Introduction The purpose of this study was to enhance the prac experience of undergraduate nursing students and registered nursing staff. An innovative model of clinical education, the Clinical Education Unit (CEU) model was developed, implemented and evaluated. Background to the study Clinical education is a vital component of the undergraduate nursing curriculum. 'Real world' practice provides students with the opportunity to develop the knowledge, attitudes and skills needed to function effectively as a registered nurse. Despite the commitment of universities to produce competent graduates, there has continued debate regarding the preparedness of new graduates for practice as registered nurses. This has focussed continued attention on the adequacy of students' clinical education and, in particular, on the models used for clinical facilitation/supervision. There is little published evidence that clearly demonstrates the effectiveness of any of the current models of clinical education or that any particular model is better than any other in achieving quality outcomes (Wellard, Williams and Bethune 2000; Clare, White, Edwards and Van Loon 2002). Hence, as recommended in the recent National Review of Nurse Education (2002), ongoing evaluation of nursing curricula and teaching practice, including clinical education, is clearly warranted. Methods The study utilised action research methodology to examine the effects of the Clinical Education Unit (CEU) on the quality of clinical prac as experienced by undergraduate nursing students and registered nurses working with the students in wards where they were placed for their practicums. It was undertaken in two iterations or phases: Phase 1 - Development, implementation and initial evaluation of an innovative model of clinical education (the CEU model) and Phase 2 - Refinement and re-evaluation of the CEU model of clinical education. Using focus group discussions and survey questionnaires, qualitative and quantitative data were collected from undergraduate nursing students and clinical nursing staff in conjunction with each iteration of the study. Results Phase 1 results indicated that the CEU model was evaluated more positively by students and registered nurses than were the non-CEU models that were used for comparison. This result was demonstrated in the comments of students and registered nurses with regard to the respective models of clinical education and supported by their ratings of the quality of clinical experience through the QPE-Phase questionnaires. A similar trend was found in the results from Phase 2. The CEU-2 model was again evaluated more positively by students and registered nurses than were the non-CEU models that were used for comparison. Conclusion In summary, the results of this study indicate that the CEU model had a positive impact on the prac experience of students and registered nurses. In both phases of the study, students and registered nurses in wards where the CEU model was being used evaluated the prac experience more positively than did students and registered nurses in wards where non-CEU models were being used. Two key factors were found to be important in achieving this outcome: the collaborative nature of the CEU model and nursing staff ownership of students' clinical education. These factors provided an operating framework which enabled the development of positive learning environments in the wards where students were placed for prac. Equally important were arrangements for the supervision of students' practice which involved local clinical facilitation and the explicit inclusion of other nursing staff in the ward. Further, continued support from the university to allow the clinical facilitators to take a supernumary role when facilitating students, to provide staff development for clinical education and to support staff on a day-to-day basis during the prac was also important, if not essential. It is proposed that these factors, acting synergistically, promoted enhanced access to learning opportunities for students and improved learning outcomes for students and staff. The study makes an important contribution to nursing education by providing evidence that can inform future developments in the area of undergraduate clinical education. It has potential benefits for nursing education not only in the local context, but within the international arena as well.

No / The processes whereby nurses develop the skills and knowledge required to deliver individualized and holistic care were examined in a 2-year study of nurses in a range of clinical settings and a university department of nursing in England. Members of two research teams of qualified nurses joined various communities of nursing practice as participating members and simultaneously "shadowed" designated nurses. At day's end, shadowers and shadowees reviewed the day's practice in critical incident interviews. The powerful processes of nurse socialization that create a strong core identity of the "good nurse" proved central to understanding the acquisition, use, and protection of nursing skills. Learning to become a nurse was always situated within particular communities of practice. Learning in such contexts, both in clinical and educational settings, entailed not just mastering a range of intellectual concepts but also learning through embodied performances involving engagement and interaction with the community of practice. The following were among the study recommendations: (1) link educational and clinical settings by helping clinical staff understand their collective role in the educational experience; (2) enhance the mentor and assessor functions; and (3) enable, support, and resource time in education for clinicians and time in practice for educators.

A quantitative, descriptive non-experimental design was used to identify the factors that influence clinical teaching of midwifery students in selected postnatal clinical settings in Tanzania. Structured questionnaires were used to collect data from midwifery tutors/preceptors. The major findings of the study showed that both the professional and educational qualification of tutors was low; tutors and preceptors were overworked due to shortage of staff; the school skills laboratory and postnatal wards lacked equipment and necessary supplies; there were no clinical accompaniment guidelines, and overcrowding of postnatal patients. Recommendations included developing the clinical teaching guidelines, employing more tutors, preceptors and clinical staff; improving the tutors'/ preceptors' educational and professional qualifications and updating the qualifications of ward supervisors and clinical facilitators. / Health Studies / M.A. (Health Studies)

Over a decade after the regulation change in Virginia allowing individuals without teaching experience to pursue school counseling careers, no known study had focused exclusively on differences site supervisors observe when training school counselors from different professional backgrounds and the extent to which those counselors employ a tailored supervision approach in the clinical setting. While site supervisor training has been an area of interest in recent articles (e.g., Dollarhide & Miller, 2006), its relationship to supervision philosophies and technique differentiation has not been previously addressed. The researcher investigated those topics using a mixed-method research design shaped by suggestions from recent literature (e.g., Better-Fitzhugh, 2010; DeKruyf, 2007; Luke, Ellis, & Bernard, 2011; Miller & Dollarhide, 2006; Peterson & Deuschle, 2006; Stephens, 2008). This study analyzed site supervisors’ perspectives on supervision, the role training can play in developing site supervisors’ confidence and philosophical orientation, and the beliefs and practices site supervisors employ when supervising former teachers and non-teachers. Observed differences between former teachers and non-teachers in the clinical setting existed, yet 7 out of 12 site supervisors did not differentiate their supervision approach in order to close this gap. Findings from both Phase I (survey) and Phase II (interview) of this study indicated that practice is linked to training. Site supervisors who reported receiving supervision training were more likely to work from a philosophy of site supervision, feel more confident about their ability to supervise, and believe that differences between former teachers and non-teachers were slight and could be overcome with supportive, intentional supervision.

Doctor of Philosophy (PhD) / Abstract Clinical teachers’ experiences of nursing and teaching Clinical nurse teachers’ experiences of nursing and teaching undergraduate nursing students on clinical placement are explored in this thesis because of concerns about the quality of nursing students’ learning outcomes. The aim was to identify variation in clinical teachers’ conceptions of nursing and their conceptions of, and approaches to teaching undergraduate nursing students. The study was significant because clinical teachers’ conceptions of nursing and approaches to clinical teaching have not been researched previously. Underpinning the study was a phenomenographic perspective on learning and teaching. This perspective views learning and teaching in terms of how they were experienced. Experience of nursing and clinical teaching, for example, can be understood in terms of related ‘what’ and ‘how’ aspects. The ‘what’ aspect concerns how nursing and clinical teaching were understood. The ‘how’ aspect is concerned the ways nursing and clinical teaching were approached. Experience of nursing and clinical teaching were described and analysed in terms of the separate ‘what’ and ‘how’ aspects and are understood in terms of the relationship between each of the aspects. Data from semi-structured interviews with twenty clinical teachers were analysed using phenomenographic research techniques (Marton & Booth, 1997) in order to identify variation in how nursing and clinical teaching were experienced. To extend the description, the research also sought to identify the empirical relationships between each of the aspects investigated. Key aspects of variation in clinical teacher experiences of nursing and clinical teaching and associated relationships have been identified. The results suggest that clinical teachers who adopted a student-centred approach to teaching conceived of nursing and clinical teaching in complex ways. The phenomenographic approach provides for an experiential and holistic account of clinical teaching: a perspective absent in nursing education research literature. The research findings extend knowledge that will assist with preparation and support of clinical teachers.

Doctor of Philosophy (PhD) / Abstract Clinical teachers’ experiences of nursing and teaching Clinical nurse teachers’ experiences of nursing and teaching undergraduate nursing students on clinical placement are explored in this thesis because of concerns about the quality of nursing students’ learning outcomes. The aim was to identify variation in clinical teachers’ conceptions of nursing and their conceptions of, and approaches to teaching undergraduate nursing students. The study was significant because clinical teachers’ conceptions of nursing and approaches to clinical teaching have not been researched previously. Underpinning the study was a phenomenographic perspective on learning and teaching. This perspective views learning and teaching in terms of how they were experienced. Experience of nursing and clinical teaching, for example, can be understood in terms of related ‘what’ and ‘how’ aspects. The ‘what’ aspect concerns how nursing and clinical teaching were understood. The ‘how’ aspect is concerned the ways nursing and clinical teaching were approached. Experience of nursing and clinical teaching were described and analysed in terms of the separate ‘what’ and ‘how’ aspects and are understood in terms of the relationship between each of the aspects. Data from semi-structured interviews with twenty clinical teachers were analysed using phenomenographic research techniques (Marton & Booth, 1997) in order to identify variation in how nursing and clinical teaching were experienced. To extend the description, the research also sought to identify the empirical relationships between each of the aspects investigated. Key aspects of variation in clinical teacher experiences of nursing and clinical teaching and associated relationships have been identified. The results suggest that clinical teachers who adopted a student-centred approach to teaching conceived of nursing and clinical teaching in complex ways. The phenomenographic approach provides for an experiential and holistic account of clinical teaching: a perspective absent in nursing education research literature. The research findings extend knowledge that will assist with preparation and support of clinical teachers.

A quantitative, descriptive non-experimental design was used to identify the factors that influence clinical teaching of midwifery students in selected postnatal clinical settings in Tanzania. Structured questionnaires were used to collect data from midwifery tutors/preceptors. The major findings of the study showed that both the professional and educational qualification of tutors was low; tutors and preceptors were overworked due to shortage of staff; the school skills laboratory and postnatal wards lacked equipment and necessary supplies; there were no clinical accompaniment guidelines, and overcrowding of postnatal patients. Recommendations included developing the clinical teaching guidelines, employing more tutors, preceptors and clinical staff; improving the tutors'/ preceptors' educational and professional qualifications and updating the qualifications of ward supervisors and clinical facilitators. / Health Studies / M.A. (Health Studies)

Zielsetzung dieser Arbeit ist die Vorstellung des klinischen Aufbaus und des Arbeitsablaufs eines robotischen Assistenzsystems für bildgeführte Interventionen in einem konventionellen Magnetresonanztomographen (MRT), sowie die Beurteilung der Genauigkeit und der klinischen Erfahrungen bei perkutanen Biopsien in verschieden Körperregionen. Material und Methoden: Das MR- kompatible, servopneumatische robotische Assistenzsystem lässt sich mit dem Patienten in die 60- cm Gantry eines Standard- MR- Scanners fahren. Die Genauigkeit des Systems wurde anhand von Nadelpunktionen (n= 25) in einem Phantommodell ermittelt. Perkutane diagnostische Biopsien wurden bei sechs Patienten durchgeführt. Ergebnisse: Für eine Interventionstiefe zwischen 29 und 95 mm wurde eine 3-DGenauigkeit von 2,2 +/- 0,7 mm (Intervall 0,9- 3,8 mm) bestimmt. Patienten mit einem BMI bis zu ≈30 kg/m2 konnten mit dem System punktiert werden. Die klinischen Arbeitsschritte werden anhand der Fallbeispiele dargestellt. Die mittlere Interventionszeit betrug 44 Minuten (Intervall 36 – 68 Minuten). Zusammenfassung: Die Punktion verschiedener Körperregionen ist mit Hilfe des robotischen Assistenzsystems in einem geschlossenen MRT erfolgreich und sicher möglich. Die Genauigkeit des Systems ist vergleichbar mit anderen Assistenzsystemen in der Literatur und genügt den klinischen Anforderungen. Eine kürzere Interventionszeit ist mittels einer Optimierung der einzelnen Arbeitsschritte möglich.:Einleitung 1 Publikation 5 Titelseite mit Abstract 6 Einleitung Publikation (Introduction) 7 Material und Methoden (Materials and Methods) 8 Robotisches Assistenzsystem (Robotic Assistance System) 8 Phantommessung (Phantom Experiment) 9 Patientenauswahlkriterien (Patient Selection Criteria) 11 Magnetresonanztomographie (MRI) 11 Biopsiedurchführung (Biopsy Procedure) 12 Ergebnisse (Results) 13 Phantommessung (Phantom Experiment) 13 Klinische Fälle (Clinical Experience) 14 Weichteilbiopsie kleines Becken (Soft-Tissue Biopsy in the Lesser Pelvis) 14 Weichteilbiopsie iliakaler Lymphknoten (Soft-Tissue Biopsy in Iliac Lymph Node) 15 Knochenbiopsie rechtes Femur (Bone Biopsy in Right Femur) 16 Knochenbiopsie Beckenkamm (Bone Biopsy in Iliac Crest) 17 Abszessaspiration (Abscess Aspiration) 18 Weichteilbiopsie Leber (Soft-Tissue Biopsy in the Liver) 19 Diskussion (Discussion) 22 Danksagungen (Acknowledgments) 25 Literaturverzeichnis Publikation (References) 25 Interpretation und Bewertung 30 Zusammenfassung 35 Literaturverzeichnis 39 Tabellenverzeichnis 46 Abbildungsverzeichnis 46 Erklärung über die eigenständige Abfassung der Arbeit 47 Lebenslauf und wissenschaftlicher Werdegang 48 Danksagung 49 Anlagen Anlage 1 Aufklärungsbogen zur Studie 50 Anlage 2 Einverständniserklärung 54 Anlage 3 Zertifikat des Assistenzsystems 57 durch TÜV- Süd

Simulation, in its many forms, has been a part of nursing education and practice for many years. The use of games, computer-assisted instruction, standardized patients, virtual reality, and low-fidelity to high-fidelity mannequins have appeared in the past 40 years, whereas anatomical models, partial task trainers, and role playing were used earlier. A historical examination of these many forms of simulation in nursing is presented, followed by a discussion of the roles of simulation in both nursing education and practice. A viewpoint concerning the future of simulation in nursing concludes this article.