Aiming for quality in nursing home care: Rethinking clinical supervision and assessment of nursing students in clinical studies

The Improving quality in clinical placement studies in nursing homes (QUALinCLINstud) project addresses the urgent need for improved quality and efficiency in clinical supervision and assessment of student nurses in nursing home placements. This will be achieved through a novel, collaborative, co-productive, social innovation and learning process between the nurse education system, student nurses and clinical care institutions for older people. The aim of the QUALinCLINstud project is to develop and evaluate how a web-based program can optimize supervision, assessment and learning during nursing home placements. Given the multiple stakeholders and complexity of issues involved in clinical supervision and assessment practices, the web-based program will target three stakeholder groups: (1) nurse mentors, (2) first-year student nurses and (3) nurse educators. The web-based program aims to improve the following quality dimensions: (1) student nurses? learning experience and reflective thinking skills; (2) nurse mentors? supervision and assessment competence and (3) the efficiency of administrative tasks and processes. The project (2018-2023) employs an explorative and descriptive multiple case study design using a mixed-method approach and incorporating the methodology of Co-creation. For more information about the study read our published study protocol. The study is structured across four sequential work packages (WPs). WP1 (2018/2019), comprised an exploratory study of how the nurse education institution address quality in clinical education in nursing home placements and the challenges they experience. Data consists of fifteen in-depth interviews with program leaders of nurse bachelor programs (n=4), course leaders (n=6) and practice coordinators (n=5) across the case study sites. Findings are published in BMC nursing. In WP2 (2019/2020), clinical supervision and assessment practices have been explored from a multiple stakeholder perspective. A qualitative approach has been applied in which data have been collected through observations (287 hours), individual in-depth and focus group interviews with key stakeholders (i.e., student nurses, nurse mentors, nurse teachers). A complete analysis of data from WP2 was performed in 2021. Findings are reported in BMC nursing and Journal of Clinical Nursing. WP3 (2020/2021) comprised developing the interactive digital educational resource targeting quality dimensions in nursing home placements with focus on supervision and assessment. The development was informed and guided by a tentative synthesis of first impression findings from WP1 and WP2 in close collaboration with key stakeholders and e-learning designers. The co-production process ensured that the program meets stakeholders` needs and user interface providing benefits in use. Workshops and dialogue meetings have been conducted as the main co-creation activity. A total of five workshops have been conducted with stakeholder groups. Additionally, the project mapped and appraised the co-production development process. To do this, observations have been conducted during the workshops to explore the degree of participation, involvement, and group interactions. Furthermore, three focus group interviews with the key stakeholder participants have been conducted to explore their views and experiences concerning their involvement. A complete analysis of data from WP3 was performed in 2022. The aim of the projects final stage (WP4 2021-2023) was to pilot-test, explore and describe the outcomes and usefulness of the interactive digital educational resource (digiQUALinPRAX); developed and validated in WPs 1-3. In 2022, a digital educational intervention target to enhance nurse mentors’ supervision and assessment competence was piloted in one of the case study settings. 30 registered nurse mentors across three nursing homes participated and their experiences of the program was explored by means of focus group interviews. An analysis of data from this pilot study was performed in 2022. The full scale interactive digital educational resource targeting all stakeholder was tested in 2022 (WP4). Beyond this, in 2022-2023, four international overseas scholarships were granted for the doctorate candidates and researchers at Roskilde University, DK, and at the University of Wollongong, AU. In 2023, the main activities have focused on data analysis, publications, and dissemination. In light of this, a half day seminar/conference was arranged successfully to finalize the project for the nurses/mangers from the three involved nursing homes.

Forskningsprosjektet har bidratt til: 1) økt kunnskap om veilednings, og vurderingspraksis i sykehjem, synliggjort forbedringsområder, samt dokumentert nytteverdien av brukermedvirkning i utviklingsprosesser og bruk av digitale lærings- og veiledningsverktøy/ressurser anvendt i praksisstudier til sykepleierstudenter, 2) utvikling av to utdanningsressurser: et faglig-pedagogisk e-læringsprogram (DigiVIS) for å styrke praksisveilederes veiledningskompetanse samt et faglig-pedagogisk interaktivt digitalt program (DigiPrax) for å styrke kvalitet i praksisstudier i sykehjem, 3) et styrket nasjonalt og internasjonalt samarbeid omkring utdanningsforskning og forskning knyttet til kvalitet i praksisstudier særskilt, 4) flere ‘spinnoff’ prosjekter/søknader og nye samarbeidspartnere inkludert kompetanseheving på Ph.d., førstelektor og professornivå, 5) sosial innovasjon og livslanglæring, og 6) et betydelig verdiskapende potensiale. Potensielt kan det bidra til å utvikle nasjonale føringer knyttet til veilednings- og vurderingsverktøy i sykepleierutdanningene, noe som i dag mangler standardisering og konkrete føringer. Utover det, kan kunnskapen bidra til å effektivisere praksisstudier, styrke dialog og trepartssamarbeid mellom studenter, akademia og praksisfeltet.

The QUALinCLINstud project addresses the urgent need for improved quality in clinical supervision and assessment of student nurses in nursing home studie through a novel, collaborative and co-productive partnership between the nursing education system and clinical care institutions for older people. The QUALinCLINstud project aims to explore and extend current knowledge on clinical supervision and assessment practices in nursing home placements. Furthermore, the study will develop, pilot test and evaluate an innovative web-based supervision and assessment program targeting quality improvements in clinical supervision and assessment in the nursing home context. The innovation will target three stakeholders groups (1) nurse mentors (2) first-year nursing students and (3) nurse teachers and aims to improve the following quality dimensions; a) nurse mentors supervision and assessment competence b) student nurses critical thinking skills and learning experience and c) nurse teachers assessment tools. Thus, this project entails testing of innovative tools (e-learning tools) to optimize efficiency in education and practice. The QUALinCLINstud project will employ a multiple case study design using a mixed- method approach organized in four work packages. WP 1 will explore how the nurse education system ensures high-quality in nursing home placements. In WP 2, we will explore clinical supervision and assessment practices from a multiple stakeholder perspective using a triangulation of qualitative methods. Based on a synthesizing of findings from WP 1-2 we will develop an innovative web-based supervision and assessment program in close collaboration with key stakeholders in WP3. In WP 4, we will test and evaluate the web-based program by using a mixed-method approach. Combined, this project holds great potential for value creation where tools to increase students learning experience and outcomes are seen as crucial for preparing students for the 21st century labor market.