Clinical supervision in podiatry in Australia and New Zealand: supervisor challenges in this role.

BACKGROUND: Clinical supervisors play an integral role in preparing podiatry graduates for clinical practice. Not enough is, however, known about how prepared podiatry clinical supervisors are for this role, in terms of training received and the challenges they face in the role. Informed by previous qualitative research, this study extends our understanding of what it means to be a clinical supervisor in podiatry. METHODS: An online survey comprising closed and open-ended questions gathered data from 67 registered podiatrists who were also clinical supervisors. Descriptive analysis was undertaken. Chi-square analysis was used to test independence between preparedness for supervision and variables of interest (e.g. training received). Item analysis was assessed using Cronbach's alpha coefficients and Kendall's Tau to determine whether statistically significant associations existed across the broad challenges previously identified (i.e. supervisor-specific, curriculum and students). Open-ended comments were analysed using content analysis. RESULTS: Generally, most supervisors (64%, 43/67) initially felt " prepared" to supervise, despite the majority (58%, 39/67) not having received any training or educational support. Overwhelming, supervisors (97%, 65/67) considered universities responsible for ensuring quality clinical supervision. They perceived many of the previously identified supervisor-specific challenges (e.g. time-consuming), curriculum issues (e.g. limited hands-on patient contact in private practice placements) and student deficiencies (e.g. poor time management). Positive correlations were found across the three sets of challenges, with the strongest measure of association found between overall student deficiencies and overall curriculum issues (p < .001). CONCLUSION: These findings contribute to a deeper understanding of clinical supervision in podiatry. The study identified inconsistent support for clinical supervisors from partner universities. This study found a clear desire and need for supervisor training. A partnership approach is recommended in which universities work with clinical supervisors to address their overall challenges in terms of supervisor professional development, paying attention to curriculum issues, and improving student preparedness during placements.

Use of Critical View of Safety and Proctored Preceptorship in Preventing Bile Duct Injury During Laparoscopic Cholecystectomy-Experience of 3726 Cases From a Tertiary Care Teaching Institute.

INTRODUCTION: Bile duct injury (BDI) continues to occur despite technological advances and improvements in surgical training over the past 2 decades. This study was conducted to audit our data on laparoscopic cholecystectomies performed over the past 2 decades to determine the role of Critical View of Safety (CVS) and proctored preceptorship in preventing BDI and postoperative complications. MATERIALS AND METHODS: All patients undergoing elective laparoscopic cholecystectomy were analyzed retrospectively. The data were obtained from a prospectively maintained database from January 2004 to December 2019. Proctored preceptorship was used in all cases. Intraoperative details included the number of patients where CVS was defined, number of BDI and conversions. Postoperative outcomes, including hospital stay, morbidity, and bile duct stricture, were noted. RESULTS: Three thousand seven hundred twenty-six patients were included in the final analysis. Trainee surgeons performed 31.6% of surgeries and 9.5% of these surgeries were taken over by the senior surgeon. A CVS could be delineated in 96.6% of patients. The major BDI rate was only 0.05%. CONCLUSION: This study reiterates the fact that following the basic tenets of safe laparoscopic cholecystectomy, defining and confirming CVS, and following proctored preceptorship are critical in preventing major BDI.

Nurse preceptors' perceptions of the fundamentals of nursing knowledge gained by students in clinical rotations at nursing homes: A qualitative study.

BACKGROUND: International evidence suggests that clinical nurses and nursing students perceive fundamental care as not being important, not complicated and even not a nurse's responsibility, thus resulting in negative patient outcomes. AIM: To explore nurse preceptors' perceptions about the factors that influence nursing students' gaining of knowledge about fundamental care during their clinical practice at nursing home. METHODS: A qualitative descriptive study using individual interviews was conducted from September 2020 to April 2021. Nine nurse preceptors employed at five nursing homes participated. The data were analysed by employing an inductive qualitative content analysis. FINDINGS: The analysis generated one main category-'Fostering students' knowledge and understanding of fundamental care'-supported by two categories: (i) 'Nurse preceptors - enablers of nursing students' learning fundamental care' and (ii) 'Nursing home - a learning environment that facilitates students' learning about the delivery of fundamental care', which can be interpreted as the preconditions that may contribute to fostering students' knowledge and understanding of fundamental care. CONCLUSION: The study reveals that nurse preceptors' attributes, an effective preceptorship and a social learning environment can create opportunities for nursing students learning the provision of fundamental care in nursing homes. Furthermore, Vygotsky's theory of sociocultural learning may be applied when teaching in clinical nursing education.

The COVID-19 e-lective: using innovation to manage disrupted medical student clinical placements.

BACKGROUND: The COVID-19 pandemic changed the way we work, spend, live, and learn. The impact was felt in the health sector where hospitals cancelled elective surgery, put on hold outpatient services, and implemented new social distancing procedures and telehealth systems, to enable hospitals to increase bed capacity. For medical students, these factors meant significant disruption to their clinical placements, remote delivery of their education, cessation of international and interstate placements, complicated by significant travel restrictions and border closures. There were concerns that final year students might be unable to graduate that year due to this lack of clinical exposure. INNOVATION: As a result of this disruption in late March 2020 we developed an innovative 6 week 'COVID-19 e-lective' rotation, consisting of online modules, virtual clinical tutorials and a COVID project totalling the equivalent of 200 h of work. RESULTS: An evaluation was undertaken that found it to be remarkably successful in meeting the students' learning needs and alleviating concerns about disrupted placements. It was also conducted during 2021 for all Year 4 students to help expand clinical placement opportunities. OUTCOMES: This paper describes the e-lective, its innovations, its challenges, and its evaluation findings, for others to learn from.

Nursing students' achievement emotions in association with clinical practicums and alternative learning.

OBJECTIVES: This study aimed to identify and compare nursing students' achievement emotions associated with clinical practicums and alternative learning during the COVID-19 pandemic. METHODS: This cross-sectional, descriptive study enrolled 236 nursing students. Participants completed a web-based, self-administered survey regarding achievement emotions. Wilcoxon signed-rank tests were used to calculate mean differences in achievement emotions associated with clinical practicums and alternative learning. RESULTS: Nursing students who undertook e-learning reported higher negative achievement emotions than those who experienced other alternative learning modalities. Higher achievement emotions were associated with clinical practicums than with alternative learning. The most frequently reported negative emotions were anxiety associated with clinical practicums and boredom with alternative learning. CONCLUSIONS: Nurse educators should design and implement supportive clinical learning experiences to engender productive achievement emotions. Implications for an international audience: Nurse educators should play roles in providing well-designed and supportive clinical learning environments to help nursing students regulate achievement emotions.

Investigating preceptor experiences with cultural intelligence in pharmacy education.

BACKGROUND: A culturally intelligent pharmacy workforce is critical for addressing health disparities and ensuring that healthcare teams are equipped to support the medication needs of patients. Despite the critical role of preceptors in developing aspiring pharmacists, little is known about how they create or manage cross-cultural situations for students. OBJECTIVE: The objective of this study was to explore preceptor experiences teaching cultural intelligence within experiential pharmacy settings. METHODS: A convergent parallel mixed methods approach was used with a 10-item survey measuring preceptor teaching self-efficacy (measured from 0-cannot do at all to 10-highly certain can do) and interviews/focus groups to further understand cultural intelligence teaching experiences. Data were analyzed according to the 4 domains of the cultural intelligence framework (i.e., cultural awareness, cultural knowledge, cultural practice, and cultural desire). Survey data were analyzed descriptively and qualitative data were analyzed deductively. RESULTS: Participants (n = 24) were most confident Discussing factors underlying health and healthcare disparities (e.g., access, socioeconomic status, environment, racial/ethnic) (7.54 ± 2.04) and least confident in Understanding the importance of cultural desire in teaching students to be culturally intelligent healthcare practitioners (5.21 ± 2.72). All four cultural intelligence domains were identified in the qualitative data (n = 315 codes), with preceptors providing evidence of cultural awareness (n = 38, 12.1%), cultural knowledge (n = 54, 17.1%), cultural practice (n = 183 codes, 58.1%), and cultural desire (n = 40, 12.7%). Preceptors described various pedagogical strategies, such as case discussions, reflection, and simulation. CONCLUSIONS: Participants provided insight into pedagogical strategies for cultural intelligence that could promote student learning in experiential settings and help explicate curricular gaps. Further research regarding applicability of the cultural intelligence framework is needed, including application of these strategies and opportunities for preceptor development.

Nursing students' achievement emotions in association with clinical practicums and alternative learning.

OBJECTIVES: This study aimed to identify and compare nursing students' achievement emotions associated with clinical practicums and alternative learning during the COVID-19 pandemic. METHODS: This cross-sectional, descriptive study enrolled 236 nursing students. Participants completed a web-based, self-administered survey regarding achievement emotions. Wilcoxon signed-rank tests were used to calculate mean differences in achievement emotions associated with clinical practicums and alternative learning. RESULTS: Nursing students who undertook e-learning reported higher negative achievement emotions than those who experienced other alternative learning modalities. Higher achievement emotions were associated with clinical practicums than with alternative learning. The most frequently reported negative emotions were anxiety associated with clinical practicums and boredom with alternative learning. CONCLUSIONS: Nurse educators should design and implement supportive clinical learning experiences to engender productive achievement emotions. Implications for an international audience: Nurse educators should play roles in providing well-designed and supportive clinical learning environments to help nursing students regulate achievement emotions.

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.

Level 2 clinical supervision for community practitioners working with palliative and end-of-life care patients.

BACKGROUND: Little has been written on the availability of specialist level 2 supervision groups to support community practitioners regarding the emotional components of their palliative and end-of-life caseload. Adapted level 2 groups (AL2Gs) have been piloted in three community teams in the NHS to address this. AIMS: This study aimed to evaluate whether access to AL2Gs benefited community palliative and end-of-life practitioners at three sites. The outcomes for those who attended and those unable to attend were considered. FINDINGS: Attendees found AL2Gs beneficial, reporting better confidence and wellbeing, plus a sense of containment through group cohesion and trust in the facilitators and fellow AL2G members. Most would recommend the groups to all staff working in community palliative care. Practitioners who were not able to attend relied on informal and ad-hoc peer support, and had concerns about their skills in managing patients' psychological needs. CONCLUSION: Community nurses benefit from attending AL2Gs to support them with their palliative care/end-of-life caseloads. It is recommended that all community staff involved in this type of care have access to regular clinical supervision, especially in a group format.

Excellence in Nursing Preceptorship-to-Hire, part 1.

An academic-practice partnership to recruit and retain nurses.

Successful Clinical Nurse Specialist Recruitment: Creating a Talent Pipeline.

BACKGROUND: The future of the clinical nurse specialist (CNS) role depends on nurses enrolling in CNS programs and having access to clinical experiences. At 1 institution, challenges with CNS recruitment and variations in how students were precepted were noted. This article describes a successful CNS student program and its value in creating a talent pipeline. PROJECT: A revision to student placements was initiated to create a formalized program including enhanced academic partnerships, standardized expectations and goals, assigned clinical projects and end-of-semester presentations, appointment of a student coordinator, and structured preceptor preparation. OUTCOMES: Outcomes included 100 placements for 50 different students; the primary source of recruitment for the organization is now prior students, with 17 being hired since program inception. A 325% increase was also noted in qualified preceptors. Student productivity increased, and 11 students were accepted for national presentations. Academic sites have reported increased satisfaction. CONCLUSION: Organizations looking to increase CNS recruitment should consider the revision of their student program. A centralized CNS responsible for student experiences can ensure standardization and provide preceptor support. The CNSs have an essential role in securing their future nationally and can do so through growing new talent and aiding in preparation for practice.

Excellence in Nursing Preceptorship-to-Hire, part 1.

An academic-practice partnership to recruit and retain nurses.

Preceptors' preparedness to teach about substance and opioid use disorder: a qualitative study.

STUDY AIM: Little is known about preceptors' comfort and readiness to teach clinical students about the care of patients with substance and opioid use disorder (SUD/OUD). This study explores preceptors' views about caring for such patients, and their preparedness to teach about SUD/OUD management, to improve graduate competencies. METHODS: Participants were recruited by convenience and snowball sampling. Semi-structured interviews were conducted with physician, physician assistant, and nurse practitioner preceptors who taught medical and physician assistant students. Interviews were conducted via Zoom® videoconferencing. Transcripts were generated and independently analyzed for themes by 4 experienced coders using constant comparison and a grounded theory approach. RESULTS: Fifteen interviews were conducted to theme saturation. We identified 3 major themes and 10 subthemes supported by exemplar quotes. The major themes were: education about SUD/OUD in primary care (subthemes include need for longitudinal curriculum, redefining 'success' in treatment, and precepting challenges), treatment of SUD/OUD in primary care (need for systemic support and care continuity), and medication-assisted therapy (MAT) training as a tool for teaching (preceptors' own training, and need for clinical students to be trained). CONCLUSIONS: Preceptors agreed that treatment of SUD/OUD belongs in primary care and students should learn about SUD/OUD from the start of their medical education. Data analysis enabled the construction of an emerging conceptual framework reflecting a diversity of experiences and opinions of preceptor comfort and preparedness to teach about SUD/OUD, associated with various barriers and motivators. This framework can guide future strategies to address facilitators and obstacles to advance and promote preceptor preparedness to teach students about the care and management of patients with SUD/OUD.

The Experiences of Psychiatric Mental Health Nurse Practitioners with Clinical Supervision in South Korea: A Grounded Theory Approach.

Clinical supervision (CS) helps improve expertise and job satisfaction in nursing staff, but its grounded research is limited. This study was conducted to derive a grounded theory based on the lived experiences of psychiatric mental health nurse practitioners (PMHNPs) in clinical supervision. Data were collected from January to April 2018 through in-depth unstructured interviews with 19 PMHMPs. Supervision of mental health nurses was necessary because of the "lack of ability to integrate theory and practice" and "difficulty working alone". The "poor supervision system" has been strengthened. The nurses used strategies such as "asking for help", "intensive training and sharing with the supervisor", "modeling of the supervisor and developing competencies", "continuing self-reflection and learning", and "participating in professional activities", according to the level of "personality characteristics", "institutional supervision policy", and "relationship with the supervisor". Consequently, the core objective of "supporting each other and becoming healthcare experts" was achieved. These findings can be used as a basis for education, practices, research, and policy development of mental health nursing. This study highlights areas for policy improvement to ensure that high-quality mental health nursing can be achieved through appropriately targeted CS.

Psychometric Testing of the Preceptor Self-Assessment Tool (PSAT)-40 for Nursing Preceptors.

Background The aim of this study was to complete the third phase of development of the Preceptor Self-Assessment Tool (PSAT). Method Psychometric testing was conducted via an online Qualtrics survey with a statewide sample of 320 nurse preceptors from July to September 2020. Exploratory factor analysis and internal consistency and scale reliability testing were conducted on the 64-item PSAT. Results Exploratory factor analysis identified three factors: (1) inter/intrapersonal skills and attitudes, (2) knowledge and understanding, and (3) administrative resources and support. Cronbach's alpha values for the PSAT-40 ranged from 0.978 to 0.998. Final scale reliability was excellent at 0.983. Conclusion The Preceptor Self-Assessment Tool, now in its final form as the PSAT-40, has established construct validity and reliability and can be used to assess competency as a preceptor. Nurse educators can use this instrument to assess the needs of nurse preceptors and develop strategic nursing preceptor education programs. [J Contin Educ Nurs. 2022;53(11):491-499.].

Preceptor support during the COVID-19 pandemic: Recommendations for continuing development.

BACKGROUND:  Mentally fit preceptors may be more capable and flexible in providing students with system, emotional and cognitive support in the clinical learning environment (CLE) in the face of any life-threatening outbreaks. Existing professional development programmes for preceptors emphasise the development of preceptor competence in a normal CLE with minimal focus on their ability to engage with adverse events that challenge their mental health. OBJECTIVE:  The study sought insight from preceptors' experiences during the coronavirus disease 2019 (COVID-19) pandemic to identify their professional development programme needs while providing support to students during accompaniment. METHOD:  A mixed methods convergent parallel design was used to collect data from 24 preceptors at a nursing education institution (NEI). Eleven preceptors responded to the survey that included the coronavirus disease 2019 (COVID-19) Stress Scale (CSS) and Burnout Assessment Tool (BAT) to collect quantitative data. Semistructured interviews were conducted with five purposively selected preceptors to collect qualitative data regarding their experiences while accompanying students during the COVID-19 pandemic. RESULTS:  Subscales within the CSS and BAT instruments were mapped against an existing preceptor support framework. Overall CSS data for each subscale indicated an average score varying from no stress to moderate stress, while BAT data shows that respondents rarely experienced burnout. However, some respondents experienced very high levels of stress and burnout. Qualitative data supplemented results. CONCLUSION:  The COVID-19 pandemic influenced preceptors' role in supporting students and reflecting that they amended their functioning role. Existing preceptor professional development programmes should be reviewed to ensure that the necessary concepts that foster resilience are integrated to enhance the functional role of preceptors in adversity.Contribution: Existing preceptor professional development programmes should be reviewed to ensure that the necessary concepts that foster resilience are integrated to enhance the functional role of preceptors in adversity.

Interpersonal and communication skills development in general nursing preceptorship education and training programmes: A scoping review.

AIM: The aim of this systematic scoping review is to examine and synthesise the available literature on developing interpersonal and communication skills in general nursing preceptorship education programmes. BACKGROUND: Highly developed interpersonal and communication skills are an essential component of nursing preceptorship. Preceptors are integral in facilitating, guiding, and developing positive interpersonal relationships between the nursing student (the preceptee), the qualified nurse (the preceptor), and patients. They also have a responsibility to foster and develop preceptees' interpersonal and communication skills and assess and deem preceptees as competent in such skills. Furthermore, preceptors require effective interpersonal and communication skills to carry out key responsibilities of their role, including creating a safe clinical learning environment, teaching, and providing effective feedback. DESIGN: A scoping review was conducted using the methodological framework of Arksey and O'Malley. The PRISMA Extension for Scoping Reviews guided the reporting. METHODS: Five electronic databases were searched for relevant articles in consultation with a librarian, supplemented by hand-searching and internet searches for grey literature. A total of 19,431 potentially relevant articles published between Jan 2000 and August 2021 were retrieved from the initial search, and an additional six articles were obtained from the supplemental search. A total of 146 articles were independently reviewed by two researchers, resulting in 24 articles eligible for inclusion in the review. RESULTS: Several themes were identified in the literature that influenced the development of interpersonal and communication skills in preceptorship education and training programmes, including design and development of programmes, key learning outcomes, pedagogical approaches of preceptorship education and training programmes and interpersonal & communication skills development in preceptorship education and training programmes. Conclusions This review highlighted that research on developing interpersonal and communication skills amongst preceptors is mainly absent from the literature. Further research to address these knowledge gaps is warranted. The results from this review can be used to inform future curriculum design and development of nursing preceptorship education and training programmes.

Development and Preliminary Evaluation of the Effects of a Preceptor Reflective Practice Program: A Mixed-Method Research.

Studies on methods to share nursing and learning experiences with preceptors are lacking. This study was conducted to determine the preliminary effects of developing and applying a reflective practice program for preceptor nurses who experience stressful situations to convert negative emotions into positive ones. This study was conducted over 12 weeks from March to May 2022 on 47 participant nurses in South Korea. Preceptor Reflective Practice Program (PRPP) was conducted in parallel with writing a reflective journal and a reflective practice workshop. Data collection was integrated through quantitative and qualitative approaches. Quantitative data were collected through questionnaires on stress coping, the burden of preceptors, social support, and emotional intelligence, and analyzed by SPSS WIN 26.0 program. The questionnaire data were analyzed after the preceptor nurses had written a reflective journal. Stress coping, social support, and emotional intelligence significantly increased in preceptor nurses after participating in the PRPP. This study found that the PRPP helped nurses improve their emotional intelligence through reflective practice and convert stress into a more positive direction. Therefore, at the organizational and national levels, a reasonable compensation system to provide support workforce and to the work of preceptor nurses should be established.