A systematic review of placement-related attrition in nurse education.

BACKGROUND: Attrition in nurse education is a worldwide issue. Clinical placements form a major part of nurse education and have an important role in students' perceptions of nursing. Student nurses cite unsatisfactory placement experiences as a reason for leaving nursing education. OBJECTIVE: To conduct a systematic review to establish nursing students' placement-related reasons for leaving their programme. DATA SOURCES: Major health literature databases were searched, including studies from 1995 to 2011. REVIEW METHODS: This review considered quantitative and qualitative research investigating student nurse attrition, with an emphasis on placement-related issues. After a systematic selection process, included studies were quality assessed by three researchers. RESULTS: Eighteen studies were included in the review. The studies investigated personal reasons for leaving, demographic and other factors, and students' attributes. As for all student attrition, there was no single reason (related to placements) why students chose to leave, however, being a young or a male student were major factors, along with being exposed to unpleasant placement experiences, the attitudes of placement staff, and lack of support. Perceptions of the nursing profession and practice assessments were also factors in placement-related attrition. CONCLUSIONS: There is a need for more high quality reporting in the area of attrition in student nursing, whether this is due to placement issues or other reasons. Prior work experience in healthcare settings is important in enabling students to complete their programmes and recruitment and retention strategies should consider this. When students are recruited with limited or no healthcare experience, targeting retention strategies and support on these students may be useful.

Longitudinal evaluation of the impact of placement development teams on student support in clinical practice.

AIMS: To investigate the impact of a new structure for supporting healthcare students and mentors in practice placements (Placement Development Teams). INTRODUCTION: The English Model National Partnership Agreement for healthcare education required Strategic Health Authorities, Higher Education Institutions and National Health Service Trusts to redesign strategies for student support. Placement Development Teams are one English University's response to this. MATERIALS AND METHODOLOGY: This study was phase 2 of a longitudinal qualitative evaluation of Placement Development Teams. Data were collected after establishment of Placement Development Teams, and compared and contrasted with those collected prior to their implementation. Telephone interviews were conducted with key educational stakeholders in Trusts and Strategic Health Authorities. Focus groups were conducted with third year non-medical healthcare students and first year paramedics working in 16 NHS Trusts in the south west peninsula of England. RESULTS: Pre-Placement Development Teams, themes from the students' data were: Supportive and unsupportive behaviour of staff; Mentor allocation; Placement allocation; Benefits of students to the placement area and Perceived control over the learning experience. Post-Placement Development Teams, the themes were Communication; Supportive and unsupportive behaviour of staff; The effect of peers on the placement experience; Knowledge and perceptions of the work of the PDTs. Form the staff data, pre-Placement Development Teams the themes were: Vision for improving student support. Post-Placement Development Teams themes from the staff data were how they provided a central point of contact for student and mentor support; and how they supported students and mentors. CONCLUSION: Support of students and mentors is particularly important following the introduction of The English Model National Partnership Agreement for healthcare education. Placement Development Teams can facilitate partnership working between higher education institutions and placement providers for student support.

Placement Development Teams and interprofessional education with healthcare students.

AIMS AND OBJECTIVES: The aim was to investigate the impact of a new structure for supporting students and mentors in practice placements (Placement Development Teams) in fostering interprofessional education from the perspective of non-medical health care students and staff. BACKGROUND: Interprofessional education is an important international issue which received significant impetus in the UK as a result of many high-profile cases where uni-professional boundaries and cultures have contributed to adverse patient and client outcomes. DESIGN: This study was part of a longitudinal qualitative evaluation of Placement Development Teams. The design for this stage was cross-sectional. METHODS: Data were collected using telephone interviews with key educational stakeholders in trusts and Strategic Health Authorities and focus groups with third-year non-medical health care students working in the south-west peninsula of England. RESULTS: Students' focus group data indicated that interprofessional support and learning was key. Students had mixed views on how much they valued support gained from staff and students from other professions. Staff data indicated that they facilitated communication. Staff discussed their practical activities which made a difference and helped change the organisational culture in favour of interprofessional education. CONCLUSION: If interprofessional education in clinical practice is to be effective, it needs local facilitation and structures that support it. Placement Development Teams can provide this. The 'best' means of 'doing interprofessional education' in clinical practice and its impact on patient outcomes requires further large-scale research work with rigorous methodologies at a national level. RELEVANCE TO CLINICAL PRACTICE: To embed interprofessional education in practice-based professions' curricula and clinical placements requires active, supportive structures and local facilitation. Structures such as Placement Development Teams can help to achieve this where organisational cultures are influenced by committed staff. Students require persuasion concerning the benefits of interprofessional education.

Improving student support using Placement Development Teams: staff and student perceptions.

AIMS AND OBJECTIVES: To explore the experience of student support prior to the implementation of a new structure for supporting students and mentors in practice placements (Placement Development Teams) for health care professionals. This study reports findings relating to acute sector adult nursing students and staff. BACKGROUND: Clinical practice is essential in pre-registration health care professional education programmes. The English Model National Partnership Agreement for health care education gives a new impetus to Strategic Health Authorities, Higher Education Institutions and National Health Service Trusts to evaluate and redesign their strategies for student support. DESIGN: This study was phase one of a large longitudinal qualitative evaluation of Placement Development Teams' introduction. The design for this phase was cross-sectional. METHODS: Data were collected using telephone interviews with key educational stakeholders in trusts and Strategic Health Authorities and focus groups with third-year adult nursing students working in six acute sector trusts. RESULTS: Five themes emerged from the nursing students' focus group data. These were (1) Supportive and unsupportive behaviour of staff. (2) Mentor allocation. (3) Placement allocation. (4) Benefits of students to the placement area. (5) Perceived control over the learning experience. Four themes emerged from data analysis of the staff telephone interview data. These were (1) Vision of support services. (2) Proactive versus reactive support. (3) Barriers to achieving proactive support. (4) Bridging the gap between education and the trusts. CONCLUSION: Supporting students in practice is multifaceted and interpersonal and structural factors are important. This study illustrates how student support activity can be redesigned to meet the needs of the Model National Partnership Agreement. RELEVANCE TO CLINICAL PRACTICE: Good mentoring is particularly important for student support. Where there are high student numbers in placement, this can adversely affect students' placement learning.

Improving student support in professional placement learning: findings from the South west peninsula pilot of a new english national placement quality assurance and enhancement process.

English stakeholder collaboration has resulted in a new quality assurance process for non-medical health and social care placement providers and higher education institutions. This study aimed to discover the impact on student support that taking part in a pilot had on participating placement areas. Using a questionnaire survey with longitudinal follow-up one year later, we found that placement staff valued the opportunity to review and improve student support practices. This was still in evidence a year later where the pilot was described as giving the opportunity to provide evidence of aspects of student support practice; communicating and changing or developing aspects of that practice. Benefits accrued from interdisciplinary working in sharing and collaborating with other professions and organisations. Such activity could enhance clinical support staff activities and facilitate strategic partnerships between placement providers and higher education institutions.