Maximising opportunities in the university setting to practice nursing skills prior to clinical placement has become increasingly important to ensure that students are adequately prepared, leading to achievement of core nursing competencies prior to graduation. Traditionally, nursing students learn how to perform a skill or use equipment in classrooms, designed as clinical laboratories and/or practical group sessions. Opportunities to practice these skills arise during clinical placement, where students are expected to improve from beginning to independent skill levels during their training for core nursing competencies. An essential component of nursing curricula is that on completion of the course, nursing graduates are able to practice safely and effectively as a nurse. According to Bowtell et al (2013), nursing students have shown difficulty in mastering these nursing skills in the limited time that is provided in nursing curricula. With rising numbers of students enrolled in undergraduate nursing courses, there is competitiveness and rationalisation of expenditure and clinical placements. Hence, most courses are designed with the minimum number of theoretical and practical hours to gain accreditation with the relevant statutory bodies (e.g., the Australian Nursing and Midwifery Accreditation Council. (2015) There is a requirement of 800 hours of clinical placement for registered nursing courses in Australia. However, gaps remain, with reports of deficit in nursing skills for new graduates at an international level (Athlin. E., Larsson et al. 2012). Kajander-Unkuri et al. (2014) suggests that the lack of clinical placements and diminished learning opportunities have contributed to this practice deficit for nursing graduates. Strategies to enhance performance of clinical skills have been introduced to complement nursing curricula, such as self-directed learning (SDL) laboratories (Keetsemang, Mugarurwa et al. 2008) and simulation (Aebersold and Tschannen 2013). An extension of this concept is directed self-guidance, which in the context of health professional education, is a skill that the teacher and learner develop through a process of collaborative directed self-guidance (Brydges et al; 2009). McCauley and McLelland (2004) suggest that students may not be well-equipped for SDL based on a ‘Do It Yourself’ model and that SDL should not be a fully independent student activity. They recommend intensive teacher input and investment to foster student’s motivation to engage in SDL. In late 2014, concerns were raised by industry partners about the preparedness of students for professional practice. In addition, no specific strategy was in place to manage progress issues for students enrolled in the undergraduate Bachelor of Nursing course, leaving responsibility for achieving the required competencies in the clinical setting solely with the student. At the academic institution in which this study was conducted, an equipped area had been available to undergraduate nursing students for self-directed learning and practice for several years. However, the facility was rarely used.
The innovation: To support student learning and enhance work readiness, a self-directed learning laboratory (SDL Lab) was introduced in February 2015. This new resource was furnished with equipment and provided access to clinical education staff, seconded from a major industry partner. This ‘real-life’ innovation aimed to assist the student to be ‘work safe’ and ‘work ready’ for professional practice in the clinical setting. Students were invited to self-nominate and practice skills in the SDL Lab, previously taught in structured formal classes including lectures, and theoretical and laboratory classes. The following objectives guided implementation of the SDL Lab: 1) Build clinical skills to improve student performance in the clinical setting; 2) Assist to ensure that students are work safe and work ready for clinical placements and beyond; 3) Maintain a strong emphasis on understanding the rationale behind each skill practiced; 4) Challenge the students to identify their own knowledge deficits and work with the student to understand the required information to overcome these deficits.
Evaluation: Evaluation of the SDL Lab was informed by a qualitative descriptive method using semi-structured face-to-face interviews. The purpose of this study was to explore the experiences and viewpoints of the undergraduate nurse participants, with particular focus on the perceived benefits and limitations of the SDL Lab and impact on learning and preparedness for professional practice. Students volunteered to participate, and provided written consent. Ethics approval was obtained from the educational institution. Interviews were recorded by digital audio recorder, and data was analyused by thematic analysis.
Findings: Twelve participants, all final year Bachelor of Nursing students, were interviewed. Overall, there was very positive feedback about the SDL Lab. The three main themes included: 1) Students valued the opportunity for guided practice in the SDL Lab which strengthened their confidence and competence during workplace experiences; 2) The safe environment encouraged enquiry and bridged the theory-practice gap; 3) The teaching space could be improved to enhance accessibility and realism with up-to-date and contemporaneous equipment, and general layout.
Implications and Future Research: This study confirmed that students valued the SDL Lab, and they were able to articulate clear benefits of this new strategy. The findings support evidence from other health disciplines that SDL strategies may support traditional teaching modalities (Wright et al. 2012). Suggestions to enhance the resource have the capacity to strengthen this facility, which may lead to enhanced preparedness for practice and support successful progress through undergraduate study in nursing. Future research should evaluate whether the strategy enhanced students’ competence and confidence in the professional practice setting and positively affected their academic progress. In response to student feedback, a new and larger facility was established in February 2016 to improve this teaching and learning innovation.
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