Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme - Whitireia New Zealand Capital and Coast District ...

 
Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme - Whitireia New Zealand Capital and Coast District ...
Evaluation of Capital and Coast District
Health Board Dedicated Education Unit
pilot programme

Whitireia New Zealand
Capital and Coast District Health Board
Massey University
2017
Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme - Whitireia New Zealand Capital and Coast District ...
Evaluation of Capital and Coast District Health Board Dedicated Education Unit
                                pilot programme

This evaluation was undertaken in 2016 by a team from Whitireia New Zealand, Capital and Coast
DHB and Massey University

Evaluation Team

Dr Ruth Crawford, RN BA MPhil (SocSci) PhD, Principal Lecturer, Faculty of Health, Whitireia NZ

Adelaide Jasonsmith, RN BN PG Diploma Nursing Science, Nurse Educator, Ward 6 Kenepuru, Capital
and Coast DHB

Deborah Leuchars, RN ICU Cert BA (Edu) MN FCNA (NZ), Senior Professional Clinician, Massey
University

Anjana Naidu, RN BN MN, Associate Director of Nursing Workforce Development, Capital and Coast
DHB

Leanne Pool, RN BSN MPhil (Nursing), Academic Leader, Bachelor of Nursing, Faculty of Health,
Whitireia NZ

Laura Tosswill, RN BN PG Diploma, Nurse Educator 6 South, Capital and Coast DHB

Kathy Trezise, RN BN MN, Nurse Educator, Director of Nursing and Midwifery Office, Capital and
Coast DHB

Ms Alexandra Wordsworth, RN BN MHSc CALT CERT Proficiency Simulations and Clinical Skills
Teaching, Senior Nurse Lecturer, Whitireia NZ

Acknowledgements
The Evaluation team wishes to thank the nursing students from Whitireia NZ and Massey University
and staff from Capital and Coast District Health Board, Massey University and Whitireia New Zealand
who participated in this evaluation and contributed to its findings.

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme    i
Executive summary
This report presents findings of research undertaken in 2016 to evaluate the Capital and Coast District
Health Board’s (CCDHB) Dedicated Education Unit (DEU) Programme.

Purpose of the DEU evaluation
A new teaching learning model, the Dedicated Education Unit was developed in the late 1990’s at
Flinders University in Australia. The DEU model has been successfully integrated into clinical learning
environments in Christchurch, Counties Manukau and Hawke’s Bay District Health Boards (DHBs), as
well as being adopted in some clinical areas in Canada, Australia and the UK.

Capital and Coast District Health Board developed a strategic plan to implement a DEU pilot in three
clinical areas in semester two 2016, commencing 25 July 2016. The areas piloting the DEU were Ward
7 North, General Surgical and Vascular ward; Ward 6 South, Regional Heart and Lung Unit; both at
Wellington Regional Hospital and Ward 6 Rehabilitation ward at Kenepuru Hospital. Ward 7 North and
Ward 6 South each placed 10 pre-graduate nursing students from Whitireia New Zealand (Whitireia)
and Massey University (Massey). Ward 6 at Kenepuru placed six pre-graduate students from Whitireia
and Massey, a total of 26 students.

The aim of this research was to evaluate the impact of the DEU pilot on CCDHB nursing staff and
nursing students from Whitireia New Zealand and Massey University.

Key findings
Overall this pilot programme has been very successful, for both students and staff:
     Students described being supported by DHB staff who valued their presence and were
      interested in their learning
     Students were well orientated to the DEU model and to their clinical areas, although
      there were technical issues with the link to Kenepuru; students were issued swipe cards
      and given ICT access which they appreciated, describing feeling as though they
      “belonged”
     Students gained confidence and personal growth and “felt like a nurse”
     Students were given responsibility for patients and preferred to change RN preceptors
      rather than patients in allocated ‘pods’
     Staff reported valuing nursing students presence in the DEU
     All staff took responsibility for student learning, including non-nursing staff
     The Clinical Liaison Nurse (CLN) and Academic Liaison Nurse (ALN) relationship worked
      well generally, ensuring student learning needs were met

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme        ii
Conclusion
The overall success of the DEU pilot is evident in the responses from DHB staff involved in the pilot as
well TEP participants and students. Participants from all focus groups viewed the pilot as being very
positive and DHB participants wanted to see it continue and extended to all areas with an
implementation plan.

This evaluation has found that the impact of the DEU on DHB staff and students has been mainly
positive and beneficial. The DEU is meeting the learning needs of students. Minor quality improvement
issues have been identified and addressed.

Recommendations
1. The DEU continues in 2017 and includes second and third year nursing students. A further
    evaluation is undertaken.
2. Specific DEU roles, Academic Liaison Nurse, Clinical Liaison Nurse and Registered Nurse, are
    agreed upon, clarified and communicated in all areas.
3. Resourcing for the DEU and workload issues are addressed.
4. The CLN is rostered on the DEU unit roster and allocated hours to complete student
    documentation.
5. Improved DEU orientation.
6. A set of DEU principles is agreed upon by the DEU working party.
7. Tertiary Education Providers consider using the same summative documents to assess student’s
    competencies.

            “I felt fully supported and included as part of the team. Learning opportunities
           were encouraged and staff provided all of these…felt comfortable discussing my
                              concerns” [Student participant, online survey]

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme        iii
Contents
Acknowledgements.................................................................................................................................. i
Executive summary ................................................................................................................................. ii
Purpose of the DEU evaluation ............................................................................................................... ii
Key findings ............................................................................................................................................. ii
Conclusion .............................................................................................................................................. iii
Recommendations ................................................................................................................................. iii
Background and introduction ................................................................................................................. 1
    Literature review ................................................................................................................................ 1
    Purpose of Evaluation......................................................................................................................... 3
    Methods.............................................................................................................................................. 4
    Ethical considerations......................................................................................................................... 4
    Data collection .................................................................................................................................... 4
        Phase One: Survey.......................................................................................................................... 4
        Phase Two: Focus groups ............................................................................................................... 5
    Data analysis ....................................................................................................................................... 5
Results ..................................................................................................................................................... 5
    Registered Nurse Survey..................................................................................................................... 5
    Student Nurse Responses ................................................................................................................. 11
Summary of survey findings.................................................................................................................. 18
Qualitative results ................................................................................................................................. 18
    Benefits ............................................................................................................................................. 19
    Improved learning structure............................................................................................................. 19
    Flexibility of DEU structure ............................................................................................................... 20
    Documentation completed by CLN .................................................................................................. 21
    Nurturing Learning Environment ...................................................................................................... 21
    Support for learning ......................................................................................................................... 23
    Teamwork ......................................................................................................................................... 25
    Learning Partnerships ....................................................................................................................... 26
    Managing workload .......................................................................................................................... 28
    Preparation and effective communication ....................................................................................... 28
    Challenges......................................................................................................................................... 28
    Role Clarity........................................................................................................................................ 28
    Building collaborative relationships ................................................................................................. 31
    Resourcing and workload ................................................................................................................. 32
    Communication ................................................................................................................................ 32
Summary of focus group findings ......................................................................................................... 33

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme                                                              iv
Discussion.............................................................................................................................................. 33
Limitations ............................................................................................................................................ 35
Conclusion ............................................................................................................................................. 35
Recommendations ................................................................................................................................ 35
References ............................................................................................................................................ 36
Appendix 1A Surveys............................................................................................................................. 39
    Staff survey ....................................................................................................................................... 39
Appendix 1B .......................................................................................................................................... 42
    Student survey .................................................................................................................................. 42
Appendix 2 ............................................................................................................................................ 45
    Focus group questions ...................................................................................................................... 45

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme                                                           v
Background and introduction
They came and for a time they shared a time, a place, a journey (Anonymous)

This report presents findings of research undertaken in 2016 to evaluate the Capital and Coast District
Health Board’s (CCDHB) Dedicated Education Unit (DEU) Programme. Following ethical approval, a
quantitative survey was conducted with nursing students and DEU nursing staff, followed by six focus
groups with nursing students and DEU nursing staff. This report begins with a review of the literature,
followed by a discussion of the evaluation methods, results and discussion. Recommendations and
conclusion complete the report.

A new teaching learning model, the Dedicated Education Unit was developed in the late 1990s at
Flinders University in Australia. The DEU model has been successfully integrated into clinical learning
environments in Canterbury, Counties Manukau and Hawke’s Bay District Health Boards (DHBs), as
well as being integrated into some clinical areas in Canada, Australia and the UK. The DEU “creates an
environment in which students are encouraged and supported to learn nursing practice, clinical staff
are supported to teach students and academic staff are supported to spend time in the DEU”
(Edgecombe & Bowden, 2014, p. 5). Key principles of the DEU are:

     Clinicians and academics stand alongside each other, acknowledging each other’s
      strengths: clinicians are expert practitioners, academics are expert educators
     Collaborative learning and teaching with academics, clinicians and students
     Preparation, all (students, academics, clinicians) know their roles, responsibilities and
      actions (Edgecombe & Bowden, 2014, p.3).
Capital and Coast District Health Board developed a strategic plan to implement a DEU pilot in three
clinical areas in semester two 2016, commencing 25 July 2016. The areas piloting the DEU were Ward
7 North, General Surgical and Vascular ward; Ward 6 South, Regional Heart and Lung Unit; both at
Wellington Regional Hospital and Ward 6 Rehabilitation ward at Kenepuru Hospital. Ward 7 North and
Ward 6 South each placed 10 pre-graduate nursing students from Whitireia New Zealand (Whitireia)
and Massey University (Massey). Ward 6 at Kenepuru placed six pre-graduate students from Whitireia
and Massey, a total of 26 students.

Literature review
The relevance of the clinical learning environment to the practice and development of the registered
nurse workforce is integral aspect to the sustainability of the nursing workforce. The clinical
environment has a significant role in nursing education as this is where nursing lives and breathes. It
is where nurses think, feel, behave, demonstrate their values and engage in different communication
styles. The clinical environment is where students experience the complexity and challenges nurses
encounter daily (Levett-Jones & Bourgeois, 2015). Additionally the clinical setting provides

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme       1
opportunities for socialisation, integration of learning, practise, observation and learning the role of
the nurse (Edgecombe & Bowden 2014; Levett-Jones, Lathlean, Higgins & McMillian, 2009).

Undergraduate nursing programmes in New Zealand, under the jurisdiction of the Nursing Council of
New Zealand, require a minimum of 1100 supervised clinical practice hours under the guidance of
registered nurses. This allows students to integrate theory with practical experiences, socialise to the
role of the registered nurse and attain the competencies required for registration (Nursing Council of
New Zealand, 2009). The educational outcomes for student nurses are in part dependent upon the
quality of the teaching and learning that occurs within the clinical environment (Watson et al., 2010).
Students engaged in a positive and supportive clinical learning environment are more likely to feel
they belong and may favour the provider as a potential future employer.

The education of the nursing workforce has undergone significant change, in addition to the increasing
complexities of the clinical environment; the clinical nurse is expected to have a dual working teaching
relationship that requires the nurse to provide bedside care in conjunction with facilitating student
learning in a preceptor role. The literature provides multiple descriptions of the nurse preceptor role
and experience (Billay & Myrick, 2008; Sedgwick & Harris, 2012; Udis 2008). This traditionally has
included a one-on-one working relationship over a period of time to assist the student to develop skills
and complete learning objectives (Myrick & Yonge, 2004). Despite the wealth of information regarding
the importance of the preceptorship role to a student’s learning, Benner, Sutphen, Leonard, and Day
(2010) find that although the traditional models of clinical learning still occur, there is a need to find
alternative methods to support nursing students in the clinical environment.

The quality of the placement and the exposure to appropriate and meaningful learning opportunities
are pivotal aspects of the clinical environment (Henderson et al., 2010). Without quality placements
and supported learning opportunities, the future development of the nursing workforce is at risk of
not meeting the future needs of the health sector (Nana, Stokes, Molano & Dixon, 2013; National
Nursing Organisations, 2014).

A review of undergraduate nursing education undertaken by KPMG Consulting in 2001 recommended
that education and health service providers share the responsibility for undergraduate education
through developing and maintaining partnerships. As a result of the continued focus on workforce
development and the need to support workforce ready graduates, Capital and Coast District Health
Board recognised the need to provide a better student experience to facilitate the graduate nurses’
ability to integrate into the health workforce.

There are a number of models utilised to facilitate improved student outcomes however the
Dedicated Education Unit (DEU) model developed in Australia by Flinders University is foremost a
student centred model (Edgecombe & Bowden 2014). The DEU model has been well researched since

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme          2
its conception and successfully adapted to the New Zealand health environment (Fourie & McClelland
2008; Jamieson et al., 2008). The DEU model contributes towards the development of the key nursing
attributes such as critical thinking and decision making and through a collaborative approach to
learning and research, enables the development of professional knowledge and clinical practice
(Benner et al., 2010).

Miller (2005) describes some key aspects of the DEU that are beneficial to both health facilities and
academia, including a supportive environment where students and academic staff are considered
assets instead of a cost or burden in the clinical area. Miller further notes that the DEU encourages
the development of collegial relationships, which fosters a sharing of knowledge. Additionally
Moscato, Miller, Logsdon, Weinberg and Chorpenning (2007) and Pappas (2007) observe that DEU
resources were used efficiently to provide a positive outcomes for patients and health care providers.

Importantly students in the DEU gain important skills through active learning and participation in a
collaborative framework of working together, where nursing and academic cultures are combined
along with the wider multidisciplinary team in forming a community of practice (Egan & Jaye, 2009;
Wenger, 1998). Major contributors to these nursing skills are the development of peer teaching and
learning (Gonda, Wotton, Edgecombe & Mason, 1999). Furthermore students gain a sense of
belonging (Levett-Jones et al., 2009) and socialisation to the culture that is nursing (Flinders University
2003).

Capital and Coast District Health Board (2017) identified the importance of developing the nursing
workforce through leadership and professional development opportunities, with a particular focus on
the Māori and Pacific workforce. Additionally Edgecombe and Bowden (2014) describe how providing
on-going development in communication and leadership are important aspects in the development
of the nursing workforce. The DEU provides an ideal environment for succession planning nurses into
roles in education and management.

The DEU model facilitates a consistent, quality clinical learning environment that is able to meet the
cultural and clinical learning requirements of all nursing students in preparation for their roles as
health professionals (Edgecombe & Bowden 2014).

Purpose of Evaluation
The aim of this research was to evaluate the impact of the DEU pilot on CCDHB nursing staff and
nursing students from Whitireia New Zealand and Massey University. The objectives of the research
were to:
   investigate the impact of the DEU on nursing staff and students
   ascertain if the DEU is meeting the learning needs of undergraduate nursing students from
    Whitireia and Massey
   make recommendations about quality improvement issues of the DEU.

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme           3
Methods
This evaluation was undertaken using a mixed method descriptive evaluation research design. Mixed
method designs integrate quantitative and qualitative data within one investigation, enabling a more
complete utilization of data than separate data collection and analysis (Watson & Creswell, 2013).
Mixed methods evaluation is an approach to evaluation that “systematically integrates quantitative
and qualitative methodologies and methods at all stages of an evaluation” (Bamberger, 2013, p.2).
According to Watson and Creswell, the following are advantages of a mixed methods study:
understanding contradictions between quantitative results and qualitative findings; give voice to
study participants and ensure study findings are grounded in participant’s experiences; enable
flexibility and adaptability; and collect rich comprehensive data. This design is appropriate in this study
which combines quantitative survey data with qualitative focus group data, evaluating a pilot
programme.

This study had two phases of data collection. Phase One was an online anonymous survey of all nurses
(registered and enrolled and Academic Liaison Nurses), employed in the three DEUs and all twenty six
undergraduate third year nursing students. The nursing students were completing their final nine
week pre-graduate placement and included ten Massey BN students, ten Whitireia BN students and
six students from the Whitireia BN Pacific programme. Phase Two involved six separate focus groups
with registered nurses and undergraduate nursing students following analysis of survey data.

Ethical considerations
Following approval for this study from Whitireia Faculty of Health Board of Studies (19/7/16) and the
Whitireia/WelTec Ethics and Research Committee (3/8/16), participant recruitment began. Flyers
were distributed in prominent places in the DEU and clinical setting, informing potential participants
of the study. All nursing staff (registered nurses (RNs), enrolled nurses (ENs), Nurse Managers, Nurse
Educators, Clinical Liaison Nurses (CLNs), Academic Liaison Nurses (ALNs) and nursing students (NSs)
in the DEU were invited to participate in the study. There were no exclusion criteria regarding the
nurses’ years or experience, professional roles or formal clinical titles. Participants could withdraw at
any stage.

Data collection
Phase One: Survey
Potential participants were invited to participate via email or during a face to face meeting in the DEU.
Potential participants were provided with the information sheet for participants and a consent form
to complete. Separate surveys were used for the students and staff. The surveys were developed by
the evaluation team and are attached as Appendix 1A and 1B. Those who agreed to participate were
emailed a link to the online 22 question survey. Forty-two staff members completed the survey out of

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme           4
a potential 160 staff, a response rate of 26%. Twenty-four nursing students completed the survey out
of a potential 26 students, a response rate of 92%.

Phase Two: Focus groups
The purpose of the focus groups was to follow up on the data collected in the surveys, to clarify issues
and to add validity to the findings by checking ‘hunches’ following analysis of the survey data. Focus
groups were held with those who agreed to participate at the completion of the nursing students’
clinical placement in the DEU. The structured questions for the focus groups were developed by the
evaluation team following analysis of the survey data. Focus group questions are attached as Appendix
2. Six focus groups were held, one with ALNs, two with nursing students (Whitireia and Massey), and
three with nursing staff (staff CCDHB and staff Kenepuru). Sixteen nursing students and seventeen
staff participated in focus groups. The focus groups facilitation were undertaken by members of the
team who had no relationship with the group members. The focus groups were transcribed by an
independent transcriber who signed a confidentiality agreement.

Data analysis
Survey data were analysed using descriptive statistical methods, looking for variances, percentages
and distribution patterns. Qualitative data was thematically analysed using a general inductive
approach described by Thomas (2006). The qualitative data was summarised into key themes. Links
were then established between the themes and the research objectives. Care was taken to ensure
that research team members did not analyse their own areas; that is nurse educators analysed nursing
staff responses and nursing staff analysed nursing students’ responses. All research team members
were involved in the analysis of both quantitative and qualitative data, individually and at team
meetings. This final report has been written by all team members.

Results
Registered Nurse Survey
This section of the report provides a summary of nursing staff responses to the quantitative and
qualitative questions of the survey. Nursing staff included all preceptor staff (Enrolled Nurses (EN), or
Registered Nurses (RN) as well as Clinical Liaison Nurses (CLN), Academic Liaison Nurse (ALN), Nurse
Managers and Nursing Educators who worked alongside the students in the DEU. There were 42
responses in total.

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme         5
Figure 1: Gender of nursing staff

The gender of nurses is mainly female (95%) and 4% were male. Age of the nursing staff was 27-50
plus years, with two participants declining to mention their age. The average age of participants was
40.3 years.

                                     Figure 2: Ethnicity of nursing staff

The majority of nursing staff were New Zealand European (54%) or other European (19%) with Pacific,
New Zealand Māori and Indian being 7.14% of the participants.

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme     6
Figure 3: Nursing Registration

The majority of the nursing staff were Registered Nurses (92.68%) with one to 39 years’ experience.
Enrolled Nurses made up 7.32% of the participants. One nurse did not identify their registration status.

All three DEU areas were represented. Ward 7 North and 6 South had 35.9% representation and Ward
6 Rehabilitation 28.21%. Three nurses declined to answer where they work.

Ninety-six percent of nursing staff had a Bachelor’s degree, 19% a Diploma in nursing and 14% ‘other’.
Sixty-six percent of nurses answered yes as to whether they had postgraduate qualifications, 33% did
not have a postgraduate qualification. Three nurses declined to answer this question. Forty-eight
percent of nurses had a Postgraduate Certificate, 29% a Masters degree and 22% a Postgraduate
Diploma. Fifteen nurses did not answer this question.

  Figure 4: Nurses’ level of practice on the Professional Development and Recognition Programme
                                           (PDRP) programme

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme        7
The majority of nurses were at proficient level on the PDRP (43%), 28% competent, 17% senior and
10% expert. Three nurses did not answer this question.

The majority of respondents were registered nurses (52%), 16% CLN and the others were divided
between EN 4.76%, ALN 4.76%, nurse educator 4.76%, Clinical Nurse Specialist 2.38%, acting Clinical
Nurse Manager 9.53%, Clinical Nurse Manager 2.38% and other 2.38%.

                                     Figure 5: Nurses’ role in the DEU

                     Figure 6: Nurses’ level of satisfaction in participating in the DEU

Thirty-eight percent (n=16) of nurses stated that they felt very satisfied with participating in the DEU,
23.91% (n=10) satisfied, 23.81% (n=10) somewhat satisfied, 4.76% (n=2) somewhat unsatisfied and
9.52% (n=4) very unsatisfied.

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme         8
Participants’ qualitative responses to this question included that the DEU is a supportive learning
environment for students and DEU allowed for more collaboration and dialogue. However nurses
needed more preparation for individual roles.

      Figure 7: Nursing staff perception of the DEU orientation programme for staff and students

Seventy-eight percent of nurses rated the orientation programme for nursing staff in the DEU as good
(43.9%), very good (24.39%) or excellent (9.76%).

Again nurses’ rating of the orientation programme for nursing students in the DEU was rated as poor
to excellent. The majority of nurses rated the orientation programme for students to be very good
(36.59%) and good (24.39%). Twenty-two percent rated the orientation programme for students to
be excellent, 12.2% satisfactory and 4.88% rated the orientation programme as being poor.

Some nurses commented on the poor video link to Kenepuru for students and on the orientation day
for nurses too much time was spent on the premise of the DEU rather than working through the
operational requirements of a DEU. However noted was DEU project leader’s support and that this
was a pilot project. Nurses observed they needed more education and support around the DEU and
DEU roles.

                    Figure 8: Nurses’ relationships with nursing students in the DEU

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme     9
All participants stated they either had a very positive relationship (57.14%), a positive relationship
(21.43%) or a somewhat positive relationship with nursing students (21.43%).

Qualitative responses to this question indicated students needed to develop trust with the staff.
Respondents also commented that the culture of the unit influences students and staff relationships.

                  Figure 9: Nursing staff perception of ALN & CLN support for students

Respondents rated the support for nursing students provided by the ALN in the DEU to be good
(48.78%) and excellent (39.02%). Only 12.2% of respondents rated little support. Respondents rated
the support for nursing students provided by the CLN to be excellent, (54.76%), and good (42.86%).
Only 2.38% rated support to be little. No respondents for both roles CLN and ALN described the roles
as providing no support.

Responses to this question indicated that visibility of the ALN to staff on the unit was a concern
however a CLN commented they met the ALN regularly and spent the allotted time with nursing
students yet one CLN noted they had to approach the ALN and another respondent thought the ALN
was not sure of their role. Furthermore one respondent stated the CLN provided a lot of support but
another commented the CLN found with shift work and annual leave, it was difficult to provide
support.

Nurses enjoyed working with the students as they could share their knowledge and assist them in
managing a patient load, which respondents commented made the students feel more like part of the
team. It was also commented upon that students were more proactive than previously. Nurses
commented that CLN support was valuable and if it was not available other staff took on that role
however CLN unavailability did make assessments and communication around student progress
difficult. Some comments mentioned CLNs were working with students and supported them in
providing learning experiences. Working with one ALN was easier and one commented that the ALN
was providing more academic support. Responses to the main impact on nursing workload of being in
the DEU included an increase in workload when students arrived in the Unit, which then decreased
over time. Several nursing staff commented that it took longer to explain and demonstrate concepts

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme     10
with students. Staff also commented if the unit was short staffed it meant that they could not dedicate
time with the student. One respondent commented that CLN support was valuable initially in students’
first few weeks. There were a number of comments around the CLN recruitment time and CLN time
to complete student assessments. The time involved setting up the DEU, was also noted. ALNs
commented that workload was organised differently from previous models and required more time
with students for assessments.

Responses to the difference/similarities between the DEU model and the previous preceptor model
on the nursing student demonstrated the DEU provided more students support with the CLN and ALN
roles. Respondents also commented that students worked more in the Pods and did not follow one
preceptor, which provided a more team approach to student learning and one respondent stated they
consequently knew student progress. The majority of respondents further observed there was also
less paperwork for RNs as the CLN and ALN completed student documentation. One respondent noted
it was difficult for the CLN/ALN to spend time with all the preceptors. One respondent stated the CLN
was able to provide additional teaching and another stated they could liaise with the ALN. One
commented it was good to have time to discuss student progress with the ALN.

Responses to recommendations for the DEU moving forward, showed a majority of respondents
wanted the DEU to continue as it provided greater support for the students. However a number of
respondents mentioned that there needed to be more clarity of role and expectations for CLN and
ALN. Additionally there is a need to have the CLN on the unit roster to be more available for students
as well as have allocated hours to complete student documentation. A number of comments also
mentioned better staff and student orientation to the DEU. A further recommendation was that the
two education providers align their documentation.

Student Nurse Responses
This section of the report provides a summary of student responses to the quantitative and qualitative
questions of the survey. There were 24 responses in total. Students from both tertiary education
providers equally responded, 50% of students were from Massey and 50% from Whitireia NZ.

The student participants were aged from 20 to 50 years. The average age of students was 25. Most
students were female 91.67% with 8% male.

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme      11
Figure 10: Ethnicity of students

The majority of students were New Zealand European (n=18), with New Zealand Māori (n=2) and
Pacific, including Fijian Indian (n=3) of the respondents, with other European being 4.17% (n=1) of the
respondents.

                                  Figure 11: Location of DEU placement

The majority of students completed their DEU placement in 7 North (41.67%). The rest of the students
completed their placement in Ward 6 South (37.5%) and in Ward 6 Rehabilitation (20.83%).

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme      12
Figure 12: Students’ level of satisfaction participating in the DEU

The majority of the students rated that they were very satisfied with their DEU placement (37.5%),
25% rated they were satisfied and 29.17% were somewhat satisfied with only 8.33% rating they were
very unsatisfied.

                                        Figure 13: DEU orientation

Nearly half (45.83%) of the students described their orientation programme to the DEU as excellent.
The rest of the students described the orientation programme as very good (25%) and good (20.83%)
with only 8.33% stating that it was satisfactory. No students described the orientation programme as
being poor.

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme   13
Figure 14: Nurses’ relationships with nursing students in the DEU

Over half (58.3%) of all students described their relationship with nurses (RNs/ENs/Health care
assistants (HCAs)) in the DEU as being very positive, 29.17% of students described their relationship
with nurses as being somewhat positive and 12.5% positive. No students described their relationships
with nurses as being somewhat negative and negative.

Regarding support for nursing students, most students felt supported and welcomed to the DEU. One
student particularly commented upon the CLN support. Comments also mentioned that nursing staff
support depended upon whether they understood the DEU and their level of practice as a student.

              Figure 15: Students’ rating of support from DEU ALN, CLN and nursing staff

Eighty-seven percent of the students rated the Academic Liaison Nurse (ALN) support as being good
to excellent, with majority of students rating support as good (58.3%) and 29.17% stating support as
being excellent. Only 12.5% of the students rated they had little support from the ALN. With regard to
CLN support most students (91.67%) rated CLN support as good to excellent, with the majority rating
support as excellent 54.17% and 37.5 % good. Only 8.33% of the students rated support to be little.

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme     14
Most of the students regarded nurses’ support as being excellent (58.33%) with 41.67% rating support
as good. No students rated CLN support as little. No roles were rated as providing no support at all.

Most students commented that the CLN provided direct or more indirect support and organised
learning experiences. Additionally the senior staff, ALN and CLN were approachable and nursing staff
were supportive. However students commented regarding lack of direct contact with CLNs in the DEU.

             Figure 16: Students’ rating on feedback from DEU ALN, CLN and nursing staff

Students rated the feedback be excellent or very good from the CLNS at 82%, ALNs at 65% and nursing
staff at 78%. One student commented that ALN and CLN feedback was general and irregular, another
student commented feedback occurred in weekly meetings.

                               Figure 17: Students’ main support in the DEU

Half of the students (50%) stated that their main support in the DEU came from the RN, 33% from the
CLN, with 16% being ‘other’. Academic Liaison nurse, enrolled nurse and nurse manager were not
mentioned as the main support by any nursing students.

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme      15
Figure 18: Students’ experience of being part of the nursing team in the DEU

Over three quarters of students (79%) stated their experience of being part of the nursing team in the
DEU was excellent, with 41.67% stating it was good. Eight percent stated their experience of being
part of the nursing team in the DEU was satisfactory. No students mentioned their experience of being
part of the nursing team in the DEU as being poor.

All 24 student respondents stated that they had been able to meet their learning goals in the DEU and
the majority, 91.67% would recommend a DEU as a placement to other nursing students. Only 8.33%
if students would not recommend DEU as a placement.

Regarding whether the student would recommend a DEU placement to other nursing students, two
students noted the supportive and friendly DEU environment and the placement being a great
transition for NETP. Conversely two students commented upon the frustration of having different
preceptors.

Students additionally commented upon the value of having Information Technology (IT) access to
patient management systems and eLearning. One student suggested the DEU processes need to be
better streamlined however another two comments mentioned that the DEU supported and
organised their learning and helped them connect to the nurses, multi-disciplinary team and patients.

The main benefits of a clinical placement in the DEU were computer access to locate polices, e learning
as well as the Medical Application Portal (MAP) thus providing students’ autonomy with patient care.
Further benefits of a DEU placement were more student support, more learning opportunities, being
able to meet clinical and academic objectives, feeling part of a team, with the opportunity to meet
and share resources with students from the other Tertiary Education Provider (TEP). Finally students
observed that working with wide variety of staff and seeing different ways of doing things was useful.
One student noted,

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme      16
I felt fully supported and included as part of the team. Learning opportunities were encouraged
        and staff provided ample of these. I also felt supported and encouraged with my school studies,
        and felt comfortable discussing any concerns with my DEU preceptor.

Disadvantages of a clinical placement in the DEU were noted by students to be the number of
preceptors they worked with, meaning rapport and trust was difficult to develop and the student had
to work at different levels and prove competence. Students also commented on their lack of
confidence in the CLN undertaking their assessments when the student did not work directly with the
CLN. This student commented,

        Didn't work much with CLN who did our paperwork and references. Some staff didn't trust us
        with as much responsibility as they didn't know us/our capabilities.

Additionally students commented that nursing staff sometimes had a poor understanding of the DEU
and some staff were not supportive of students. Students also commented on the amount of
documentation to be completed much of it mirroring their clinical portfolio.

Regarding recommendations for the DEU, most students commented upon the need for better
education of nursing staff as well as more consistency with preceptors and the CLN. Students
commented that this would enable staff to be involved and provide maximum support. Students also
noted that better planning could enable rostering with the CLN and could also help with more
consistency with preceptors and meetings with CLN. Students recommended the CLN and ALN meet
regularly. One student commented,

        Better warning and explanation to staff of what DEU is and that third years were coming to
        the ward. Rosters more coordinated with CLNs roster so we can work with them more

And

        Keep the orientation and the meet ups between the CLN and ALN. However there should be
        more continuity of preceptors eg no more than 4-5 for one student

Students also commented upon the need to fix short staffing so students do not miss out on learning
experiences,

        I think improving the short staffing issue would help. I understand short staffing happens
        anywhere you go but if it’s happening on a daily basis it could impact the DEU moving forward,
        particularly the pressure it puts on the RN's during that shift working short staffed and the
        students that could miss out on valuable learning time with their RN.

Finally students commented that staff needed to let them do more skills as well as have more MDT
education sessions,

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme      17
think it would be helpful to have focused sessions with other disciplines: learning from PT
        [physiotherapist], SLT [speech language therapist] and OTs [occupational therapist] will
        develop our practice and we can utilise those skills in other areas… Even feeling as though we
        are welcome to attend a Drs ward round is good learning. We will be better nurses if we
        understand the role of the whole team.

Summary of survey findings
Overall the staff and the students stated the DEU supported student’s clinical learning experience.
However it was commented upon by both staff and students that the CLN needed to be more readily
available to students and needed time to complete clinical documentation and organizing student
learning experiences. Students and staff also stated all staff need to be orientated to their role in the
DEU and role clarity was required particularly for the ALN and CLN. Students wanted DEU staff to be
better orientated to the model, to resolve short staffing issues and to have more consistent
preceptorship to assist their learning. Students did state they could meet their learning objectives in
the DEU and staff acknowledged that students were considered more as part of the team. Students
also observed computer access helped them feel like a team member.

Qualitative results
This section of the report presents the focus group findings. The headings are the major themes which
arose from the analysis. Staff focus groups are identified as RN1, RN2, RN3 with individual participants
then identified by their number on the transcripts. On some transcripts the interviewer was identified
as speaker 1, the numbers on the transcripts have been retained and therefore started with P2 as the
first participant. ALNs are identified as AN; student focus groups are identified as S1 and S2. Words in
italics are verbatim comments from participants.

The focus group findings provided further evidence of the high levels of satisfaction and support from
all participants for the DEU model of clinical learning. One of the Academic Liaison Nurse [ALN]
participants linked her enthusiasm for the pilot to her passion for student learning,

     (….I felt like I was with a group of people really taking it seriously about these students….
    I’m quite passionate about the students. That’s why I enjoy this role. But I felt like
    everybodys on board and we’re taking it very seriously…I think the buy in from them
    [staff] was hugely noticeable for me [ANP4].

Most of the themes from the findings link to perceived benefits of the DEU model with the challenges
identified as areas for improvement in implementation of the model.

The opportunities for teamwork and learning partnerships were also identified as significant themes
which contributed to the success of the DEU model. A more manageable workload particularly for

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme        18
DHB staff and adequate preparation and effective communication were also identified as perhaps
lesser but still important themes in the findings.

Challenges linked to adapting to the new model of clinical teaching occurred in relation to role clarity
for the ALN and CLN positions and building collaborative relationships in these new roles. Resources
and workload also emerged as a challenge when adapting to the new model. Communication was
also identified as a challenge. Each of these themes is discussed in relation to evidence from the focus
group discussions.

Benefits
The themes that emerged as benefits linked to the structure provided for student learning and the
nurturing learning environment that this structure created. The DEU created a supportive
environment for learning that was of benefit for the student learner, the facilitators of learning, and
for the setting itself including patients.

Improved learning structure
The DEU model provided structure and put the focus on the student and learning, as observed by this
RN,

        I think from our previous experiences with nurses coming to us and us being preceptors, this
        time it seemed a little bit more structured and it was more focused on the patient and on the
        students that were coming. And I think they felt that way as well. Although having like a
        primary preceptor helping them through the day they knew that they were allocated someone
        like the Liaison Nurses whom they could actually go and – you know for feedback whether it
        was positive or negative. …because it was more structured, everybody knew what was
        happening, there was a lot of transparency because our board – all the information on there.
        The preceptors themselves knew what to expect from the students. And the students
        themselves knew what was expected of them. So there were no misunderstandings. People
        weren’t falling behind and things like that. So I think this time it was different. So in that way
        I would think that this unit was beneficial in that way [RN2P2]

         … I thoroughly enjoyed it… because it wasn’t ad hoc it just felt a lot more – you know structured
        [RN2P7].

Students were given rosters which provided a more structured format than having the student roster
linked to a preceptor. The ALNs felt that the student rosters were helpful in planning their interactions
with students, as noted by this ALN,

        … they knew what their workload was. And I think that’s important. Because it should be a
        time where they have enjoyed their learning and start consolidating and putting their theory
        into practice [ANP3].

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme         19
Students also felt that the rosters were structured well with the ability for the student to follow the
patient journey with more flexibility than following a preceptor. One student said,

        …It made our rosters better ….because it meant we didn’t have to follow someone who wasn’t
        full time [S1P2].

Clinical Liaison Nurses [CLN] were responsible for planning learning opportunities for students and this
was valued by participants across all the focus groups. One CLN participant described the role as,

        working alongside them [students] and giving them opportunities …so if the patient needed a
        bladder scan or something interesting that they wouldn’t normally do… then giving the
        opportunity to do that [RN3P6].

One CLN participant identified that the CLN position gave the opportunity to try an interesting new
role focused on student learning and advocacy. The structure of the DEU model meant that students,
ALNS and DHB staff all felt that they had one person to go to for managing any issues, as noted by this
RN,

        And having point of call I think was good for the students to know that they would have definite
        people they could go to if they had a question or an issue. So – you know the fact that there
        was…the nurse that they were allocated to plus there was somewhere they could go if they…
        because you do end up with different nurses working with students and so there’s consistency
        for the students [RN1P4].

Having a ‘go to’ person was particularly valued by the ALNs and RNs. The CLN was highlighted as being
a key person for the student by both ALN and RN participants. Students discussed a lack of clarity of
the CLN role and noted that different CLNs approached the role in various ways. These findings will be
discussed further in the section on challenges.

Flexibility of DEU structure
CLN participants valued the flexibility of the DEU structure which enabled them to respond to
student’s learning needs whilst also matching the needs of the staff and patients in the clinical
environment, as noted,

        Like we had allocated the students just to a pod and not to a nurse. And then the students
        …they could feedback to us and say “well actually it’s actually really helpful to be allocated to
        a nurse.” So then we went back to actually “no we will allocate you to a nurse but it will be
        done on the day, it’s not going to be pre-allocated like we used to do.” We used to have
        someone allocated to a specific nurse for three weeks or whatever and you’d just follow them
        and follow the different pods that they went to. So yeah, so they were really adaptable. They

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme        20
could just work with whoever each day but they could also tell us what wasn’t working
        [RN1P2].

The student concurred that the consistency in working with the same patients was also preferred,

        I would’ve hated to move around pods so I think I’d prefer to have different preceptors than
        rotate between pods each day because I found that the consistent like conditions and that you
        were seeing in one pod was really really helpful [S1P1].

The RNs also valued not having the student “tied to one preceptor” sharing the belief that,

        “I think that they [students] saw that as an enrichment in that – I think that they thought that
        it would be an enriching thing because we [preceptors] all do things slightly differently and so
        I think it added to their toolkit to see different ways that people did things [RN1P3].

Documentation completed by CLN
The DHB participants all identified the benefits of having the CLN role for completing student
documentation. RNs felt that this freed them up to engage in teaching the student without having to
be concerned about completing their assessments. One preceptor participant identified that
previously RNs had felt the burden of taking on the responsibility of a student in conjunction with also
carrying a full patient load. The responsibility mentioned seemed to be mainly linked to the need to
complete ‘paperwork’ [assessments] rather than the need to teach and facilitate learning for the
student. Another participant felt that the CLN role in supporting student assessment was important in
fairly evaluating student progress,

        “But the DEU thing with the paperwork – having two central people doing it – they were better
        gauge when they’re getting feedback from students …actually they’re going to be able to
        gauge which they were doing more with the patient interaction and learning more skills and
        learning – you know instead of if I have somebody, and somebody else has somebody. My
        perception of what’s great and somebody else’s perception of what’s great, and my
        expectations will be different, whereas when you’ve got two dedicated people evaluating
        everybody actually it’s going to be more – you know more consistent I think. I think it’s
        probably fairer” [RN1P4].

The structure of the weekly meetings between the CLNs and ALNs was also mentioned as being
important. These meetings provided the structure for meaningful feedback for students.

Nurturing Learning Environment
A second theme evident across all the participants’ feedback related to the benefit of the nurturing
learning environment that the DEU model created. Participants identified that the experience was
positive for the ward with staff and students benefiting. One student participant noted,

Evaluation of Capital and Coast District Health Board Dedicated Education Unit pilot programme       21
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