreciated to help understand.”

Midway through the student placement students were asked about their understanding of the CLN role,

the results are reflected in the following graph.

75%

25%

0% 0%

46% 46%

8%

0%

60%

36%

4%0%

0%

10%

20%

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40%

50%

60%

70%

80%


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Response

Preparation of CLN

Ward 6

Ward 24

Total

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Figure 7: Did you understand the role of the Clinical Liaison Nurse (CLN)?

Ninety-six percent of the students understood the role of the CLN at the midway point in their

placement. Students were again asked the same question on completion of their placement and at this

point 100% of the students indicated that they understood the role. This finding is restricted to Ward 6

as insufficient questionnaires were returned from Ward 24 to make comparisons.

92%

8%

100%

0%

96%

4%

0%

20%

40%

60%

80%

100%

120%

Yes No

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Response

Understand the role of the Clinical Liaison Nurse (CLN)

Ward 6

Ward 24

Total

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Figure 8: Did you understand the role of the Clinical Liaison Nurse (CLN)?

The Role of the Academic Liaison Nurse

The ALN has to build rapport with the DEU staff and the CLN in order to be effective as the ALN is not

part of the usual ward staff and represents another organisation, the ALN therefore has to work at

getting to know the staff and becoming accepted by them. “There are also a few groups of staff in

*name removed+ who I will have to get alongside in order to work effectively” In addition, the ALN

needed to establish a working partnership with the CLN to support her in dealing with students’ learning

needs. “I realise she (CLN) will need a lot of support in the CLN role and encouragement too – not just the

students.”

From the data the availability of the ALN and the ability to provide an immediate response when needed

were valued by staff and students. Availability and presence on the unit allowed for many on the spot

teachable moments which otherwise would not have been possible. Students described the ALN as

being present and able to give instant correction if needed while also pointing them to the right

resources. “I felt like we were just so supported, that you were definitely on the path to success. You

would be caught and put back on the right road at any stage you wandered off into the wrong path.” At

the same time one of the ALNs reported that as a result of her presence in the unit there was less need

for students to contact her by cellphone as would otherwise be the case. “My cellphone usage has

decreased! This is real evidence that students have daily access to me so don’t need to text as much as

they previously did.” Students suggested that both CLN and ALN should be more available on afternoon

shifts as explained in the section on the role of the CLN. One of the ALNs however needed to cover

students in other nearby wards (non-DEU) which may have impacted on her availability to work with

students and the CLN.

100%

0%

92%

8%

0%

20%

40%

60%

80%

100%

120%

Yes No

Understanding the role of the CLN: Ward 6

End of placement

Midway through placement

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She [ALN] pops in or pops out. Maybe that is the problem, because she has that feeling that

she is burdening us. I know when she came in one day I was doing the drugs, “oh she is

busy I can’t see her”. Again I was expecting some dedicated time, so that we knew [sic]

everyday and we talked about this when we had the introduction to this, that there would

be set times for one-to-one with [ALN]. It’s not like that, it’s just ad hoc. I think sometimes

that is the issue, because the preceptors have got us doing some learning and she comes in

and takes us away.

An important part of the ALN role is to link theory and practice as they understand the curriculum and

assessments and what was covered in class.

She understands the curriculum and I think that is the great difference between [CLN] and

[ALN] is that [ALN] really understands what marks we have to have and what we have to

achieve while we are in the clinical. She also kind of brings us up to a more professional

level, feeling supported.

However, some students felt that there could have been a better match between what was covered in

class and what was happening in the unit. This appeared to be more a timing issue rather than a lack of

linking theory with practice.

The ALNs felt supported by the CLN who provided clinical examples of students’ progress. The CLN role

assisted the ALN in getting feedback on students. “The CLN role has helped me immensely with giving

me clinical examples of students’ progress and not [sic] progress.” Good communication between the

CLN and ALN is essential in order to coordinate, share information, and organise students. Students

reported that the CLN and ALN had lots of meetings (formal and informal) and that they would catch up

for 10 minutes here and there or at a planned meeting. “I have never for one moment think [sic] that

‘Oh gosh I wish they would talk to one another’. They always seem to be on the same page.” In contrast,

some participants reported a lack in communication between the ALN and CLN such as changes in

student rosters.

Critical to the success of the ALN role is the sense of belonging and not feeling like an outsider in the

unit. “Previously I was a visitor to the hospital, I always felt like an outsider. I wasn’t one of the ward

staff and I wasn’t one of the students, so for me the DEU has meant I have a real sense of belonging

somewhere.” While the sense of belonging is influenced by the attitude of everyone working in the

DEU, the role of the Charge Nurse Manager (CNM) in making the ALN feel welcome and accepted is

most important and valued. “ [The CNM] was extremely welcoming – telling me I didn’t need to ask her

if it was ok for visitors – “it’s your ward now. Just a little phrase but very reassuring” Being accepted

and developing a sense of belonging is not a one-way relationship and ALNs could do a lot to facilitate or

enhance their acceptance in the unit. “To ensure that I am accepted as one of the team I answer

phones, wipe discharge beds, check IV a/b’s + help an RN.”

While the ALNs developed a sense of belonging in the unit they began to feel disconnected from their

semester team back at the Institute and felt disappointed about a perceived lack of support and

understanding by their teaching peers. “My team members tell me they feel “left out”. At times I feel

19

left out!! Kind of feels we are damned if we do, damned if we don’t!” Another participant commented

“It is disappointing to think that our ALNs feel undermined in this respect by colleagues.” Peers also

perceived DEU students as being advantaged over others which added to the ALNs feelings of

disconnection with the team. Over time the relationship with peers improved and one ALN reported

“My team members (BN3 team) have stopped telling me that they feel DEU students are advantaged. A

good thing!”

Figure 9: How do you rate the preparation of the Academic Liaison Nurse for the DEU?

Twenty-three percent of students in Ward 24 felt that the preparation of the ALN was poor compared to

8% in Ward 6. 75% of Ward 6 students felt the preparation of the ALN was excellent, compared to 46%

in Ward 24.

Students reported that the ALN was well prepared as reflected in the following statement: “Very well

prepared. Always there to support our clinical experience with academic knowledge.” However, some

BN semester two students felt: “I did not feel there was any preparation, she visited us ad hoc and this

was not productive as we could not plan or be prepared for her visits.” This perceived lack of

preparation of the ALN by BN Semester two participants appeared to be in relation to their

understanding of the role and the fact that the ALN was also supervising students in other wards.

75%

17%

8%

0%

46%

31%

23%

0%

60%

24%

16%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%


Re

spo

nse

Fre

qu

en

cy

Response

Preparation of ALN

Ward 6

Ward 24

Total

20

Figure 10: Did you understand the role of the Academic Liaison Nurse (ALN)?

Ninety-six percent of students indicated that they understood the role of the ALN at the midway point in

the placement. Students were again asked the same question on completion of their placement and at

this point 100% of the students indicated that they understood the role. However, this finding is

restricted to Ward 6 as insufficient questionnaires were returned from Ward 24 to make comparisons.

92%

8%

100%

0%

96%

4%

0%

20%

40%

60%

80%

100%

120%

Yes No

Re

spo

nse

Fre

qu

en

cy

Response

Understand the role of the Academic Liaison Nurse (ALN)

Ward 6

Ward 24

Total

21

Figure 11: Did you understand the role of the Academic Liaison Nurse (ALN)?

Figure 12: To what extent is there an overlap between the roles of the CLN and ALN?

100%

0%

92%

8%

0%

20%

40%

60%

80%

100%

120%

Yes No

Understanding the role of the ALN: Ward 6

End of placement


50%

8%

25%

17%

8%

38%

31%

23%

28%24%

28%

20%

0%

10%

20%

30%

40%

50%

60%

Fully Substantially Partially Not at all

Re

spo

nse

Fre

qu

en

cy

Response

Extent of overlap between CLN and ALN roles

Ward 6

Ward 24

Total

22

Fifty-two percent of students felt that there was either full (28%) or substantial (24%) overlap between

the roles of ALN and CLN. This finding is acceptable as some overlap is desirable and despite the

perceived overlap most students clearly understood the roles of the CLN’s and ALN’s

Teamwork

Students reported that they contributed to the team and that they were able to support staff in return.

“The fact that I can actually help and not just be there and get their support, but I can actually support

them back in some ways was good.” Being part of the team was seen as everyone getting something

out of the situation, in other words, a win-win situation for all involved. “It’s a knock-on effect as well

because you get something from the nurses and you give something to someone else. Everyone gets

something out of the situation.” Staff reported that students were very much a part of the team. “You

could actually see the students actually blending in, becoming part of the team like they actually belong

there.”

There was strong evidence that the CLN, ALN and CNM made a good team and that they worked well

together. The role of the CNM in promoting teamwork is not to be underestimated as reflected by an

ALN. “She [CNM] would always check with me every week, she would say “how are your students?” and

we would just have a half hour conversation and just talk about the students.”

I also like the way the charge nurse makes sure that all the students work, for example

everyday we have meetings where the doctors rounds are discussed and she makes sure all

the students are happy with preceptors. That makes us feel like we are part of the team.

Support from preceptors was valued and they were perceived as better informed about students.

Generally the preceptors coped really well. I think they were a bit better informed than

usual about what were the expectations of our BN2, BN3 and BN6 students. They were a

bit more aware of the different levels. They seemed to have more understanding of the

students’ assignments, because they have to do care studies.

I reckon if you have a really good day with your preceptor you learn heaps. Like one of

them said to me you know you are so enthusiastic and it’s really good for me that you are

asking questions, because I learn as well.

Data suggested that non-preceptoring staff supported students and that students perceived them as

interested in their learning and that they cared about them. “But sometimes even though they are not

our preceptors the other nurses are willing to help.” The level of support in the DEU was such that if a

preceptor relationship did not work out it did not matter much. “The preceptor to student didn’t always

work, but you have so much support it didn’t really matter if it didn’t work.” There were also reports

that the multidisciplinary team members included students in learning opportunities. “They actually

went out of their way sometimes if they were doing something and there were some students around.

They took us with them and showed us what they were doing.” Teamwork was also seen as more

23

structured compared to non-DEU wards “the structure is really good, for example there is a special nurse

doing their roster and all those sorts of things.” With students included in the team, the level of

commitment, by staff, to student learning increased as reflected in the following quotation.

Before this programme for me personally I don’t care whether I get the students or

whatever, because I am so busy. I don’t have a student, “oh that is my blessing”. But now it

is different, that is my role and I have to fulfill it.

A positive effect of teamwork was the building of students’ confidence and the development of trust in

students by staff. “I think it gives them more confidence, like trusting them to make a phone call to the

doctor.”

Figure 13: To what extent were your responsibilities within the health care team explained?

Forty-six percent of students felt that their responsibilities within the health care team was either

partially (42%) or not at all (4%) explained.

54%

8%

38%

0%

23% 23%

46%

8%

38%

15%

42%

4%

0%

10%

20%

30%

40%

50%

60%


Re

spo

nse

Fre

qu

en

cy

Response

Explanation of own responsibilities within health care team

Ward 6

Ward 24

Total

24

Figure 14: To what extent did the organisation of care reflect a commitment to teamwork?

Seventy-seven percent of the students reported that the organisation of care reflected a commitment to

teamwork and 31% felt this was done fully and 46% felt it was substantial.

Figure 15: To what extent did the organisation of care enable you to function as a member of the health care team?

46%

23%31%

0%

15%

69%

15%

0%

31%

46%

23%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%


Re

spo

nse

Fre

qu

en

cy

Response

Organisation of care reflected a commitment to teamwork

Ward 6

Ward 24

Total

54%

23% 23%

0%

23%

62%

15%

0%

38%42%

19%

0%0%

10%

20%

30%

40%

50%

60%

70%


Re

spo

nse

Fre

qu

en

cy

Response

Functioning as a member of the health care team

Ward 6

Ward 24

Total

25

Eighty percent of the students reported that the organisation of care enabled them to function as a

member of the health care team. Students state that “the team worked well; especially being a part of

the multidisciplinary team was a wonderful experience.”

Support

Peer Learning and Peer Support

The DEUs are unique in that students of different levels were in clinical at the same time, creating the

opportunity for peer learning and peer support. “I felt I was part of this team with the students, because

while you may not be comfortable to ask a nurse you can ask from [sic] a student.” This participant went

on to say “It helps when you have your peers to support you.” Less experienced students valued learning

from more experienced students as they find them easy to approach and ask questions.

It was so helpful to have BN6 students, because they are more knowledgeable than us

and more experienced than us. Sometimes it was easy to go and ask them some of the

things that we are not familiar about in the ward.

Besides learning from each others experiences, students felt that their peers were accessible and

available to them as they were always around, checking on each other’s welfare. “She [fellow student]

is always around and if you’re just doing something she will come and ask if you are okay or if you need

help.” This participant went on to say. “I think it is good to have someone at an upper level than you

are, because you know you can go and ask them things that you don’t know.”

Peer teaching and learning was encouraged and observed by staff as students took initiative in

establishing their own support groups. “The second year showed the third year how to set up an

infusion. She just went through the process and I [preceptor] just stood back and listened to her.”

Through peer support and learning, students developed assertiveness. “Just knowing I guess that each

of us have the support of one another helped us kind of stand up to those issues that were hard.”

Student saw peer learning as two way learning, a way of refreshing your own knowledge. “It’s like

refreshing your own knowledge. I think it is a great thing teaching someone else, because it’s both way

learning. It’s not just you telling someone else, but it’s yourself as well.” In addition it enables students

to identify others in need. “It is interesting that the group [fellow students] have identified the

struggling students for themselves.”

Students have identified the need for more time to provide support to one another and that this may be

structured by the DEU.

26

Figure 16: To what extent did you make use of the opportunity for peer learning and support from other students?

Ninety-two percent of students made either fully (54%) or substantially (38%) use of peer and student

support at the midway point of their placements. Students were asked the same question on

completion of their placement and at this point 88% indicated that they fully use peer and student

support and the remaining 13% used it substantially. This finding is restricted to Ward 6 as insufficient

questionnaires were returned from Ward 24 to make comparisons.

46%

38%

8% 8%

62%

38%

0% 0%

54%

38%

4% 4%

0%

10%

20%

30%

40%

50%

60%

70%


Re

spo

nse

Fre

qu

en

cy

Response

Making use of peer and student support

Ward 6

Ward 24

Total

27

Figure 17: To what extent did you make use of the opportunity for peer learning and support from other students?

Student felt the tutorials were very useful as reflected in the following statement: “Attended tutorials

where students were able to talk about their experiences and share info. Very good and beneficial

sessions.” They went on to say “there was a huge support given by senior students especially those in BN

6.”

Additional Support

The support by the CNM was very visible and her interest in the students was highly valued.

We would find the charge nurse coming frequently to us and asking how we are going,

what our progress was, and what our problems were. She was really eager to help us. I

thought that was really good, because in my previous placement I hardly spoke to the

charge nurse, so it was really good. I felt really supported.

The support from other staff was also valued, they were seen as willing, dedicated, interested, and

looking out for learning opportunities for students. “From the nurses to health care assistants, everyone

in the ward, I think the fact they knew we were students I think the support was really good.” However,

students reported variability in the support from preceptors and felt that some preceptors required

more information about the students and how to provide constructive feedback. A preceptor day was

suggested as a possible solution to this issue.

88%

13%

0% 0%

46%38%

8% 8%

0%10%20%30%40%50%60%70%80%90%

100%

Use of peer learning and support by students: Ward 6

End of placement


28

Students Learning Needs

The data from both staff and students suggested that there were too many students at certain times,

resulting in too many bodies for the physical space and for the available equipment. This was not seen

as a major problem with the DEU concept but rather a practical issue of accommodating so many people

in one space. This was particularly the case during the early afternoons when morning and afternoon

shifts overlapped and when all three levels of students were allocated to the DEUs. “I think sometimes

for the staff we are just too much for them. For us it is about six on the morning and sometimes six in the

afternoon.” A staff member suggested “We don’t find it as stressful as before, even though we are

having two or three students to one nurse, it is not as stressful as how we used to look at it before the

DEU started.” Participants offered possible solutions such as the use of the whanau room or arranging

study sessions during these peak hours.

Students were growing in confidence as a result of being in a DEU and they started taking on

responsibility for their own learning. Students became more committed to learning. “Everyone is so

focused on teaching you, so you are more interested in making your own learning. I think it has been

really good and one of the best experiences I have had on the ward.” A staff member remarked “They

had their own small timetable set so at this hour I am doing this, at this [sic] hour I am doing this [sic].

That actually worked quite well.” Because of the support in place it was possible to identify students in

need at an early stage as reflected in the following statements. “But with this system there is no room

for the students to escape.” “It highlighted the ones that were slow.”

While the DEUs enhanced the students’ learning experiences, the workload of the unit impacted at

times, on students’ learning needs as students felt they did everything instead of focusing on their

learning. “We end up helping everyone and sometimes I think we need some time to actually focus on

them and really focus on the care and not with everyone else as well.” By attending too many patients

students got mixed up and confused when questioned by the ALN or CLN. “My lecturer would ask

about the medications for my focus patient and then I wouldn’t be able to remember, because I get

mixed up with everyone else.”

Student learning was also influenced by inconsistency in feedback and some preceptors were not as

confident as others in providing feedback.

Sometimes you work with a nurse and you just go and do your thing and there is no

feedback or communication and sometimes someone you have got someone else who

takes the time to say this I what you have done and can you give me the rationale and

this is what you can do to improve. That is more helpful, so you find you would rather

be with this person and you feel short changed when with the other nurse. I think it

should be consistent throughout, so there should be a way at looking at it so nurses

operate in a uniform manner. Another participant stated “We are coming to our last

two weeks now and I have looked at some of our ongoing assessments and we need

constructive criticism.”

29

From the data is was clear that BN semester two students needed more CLN and ALN contact and a

more structured approach to their learning within the DEU. The expectations of BN semester two

students were not always clear.

There would be some kind of plan of action for our [BN semester two] education while we

were there. I will be honest with you [CLN] has never stopped and said “how’s it going?,

have you done this yet?, have you done that?, have you done an assessment?”

There was also a general need for more clarification of student scopes of practice and tasks.

There was this whole grey area over administration of medicine through an IV line and

they kept pulling up information of the Counties Manukau District Health Board

website and saying look you can, its right here. We can’t, we are not allowed to.

Access to information

Access to the intranet and the internet via computers impacted on student learning with some students

feeling that they had good access even though they had to ask staff to log them on while others were

very critical about this. Staff felt that student access would enhance their performance.

I think from an education perspective it would have been great for students to have I

don’t know whether they have it before they come in or after they come in computer

access. It proved really hard for us. I think it would be good if a preceptor can say “go

could you quickly go and look up this and look up that.”

30

Figure 18: To what extent were you able to access electronic information within the area e.g. policies, procedures, forms?

Twenty-seven percent at the midway point of the placement felt that they only had partial access to

electronic information while 4% felt they had no access at all. When asked again on completion of the

placement 43% felt they had only partial access and 14% felt they had no access at all to electronic

information. This finding is restricted to Ward 6 as insufficient questionnaires were returned from Ward

24 to make comparisons.

31%

38%

31%

0%

38%

31%

23%

8%

35% 35%

27%

4%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


Re

spo

nse

Fre

qu

en

cy

Response

Access to electronic information

Ward 6

Ward 24

Total

31

Figure 19: To what extent were you able to access electronic information within the area e.g. policies, procedures, forms?

While students felt that Southnet was very useful, they had issues with gaining access as reflected in the

following statement: “Only problem was that sometimes we needed to ask staff to log in for us to access

electronic info.”

29%

14%

43%

14%

31%

38%

31%

0%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


Access to electronic information

End of placement


32

Figure 20: To what extent were you able to access written information within the area e.g. policies, procedures, forms?

Fifteen percent of the students felt they only had partial access to written information on the DEU at the

midway point of their placements. When asked again on completion of the placement 19% answered

the question in the negative of which 12.5% felt they had no access to written information. This finding

is restricted to Ward 6 as insufficient questionnaires were returned from Ward 24 to make comparisons.

54%

38%

8%

0%

46%

31%

23%

0%

50%

35%

15%

0%0%

10%

20%

30%

40%

50%

60%


Re

spo

nse

Fre

qu

en

cy

Response

Access to written information

Ward 6

Ward 24

Total

33

Figure 21: To what extent were you able to access written information within the area e.g. policies, procedures, forms?

A series of questions were put to students to gauge how the DEU was meeting their learning needs.

Figure 22: To what extent did staff enable you to contribute to patient assessments?

50.0%

37.5%

0.0%

12.5%

53.8%

38.5%

7.7%

0.0%0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Access to written information: Ward 6

End of placement


42%

33%

25%

0%

31%

38%

23%

8%

36% 36%

24%

4%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


Re

spo

nse

Fre

qu

en

cy

Response

Contribution to patient assessment

Ward 6

Ward 24

Total

34

At the midway point in the placement 24% of students felt that staff only partially enabled them to

contribute to patient assessments and 4% felt that it was not occurring at all. Students were asked the

same question on completion of their placement and at this point 50% indicated that they fully

contributed to patient assessment and 50% felt they did so substantially. This finding is restricted to

Ward 6 as insufficient questionnaires were returned from Ward 24 to make comparisons.

Figure 23: To what extent did staff enable you to contribute to patient assessments?

50% 50%

0% 0%

42%

33%

25%

0%0%

10%

20%

30%

40%

50%

60%

Fully

Sub

stan

tial

ly

Par

tial

ly

No

t at

all

Contribution to patient assessment: Ward 6

End of placement


35

Figure 24: To what extent did staff enable you to contribute to care plans?

Midway through their placement 19% of students felt that staff only partially enabled them to

contribute to care plans and 4% felt that it was not occurring at all. Students were asked the same

question on completion of their placement and at this point 37.5% indicated that they fully contributed

to care planning and 62.5% felt they did so substantially. This finding is restricted to Ward 6 as

insufficient questionnaires were returned from Ward 24 to make comparisons.

38% 38%

23%

0%

31%

46%

15%

8%

35%

42%

19%

4%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%


Re

spo

nse

Fre

qu

en

cy

Response

Contribution to care plans

Ward 6

Ward 24

Total

36

Figure 25: To what extent did staff enable you to contribute to care plans?

Figure 26: To what extent did staff enable you to contribute to nursing interventions?

Midway through their placements 20% of students felt that staff only partially enabled them to

contribute to nursing interventions. Students were asked the same question on completion of their

37.5%

62.5%

0.0% 0.0%

38.5%

38.5%

23.1%

0.0%0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Fully

Sub

stan

tial

ly

Par

tial

ly

No

t at

all

Contribution to care planning: Ward 6

End of placement


42% 42%

17%

0%

31%

46%

23%

0%

36%

44%

20%

0%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%


Re

spo

nse

Fre

qu

en

cy

Response

Contribution to nursing intervention

Ward 6

Ward 24

Total

37

placement and at this point 50% indicated that they fully contributed to nursing intervention and 50%

felt they did so substantially. This finding is restricted to Ward 6 as insufficient questionnaires were

returned from Ward 24 to make comparisons.

Figure 27: To what extent did staff enable you to contribute to nursing interventions?

Figure 28: To what extent did staff enable you to contribute to the evaluation of care?

Midway through their placements 28% of students felt that staff only partially enabled them to

contribute to the evaluation of care and 8% felt that was not occurring at all. Students were asked the

50.0% 50.0%

0.0% 0.0%

41.7% 41.7%

16.7%

0.0%0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Fully

Sub

stan

tial

ly

Par

tial

ly

No

t at

all

Contribution to nursing intervention: Ward 6

End of placement


25%

42%

17% 17%

31% 31%

38%

0%

28%

36%

28%

8%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


Re

spo

nse

Fre

qu

en

cy

Response

Contribution to evaluation of care

Ward 6

Ward 24

Total

38

same question on completion of their placement and at this point 38% indicated that they fully

contributed to the evaluation of care and 62% felt they did so substantially. This finding is restricted to

Ward 6 as insufficient questionnaires were returned from Ward 24 to make comparisons.

Figure 29: To what extent did staff enable you to contribute to the evaluation of care?

Figure 30: Was time set aside to discuss your individual learning outcomes and responsibilities with the ALN?

38%

62%

0% 0%

25.0%

41.7%

16.7% 16.7%

0%

10%

20%

30%

40%

50%

60%

70%

Fully

Sub

stan

tial

ly

Par

tial

ly

No

t at

all

Contribution to the evaluation of care: Ward 6

End of placement


77%

23%

73%

27%

75%

25%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Yes No

Re

spo

nse

Fre

qu

en

cy

Response

Time set aside to discuss learning outcomes with ALN

Ward 6

Ward 24

Total

39

Twenty-five percent of students felt there was no time set aside to discuss learning outcomes with the

ALN.

Figure 31: Was time set aside to discuss your individual learning outcomes and responsibilities with the CLN?

Thirty percent of the students felt that there was not enough time set aside to discuss their learning

needs with the CLN. Students reported that “both ALN and CLN were dedicated and helpful and ensure

my learning progress goes well” While this appears to be working well, students felt there was “not

enough time set for both.”

77%

23%

60%

40%

70%

30%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Yes No

Re

spo

nse

Fre

qu

en

cy

Response

Time set aside to discuss learning outcomes with CLN

Ward 6

Ward 24

Total

40

Figure 32: To what extent did this clinical experience enable you to achieve your learning outcomes?

At the midway point in their placements 92% percent of students felt that the clinical experience

enabled them to achieve their learning outcomes either fully (42%) or substantially (50%). Students

were asked the same question on completion of their placement and at this point 75% indicated that

the clinical experience enabled them to fully achieve their learning outcomes and 25% felt it did so

substantially. This finding is restricted to Ward 6 as insufficient questionnaires were returned from

Ward 24 to make comparisons.

64%

27%

9%

0%

23%

69%

8%0%

42%

50%

8%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%


Re

spo

nse

Fre

qu

en

cy

Response

Achievement of learning outcomes

Ward 6

Ward 24

Total

41

Figure 33: To what extent did this clinical experience enable you to achieve your learning outcomes?

Figure 34: To what extent did this clinical experience enable you to achieve the prescribed competencies?

75%

25%

0% 0%

64%

27%

9%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%


Achievement of learning outcomes: Ward 6

On completion of placement


64%

27%

9%

0%

38%

62%

0% 0%

50%46%

4%0%

0%

10%

20%

30%

40%

50%

60%

70%


Re

spo

nse

Fre

qu

en

cy

Response

Achievement of prescribed competencies

Ward 6

Ward 24

Total

42

Midway through their placements 96% of students felt that the clinical experience enabled them to

achieve the prescribed competencies either fully (50%) or substantially (46%). Students were asked the

same question on completion of their placement and at this point 62.5% indicated that the clinical

experience enabled them to fully achieve the prescribed competencies and 37.5% felt it did so

substantially. This finding is restricted to Ward 6 as insufficient questionnaires were returned from

Ward 24 to make comparisons.

Figure 35: To what extent did this clinical experience enable you to achieve the prescribed competencies?

BN semester 2 students felt that “2 weeks of placement is short to achieve learning outcome.” This

constraint is related to the structure of the curriculum and not the DEU.

62.5%

37.5%

0.0% 0.0%

63.6%

27.3%

9.1%0.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Fully

Sub

stan

tial

ly

Par

tial

ly

No

t at

all

Achievement of competencies : Ward 6

On completion of placement


43

Figure 36: To what extent did the DEU environment enable you to practise in a culturally safe manner?

Midway through their placements 38% of students in Ward 6 reported that the DEU environment only

partially enabled them to practise in a culturally safe manner compared to 8% in Ward 24. Students

were asked the same question on completion of their placement and at this point only 13% felt that the

environment only enabled them to partially practise in a culturally safe manner. This finding is

restricted to Ward 6 as insufficient questionnaires were returned from Ward 24 to make comparisons.

46%

15%

38%

0%

31%

62%

8%

0%

38% 38%

23%

0%0%

10%

20%

30%

40%

50%

60%

70%


Re

spo

nse

Fre

qu

en

cy

Response

Practising in a culturally safe manner

Ward 6

Ward 24

Total

44

Figure 37: To what extent did the DEU environment enable you to practise in a culturally safe manner?

The questionnaires provided students with the opportunity to comment on how the DEU compared with

their previous experiences in the preceptor model. A student reported the difference as: “More support

from CLN + ALN, felt more like I was part of the team. More opportunities to observe procedures + be

with other nurses outside the main ward. More students on the ward so I had more peer support.” They

also felt that the “DEU is concentrated on the attainment of the competencies of the student while

previous experience of the preceptor model is just a matter of compliance with the academic

requirements.”

The questionnaire also explored things that were most valuable to their learning needs. Numerous

students reported positively about their DEU experience as reflected in the following comments:

“I have really enjoyed being part of the DEU and feel that it is definitely the best way for students to

learn in the future.”

“I’ve had a great experience so far that it contributing to the nurse that I will become. A very helpful and

positive experience personally.”

“The ability to use other [students] for peer learning. The willingness of staff to facilitate learning

outcomes.”

63%

25%

13%

0%

46.2%

15.4%

38.5%

0.0%0%

10%

20%

30%

40%

50%

60%

70%

Practising in a culturally safe manner: Ward 6

End of placement


45

“Teaching sessions from different health care workers eg physios, pacific health care supporters,

infection control etc.” The multidisciplinary approach to learning was most valuable to the students’

learning needs and is unique to the DEU.

46

RECOMMENDATIONS

From the results of this study the researchers recommend the following considerations for the second

cycle of the action research project:

Students should be informed about the DEU in a timely and consistent manner prior to the

orientation day and commencement of the DEU

The process in allocating students to the DEU should be fair and transparent

A process should be developed to inform all multidisciplinary team members, including

preceptors about the DEU model

Ensure that MIT semester teams and DEU processes are aligned and supportive of the ALN and

the students allocated to the DEU

During the orientation day further clarification is required on:

the learning outcomes and student scopes of practice

roles and responsibilities of ward staff and team members. Where possible DEU staff

could be introduced to students to talk about their roles and expectations

Generate a list of frequently asked unit questions and answers, that would assist future students

to adapt to their clinical environment

Provide new staff with orientation to the DEU model as soon as possible

Ensure the supernumerary status of the CLNs and ALNs is maintained while students are present

on the units

Consider additional availability of the ALNs and CLNs on afternoon shifts

Further develop the partnership between CLN, ALN, preceptor and student to more closely link

theory and practice and to maximise the unique learning opportunities in the unit

Consider how the number of students in a physical space such as the duty room could be

reduced during handover without compromising the students’ learning

The placement period of BN semester 2 students should be more structured to maximise the

limited time in the DEU. Both students and DEU staff need to be clear on what they should

achieve during their placement

Consider better ways for students to access electronic information

Consistency with feedback from preceptors and nurses and, preceptors should be allocated time

to give constructive feedback to students

Consider developing students’ ability to receive and deliver constructive feedback.

47

REFERENCES

Baird, S., C., Bopp, A., Kruckenberg, K., K., Langenberg, A., S., & Matheis-Kraft, C. (1994). An

innovative model for clinical teaching. Nurse Educator, 19(30), 23-25.

Henderson, A., Twentyman, M., Heel, A., & Lloyd, B. (2006) Student’s perceptions of the psycho-

social clinical learning environment: an evaluation of placement models. Nurse Education

Today, 26(7), 564-571.

Joynt, J., & Kimball, B. (2008). Blowing open the bottleneck: Designing new approaches to increase

nurse education capacity. Oregon Healthcare Workforce Institute. White Paper.

Kemmis, S., & McTaggart, R., (1988). The action research planner. 3rd ed. Deakin University: Victoria.

KPMG Consulting. (2001). Strategic review of undergraduate nursing education: Report to Nursing Council of New Zealand. Wellington, New Zealand: Author

Melander, S., & Roberts, C. (1994). Clinical teaching associate model: creating effective BSN

student/faculty/staff nurse triad. Journal of Nursing Education, 33(9), 411-416.

Mills, G. E., (2003). Action research: A guide for the teacher researcher. 2nd ed. Merrill Prentice Hall:

New Jersey.

Nehls, N., Rather, M., & Guyette, M. (1997). The preceptor model of clinical instruction: the lived

experiences of students, preceptors and faculty- of-record. Journal of Nursing Education,

36(5), 220-227.

Ranse, K., & Grelish, L. (2007). Nursing students’ perceptions of learning in the clinical setting of the

Dedicated Education Unit. Journal of Advanced Nursing, 58(2), 171-179.

48

Appendix 1: Tables with Qualitative Comments

Table 1: How do you rate your orientation to the area?

Ward BN Comment

6 Had a day of orientation which prepared me adequately for the ward.

6 I have to ask which one is my preceptor. However she was very organised maybe she wasn’t told! (just thoughts or views).

6 Orientation was very clear and staff welcome to help identify some areas in the ward.

6 3 Fantastic – We had a lot of small orientations to help us learn the layout in small time frames, so we weren’t overwhelmed.

6 The CLN did a great job showing and telling us about everything about the ward.

6 2 The orientation was fantastic. Gave a good indication of what the DEU was all about.

24 Friendly open, easy to approach staff.

24 2 Need more orientation about the routine of each shift.

24 The area was well oriented.

24 I had routine of ward and PM shift. I had chance to supervision of basic nursing care and course about roles of health care team members.

24 3 The Clinical Liaison Nurse showed all around, where everything was in the ward on orientation.

24 3 Within the 1st

week we were shown everything around the ward.

24 2 Had been given orientation 3 times, which was fine by me, were more knowledgeable and I felt more confident.

24 3 I know the ward well within short period of time.

24 2 It was quite fast but suppose it was not what I expected in orientation in the area on my first day. I put my bag in a little office with everyone else’s stuff squashed on the table. People just staring but I just smiled and did whatever until my preceptor came at 3 pm when I started at 1pm.

24 2 We were shown around the ward and the major points of interest (ie storage room, med room etc) were pointed out.

24 2 Referring to the critical orientation with [Clinical Coordinator] this was very good, but there was no orientation of the ward on our first day.

49

Table 2: How do you rate your welcome to the area?

Ward BN Comment

6 Most nurses were friendly and welcoming making me feel at ease

6 Excellent staff were good. Welcoming environment

6 Must be past experiences they weren’t introduced! Just a personal viewpoint

6 Some staff don’t look happy or not welcoming to students

6 3 Because we had induction day – I felt very welcome on my first day

6 The orientation day really helped I knew where I was going, the staff knew we were coming

and they were really welcoming

6 2 Don’t really get welcomed on my first day. Just went with my preceptor

24 Friendly staff, all willing to help and orientate us

24 A warm welcome was given

24 They put the welcome sheet on the announcement board and introduce me to all the staff

24 3 We had a tour all around the ward on orientation day

24 3 Most of the nurses were welcoming

24 2 It was warm, inviting, my preceptors were great at teaching and educating me

24 3 Warm welcome to a friendly ward/environment

24 2 I introduced myself and explained who I was. Then I asked who would be my preceptor –

staff was unsure. I just went to a colleague student and helped do the medication orders

with the RN present

24 2 Although there was a note near the front entrance of the ward say “welcome to BN2

students” there was no formal introduction to any of the staff until 2 hrs later when we

attended handover.

50

Table 3: How do you rate the preparation of ward staff for the DEU?

Ward BN Comment

6 Most of them were open and communicated well. Some however, did not say much which

was not very helpful to student’s learning

6 Staff were more than prepared and willing

6 However the preceptor I had was awesome and helpful. She works smarter not harder

(Maybe because she was an MIT graduate! Complement!)

6 3 I think the staff were prepared, but perhaps not for the quantity of students arriving

6 2 Clinical liaison nurse and academic liaison nurse was very good and helpful. Ward staff

weren’t that prepared

24 At times I felt some may not have been informed of what was happening with DEU students.

Some are not as forthcoming as others.

24 Having said that some staff are not welcoming and shows dislikes of students

24 The ward staff were more cooperative and helpful

24 3 The staff for the DEU were very helpful specially the Clinical Liaison and Academic Liaison.

24 3 It was okay

24 2 Very good most of the staff were aware of us even though they could have easily mixed us

from BN3 and BN2

24 3 Well planned and prepared

24 2 Only the staff on the DEU programme knew about the DEU whereas the rest did not know

what was expected of us. I was buddied up with 4 different preceptors 1 Sen Enrolled N, a

new grad (1yr) RN and a RN of many years of experience. I took upon myself to do my own

learning.

24 2 All the staff on duty were aware of who we were are, what we were therefore and why

24 2 I did not see any preparation, it would have been beneficial if there had been plans drawn up

as to what our objectives were in relation to the DEU

51

Table 4: How do you rate the preparation of the Clinical Liaison Nurse for the DEU?

Ward BN Comment

6 Very helpful especially at the start of the clinical experience. Ensured that we learnt how to

do things the right way and supported us throughout

6 Very helpful and dedicated working with students

6 Clinical liaison’s always prepared for the next week and students know what to expect

6 3 I think the CLN was prepared for the role and was also very supportive

6 She has been wonderful, her clinical expertise really helped me

6 2 Was very good

24 Helpful, punctual, dedicated, hardworking in planning education seminars/teaching sessions

for us which have been very helpful and much appreciated to help understand

24 Good, supportive, caring

24 3 She’s well organised and each week she arranges education day with different people who

contribute to the ward. It’s really helpful to us

24 3 The CLN was very supportive, she makes sure that the students are comfortable and if we

have any concerns

24 2 She was prepared with copies for us and keep us informed of any education presentations

24 3 Well prepared and very dedicated and helpful

24 2 At the beginning of placement, I am not sure if she was to approach me, so I approached her

and asked some stuff. She was my preceptor for 1 day but from the second wk I know she is

good in her role. I think she was also busy with the BN 3 students

24 2 Again no preparation was made except the buddy system with RN. We attend workshops

along with other staff from the ward, but I don’t think this was prepared for students

52

Table 5: How do you rate the preparation of the Academic Liaison Nurse for the DEU?

Ward BN Comment

6 2 Don’t really understand her role but ALN role is probably more prominent in BN3

6 Very well prepared. Always there to support our clinical experience with academic

knowledge

6 Good communication with students, excellent work

6 Academic liaison were always helpful and always there when needed

6 3 I think the ALN was very prepared for their role, and I felt very supported by her

6 She has done a wonderful job. It was a great help having her in the wd, if I had any doubt

about anything I always went to her.

6 2 Was very good

24 Very helpful and punctual. The ALN I have found informative and very passionate about our

learning

24 The Academic Liaison Nurse was very supportive, co-operative, knowledgeable, caring

24 3 She’s really helpful and explains us things if we are unsure of anything. She visits us

everyday during clinicals

24 3 It was helpful, and she always made sure we were happy with everything

24 2 Very thorough and patient

24 3 Well prepared and very dedicated and helpful

24 2 I did not get much help from her. She is a lovely person. I rarely saw her just passing by

quickly. I would have preferred a set time to sit down and discuss some of my concerns with

the learning and requirements for assignments?

24 2 I did not feel there was any preparation, she visited us adhoc and this was not productive as

we could not plan or be prepared for her visits

53

Table 6: To what extent is there an overlap between the roles of the CLN and ALN?

Ward BN Comment

6 They both had experience and knowledge in each others fields. This made it easier for us

because if you talked to one, you would get the amount of info from both sides

6 CLN & ALN were doing a good job when we want to know something

6 Both were supportive as they both could help in academic and clinical situations

6 3 I feel that I approached the CLN and ALN for different reasons

24 CLN and ALN have their own area of responsibility however there is excellent relationship

between the two roles

24 3 The CLN and ALN both supported my learning in every way

24 2 I did not see any overlapping. The ALN just came and went. I am unsure of what the content

of her role involves. The CLN was more involved with BN3 students. This is not a negative

feedback.

2 There didn’t seem to be any cohesiveness between them

Table 7: To what extent were your responsibilities within the healthcare team explained?

Ward BN Comment

6 Just after 1-2 wks of placement most of the nurses knew what our scope of practice was and

the learning outcomes they helped me to achieve them

24 We kind of have to explain what we can and cant do

24 Preceptors usually take the students as HCA and not students need learning and guidance

24 3 I had a good role of taking care of couple of patients myself and ensuring their healthcare

24 2 The preceptors were very thorough and explained everything well

24 2 I just read the expectations on the handouts given at the DEU orientation day early in the year.

The DEU programme information.

24 2 Our responsibilities were not clearly explained and again it was mainly determined by the

preceptor on each shift.

24 2 Never, I was asked what they were

54

Table 8: To what extent did the organisation of care reflect a commitment to teamwork and enable

you to function as a member of the health care team?

Ward BN Comment

6 Team nursing was practised. All patients were everyone’s responsibility even the students

24 Very helpful to be appointed pts as you feel more part of the team. Also encouragement to participate in MDT’s

24 3 Some nurses (preceptors) does not work with the students. They don’t teach much and the enrol nurses do much anyway

24 3 Most of the team was co-operative

24 2 The team worked well; especially being a part of the multi-disciplinary team was a wonderful experience

24 2 I was always willing to assist in whatever nursing care was needed to any patient. I asked if there was anything I could do if I wasn’t needed or busy on my side. I assisted on the other side.

24 2 There were many disputes during handover, especially afterwards about the practice of care by various nurses

Table 9: To what extent did you make use of the opportunity for peer learning and support from other

students?

Ward BN Comment

6 Attended tutorials where students were able to talk about their experiences and share info. Very good and beneficial sessions

6 3 We often spoke to other students to do peer focussed learning

6 We had meeting every wk where students discussed about 1 patient and it was really helpful

24 With other levels of students knowledge it is easier to relate to them. Also to help other students below with things they need to know

24 There was a huge support given by senior students especially those in BN 6

24 We share knowledge between BN6 and BN 3 students

24 3 I always shared my experiences with my peers as I learn a lot from them too

24 2 By asking lots of questions? Attending and participating in the pharmacy, stroke, skin integrity workshops and presentations

24 2 I asked questions and read as much of what I needed to complete my assignment. My preceptors were approachable so I could ask them anything. My student colleagues BN3 were most helpful too. I used my time in the ward to understand the nursing process in a inpatient setting. The experience was great.

24 2 The BN3 students were always very willing to help or answer questions and where possible allowed us to be fully involved with tasks

24 2 I was always asking questions and volunteering myself, the BN3 students were very supportive when requiring help with assignments

24 2 Managed to ask questions from peers and seniors during break time and when the ward was quiet

55

Table 10: To what extent were you able to access electronic information within the area e.g. policies,

procedures, forms?

Ward BN Comment

6 Only problem was that sometime we needed to ask staff to log in for us to access electronic info

6 Haven’t done any within policies & procedures apart from patient notes.

6 Southnet is very useful

6 Had to ask nurses to log on for us

6 3 Although we didn’t have passwords to computer systems all of the RN’s were helpful in gaining access

6 The staff were very helpful in finding any information that I needed

24 Southnet is a very useful tool

24 I can’t get onto the Internet because I don’t have ID and password. But we can get on to Southnet to get the CMDHB information

24 3 We had good access to the Internet and Southnet which helped our learning

24 2 Forms were available so that was easy. Reading patient notes and photocopied – no patient ID’s. Observer data entered by RN for patient.

24 2 Because I asked I was told

Table 11: Was time set aside to discuss your individual learning outcomes and responsibilities with the

ALN and CLN:

Ward BN Comment

6 They were always keen to discuss our outcomes at any time. Always made time for us at least once a week

6 We did have a session on Tuesday with XXXXX, about half an hour where we could discuss patient s that we had worked with

6 3 On a weekly basis

6 They were so great that if forgot about my appointment they came looking for me.

6 2 Didn’t bother me too much though as I was just there to observe and didn’t have any specific objectives

24 At times, times was set out but not continually

24 I wrote down my personal learning outcomes and showed to ALN and CLN

24 3 Yes, ALN takes out time for individual feedback on clinical area and relate things from practical to theory

24 3 Both of them ensured best of learning

24 2 CLN such a busy person + may have got BN3 confused with us BN2 and thought she has discussed learning outcomes

24 3 Both ALN and CLN were dedicated and helpful and ensure my learning progress goes well

24 2 If this DEU programme is to continue it is important to be given some time to welcome students to the programme, establish and understanding of the programme with the preceptors involved.

24 2 A plan of objectives and goals would have benefited, basically we went ahead and did our own thing

24 2 Not enough time set for both

Table 12: To what extent did this clinical experience enable you to: Achieve your learning outcomes;

Achieve the prescribed competencies?

56

Ward BN Comment

6 Everything in the clinical area including staff, Clinical Liaison Nurse and Academic Liaison Nurse were helpful

6 However is a lot to learn & to absorbed, maybe when the DEU system is effectively implemented.

6 What were the learning outcomes?? What were the prescribed competencies??

6 3 At all times during my placement – I Felt fully supported

24 2 2 weeks of placement is short to achieve learning outcome

24 3 Like what we are taught in lecture we get to see in practical in the ward for example different diseases and things.

24 3 I had many different opportunities to learn different things

24 2 Depending on which RN was our preceptor determined how much we were able to do on the ward. Some preceptors were more inclined to allow us to do tasks, some preferred for us to just watch and follow them

24 2 Through being proactive and keen to learn I was able to achieve

Table 13: To what extent did the DEU environment enable you to practice in a culturally safe manner?

Ward BN Comment

6 Potentially maybe because it’s a new project. However culturally safe manner was implemented at all/most times

6 Very supportive DEU staff, so felt safe in the ward and nurses were helpful to

24 By having a cultural safety teaching session

24 3 Having different patients from different culture and working with nurses from different cultures helped my learning

24 2 XXXX the Maori nurse liaison had taken us for cultural safety workshop which was valuable and should be often repeated.

24 2 The ward pt was mainly European and they were lovely and caring. The staff were of cultural diversity, but that was good. The 2

nd last week there were 3 different cultures pt. I asked

where they were from. I greeted a PI patient, cultural safety was respected I felt.

57

Table 14: Comparison with previous experience of preceptor model

Ward BN Comment

6 More support from CLN + ALN, felt more like I was part of the team. More opportunities to observe procedures + be with other nurses outside the main ward. More students on the ward so I had more peer support.

6 DEU makes us work hard and be focussed

6 To be honest I haven’t seen the DEU previous experience of the preceptor model but I assume is not as same and sophisticated as the new DEU, otherwise I wont be writing all these.

6 Staff are very thorough and competent. Very welcoming staff

6 DEU is concentrated on the attainment of the competencies of the student while previous experience of the preceptor model is just a matter of compliance with the academic requirements.

6 Preceptors this year – they knew about the DEU so everyone tried to support the students

6 3 I have really enjoyed being part of the Ward 6 team – cause I really felt like I was a valued member of the team – on previous placement I didn’t have that

6 DEU had a better learning environment esp with CLN and ALN being present in the ward most of the time. The DEU staff were more welcoming towards the students, it didn’t feel I was a burden for them.

6 2 DEU experience helped me a lot with regards to the participation and support of Clinical Liaison Nurse and Academic Liaison Nurse and other students

24 Knowledge, experience, helpfulness

24 Compare to my previous experience, DEU experience is giving me time, authority as a student to function in a way the student nurse should be. Not too much pressure for the students

24 No previous experience of the preceptor model

24 Each shift I can know who’s my preceptor and she would discuss the patient and time management of the care with me. Compare with my previous experience in surgical ward. I needed to find a preceptor each shift because my name was not on the roster

24 3 More attention given more support and better learning opportunity

24 2 Preceptor would understand and know your learning outcomes and ensure time was planned in to achieve them

24 2 To become more involved with the preceptor in DEU than the previous model

58

Table 15: Additional comments

Ward BN Comment

6 This is an excellent program which I think should not end up with us but to continue. It is excellent.

6 Analyse the comments at areas mentioned above but the DEU is a very good education system introduced. Will fruit effectively in the near future!

6 No comment

6 DEU should be strengthened for the benefit of the students because it supports the students in their clinical experience and it should be shared to other students to experience the process being implemented in the pilot areas

6 DEU is a great way of supporting students and encouraging student to learn and gain confidence because there is a lot of people to support

6 3 I have really enjoyed being part of the DEU and feel that it is definitely the best way for students to learn in the future

6 2 I feel more confident to start my shift as I was oriented very well and it was easier for me to work because I am more familiar around the area. I met a few people even before the start of my duty on the orientation w/c makes me more at ease

6 I think it a great idea to have DEU. I feel the CLN did a great job getting other health professionals to talk to us, it gave me a good understanding about their roles.

24 Ive had a great experience so far that it contributing to the nurse that I will become. A very helpful and positive experience personally.

24 During my first 2 days at the placement, I was assigned to a enrolled nurse, who did not help me achieve my goals of my placement. However, this was highlighted to the Academic Liaison Nurse, who made the necessary arrangement for a new preceptor. At once my preceptor told me not to use the Dianamap but to take manual BP. She said students are not allowed to use the Dianamap but I did not use it further in my placement.

24 3 The nurses should be more into it but they don’t seem to teach students much. Some nurses are even rude to students.

24 3 My experience in the DEU is good so far, but it would be helpful if some of the nurses had a better attitude towards student learning.

24 2 I think there were too many students in 1 ward which would have easily confused both staff and patients. So the ration should be a lot lower.

24 3 Is there any opportunity for students to rotate around different wards?

24 2 My personal learning about nursing in an inpatient setting was a great experience. But it would have been better of orientation was done on the first day at placement. Define the roles and expectations and the outcomes required at completion of the DEU programme. It may be just the same if it was not a DEU programme. Privileged to be part of the DEU but could not see the difference to the other students in a ward placement not in DEU. Just wanted to add on why our shifts starts at 1pm and the preceptor starts at 3pm

24 2 I feel that at the end of the clinical experience a type of debrief of our time on the ward would have been valuable. Input and comment from the staff that we worked with would enable us to be aware of areas that we did well in and be able to make changes in those that we were not so competent in

24 2 I believe having a planned itinerary of practices and experiences would enhance the students learning. An opportunity to debrief with the Charge nurse and the CLN and ALN would also be of benefit

2 There should be written plan / guidelines as to what students must achieve at the end of their clinical experience including being able to learn practical things which has not been taught in class so that when the student goes back to class and are introduced to a new topic/concept they will get more understanding because they’re already done the practical aspect

59

Table 16: List two things that were most valuable to your learning needs

Ward BN Comment

6 3 The ability to use other for peer learning The willingness of staff to facilitate learning outcomes

6 3 To work in a DEU ward as provided good support and a very organised environment to learn in

6 3 The ALN, CLN both were very beneficial in guiding our learning and the ward’s nurse were very helpful and helped us to meet our goals every week and the support by everyone was fantastic because I think its DEU so they make sure that students learn

6 3 Communication with nurses and patients Relating patients diagnoses to medications

6 3 Understanding the relationship between theory and practice, putting theory into practice through the help of the medical staff (nurses, doctors etc) in ward 6 Knowing the policies and procedures with the ward

6 3 Teaching sessions from different health care workers eg physios, pacific health care supporters, infection control etc

6 All nurses being very supportive and easy to approach Having the CLN and ALN within the ward so that I could always ask them things that I didn’t know

6 6 Guidance and support form ALN and CLN Peer support learning

24 3 Several educational seminars organised by DEU. Received a lot of attention in my clinical learning from DEU team esp ALN & CLN

Table 17: List two things that you would like to see changed in the DEU

Ward BN Comment

6 3 Having too many students in one space affects students learning needs. Eg not enough preceptors for each student nurse

6 3 Internet access so that we can review stuff, find out information etc. for educational use

6 3 More access to resources eg textbooks

6 3 I think reorientation for the other members of the medical staff in ward 6 should be conducted as it has been observed the other nurses are not aware regarding the practice

6 3 Reduce the number of students in the ward

6 There were few nurses who did not really understand that as students we needed to achieve our learning outcomes and not be there just to do obs for them

6 6 Internet access on the ward More communication from preceptors

24 3 It will be even more beneficial if students are allowed to rotate among different wards so that we can learn other medical ward settings

60

Table 18: Comparison between DEU and old model.

Ward BN Comment

6 3 Enables the student from the very beginning to feel a part of the team

6 3 DEU has made things easy for both students and staff. Both students and staff are more organised than other wards within Middlemore. That makes so much easy

6 3 DEU model seems to be more supportive as I received a lot of support from the CLN and ALN and other nurses. They made me feel like I was a part of the team

6 With DEU all the staff knew that we were suppose to be there and they were very welcoming

6 6 Students benefit more from having different preceptors. Greater support from ALN and CLN as they are available for more hours. Students learning needs are prioritised instead of doing routine tasks like vital signs, bed making etc.

61

Appendix 2: Participant Information Sheet

PARTICIPATION INFORMATION

Title of Project: Dedicated Education Unit (DEU) - Pilot

Principal Investigators: Willem Fourie & Bev McClelland

INVITATION TO PARTICIPATE:

You are invited to take part in the above study. Please take the time to read this document. Your

participation is voluntary and you can decline without penalty of any kind. You may also withdraw from

the research without giving reasons and without being penalised.

ABOUT THE STUDY

The study is a joint initiative between MIT and Counties Manukau District Health Board (CMDHB) and is

aimed at establishing two Dedicated Education Units at Middlemore Hospital in 2009 with the view of

establishing more units across CMDHB services thereafter. DEUs have been introduced in response to

the success factors identified for quality clinical learning and have proven to be sustainable through

their placement of a greater number of students at any one time in a clinical learning context dedicated

to excellence (Henderson et al., 2006).

A DEU is a collaborative model of clinical teaching & learning that:

Facilitates a closer working relationship between clinical staff and MIT to prepare graduates to meet service needs.

Provides consistent clinical support for students and staff. Focuses on the learning needs of students. Encourages and values peer teaching.

All staff in a DEU are strongly focussed on teaching and learning and both staff and students are assisted

and supported by an appointed Clinical Liaison Nurse and Academic Liaison Nurse.

OBJECTIVES OF THE STUDY

The objectives of this project is to pilot DEUs in two identified wards at CMDHB to:

62

Document through research the process of trialling DEU pilot sites

Evaluate the model’s potential ability to support undergraduate nursing students within CMDHB

Make recommendations to the Collaborative Nursing Development Unit (CNDU) on completion of

the project as to the model’s suitability for use as an ongoing undergraduate nursing clinical

education.

Build research capacity through team research between MIT and CMDHB.

PARTICIPANTS IN THIS STUDY:

All staff and students of MIT and CMDHB in Wards 6 and 24 will be invited by one of the principal

investigators to participate. While participation is voluntary there are no exclusion criteria.

The study is likely to involve:

BN students allocated to Wards 6 and 24

2 Clinical Liaison Nurses

2, Academic Liaison Nurses

8 Registered nurses working in the DEU

All project team members not already working in the wards

HOW WILL THIS INVOLVE ME? You may be asked to participate in either individual or focus group interviews. Your interview will be

audio taped. You can ask for the tape recording to be stopped at any time, or for parts, or all of the

tape to be erased. In the case of focus groups it is important to understand that while you could

withdraw from the study at any time it may not be possible to remove your information from the tapes.

Focus groups by nature cannot guarantee anonymity but care will be taken to ensure confidentiality and

that no identifying information is used in any report or presentation. The tapes will be transcribed and

you will not be identifiable in any transcriptions or subsequent research reports or publications. You

may also be asked to complete an anonymous questionnaire to evaluate the DEU. Consent will be

implied by your completing and returning your questionnaire. You may be asked to keep a journal/diary

of your experience in which case your written consent will be asked before the journal diary could be

analysed. Again no identifying information will be used in any report or presentation. You have the

right to request a copy of the research report and to check that no information that could identify you

has been included. Data for the study will be collected during each action research cycle and will come

from the following sources:

Documents such as minutes, duty rosters, action plans, reports and clinical placement evaluations

Focus groups

Individual interviews

Questionnaires

Journals/diaries

63

BENEFITS & RISKS:

The establishment of a DEU will increase the quality of the clinical learning and increase the number of

nursing students supervised in an area at any one time, which in turn will contribute to an increase in

the number of graduates available to the CMDHB workforce. Students will experience a quality learning

experience which will better prepare them for their role and enhance their retention on the programme.

Student’s sense of belonging to CMDHB will be enhanced. Collaboration between service and education

will be further developed increasing the concept of ‘joint responsibility’ for preparing the future

workforce. The DEU environment will encourage collegial relationships between students, nursing staff

and lecturers. The Clinical Liaison Nurse role is an additional career opportunity for RNs and will

contribute to personal professional advancement and succession planning. Students from different

levels of the Bachelor of nursing (BN) could be accommodated in one area with less confusion. The

model is transferable to other nursing schools

FURTHER INFORMATION:

For further information about this research project please contact the researchers directly at:

Dr Willem Fourie: Department of Nursing and Health Studies, Private Bag 94006, Manukau City,

Auckland. Tel (09) 968 8606 ext 8606. Email: [email protected]

Ms B McClelland: Nurse Leader Education and Professional Development CMDHB Tel 021 512 314

Email: [email protected]

You may also contact Dr Helen Anderson of the Manukau Institute of Technology Ethics Committee, for

any ethical concerns regarding this research at: Manukau Institute of Technology, Private Bag 94006,

Manukau City, Auckland. Tel 027 568 8754 Email: [email protected]

APPROVED BY THE MANUKAU INSTITUTE OF TECHNOLOGY ETHICS COMMITTEE on 11 November

2008, for a period of 3 years, until November 2011. Reference E08/NHS/21

mailto:[email protected]


64

Appendix 3: Questionnaire Midway through Placement

STUDENT FEEDBACK ON DEU



Purpose

This student evaluation tool was designed to provide comprehensive feedback on the effectiveness of

communication within the DEU, the teaching and learning opportunities available and the

appropriateness of the environment for student learning.

The evaluation tool is anonymous and will be completed by students. Completed questionnaires will be

treated as confidential and will only be accessible to Willem Fourie and Bev McClelland. Feedback will

be collated and returned to the Research Management Team for analysis and interpretation. This

evaluation tool will assist in the ongoing monitoring and evaluation of each DEU to ensure a quality

clinical experience is available for students.



Dr Willem Fourie: Department of Nursing and Health Studies, Private Bag

94006, Manukau City, Auckland. Tel (09) 968 8606 ext 8606. Email:

[email protected] Ms B McClelland: Nurse Leader - Professional Development CMDHB Tel 021 512 314 Email: [email protected] You may also contact Dr Helen Anderson of the Manukau Institute of Technology Ethics Committee, for







65

Midway Questionnaire

DEU: Ward 6; 24 (circle the one applicable) BN Semester: 2; 3; 6 (circle the one applicable)

Based on your experience, please answer the following questions. Your feedback will help us

ensure students’ clinical experience continues to be positive and valuable. The majority of

questions require you to circle the most appropriate response or mark Yes or No. Space is

provided for you to write any comments you believe are relevant or important. DO NOT write

your name on the questionnaire.

PLEASE INDICATE YOUR RESPONSE AFTER EACH QUESTION by circling the appropriate number

1 =Excellent 2 = Very Good 3 = Poor 4 = Very Poor

1. How do you rate your welcome to the area? 1 2 3 4

Comments:

2. How do you rate your orientation to the area? 1 2 3 4

Comments:

66

3. How do you rate the preparation of ward staff for the DEU? 1 2 3 4

Comments:

4. How do you rate the preparation of the Academic Liaison Nurse

for the DEU? 1 2 3 4

Comments:

5. How do you rate the preparation of the Clinical Liaison Nurse for

the DEU? 1 2 3 4

Comments:

6. Was time set aside to discuss your individual learning outcomes

and responsibilities with the:

6.1 Academic Liaison Nurse (ALN) Yes No

6.2 Clinical Liaison Nurse (CLN) Yes No

Comments:

67

Please use the scale below to answer questions 7 - 16

1 = Fully 2 =Substantially 3 = Partially 4 = Not at all

7. To what extent did this clinical experience enable you to:

7.1 Achieve your learning outcomes 1 2 3 4

7.2 Achieve the prescribed competencies 1 2 3 4

Comments:

8. To what extent did the DEU environment support your learning? 1 2 3 4

Comments:

9. To what extent were your lines of communication in the area

clearly defined and explained to you? 1 2 3 4

Comments:

10. Information

10.1 To what extent were you able to access written

information within the area e.g. policies, procedures,

forms?

1 2 3 4

68

10.2 To what extent were you able to access electronic

information within the area e.g. policies, procedures, forms? 1 2 3 4

Comments:

11 To what extent were your responsibilities within the healthcare

team explained? 1 2 3 4

Comments:

12 To what extent did staff enable you to contribute to all or any

of the following activities with patients:

12.1 patient assessment 1 2 3 4

12.2 care planning 1 2 3 4

12.3 nursing intervention 1 2 3 4

12.4 evaluation of care 1 2 3 4

Comments:

13 To what extent did the organisation of care

13.1 reflect a commitment to teamwork 1 2 3 4

69

13.2 enable you to function as a member of the health care

team 1 2 3 4

70

Comments:

14 To what extent did the DEU environment enable you to practice

in a culturally safe manner? 1 2 3 4

Comments:

15 To what extent is there an overlap between the roles of the CLN

and ALN? 1 2 3 4

Comments:

16 To what extent did you make use of the opportunity for peer

learning and support from other students? 1 2 3 4

Comments:

71

17 Did you understand the role of the Clinical Liaison Nurse

(CLN)?

18 Did you understand the role of the Academic Liaison Nurse (ALN)

19 Were the roles of different people in the area explained to you?

If any roles were not explained please indicate which they were

20. General Comments:

If you are in a position to compare the DEU experience with a previous experience of the

preceptor model, please highlight the main differences from your perspective.

21. If there is anything else you would like to comment on about any of the areas discussed

above, or about the DEU. We would appreciate your feedback.

Please return the completed questionnaire to Sheona Watson or place it in the suggestion box

at A-block reception. Thank you for taking the time to share your perceptions, they will be

collated with those of other students.

YES NO

YES NO

YES NO

72

73

Appendix 4: Questionnaire on Completion of Placement

STUDENT FEEDBACK ON DEU



Purpose

This student evaluation tool was designed to provide comprehensive feedback on the effectiveness of

communication within the DEU, the teaching and learning opportunities available and the

appropriateness of the environment for student learning.

The evaluation tool is anonymous and will be completed by students. Completed questionnaires will be

treated as confidential and will only be accessible to Willem Fourie and Bev McClelland. Feedback will

be collated and returned to the Research Management Team for analysis and interpretation. This

evaluation tool will assist in the ongoing monitoring and evaluation of each DEU to ensure a quality

clinical experience is available for students.



Dr Willem Fourie: Department of Nursing and Health Studies, Private Bag 94006, Manukau City, Auckland. Tel (09) 968 8606 ext 8606. Email: [email protected] Ms B McClelland: Nurse Leader - Professional Development CMDHB Tel 021 512 314 Email: [email protected] You may also contact Dr Helen Anderson of the Manukau Institute of Technology Ethics Committee, for







74

Questionnaire on completion of the DEU placement

Some questions are the same as the questions you answered in the first questionnaire, this is

necessary to compare students’ experiences of placements. A ref number is included for this

purpose. Based on your experience, please answer the following questions. Your feedback will

help us ensure students’ clinical experience continues to be positive and valuable. The majority

of questions require you to circle the most appropriate response or mark Yes or No. Space is

provided for you to write any comments you believe are relevant or important. DO NOT write

your name on the questionnaire.

PLEASE INDICATE YOUR RESPONSE AFTER EACH QUESTION by circling the appropriate number

DEU: Ward 6; 24 (circle the one applicable)

BN Semester: 3; 6 (circle the one applicable)

1 =Excellent 2 = Very Good 3 = Poor 4 = Very Poor

1. (ref 6) How well was your individual learning outcomes and

responsibilities addressed by the:

1.1 Academic Liaison Nurse (ALN) 1 2 3 4

1.2 Clinical Liaison Nurse (CLN) 1 2 3 4

Comments:

75

Please use the scale below to answer questions 2 - 11

1 = Fully 2 =Substantially 3 = Partially 5 = Not at all

2. (Ref 7) On completion of the placement to what extent did

this clinical experience enable you to:

2.1 Achieve your learning outcomes 1 2 3 4

2.2 Achieve the prescribed competencies 1 2 3 4

Comments:

11. (Ref 8) To what extent did the DEU environment support your

learning? 1 2 3 4

Comments:

12. (Ref 9) On completion of the placement to what extent did you

feel comfortable with the lines of communication in the area? 1 2 3 4

Comments:

13. (Ref 10) Information

13.1 To what extent were you able to access written 1 2 3 4

76

information within the area e.g. policies, procedures,

forms?

13.2 To what extent were you able to access electronic

information within the area e.g. policies, procedures, forms? 1 2 3 4

Comments:

14 (Ref 11) To what extent did you take on your responsibilities

within the healthcare team? 1 2 3 4

Comments:

15 (Ref 12) To what extent did staff enable you to contribute to all

or any of the following activities with patients:

15.1 patient assessment 1 2 3 4

15.2 care planning 1 2 3 4

15.3 nursing intervention 1 2 3 4

15.4 evaluation of care 1 2 3 4

Comments:

77

16 (Ref 13) To what extent did the organisation of care

16.1 reflect a commitment to teamwork 1 2 3 4

16.2 enable you to function as a member of the health care

team 1 2 3 4

Comments:

17 (Ref 14) To what extent did the DEU environment enable you to

practice in a culturally safe manner? 1 2 3 4

Comments:

18 (Ref 15)To what extent is there an overlap between the roles of

the CLN and ALN? 1 2 3 4

Comments:

19 (ref 16) To what extent did you make use of the opportunity for

peer learning and support from other students? 1 2 3 4

Comments:

78

20 (Ref 17) Did you understand the role of the Clinical Liaison

Nurse (CLN)?

21 (Ref 18) Did you understand the role of the Academic Liaison Nurse (ALN)

If any roles were not explained please indicate which they were

22. Reflecting on your DEU experience please outline two things that was most valuable to you

in meeting your learning needs

23. Reflecting on your DEU experience please outline things that you would like to see changed

to ensure your learning needs are better met.

24. Please comment on how the DEU model compares to the traditional preceptor model used

elsewhere in Middlemore Hospital (Answer this question only if you have previously

experienced the traditional preceptor model)

YES NO

YES NO

79

Please return the completed questionnaire to Sheona Watson or place it in the suggestion box

at A-block reception. Thank you for taking the time to share your perceptions, they will be

collated with those of other students.

80

Appendix 5: Consent Students

CONSENT TO PARTICIPATION IN RESEARCH

Students


Researchers: Willem Fourie & Bev McClelland

I have been given a verbal and written explanation of this research project and I understand that explanation. I

have had an opportunity to ask questions and have them answered. I understand that I may withdraw myself or

any information I have provided from this project (before data collection is completed), without having to give

reasons and without penalty of any sort. I consent to participate in this research through focus groups and/or the

completion of evaluation forms. I understand that I will not be identified in any transcriptions or subsequent

research reports or publications. I understand that the research findings may be presented at a suitable

conference and that they may be published in an appropriate journal. I understand that taking part in this study is

voluntary and will not affect my studies at MIT or my clinical experience at CMDHB. I understand that the consent

form and data will be stored separately in a locked cabinet at MIT and will be kept for a period of 6 years. I have

had time to consider whether to take part. I know whom to contact if I have any questions about the study.

I agree to take part in this research.

Signed:

Name:

(please print clearly)

Date:

I would like to receive a copy of the research findings: [ ]

This consent form will be held for a period of six years

APPROVED BY THE MANUKAU INSTITUTE OF TECHNOLOGY ETHICS COMMITTEE on 11 November 2008, for a

period of 3 years, until November 2011. Reference E08/NHS/21

81

Appendix 6: Consent Staff

CONSENT TO PARTICIPATION IN RESEARCH

Staff – CMDHB/MIT


Researchers: Willem Fourie & Bev McClelland

I have been given a verbal and written explanation of this research project and I understand that explanation. I

have had an opportunity to ask questions and have them answered. I understand that I may withdraw myself or

any information I have provided from this project (before data collection is completed), without having to give

reasons and without penalty of any sort. I consent to my journal/diary being analysed. I consent to participate in

this research through focus groups / individual interviews and/or the completion of evaluation forms. I

understand that I will not be identified in any transcriptions or subsequent research reports or publications. I

understand that the research findings may be presented at a suitable conference and that they may be published

in an appropriate journal. I understand that the consent form and data will be stored separately in a locked cabinet

at MIT and will be kept for a period of 6 years. I understand that taking part in this study is voluntary and will not

affect my employment at MIT/CMDHB. I have had time to consider whether to take part. I know whom to contact

if I have any questions about the study.

I agree to take part in this research.

Signed:

Name:

(please print clearly)

Date:

I would like to receive a copy of the research findings: [ ]

This consent form will be held for a period of six years

APPROVED BY THE MANUKAU INSTITUTE OF TECHNOLOGY ETHICS COMMITTEE on 11 November 2008, for a

period of 3 years, until November 2011. Reference E08/NHS/21

82

Appendix 7: Focus Group Questions

Focus Group – Students [Note: Similar questions were used for staff and the Action Group members]

Questions:

The preparation of the unit, staff and students

o Tell us about your preparation before arriving in the DEU unit

o Tell us about your preparation upon arrival at the DEU, the first day and first week

o What are your impressions of the preparation of students in the unit

o What are your impressions of the preparation of staff in the unit

Tell us about the role of the CLN, how do see it?

Tell us about the role of the ALN, how do see it?

Tell us about the support for your learning within the unit

Tell us about the team and how you fit in it?

Can you identify any improved clinical educational processes and why do you think they are

improved?

What are your views and experience of peer learning and support within the unit?

Can you identify any educational issues and how they could possibly be resolved?

Tell us how you experienced the communication and liaison between MIT and CMDHB

What re-planning is necessary?

83

Appendix 8: Ethics Approval Letter

84

Appendix 9: CMDHB Approval Letter

Research Officer First Floor, Room 132

Clinical Support Building Middlemore Hospital

12 January 2009 Bev McClelland Education and Professional Development Middlemore Hospital Auckland 1640 Dear Ms McClelland Thank you for the information you supplied to the Clinical Board regarding your research proposal:

EO8 / NHS / 21 Dedicated Education Unit (DEU ) - Pilot

I am pleased to inform you that the Clinical Board Executive has approved this research with you as CMDHB investigator. We wish you well in your project and require an update on how it is progressing. A copy of the progress report that is required by the Ethics Committee is sufficient, and should be submitted to the Research Officer by 12 January 2010. Please note failure to submit the progress report may result in the withdrawal of ethical approval. Yours Sincerely, Alison Robertson Research Officer Cc Willem Fourie

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