Clinical placements are the keystone of any baccalaureate nursing program to enhance student integration of knowledge into practice. However, the curricular structure of the clinical placement has been minimally considered as it relates to the perceived impact on student learning (Danner, 2014). A clinical model that allows for students to be in the clinical setting for multiple consecutive shifts for approximately 36 hours per week can be described as a block clinical model. In this model, students are not registered in other concurrent theory courses or labs. A clinical model that allows for students to attend clinical for 8 to 12 hours per week while concurrently taking other courses can be described as a non-block clinical model (Rohatinsky, Chachula, Compton, Sedgwick, Press, & Lane, 2017).
Purpose
This descriptive exploratory study used a combined 91-item Likert survey tool with open ended questions to investigate the effects of two different clinical models on student learning from both student and instructor perspectives. This presentation will describe the thematic analysis results from the open ended question: Given a choice between [participating in /teaching in] block clinical or non-block clinical, which would you choose? Why?
Methods
Perspectives from clinical instructors and baccalaureate nursing students in five universities located across four western Canadian provinces were sought. The targeted universities offered both block and non-block clinical models. Instructors were eligible to participate in the study if they had taught in at least one clinical rotation in any year of the nursing program. Nursing students were eligible to participate in the study if they had completed at least one clinical rotation in any year of their program.
After ethical and organizational approvals were obtained from the participating institutions, students and instructors were invited to participate via email containing a link to a secure survey site. Responses were received from 141 students and 52 instructors. The researchers used Braun and Clarke’s (2006) thematic analysis method to code and analyze the data from the open-ended question.
Results
When participants were asked about their preference for a block versus non-block clinical model, four major themes arose: learning and applying nursing knowledge; time for growth, evaluation, and reflection; integrating and immersing into the clinical environment; and assimilating and transitioning into the real world of nursing.
Learning and Applying Nursing Knowledge
Instructor perspectives. The non-block clinical model was seen as an opportunity to develop, facilitate, and scaffold student learning by building upon the knowledge and skills learned in the classroom and applying them in the clinical environment.
Student perspectives. The development of knowledge, skills, and abilities was believed to occur in both block and non-block clinical models. Students believed that praxis occurred in both clinical models and that the application of theory in practice was important to support evidence-informed nursing care.
Time for Growth, Reflection, and Evaluation
Instructor perspectives. Instructors believed non-block clinical allowed students greater time to reflect and grow in their experiences and thus facilitate student learning. This model also allowed students the ability to show growth and improvement and allowed instructors to more easily evaluate and support students if required.
Student perspectives. Both block and non-block clinical environments encouraged time for growth and professional development as a student nurse. Although, students indicated that block clinical allowed for more time to prepare for and focus on the clinical day, with fewer distractions and more social time.
Integrating and Immersing into the Clinical Environment
Instructor perspectives. Block clinical allowed students the opportunity to refine their technical skills and develop proficiency in clinical reasoning, problem solving, critical thinking, and organization. Some instructors mentioned drawbacks of block clinical including challenges in making up for lost clinical time if students were absent. Opportunities with block clinical included mentoring of students by staff members.
Student perspectives. Students commented on developing greater confidence and increased independence as an outcome of the block clinical model. The block model was also preferred over the non-block model with regards to developing professional relationships with staff and patients.
Assimilating and Transitioning into the Real World of Nursing
Instructor perspectives. Instructors believed block clinical simulated the realities of nursing and shiftwork expectations. Instructors believed that the implementation and application of the nursing process was better enacted by students within the block model as it facilitated continuity of patient care and the building of patient rapport. This type of clinical model allowed students to concentrate solely on their clinical experiences. However, block clinical often resulted in exhaustion of students by the end of the block of shifts.
Student perspectives. Students reported that block clinical provided a greater experience that reflected the ‘real world’ of nursing and facilitated transition into practice. Students also found that block clinical provided greater continuity of care and allowed them to follow their patients’ through the nursing process.
Conclusion and Implications for Nursing Curricula
According to participants, the acquisition and application of nursing knowledge occurred in both block and non-block clinical models. Strengths and challenges were identified for each model. However, participants believed the non-block model better supported learning within the early years of nursing education to create a foundation of practice that links theoretical content with nursing skills; whereas the block model better supported immersion, consolidation of practice, and transition into nursing practice. This study aligns with previous literature in which participants reported non-block clinical was better suited for novice students developing their nursing knowledge who required time to adjust to the clinical environment, while the block model was better suited for students in upper years of the nursing program for integration into practice (Rohatinsky et al., 2017). Ultimately, both types of clinical models are beneficial to integrate into nursing curricula to facilitate student learning.