Merylin Cross

The evidence for ‘flipping out’: A systematic review of the flipped classroom in nursing education

BACKGROUND The flipped classroom has generated interest in higher education providing a student-centred approach to learning. This has the potential to engage nursing students in ways that address the needs of todays students and the complexity of contemporary healthcare. Calls for educational reform, particularly in healthcare programs such as nursing, highlight the need for students to problem-solve, reason and apply theory into practice. The drivers towards student-based learning have manifested in team, problem and case-based learning models. Though there has been a shift towards the flipped classroom, comparatively little is known about how it is used in nursing curricula. OBJECTIVES The aims of this systematic review were to examine how the flipped classroom has been applied in nursing education and outcomes associated with this style of teaching. DATA SOURCES Five databases were searched and resulted in the retrieval of 21 papers: PubMed, CINAHL, EMBASE, Scopus and ERIC. REVIEW METHODS After screening for inclusion/exclusion criteria, each paper was evaluated using a critical appraisal tool. Data extraction and analysis were completed on all included studies. RESULTS This systematic review screened 21 titles and abstracts resulting in nine included studies. All authors critically appraised the quality of the included studies. Five studies were identified and themes identified were: academic performance outcomes, and student satisfaction implementing the flipped classroom. CONCLUSIONS Use of the flipped classroom in higher education nursing programmes yielded neutral or positive academic outcomes and mixed results for satisfaction. Engagement of students in the flipped classroom model was achieved when academics informed and rationalised the purpose of the flipped classroom model to students. However, no studies in this review identified the evaluation of the process of implementing the flipped classroom. Studies examining the process and ongoing evaluation and refinement of the flipped classroom in higher education nursing programmes are warranted.

The evaluation of a successful collaborative education model to expand student clinical placements.

Worldwide, universities have been encouraged to increase the number of students enrolled in nursing courses as a way to bolster the domestic supply of graduates and address workforce shortages. This places pressure on clinical agencies to accommodate greater numbers of students for clinical experience who, in Australia, may often come from different educational institutions. The aim of this study was to develop and evaluate a collaborative model of clinical education that would increase the capacity of a health care agency to accommodate student placements and improve workplace readiness. The project was undertaken in a medium sized regional hospital in rural Australia where most nurses worked part time. Through an iterative process, a new supported preceptorship model was developed by academics from three institutions and staff from the hospital. Focus group discussions and interviews were conducted with key stakeholders and clinical placement data analysed for the years 2004 (baseline) to 2007. The model was associated with a 58% increase in the number of students and a 45% increase in the number of student placement weeks over the four year period. Students reported positively on their experience and key stakeholders believed that the new model would better prepare students for the realities of nursing work.

Expanding the clinical placement capacity of rural hospitals in Australia: Displacing Peta to place Paul?

In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines. Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE). Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas.

“A golden opportunity”: Exploring interprofessional learning and practice in rural clinical settings

Abstract Little is known about interprofessional practice (IPP) and interprofessional learning (IPL) in rural health services, despite national funding and continuing emphasis on increasing students’ clinical placements in rural areas. This short paper outlines a study in Tasmania, Australia, which investigated how and under what contexts and conditions IPP and IPL occur in rural clinical settings, and the enabling factors and strategies that promote this learning and practice. This study employed a mixed method design comprising focus group discussions and a survey involving health professionals from two rural health services. The findings demonstrate that formal and informal arrangements, the collaborative nature of small, close-knit healthcare teams and patient-centred models of care employed in rural practice settings, provide ideal contexts for IPP and IPL. The study has implications for promoting organisational readiness for IPP and IPL and harnessing the potential of rural services to promote and develop students’ interprofessional capability.

Interprofessional practice and learning in a youth mental health service: a case study using network analysis

Abstract Few studies have examined interprofessional practice (IPP) from a mental health service perspective. This study applied a mixed-method approach to examine the IPP and learning occurring in a youth mental health service in Tasmania, Australia. The aims of the study were to investigate the extent to which staff were networked, how collaboratively they practiced and supported student learning, and to elicit the organisation’s strengths and opportunities regarding IPP and learning. Six data sets were collected: pre- and post-test readiness for interprofessional learning surveys, Social Network survey, organisational readiness for IPP and learning checklist, “talking wall” role clarification activity, and observations of participants working through a clinical case study. Participants (n = 19) were well-networked and demonstrated a patient-centred approach. Results confirmed participants’ positive attitudes to IPP and learning and identified ways to strengthen the organisation’s interprofessional capability. This mixed-method approach could assist others to investigate IPP and learning.

Treatments for people living with schizophrenia in Sub-Saharan Africa: an adapted realist review

AIM To identify the treatments and interventions available and their impact on people living with schizophrenia in Sub-Saharan Africa. BACKGROUND Help-seeking behaviour and the choice of treatment are largely influenced by socio-cultural factors and beliefs about the causes of mental illness. This review addresses the gap in knowledge regarding the treatment options available to people living with schizophrenia in Sub-Saharan Africa. DESIGN Adapted realist literature review. DATA SOURCES Electronic databases searched in June 2016 included PubMed, EMBASE, PsycINFO, ProQuest and CINAHL. REVIEW METHODS The adapted realist review approach used to synthesize the published research involved identifying the review aim, searching and selecting relevant studies, extracting, iteratively analysing and synthesizing relevant data and reporting results. RESULTS Forty studies from eight countries were reviewed. Most people were treated by both faith/traditional healers and modern psychiatry. Common treatments included antipsychotics, electroconvulsive therapy and psychosocial interventions. Few treatment options were available outside major centres, there was poor adherence to medication and families reported a high level of burden associated with caring for a relative. LIMITATIONS Major limitations of this review were the lack of studies, variable quality and low level of evidence available from most countries from Sub-Saharan Africa and lack of generalizability. CONCLUSION People living with schizophrenia in Sub-Saharan Africa were treated by faith, traditional healers and modern psychiatry, if at all. Further research is needed to better understand the local situation and the implications for caring for people from this region. IMPLICATIONS FOR NURSING AND HEALTH POLICY Mental health services in Sub-Saharan Africa are limited by fiscal shortages, lack of mental health services and qualified mental health professionals. This review provides evidence to inform nursing and healthcare policy, including recruiting and training mental health professionals and ensuring access to evidence-based, person-centred and culturally relevant mental health services within the primary care context.

End-of-Life care in a community garden: Findings from a Participatory Action Research project in regional Australia

Abstract This article presents findings from research that explored how a community garden might function as a place of end‐of‐life and bereavement support. Adopting Participatory Action Research (PAR) methods, and informed by Third Place theory and notions of therapeutic landscape, creative consultations were held in the Garden and peoples homes. The findings provide insights into the nature of informal care as it is played out in the liminal garden space, between home and institution. The results illuminate the therapeutic landscape of community gardens, and contribute new understandings to the fields of PAR, health geography and end‐of‐life care. HighlightsThe therapeutic landscape of a Community Garden in end‐of‐life care is explored through participatory research.A Community Garden provides end‐of‐life care that intersects with formal palliative and bereavement care.Informal caregiving is understood through a spatial‐therapeutic lens.A Community Garden is understood as a geographically and therapeutically liminal space.

The benefits and challenges of academic writing retreats: an integrative review

ABSTRACT The immediate drivers to increase publication outputs in higher education are government and research funding, organisational status, performance expectations and personal career aspirations. Writing retreats are one of a range of strategies used by universities to boost publication output. The aims of this integrative review were to synthesise the available evidence, identify the attributes, benefits and challenges of academic writing retreats and examine the components that facilitate publication output. The review was based on a systematic search of six electronic databases. Of the 296 articles identified, 11 primary research papers met the inclusion criteria. Thematic analysis of the data highlighted a raft of personal, professional and organisational benefits of writing retreats. The five key elements of writing retreats conducive to increasing publication output were protected time and space; community of practice; development of academic writing competence; intra-personal benefits and organisational investment. Participants involved achieved greater publication outputs, particularly when provided ongoing support. Further research is required to examine more substantively the feasibility of writing retreats, their cost-effectiveness and the features that increase publication outcomes.

Navigating Nuances of Language and Meaning: Challenges of Cross-Language Ethnography Involving Shona Speakers Living With Schizophrenia:

For people living with schizophrenia, their experience is personal and culturally bound. Focused ethnography enables researchers to understand people’s experiences in-context, a prerequisite to providing person-centered care. Data are gathered through observational fieldwork and in-depth interviews with cultural informants. Regardless of the culture, ethnographic research involves resolving issues of language, communication, and meaning. This article discusses the challenges faced by a bilingual, primary mental health nurse researcher when investigating the experiences of people living with schizophrenia in Zimbabwe. Bilingual understanding influenced the research questions, translation of a validated survey instrument and interview transcripts, analysis of the nuances of dialect and local idioms, and confirmation of cultural understanding. When the researcher is a bilingual cultural insider, the insights gained can be more nuanced and culturally enriched. In cross-language research, translation issues are especially challenging when it involves people with a mental illness and requires researcher experience, ethical sensitivity, and cultural awareness.

Ruralization of students’ horizons: insights into Australian health professional students’ rural and remote placements

Introduction Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students’ future rural practice intentions. Methods Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. Results The core concept identified from the thematic analysis was “ruralization of students’ horizons,” a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, “preparation and support,” “rural or remote health experience,” and “rural lifestyle and socialization,” each of which includes multiple subthemes. From the content analysis, factors that promoted students’ rural practice intentions were having a “positive” practice experience, interactions with “supportive staff,” and interactions with the “community” in general. It was apparent that “difficulties,” eg, with “accommodation,” “Internet” access, “transport,” and “financial” support, negatively impacted students’ placement experience and rural practice intentions. Conclusions The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building.