BILL DEANS

Senior Lecturer
Te Tari Matauranga Hauora
Faculty of Nursing and Health Studies
Manukau Institute of Technology
Auckland, New Zealand

Sabaah Al-khayr

The Context
Rapid social and economic growth in countries of the world has
resulted in an increase both in the number of elderly people who are
prone to degenerative and chronic diseases, and new patterns of
illnesses that are brought on by social and economic factors such as
occupational hazards, accidents, and environmental poisonings caused
by air pollution, noise and contaminated water. Communities are
struggling with a large number of people across the lifespan, who
receive minimal or no health care because they cannot afford or access
services. Moreover, public concerns regarding quality, cost, access and
fragmentation of health care have contributed to a shift in care from the
more traditional acute care settings to the community. This has led to
changes in nursing practice.
(WHO, 2010)

The Context
Rapid social and economic growth in countries of the world has
resulted in an increase both in the number of elderly people who are
prone to degenerative and chronic diseases, and new patterns of
illnesses that are brought on by social and economic factors such as
occupational hazards, accidents, and environmental poisonings caused
by air pollution, noise and contaminated water. Communities are
struggling with a large number of people across the lifespan, who
receive minimal or no health care because they cannot afford or access
services. Moreover, public concerns regarding quality, cost, access and
fragmentation of health care have contributed to a shift in care from
the more traditional acute care settings to the community. This has led
to changes in nursing practice.
(WHO, 2010)

The Context
Rapid social and economic growth
Increase in number of elderly people and
chronic diseases
New patterns of illnesses
Large number of people with minimal or no
health care
Public concerns about quality, cost, access
and fragmentation of health care
Changes in nursing practice

The Problem
Community-based health and social
services are changing at a
remarkable rate and nurses will be
key players in the delivery of many
of these services.
Moving the focus from hospital to
primary health care, has resulted in
reduced numbers of placements.

The Concern
Increased co$t in supporting /
supervising students across a
wider range of service providers
and larger geographical area.
Increased pressure on physical
accommodation
and/or
staff
availability making it difficult to
take students for long periods or
block placements.
Placements where the level of
clinical opportunity fluctuates
during the working day or week.

The Solution
Identify, or create, placement
models that are flexible rather
than the one size fits all
approach that we have been using.
Design courses and clinical
outcomes aimed at developing a
different range of skills required
for working in this new
environment.

The Challenge
The emerging multi-disciplinary
and inter-professional nature of
health and social care delivery
demands that:
education and service providers
think more creatively about the
type of placement experience our
future workforce will require in
order working in this new
environment.
develop
new
supervision
arrangements where there is
limited access to an RN or no RN
onsite.

Traditional Placement Models

The most common of the traditional clinical
supervision models are:
1. Preceptor-guided Practice Education Model
2. Team Preceptor Model
Traditional placements are normally 8-12 and typically
looks like this.
No. Weeks
Student

Placement

6
Break

10

Placement

The number of students placed with a service provider

would be based on the physical capacity of the facility
and/or the number of RNs able to act as Preceptors.

Alternative Clinical Placement Models

In the Community Nursing with a Community Focus paper we have
introduced variations on three (3) additional models:

1. PROJECT-FOCUSED CLINICAL PLACEMENT MODEL

2. FACILITATED CLINICAL SUPERVISION MODEL
3. STUDENT-LED CLINICAL FACILITATION MODEL

1. Project-focused Clinical Placement Model

1. Project-focused Clinical Placement Model

How this might look?
EXAMPLES: Based on 2 students
No. Weeks

10

Student 1

Clinical

Break

Project

Student 2

Project

Break

Clinical

Student 1

Clinical

Project

Break

Student 2

Project

Clinical

Break

Student 1

Student 2

Student 1

Student 2

2. Facilitated Clinical Supervision Model

3. Student-led Clinical Facilitation Model

Student
Nurse

Student
Nurse

Student
Nurse

STUDENT
FACILITATOR

SERVICE
Student
PROVIDER
Nurse

Student
Nurse

Student
Nurse
Student-led Clinical Facilitation Model (Bill Deans, 2011)

A combination of models 1 & 3

Online Training
Medical Receptionist Tutorial Series

Introduction
Answering the Phone
Confidentiality
Confirming Appointment

Closing the Call

Self Test

Instructions

eGuide 2012 I Property of Bill Deans

Archiving

References/Bibliography

Clendon, J. (2004). Demonstrating outcomes in a nurse-led clinic: How primary health

care nurses make a difference to children and their families. Journal for the Australian
Nursing Profession , 18 (1-2), 164-176.
Deans, B. (2011) Student-led Clinical Facilitation Model. A pilot project. MIT Report.
Dickson, C., Walker, J., & Bourgeois, S. (2006). Facilitating undergraduate nurses clinical
practicum: The lived experience of clinical facilitators. Nurse Education Today , 26 (5),
416-422.
Fortune, T., Farnworth, L., & McKinstry, C. (2006). Project-focused fieldwork: Core
business or fieldwork fillers? Australian Occupational Therapy Journal , 53 (3), 233-236.
Pagels, A. A., Wng, M., & Wenstrm, Y. (2008). The impact of a nurse-led clinic on selfcare ability, disease-specific knowledge, and home dialysis modality. Nephrology Nursing
Journal , 35 (3), 242-248.
Smith, M., & Flint, E. (2006). Project-focused placements: Enhancing students
understanding of citizens' perspectives. Nurse Education in Practice , 6 (2), 117-121.
Whitehorse Division of General Practice. (2007). Nurse Led Clinics - Chronic Disease
Management in General Practice. Victoria: Whitehorse Division of General Practice.

Thank You

BILL DEANS
Senior Lecturer
Te Tari Matauranga Hauora
Faculty of Nursing and Health Studies
Manukau Institute of Technology
Auckland, New Zealand

http://www.billdeans.net
billdeans.nz@gmail.com