Understanding medical students' transformative experiences of early preclinical international rural placement over a 20-year period.

INTRODUCTION: Rural placements are an important component of rural medical education programs seeking to develop rural practice pathways for medical students. These placements are usually domestic, but James Cook University in Australia developed an international rural placement program in the first half of the medical course that was funded through bursaries. This study explores how the international rural placement helped to shape the lives (personal development and learning) of the participants, using Transformational Learning Theory as a framework for identifying and describing the transformational elements, process and impact of the program. METHODS: Sixty-five students received a bursary for an international rural placement between 2001-2019. All were contacted by email and invited to participate in a short survey and a follow-up interview. Fifteen participants agreed and twelve were able to participate in individual semi-structured interviews which were recorded, transcribed and analysed using inductive thematic analysis. RESULTS: Participants reported that the bursary provided a "once in a lifetime opportunity" to "experience eye-opening and culturally rich difference". Nonetheless, some elements of the placement experience presented disorientating dilemmas that triggered deep reflections and shifts in perceptions. The bursary recipients realised that "being open-minded" allowed them "enjoy good company". They were also able to assume "outsider view which allowed reassessment of their own country" and the "isolation experiences gingered desire to right health wrongs". The triggers and mental shifts had significant impact on the bursary recipients and fostered the development of "inspirational new horizons" based on an appreciation of the "value of rural practice" and "role-modelling for life-long learning." These findings are consistent with Transformational Learning Theory. CONCLUSION: Participants in this study reported meaningful and strongly positive impacts from the experiences gained during an international rural clinical placement early in their course. They described transformative experiences which appear to contribute strongly to personal development. This finding supports maintaining opportunities for international experiences during rurally-oriented medical programs as these may impact longer term career choice.

Evaluation of the impact of leadership development on nurses and midwives underpinned by transformational learning theory: a corpus-informed analysis.

PURPOSE: The purpose of this paper is to evaluate the impact of leadership development programmes, underpinned by Transformational Learning Theory (TLT). DESIGN/METHODOLOGY/APPROACH: A corpus-informed analysis was conducted using survey data from 690 participants. Data were collected from participants' responses to the question "please tell us about the impact of your overall experience", which culminated in a combined corpus of 75,053 words. FINDINGS: Findings identified patterns of language clustered around the following frequently used word types, namely, confidence; influence; self-awareness; insight; and impact. RESEARCH LIMITATIONS/IMPLICATIONS: This in-depth qualitative evaluation of participants' feedback has provided insight into how TLT can be applied to develop future health-care leaders. The extent to which learning has had a transformational impact at the individual level, in relation to their perceived ability to influence, holds promise for the wider impact of this group in relation to policy, practice and the promotion of clinical excellence in the future. However, the latter can only be ascertained by undertaking further realist evaluation and longitudinal study to understand the mechanisms by which transformational learning occurs and is successfully translated to influence in practice. ORIGINALITY/VALUE: Previous research has expounded traditional leadership theories to guide the practice of health-care leadership development. The paper goes some way to demonstrate the impact of using the principles of TLT within health-care leadership development programmes. The approach taken by The Florence Nightingale Foundation has the potential to generate confident leaders who may be instrumental in creating positive changes across various clinical environments.

Palliative care learning model based on transformational learning theory in palliative care of nursing students in Indonesia.

INTRODUCTION: Palliative care competence is one of the competencies that must be possessed by generalist nurses. For this reason, strategies for developing palliative care learning models need to be carried out to ensure nursing students have palliative care competencies. Therefore, this study was structured to develop a transformation theory-based palliative care learning model that prioritizes the active participation of students to deal with palliative care in future practice. METHODS: This study was a cross-sectional study involving 189 nursing students as participants. The proposed model involves six variables, namely student characteristics, educator characteristics, learning media, palliative care competencies, transformative learning theory (TLT)-based palliative learning, and competency achievement. Data were collected using a questionnaire that was tested using the Structural Equation Modeling (SEM) technique. RESULTS: SEM analysis showed that the R2 value of TLT-based palliative care learning was 0.707 or 70.7%. These results indicate that the diversity of TLT-based palliative care learning variables can be explained by the variables of students, educators, palliative competencies, and learning media by 70.7%. Each construct has a value of Q2 > 0, which means the model is satisfactory. The path coefficient value of 0.627 indicates that the characteristics of educators have the most significant contribution to the TLT-based palliative care learning model. CONCLUSION: It can be concluded that the teaching-learning process based on TLT is a promising strategy to support nursing students to achieve palliative care competence.

Adult student nurses' experiences of encountering perceived child abuse or neglect during their community placement: Implications for nurse education.

INTRODUCTION: While child nursing students may expect to encounter child abuse and neglect and assume a safeguarding role when they qualify, those undertaking adult nursing courses may not expect to come into contact with children and may be even less likely to expect to encounter child abuse or neglect. This paper presents the findings of an interpretative phenomenological analysis (IPA) study. Students learn through experience and reflection and Mezirow's Transformational Learning Theory (TLT) was used to explain the various ways in which nine adult nursing students attempted to make sense of and learn from their experiences of encountering perceived child abuse and neglect during their community placement. STUDY AIM: The study aimed to examine the learning journeys of undergraduate adult nursing students who encountered perceived child abuse and neglect during their community placement. DESIGN: The research was located within an interpretative philosophical paradigm. Interpretative phenomenological analysis (IPA) provided an in-depth insight into participants' individual lived experiences. SETTING AND PARTICIPANTS: The fieldwork was undertaken at a Higher Education Institution in the North East of England. Participants were in the first year of an undergraduate nursing programme. METHOD: Data were collected using semi-structured face-to-face interviews and analysed using IPA. FINDINGS: The nine participants underwent a process of transformational learning after encountering perceived child abuse and neglect. They found the initial experience disorientating because it challenged their pre-conceived ideas about families and communities. They experienced a range of negative emotional responses, including anger and some expressed judgmental views towards parents. However, their frames of reference changed as they began to critically reflect on and process their experiences and they were able to recognize, albeit to varying degrees, that they had enhanced their knowledge and learnt from the experience. Their understanding of the role of the adult nurse changed and they recognised they had an important role to play alongside other professionals in safeguarding children. CONCLUSIONS: The findings highlight there is a need for HEIs to ensure students on adult nursing programmes understand they have a role to play in protecting children; they also highlight a need for more effective preparation and support.

Food Insecurity Experience: Building Empathy in Future Food and Nutrition Professionals.

OBJECTIVE: To assess changes in empathy in students completing a food insecurity experience. DESIGN: Mixed methods; quantitative data from survey in years 1 and 2; qualitative data extracted from students' workbooks in years 2-5. This study was conducted over 10 weeks annually for 5 years. SETTING: Northwest US land-grant university. PARTICIPANTS: Students enrolled in a community nutrition course who chose to complete the food insecurity exercise. Total included 58 students in quantitative analysis in years 1 and 2 and 119 in qualitative analysis, years 2-5. INTERVENTION(S): The intervention was a food insecurity experience in which participants spent no more than $3/d on food for 5 days ($15 total) while striving for a nutritious diet and reflecting on their experience. MAIN OUTCOME MEASURES: Empathy scores measured by Likert scales; participant responses and reflections recorded in workbook journals. ANALYSIS: Comparison of means across time using paired t tests (P < .05); coding and sorting themes from workbook journals. RESULTS: Quantitative findings indicated that both classroom content and experiential exercises were important for enhancing empathy about food insecurity. Empathy scores increased from time I to time II and from time I to time III. Qualitative reflections among participants included terms such as guilt, empathy, compassion, and raised consciousness about food insecurity. CONCLUSIONS AND IMPLICATIONS: Experiential and transformational learning to develop empathy can take place in a 5-day food insecurity experience during a typical university-level community nutrition course. This intervention can be tested for applications in other contexts.

Modelo de aprendizaje de cuidados paliativos basado en la teoría de aprendizaje transformacional de cuidados paliativos de los estudiantes de enfermería en Indonesia / Palliative care learning model based on transformational learning theory in palliative care of nursing students in Indonesia

Introducción: La competencia sobre cuidados paliativos es una de las aptitudes que deben poseer los enfermeros generales. Por este motivo, deben llevarse a cabo estrategias para desarrollar modelos de aprendizaje de cuidados paliativos a fin de garantizar que los estudiantes de enfermería posean competencias en dicha materia. Por tanto, este estudio fue estructurado para desarrollar un modelo de aprendizaje de cuidados paliativos basado en la teoría de la transformación, que priorice la participación activa de los estudiantes, de cara a tratar los cuidados paliativos en la práctica futura. Métodos: Estudio transversal que incluyó a 189 estudiantes de enfermería como participantes. El modelo propuesto incluye 6 variables: características de los estudiantes, características del educador, medios de aprendizaje, competencias sobre cuidados paliativos, formación en paliativos basada en la teoría de aprendizaje transformativo (TLT) y logro de competencias. Los datos fueron recopilados utilizando un cuestionario probado mediante la técnica SEM (Structural Equation Modeling [Modelo de ecuaciones estructurales]). Resultados: El análisis SEM mostró que el valor R2 del aprendizaje de cuidados paliativos basado en TLT fue de 0,707, o 70,7%. Dichos resultados indican que la diversidad de las variables del aprendizaje de cuidados paliativos basado en TLT pueden explicarse mediante las variables de estudiantes, educadores, competencias sobre paliativos, y medios de aprendizaje en un 70,7%. Cada constructo tuvo un valor de Q2>0, lo cual significa que el modelo es satisfactorio. El valor del coeficiente por pasos de 0,627 indica que las características de los educadores tienen la contribución más significativa al modelo de aprendizaje de cuidados paliativos basado en TLT. Conclusión: Puede concluirse que el proceso de aprendizaje-formación basado en TLT es una estrategia prometedora para respaldar...(AU)

Introduction: Palliative care competence is one of the competencies that must be possessed by generalist nurses. For this reason, strategies for developing palliative care learning models need to be carried out to ensure nursing students have palliative care competencies. Therefore, this study was structured to develop a transformation theory-based palliative care learning model that prioritizes the active participation of students to deal with palliative care in future practice. Methods: This study was a cross-sectional study involving 189 nursing students as participants. The proposed model involves six variables, namely student characteristics, educator characteristics, learning media, palliative care competencies, transformative learning theory (TLT)-based palliative learning, and competency achievement. Data were collected using a questionnaire that was tested using the Structural Equation Modeling (SEM) technique. Results: SEM analysis showed that the R2 value of TLT-based palliative care learning was 0.707 or 70.7%. These results indicate that the diversity of TLT-based palliative care learning variables can be explained by the variables of students, educators, palliative competencies, and learning media by 70.7%. Each construct has a value of Q2>0, which means the model is satisfactory. The path coefficient value of 0.627 indicates that the characteristics of educators have the most significant contribution to the TLT-based palliative care learning model. Conclusion: It can be concluded that the teaching-learning process based on TLT is a promising strategy to support nursing students to achieve palliative care competence.(AU)