Theory meets practice

rfT.*» « ^

£-1 I,-I ' i w t ^ u r a

VJ

ademfeMd* clj. elopment ndergraduatj 1

i.

'-'^

The difficulty nursing students experience in making the transition from the university to clinical context is attributed to the gap between theory and practice, and education and service. Collaboration between academics and clinicians in the provision of undergraduate education is considered to be a strategy for overcoming these problems. A project team consisting of four academics and six clinicians collaboratively developed and implemented an acute care topic, in the third year of a pre-registration nursing course at the School of Nursing, Flinders University. A review,of the literature did not provide examples of collaborative models relevant to undergraduate teaching. The subsequent model, devised by the project team, focused on technical, cultural and interpersonal aspects of collaborative teaching. The model was evaluated by illuminative research methods. Participants in the project included academics (n=4), clinicians (n=6) and students (n=104). Student questionnaires and academic and clinician interviews were used to inform evaluation procedures. The qualitative data was coded and analysed based upon the definitions and characteristics of collaboration described by Henneman et al (1995). Study findings demonstrated that the model was effective in facilitating collaborative relationships necessary for the successful development and implementation of reality-based learning for Students. By Lee-Anne Gassner, Karen Wotton, Judith Clare, Anne Hofmeyer and Julie Buckman. [Refereed]

Key Words: Collaboration, undergraduate teaching, illuminative evaluation, reality-based learning, collaborative models of

and service will continue. A consequence ol

the

this alienation is lhal academics may be

industries (Trigwell & Reid 1998) to afford

implcmcnlalion of a model of collaborative

distanced from the values and norms of

students the o p p o r t u n i t y to be involved

leaching,- a description of the methodology

nursing practice (Clare 1993a). Clinical

with work-based activities. However, often

of illuminative evaluation,- evaluation of the

s t a l l are o f t e n r e q u i r e d to s u p e r v i s e

this is a one-way liaison with (he university

model

of

students undertaking generic baccalaureate

controlling all phases of the collaboration.

collaboration outlined by Henneman et al

nursing programs but do not always feel

T h e input of stakeholders at the planning

{1995),- and a conclusion which summarises

prepared or informed about curricula aims

stage is essential for the credibility of the

the implications for teaching and research.

(Craddock 1993).

T h e majority of universities today have

theory-practice

working relalionships with

collaboration,-

relevant

using

gap and

models

a description

the

of

consequences

program and to ensure that all parties will

In a d d i t i o n , differences b e t w e e n the

The Ivory Tower and the Real World of Practice

cultures of universities and health care

a n d t h e n c r i t i q u e of t h e p r o c e s s a n d o u t c o m e s (Mellor 1998). This

A central purpose of university education is

in transferring and applying knowledge and

be actively involved in the implementation

paper

facilities contribute to students' difficulties

r e p o r t s on a face! ol a larger r e s e a r c h

to facilitate students' eflcctivc use of theory

skills. In respect to nursing, these cultural

project

developing

and knowledge in a variety of clinical areas.

d i f f e r e n c e s are t h e r e s u l t , in p a r t , of

teaching and learning partnerships between

However, c o n t e m p o r a r y criticism exists

ideological conflict between realistic values

clinicians, a c a d e m i c s and s t u d e n t s a n d

that nursing education fails to address the

of health care facilities and idealistic values

describes a model of collaborative teaching

complexity and reality of practice (Minarik

of

and its evaluation.

1990; Watts 1990; Nursing Education in

Winifreyda

this paper, students are considered to be

Australian Universities 1994,- Andrews &

1996). In spite of the recognition of these

consumers of services. Specific aspects of

Jones 1996). Various hypotheses have been

differences by academics and clinicians,

s t u d e n t learning were c o n s i d e r e d to he

p u t f o r w a r d to e x p l a i n t h i s a p p a r e n t

there is an expectation by hospitals and the

b e y o n d the scope of this paper. Student

p h e n o m e n o n , however, the gap between

universities, that students will be able to

learning is discussed briefly as it relates to

theoiy and practice and between education

m o v e in a n d o u t of t h e s e p h y s i c a l l y ,

the evaluation of the overall collahorative

a n d service a p p e a r s to b e a d o m i n a n t

professionally and intellectually distanced

strategy designed to promote reality based

c o n t r i b u t i n g factor. W h i l e t e a c h i n g is

cultures, and acquire a level of competence

learning. This paper consists of five parts: a

considered to be the exclusive domain of

deemed appropriate to both cultures (Clare

review of the literature in relation to the

academia, alienation b e t w e e n education

1993b).

concerned

with

the

universities

(Greenwood

&

1995; H e w i s o n & W i l d m a n

T h e model, introduced into the third year of a prc-rcgislration acute care nursing topic at the School of Nursing, Flinders University,

describes

aspects

of

collaborative teaching designed to promote reality based learning. For the purposes of

Collegian Vol 6 No 3 1999 15

P r o f e s s i o n a l

issue

Models of collaboration

midpoint ol Style's Unity Continuum, as

practice gap by incorporating theory in

It is argued that a way to resolve these

we

communication,

p r a c t i c e a n d p r e v e n t i n g t h e o r y from

issues is to increase the discourse between

consultation and consent were essential to

moving loo far away from the reality of

e d u c a t i o n a n d nursing service, t h r o u g h

the success of our project. We did not seek

practice (Barrcll & Hamric 1986,- Minarik

academics and clinicians working together

to achieve unified policy or struclurc. An

I990 ; Clare, Mann & Byrnes 1997). Yet,

example ol a merger or single entity status

examples of such collaborative efforts can

is portrayed by the unification model used

be problematic.

in

a

fa c i I i ta t i ve

and

collaborative

relationship (Just Adams & De Young 1989,

believed

that

H c w i s o n & W i l d m a n 1996 ; Clare el al

at t h e R o c h e s t e r M e d i c a l C e n t r e , U S ,

1997) lor the benefit ol student learning.

which aimed to link practice, education

d e v e l o p m e n t of l e c t u r e r p r a c t i t i o n e r s

a

and research by use of shared location and

showed that clinicians appointed to this

problematic concept, as it often remains a

a d m i n i s t r a t i v e structures (Sovie 1981).

role

t h e o r e t i c a l ideal r a t h e r than a t a n g i b l e

However, as in the past, shared location

managers with minimal contact with

o b j e c t i v e (Barrell & H a m r i c 1986) and

a n d a d m i n i s t r a t i v e s t r u c t u r e s d i d not

students placed in their clinical area. Thus,

difficult to apply in the education setting

n e c e s s a r i l y facilitate an e q u a l s h a r i n g

an innovative model evolved to maintain

(Gassner et al 1998). Indeed, confusion

b e t w e e n a c a d e m i c s a n d c l i n i c i a n s in

the status quo in relation to the theory

over the m e a n i n g of c o l l a b o r a t i o n has

teaching. Just, Adams and De Young (1989)

praclicc gap. SiTnilarly, Minarik (1990) in

However,

collaboration

is

Lathlean's (1995) work with

functioned

as

academics

the

and

a joint appointment as a psychiatric liaison Clinical N u r s e Specialist a n d Assistant ;, :

./|t::;

:>v

•:•••;):••>(•»Hrt

feH:!

! i ; ; - ^ ; 0:V

Clinical Professor r e p o r t e d

;:-2

insufficient

time for lull involvement in facilitation of student learning or for individual student guidance. Collaboration between academics and clinicians is essential to the development hindered its usefulness as found in studies

c l a i m e d t h a t t h e u n i f i c a t i o n m o d e l is

of the profession of nursing. However,

that have a t t e m p t e d

to e v a l u a t e its

inappropriate for schools ol nursing not part

w h a t is not clear from a review of the

effectiveness ( H e n n e m a n Lee & C o h e n

of a m e d i c a l or h e a l t h c a r e c e n t r e . A

literature is how to develop and maintain

1995).

of

further criticism is thai the unification

effective c o l l a b o r a t i o n w h i l e k e e p i n g

collaborative teaching, we chose to use the

model has tended to focus on a one-way

individual institutional and

defining characteristics of collaboration

e x c h a n g e a i m e d at assisting faculty to

identities. O u r project tried to address

outlined by Henneman et al in 1995.

b e t t e r p r e p a r e n u r s e s . H o w e v e r , less

s o m e of t h e s e issues b y d e v e l o p i n g a

Defining characteristics include:

emphasis has been given lo the support

partnership between academics

thai faculty can give to service (Parker

c l i n i c i a n s in all stages of t h e l e a r n i n g

In

developing

a

model

Joint venture, cooperative endeavour, willing participation, shared planning and decision-making,

cultural

and

c y c l e . In o t h e r w o r d s , a c a d e m i c s a n d

1994).

clinicians worked together in selecting the

team approach, contribution oj expertise, shared

Styles' (1984) prediction that the

responsibility, non-hierarchical relation-ships, power

future of nursing lay with the creative and teaching methodology, preparing teaching

as shared based on knowledge or expertise

intense

mid-

r e s o u r c e s , l e a c h i n g u s i n g a v a r i e t y of

(Hcnneman el al 1995: 105).

c o n t i n u u m level has been validated by

formats and evaluating the p r o g r a m . A

A tinily continuum described by Styles

current trends in collaboration between

challenge for this project was to devise a

(1984) provides a useful framework for

e d u c a t i o n and service over the past 15

m o d e l w h i c h was a p p l i c a b l e to t h e

a n a l y s i n g s t a g e s or d e g r e e s of u n i t y

years.

c o l l a b o r a t i v e p r o c e s s e s u s e d in t h e

development

at

the

b e t w e e n i n s t i t u t i o n s in a c o l l a b o r a t i v e

M o s t c o l l a b o r a t i v e cflorls c o u l d be

r e l a t i o n s h i p . At o n e e x t r e m e of t h e

classified as m i d - c o n t i n u u m , i n c l u d i n g

continuum

joint

is v i r t u a l l y , n o " t o g e t h e r

appointments,

joint

advisory

development

and

leaching

of

an

u n d e r g r a d u a t e t o p i c . !n d e v i s i n g t h i s model, the researchers were cognisant that

activity",- at the other extreme is a merger

committees,

and

collaboration is not confined to merely

or single entity status. Activities described

c o n t r a c t u a l a p p o i n t m e n t s for s p e c i f i c

one or two areas, but rather is dependent

by S t y l e s (1 9 8 4 ) as m i d - c o n t i n u u m

functions.

on t h e ' g o o d n e s s of fit' b e t w e e n key

faculty

practice

mid-coniinuum

a s p e c t s . I h e key a s p e c t s u s e d in o u r

consultation and consent. We decided to

collaborative efforts in nurse e d u c a t i o n

model of collaborative teaching include:

focus our collaborative activities around the

have been useful in narrowing the theory-

technical,

arc c h a r a c t e r i s e d by c o m m u n i c a t i o n ,

16 Collegian Vol 6 Nu3 1999

In

general,

s o c i o (c u 11 u r a I)

and

interpersonal. Sweeney, Guiino, Lora and

o t h e r s . T h u s it was h y p o t h e s i s e d that,

u n i v e r s i t y ' . To a c h i e v e this, c l i n i c i a n s

Small described these aspects in 1987 in

attention

would

required access to communication, office

their

framework

conducting

increase the efficacy of the collaboration.

space and material resources. Access to

collaborative multinational research

Teaching is central because the interface

communitatio n

studies. In our model, the 'goodness of fit'

between each of the other three aspects is

providing each clinician with c o m p u t e r

between

a

essential to the effectiveness and quality ol

facilities, a t e l e p h o n e with an answering

foundation for collaboration and effective

t e a c h i n g . Teaching a n d learning in the

teaching was viewed as a consequence ol

clinical a n d u n i v e r s i t y e n v i r o n m e n t is

successful c o l l a b o r a t i o n . T h i s a r t i c l e

c o n s i d e r e d to be i n t e r d e p e n d e n t

reports on the implcmenlation of a model

complementary.

these

lor

to all c o m p o n e n t s

aspects

provided

was

achieve d

by

i

of c o l l a b o r a t i v e evaluation.

teaching

and

and

machine and a pigeon hole for personal and professional c o m m u n i c a t i o n s and g e n e r a l i n f o r m a t i o n p e r t a i n i n g to the u n i v e r s i t y . A c c e s s to r e s o u r c e s w a s achieved by orientation to classroom and

its

Technical

clinical laboratory facilities, provision ol

Technical aspects of teaching arc defined as

library and p h o t o c o p y i n g facilities. In

Implementation of a model of

the

organisational

addition, it was perceived that life in the

collaborative teaching

components (Perry & Moss 1989). As the

university is relatively unstructured when

T h e a u t h o r s of t h i s p a p e r v i e w t h e

project was introduced into a pre-existing

c o m p a r e d to t h e clinical e n v i r o n m e n t .

development of a collaborative curriculum

subject, curriculum d e v e l o p m e n t had to

Therefore, clinicians were oriented to the

as more than 'working together'. Rather, it

reflect the aims and objectives of lhat topic

flexibility of managing workload rather

is a process ol shared learning b e t w e e n

a n d t h e p h i l o s o p h y of t h e S c h o o l of

t h a n i n f l e x i b i l i t y of c o m p l e t i n g t i m e

two nursing cultures, academia and

Nursing, Flinders University, as well as

s h e e t s . T h i s was a c h i e v e d by firstly

clinical. In this collaborative project, nurses were brought together from three

Figure 1 Collaborative Teaching: Interrelationship between

s t r u c t u r i n g t h e time of clinicians, then

o r g a n i s a t i o n s c o n s i d e r e d to be u n i q u e ,

Technical,

development. Ultimately,

d y n a m i c , living organisms having clear and

distinctive

components,

structural

and

(Socio)cultural

and

g r a d u a l l y i n c o r p o r a t i n g free l i m e for clinicians

became a u t o n o m o u s in structuring their

Interpersonal A s p e c t s

time around their teaching commitments.

each

possessing (heir own nursing philosophy,

Cultural

culture and identity. T h e members of the project team r e c o g n i s e d t h a t t h e s e

A l t h o u g h o r g a n i s a t i o n a l c u l t u r e is

c u l t u r a l d i f f e r e n c e s in i d e o l o g y

often

would present challenges to the collaborative process. For

the

defined

interest

as t h e

collective

and unification

orga n i s a t i o n through

purposes

of

an

shared

s y s t e m s of b e l i e f s , h a b i t s a n d

of

developing and promoting a

traditions,

it

can

also

be

collaborative relationship and

construed as a dynamic process of

a p r a c t i c e - b a s e d curriculum,

human interaction

the

related to the dynamics of power

team

comprehensive,

devised yet

a

flexible

inevitably

( C i r o u x , 1 9 8 3 ) . T h u s c u l t u r e is

theoretical framework. T h e model

intimately related to structuring and m e d i a t i o n of s o c i a l p r o c e s s e s a n d

o u t l i n e d in F i g u r e I, is u s e d t o describe the interrelationship between

t r a n s f o r m a t i v e a c t i o n of l a n g u a g e and

technical, (socio)cultural, interpersonal

shared

aspects of t e a c h i n g . W h e r e a s , previous

resources

in

resisting

and

reconstituting those processes. The

frameworks used to analyse institutional

r e f l e c t i n g t h e r e a l i t y of t h e c l i n i c a l

collaboration between academics and

collaboration in nursing show a hierarchy

e n v i r o n m e n t . T h e s e q u e n c i n g of t o p i c

c l i n i c i a n s in this p r o j e c t reflected t h e

of e l e m e n t s ol c o l l a b o r a t i o n ( S t y l e s ,

content also had to articulate with other

c o m b i n i n g of two different world views.

1984), this model emphasises equality of

third year undergraduate nursing topics

W h i l e acadcmia is characterised by the

concepts. Each component of the model is

and the timetable for clinical placement.

' i d e a l ' v i s i o n of n u r s i n g c a r e a n d a

c o n s i d e r e d to be of equal i m p o r t a n c e because of the interaction between them and the potential of each to influence the

Facilitation

of t h e

collaborative

concentration on the provision of holistic

process was d e p e n d e n t u p o n clinicians

care, clinical practice emphasises the

e n t e r i n g into the t e c h n i c a l l i f e of t h e

'real', that is, the importance of 'getting Collegian Vol 6 No 3 1999 1 7

Professional

issue resources for each class, facilitation ol

of

Wtnifreyda, 1995:186). Clinicians tend to

l e a r n i n g a c t i v i t i e s , and s u p e r v i s i o n of

reflective journal to e n a b l e analysis of

emphasise aspects of technical expertise.

c l i n i c a l e x a m i n a t i o n s . For a c a d e m i c s

practice in clinical and classroom settings.

This

through

the

work'

(Greenwood

&

the

project

team

maintained

a

the

employed by the university their primary

T h e s e journals were used as a basis for

imperative to deliver quality nursing care

role was classroom t e a c h i n g , however,

discussion

within the c o n s t r a i n t s of scarce h u m a n

t h e y also h a d clinical a s s o c i a t e s t a t u s

understanding ol practice.

and e c o n o m i c resources (Hewison &

within the h o s p i t a l s e t t i n g . A c a d e m i c s

Wildman

had their own areas of clinical expertise

reality

is

influenced

1996). However,

by

Rafferty,

to

promote

a

shared

Interpersonal Interpersonal aspects take into a c c o u n t the uniqueness o I individuals,

i

personalities,

•* > . - ; H , -

personal

their

goals

and

behaviours. Project team members were

V ^ K f ; L ^ ; » i i ^ ^li'Yi('.•'{ 0.-';!!iif*iii(;i^.'!t; u«-.-)iu-.:•..;

recruited from a wide variety of clinical and academic backgrounds,- consequently there was the potential to develop a rich

Allcock & Lathlean (1996) argue that this

and affiliation. Students undertaking the

learning milieu. T h e advantages of group

tension between theory and practice can

clinical c o m p o n e n t of the subject were

sharing included

b e usefully e x p l o i t e d in t e a c h i n g and

supervised by academics working in their

personal

research. In particular, discussion, debate

clinical specialty areas.

attributes offered by each individual and

and negotiation cannot be achieved unless

E s s e n t i a l t o t h e a c h i e v e m e n t of a

their

goals,

c r i t i c a l r e v i e w of an a n a l y s i s

understanding

of

of

the

leaching

the

collaborative culture was the sharing of

m e t h o d o l o g i e s . I h e exploration of the

differences between the two environments.

knowledge. This was achieved by regular

above aspects added new insights to the

In other words, the dynamic tension that

meetings in both university and practice

subsequent collaborative curriculum

exists between the two cultures can be used

settings to facilitate the notion of a team

development

c o n s t r u c t i v e l y to c h a l l e n g e ideas a b o u t

and

understanding ol each other's world views

practice and education to create meaningful

clinicians and s t u d e n t s . T h e r e

curricula (Perry & Moss 1989, Clare

however, differences

teams recognise and understand

discourse

in

were

knowledge

H o w e v e r , t h e r e w e r e a n u m b e r of

relevant

While

potential and actual difficulties that the

clinicians seemed to be more 'practical'

team had to overcome. As the impetus for

t h e n o t i o n of s h a r e d u n d e r s t a n d i n g in

and focusscd on curriculum

content,

t h e p r o j e c t c a m e from t h e u n i v e r s i t y

relation to teaching and clinical roles and

academics were 'theoretical' and focusscd

initially, the project was 'owned' by the

knowledge relevant to the curriculum. For

on problem solving and process. T h e

a c a d e m i c s . D i v e s t i n g a n d s h a r i n g of

this to occur, the project g r o u p had to

solution was to marry process and content

o w n e r s h i p was assisted by efforts that

develop a culture of its own that would

by u s i n g case s t u d y m e t h o d s in b o t h

w e r e m a d e w i t h i n t h e g r o u p s u c h as

achieve consensus but value d e b a t e and

university and clinical settings. Teaching

working

nurture the feeling of competence in one's

and learning strategies associated with the

curriculum, sharing leaching, and sharing

area of expertise. In addition, members of

use of the case study method, reported by

in t h e d i s s e m i n a t i o n ol

the project group h a d to recognise the

W o t t o n & Cassner, (1998) demonstrated

related to project outcomes.

boundaries

its usefulness in the promotion of reality-

in

roles.

learning

curriculum.

and lostered effective group dynamics.

1993b).

overlap

the

academics,

enhanced

Integral to the process of collaboration was

and

to

between

and

and

collaborative

together

to

develop

the

information

T h e size of the c o l l a b o r a t i v e g r o u p

C l i n i c i a n s had a dual role in t h a t they

based

were employed by the hospital for three

approaches to teaching. In addition, the

individual participation and decrease

days and were seconded to the School of

team examined and identified strategics

c o h e s i v e n e s s . To o v e r c o m e this, small

Nursing, Flinders University to undertake

for integration of the 'real' with the 'ideal'.

working groups were established to deal

teaching responsibilities for the remainder

Attention was given to informal social

with specific work associated with t h e

of the week. Clinicians were allocated an

activities to enable team building as well

academic teaching partner and were

as s c h e d u l e d f o r m a l m e e t i n g s . Staff

represented

involved in teaching tutorial and clinical

d e v e l o p m e n t sessions were designed to

clinicians. T h i s m e a n t that m e m b e r s of

laboratory classes for the duration of the

promote a shared understanding

semester.

curriculum

Teaching

responsibilities

i n c l u d e d p r e p a r a t i o n of m a t e r i a l s a n d 1 8 Collegian Vol 6 No3 1999

(N= 10) also had the potential to minimise

project.

These both

working

groups

academics

and

of

the team had opportunities to work with

proposed

others apart from their teaching partners

teaching and learning strategies. Members

and hence the collaborative process was

content

and

expectations of the collaborative teaching

enhanced. Ultimately, teaching was

Setting

achieved in b o t h clinical a n d a c a d e m i c

Students

and

project. Interviewing was open-ended and

environments.

w o r k s h o p s in t h e S c h o o l of N u r s i n g .

participants were asked questions in the

However, students also had 4 weeks of

same order.

RESEARCH DESIGN

acute care clinical p r a c t i c e t h a t was

Research aims and objectives

undertaken in a variety of clinical venues

Analysis of data

undertook

tutorials

i

This study was undertaken to evaluate a m o d e l of c o l l a b o r a t i v e t e a c h i n g - T h e

i n c l u d i n g t h e w a r d s of t h e c l i n i c i a n s

T h e study describes and interprets

involved in the collaboration.

c o n c e p t s from across all t h e interviews

Ethical Approval

analysis documented the communication

rather than single case analysis. Thus the

objectives were to: 1. Facilitate further co-operation between the university and its industry p a r t n e r s

Ethical approval

for t h e s t u d y w a s ethics

theoretical relationships. T h e aim of this

c o m m i t t e e s and the Flinders University

a p p r o a c h t o a n a l y s i s is t o d e v e l o p an

E t h i c s C o m m i t t e e . As t h e t e a c h i n g

insightlul description of commonalties in

m e t h o d o l o g y was b a s e d on t h e use of

the data a n d to build up a detailed

patient case notes, informed consent was

a c c o u n t of t h e c o n t e x t in w h i c h t h e

o b t a i n e d from p a t i e n t s p r i o r t o t h e

collaboration occurs. T h e following steps

copying of their case notes. In addition,

were taken to develop a framework for

used

d o c u m e n t a t i o n identifying t h e p a t i e n t ,

coding and analysis ol the qualitative data

evaluation research and more specifically

relatives or slalf was r e m o v e d from t h e

o b t a i n e d in the interviews (focus group

i l l u m i n a t i v e e v a l u a t i o n (P a r I c 11 a n d

copy of the case notes.

a n d individual a c a d e m i c a n d c l i n i c i a n

and between academics and clinicians. 1. D e v e l o p l e a r n i n g o p p o r t u n i t i e s for undergraduate nursing students that rcllcct the background, purpose and reality of the practice environment.

Methodology Methodologically,

this

study

o b t a i n e d Irom b o t h h o s p i t a l

of meaning, as well as the verification of

Hamilton, 1976). Illuminative evaluation

Methods of Data Collection

interview) and additional open ended

was deemed appropriate for this study as

Two methods of data collection were used

comments

its assumptions are congruent with that o!

to inform evaluation procedures

questionnaires:

Student questionnaires

entirety, prior to coding, in order to get a

collaboration, namely: ...The

f ro m

the

student

• Transcripts were initially read in their

importance of understanding people

and programs in context; a commitment to study

Students were asked to r e s p o n d

naturally

individual items using a rating scale with a

• C o d e s w e r e a p p l i e d to s e n t e n c e s or

r a n g e of I ( s t r o n g l y d i s a g r e e ) t o 7

p a r a g r a p h s . C o d i n g of t r a n s c r i p t s was

the assumption thai understanding emerges most

(strongly agree) and p r o v i d e additional

aided by the use of a computer program,

meaningfully from an inductive analysis of open-

comments.

NUD*1ST.

occurring

phenomena

without

introducing external controls or manipulation, and

to

ended, detailed descriptive, and (fuolational data

sense of the whole.

• Specific criteria for j u d g i n g t h e data

gathered through direct contact with the program

Academic and clinician interviews

codes were developed. T h e coding

and its participants (Patron, 1990:1 19).

Academic

criteria

and clinician

interviews

consisted of locus groups and individual

Participants P a r t i c i p a n t s in t h e p r o j e c t

included

for

the

collaboration

consequences

was based

upon

of the

interviews. Each locus g r o u p interview

definitions and defining characteristics of

lasted about two hours. Interviews with

collaboration described by H e n n c m a n et

a c a d e m i c s (n = 4), c l i n i c i a n s (n = 6) a n d

clinicians and academics were

held

al ( 1 9 9 5 ) . An a c a d e m i c and a clinician

students

separately

were

reviewed the coded transcripts.

(n = 1 0 4 ) . C l i n i c i a n s

were

as

these

groups

teaching

considered to be relatively h o m o g e n o u s .

Evaluation

hospitals. Each of the six clinicians was

P a r t i c i p a n t s w e r e a s k e d t o reflect on

Project team m e m b e r s were c o g n i s a n t

allocated a t e a c h i n g partner (academic)

q u e s t i o n s a s k e d by t h e i n t e r v i e w e r .

from t h e c o m m e n c e m e n t of t h e project

seconded

from

two major

Typically, questions were framed to focus

that

on the most important topics and issues

socio(cultural) and interpersonal factors

in t h e

ol t h e collaborative project. Interviews

c o u l d i n f l u e n c e t h e s u c c e s s of t h e

collaborative teaching project. T h e s e

were held halfway through and at the end

c o l l a b o r a t i v e v e n t u r e . A c c o r d i n g to

students were assigned to 6 groups and

of the teaching program. T h e interviews

Henneman

each group had an academic and clinician

w e r e t a p e d a n d t r a n s c r i b e d . A pre and

c o n s e q u e n c e s of c o l l a b o r a t i o n for t h e

facilitator for all classes scheduled in the

post i n t e r v i e w was u s e d t o c o m p a r e

individual, t h e g r o u p , t h e o r g a n i s a t i o n

topic.

participants'

and t h e consumer. T h e s e c o n s e q u e n c e s

lor the duration of the project. A convenience sample of 104 students was s e l e c t e d

to p a r t i c i p a t e

understanding

and

a

number

of

technical,

e t al ( 1 9 9 5 ) , t h e r e

are

Collegian Vol 6 N o 3 1999 1 9

Professional of

collaboration

organisational

provide

framework

for

issue an the

presentation of evaluation findings. Individuals benefit from an appreciation of

the cultures of academia and the clinical

competitive way. Study findings showed

setting and the differences

between

that the collaboration utilised shared

a c a d e m i c s a n d clinicians in k n o w l e d g e

planning and decision making. Recurrent

base and l a n g u a g e .

throughout the interview data is the notion

Respect

is also

their unique contribution to the workings of the

described as a process of mutual learning.

group.

Clinician: 1 mean it's a good sharing of knowledge, clinicians al all stages of the learning cycle.

of d i s c o u r s e b e t w e e n a c a d e m i c s a n d

Analysis of the interview data suggests

you've got a collection of knowledge because we are This discourse extended beyond the life of

that participants believed that they were

gathering it together and bouncing off each other

the collaborative project and is considered

able to make a worthwhile contribution

too. I can't really see any disadvantage.

to be integral to b r i d g i n g t h e t h e o r y -

to the workings of the group- Individuals

We have the more up to date clinical knowledge p r a c t i c e

gap

and

the

gap

between

also r e p o r t e d a s e n s e of p e r s o n a l a n d

and we can learn from each other. I can learn theoryacademic and clinician.

professional accomplishment and feelings

and the academics can give the more up to date

of

clinical knowledge that is going on o\tt there, or the perspectives ... the discourse in the classroom that

self-worth.

This

sense

of

Academic: We were able to present two different

accomplishment was primarily linked to

practices that have changed or the rationale behind it.was beneficial that you had two different people to

h a v i n g c o n f i d e n c e in their k n o w l e d g e

Academic: Clinicians learnt what academics do,

present a point of view, and thai was beneficial to

base a n d / o r clinical skills. In a d d i t i o n ,

which i think was an eye opener for them ... They

student learning, and our own as well. I think it's

academics

learnt that we were just as busy as they were, that because you start at that discourse here, so that

reported

(hat

having

a

clinician present in their classroom often

we were up-to-date in clinical practice, that our

when we tjo out in the world we do the same thing.

v a l i d a t e d and p r o v i d e d g r e a t e r insight

knowledge base is different, that our language is

And so whatever we did here translated back into the

into aspects of their teaching practice.

different.

reality of practice, so that the academic and

Clinician : I have gained a lot out of it and I am

Respect and collegiality is also associated

clinician were seen as part of a team.

sure i mould like to see other people act an

with shared power. E m e r g e n t from t h e

opportunity to refresh their knowledge base. I've

d a t a is t h e s e n s e of s t r i v i n g lo find a

academic, increasing the discourse between service

certainly had growth. I've had incredible personal

balance between the different cultures and

and education.

Decreasing the gap between clinician and

Clinician: Tioo access people, two people to talk to about things and if one doesn't know hopefully the other will and vice veisa. We worked together as a team in the lab we were able, because sometimes things were a little bit different at one hospital than what they had done at the other and probably somewhere else so it was growth since I've had this experience, personal and

the "breaking down of barriers."

bringing together those ideas and saying you know

professional. Yeah it's just amazing.

Clinician: I feel really passionate about the

Academic: / had greater insight into my own

concept of what we are doing, because S think we

suggested that the model of collaboration

teaching, because I had lo analyse what i do and

have been a stabilising balance into the university

used provided positive outcomes in terms

explain it to somebody else. The one thing, not so

and 1 think it's a nice balance. We need to teach at of

much what I learnt from it... I guess I learnt that

the ion' and break down the barriers.

H o w e v e r , p o s s i b l e l i m i t a t i o n s of t h e

we can be happy with the knowledge we have in

A c a d e m i c : I thought it was a wonderful

collaboration include: insufficient time, the

clinical areas.

opportunity to make links with the clinical area. We

large size of the group and the expressed

got lo know clinicians very well it was a different

need

relationship. There was a different relationship

d e v e l o p m e n t in r e l a t i o n to t e a c h i n g

Analysis of individual interview data,

teaching

and

student

learning.

by c l i n i c i a n s for f u r t h e r

Collaboration promotes an intra-professional cohesiveness

between them and us, not just the clinicians that werep r a c t i c e s . A c a d e m i c s

Collaboration plays an important pari in

here, but the ward clinicians.

and

staff

clinicians

reported that they would have liked more

enhancing collegialily and respect among

t h a n six m o n t h s of c o l l a b o r a t i o n

professionals (Miccolo & Spanier 1993 ;

Collaboration

H e n n e m a n e t a I 1995).

fosters

discourse

in

teaching. Clinicians reported that they felt

and increased productivity

more comfortable in their role as teacher as

numerous exemplars from the study data,

A c c o r d i n g to H c n n e m a n et al ( 1 9 9 5 )

time progressed. Similarly, academics felt

which support this theme. Respect among

organisations that promote collaboration

more comfortable with the collaboration

the

an

can benefit as members utilise their talents

o v e r t i m e . T h e g r o u p c o n s i s t i n g of

understanding of the differences between

a n d skills in a c o o p e r a t i v e a n d n o n -

a c a d e m i c s a n d clinicians c o m p r i s e d 10

participants

is b a s e d

2 0 Collegian Vol 6 N o 3 \99l.)

There

upon

are

members and this may have limited the

between teaching in the university setting

required

overall discourse between academics and

and clinical practice was considered lo be

c l i n i c i a n s p e r c e p t i o n s of the level a n d

clinicians, as it was difficult to schedule

vital to the project and part of a strategy to

degree of collaboration existing between

meetings and to enable all members of the

e n h a n c e reality-based learning. T h e m e s

staff in university and clinical settings.

t e a m lo e x p r e s s t h e i r c o n c e r n s

and

e m e r g e n t from the data s u g g e s t e d that

T h e r e arc c u r r e n t l y n o available tools,

opinions. T h e staff development program

clinicians knew where the students were in

which have been reported, as reliable and

for clinicians was generally perceived lo

the learning process thus expectations of

valid w h i c h can be used in m e a s u r i n g

a d d r e s s t h e key e l e m e n t s r e q u i r e d for

clinical staff for student achievement in the

collaboration.

teaching in the topic. However, clinicians

clinical

believed that more input on approaches lo

partnership in the classroom also helped to

Acknowledgement

selling

were

realistic.

to measure academics

and

1 he

l e a c h i n g and learning would have been

establish

student/teac her/clinician

T h i s research was s u p p o r t e d by a grant

beneficial. O n the other hand, the amount

relationships before and t h r o u g h o u t the

Irom t h e D e p a r t m e n t of E m p l o y m e n t ,

of time and content allowed for this was

clinical placement. However, a limitation of

Education, Training and Youth Affairs. T h e

c o n s i s t e n t with the aims of the project

the project was that only a small number ol

a u t h o r s also a c k n o w l e d g e t h e c e n t r a l

which was framed on the assumption that

students (n=12) had a clinician from the

i m p o r t a n c e of academics, clinicians and

c l i n i c i a n s w o u l d assist in c u r r i c u l u m

project on their ward.

students who participated in this study.

development and thus there was a desire lo

Generally, students found that exposure

reduce bias in the selection of t e a c h i n g

to different clinical perspectives enhanced

methodology. T h e focus group data also

their learning. In no w a y d o c o m m e n t s

suggests that clinicians' found the teaching

suggest that the academic or clinician had

and learning strategies to promote reality-

t h e "right" answer, but rather, s t u d e n t s

based learning initially difficult to work

appreciated that they were coming from a

with in the c l a s s r o o m . O n e reason put

different perspective. A limitation of this

forward by c l i n i c i a n s is t h a t t h e y lelt

survey was that students were not asked to

students should be "taught" the c o n t e n t

comment on the perceived "reality" base of

rather

the

than

using

problem

solving

academic.

However,

students'

strategies. All clinicians reported that they

comments showed that they perceived the

felt more comfortable using these leaching

clinician was complementary to and not a

strategies in the clinical laboratory rather

replacement for the academic.

than in the tutorial setting. Academics, however,

reported

that

they

felt

Conclusion

comfortable with the implementation of

C o l l a b o r a t i o n is a much used but often

t e a c h i n g s t r a t e g i e s in c i t h e r s e t t i n g .

poorly understood concept.

Ultimately clinicians supported, owned and

effective working relationships between

Clearly,

were excited by the method of teaching.

industry and academia are dependent upon Clinician: / think we should be starting something a two way liaison based upon attributes of like this meiyhe even in the second year and then thirdcooperation, shared planning and decision year we would carry it on.

making, shared power and non-hierarchical

Looking at new ways of teaching or mw ways of

relationships. Students' ability to perform in

reasoning has increased my knowledge base... 1 think the clinical area is influenced by the nature right across the board this program is going to help of this two-way liaison. T h e evaluation data everyone. i am also very excited about the way this

clearly showed that the model was effective

is going. I want to be on board; 1 think what tve are in facilitating collaborative relationships necessary for the successful development

teaching the students is really relevant.

a n d i m p l e m e n t a t i o n of

The consumer benefits most from services

that

are delivered

in a

reality-based

learning for students. T h e model of collaboration developed

collaborative manner.

in this project oilers a useful approach to

In this study, the student is considered to

the development, i m p l e m e n t a t i o n and

b e a c o n s u m e r of s e r v i c e s . T h e

evaluation ol curricula. Further research is

link

References A n d r e w s M & J o n e s PR 1996 P r o b l e m - b a s e d learning in an undergraduate musing program case study. Journal of Advanced Nunim) 23i2} : 357365. Barrel I I.M, H a m r i c AF> 1986 E d u c a t i o n and service: a c o l l a b o r a t i v e model to improve patient care. Nursing ami Health Cure 7(91.496-503 C l a r e J 1993a C h a n g e t h e c u r r i c u l u m - or transform the c o n d i t i o n s of practice 1 Ntuse Education Today I 3(4t 282-286 Clare J 1993b A c h a l l e n g e to the rhetoric of emancipation recreating a professional culture. Journal of Advanced Nunim] 18(71:1033-1(138 Clare J Wot ton K Cassncr L Ingham Li Button I.) 1997 The Development oj Teaching and Learning Paitnerships in Nursing- Academics, (.linicntns and Students Final R e p o r t DLiLiTYA C a n b e r r a Australia Clare I Mann S & Byrnes I 1997 Curriculum c o l l a b o r a t i o n and the O t t a w a C h a r i e r : a nursing initiative, (.onlempoiary Nwse 6( 3):98-103 Craddock Li 1993 Developing the facilitator role in t h e clinical area. Nurse Education Today l3(3):2l7-224 Gassner L Clare J ISutton £ Wotton K is. Ingham F 1998 the waiJ collaborates with the ivory lower, the development of a practical and thmritkal fititmwoik for cuniculum development and teaibiiu) Presented at the T h i r d Nursing A c a d e m i c International Congress, Collaboration in Nursing: Making a Difference to Health Outcomes. Canberra G i r o u x H 1983 Critical Theory and Educational Practice Deakin University Victoria Greenwood j & Winifreycia A 1995 Two strategies for p r o m o t i n g clinical c o m p e t e n c e in prercgistration nursing students. Nurse Education Today 15(3}: 184-189 H c n n c m a n EA l.cc JL. S; C o h e n Jl 1995 Collaboration a concept analysis, lounial of Advanced Nursing 21 103-109 1 lewison A & Wildman 1996 I he theory practice gap in nursing: a new dimension. Journal of Advanced Nursing 24(4):754-761 fust G A d a m s E is D e Y o u n g S 1989 Faculty Practice Nurse Educators' views and proposed models. Journal of Nuisini) Education 28(4): 161 -168. I.athlean j I 1995) The Implementation and Development of Lectuiei Practitioner Roles in Nursini) D p h i l I hesis. University of Oxford, Steeple Aston, Ashdale Press Melloi' R 1998 Developing learning programs in partnerships in N S W local government — a Collegian Vol 6 No 3 1999 2 1

Values. An introduction to critical thinking for nurses. Behaviour ol Helping Professionals. Josscy-Bass References Maclennan + Petty, Sydney Publishers, San Francisco Andersson C and Glesnes-Andcrsson VA 1987 Hussey T 1990 Nursing ethics and Project 2000. Severinsson F. 1994 The concept of supervision in Ethical thinking and decision making for health Journal of Advanced Nursing 15: 1377-1382 psychiatric care - compared with mentorship care supervisor. Health ( are Supervisor 5(4): I-1 2 Hunt G 1992 What is nursing ethics? Nuise Education and leadership. A review of the literature. Journal Begat I S e v e r i n s s o n E and Bcrggren I 1997 Today 12:323-328 of Nursing Management 1. 271-278 I m p l e m e n t a t i o n of clinical supervision in a Severinsson E 1995b The phenomenon of clinical Kohlberg L 1976 Moral stages and moralisation: medical departments: ! he nurses' views on llie the cognitive developmental approach. supervision in psychiatric health care. Journal of effects, Iournal of Clinical Nursing 6:389-394 Psychiatric & Mental Health Nursing 2:310-309 Bcauchamp TL and Childress Jl : 1989 Principles of hi: Lickona T (Eds.) Alum! Development and Behaviour. Severinsson E 1995a Clinical Nursing Supervision in theory and social issues. H o l t , R i n e h a r t and Biomedical Ethics. Ihird edition Oxford University Winston, New York Health Care. Doctoral thesis. The Nordic School Press, New York London P 1986 Tlx Modes and Morals of Psychotherapy. of Public Health, Ooteborg Bishop AH and ScudderJR 1987 Nursing ethics in Severinsson E and Hallberg IR 1996a Systematic Hemisphere publishing corporation, US an age of controversy. Advances in Nursing Science 9 clinical supervision, working milieu and influence over lyles Rl and Joiner C 1986 Supervision in Health Can (3): 34-43 Organizations. John Wiley & Sons Inc. Canada duties: psychiatric nurse's viewpoint - a pilot study. Boland Patterson J 1989 Ethics and rehabilitation. International Journal of Nursing Studies 33 (4):394-406 lyneham J 1988 The ethics of teaching ethics The Journal of Rehabilitation Oci/Nov/Dec: 44-49 Australian Journal of Advanced Nursing Vol. 5 (4): 10- Severinsson E and I lallberg IR 1996b Clinical Brosman J and Ruper !M 1997 T h e reality o( I I supervisors' view of their leadership role in the political ethical c o n f l i c t s . N u r s e m a n a g e r l.uizen K 1993 A lord/ Soisilii'i'fy,- A study of subjective clinical supervision process within care. Journal dilemmas. JONA Vol.27 (9)-. 42-46 aspects of the process of moral decision making in of Advanced Nursing 24 151-161 Burnard P 1987 Spiritual distress and the nursing Severinsson E 1996 Nurse supervisors' views of psychiatric care. D o c t o r a l Dissertation, r e s p o n s e : t h e o r e t i c a l c o n s i d e r a t i o n s and Department of Psychiatry, Karolinska Institute. their supervisory styles in clinical supervision: a counselling skills. Journal of Advanced Nursing h e r m e n e u t i c a l a p p r o a c h . Journal of Nursing Huddinge University Hospital 12:377-382 Matkin RE, Sawyer HW, Lorenz JR and Rubin SE Management 4: 191-199 Chambers M and l o n g A 1995 Supportive clinical Severinsson E and Borgenhammar E 1997 Expert 1982 R e h a b i l i t a t i o n a d m i n i s t r a t o r s and s u p e r v i s i o n : a c r u c i b l e for personal and supervisors: Their work assignments, training views on clinical supervision: a study based on professional c h a n g e . Journal of Psychiatric and interviews. Journal of Nursing Management 5:175needs, and suggestions for preparation. Journal of Mental Health Nursing 2:311-316 183 Rehabilitation Administration 6.170-183 C r i t c h l e y DL 1987 Clinical supervision as a Szecsody I 1990 The learning process in psychotherapy M c K e n z i e L 1993 M a n a g e m e n t ethics for the learning tool for the therapist in milieu sellings. supervision. Doctorial Thesis. Kongl Carolinska health care supervisor. Health Care Supervisor 1 I Journal of Psychosocial Nursing 25.18-22 medio chirurgiska institute, Stockholm (4): 1-10 Davis AJ and Aruskar M. 1983 Ethical Dilemmas and T a p p a n MB 1990 H e r m e n e u t i c s and moral M i n o l SR and Adamski TJ 1989 E l e m e n t s of Nursing Practice. Appclton-Century-Crofts US effective clinical s u p e r v i s i o n . Perspectives in development: Interpreting narrative Davis AJ 1991 The sources of a practice code of r e p r e s e n t a t i o n s of moral experience. Psychiatric care 25:22-26 ethics for nurses. Journal of Advanced Nursing Noddings N 1984 Caring: a Feminine Approach to Ethics Developmental Review 10(3): 239-265 16:1358-1362 and Moral Education. University of California The Oxford Dictionaiy of Current English 1996. Oxford Dyson L 1997 An ethic of caring: conceptual and T s c h u d i n V 1995 Counselling Skills for Nurses. Press, Berkeley practical issues. Nursing Inquiry 4:196-201 Page S and W o s k e t V 1995 S u p e r v i s i n g the Bailliere Tindall, London Farkas-Cameron MM 1995 Clinical supervision in counsellor. A cyclical model. Routledge, London Tschudin V 1997 Nursing as a moral art. In psychiatric nursing. Journal of Psychosocial Nursing Packard JS and Ferrara M 1988 In search of the Marks-Maran D & Rose P (eds.) Reconsiruciuring 33:31-37 moral foundation of nursing. Advances in Nursing Nursing- Beyond ait and science. Bailliere Tindall, Eriksson K 1995 towards a Carilative Caring Ethics (In Silence I0(4):60-7I London Swedish). Department of Caring Science. Abo Paunonen M 1991 P r o m o t i n g nursing quality Yarling RR and McF.lmurray BJ 1986 T h e moral Akademi, Vasa, 5 t h r o u g h supervision Journal of Nursing Staff foundation of nursing. Advances in Nursing Science Gillian C 1982 In a Different Voice. H a r v a r d Development Scpt/Oct: 229-233 8 (2): 63-73 University Press, Cambridge P l a t l - K o c h LM 1986 Clinical supervision for Yeo M 1989 Integration of nursing theory and Gillian C, Ward J and Taylor J (eds.) 1988 Mapping nursing ethics. Advances in Nursing Science 1 1 (3): the Moral Domain: a Contribution of Women's thinking to psychiatric nurses. Journal of Psychosocial Nursing 26:7-15 33-42 Psychology and Education. MA: Harvard University Rankin DJ 1989 T h e r a p y s u p e r v i s i o n : t h e Young AP 1995 T h e c o n t r o l of p r o l e s s i o n a l Graduate School of Education, Cambridge phenomena and the need. Clinical Nurse Specialist 3 behaviour. In Ethics Professional Issues (F.ds. Hingley P and Cooper CL 1986 Stress and Nurse Tschudin V. Scutari Press, Harrow, England (4): 204-208 Manager. J o h n Wiley and Sons, Portmounth Yukl GA 1989 Leadership in Organizations. PrenticeSarason SB 1985 Caring and Compassion in Clinical pp.39-158 Hall Inc New-Jersey. Practice Issues in the Selection, Training, and Van Hooft S. Gillam L and Byrnes M 1995 Facts and

Evaluation of a model of collaboration case study. Higher Education Research and Development, I7(2):l 83-190 Miccolo MA & Spanier AH 1993 Critical care management in the 1990s: making collaborative practice work. Critical Care Climes 9(3):443-453. Minarik PA 1990 Collaboration between service and e d u c a t i o n : perils or pleasures for t h e Clinical Nurse Specialist? Clinical Nurse Specialist 4(2): 109-1 14 Nursing Education in Australian Universities: Report of the National Review of Nurse Education in the Higher Education Sector- 1994 and Beyond ( 1 9 9 4 ) Australian G o v e r n m e n t Publishing Service: Canberra Parker JM 1994 Collaboration in practice: The concept of faculty practice. Paper presented at the First Nursing A c a d e m i c International C o n g r e s s , Collaboration in Nursing: Working Together 2 8 Collegian Vol 6 No 3 1999

to Achieve Academic Excellence. Canberra ACT Parlelt M & H a m i l t o n , D 1976 Evaluation as illumination: a new approach to the study of innovatory programs. In Evaluation Studies Review Annual. Vol 1, e d i t e d by G.V. Glass, Sage Publications, Beverly Hills, California Patlon M Q 1990 Qualitative Evaluation and Research Methods (2nd ed), Sage Publications, Newbury Park California Perry J & Moss C 1989 Generating alternatives tn n u r s i n g : t u r n i n g c u r r i c u l u m i n t o a living process. Australian Journal of Advanced Nursing 6(2):35-40 Rallerty MA Allcock N & Lathlcan J 1996 T h e t h e o r y / p r a c t i c e gap': Taking issue with the issue. Journal of Advanced Nursing 23(4):685-691 Sovie M D 1981 Unifying education and practice: one medical centre's design Part I. Journal of Nursing Administration I A I -49

Styles MM 1984 Reflections on collaboration and u n i f i c a t i o n . Image: The Journal of Nursing Scholarship 16(l):21-23 Sweeney MA C u l i n o C Lora JM & Small MA 1987 C o l l a b o r a t i o n in clinical r e s e a r c h : b i n a t i o n a t p r o j e c t s s h e d new l i g h t on old issues. Journal of Professional Nursing 3:28-38 Trigwell K & Reid A 1998 I n t r o d u c t i o n w o r k b a s e d l e a r n i n g and t h e s t u d e n t s ' p e r s p e c t i v e . Higher Education Reseatcb and Development. 17(2):I41-1 54 W a t t s N T 199(1 Handbook of Clinical Teaching. Churchill Livingstone Melbourne W a l t o n K & Gassner L 1998 Nursing students' i n t e g r a t i o n of t h e o r y and p r a c t i c e : the development and implementation of a practical and theoretical framework for teaching — a case study. Higher Education Research and Development, 17(21:239-249.