A metasynthesis of nurses and midwives' experiences of clinical supervision.

PROBLEM: Given the current rate of burnout and attrition among nurses and midwives globally, there is a need to understand the effectiveness of supportive strategies to help retain this workforce. BACKGROUND: Clinical supervision can help to ensure that nurses and midwives are supported and have the capacity to cope with their job demands. Yet there are no metasyntheses that provide a collective understanding of their experiences with clinical supervision. AIM: To synthesise the experiences of nurses and midwives who have accessed clinical supervision. METHODS: A metasynthesis was conducted by systematically searching academic databases for relevant publications; assessing their quality using an established checklist; extracting and analysing qualitative content; and synthesising key findings about the experiences of nurses and midwives regarding clinical supervision. FINDINGS: Themes and subthemes were identified from 12 papers, including: optimal logistics; support; safety and confidentiality; improving practice through reflection; and trust in the group. DISCUSSION: For clinicians to feel comfortable discussing their practice and workplace with the facilitator and colleagues, nurses and midwives needed to feel safe during clinical supervision and trust the process and their peers. Despite common difficulties of finding time for the sessions, clinical supervision can enhance collaboration and communication in the workplace. CONCLUSION: Clinical supervision that adheres to group rules can provide professional support within a safe, confidential space. Having trust in peers and facilitators at the sessions can help staff develop confidence, provide personal development and professional sustenance.

Midwifery students' perceptions of clinical learning experiences and midwifery preceptors in Turkey.

BACKGROUND: The clinical education environment presents a valuable opportunity for students to learn, acquire and develop the clinical skills essential for professional midwifery practice. The presence of competent and relevant preceptors plays a pivotal role in ensuring the success of midwifery students and fostering positive clinical experiences. AIM: This study was conducted to evaluate the clinical practice experiences of midwifery students and their perceptions of midwifery preceptors. DESIGN: A descriptive and cross-sectional study. METHODS: This study was conducted with 205 students enrolled in the midwifery department of the Faculty of Health Sciences of a state university in Turkey. Data collection used a participant information form and the Clinical Learning Environment and Midwifery Preceptor Scales designed to assess factors affecting midwifery students' clinical learning. Data analysis was performed using the SPSS 22.0 program, employing methods such as the Independent Sample T-Test, One-Way Analysis of Variance and Tukey test. RESULTS: The average total score on the Clinical Learning Environment scale was 31.08±2.16 out of a possible 32, while the average total score on the Midwifery Preceptors scale was 17.60 (SD 1.27) out of a possible 18. The mean total score of the Midwifery Preceptor Scale and the mean scores of the sub-dimensions of Skill Development and Midwifery Practice Philosophy were found to be statistically significantly higher in those aged 21 years and older than aged 20 years and younger (P < 0.05). The Midwifery Preceptor Scale total score, the Clinical Learning Environment Scale total score and Skill Development sub-dimensions mean scores of the second-year students were found to be statistically significantly higher than the first and third-year students (P <0.05). Furthermore, students who received education in larger groups and willingly chose and had a passion for the midwifery profession demonstrated significant positive perceptions regarding their clinical learning environment experiences and the impact of their preceptors on their professional growth. CONCLUSIONS: Understanding the perspectives of midwifery students regarding the clinical education environment, preceptors and the teaching and learning process holds great importance for enhancing the quality of the clinical education environment and fostering the development of clinical competencies among midwifery preceptors.

Midwifery professional placement: Undergraduate students' experiences with novice and expert preceptors.

BACKGROUND: In recent decades, increased midwifery university places have been offered to address midwifery workforce shortages. As a result, more graduate midwives entered the workforce, in turn leading to more midwifery students precepted by novice midwives when on professional placement. It is not known whether this more junior midwifery workforce impacts student experience. AIMS: To explore undergraduate midwifery students' experiences with novice and expert midwifery preceptors, and to identify the benefits and challenges of working with novice and expert preceptors, from the perspective of undergraduate student midwives. METHOD: This study used a qualitative descriptive approach. Nineteen third/fourth-year Bachelor of Nursing/Bachelor of Midwifery (Honours) students attended six focus groups (ranging from 2 to 5 participants). Data were analysed thematically. RESULTS: Three overarching themes were identified: 'Building relationships'; 'Teaching and learning'; and 'Improvements to professional placement'. Benefits and challenges existed with both novice and expert preceptors. Importantly, feeling welcomed and receiving critical feedback were identified. CONCLUSION: The student/preceptor relationship is based upon feeling welcomed, and relatability, and is developed more easily with novice preceptors. Expert preceptors provide insightful and valuable feedback and are more able to actively teach. Novice preceptors' consolidation of practice can impact student learning opportunities. Including students in decision-making aids development of critical thinking. Allocation practices which address student learning needs will improve the student professional practice experience. Midwifery students benefit from working with midwifery preceptors of all experience levels. Translating the findings from this project into preceptorship training programs for midwives will improve student satisfaction and outcomes.

Analysis of professional training in Multiprofessional Health Residency Programs in Brazil from the perspective of residents. / Análise da formação em Programas de Residência Multiprofissional em Saúde no Brasil: perspectiva dos egressos.

The aim of this study was to analyze professional training in multiprofessional health residency programs (MHRPs) in primary care from the perspective of residents from 20 programs who had completed residency in the period 2015-2019. We undertook a cross-sectional study analyzing criteria in the dimensions Pedagogical Approach and In-Service Education Settings responded using a 10-point Likert scale. The study sample consisted of 365 graduates from MHRPs in 12 Brazilian states. The highest-scoring criteria in the dimension Pedagogical Approach (Cronbach's α=0.94) were broad concept of care and professional training oriented towards comprehensive care (P50=10). The lowest scoring criteria were those involving preceptorship (P50=7). With regard to the In-Service Education Settings dimension (Cronbach's α=0.90), the main strength was group educational activities (P50=9) and the main weaknesses were adequacy of the physical structure of health facilities (P50=6), participation of residents in local health committees (P50=6), and coordination with medical residency programs (P50=5). The findings show that professional training in MHRPs is aligned with the principles and guidelines underpinning Brazil's public health system, with emphasis on comprehensiveness and prevention. However, efforts are needed to improve preceptor training and address weaknesses in practice settings.

Objetivou-se analisar a formação em Programas de Residência Multiprofissional em Atenção Básica (PRMAB) no Brasil a partir dos egressos de 20 Programas no período de 2015 a 2019. Trata-se de um estudo transversal que analisou as dimensões Abordagem Pedagógica (AP) e Cenários de Educação em Serviço (CES) com escala do tipo Likert. Participaram do estudo 365 egressos de programas instalados em 12 estados da federação. Na dimensão AP (α de Cronbach=0,94) destacaram-se os critérios sobre a concepção ampliada do cuidado e formação pautada em cuidado integral (P50=10), enquanto os com pior desempenho se relacionavam à preceptoria (P50=7). Quanto aos CES (α de Cronbach=0,90), foram reveladas potencialidades para as atividades educativas em grupo (P50=9) e fragilidades para critérios relativos à suficiência de espaço físico nas unidades de saúde (P50=6), participação dos residentes em Conselhos (P50=6) e articulação com Programas de Residência Médica (P50=5). A formação nos PRMAB mostra-se sintonizada com os atuais paradigmas da atenção à saúde, com ênfase na integralidade e prevenção. Contudo, os Programas carecem de investimento na formação de preceptores e melhoria de fragilidades no âmbito dos cenários de prática.

The relationships between clinical teaching behaviour and transition shock in newly graduated nurses.

AIM: To explore the relationships between clinical teaching behaviour and transition shock in newly graduated nurses and significant differences in the northwest and northeast China. DESIGN: A cross-sectional design. METHODS: A total of 211 (nurses) and 925 (preceptors) were recruited in six Third-class different hospitals from July to August 2019. RESULTS: The transition shock is negatively correlated with the clinical teaching behaviour in northwest and northeast China, while the transition shock in the northwest is higher than that in the northeast for the behindhand economy and natural limit. CONCLUSION: The transition process of newly graduated nurses in northeast China with ethnic minorities and the behindhand economy is more difficult. For newly graduated nurses, personal health and a supportive environment need further improvement. Teaching strategies for preceptors need to be enhanced. Two-way feedback is more useful for both the newly graduated nurses and preceptors to improve quality care, and holistic care.

The impact of rural nursing and midwifery clinical placements from the perspective of health service staff.

OBJECTIVE: To explore the impact of providing nursing and midwifery student placements from the perspective of regional, rural and remote health service staff involved in hosting students. SETTING: Hospital and health services across regional, rural and remote southern Queensland. PARTICIPANTS: Thirty-six nursing and midwifery staff working in clinical and/or management roles who were direct clinical supervisors of students or in leadership positions with responsibility for overseeing and supporting clinical placements. DESIGN: Semi-structured interviews exploring the experiences and perspectives of nursing and midwifery health service staff who support student placements. Data were subject to thematic analysis. RESULTS: Five key themes were identified as follows: (a) bringing new ideas and perspectives, (b) opportunities for development, (c) supporting the future rural workforce (d) impacts on workload and productivity and (e) strategies for balancing supervision. CONCLUSION: The results indicate that there are a range of perceived benefits and challenges of providing nursing and midwifery student placements within regional, rural and remote settings. The findings also indicate that there are opportunities to further support rural health services to optimise the positive impacts and mitigate the challenges of providing placements. To do so requires collaboration between health services and education providers to allocate students appropriately to health services and support health service staff.

A invenção de um setting on-line para atendimento psicológico remoto / The invention of an online environment for remote psychological care / La invención de un entorno en línea para la atención psicológica remota

Com o advento da covid-19, foi declarado estado de emergência de saúde pública e decretadas medidas de isolamento e distanciamento social para conter a propagação da doença. O Conselho Federal de Psicologia, considerando a importância do acolhimento seguro durante a pandemia, publicou a Resolução CFP nº 4/2020, permitindo que serviços psicológicos aconteçam de maneira remota. O presente estudo visa, através do Método da Cartografia, apresentar a construção de um setting on-line para intervenções grupais e os desafios na oferta de acolhimento e atendimento remoto. Foram ofertados grupos terapêuticos, por meio da plataforma Google Meet, para estudantes da Universidade Federal Rural do Rio de Janeiro. Um diário de bordo foi produzido para acompanhar as forças que atravessavam e constituíam o território e a experiência grupal remota. Compreendemos que o território-espaço-grupal-on-line era composto pelo espaço virtual em que nos reuníamos, pelos espaços individuais de cada integrante e pelas forças que os atravessavam. Observamos que nem sempre os participantes dispunham de um lugar privado, mas estiveram presentes no encontro com câmeras e áudios abertos e/ou fechados e/ou através do chat da videochamada. A participação no grupo funcionou como alternativa no momento de distanciamento social, sendo uma possibilidade para o atendimento psicológico em situações de dificuldade de encontros presenciais; entretanto, se mostrou dificultada em diversos momentos, pela falta de equipamentos adequados e instabilidade na internet, fatores que interferiram nas reuniões e impactaram na possibilidade de falar e escutar o que era desejado.(AU)

With the advent of COVID-19, a state of public health was declared, and measures of isolation and social distance to contain the spread of the disease was decreed. The Federal Council of Psychology, considering the importance of safe reception during the pandemic, published CFP Resolution No. 4/2020, allowing psychological services to happen remotely. This study narrates, via the Cartography Method, the experience of inventing an Online Setting for group reception. Therapeutic groups were offered, via Google Meet Platform, to students at the Federal Rural University of Rio de Janeiro. A logbook was produced to accompany the forces that crossed and constituted the territory and the remote group experience. We understand that the territoryspace-group-online was composed by the virtual-space that we gathered, by the individualspaces of each member and by the forces that crossed them. We observed that the participants did not always have a private place, but they were present at the meeting with open and/or closed cameras and audio and/or through the video call chat. Participation in the group worked as an alternative at the time of social distancing, being a possibility for psychological care in situations of difficulty in face-to-face meetings, however, it proved to be difficult at various times, due to the lack of adequate equipment and instability on the internet, factors that interfered in meetings and impacted the possibility of speaking and listening to what was desired.(AU)

La llegada de la COVID-19 produjo un estado de emergencia de salud pública, en el que se decretaron medidas de confinamiento y distanciamiento físico para contener la propagación de la enfermedad. El Consejo Federal de Psicología, considerando la importancia de la acogida segura durante la pandemia, publicó la Resolución CFP nº 4/2020, por la que se permite la atención psicológica remota. Este estudio tiene por objetivo presentar, mediante el método de la Cartografía, la elaboración de un escenario en línea para la intervención grupal y los desafíos en la oferta de acogida y atención remota. Grupos terapéuticos se ofrecieron, en la plataforma Google Meet, a estudiantes de la Universidad Federal Rural de Río de Janeiro. Se elaboró un diario para acompañar a las fuerzas que atravesaron y constituyeron el territorio y la experiencia remota del grupo. Entendemos que el territorio-espacio-grupo-en línea estaba compuesto por el espacio-virtual que reunimos, por los espacios individuales de cada integrante y por las fuerzas que los atravesaban. Observamos que los participantes no siempre tenían un lugar privado y que estaban presentes en la reunión con cámaras y audio abiertos y/o cerrados y/o por el chat de la videollamada. La participación en el grupo funcionó como una alternativa en el momento del distanciamiento físico y revela ser una posibilidad de atención psicológica en situaciones de dificultad en los encuentros presenciales, sin embargo, se mostró difícil en varios momentos, ya sea por la falta de medios adecuados o por inestabilidad en Internet, factores que interferían en las reuniones e impactaban en la posibilidad de hablar y escuchar lo que se deseaba.(AU)

Supporting nursing, midwifery and allied health professional teams through restorative clinical supervision.

The mental health and wellbeing of healthcare staff have been significantly affected by the demands resulting from the recent COVID-19 pandemic. Restorative supervision is a type of clinical supervision that supports reflective practice that can help build practitioners' resilience by focusing on the individual's experience, aiming to sustain their wellbeing and their motivation at work. This model has been shown to reduce stress and burnout and increase compassion satisfaction. This article discusses the implementation of a restorative clinical supervision programme used to support staff wellbeing in nursing, midwifery and allied health professional teams in a large London-based NHS trust.

Humanistic Nursing Care for Patients in Low-Resourced Clinical Settings from Students' Perspectives: A Participatory Qualitative Study.

INTRODUCTION: It is of utmost importance to understand how we can better prepare students to value humanistic spirits and provide humanistic care, a core element of quality care for patients/family characterized by empathy and holistic care, from school to clinical settings (practicum) in low-resourced healthcare environments with seriously low nursing staffing levels. The current study explored participants' experiences of learning and delivering humanistic care for patients. METHODOLOGY: This is a participatory qualitative study. Eligible participants are undergraduate students who completed all the core curricula and are ready to start their one-year clinical practicum/internships. A total of 120 eligible undergraduate students were included in the study. Participants were encouraged to share their own thoughts, questions, and perspectives on learning and providing humanistic care in clinical settings during their one-year practicum from 2020 to 2021. RESULTS: Three major themes emerged: 1. From Textbook to Providing Humanistic Care in low-resourced work contexts; 2. Ethical Considerations; and 3. Implications for Humanistic Nursing Care Education. DISCUSSION: Systematic reforms are needed to make clinical settings more humanistic care-friendly for nurses and nursing students. It is significant to help students internalize the essence of humanistic care in low-resource settings.

What strategies facilitate & support the successful transition of newly qualified midwives into practice: An integrative literature review.

OBJECTIVE: The aim of this review was to identify strategies that facilitate newly qualified midwives to transition successfully from midwifery student to confident, competent practitioner. DESIGN: Integrative literature review. DATA SOURCES: The following databases were accessed: CINAHL complete, Medline complete, APA PsycINFO, Cochrane Library, Joanna Briggs Institute (JBI), Scopus and Google Scholar. REVIEW METHODS: A systematic search of key terms across all data sources for the period January 1990 to September 2021 identified 316 papers whose titles/abstracts were screened against our inclusion/exclusion criteria. Thirty-six full texts were screened for eligibility and three papers were identified through ancestral searching. Ten papers were included in our final review. RESULTS: Mentorship or preceptorship for newly qualified midwives by experienced midwives appears to enhance experiences, either as a standalone strategy, or component of structured programs of transition support. Supernumerary time, designated study days and planned rotations are also valued, particularly when rotating through clinical areas. Smaller teams providing continuity of midwifery care, or organisations that fund mentorship programs appear more able to facilitate support. Mechanisms of online support and learning may also enhance early transition but similarly, require organisational investment to aid success. Whilst most programs were described as helpful none of the studies used validated measures to assess this. CONCLUSION: Whilst elements of tailored support programs and mentoring/preceptorship from experienced colleagues appear to offer valuable support to transitioning practitioners, it is important to note that the structure of maternity care appears fundamental to the success of many of these strategies. Consequently, maternity care reform which focuses on the adoption of sustainable models of midwifery continuity, alongside urgent investment in midwives, are likely the most promising, over-arching strategies required to support student to midwife transition.

"They hold your fate in their hands": Exploring the power dynamic in the midwifery student-preceptor relationship.

AIM: To examine (1) what role preceptors play in students' learning; (2) how student-preceptor relationships can impact students' views of the profession and their decision to leave the program; and (3) what strategies can be used to improve the preceptor-student relationship to facilitate student retention. RESEARCH DESIGN AND PARTICIPANTS: We used a qualitative methodological approach utilising semi-structure interviews with 31 midwifery students across Canada. Participants were recruited from all midwifery education programs and were in various stages of their educational journey. The interviews were conducted in English and French. Inductive analysis followed Charmaz's guidelines moving from line-by-line to focused coding and development of analytical categories. FINDINGS: The results show that positive relationships with preceptors boosted students' confidence and contributed to the constructive learning experiences among trainees. Students pointed out that their best learning experiences were facilitated by preceptors who created a safe space to make mistakes and were knowledgeable and invested in students' learning. Students also suggested that power imbalance is embedded in student-preceptor relationships and can negatively impact students' learning experiences and their decision to stay in the program. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It is important to consider how to mitigate the power imbalance embedded in preceptor-student relationship. Offering more training to preceptors, oversight of preceptors' mentorship skills by midwifery educators, and creation of ombudsperson's position might mitigate some of the power differential and facilitate students' ability to complete midwifery training.

Open dialogue - A grounded theory study on peer learning at birthing units.

BACKGROUND: Peer learning in clinical settings is supported in nursing research but has rarely been studied in the context of student midwives at birthing units. AIM: To create a theoretical model of peer learning in the context of birthing units. SETTINGS: Four hospitals and maternity units in Stockholm, Sweden. METHODS: A Straussian approach to grounded theory was applied. Data consisted of interviews with fifteen final-term student midwives and 21 preceptors. Further, six peer learning seminars were held with approximately 200 midwives. At these, data was collected from fourteen preceptors presenting their experiences of working with peer learning. FINDINGS: The core of the action emerging was the Open dialogue describing the communication between the pair of students, between students-preceptor and students-becoming parents, that developed skills in communication, participation and reduced prestige and hierarchy. It facilitated social interaction and reinforced a dynamic way of learning and teaching midwifery. CONCLUSIONS: With preparation and a clear framework, peer learning can be used with midwifery students at birthing units. The open dialogue includes the becoming family in decision making and fits in a woman centered care providing support, safety, and participation. The pedagogical benefits are consistent with previous studies on nursing students.

Group Clinical Supervision for midwives and burnout: a cluster randomized controlled trial.

BACKGROUND: There are major shortfalls in the midwifery workforce which has been exacerbated by the COVID 19 pandemic. Midwives have high levels of burnout and many, often early career midwives, are planning to leave the profession. There are reports of a poor workplace culture in maternity units, including bullying. Support is essential for the welfare of the workforce to be able to cope with the demands of their jobs. Supportive strategies, such as Clinical Supervision, a recognised approach in healthcare, enable reflection in a facilitated, structured way, and can enhance professional standards. The purpose of this research is to study burnout levels in midwives, those exiting their workplace and perceptions of workplace culture in relation to access to, and attendance of, monthly Clinical Supervision. METHODS: This study will be a cluster randomised controlled trial of maternity sites within Sydney and the surrounding districts. Twelve sites will be recruited and half will receive monthly Clinical Supervision for up to two years. Midwives from all sites will be requested to complete 6-monthly surveys comprising validated measurement tools: the Copenhagen Burnout Inventory (CBI), the Australian Midwifery Workplace Culture (AMWoC) tool and the Clinical Supervision Evaluation Questionnaire (CSEQ) (the latter for intervention sites only). Primary outcomes are the levels of burnout in midwives (using the CBI). Secondary outcomes will be the quality of the intervention (using the CSEQ), perceptions of workplace culture (using the AMWoC tool) and midwives' intention to stay in their role/profession, as well as sick leave rates and numbers of exiting staff. We will also determine the dose effect - ie the impact in relation to how many Clinical Supervision sessions the midwives have attended, as well as other supportive workplace strategies such as mentoring/coaching on outcomes. DISCUSSION: Through attending monthly Clinical Supervision we hypothesise that midwives will report less burnout and more positive perceptions of workplace culture than those in the control sites. The potential implications of which are a productive workforce giving high quality care with the flow-on effect of having physically and psychologically well women and their babies. TRIAL REGISTRATION: The ACTRN Registration number is ACTRN12621000545864p , dated 10/05/2021,.

Learning to be a midwife: Midwifery students' experiences of an extended placement within a midwifery group practice.

AIM: To investigate the experiences, perspectives and plans of students who had a six-month placement with the midwifery group practice. METHODS: Focus groups were conducted with fifteen third - year Bachelor of Midwifery students who had undertaken an extended placement at a midwifery group practice in a large tertiary referral hospital in Queensland, Australia. RESULTS: Four main themes were identified in the data: Expectations of the Placement; Facilitating learning within a midwifery group practice model; Transitioning between models of care and Philosophy and culture of midwifery group practice. DISCUSSION AND CONCLUSION: Third-year midwifery students valued the experience of working one-on-one for an extended placement with a midwife providing continuity of care within a caseload model. The experience was the highlight of their degree and they learned 'how to be a midwife'. Most students found reintegrating back into the hospital system of care challenging, reporting that their developed skills of supporting women holistically and facilitating normal birth were not fully utilised when returning to the task-orientated birth suite. Students valued thoughtful, kind and supportive midwifery preceptors who supported them to transition back into the hospital. IMPLICATIONS AND RECOMMENDATIONS: Undertaking an extended placement within a midwifery group practice provides students with a rich and holistic learning experience and helps them develop a sense of professional identity. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities. Research of the longer-term impacts of an extended midwifery group practice clinical placement on midwifery graduates' capabilities and competencies 3-5 years post registration should be conducted.

A literature review to determine midwifery students' perceived essential qualities of preceptors to increase confidence and competence in the clinical environment.

BACKGROUND: Midwifery students' experiences with preceptors in the clinical environment plays an integral role in developing the confidence and competence of students. As up to 50% of the midwifery program is taught in the clinical environment, an analysis of the preceptorship role in the context of midwifery student confidence and competence may be important to inform future practice and policy. AIM: To discover, whilst on clinical placement, what is required by preceptors to suitably equip midwifery students to develop confidence and competence in the clinical environment. METHODS: A search of the literature was undertaken using health and midwifery related electronic databases of PubMed, CINAHL, Intermid, SCOPUS and Web of Science. Grey literature, and reference lists from studies were also part of the thorough search process. FINDINGS: After critical reading of the 15 included studies, there were a number of themes identified as the preceptor qualities that contributed to student confidence and competence. Those themes include 'belongingness', 'hands on experience/skill development', 'students' development of professional identity' and 'preceptor characteristics that impact student learning'. DISCUSSION: Student confidence and competence can be dependent on the preceptor who supports them. There are preceptors who enable students to flourish in their confidence and competence, and there also appears to be preceptors who do not possess these qualities, which requires further enquiry. CONCLUSION: As the evidence appears to find that trained preceptors are optimal for student confidence and competence, further enquiry is warranted to inform policy and practice around the concept of preceptorship training for midwives.

Number of students in clinical placement and the quality of the clinical learning environment: A cross-sectional study of nursing and midwifery students.

BACKGROUND: Clinical placement is an important component of nursing and midwifery education. It exposes students to the real-world healthcare environment, where theoretical knowledge is put into practice. However, the quality of the clinical learning environment in sub-Sahara Africa has not been well explored. OBJECTIVE: The objectives of this study were to assess trainees' perceptions of the number of students on the ward or clinical unit, and the quality of the clinical learning environment. DESIGN: Cross-sectional survey. SETTING: Nursing and midwifery students were recruited from three public hospitals in the Upper East Region, Ghana, between July and August 2019. PARTICIPANTS: 254 nursing and midwifery students were recruited using the convenience sampling technique. METHODS: Data were collected with the Clinical Learning Environment and Supervision + Nurse Teacher questionnaire. Data were analysed using univariate, bivariate and multivariable analyses. RESULTS: It was found that the participants rated supervisory relationship; pedagogical atmosphere; role of nurse teacher; leadership style of ward managers; and premises of care on the ward as average. Students' perceptions of the quality of the clinical learning environment were predicted by supervisory relationship (ß = 0.219, 95% CI: 0.016-0.070), leadership style (ß = 0.199, 95% CI: 0.011-0.133) and perception of number of students in clinical placement (ß = 0.224, 95%CI: 0.022-0.093). The trainees indicated that the number of students on the ward did not correspond with the amount of medical equipment and supervisors. CONCLUSION: The quality of the clinical learning environment was perceived to be suboptimal. Leadership style, supervisory relationship and perception of the number of students on the ward were the salient factors that influenced students' perceptions of the quality of the clinical learning environment. Leaders of nursing and midwifery training institutions must liaise with stakeholders to enhance the quality of the clinical learning environment.

The effect of stage IV childbirth care module through the preceptorship method.

OBJECTIVE: This study aims to determine the effect of the module through the preceptorship method on the improvement of stage IV childbirth care skills of D-III Midwifery students in childbirth care courses. METHODS: This study used a Quasi Experiment (pre-test post-test control group design). The population of all students who program the subject of childbirth care is 141 students. The sampling technique used total sampling. The sample was 141 semester II students at Program study of D-III Midwifery, STIKES Pelamonia Kesdam VII Wirabuana. Previously, a pre-test was carried out on stage IV childbirth care skills then divided into modules. After that, the preceptorship method was carried out for three meetings with 2×50min at each meeting. At the end of the meeting, a post-test was conducted. Data were analyzed using Mann-Whitney. RESULTS: This study indicates a significant effect, the value (p=0.000, p<0.05) in improving the skills of D-III midwifery students in semester II regarding stage IV delivery care in the module group and the preceptorship method compared to the demonstration and module groups. CONCLUSION: The results of data analysis and evaluation results on the module and preceptorship method significantly increase stage IV childbirth care skills for D-III midwifery students.

Estágio Supervisionado em Odontologia no Sistema Único de Saúde: revisão integrativa / Supervised internship in dentistry in the unique health system: an integrative review

Este estudo visa analisar a relevância dosEstágios Supervisionados em Odontologia no Sistema único de Saúde para o ensino, serviço e comunidade. Trata-se deuma revisão de literatura integrativacombusca nas bases de dadosBVS/LILACS, SciELO e Google Acadêmico. Os estudos para análise foram escolhidos após o estabelecimento de critérios de inclusão(artigos publicados nos últimos 5 anosque tratem das percepções dos envolvidos nessa vivência de integração,autores clássicos, teses, relatos de experiência, artigos em português, inglês e espanhol)e exclusão(artigos semDOIoutratando deestágiosem outras áreasesistemas de saúde). Assim, após a busca inicial, foram selecionados 113 estudosno total sendo 25, 8e 100,respectivamente,da BVS/LILACS, SciELO e Google Acadêmico. No entanto, após a leitura dos artigos na íntegra somente 17publicaçõesforam selecionadas. Dessa forma, das competênciasgerais apresentadas pelas Diretrizes Curriculares Nacionais em Odontologia, os estudos indicam que trabalho em equipe, atenção integral à saúde do usuário e comunicação adequada com usuários e membros da equipe são as características mais estimuladasna formação dos estudantes. Ademais, destaca-se a atenção primária como principal cenário de atuação do estagiário, compouco enfoque nos demais níveis de atenção. Analisou-se que perante as fragilidades desse processo, o estudante, sob orientação da preceptoria, deve adaptar-se àrealidade vivenciada para exercer a sua função com sucesso. Logo, o estágio insere o estudante na realidade profissional,além de trabalhar as suas insegurançase a capacidade de adaptação (AU).

This study aims to analyze the relevance of Supervised Internships in Dentistry at SUS for teaching, serviceand community. This is an integrative literature review, which was elaborated through a search in the databases: BVS/LILACS, SCIELO and GOOGLE ACADEMIC. The studies for analysis were chosen after the establishment of inclusion criteria: articles publishedin the last 5 years dealing with the perceptions of those involved in this integration experience, classical authors, theses, experience reports, articles in Portuguese, English and Spanish; and exclusion: articles without DOI and dealing with internshipsin other areas and health systems. Thus, after reading the titles, 113 studies were selected in total, 25, 8 and 100 respectively from the BVS/LILACS, SCIELO and Google academic. However, after reading the articles in full, only 17 publications were selected. Thus, from the general characteristics presented by the National Curriculum Guidelines in dentistry, studies indicate that teamwork, comprehensive care to the user's health and adequate communication with users and team members are the characteristicsmost encouraged by academics. Furthermore, primary care is highlighted as the main scenario in which the intern works, with little focus on other levels of care. It was analyzed that, in view of the weaknesses of this process, the student, under the guidance of the preceptorship, must adapt to the reality experienced in order to successfully perform his role. Therefore, the internship inserts the student into the professional reality, in addition to working on their insecurities and adaptability (AU).

Strategies for Success: Simple Education Interventions to Equip Nursing Students in Rural Liberia.

Severe shortages of skilled health workforce remain a major barrier to universal health coverage in low income countries including Liberia where nurses and midwives form more than 50% of the health workforce. According to the 2018 Service Availability and Readiness Assessment (SARA) report, Liberia has 10.7 core healthcare workers per 10,000 people, far below the WHO benchmark of 23/10,000 people. High quality training for nurses and midwives is one of the most important strategies to addressing these health workforce shortages. Since 2015, William V.S Tubman University (TU) faculty and Partners in Health (PIH) have partnered in nursing and midwifery education to address nursing and midwifery workforce shortages in Southeast Liberia. In our collaboration we have sought to not only increase the quantity of graduate nurses and midwives but also improve the quality of the training to ensure they are equipped to serve the population. TU strives to produce highly competent generic nurses who will excel in their clinical practice and future specialized training. By applying the theory of deliberate practice, learners are allowed to practice and self-evaluate repeatedly until they attain proficiency. Simulation training was adopted early in the training of nurses and midwives at TU to ensure students are well-prepared for real-life patient care. TU also established a preceptorship program to ensure that students receive skilled mentorship during clinical rotations. Internship for graduating senior Nursing/Midwifery students, where they focus on enhancing psychomotor and assessment skills, professional communication, safety and organization, medication administration and documentation, ensures successful integration into clinical practice after graduation. This progression of the student nurse or midwife from the exposure in the skills lab during pre-clinical modules, to individual preceptorship during clinical rotations to a structured internship experience with an intensive pre-internship "boot camp" have been the major innovations that have helped our partnership flourish. The foundation of these interventions is strong and sustained investment in nursing and midwifery faculty both at the university and the health facilities.