Clinical placements in Australian general practice: (Part 1) the experiences of pre-registration nursing students
Introduction
An ageing population, the de-institutionalisation of mental health and the early discharge from tertiary hospitals have increased the number of high acuity patients managed in the community (Australian Institute of Health and Welfare, 2010, Happell, 1999). Despite clear evidence that a strong primary care system improves health outcomes, the growing burden of chronic and complex illness treated in the community has exacerbated the workload of nurses employed in primary care (Department of Health and Ageing (2013); Jolly, 2007). Introducing pre-registration nurses to this healthcare sector may help sustain and replenish the primary care nursing workforce and equip students with the skills to work in a complex and rapidly changing healthcare environment (Harris et al., 2011, McClimens et al., 2013).
General practices are recognised as one of the largest components of the primary care system and are ideally located within community settings to provide comprehensive, patient centred care to individuals and families across the lifespan (RACGP, 2014). The contemporary environment of general practice now includes various nursing roles to support the traditional work of general practitioners (Halcomb et al., 2007, Halcomb et al., 2006). Whilst much work has been undertaken exploring the roles of these nurses and their contribution to primary care service delivery, there has been limited attention to the recruitment of beginning nurses to this setting.
Higher Education Institutions (HEIs) appear to be slow to reflect the shift towards primary care in both the nursing curricula and via clinical placement experiences (Albutt et al., 2013). To date, contemporary studies exploring clinical placements have been largely undertaken in the acute tertiary care sector and do not reflect the international shift towards strengthening primary care services (Bjørk et al., 2014). Such trends are not keeping pace with health reforms to build and sustain a strong primary care nursing workforce and threatens the confidence and ability for beginning nurses to work in primary care (Ali et al., 2011, Keleher et al., 2010). Given that clinical placements challenge preconceived ideas of the clinical areas in which pre-registration nursing students wish to practice, it is important to ensure that the placement experience is positive (Henderson et al., 2007, McKenna et al., 2010).
Section snippets
Background
The clinical environment is a core component of contemporary nursing education. It provides opportunities for pre-registration nurses to transfer theoretical knowledge into practice and has been cited as influencing the student's attitude to learning and future career choices (Happell, 1999, Newton et al., 2009a, Smedley and Morey, 2010). However, as a multi-dimensional and dynamic entity, the clinical environment does not always provide a positive learning experience. Ward culture, the
Research design
A concurrent mixed methods approach was adopted to explore pre-registration clinical placements in Australian general practices. Qualitative (interview) data and quantitative (survey) data were collected at approximately the same time and assigned equal weighting and priority. Data were analysed separately before being integrated during the interpretation. The qualitative study employed in this mixed methods project explored the narrative accounts of fifteen pre-registration nurses following a
Findings
Consistent with the gender mix of nursing, most participants were female. Audio-recorded interviews lasted between 12 and 44 min (mean 18 min). Four themes arose from the interviews. The first theme, Knowledge of the practice nurse role evolved as participants articulated their limited understanding of the role that nurses working in general practice play. The second theme, Quality of the learning experience, encapsulates the participant's response to learning within a general practice
Discussion
The most significant limitation arising from this study is that participants were drawn from a single campus of an Australian university and thus the sample may not be representative of students from other tertiary settings. However, recruiting a cross-section of participants from different nursing programs may have helped offset this limitation. To further explore this phenomenon additional research with a broader cohort from different institutions and primary care contexts will be required.
It
Conclusion
It is evident that pre-registration nurses are positive about the quality of clinical learning in Australian general practices. Exposure to a range of population based skills and opportunities to actively participate within a supportive, multidisciplinary environment are considered to be positive elements of clinical learning in general practice. Further research should focus on the perspective of undergraduate clinical placements in primary care settings other than general practice.
Ethical approval statement
Approval for the conduct of this study was gained from the Human Research Ethics Committees of the relevant institutions.
Role of funding source
Funding was not sought for the conduct of this study.
Conflict of interest statement
Nil conflicts.
Contributions
A3 & A4 conceived and designed the study. A1 conducted the data collection and, together with A2 undertook the data analysis. A4 assisted in refining the analysis. All authors participated in drafting and critically revising the paper.
Acknowledgements
We acknowledge both the students who generously gave their time to participate in this study and University staff for their assistance in designing and recruiting participants.
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