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Clinical and Fieldwork Placement
in the Health Professions
Second Edition
Lists of Figures,
Tables and Case Studies
Figures
2.1 Common foundation for information between stakeholders 20
2.2 University mechanisms to address student concerns 27
3.1 Gibbs’ model of reflection (1988) 39
4.1 The Reflective Learning Model showing the four stages of reflection
to arrive at a practical outcome (Davys & Beddoe 2010) 53
5.1 The Fieldwork Learning Framework 58
8.1 IPL umbrella terms 99
8.2 Links between IPL and outcomes 103
9.1 Readiness to learn from failure in a fieldwork placement 122
10.1 Healthcare Blogger Code of Ethics symbol 131
10.2 HONcode symbol 131
10.3 RSS symbol 137
12.1 The doughnut principle 163
12.2 The person-centred risk assessment 164
12.3 The supported decision-making model 166
12.4 The decision-making pathway 168
13.1 Appropriate care near the end of life 177
13.2 Gibbs’ model of reflective practice 183
14.1 The Australian hospital system: A patient perspective 197
14.2 The iceberg concept of culture 203
15.1 Main skills of a health professional working with mothers and babies 213
16.1 The effective paediatric practitioner 231
16.2 Paediatric clinical reasoning process 235
16.3 The clinical reasoning process (thinking process) used by the health
professional for Sarah 236
viii
Lists of Figures, Tables and Case Studies ix
Tables
1.1 Planning and organising for placement 6
1.2 First week: Planning and organisation 7
2.1 Examples of stakeholders’ interests 15
2.2 Outline of stakeholder three Rs 16
4.1 Function and task checklist for you and your fieldwork educator 45
4.2 Five approaches to supervision 47
4.3 Strengths and limitations of the apprenticeship approach 48
4.4 Strengths and limitations of the growth therapeutic approach 48
4.5 Strengths and limitations of the role systems approach 49
4.6 Strengths and limitations of the competency-based approach 49
4.7 Strengths and limitations of the critical reflection approach to supervision 50
5.1 Personal attribute scenarios 60
5.2 Reframing generational attributes and behaviours 61
5.3 Alternative response types 62
5.4 Reflecting on practice window 64
6.1 Differences between clinical assessment and assessment in
formal academic settings 71
6.2 Assessment criteria used during clinical placements, and activities
used to reveal achievement of these criteria 73
6.3 Developing self-assessment skills throughout a clinical placement 77
8.1 Stereotypes: Helpful and unhelpful approaches 97
8.2 Myths and realities of IPL 100
8.3 IPL sample objectives 107
8.4 Post-placement objectives and activities 111
8.5 Stages of interprofessional competence 112
9.1 Characteristics of students experiencing difficulties and possible
competencies affected 116
10.1 Digital technology tools: Function and application in fieldwork 138
x Lists of Figures, Tables and Case Studies
Case Studies
Grier’s situation 10
What information is missing in the following situation? 21
Three scenarios 28
Working with Mr Omar 52
Jenna, part 1 62
Jenna, part 2 65
Jenna, part 3 67
The OWLS program 90
Eliot 91
Teamwork in adversity 96
An illustration of structured post-fieldwork IPL 105
Chris’s story of failing fieldwork 117
Rita’s story of failing fieldwork 120
Meg the blogger 133
Forcefield analysis of the fieldwork enterprise 154
Lillian’s story 166
David 179
Jim and June 180
Samuel the dietitian’s first day on placement 200
Fragmented care 214
Sarah 225
What a day! 250
It’s all in a day 251
Comparison of management for elective hip replacement surgery
between a well and a frail elderly person 264
Lists of Figures, Tables and Case Studies xi
Comparison between two frail older persons who both have complex and chronic
conditions266
Alfie 280
A referral from the DVA 293
Workplace safety 295
The negotiation 296
Be quick in private practice 309
Pleasing the client 310
My first week 326
Nancy and Geoff 339
Jane’s fieldwork experiences 358
Sri at work 361
Leah as a fieldwork educator 364
Learning to work together 373
Nita 375
Josie 378
John leaves home for the country 386
Preface
Welcome to the second edition of this book! This book is aimed at students enrolled in
a health profession. It is not a discipline-specific book. This second edition places more
emphasis on competencies in practice and includes two new chapters—one on reflective
practice and one on palliative care. Gaining competencies through clinical fieldwork
placement or working in the field is experienced by all health students and is an important
part of education for those who are planning to start their career in a health-related area.
In all health professions, there are common competencies as all health professions are
concerned with providing best practice to patients or clients. Curran et al. (2011) noted that
competency is more than discipline-specific knowledge, skills and attitudes, but also includes
understanding the context of the workplace, a person’s cognitive and affective resources
and provision of a common understanding towards interprofessional collaborations. These
common competencies include professional behaviour, ethical behaviour, communication,
knowledge of discipline-specific assessment and treatment, lifelong learning and
interprofessional practice (collaboration and working in teams). In order to gain these
competencies through clinical fieldwork placement, the student is required to spend a
certain number of hours in a healthcare setting working within their discipline-specific
profession. This requirement is essential to becoming a competent health professional/
practitioner and is called various names, such as authentic learning, work-situated learning
or work-integrated learning. While you may have thought that, ‘This is voluntary, so it is not
that important to me, but since I have to pass it to pass the course, I’ll have to go through with
it!’, the clinical fieldwork placement or clinical practicum is where you, as a student, start to
understand how theory becomes applied when real, live people require your professional
service. It is also the context where professional and ethical behaviours are honed.
Writing a book for all health professions has meant that we, the editors, have made some
pragmatic decisions about terminology throughout the book. By using the same terminology
throughout, it will be clearer to you what is being referred to, and chapters can be compared using
the same terminology. As there are several disciplines represented in this book, the decisions
made on terminology were based on the most common terminology used by authors across
these disciplines. Here, in the Preface, we want to make it clear what the terminology means.
The term ‘fieldwork placement’ is used throughout this book as the term that refers
to the place where the student is learning about how to apply their competencies in
practice through developing and consolidating professional behaviour, knowledge and skills.
‘Fieldwork’ was chosen as it is broader than ‘clinical’, as not all placements of all students
are always in a hospital or clinical setting. For example, sometimes, the student is placed in
xii
Preface xiii
a school or office setting where they work on a particular project. So, ‘fieldwork placement’
has been used to represent the following: fieldwork, clinical placement, clinical practicum,
clinical education, fieldwork experience and work-integrated learning settings.
‘Fieldwork educator’ is the term used for the person who supervises the student in the
placement setting. Depending on your profession, this person could also be called your
‘preceptor’, ‘clinical supervisor’ or ‘clinical educator’. Sometimes this person may also be
an academic staff member from the university or educational institution that the student
attends, but this is rare. The university staff involved in fieldwork organisation, collaboration
or liaison is clearly identified in the text as a university staff member.
Other terms to refer to persons in this book are: ‘health professional’, ‘patients’ or ‘clients’,
and ‘student’. ‘Health professional’ refers to any person working in a health area and who
has attained a minimum of a bachelor degree in their discipline area. Patients and clients
are the people the student is assessing, treating, interviewing or working with in other ways.
Both terms are used throughout the book as some case studies refer to clinical situations
(where ‘patient’ is used) and other case studies refer to non-clinical situations (where ‘client’
is used). The student is you. We use the term ‘entry level degree’ as this encompasses both
bachelor degrees and masters entry level degrees.
The term ‘work integrated learning’ (WIL) is used in this book. This term is still used
widely (at the time of writing this second edition) for what we would call ‘fieldwork’ or
‘practicum’. In 2009, the then Australian Learning and Teaching Council completed a large
scoping study in thirty-five universities across Australia in relation to this topic from the
perspectives of universities and students. The term ‘WIL’ was defined by them as ‘an umbrella
term for a range of approaches and strategies that integrate theory with the practice of work
within a purposefully designed curriculum’ (Patrick et al. 2008: iv, cited in Smith et. al. 2009:
23). In this sense WIL encompasses more than just fieldwork placements per se and is really
looking at how these are embedded and integrated within the whole student experience
and how we endeavour within the curriculum to integrate the theory with the practice in
order to develop a student’s competence in practice. We have referred to ‘work-integrated
learning’ in some sections in some chapters when it is appropriate. The term is not always
appropriate, and hence we have used ‘fieldwork placement’ to be more specific and used
‘work-integrated learning’ when references are to the student learning experience.
There are three parts in the book. Part 1 is Issues for Practice. In this part, information
that is important for you to know—regardless of the setting where you will be undertaking
your placement—is presented. Topics covered here are: what you need to prepare for
placement; your role, rights and responsibilities; models of supervision; assessment; how to
get the most out of your fieldwork experience; working in teams; how to positively move on
from failure; technology; and reflective practice. Part 2 is Contexts of Practice, and in this
part each chapter addresses a specific situated learning experience and guides the student
through what to prepare for, what to expect and issues that would be helpful to be aware of
during placement. The final part, Part 3, looks at Transition to Practice where the chapters
cover aspects of becoming a fieldwork supervisor and how to plan for a student to come
back and work in the area. At the end of each part is a checklist for easy reference.
We wish you all the best in your fieldwork placements.
Karen Stagnitti
Adrian Schoo
Dianne Welch
xiv Preface
References
Curran, V., Hollett, A., Casimiro, L., McCarthy, P., Banfield, V., Hall, P., Lackie, K., Oandasan, I.,
Simmons, B. & Wagner, S. (2011). Development and validation of the interprofessional
collaborator assessment rubric (ICAR). Journal of Interprofessional Care, 25: 339–44.
Smith, M., Brooks, S., Lichtenberg, A., McIlveen, P., Torjul, P. & Tyler, J. (2009). Career development
learning: maximising the contribution of work-integrated learning to the student experience.
Final Project Report. Australian Learning & Teaching Council, University of Wollongong.
Contributors
Lynne Adamson, Associate Professor, Occupational Science and Therapy, School of Health
and Social Development, Deakin University, Victoria.
Uschi Bay, Senior Lecturer, Social Work, Faculty of Medicine, Nursing and Health Sciences,
Monash University, Melbourne, Victoria.
Liz Beddoe, Associate Professor in the School of Counselling, Human Services and Social
Work, Faculty of Education, University of Auckland, Auckland.
Michelle Courtney, Senior Lecturer, Occupational Science and Therapy, School of Health
and Social Development, Deakin University, Victoria.
Ronnie Egan, Associate Professor of Field Education, School of Global Urban and Social
Studies, RMIT University, Melbourne, Victoria.
Joanne Gray, Associate Dean (Teaching and Learning), Faculty of Health, University of
Technology, Sydney.
Anita Hamilton, Lecturer Occupational Therapy, School of Health and Sport Sciences,
Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast.
Tim Kauffman, Kauffman Gamber Physical Therapy, Lancaster, Pennsylvania; and Adjunct
Faculty, Columbia University, New York.
Sharon Keesing, Lecturer, School of Occupational Therapy and Social Work, Curtin
University, Western Australia.
Helen Larkin, Lecturer, Occupational Science and Therapy, School of Health and Social
Development, Deakin University, Victoria.
xv
xvi Contributors
Lindy McAllister, Professor and Associate Dean of Work Integrated Learning, Faculty of
Health Sciences, University of Sydney.
Jane Maidment, Senior Lecturer, School of Social and Political Sciences, University of
Canterbury, New Zealand.
Eva Nemeth, Director of Clinical Education, Master of Speech and Language Program,
Macquarie University, Sydney.
Jennifer Nitz, Geriatric Teaching and Research Team Leader, Division of Physiotherapy,
School of Health and Rehabilitation Sciences, University of Queensland.
Sharleen O’Reilly, Senior Lecturer, School of Exercise and Nutrition Sciences, Deakin
University, Victoria.
Geneviève Pépin, Senior Lecturer, Occupational Science and Therapy, School of Health and
Social Development, Deakin University, Victoria.
Kelly Powell, Lecturer, Occupational Science and Therapy, School of Health and Social
Development, Deakin University, Victoria.
Lorna Rosenwax, Professor and Head of School, Occupational Therapy and Social Work,
Curtin University, Western Australia.
Rachael Schmidt, Lecturer, Occupational Science and Therapy, School of Health and Social
Development, Deakin University, Victoria.
Megan Smith, Associate Professor, Sub Dean Workplace Learning, Faculty of Science,
Charles Sturt University, Albury.
Karen Stagnitti, Professor, Personal Chair, Occupational Science and Therapy Program,
School of Health and Social Development, Deakin University, Victoria.
Nick Stone, Research Fellow, Faculty of Health Sciences, La Trobe University; Lecturer,
Department of Management and Marketing, University of Melbourne; Consultant
(including Culture Resource Centre, Deakin, Murdoch, Wollongong, Macquarie and Nelson
Mandela Universities).
Contributors xvii
Judy Taylor, Adjunct Associate Professor, School of Medicine and Dentistry, James
Cook University; Adjunct Associate Professor, Centre for Rural Health and Community
Development, University of South Australia, Whyalla.
Kym Thomas, Coordinator, Aboriginal Health Unit, Spencer Gulf Rural Health School,
University of South Australia.
Doris Testa, Lecturer/Academic Leader Field Education, Social Work, Victoria University.
Dianne Welch, Director of Clinical Studies, School of Nursing, Deakin University, Victoria.
Deirdre Whitford, Associate Professor, Head of Education, Spencer Gulf Rural Health
School, South Australia.
Linda Wilson, Coordinator Bachelor Health Science, School of Health and Social
Development, Deakin University, Victoria.
Acknowledgments
Thank you to Michelle Day (Occupational Therapist, Coordinator, Early Years Program
Bellarine Community Health Ltd, Victoria), Jennifer Pascoe (Occupational Therapist, World
Federation of Occupational Therapists) and Angela Russell (Student Coordinator and Special
Projects, Spencer Gulf Rural Health School, in partnership with Pika Wiya Health Service,
Port Augusta), who contributed to the first edition of the book.
The author and the publisher wish to thank the following copyright holders for reproduction
of their material.
British Medical Journal for extracts from Murray, S., Kendall, M., Boyd, K. Sheikh, A.
‘Illness trajectories and palliative care’, 2005; Mapping Knowledge for Social Work Practice:
Critical Interactions, E Beddoe and J Maidment, Cengage Learning, 2009, pp 27–28; Davys &
Beddoe, (2010). Best Practice in Professional Supervision: A Guide for the Helping Professions,
Jessica Kingsley Publishers, London and Philadelphia. Reproduced with permission of
Jessica Kingsley Publishers; When caring is not enough. Examples of reflection in practice,
S Mann and T Ghaye, Quay Books, London, 2011, p78 www.quaybooks.co.uk; Making the
Most of Field Placement (2nd edn), H Cleake & J Wilson, Thomson, 2007, South Melbourne,
pp 57–8; World Health Organization for The 5 moments for hand hygiene http://www.who.int/
gpsc/5may/background/5moments/en/index.html October 2012.
Every effort has been made to trace the original source of copyright material contained
in this book. The publisher will be pleased to hear from copyright holders to rectify any
errors or omissions.
xviii
Part 1
With the second edition we have put the broader issues relating to practice in the first
part of the book. By doing this you have a broader view of the context in which clinical
fieldwork practice sits. In Part 1 we cover issues such as getting ready for placement, your
role, rights and responsibilities, supervision, assessment, failing placement, reflective and
ethical practice and working in teams.
1
Chapter 1
Learning outcomes
After reading this chapter you should be able to:
Key terms
Emotional intelligence (EI) Fieldwork placement Work-integrated learning
Experiential learning Self-awareness Workplace literacy
Fieldwork educator Self-regulation
Introduction
This chapter outlines a range of factors to consider before embarking on a fieldwork
placement. These considerations focus mainly on practical matters, and will be relevant to
you, regardless of your health-related discipline. Work-integrated learning (WIL) has a long
and strong tradition in most health-related disciplines. Many seasoned health professionals
consider their past student fieldwork placement as the most significant and memorable
learning experience in their early careers, which shaped and radically influenced their style
of working, future career choices and identification with their chosen discipline. Engaging
with real clients in the context of a bona fide workplace brings a critical edge to learning that
cannot be captured in the classroom. Together, these factors create an exciting, dynamic
3
4 Part 1 Issues for Practice
and challenging milieu. In order to make the most of the learning opportunities offered in
the field it is important to build a sound foundation from which to begin your fieldwork
placement. Understanding the scope and purpose of the fieldwork placement is the logical
place to start.
›› discovering and articulating the connections between the theory you have learnt in the
classroom and the client situations you encounter on fieldwork placement
›› developing greater awareness and analysis of your own professional values in situ, where
challenging ethical dilemmas can arise
›› learning how interdisciplinary teamwork operates, and about ways in which you and
people from your discipline might contribute to the team in order to better serve the
client population.
might include, but will not be limited to, older persons, mothers with babies, people with
mental health issues or those attending rehabilitation. Throughout your degree program
you will have opportunities to learn about and experience work in a variety of settings.
The duration of a fieldwork placement can vary, and may include individual days in
an agency, blocks of several weeks in full-time or part-time work, or year-long internships.
Student fieldwork placement opportunities usually increase in length and intensity over
the course of a degree program, with many prescribing regulations for the numbers of
days and hours that must be completed. These guidelines are set down by professional
accreditation bodies such as the Australian Association of Social Work, the Australian
Nursing and Midwifery Council, the World Federation of Occupational Therapy and the
World Confederation of Physical Therapists. In Chapter 11 you will be able to read more
about the significant role of professional associations in providing governance and regulation
influencing health education and practice.
While you may have entered the program with the goal of working in a specific field such
as disability or mental health, it is important to be open to the professional opportunities
that can be generated in all settings. Frequently after having been on placement, students
become passionate about working in fields they had not previously thought about. It is
important not to hold tight to preconceived ideas about a specific place or client group you
want to work with until you have finished your degree. If you are placed in an agency that
differs from your preferred choice (which happens frequently), demonstrating annoyance
or lack of interest will have a negative impact upon your engagement with the staff and
clients in that agency. This standpoint can also lead to you becoming less open to exciting
alternative learning and career possibilities.
Wherever you go on placement, paying attention to planning and organising is the
key to successful completion. Research on problems experienced by students on fieldwork
placement identifies common stressors that can be addressed with some forward planning.
These include issues such as financial constraints, managing child care, travel arrangements
and attending to personal safety (Maidment 2003).
Getting ready
Planning for the placement begins well before your actual start date. Table 1.1 lists a series
of factors to consider, and strategies that past students have utilised.
Jane Maidment
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