7.1 Student registered nurses
Search results
This review included 90 international reviews and 156 Australian studies on the topic of skill development for student RNs.
The quality of the literature was mixed, with the main limitations being the paucity of large scale, multi-site experimental designs.
The challenge of studying educational preparation of clinical skills is conducting studies that identify translation of learning into practice. Studies that attempted to do this often relied on self-reported data, and the inherent bias meant the results should be used with caution. Further, very few studies involved longitudinal follow-up, and therefore the long-term impacts of learning have not been explored.
A number of different tools have been used to assess various approaches to learning and competency. While some of these were validated, others were investigator developed.
Clinical skills
The wide range of skills discussed in the literature demonstrates the diverse role of RNs in contemporary clinical practice.
Most studies and reviews focused on technical skills such as medication administration, identification of a deteriorating patient, indicating the acute-care focus of educational preparation. There was less emphasis on skills related to primary and community care or aged care.
There was also an emphasis on non-technical skills, such as communication, resilience and empathy. This is interesting, because whilst nursing is fundamentally a practical profession, the development of non-technical skills is equally important to ensure a patient-centered approach to clinical practice.
Approaches to teaching and learning
Whilst there are multiple factors that contribute to optimal learning, the focus of the studies included in this review has been towards the approaches to learning, including IPE, clinical placements and simulation.
There is a definite shift in approaches to learning, towards using innovative methods of program delivery. Perhaps the most common approach was blended learning in terms of a combination of lectures, online resources, practical activities and simulation. There was evidence to support that most forms of learning were more effective than using didactic lectures only to deliver information. However, the heterogeneity of combinations of delivery within interventions makes it difficult to identify specifically which modalities derive the most impact on student learning.
The evidence on the impact of IPE is unclear. Many nursing educational programs include some form of IPE in their content, although often this is optional and not assessed. The evidence around the impact of IPE is limited and is restricted to small-scale studies using
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self-reported data. From the available evidence, it appears that students enjoy IPE activities and perceive them to be helpful in developing teamwork, communication and collaboration skills and to understand the roles of other health professionals. The impact of IPE on skills and knowledge acquisition, clinical practice and patient care is not clear.
Assessment of learning
The most popular approach used to assess clinical skills are OSCEs.
There is evidence to suggest that the assessment of students is inconsistent, with some assessors more and less lenient than others and some reluctant to fail students, particularly on clinical placement.
Clinical placement
There was agreement across the literature that clinical placements are a fundamental component of the educational preparation of RNs.
The increase in student numbers and the limited availability of clinical placements appeared to have re-vitalised research interest in clinical placements as a contributor to optimal skill development.
A number of studies focused on student attitudes to placements in specific settings such as aged care, mental health, and primary care. These studies reported that students were often initially negative towards placements in these areas.
Although the roles of the clinical facilitator and RN preceptor are crucial to the students’ experience of the clinical placement, there is evidence that facilitators and preceptors receive limited preparation for the role.
Simulation
Simulation has become a mainstream approach to education delivery and is used in many forms. The innovations identified in the Australian literature provided authentic real-life scenarios for students to engage with and make meaning from.
The evidence regarding the fidelity of simulation was, to a degree conflicting, yet there was evidence to support the consideration that high and medium fidelity simulation are more effective than low fidelity forms.
The substitution of clinical placements with simulation has been explored in the UK and the US.
7.2 Student enrolled nurses
There is very limited literature around the factors affecting the optimal skill development of ENs and therefore it is difficult to draw any conclusions. This review included only three primary studies and no literature reviews relating to student ENs.
7.3 Nurse practitioner candidates
Very few studies focused on the educational preparation of NPs and the factors affecting optimal skill development. This review included two international literature reviews and four primary studies relating to NP candidates.
Australian studies identified the challenges of the current approach to the educational preparation of NPs and the onus that is placed on the NP candidate to organise clinical education that is related to their specialty, including the recruitment of appropriately qualified assessors in their clinical workplace.
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