Dedicated Education Units: Evaluation of Innovative Clinical Learning Environments for Undergraduate Nursing Students

Saturday, 28 October 2017

Janet Banks, DNP
School of Nursing, University of Portland, Portland, OR, USA
Mary T. Quinn Griffin, PhD
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA

Background: For many years Nursing educators have been negotiating the increasing shortage of appropriate clinical learning environments for undergraduate nursing students. Innovative methods have been called upon to resolve the question of where nursing students can practice their skills. Some innovation was spurred by a need to strengthen the relationship between theory and practice. Additional innovation was related to the shortage of nurse educators and decreasing access to clinical sites. A number of innovative strategies have been implemented to address these issues, from the introduction of the dedicated education unit (DEU) (Jeffries et al., 2013; Mullenbach & Burggraf, 2012) to alternative clinical settings such as Long Term Care settings (Mullenbach & Burggraf, 2012; O'Lynn, 2013).

The DEU makes use of clinical sites that a school of nursing may already be using, but adapts them for optimal student learning. Staff nurses interested in teaching student nurses become Clinician Instructors (CI) and are offered education in adult teaching and learning principles, promoting critical thinking, providing immediate feedback and overall evaluation, and the principle objectives involved in a DEU clinical experience. The nurses not actively teaching take on a supportive role with the rest of the unit staff. The school of nursing faculty members takes on the role of Clinical Faculty Coordinator (CFC) and guides the Cis and provide professional development to the nursing student. A typical medical-surgical unit (of 24- to 40-beds) can accommodate four to eight students during a six-week clinical rotation.

Purpose: To determine differences in student learning outcomes of the Adult and Elder Health course series between undergraduate nursing students whose clinical education takes place in Acute Care DEU versus a Long Term Care DEU.

Methods: This is a retrospective study. Data retrieved included formative simulation scores, summative simulation scores, course grades and standardized exam scores earned during the Adult and Elder Health II course. These data were used to determine differences in student learning outcomes of the Adult and Elder Health II course between students whose clinical education in Adult & Elder Health I took place in an acute care setting versus a long-term care setting.

Sample: A convenience sample of 116 undergraduate baccalaureate degree nursing students from a large, private school of nursing in the Northwest United States were included in the study. Students graduated in May 2014. Students were enrolled in Adult & Elder Health I and Adult & Elder Health II. Adult & Elder Health II builds on Adult & Elder Health I by increasing the level of practice and application of knowledge. Both courses are about the nursing management of adult and elderly clients. The Adult & Elder Health I course includes clinical education in either a long-term care (LTC) setting, or an acute care (AC) hospital. All students in Adult & Elder Health II are placed in AC settings for their clinical education.

Procedure: Institutional Review Board approval was obtained. A designated program assistant reviewed the student records and record scores for the students in the study and retrieved the data for the study variables.

The data were de-identified prior to the researcher gaining access to them…

Results: Description of the Sample - The majority of the 116 students was female at the start of the undergraduate program. The mean age of the students at the start of the undergraduate program was 18.3 years.

Differences in Learning Outcomes - There were no differences in the learning course outcomes (simulation scores, course grade, and standardized exam scores) in nursing students placed in acute care versus long-term care. The acute care student evaluation of clinical sites was significantly higher than long-term care evaluation of clinical sites.

Conclusion: There were no significant differences in the learning outcomes in the Adult & Elder Health course regardless of the clinical placement. This result is significant for nursing education globally as it provides beginning evidence for the expansion of clinical sites for certain courses. Worldwide excellent clinical placements are at a premium and nursing schools often have difficulty placing students in these environments, The results of this study provide data for a forum for nurse educators and nurse clinicians to discuss opportunities for alternative clinical placemnentsand to design evaluation strategies for theseclinical environments. It is interesting to report that students rated the acute care clinical site higher than the LTC site. Generally students like the experience of AC rather than LTC and the results of this study may be provided to students when discussing student experiences in different clinical placements with them.

All student clinical placements in this study were on Dedicated Education Units (DEU) and results must be limited to this clinical environment. Recommendations for future research include expansion of this study to traditional clinical placements. Prospective longitudinal studies will help provide evidence on using alternative clinical environments for undergraduate education.