learning by doing: students’ experiences of a practicum michelle beattie, lecturer, high land...
TRANSCRIPT
Learning by Doing: Students’ Experiences of a Practicum
Michelle Beattie, Lecturer, High land Campus; Brian James,, Senior Teaching Fellow, Highland Campus; Rebecca Stuart, Student Nurse, Highland Campus, Dr Ashley Shepherd, Senior Lecturer, Stirling Campus; Lorraine Armstrong,
Clinical Academic Fellow, Stirling Campus.
- Morally and ethically right- Professional standards and codes- Political drivers- Demographic and societal changes- Statutory Duty - NHS (Scotland) Act
1978
Why Quality Improvement?
Key Message: The quality of health care is variable
QI for All
Everyone can make a difference
Small improvements make a big difference
Premise: Collective effort will contribute to culture change required in healthcare
Learn by doing
Senninger (2000 cited in NHS III 2007)
Which is translated into several QI concepts, such as:
Social Constructivism and the Zone of Proximal Development (Vygotsky 1978):
What is the Practicum?
Aim: All students (230) in semester 8 will do a Practicum in Jan-Mar 2014Four Steps:
1. Identify a project and obtain agreement2. Prepare a project plan3. Test an aspect of the project with at least 2 PDSA cycles4. Write a summary report
Achieving the Impossible
• Practice based assignment within a university curriculum modular framework
• Multiple and complex environments
• Three campuses
How?• Continuously creating context
• Using QI tools and techniques
• Having a clear aim
• Engaging all partners from the off
• Building on existing resource
• Sharing international expertise
• Having a great team!
The Practicum as an Assessment
• Trial and learning to adapt the practicum to “our” systems was vital
• Development of an exemplar for students and markers led to further adaptations
• Most existing assignments at level 10 are unbalanced – they favour formal knowledge over other forms of knowledge
• Setting minimum criteria and the associated marking guide enabled non-QI experts to mark effectively
Forms of Knowledge
Forms of KnowledgeFormal Knowledge: This is the ‘knowing what’ of the evidence base.Informal Knowledge: This is the experiential/ situational tacit knowledge hidden in ‘the people’; staff, patients and relatives. Included in this are implicit mental models, knowledge people may not even know they possess.Empirical Knowledge: This is the knowledge generated by investigation.Procedural Knowledge: This is ‘knowing how’ knowledge, which draws together all the other forms of knowledge
Becky’s Project Title: “Improving communication between the cardiology ward and the coronary care unit (CCU)”.
Aim: Reduce emergency errors by improving communication.Achieve 100% reliability with sign usage by March 2015.
Why the effort: Several emergency errors occurring surrounding patients’ on telemetry.
Motivating staff by listening and involving them.
Drawing up a planResearch
Becky’s Project Patient on Telemetry!
Inform CCU if moving wards
What my improvement lead to…
• New telemetry signs • Improved communication between
departments • Improved staff morale• Improved staff relationships • Reduced datix reports• Reduces emergency errors • Improved survival rates
22% 100%
Prior to new sign
Becky’s Project How has it benefitted me and prepared me for when I qualify?
• Boosted confidence• Aware of capabilities and responsibilities• Importance and need for quality improvement• Importance of team work and leadership• Importance of sharing ideas• Importance of evidence based studies• Awareness of potential barriers to change• Aware of challenges between different members of
the team• Trial and learning– not to give up
Evaluation
What is the students’ experience of doing a Practicum as a core assessment?
-Interviewed purposeful sample of 18 students
-Thematic analysis of 50 Practicum submissions
The view of a reluctant improver:
I learnt that I didn’t hate it as much as I thought I was going to …
… because once I actually started doing it I found it OK to do … not as bad as I thought it was going to be …
… it does make a difference when you do these wee things …
… I hated it but now I don’t … I think it was worthwhile …
… now that it's all done and I've done it, and I've seen the difference it did make, it was worth it
Findings1. Time – students highlighted the necessity of time to
prepare, socialise and conduct the Practicum
2. Fear – fear of attempting change in an environment with experienced practitioners and adjustment to a new type of assessment
3. Transformation –perceptions were shifted by completing a Practicum, including a sense of achievement and acknowledging the benefit of key graduate skills
Practicum Examples• Improving communication in A&E by capturing essential data from
emergency phone calls
• Improving prioritisation of palliative specialist care by developing a palliation prioritisation tool within an acute hospital
• Increase the reliability of patients receiving their Parkinson’s treatment on time in a nursing home setting
• Improving communication between patients and consultants by introducing a patient booklet
• Improving hydration on community hospital ward
• Improving response time for urgent community calls by introducing an emergency kit bag
• Introducing Individual Story Boards for patients with dementia
Students
- Students learn quality improvement by doing quality improvement
- All students placed great value on the assignment, but a majority would not have chosen to do a practicum if an option. So, if this kind of experience is to be available to all rather than an elite few, it needs to be a compulsory assessment
- Student nurses require support to reduce the negative effects of stress
- Academics need to give credit to other forms of knowledge as well as traditional academic knowledge
- Student nurses can make a difference in clinical practice and learn key graduate skills in the process
In summary
References:NHS Institute for Innovation and Improvement (NHS III) (2007) Managing the human dimensions of change. Coventry: NHS III. (Note: Senge cited instead of Senninger. A discussion of Senninger can be found here: Eichsteller G and Holthoff S (no date) Risk Competence: Towards a Pedagogic Conceptualisation of Risk. Cumbria: ThemPra Social Pedagogy C.I.C. Available: http://thempra.com/downloads/risk.pdf [Accessed 11/01/15]).
Vygotsky, L. (1978). Mind in Society: The Development of Higher Psychological Processes. Cambridge, Massachusetts: Harvard University Press. Reprinted in M. Gauvain and M. Cole (1997) Readings on the Development of Children. New York: W.H. Freeman and Company.