Failing professional practice placements in allied health: What do we understand about the student experience? A scoping review.

Professional practice placements are an essential component of allied health and nursing programs. Whilst most students pass these placements, a small percentage of students will fail or be at risk of failing. Supporting students undergoing a failing experience is a time critical, time consuming, emotional and resource-heavy task which is often undertaken by key university staff and impacts all stakeholders. Whilst several studies have provided insight into this experience from the educator and/or university perspective, this scoping review aimed to identify the students' experience of failing or nearly failing a professional practice experience. Following Arskey and O'Malley's framework for scoping reviews, 24 papers were included in this review. This review generated six themes including the reasons for failure, how failure looks and feels, how supports, service and strategies influence the student experience of failure, the importance of communication, relationships and organisational culture, the impact infrastructure and policies have, and the consequences of failure. The outcomes of this scoping review highlighted three key characteristics of the research to date: (a) the student voice is still largely missing; (b) the student perspective is distinctly different to that of other stakeholders; and (c) the interventions used appear not to be student-informed or student-led. Better understanding this experience from the student's perspective could create a more sustainable practice education environment by designing and implementing more effective supports, services or strategies that reduce the overall impact a failing experience has on students and key stakeholders.

Australian nursing students' experiences of workplace violence during clinical placement: A cross-sectional study.

AIM: To identify the nature, degree and contributing factors of workplace violence (WPV) incidents experienced by Australian nursing students during clinical placement. DESIGN: Descriptive cross-sectional study. METHODS: Data were collected from 13 September to 25 November 2022. Eligible participants included all nursing students enrolled in nursing degrees at any Australian university who had completed at least one clinical placement. An adapted version of the WPV in the Health Sector Country Case Study survey was used. RESULTS: A total of 381 nursing students across eight states of Australia completed the survey. More than half of the students had experienced an episode of WPV; patients were the most frequent perpetrators. Personal factors of patients, staff and students, organizational factors and cultural norms within the workplace supported acts of WPV. CONCLUSION: Student nurses (SNs) most often experience violence from patients during direct care. Patient encounters are the core component of clinical placement. Education providers have a responsibility to effectively prepare students to be able to identify escalating situations and manage potentially violent situations. Registered nurses who supervise students during clinical placement require support to balance their clinical role with student supervision. IMPLICATIONS FOR THE PROFESSION: Experiencing WPV can negatively impact relationships between students, healthcare professionals and care recipients. This results in personal distress, decreased job satisfaction and potentially the decision to leave the nursing profession. IMPACT: What already is known: SNs are exposed to WPV during clinical placement. WHAT THIS PAPER ADDS: More than half the SNs in this study experienced violence inclusive of physical, verbal, racial and sexual harassment. Patients were the predominant perpetrators. Implications for practice/policy: Interventions at individual and systemic levels are required to mitigate WPV. REPORTING METHOD: This study is reported using the STROBE guidelines.

Nurturing ethical insight: exploring nursing students' journey to ethical competence.

BACKGROUND: Ethical competence is a key competence in nursing and the development of the competence is a central part in nursing education. During clinical studies, nursing students face ethical problems that require them to apply and develop their ethical knowledge and skills. Little is known about how ethical competence evolves during students' initial clinical placements. This study explored the development of ethical competence in first-year nursing students during their first clinical placements in nursing homes. METHODS: This exploratory-descriptive qualitative study used focus group interviews to collect data and a phenomenological hermeneutical method for analysis. Twenty-eight first-year nursing students participated in six focus groups. The data were collected between March and April 2024 at Oslo Metropolitan University in Norway. RESULTS: The naïve reading of the data involved an awareness of the students applying their prior knowledge, modifying their prior knowledge and developing skills that allowed them to manoeuvre ethical practices that, in some cases, appeared excellent and, in other cases, grim. The structural analysis identified three themes: (i) ethical competence forges in practice, (ii) ethical competence evolves at the intersection of knowledge and skills and (iii) ethical competence unfolds through meaningful discussions. A comprehensive understanding of the data was formulated as 'Being on a journey towards ethical competence'. This presents a metaphor illustrating that nursing students embark on a journey towards ethical competence; from their point of departure, their clinical experiences forge the essential waypoints along their path, knowledge and skills fuelling their navigation in rugged terrain towards their destination. CONCLUSIONS: Nursing students' ethical competence evolved in intricate ways during their initial clinical period. Being informed bystanders or participants in the care of nursing home residents in situations of ethical tension may be a unique position enabling students to evaluate care options differently from those immersed in the ward culture. The findings indicate that organised professional development in nursing homes needs to focus on more reflexively driven ways of supervising students in their first clinical study period. Educational institutions need to continue and further develop reflection-based learning activities and meeting points with students and their peers during their clinical placement periods.

R425 first year student nurses 'experience of encounters with death of a patient during clinical placement.

BACKGROUND: In the course of caring, nurses often experience the death of patients, and this experience has an effect on the nurse. Every nurse responds to this experience in a different way, and it can be either a negative emotional response, or a positive emotional response. As part of their curriculum, R425 first-year student nurses are placed in clinical facilities to acquire competency in nursing skills, and here they may be exposed to patients dying. R425 is a South African Nursing Council regulation relating to the approval of and the minimum requirements for the education and training of a nurse (General, Psychiatric, and Community) and Midwife, leading to registration. End-of-life care can be rewarding, yet emotionally and psychologically challenging. Little is known about R425 first-year student nurses' experiences of patients dying while being cared for by nurses on clinical placement. The study, therefore, explored and describes R425 first-year student nurses' experiences of the death of a patient during clinical placement. METHOD: A qualitative exploratory descriptive and contextual research design was adopted, and a purposive, nonprobability sampling approach applied. Data were collected through unstructured individual interviews with 15 R425 first-year student nurses. Data were analysed using content analysis. RESULTS: Four themes emerged, namely, knowledge, psychological trauma, low self-esteem, and nutritional disorders, and subthemes were identified. Results reveal both negative and positive responses to encountering the death of patients, with more negative responses, and fewer positive responses. CONCLUSION: Results show that first-year student nurses struggle to cope with the death of a patient, mainly because they lack knowledge and the skills required to provide end-of-life nursing. It is the requirement for student nurses to be competent in a skill, 'last office', which involves laying out of a dead person. Such skill can be deferred in the first year of study, and can only be introduced at a later stage, either in third year or fourth year of study, when students are better equipped with knowledge and skills relating to dealing with death. There is a need to review the curriculum of R425 first-year student nurses, so that outcomes such as death and dying can be introduced in the third or fourth year of study.

Feelings and thoughts of midwifery students during their first birth suite placement: A qualitative study.

This descriptive qualitative study aimed to understand the feelings and thoughts experienced by 4th year midwifery students during the first birth they attended during clinical practice. Focus group interviews were conducted with 22 final year midwifery students in Istanbul, Türkiye December 2020. The transcribed data were analyzed by the descriptive qualitative analysis method. The students experienced not only negative feelings such as fear, torment, anxiety but also positive feelings such as hope, excitement, and curiosity during the first birth practice. The situations that caused negative feelings and thoughts were not only the feelings of the students but also the conditions that negatively affected the care provided to the patient in the clinic. The clinical practice environment affects the feelings and thoughts of midwifery students about the birth process. For this reason, improving the clinical practice environment and supporting students throughout the education process may contribute to the development of positive feelings and thoughts when attending as a student for their first birth suite placement.

Gamifying simulated nursing education: a digital technology approach to enhancing pedagogy and student experience.

Higher educational institutions have responded to a shortage of clinical placements for students by adopting innovative approaches, such as the use of simulated learning environments. The integration of gamification in simulated placements presents a promising opportunity to enrich and diversify the learning experience. A series of game-based resources to support simulated practice learning was developed by the academic team at the University of Bolton. This study involved evaluating the experiences of students who engaged in these interactive scenarios to assess the potential impact of these digital interventions on learning. The findings indicate that the approach had a significant impact on student learning, improving both their knowledge and their confidence in applying procedures in practice. These findings are of particular significance since it is commonly considered that students in fields such as nursing, which are known for their emphasis on human-centred care, place less value on digital learning technologies.

The early determinants of career choices for medical students following an obstetrics and gynaecology placement: Mixed methods study.

OBJECTIVE: To explore the impact of attending a clinical placement in considering a career in obstetrics and gynaecology. DESIGN: Mixed methods study. SETTING: London Medical School. POPULATION: Fifth year medical students attending a clinical placement in obstetrics and gynaecology. METHODS: Between January 2021 and January 2022, questionnaires were used and semi-structured focus groups conducted, which were audio-recorded. Descriptive statistics were conducted and a framework analysis on transcribed focus groups. MAIN OUTCOME MEASURE: The impact of the clinical placement on career choice. RESULTS: Six main themes were identified from the analysis; three contributing to considering a career in obstetrics and gynaecology; pregnancy is not an illness, extraordinary experience of observing childbirth and variable specialty and three themes emerged contributing to not considering a career; lack of work-life balance, high stakes specialty and the emotional toll. Even at an undergraduate level, medical students exhibited concerns about the long-term feasibility of achieving work-life balance and avoiding professional burnout, which was partly attributed to the responsibility of looking after both the woman and their baby. CONCLUSIONS: Obstetrics and gynaecology is perceived as an exciting and variable speciality by medical students. Students' experiences on the labour ward during a clinical placement appear to contribute to the consideration of a career in obstetrics and gynaecology. Students should be given opportunities to discuss their concerns about obstetrics, particularly over the potential psychological impact of adverse/traumatic birth events. It is crucial to provide a realistic introduction to obstetrics, to recruit enthusiastic junior doctors who will be resilient to the pressures of the speciality, to avoid burnout and minimise attrition rates.

Getting real in interprofessional clinical placements: patient-centeredness in student teams' collaborative learning.

Collaboration between healthcare providers helps tackle the increasing complexity of healthcare. When learning teamwork, interprofessional students are expected to work patient-centered; recognizing the patient's expertise and partnering with them. Research on interprofessional education (IPE) for undergraduates has illuminated learning outcomes, organization of learning activities, change in attitudes, etc. But, we know little about the interaction between patients and interprofessional student teams. This study aimed to explore how interprofessional student teams and patients interact in interprofessional clinical placements. With a focused ethnographic approach, participant observation and qualitative interviews were conducted in two contexts; a physical and an online arrangement. Central ideas in Goffman's dramaturgy constituted a theoretical lens. A reflexive thematic analysis generated three themes: (1) Preparing safe and comfortable encounters with patients, (2) Including and excluding the patient in the encounter, and (3) Adjusting to the patient's situation. We identified students' intentions of patient-centeredness when preparing encounters, but patients did not always feel included and listened to in encounters. After encountering patients, student teams adjusted their teamwork, by changing the team composition or the planned clinical interventions to better meet the patients' needs. Notably, team-based patient encounters led to a different view of the patient, their health issues, and how to collaborate. Our findings can inform educators of the importance of addressing patient-centered care in interprofessional learning arrangements. Today, clinical interprofessional placements may not exploit the potential for learning about patient-centeredness. A thematization of this, e.g., in supervision in future clinical placements can ensure an enhanced focus on this in interprofessional teamwork.

An ethnographic investigation of medical students' cultural competence development in clinical placements.

As a result of an increased understanding of culture's impact on health and healthcare, cultural competence and diversity curricula have been incorporated into many medical programs. However, little is known about how students develop their cultural competence during their training. This ethnographic case study combined participant observation with interviews and focus group to understand students' views and experiences in developing their cultural competence during clinical placements. The results show that students' development of cultural competence is an individually varied process via four distinctive yet interrelated learning avenues. Immersion in a diverse healthcare environment contributes to students' development of cultural awareness and knowledge. Observation of culturally appropriate or inappropriate practices allows students to enhance their practical skills and critical reflection. Interaction with other clinical professionals, patients, and their family members, enables students' engagement within the busy clinical practice. Reflection helps students to actively think about culture's impact on health and internalize the importance of cultural competence. Students' learning via each avenue is interrelated and constantly interacting with their learning environment, which collectively contributes to their development. Integrating the results allowed the authors to generate a theoretical model that conceptualizes medical students' cultural competence development in clinical placements, which unearths students' cultural learning within the informal and hidden curriculum. This study provides a rare view of students' development of cultural competence in clinical placements, which may inform the pedagogic development of cultural competence and diversity education in medicine and healthcare.

Challenges, coping and support during student placement abroad: A qualitative study.

BACKGROUND: During placements abroad, healthcare students are confronted with different personal and professional challenges, related to participation in practice. This study investigates when and how students respond to such challenges, and which coping and support mechanisms students use to overcome these. METHODS: Twenty-five international students shared their experiences about physiotherapy placement in The Netherlands. Using a critical incident technique, we asked participants to recall events where participation was affected by an unforeseen situation, in or outside the clinic. Further, we explored students' strategies of seeking support within their social network to overcome individual challenges. Two researchers applied thematic analysis to the interview data, following an iterative approach. Team discussions supported focused direction of data collection and analysis, before conceptualizing results. RESULTS: Participants described a wide range of challenges. The scope and impact level of challenges varied widely, including intercultural differences, language barriers and inappropriate behaviour in the workplace, students' personal context and wellbeing. Mechanisms employed by students to overcome these challenges depended on the type of event (personal or professional), making purposeful use of their available network. CONCLUSION: Students involve clinical staff, peers, family and friends during placement abroad, to make deliberate use of their support network to overcome challenges in participation, whereas the academic network remains distant. Findings may help reflect on the roles and responsibilities of academic staff and other professionals involved with placements abroad. Healthcare programmes should ensure support before, during and after placement is within students' reach.

Clinical support during COVID-19: An opportunity for service and learning? A cross-sectional survey of UK medical students.

PURPOSE: Medical students providing support to clinical teams during Covid-19 may have been an opportunity for service and learning. We aimed to understand why the reported educational impact has been mixed to inform future placements. METHODS: We conducted a cross-sectional survey of medical students at UK medical schools during the first Covid-19 'lockdown' period in the UK (March-July 2020). Analysis was informed by the conceptual framework of service and learning. RESULTS: 1245 medical students from 37 UK medical schools responded. 57% of respondents provided clinical support across a variety of roles and reported benefits including increased preparedness for foundation year one compared to those who did not (p < 0.0001). However, not every individual's experience was equal. For some, roles complemented the curriculum and provided opportunities for clinical skill development, reflection, and meaningful contribution to the health service. For others, the relevance of their role to their education was limited; these roles typically focused on service provision, with few opportunities to develop. CONCLUSION: The conceptual framework of service and learning can help explain why student experiences have been heterogeneous. We highlight how this conceptual framework can be used to inform clinical placements in the future, in particular the risks, benefits, and structures.[Box: see text].

The mental health impact of COVID-19 on pre-registration nursing students in Australia: Findings from a national cross-sectional study.

AIM: The study aimed to measure and describe the mental health impact of COVID-19 on Australian pre-registration nursing students. BACKGROUND: The COVID -19 pandemic has had a swift and significant impact on nursing students across the globe. The pandemic was the catalyst for the closure of schools and universities across many countries. This necessary measure caused additional stressors for many students, including nursing students, leading to uncertainty and anxiety. There is limited evidence available to identify the mental health impact of COVID-19 on Australian pre-registration nursing students currently. DESIGN: A cross-sectional study was conducted across 12 Australian universities. METHODS: Using an anonymous, online survey students provided demographic data and self-reported their stress, anxiety, resilience, coping strategies, mental health and exposure to COVID-19. Students' stress, anxiety, resilience, coping strategies and mental health were assessed using the Impact of Event Scale-Revised, the Coronavirus Anxiety Scale, the Brief Resilience Scale, the Brief Cope and the DASS-21. Descriptive and regression analyses were conducted to investigate whether stress, anxiety, resilience and coping strategies explained variance in mental health impact. Ethical Approval was obtained from the University of New England Human Research Ethics Committee (No: HE20-188). All participating universities obtained reciprocal approval. RESULTS: Of the 516 students who completed the survey over half (n = 300, 58.1%) reported mental health concerns and most students (n = 469, 90.9%) reported being impacted by COVID-19. Close to half of students (n = 255, 49.4%) reported signs of post-traumatic stress disorder. Mental health impact was influenced by students' year level and history of mental health issues, where a history of mental health and a higher year level were both associated with greater mental health impacts. Students experienced considerable disruption to their learning due to COVID-19 restrictions which exacerbated students' distress and anxiety. Students coped with COVID-19 through focusing on their problems and using strategies to regulate their emotions and adapt to stressors. CONCLUSION: The COVID-19 pandemic has considerably impacted pre-registration nursing students' mental health. Strategies to support nursing students manage their mental health are vital to assist them through the ongoing pandemic and safeguard the recruitment and retention of the future nursing workforce. IMPACT STATEMENT: This study adds an Australian understanding to the international evidence that indicates student nurses experienced a range of negative psychosocial outcomes during COVID-19. In this study, we found that students with a pre-existing mental health issue and final-year students were most affected. The changes to education in Australian universities related to COVID-19 has caused distress for many nursing students. Australian nursing academics/educators and health service staff need to take heed of these results as these students prepare for entry into the nursing workforce. PATIENT OR PUBLIC INVOLVEMENT: The study was designed to explore the impact of COVID-19 on the mental health of undergraduate nursing students in Australia. Educators from several universities were involved in the design and conduct of the study. However, the study did not include input from the public or the intended participants.

How will the Covid-19 pandemic shape the future of primary care undergraduate teaching? Understanding modifications and developments deployed by UK academic units of primary care, and their implications for the future.

BACKGROUND: Primary care has been under-represented in its contribution to the academic literature base on Covid-19 developments. We sought to understand how teaching and learning was modified and developed by primary care academic leaders to support the continuation of primary care-orientated learning during the Covid-19 pandemic; and explore how these changes may shape future educational delivery in primary care. METHODS: We adopted a qualitative approach, using semi-structured interviews of seven General Practice Heads of Teaching (GP HoTs) from UK medical schools. We used mixed deductive and inductive coding to analyse interview transcripts. Modifications and developments were coded to four a priori themes (clinical off-site; clinical on-site; synchronous remote; asynchronous remote). We concurrently used inductive coding to identify developments that did not readily fit into these categories. To understand how participants perceived the developments may shape primary care teaching in the future, we carried out an inductive thematic analysis. RESULTS: A range of modifications and developments were described. Examples of developments include: GP practices being provided with increased flexibility to support ongoing provision of clinical placements (on-site clinical), examples of initiatives enabling students to consult remotely from their homes (off-site clinical), transfer of face-to-face teaching to remote formats (synchronous remote) and development of new, interactive on-line teaching materials (asynchronous remote). One additional theme arose inductively: collaboration and co-operation. For future implications, five themes arose: the evolution of flexible and hybrid clinical placement models; an increased role for telemedicine; increased networking and collaboration; increased active student involvement in patient care; and opportunities for community-based teaching afforded by the pandemic. CONCLUSION: This study highlights how teaching was modified to support the continuation of primary care-based learning during the Covid-19 pandemic, and implications for the future. Collaboration and placement flexibility were notable features in the response. Participants perceived that flexible placement models containing a mixture of clinical on-site with remote synchronous and asynchronous teaching and learning activities, may persist into the post-Covid era. Further research is required to understand which developments become routinely embedded into primary care teaching in the post-Covid era and explain how and why this occurs.

The impact of pandemic disruptions on clinical skills learning for pre-clinical medical students: implications for future educational designs.

BACKGROUND: Pandemic disruptions to medical education worldwide resulted in rapid adaptations to clinical skills learning. These adaptations included moving most teaching to the online environment, decreasing the accepted "hands-on" methods of teaching and learning. While studies have shown significant impacts on student confidence in skills acquisition, there is a paucity of assessment outcome studies which would contribute a valuable perspective on whether measurable deficits were incurred. Here, a preclinical (Year 2) cohort was investigated for clinical skills learning impacts that could influence their transition to hospital-based placements. METHODS: A sequential mixed methods approach was used on the Year 2 Medicine cohort, including: focus group discussions with thematic analysis; a survey derived from the themes observed; and a cohort comparison of the clinical skills examination results of the disrupted Year 2 cohort, compared to pre-pandemic cohorts. RESULTS: Students reported experiencing benefits and disadvantages of the shift to online learning, including a decrease in confidence in their skills acquisition. End of year summative clinical assessments showed non-inferior outcomes when compared to previous cohorts for the majority of clinical skills. However, for procedural skills (venepuncture) the disrupted cohort had significantly lower scores compared to a pre-pandemic cohort. CONCLUSIONS: Rapid innovation during the COVID-19 pandemic provided the opportunity to compare online asynchronous hybrid clinical skills learning with the usual practice of face-to-face synchronous experiential learning. In this study, students' reported perceptions and assessment performance data indicate that careful selection of skills suitable for online teaching, supported by timetabled "hands-on" sessions and ample practice opportunities, is likely to provide non-inferior outcomes for clinical skills learning in students about to transition to clinical placements. The findings can be used to inform clinical skills curriculum designs that incorporate the virtual environment, and assist with future-proofing skills teaching in the case of further catastrophic disruptions.

The impact of clinical placement site, community clinic versus tertiary hospital, on midwifery students' clinical learning experience in Sierra Leone: a cohort study.

BACKGROUND: In midwifery education, the clinical learning experience (CLE) is a critical component to gaining competency and should comprise greater than 50% of a student's education. Many studies have identified positive and negative factors affecting students' CLE. However, few studies have directly compared the difference in CLE based on placement at a community clinic versus a tertiary hospital. METHODS: The aim of this study was to examine how clinical placement site, clinic or hospital, impacts students' CLE in Sierra Leone. A once 34-question survey was given to midwifery students attending one of four public midwifery schools in Sierra Leone. Median scores were compared for survey items by placement site using Wilcoxon tests. The relationship between clinical placement and student's experience were assessed using multilevel logistic regression. RESULTS: Two-hundred students (hospitals students = 145 (72.5%); clinic students = 55 (27.5%) across Sierra Leone completed surveys. Most students (76%, n = 151) reported satisfaction with their clinical placement. Students placed at clinics were more satisfied with opportunities to practice/develop skills (p = 0.007) and more strongly agreed preceptors treated them with respect (p = 0.001), helped improve their skills (p = 0.001), provided a safe environment to ask questions (p = 0.002), and had stronger teaching/mentorship skills (p = 0.009) than hospital students. Students placed at hospitals had greater satisfaction in exposure to certain clinical opportunities including completing partographs (p < 0.001); perineal suturing (p < 0.001); drug calculations/administration (p < 0.001) and estimation of blood loss (p = 0.004) compared to clinic students. The odds of students spending more than 4 h per day in direct clinical care were 5.841 (95% CI: 2.187-15.602) times higher for clinic students versus hospital students. There was no difference between clinical placement sites in regards to number of births students attended (OR 0.903; 95% CI: 0.399, 2.047) or number of births students managed without a preceptor/clinician present (OR 0.729; 95% CI: 0.285, 1.867). CONCLUSION: The clinical placement site, hospital or clinic, impacts midwifery students' CLE. Clinics offered students significantly greater attributes of a supportive learning environment and access to direct, hands-on opportunities for patient care. These findings may be helpful for schools when using limited resources to improve the quality of midwifery education.

Are the stars aligned? Healthcare students' conditions for negotiating tasks and competencies during interprofessional clinical placement.

BACKGROUND: Healthcare students must learn to collaborate across professional boundaries so they can make use of each other's knowledge and competencies in a way that benefits the patient. One aspect of interprofessional collaboration implies negotiating what needs to be done and by whom. Research, focused on the conditions under which students perform this negotiation when they are working together during interprofessional clinical placement, needs to be further developed. The study therefore aimed to explore students' negotiation of tasks and competencies when students are working together as an interprofessional team during clinical placement. METHODS: The study was designed as a focused ethnographic observational study. Two Nordic sites where final-year healthcare students perform clinical interprofessional education were included. Data consists of fieldnotes, together with informal conversations, group, and focus group interviews. In total, 160 h of participating observations and 3 h of interviews are included in the study. The analysis was informed by the theory on communities of practice. RESULTS: Students relate to intersecting communities of practice when they negotiate what they should do to help a patient and who should do it. When the different communities of practice align, they support students in coming to an agreement. However, these communities of practice sometimes pulled the students in different directions, and negotiations were sometimes interrupted or stranded. On those occasions, observations show how the interprofessional learning practice conflicted with either clinical practice or one of the student's profession-specific practices. Conditions that had an impact on whether or not communities of practice aligned when students negotiated these situations proved to be 'having time to negotiate or not', as well as 'feeling safe or not'. CONCLUSIONS: Final-year healthcare students can negotiate who in the team has the competence suited for a specific task. However, they must adapt their negotiations to different communities of practice being enacted at the same time. Educators need to be attentive to this and make an effort to ensure that students benefit from these intersecting communities of practice, both when they align and when they are in conflict.

How to prepare nursing students for mental health clinical engagement: a qualitative study.

BACKGROUND: Since clinical experience is challenging, identifying the factors influencing the learning process and acquiring clinical competence in mental departments is essential. Limited studies have investigated students' concerns regarding attending this clinical setting and how they are mentally and academically prepared. AIM/QUESTION: Explaining the various aspects of nursing students' preparation to attend the mental clinical environment. METHODS: This qualitative study was conducted on bachelorette nursing students and college professors using in-depth, semi-structured interviews. Inductive content analysis was used for data analysis, and Lincoln and Guba's criteria were used for the rigor of the data. RESULTS: The participants' viewpoints regarding how to prepare nursing students to enter mental clinical settings can be summarized in 4 categories: "understanding the students' concerns" "understanding the students' expectations" "the necessity of the students' mental preparation" and "preparing the scientific materials needed to attend in a mental ward". CONCLUSION: Nursing students have fears and worries about entering mental departments and have expectations of themselves and their instructors. To help students deal with these concerns, psychological and educational preparations should be provided, among which the role of new educational technologies can be mentioned.

Medical students' perception of learning from patient encounters in primary health care; a qualitative interview study.

BACKGROUND: Clinical practice gives medical students opportunities to develop clinical skills and to gain insight into their future profession as a physician. Students in the medical programme at Karolinska Institutet in Sweden had clinical practice in primary health care in nine of their 11 semesters. The aim of this study was to explore medical students' perceptions of learning from patient encounters in a primary health care context. METHODS: The study was a qualitative inductive interview study. The 21 participating medical students were from their 3rd, 4th and 5th (final year) year of the study programme. A semi-structured interview guide was used. The data analysis was performed with qualitative content analysis. RESULTS: The overarching theme of the study was: The individual patient encounters are the key to learning in primary health care. The patient encounters presented both useful opportunities and challenges that could contribute to the students' professional development. The following four categories were found: 1. Patient encounters in are instructive, rewarding and challenging. Practising in primary health care provided experience in meeting and communicating with a wide variety of patients. Students described it being challenging to trust in their own clinical competence and feeling a responsibility towards the patients. 2. Encounters with patients in primary health care provide opportunities for gradual professional development. Students had the opportunity of increasing independence based on their level of clinical competence. They experienced a progression in their professional development after each period in primary health care. 3. A committed supervisor plays a significant role in learning. Committed supervisors who set aside time for supervision, offered support, and encouraged the student, played an important role in the student's learning. 4. Learning in primary health care and learning in hospitals complement one another. It could be difficult for the students to sort out exactly where they learnt different things as they perceived that learning in primary health care and in hospitals complemented one another. CONCLUSIONS: The students' encounters with authentic patients in primary health care gave them recurring opportunities to develop communication skills and to be trusted to work on their own under supervision, giving them guidance on their way to becoming future physicians.

Preparing allied health students for placement: a contrast of learning modalities for foundational skill development.

BACKGROUND: With increasing pressure on placement capacity for allied health students, a need for novel and creative means through which students can develop foundational skills and prepare for practice-based learning opportunities has arisen. This study aimed to explore the experiences of domestic and international first-year students completing pre-clinical preparation programs, contrasting between in-person simulation and online options to contribute to best practice evidence for program design and delivery. METHODS: First-year students from physiotherapy, podiatry and occupational therapy self-selected to either a one-weeklong in-person simulation program or an online preparation for placement program. An integrative mixed-methods approach was employed. Qualitative findings from student focus groups were analyzed by reflexive thematic analysis and complemented by quantitative pre-post questionnaires which were examined for patterns of findings. RESULTS: There were 53 student participants in the study (simulation n = 29; online n = 24). Self-selecting, international students disproportionately opted for the simulation program while older students disproportionately selected the online program. Students appeared to benefit more from the simulation program than the online program, with alignment of focus group findings to the quantitative questionnaire data. The in-person simulation allowed students to apply their learning and practice patient communication. All simulation students reported asubsequent increase in confidence, although this seemed particularly marked for the international students. By contrast, the online program was most effective at developing students' clinical reasoning and proficiency with documentation. Both programs faced minor challenges to student perceived relevance and skill development. CONCLUSION: Both online and in-person simulation preparation programs were perceived to enhance readiness and foundational skills development for novice allied health students, with the practical nature of simulation generating more advantageous findings. This study provides useful information on the benefits and challenges of both types of delivery for foundational skills development and/or clinical preparation of allied health students.

Evaluating an undergraduate nursing student telehealth placement for community-dwelling frail older people during the COVID-19 pandemic.

AIMS AND OBJECTIVES: To evaluate a rapid response student telehealth placement experience implementing interRAI assessments of community-dwelling frail older people during the COVID-19 pandemic. To identify lessons to inform future telehealth clinical placements. BACKGROUND: New Zealand undertakes assessment of older people with disabilities using the interRAI contact assessment tool for less complex conditions and home care assessment tool for complex needs. New Zealand entered lockdown in March 2020 in response to COVID-19. New Zealand's most vulnerable community members required urgent needs assessment. DESIGN: A clinical placement whereby 3rd year undergraduate nursing students trained by interRAI-NZ educators worked remotely from home delivering telehealth assessment for 'at risk' older people across the Waikato District, New Zealand. This represented the first telehealth experience within an undergraduate nursing program approved by the New Zealand Nursing Council. METHODS: A case study evaluation utilising mixed method questionnaire and qualitative techniques within an interpretive paradigm. 19 third year students in the fifth semester of a Bachelor of Nursing program and 5 nursing staff members engaged in delivery of the initiative completed pre- and post-placement short answer questionnaires. Reflective diaries were maintained by students on placement. Post-placement interviews and focus group discussions provided in-depth data. COREQ guidelines informed analysis and reporting. RESULTS: Student and tutor responses showed consistent themes: tackling COVID-19; implementation requirements; nursing competencies; provider relationships; and community insights. These provide insight and highlight lessons learnt from this initiative. CONCLUSIONS: Student confidence in therapeutic engagement and clinical assessment and interest in aged care was increased, confirming the viability and importance of this inaugural telehealth student placement initiative. RELEVANCE TO CLINICAL PRACTICE: Graduate work readiness is enhanced through telehealth placement experience and interRAI assessor training. These are recommended as core components of future nursing education programs.