Abstract
Background
Nurses are the largest group of registered healthcare professionals and are fundamental to delivering health and aged care in Australia.
Aim
To explore how nursing students report clinical experiences when caring for older people as part of a larger study investigating how care of the older person content is included in Australian undergraduate nursing curricula.
Methods
A population sample of all Australian nursing schools that offered a Bachelor of Nursing degree (n = 35) in 2019. Nurse academics involved in curriculum development or delivery were recruited. A telephone-assisted survey was used, and qualitative content analysis undertaken.
Results
All schools of nursing participated in the survey, representing a response rate of 100%. The acute care focus of nursing curricula meant clinical experiences for nursing students related to older person's care commonly occurred in residential aged care facilities in the first year of the degree. Student reports of these experiences varied, with a majority of respondents reporting mixed or negative feedback associated with a lack of preparation and inadequate supervision.
Conclusions
This study highlights the: significance of the timing of nursing students’ clinical placements in residential aged care; the selection of appropriate care homes; and the need for the right clinical teaching staff who can supervise high quality learning experiences for students.
Keywords
Summary of relevance
Problem or Issue
Australia's population is ageing, and its health and care needs are increasing. It is projected that there will be insufficient numbers of nurses to meet these care needs.
What is already known
International and local research shows that student nurses report mixed feedback about their clinical experiences in residential aged care, such as being unprepared and feeling unsupported.
What this paper adds
Most Australian Schools of Nursing schedule clinical experiences in residential aged care facilities in the first year of the undergraduate program. Learning objectives for these experiences are associated with fundamental nursing care, despite the complexity of older people's needs. Students re-count these placements as a negative experience.
1. Introduction
Australia has an ageing population with the associated demand for healthcare (
Australian Institute of Health & Welfare 2019
). Workforce projections are that there will be an insufficient number of registered nurses (RNs) in the future (Australian Institute of Health & Welfare. (2019). Admitted patient care 2017–18: Australian hospital statistics. Health services series no. 90. Cat. no. HSE 225. AIHW, Canberra. Accessed 2 September 2021. https://www.aihw.gov.au/getmedia/df0abd15-5dd8-4a56-94fa-c9ab68690e18/aihw-hse-225.pdf.
Health Workforce Australia, 2014
). These factors should be drivers for Schools of Nursing (SoN) and the Australian Nursing and Midwifery Accreditation Council (ANMAC) to ensure graduating nurses are prepared to care for older people. Nursing curricula are vital in preparing nurses to work with older people (Health Workforce Australia. (2014). Australia's future health workforce – nurses overview. DoH, Canberra. https://www.health.gov.au/sites/default/files/documents/2021/03/nurses-australia-s-future-health-workforce-reports-overview-report.pdf.
Garbrah, Valimaki, Palovaara and Kankkunen, 2017
, Garbrah, Valimaki, Palovaara and Kankkunen, 2017
) and nurse academics play a significant role in shaping students’ attitudes to nursing older people (Dahlke et al., 2020
) especially early in their education (Garbrah, Kankkunen and Valimaki, 2020
).However, graduate nurses report that they are underprepared to work with older people (
Dahlke, Kalogirou and Swoboda, 2021
), particularly those with dementia (Khait et al., 2022
, Khait et al., 2022
). Reasons given are: nursing curricula are acute care focused (Garbrah, Valimaki, Palovaara and Kankkunen, 2017
al., Garbrah, Valimaki, Palovaara and Kankkunen, 2017
; Koskinen, Salminen, Stolt, and Leino-Kilpi, 2015
, Koskinen, Salminen, Stolt, and Leino-Kilpi, 2015
); there are insufficient academics with expert gerontological knowledge to teach undergraduate nurses (Fulmer, 2020
); and the learning objectives of clinical experiences in residential aged care facilities (RACFs) relate to fundamental nursing care that denies the complexity of needs (Laugaland et al., 2021
et al., Laugaland et al., 2021
).2. Literature review
An Australian Bachelor of Nursing degree (BN) generally takes three years full-time to complete, and SoN are mandated to provide 800 hours of relevant clinical experience for all students (
Australian Nursing & Midwifery Accreditation Council 2019
). Clinical experiences enable essential knowledge transfer, skill development and professional socialisation vital to producing work-ready graduate nurses (Australian Nursing & Midwifery Accreditation Council. (2019). Registered nurse accreditation standards 2019.ANMAC, Canberra. Accessed 2 September 2021. https://www.anmac.org.au/document/registered-nurse-accreditation-standards-2019.
Cooke, Greenway and Schultz, 2021
). However, providing sufficient and relevant clinical experiences for all student nurses does not always occur, with reports of ‘students undertaking placements in venues such as childcare centres and charity shops’ (Schwartz, 2019
, p. 37). To address this issue, different healthcare settings, such as primary care, have been trialled (Schwartz, S. (2019). Educating the nurse of the future—report of the independent review into nursing education. DoH, Canberra, Accessed 2 September 2021. https://www.health.gov.au/resources/publications/educating-the-nurse-of-the-future.
Thomas, Bloomfield, Gordon and Aggar, 2018
). The government has supported opportunities for clinical placements in RACFs (Mason, April 2013
). However, the workforce in this setting is dominated by unregulated care workers with limited numbers of registered nurses (RNs) (Mason, J. (2013). Review of Australian Government Health Workforce Programs., pp. 450. Accessed 2 November 2021. https://www1.health.gov.au/internet/main/publishing.nsf/Content/D26858F4B68834EACA257BF0001A8DDC/$File/Review%20of%20Health%20Workforce%20programs.pdf.
Committee for Economic Development of Australia 2021
; Committee for Economic Development of Australia. (2021). Duty of care: meeting the aged care workforce challenge.CEDA, Melbourne. https://www.ceda.com.au/Admin/getmedia/29cf7e90-afe9-4c92-bf4b-7abc385078f8/Aged-Care-Workforce-2021-FINAL.pdf.
Eagar et al., 2019
). This reduces the capacity of RACFs to support effective clinical experiences (Robinson, Andrews-Hall and Fassett, 2007
).A further challenge is the declining number of appropriately prepared clinical supervisors in RACFs (
Fetherstonhaugh et al., 2022
). Different definitions for the term clinical supervisor are preceptor, mentor, facilitator, supervisor, or educator (King, Edlington and Williams, 2020
). A position statement from the Australian Colleges of Midwives, Nursing and Mental Health Nursing. Position Statement. Clinical Supervision for Nurses and Midwives April 2019
outlines a definition of clinical teaching and expectations for effective clinical supervision. However, there is no comprehensive competency framework for nurse clinical supervisors’ practice (Australian Colleges of Midwives, Nursing and Mental Health Nursing. Position statement. Clinical supervision for nurses and midwives. (2019). Accessed 2 November 2021. https://www.acn.edu.au/wp-content/uploads/clinical-supervision-nurses-midwives-position-statement-background-paper.pdf.
Cutcliffe, Sloan and Bashaw, 2018
). Australian SoN commonly uses the preceptor model of clinical placement, where a student works alongside an RN employed by the health service, and the facilitator model, where an RN, usually a sessional educator employed by the SoN, supervises a group of students in the clinical setting (Cutcliffe, Sloan and Bashaw, 2018
; Fetherstonhaugh et al., 2022
). While the RN preceptor provides students with clinical learning opportunities, increased workloads and RN shortages mean that supervision of student nurses becomes a burden (Henderson and Eaton, 2013
), and impacts the supervisor's capacity to complete their clinical work (Anderson, Moxham and Broadbent, 2020
). Cowin and Moroney, 2018
found that clinical facilitators are often ‘casual or sessional’ employees, difficult to recruit with a high turnover, and many may not have a good knowledge of the curriculum. In the larger study (Fetherstonhaugh et al., 2022
), respondents supported this in their statement that clinical educators employed by Australian SoN may have little understanding of the residential aged care setting. An extensive literature review (Cutcliffe, Sloan and Bashaw, 2018
) found that clinical supervisors needed training and a competency framework to supervise students successfully. In addition, recent research found that the reduction of preceptors’ clinical workloads significantly increased their ability to support students (Soro et al., 2021
). Finally, a recent systematic review of clinical education models based on students’ preferences found limited evidence to support one model over the other (Jayasekera et al., 2018
).The quality of students’ clinical experiences in RACFs varies considerably.
Lea, Marlow, Altman and Courtney-Pratt, 2018
found students prior experience in these settings and career aspirations influenced clinical placement preferences for RACFs. Students reported they felt unprepared, especially in the first year (Keeping-Burke et al., 2020
); were often buddied with non-nursing staff such as care workers (Laugaland et al., 2021
); witnessed substandard care, poor resourcing, and inappropriate staffing mix (Jack et al., 2018
). All of these experiences influenced their perception of the setting and future career choices (Naughton, O'Shea and Hayes, 2019
).3. Method
3.1 Study design
An exploratory study was used with a semistructured survey completed as a telephone interview to understand how content on the care of older people was included and taught in Australian Bachelor of Nursing curricula.
3.2 Ethical considerations
Ethical approval was obtained from the La Trobe University Human Research Ethics Committee in 2018 and where required from the institutional ethics committee of other research team members’ universities. Respondents gave informed consent before participating.
3.3 Settings and participants
All Australian SoN offering a BN in 2019 were eligible to participate. Recruitment involved asking the SoN to nominate one or more academics who would have an in-depth knowledge of the undergraduate curriculum (i.e., curriculum/undergraduate coordinators). These academics were invited by email and/or telephone to participate (
Fetherstonhaugh et al., 2022
).3.4 Data collection
Data were collected using a semistructured survey used internationally, developed, and amended for the Australian context by the Australian Hartford Consortium for Gerontological Nursing Excellence (Aus-HCGNE). The survey was conducted as a telephone interview between February and May 2019. This method enabled the systematic collection of information while simultaneously probing and exploring responses. The survey was piloted among colleagues of the Aus-HCGNE and further amended following feedback. It contained closed questions, such as Does your school have an established curriculum advisory board? In addition, respondents could provide comments and open-ended responses about the challenges of teaching care of the older person and preparing nurses to care for older people (
Albudaiwi, 2018
). All interviews were audio-recorded, professionally transcribed, and returned to the research team as word documents.3.5 Data analysis
Descriptive statistics undertaken in SPSS Statistics v25 (IBM) were used to analyse the responses to closed questions about the BN curriculum, findings were published (
Fetherstonhaugh et al., 2022
). Responses to the open-ended questions were analysed using Krippendorff, 2018
method for content analysis. This allowed the researchers to make interpretations from data grouped according to their similarities. Finally, direct quotes illustrative of these common meanings, identified by the respondent's role and SoN ID, provided the context in findings. Methodological rigour was maintained by the use of the Consolidated Criteria for Reporting Qualitative Data (COREQ) (Tong, Sainsbury and Craig, 2007
). This paper reports findings from the qualitative content analysis of the open-ended responses of the survey.4. Findings
All 35 SoN participated with a response rate of 100%. Forty-five academics were nominated by their school, and all were interviewed, with at least one from each SoN. Each respondent spoke to their area of expertise, some referred to others to answer, and there was no incongruity among participants responses.
Respondents from all SoN reported that their school included at least one clinical experience for students where the older person's care was the focus. These experiences overwhelmingly occurred in RACFs. The majority of SoN (n = 29/35, 83%) reported that these clinical experiences in RACFs could be scheduled in the first year of the program in their SoN (Table 1). Participants often conflated clinical experiences with older people with clinical experiences in RACFs, despite older people being the majority of users of all healthcare services (
Australian Institute of Health & Welfare 2019
).Australian Institute of Health & Welfare. (2019). Admitted patient care 2017–18: Australian hospital statistics. Health services series no. 90. Cat. no. HSE 225. AIHW, Canberra. Accessed 2 September 2021. https://www.aihw.gov.au/getmedia/df0abd15-5dd8-4a56-94fa-c9ab68690e18/aihw-hse-225.pdf.
Table 1Scheduling clinical experiences in RACF.
| Years(s) | n | % |
|---|---|---|
| 1st year only | 14 | 40 |
| 1st and/or 2nd year | 5 | 14 |
| 1st and/or 3rd year | 5 | 14 |
| 1st, 2nd and/or 3rd year | 5 | 14 |
| 2nd year only | 3 | 9 |
| 2nd and/or 3rd year | 1 | 3 |
| 3rd year only | 2 | 6 |
When asked about student feedback following clinical experiences in RACFs, respondents reported that formal feedback was not generally sought. However, all respondents talked at length about informal reports from students concerning their clinical experiences in a RACF. Analysis of these responses fell into three clusters – mixed, negative, and positive experiences.
4.1 Mixed experiences
Seventeen respondents (48.5%) reported mixed student feedback following RACF clinical experiences. Among them were respondents from the SoN that scheduled this clinical experience in the second or third years. Many reports related to students being surprised at enjoying the clinical experience (positive) but being mentored by unskilled staff (negative).
We have a mixed response of positive and negative feedback, but when I speak to students, the majority really do gain experience through that placement. (SoN 32)
They're actually quite good at the end of it but we always have a couple who just don't get it. They don't see the value in it. They don't understand why they're there. Because when they're there often they're working side by side with enrolled nurses and carers. (SoN 7)
The negative feedback reported by respondents in the ‘mixed’ cluster reflected those described by respondents who reported only negative feedback from students following clinical experiences in RACFs.
4.2 Negative experiences
Fourteen respondents (40%) reported only negative student feedback following a clinical experience in RACF, especially if it was the first clinical experience or occurred in the first year. Thirteen (43.3%) were from the SoN that scheduled the RACF clinical experience in the first year. Further, respondents reported that following clinical experiences in RACFs, students associated nursing care to older people with residential aged care settings as they had little education in their first year of healthy ageing or experiences with community-dwelling older people.
The students do a clinical experience in RACF in first year and don't enjoy it and think care for the older person is aged care. First-years have no understanding of complex dimensions of care of the older person, e.g., those with dementia. (SoN 4)
Respondents’ reports of mixed/negative feedback related to three issues - curriculum design, RACF as a setting for clinical experiences, and students’ attitudes to older people.
Curriculum design
Respondents felt that their curriculum design contributed to students reporting negative experiences following RACF clinical experiences, especially the timing and intent of the RACF clinical experience.
That's the problem with the curriculum it's so jam-packed. By the time students get to the third year, they've virtually forgotten what they did in the first year. It belittles aged care by putting it up first. (SoN 3)
Scheduling the RACF clinical experience in the first year meant students were generally unprepared as they had received little content on the older person's care, and the focus of these experiences was on fundamental nursing or bodily care. Responses suggest students were expected to ‘practice’ the skills associated with fundamental nursing care during the RACF clinical experience
It's very basic, just your activities of daily living (ADLs), communication, manual handling, skin integrity, hydration, and nutrition. (SoN 11)
However, fundamental nursing care also requires communication skills, and in RACFs, knowledge of dementia, which many first-year students had not received. Respondents acknowledged that students were unprepared for the complexity of RACFs, adding that there was nothing basic about providing care to, or communicating with, residents who had multiple co-morbidities, including dementia. Some reported instances where students were placed in dementia specific units with little understanding of, or no prior education about, caring for people with dementia. A few indicated that RACFs were inappropriate settings for first-year students.
When we send the students to residential care, we're only focussing on the bodily care, and overlook some of the very important communication strategies, understanding about people's needs, in terms of grief and loss associated with ageing. We send them out unprepared. (SoN 2)
Students have been put into a dementia-specific unit and felt out of their depth, and the behaviours of the residents have been challenging, and they haven't really known what to do. I had students coming to debrief with me about their traumatic experience. (SoN 29)
They're actually placed in a very complex care environment for which they're not equipped. (SoN 14)
Respondents from three SoN that schedule RACF clinical experiences in the second or third year highlighted the challenges of the setting - residents with chronic illnesses and few RNs to supervise, as reasons to shift this placement from the first year.
[In third year] they have four weeks in acute, and then they have a six-week elective. Then they have a two-week placement in aged care linked to a care management leadership unit. So, they do actually spend time with the RNs in aged care (SoN 16).
Another issue associated with students’ negative feedback following clinical experiences in RACFs was the curriculum being acute care focused. Many respondents felt that this focus gave students an unrealistic portrayal of who they would be nursing in any healthcare setting and reinforced their beliefs about older people.
We place second-year students in RACFs in the second semester, hoping that it will bring along the complexities of the care involved. The students absolutely hate it because all they wanted to do was drips, drains and dressings. Because our [curriculum] focus is so strongly on acute care, it's devalued by staff and devalued by students as not real nursing. (SoN 14)
RACF issues
The second issue associated with negative feedback from students related to RACFs as venues for clinical experiences, especially if the students’ first clinical experience. Much of the feedback related to students’ perceptions of understaffing, their lack of supervision by RNs and observations of poor care practices. While most respondents (n = 25, 71%) reported that RNs supervised students, many could not clarify who employed them. Further, respondents also acknowledged that students were usually ‘buddied’ with enrolled nurses (ENs) (n = 13), assistants in nursing (n = 1), care workers (n = 10) and ‘other’ RACF staff (n = 2). Students often reported no experience of working with an RN.
Barriers to a positive student experience are supervision by poorly skilled staff in the aged care facility. RACFs not employing appropriately trained staff. (SoN 26)
They are just buddied up with a carer for the whole time, and they don't like that. (SoN 8)
Respondents further noted that the limited number of RNs working in this sector often left students with a distorted view of the role of RNs working in a RACF.
First-year students get exposed to bad practice in RACFs. They are not supervised by registered nurses and are supervised by unlicensed, unskilled carers. (SoN 14)
They [students] don't see the value in it. They don't understand why they're there. They don't think it's the role of the RN because they're often working side by side with ENs and carers predominantly. They don't see how that experience is useful to them as a future RN. (SoN 35)
A small number of respondents also reported that students provided feedback about instances of poor care during their clinical experience in a RACF, that negatively influenced their perception of the clinical experience and the sector.
Students reported seeing dreadful pressure areas, listening to people screaming in pain, RNs not assessing pain, RNs who don't believe in giving opioids even though it's prescribed, the restriction on the use of continence pads, not having time to be with older people. (SoN 23)
Students’ attitudes
Finally, respondents reported that students’ negative feedback related to their attitudes to nursing older people. They felt that many students, like the population in general, held ageist attitudes which influence their interactions with older people.
Students go in with the attitude, well, with ageism. They go in with that, and they are the ones that come back and say, "Well, that was pointless. I did nothing". That's why it's really important for us here to change that stereotype really early. (SoN 28)
Respondents added that nurse academics significantly reinforced students’ perceptions of nursing older people and their clinical experiences in a RACF, if they devalue the care of older people. Some cited instances where nurse academics inadvertently or directly imparted ageist views to students.
Unfortunately, I overheard a casual tutor informing the students, “Oh you poor things, you're going to aged care”. (SoN 34)
The representation of nursing in all forms of media, portrayed as working in highly technical areas, such as emergency departments (ED) or intensive care units (ICU), was also thought to influence students’ attitudes to nursing older people. In these portrayals, nurses are not seen interacting with the people who receive their care, which in Australia would most commonly be an older person.
Students don't see the value in having gone to aged care and of course wish they were in emergency or ICU. Unfortunately, students need to spend a lot more time in aged care really understanding exactly what the population is that they'll predominantly be caring for. (SoN 27)
4.3 Positive experiences
Despite mixed and negative experiences dominating the responses, two respondents reported that most of their students expressed positive feedback about their clinical experiences in RACF. This feedback related to students’ interactions with residents and their first real experience as a prospective nurse.
5. Discussion
These findings show that most Australian nursing students (83%) had a RACF clinical experience in their first year, that they were ill-prepared for the challenges of the RACF environment and inadequately supervised. Older people in RACFs require 24-hour care and support due to their complex health care needs. They have high rates of circulatory diseases (93%), and behavioural or mental disorders, including dementia (58%) and depression (54%) (
Lind et al., 2020
); and most are frail (68%) or most-frail (27%) which severely impacts their basic activities of daily living, for example, self-feeding, bathing, grooming, and dressing (Jadczak et al., 2021
). In addition, the proportion of RNs in the RACF workforce is low (Eagar et al., 2019
). Therefore, students may have little interaction with and limited supervision by an RN in these settings. These two issues, the complexity of residents’ care needs and the small numbers of RNs, reinforce the need for students to be better prepared, and supported during (Garbrah, Kankkunen and Valimaki, 2020
) these clinical experiences; RACFs are unsuitable as a venue for a first clinical experience for nursing students with no understanding of frailty and dementia (Keeping-Burke et al., 2020
). Curricula needs specific content related to dementia introduced early in nursing programs to better prepare students about dementia before RACF clinical experiences (Khait et al., 2022
).The literature outlines a multitude of reasons to explain students’ negative perceptions of RACF clinical experiences, most being pertinent to these findings. Students’ unpreparedness to work with older people is a common theme (
Dahlke, Kalogirou and Swoboda, 2021
), as is their inadequate orientation before entering the clinical setting, especially their knowledge of dementia (Khait et al., 2022
) and comprehensive assessment (Levett-Jones et al., 2015
). Poor supervision in this setting (Laugaland et al., 2021
), being buddied with carers (Jack et al., 2018
), limited interaction with an RN (Cutcliffe, Sloan and Bashaw, 2018
), and lack of support from nurse academics (Garbrah, Kankkunen and Valimaki, 2020
) are also noted. In reviewing the literature relating to nursing students' attitudes and experiences in RACFs, Algoso, Peters, Ramjan and East, 2016
concluded that student nurses’ attitudes to working in RACFs related to their own and clinical educators’ ageist attitudes, which were reinforced by curricula that were acute care focused.Inadequate clinical supervision of students in RACF was another important finding of this research. Clinical experiences must be supported by academic and clinical RNs who have knowledge and commitment to engage students and enhance their understanding of the complexities of aged care nursing (
Eccleston et al., 2015
). Involvement with, and support from, RNs (academics and clinical educators) in the clinical setting can strengthen student nurses’ professionalism and increase the likelihood of positive experiences (Flott and Linden, 2016
), and assist in shaping positive attitudes towards older people (Cooke, Greenway and Schultz, 2021
). The international literature (Flaherty and Bartels, 2019
) shows clinical supervisors have little preparation to support students during clinical experiences in a RACF, a finding support by this research (Fetherstonhaugh et al., 2022
). Similarly, students’ interactions, or lack thereof, with RNs in a RACF, can significantly impact their career interest in this sector (Ion, Smith and Dickens, 2017
). Students who do not understand the RN role in a RACF or only interact with unregulated care workers, were left with the impression that nursing older people is all about residential aged care setting and is simplistic, involving only fundamental nursing care, reinforced by their first clinical experience (Laugaland et al., 2021
).The finding about students witnessing poor care practices during RACF clinical experiences has been cited elsewhere (
Fagan, Lea and Parker, 2021
), including at the Australian Royal Commission into Aged Care Quality and Safety (Austen and Hutchinson, 2021
). The literature shows students feel anxious about clinical experiences (Levett-Jones et al., 2015
), especially in first year. They have a desire to fit in and not cause trouble (Jack et al., 2018
), however they feel powerlessness, and find it difficult to challenge poor care practice by staff (Fagan, Lea and Parker, 2021
). The literature shows that when students are well prepared, and understand the role of nurses in these settings, the experience provides opportunities for growth and professional development (Cant et al., 2021
; Laugaland et al., 2021
).Studies suggest that negative RACF clinical experiences attribute to, and perpetuate, students’ ageist beliefs about older people (
Naughton, O'Shea and Hayes, 2019
). Ageism is ‘pervasive, widely accepted, and normative in many societies and is a form of prejudice that goes unchallenged’ (Sargent-Cox, 2017
, p. 5). In Australia, younger people (18–24 years old) are more likely than any other age cohort to hold ageist attitudes (Australian Human Rights Commission, 2021
). Stereotypes about people are developed in childhood and are further heightened by images and experiences throughout life. The nursing literature demonstrated that nursing students, generally aged 18–24, hold ageist attitudes (Australian Human Rights Commission (2021). What...s age got to do with it? A snapshot of ageism across the Australian lifespan. Australian Human Rights Commission, September 2021. https://humanrights.gov.au/our-work/agediscrimination/publications/whats-age-got-do-it-2021.
Koskinen, Salminen, Stolt, and Leino-Kilpi, 2015
). Academic and clinical supervisors’ attitudes to, and knowledge of, care of older people and their lack of experience can also negatively influence students’ attitudes (Fetherstonhaugh et al., 2022
; Garbrah, Kankkunen and Valimaki, 2020
). However, promisingly, these biases diminish the longer students care for older adults during clinical experiences that facilitate positive learning (Garbrah, Kankkunen and Valimaki, 2020
).These findings highlight the inappropriateness of RACFs for nursing students’ first clinical experiences. RACFs have been described as ‘marginal learning environments’ for student nurses due to the complexity of care required by residents and the low numbers of qualified staff to supervise (
Jacobsen, Onshuus and Frisnes, 2020
, p. 2). Keeping-Burke et al., 2020
argue that the complexity of care required for residents now entering RACFs` makes learning relevant for students during both the early and later years of an educational program. Similarly, Naughton, O'Shea and Hayes, 2019
argue that planning ‘sequential’ clinical experiences for nursing care of older people across the curriculum in multiple settings may improve students’ attitudes to nursing older people (p. 8). Introducing healthy ageing concepts to students early in the curriculum has been shown to create more positive views to older people (Fox, 2013
). Positive clinical experiences occur in clinical environments where students are supported, can develop a sense of professional identity and feelings of belonging to the clinical community and culture (McCloskey et al., 2020
).- McCloskey R.
- Yetman L.
- Stewart C.
- Slayter J.
- Jarret P.
- McCollum A.
- et al.
Changes in nursing students' knowledge, attitudes and interest in caring for older adults: A longitudinal cohort study.
Nurse education in Practice. 2020; 44https://doi.org/10.1016/j.nepr.2020.102760
In Australia, predictions of an ageing population (and shortages of nurses to care for this population, particularly in RACFs are documented (
Committee for Economic Development of Australia 2021
). While the RACF workforce has been bolstered with care workers, the increased acuity of older people living there means there is even a greater need for RNs to have gerontological knowledge and skills. This point is particularly important as there is no medical leadership nor onsite access to medical care in RACF (Committee for Economic Development of Australia. (2021). Duty of care: meeting the aged care workforce challenge.CEDA, Melbourne. https://www.ceda.com.au/Admin/getmedia/29cf7e90-afe9-4c92-bf4b-7abc385078f8/Aged-Care-Workforce-2021-FINAL.pdf.
Australian Medical Association 2018
). RNs working in aged care settings need to be highly competent and skilled in assessing and managing older people. Nursing curricula must prepare nurses to care for older people, irrespective of where they work. This aim should include scheduling RACF clinical experiences when students are well prepared for, and supported in the setting, and educating clinical teachers to work with older people (Australian Medical Association. (2018). 2017 AMA aged care survey report. Barton, ACT. Accessed September 2021. https://ama.com.au/sites/default/files/documents/2017_AMA_Aged_Care_Survey_Report.pdf.
Kirshbaum, Kaas, Wyman, & Van Son, 2015
). SoN should consider routinely and formally collecting feedback from students about their clinical experiences to inform curricula, such as the appropriateness of first year clinical experiences in RACFs, something that is currently not done (Fetherstonhaugh et al., 2022
).5.1 Limitations
The respondent bias limits the findings, as nurse academics who participated may have had different knowledge and experiences to others teaching in Australian undergraduate nursing degrees. The group interview structure for some respondents may also have limited disclosure of opinions, and as respondents reported their experiences of student feedback, recall bias may limit the findings. However, the research design, including the population approach, the response rate (100%) coupled with rigorous data analysis, contributed to the reliability of the findings.
6. Conclusion
If the future nursing workforce is expected to provide quality care to older people SoN must ensure that they design and deliver programs to support this care. Scheduling RACF clinical experiences for first-year nursing students should be reassessed, especially the impact on students. The ability of nurse academics to teach older adult care (
Fetherstonhaugh et al., 2022
) and of clinical educators to supervise student nurses in RACF requires further research. Articulating the importance of older people care in nursing practice across all health settings should be at the heart of undergraduate nursing programs. Part of this plan would involve the provision of positive clinical learning experiences with older people in diverse settings, for undergraduate students.Authorship contribution statement
All authors were involved in survey design, discussion of findings and drafts of paper writing.
JR wrote and submitted the ethics application and any modifications.
DF and JR were involved in recruitment and data collection.
JR and DF undertook the qualitative data analysis.
Ethical statement
This manuscript reports findings from research project involving human subjects.
The project was fully reviewed by La Trobe University Research Ethics Committee. Approval was obtained on 18 December 2018; approval number: HEC18492.
Reciprocal ethics approval was obtained from Curtin University on 15 February 2019, approval number: HRE2019-0061; and from Griffith University on 11 March 2019, protocol approval number: 2019/149.
Conflict of interest
There is no conflict of interest to declare.
Authors JR and DF work in a research centre and are not involved in teaching in a School of Nursing. Only DF and JR were involved in recruitment and the data collection. JR and DF undertook the data analysis.
Other authors who worked in Schools of Nursing that participated in the project were not involved in recruitment, data collection or data analysis.
The project was self-funded by the Australian Centre for Evidence Based Aged Care, La Trobe University.
References
- Survey: open-ended questions.in: Allen M. The SAGE encyclopedia of communication research methods. SAGE Publications, Inc., Thousand Oaks2018: 1716-1717
- Exploring undergraduate nursing students' perceptions of working in aged care settings: a review of the literature.Nurse Education Today. 2016; 36: 275-280
- Recognition for registered nurses supporting students on clinical placement: a grounded theory study.Australian Journal of Advanced Nursing. 2020; 37 (Article 2020.373.98)
- An aged life has less value: a qualitative analysis of moral disengagement and care failures evident in Royal Commission oral testimony.Journal of Clinical Nursing. 2021; 30: 3563-3576
Australian Colleges of Midwives, Nursing and Mental Health Nursing. Position statement. Clinical supervision for nurses and midwives. (2019). Accessed 2 November 2021. https://www.acn.edu.au/wp-content/uploads/clinical-supervision-nurses-midwives-position-statement-background-paper.pdf.
Australian Institute of Health & Welfare. (2019). Admitted patient care 2017–18: Australian hospital statistics. Health services series no. 90. Cat. no. HSE 225. AIHW, Canberra. Accessed 2 September 2021. https://www.aihw.gov.au/getmedia/df0abd15-5dd8-4a56-94fa-c9ab68690e18/aihw-hse-225.pdf.
Australian Medical Association. (2018). 2017 AMA aged care survey report. Barton, ACT. Accessed September 2021. https://ama.com.au/sites/default/files/documents/2017_AMA_Aged_Care_Survey_Report.pdf.
Australian Nursing & Midwifery Accreditation Council. (2019). Registered nurse accreditation standards 2019.ANMAC, Canberra. Accessed 2 September 2021. https://www.anmac.org.au/document/registered-nurse-accreditation-standards-2019.
Australian Human Rights Commission (2021). What...s age got to do with it? A snapshot of ageism across the Australian lifespan. Australian Human Rights Commission, September 2021. https://humanrights.gov.au/our-work/agediscrimination/publications/whats-age-got-do-it-2021.
- What helps, what hinders? Undergraduate nursing students’ perceptions of clinical placements based on a thematic synthesis of literature.SAGE Open Nursing. 2021; 7: 1-20
Committee for Economic Development of Australia. (2021). Duty of care: meeting the aged care workforce challenge.CEDA, Melbourne. https://www.ceda.com.au/Admin/getmedia/29cf7e90-afe9-4c92-bf4b-7abc385078f8/Aged-Care-Workforce-2021-FINAL.pdf.
- Learning from nursing students’ experiences and perceptions of their clinical placements in nursing homes: an integrative literature review.Nurse Education Today. 2021; 100 (Article 104857)
- Modelling job support, job fit, job role and job satisfaction for school of nursing sessional academic staff.BMC Nuring. 2018; 17: 22
- A systematic review of clinical supervision evaluation studies in nursing.International Journal of Mental Health Nursing. 2018; 27: 1344-1363
- Nursing faculty and students’ perspectives of how students learn to work with older people.Nurse Education Today. 2020; 93: 1-7
- Registered nurses' reflections on their educational preparation to work with older people.International Journal of Nursing Older People. 2021; 16 (Article e12363)
- How Australian residential aged care staffing levels compare with international and national benchmarks.Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, 2019 (Accessed 2 November 2021)
- An investigation of nursing students’ knowledge of dementia: a questionnaire study.Nurse Education Today. 2015; 35: 800-805
- Student nurses’ strategies when speaking up for patient safety: a qualitative study.Nursing and Health Sciences. 2021; 23: 447-455
- Teaching the care of older people in Australian nursing schools: survey findings.Collegian. 2022; (Accepted for publication 27 February)
- Addressing the community-based geriatric healthcare workforce shortage by leveraging the potential of interprofessional teams.Journal of the American Geriatrics Society. 2019; 67: S400-S408
- The clinical learning environment in nursing education: a concept analysis.Journal of Advanced Nursing. 2016; 72: 301-313
- Educational strategies to promote nursing in long-term care: an integrative review.Journal of Gerontological Nursing. 2013; 39: 52-60
- A retrospective/prospective on the future of geriatric nursing.Geriatric Nursing. 2020; 41: 29-31
- Gerontological nurse teachers' abilities and influence on students' willingness in older people nursing: a cross-sectional, correlational survey.Nurse Education Today. 2020; 90 (Article 104461)
- Nursing curriculums may hinder a career in gerontological nursing: an integrative review.International Journal of Older People Nursing. 2017; 12e121152
Health Workforce Australia. (2014). Australia's future health workforce – nurses overview. DoH, Canberra. https://www.health.gov.au/sites/default/files/documents/2021/03/nurses-australia-s-future-health-workforce-reports-overview-report.pdf.
- Assisting nurses to facilitate student and new graduate learning in practice settings: what ‘supports’ do nurses at the bedside need?.Nurse Education in Practice. 2013; 13: 197-201
- Nursing and midwifery students’ encounters with poor clinical practice: a systematic review.Nurse Education in Practice. 2017; 23: 67-75
- “My mentor didn't speak to me for the first four weeks”: perceived unfairness experienced by nursing students in clinical practice settings.Journal of Clinical Nursing. 2018; 27: 929-938
- Nursing students’ experiences with clinical placement in a marginal Norwegian nursing home learning environment.International Practice Development Journal. 2020; 10: 7
- The Frailty In Residential Sector over Time (FIRST) study: methods and baseline cohort description.BMC Geriatrics. 2021; 21: 99
- The effectiveness of clinical education models in undergraduate nursing programs. A systematic review.Nurse Education in Practice. 2018; 29: 116-126
- Nursing students’ experiences with clinical placement in residential aged care facilities: a systematic review of qualitative evidence.JBI Evidence Synthesis. 2020; 18: 986-1018
- Nursing students’ knowledge about behavioral and biopsychosocial domains of dementia: a cross-sectional survey design.International Journal of Nursing Knowledge. 2022; 33: 116-127
- Facilitated learning to advance geriatrics: Increasing the capacity of nurse faculty to teach students about caring for older adults.Gerontologist. 2015; 55: 54-64
- The “ideal” clinical supervision environment in nursing and allied health.Journal of Multidisciplinary Healthcare. 2020; 13: 187-196
- The education received by nursing students regarding nursing older people. A scoping literature review.Scanadnavian Journal of Caring Sciences. 2015; 29: 15-29
Krippendorff, K. (2018).Content analysis: an introduction to its methodology. (4th ed.). Thousand Oaks, CA: Sage Publications, Inc.
- Nursing students’ experience with clinical placement in nursing homes: a focus group study.BMC Nursing. 2021; 20: 159
- Nursing students’ preferences for clinical placements in the residential aged care setting.Journal of Clinical Nursing. 2018; 27: 143-152
- What are the primary concerns of nursing students as they prepare for and contemplate their first clinical placement experience?.Nurse Education in Practice. 2015; 15: 304-309
- Measuring prevalence of 60 health conditions in older Australians in residential aged care with electronic health records: a retrospective dynamic cohort study.Population Health Matters. 2020; 18: 25
Mason, J. (2013). Review of Australian Government Health Workforce Programs., pp. 450. Accessed 2 November 2021. https://www1.health.gov.au/internet/main/publishing.nsf/Content/D26858F4B68834EACA257BF0001A8DDC/$File/Review%20of%20Health%20Workforce%20programs.pdf.
- Changes in nursing students' knowledge, attitudes and interest in caring for older adults: A longitudinal cohort study.Nurse education in Practice. 2020; 44https://doi.org/10.1016/j.nepr.2020.102760
- Incentivising a career in older adult nursing: the views of student nurses.International Journal of Older People Nursing. 2019; 14: e12256
- Living on the edge: issues that undermine the capacity of residential aged care providers to support student nurses on clinical placement.Australian Health Review. 2007; 31: 368-378
- Guest editorial, Ageism: we are our own worst enemy.International Psychogeriatrics. 2017; 29: 1-8
Schwartz, S. (2019). Educating the nurse of the future—report of the independent review into nursing education. DoH, Canberra, Accessed 2 September 2021. https://www.health.gov.au/resources/publications/educating-the-nurse-of-the-future.
- Preceptorship of clinical learning in nursing homes—a qualitative study of influences of an interprofessional team intervention.Nurse Education Today. 2021; 104104986
- Australia's first transition to professional practice in primary care program: qualitative findings from a mixed-method evaluation.Collegian. 2018; 25: 201-208
- Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.International Journal for Quality in Health Care. 2007; 19: 349-357
Article info
Publication history
Published online: September 03, 2022
Accepted:
June 14,
2022
Received in revised form:
May 23,
2022
Received:
January 31,
2022
Identification
Copyright
© 2022 Australian College of Nursing Ltd. Published by Elsevier Ltd.
