Pratice protocols
Audio teleconferencing: Creative use of a forgotten innovation
Carey Mather
Lecturer, School of Nursing and Midwifery, University of Tasmania
Annette Marlow
Director, Professional Experience, School of Nursing and Midwifery, University of Tasmania
PP: 177 - 184
Abstract
As part of a regional School of Nursing and Midwifery's commitment to addressing recruitment and retention issues, approximately 90% of second year undergraduate student nurses undertake clinical placements at multipurpose centres; regional or district hospitals; aged care; or community centres based in rural and remote regions within the State. The remaining 10% undertake professional experience placement in urban areas only. This placement of a large cohort of students, in low numbers in a variety of clinical settings, initiated the need to provide consistent support to both students and staff at these facilities. Subsequently the development of an audio teleconferencing model of clinical facilitation to guide student teaching and learning and to provide support to registered nurse preceptors in clinical practice was developed. This paper draws on Weimer's 'Personal Accounts of Change' approach to describe, discuss and evaluate the modifications that have occurred since the inception of this audio teleconferencing model (Weimer, 2006).
Article Text
BACKGROUND
Rationale for change
Each year, the School of Nursing and Midwifery delivers two clinical practice units to approximately two hundred second year undergraduate nursing students. Each unit comprises of 10 hours of lectures, 20 hours of laboratory workshops and 120 hours of experiential clinical practice in an acute hospital or community facility within urban or rural area within regional Australia. There are approximately 40 rural or remote agencies where students are allocated. These include multi purpose health centers, district hospitals, aged care facilities and community health centers. Given the geographical distribution of these facilities, the provision of support to both students and their registered nurse preceptors by academic staff was seen as inconsistent and inequitable. Support was provided through ad hoc face to face visits and sporadic telephone calls. It therefore became essential to devise a more cost effective strategy that would meet the needs of students, preceptors and academic staff members. The existing model was seen as expensive, inefficient and potentially exposed academics to risks associated with transport to and from teaching sites.
It is well documented that students of nursing require clinical guidance and support while undertaking clinical placement (Edwards, Smith, Courtney, Finlayson, and Chapman, 2004; Lambert and Glacken, 2005; Edith Cowen University, 2006; Henderson, Winch, and Heel, 2006; Zilembo and Monterosso, 2008). However, due to the unpredictable nature of health care environments and related staffing issues, the opportunity for students to be provided with quality or willing preceptors is sometimes reduced (Elliott, 2002), and as a result valuable learning experiences occur in a haphazard manner (Lambert and Glacken, 2005). Moreover, there is an apparent lack of consistency of support for nursing students while undertaking clinical practice in Australia (Edith Cowen University, 2006), a situation that is mirrored internationally (Lambert and Glacken 2005). Some Universities employ clinical facilitators or use a preceptor model while others utilise their nurse academics to support and guide students in the practice arena (Edith Cowen University, 2006). Academic staff at the School of Nursing and Midwifery were concerned with the provision of consistent information and guidance to both students and their registered nurse preceptors, especially in rural and remote areas, where access to academic staff members and university facilities was scant. Consistence with models of support, guidance and clinical facilitation for students was problematic because of the complex issues related to the need for preceptoring a cohort of over 200 student nurses, gaining clinical experience in a variety of settings. Some facilities accepted one student and others accommodated more than 8 students in various units within one facility.
There was a need expressed by academic staff and students undertaking clinical placement for easy and inexpensive strategies for students to contact the School of Nursing and Midwifery. The teaching team investigated student focused (Trigwell and Shale, 2004) models of clinical facilitation which could potentially support and guide both students and their rural and remote preceptors. As a result, a clinical facilitator was employed by the School of Nursing and Midwifery to telephone groups of students on a regular basis, while they were conducting their clinical placements. The 'old' technology of audio teleconferencing was considered a more equitable, accessible and flexible option given the numbers of students and how widely spread they were across the region (Weust, 1991). Within this context the clinical facilitator was employed to provide a connection between the university and the practice setting, the intent being to promote discussion, reflection on action, and to provide consistent information to students pertaining to relevant assessment items (Lambert and Glacken, 2005).
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