University of Technology Sydney – Professional Practice in Health: identifying milestones and threshold standards

Background:

Effective oral communication plays a central role in nursing practice and contributes to positive health outcomes for patients.

Communication during clinical placement requires a high level of interpersonal skill in order to speak effectively with patients, their families and health care staff.

It is important that universities address difficulties in oral communication skills because of the increasing diversity of the student cohort.

Further details: In the Bachelor of Nursing degree (BN) at UTS, students who attend the full time standard program attend clinical placement every semester. In order to gain accreditation from the Nursing and Midwifery Board of Australia (NMBA), the curriculum for a nursing degree must contain a minimum of 840 hours of professional experience in a range of health care environments. Students are assessed by the clinical facilitator (a Registered Nurse who works with UTS in supporting and assessing groups of UTS students on their placements) to determine if they meet communication thresholds for their particular year of study in the program. Students whose communication skills do not meet the standards can sometimes be assessed to be unsafe, and are therefore unable to continue their clinical placements. Satisfactory performance in the clinical placements is mandatory to obtaining the degree. Responsibility for assessing the threshold communication standards is distributed across the Health Faculty teaching staff and hospital clinical practitioners. Specific strategies for development of CS have been incorporated into the degree program for students who do not meet the threshold standards.

Current Approach:

All students commencing the Bachelor of Nursing are required to complete an online pre-enrolment language assessment before they enrol in subjects. The screening test gives the student feedback on language support.

Based on the results, students who have low scores are encouraged to enrol in targeted supportive classes within Health and Society and Assessment and Therapeutics in Health Care 1 (ATHC1). Class discussions are held in ATHC1 about the language expected of a student in clinical placement. Students are encouraged to undertake a range of strategies to improve their confidence in spoken English, utilising the services of Higher Education Language and Presentation Support (HELPS), online resources with embedded videos and HELPS buddies.

Following the diagnostic strategies above, students identified as needing language support enrol in the Clinically Speaking program. This program is held in practice labs and provides students with simulation exercises of discussions of patient care that include colloquial and medical language, and opportunities for students to reflect on and build their vocabulary, understanding and confidence to access support when they do not understand or need help.

An Objective Structured Clinical Examination (OSCE) session is facilitated by teaching staff in ATHC1, and is a core assessment item. Students are assessed on core skills that they have learnt within the subject, and English Language proficiency/CS are also assessed in this context. Students who fail the OSCE have an additional opportunity to pass on an alternate date. If they do not pass their second attempt, academic staff develop a learning support plan identifying specific learning goals based on areas of identified deficit, and this is sent on clinical placement with the student.

Clinical Placement

The clinical facilitator assesses students at the end of week one of clinical placement. Students whose communication skills do not meet the standards can sometimes be assessed to be unsafe, and are therefore unable to continue their clinical placements. Before returning to future placements, or repeating an unsatisfactory placement, they meet with a faculty member to develop a Learning Support Plan, with specific goals and strategies aimed to improve their language level. The LSP is a mandatory component of the clinical subjects. Students fail the subject if they are not satisfactory in the clinical component.

In 2016 the Australian Standards Nursing Tool ANSAT was modified for clinical facilitators to monitor students’ spoken communication. Professional development and moderation sessions are provided to facilitators who provide feedback to students about the need for development of CS. The tool can assist students to understand the requirements of their chosen career.

The ANSAT tool, used in all clinical placements, has a three tier band system (1-3 with 1 the lowest). The overall plan is that students must reach a minimum band level by each year of study. At the end of end of first year, students should have achieved a level 2, (*with the consequence of meeting with a member of the academic staff and planning a Language Support Program), at the end of second year they should have achieved a level 3, and throughout third year, maintain level 3. Note: this process is still in development phase.

Subject outlines make this graduated process clear to students.

Further details: The faculty recognises the centrality of CS and the importance of verbal and nonverbal communication. Academic staff members acknowledge that communication is far more than language level in providing professional, safe and accurate communication and that this is one of the vital skill sets for nurses.

Issues:

  • Large numbers of students
  • Timetabling constraints for supporting classes due to clinical compliance and laboratory availability

High Impact Practice:

Identifying milestones and threshold standards: The need to monitor communication skills for student nurses on clinical practice is a safety issue. The above is a whole of program approach that identifies students not meeting the required standards and puts mandatory actions in place to develop CS.

Integration of teaching and learning practices: As well as support CS programs, teaching and learning activities focused on written and spoken language are integrated across the degree.

Distributed expertise: All teaching staff (especially those teaching clinical subjects) and clinical facilitators in hospitals are involved in identifying students who do not meet the threshold standards and monitoring their developmental progress.