Person Centred Learning

an approach to enhancing
student learning & competency
in clinical practice
Professor Val Wilson
School of Nursing UOW & Illawarra Shoalhaven Local Health District

Improving Quality of Services through Advanced Clinical Teaching and Practice:

Preparing Global Health Challenge. April 11 th-12th, Jakarta, Indonesia.
Our city

22ºC 85KM
average daily to Sydney Opera
temperature (71.6ºF) House (53 miles)

27ºC 17
average summer patrolled surf beaches
temperature (80.6ºF)
11
292,500 national parks
population of Illawarra within 50km
At a glance 32,208 total student enrolment 13,539 international students
Approx. 1400 Undergrad Nursing Students and 400 post graduate students

NUMBER 1 127,754
rated university in Australia1 graduates working in
143 countries
5-STAR
rating for Getting a 5 STUDY AREAS
Full-Time Job2 rated the best in Australia5

TOP 10 TOP 20
of universities in Australia3 17th best modern university
in the world6
WINNER
Higher Education Award for TOP 1%
graduate employability4 for graduates as rated by
global employers7

1. Most star ratings in the Good Universities Guide 2016 and highest percentage across the key 12 categories in the Quality Indicators for Learning and Teaching (QILT) 2015.
2. Good Universities Guide 2016. 3. QS World University Rankings 2017. 4. Australian Financial Review 2015 5. Quality Indicators for Learning and Teaching (QILT) 2015.
6. 17th in the world– QS Top 50 Under 50 Rankings 2015. 7. QS World University Rankings Graduate Employers Survey 2015/2016
My Learning Experience
• Hospital Training • Learning on the job • Academic Training
 The Aim of the Undergraduate Nursing Degree - UOW
Course Outcomes ANMC Competency Domains UOW / HBS Graduate AQF Generic Learning and Teaching Academic Standards Statement
RN Standards for Practice* Qualities Learning Outcomes
Evaluate knowledge, skills and behaviours for the Critical thinking and Informed Thinking skills Deliver safe and effective collaborative healthcare
provision of safe and effective quality and culturally analysis
appropriate nursing care.
Critically evaluate relevant theories and frameworks Critical thinking and Informed Thinking skills Deliver safe and effective collaborative healthcare
that informs contemporary nursing analysis
Professional Practice
Demonstrate a critical awareness of knowledge, Critical thinking and Informed Thinking skills Retrieve, critically evaluate, and apply evidence in
skills and behaviours commensurate with an analysis the performance of health-related activities
effective nurse leader, educator and researcher. Professional Practice Personal skills
Assess, plan, deliver and evaluate person-centred Provision and Informed Thinking skills Assess individual and/or population health status
and family focussed care, utilising the Roper-Logan- coordination of care and, where necessary, formulate, implement and
Tierney (1996) model of living/nursing. monitor management plans in consultation with
patients/clients/carers/animal owners/communities
Promote and optimise the health and welfare of
individuals and/or populations
Use clinical reasoning skills for effective clinical Provision and coordination Problem Solver Thinking skills Deliver safe and effective collaborative healthcare
decisions. of care
Effective professional interpersonal and Collaborative and Effective People skills Demonstrate professional behaviours
communication skills. therapeutic practice Communicator
Work effectively within an inter-professional health Collaborative and Effective People skills Demonstrate professional behaviours
care team. therapeutic practice Communicator Deliver safe and effective collaborative healthcare
Demonstrate initiative and judgement within Professional Practice Responsible Thinking skills Demonstrate professional behaviours
professional, ethical and legal frameworks. Deliver safe and effective collaborative healthcare
Demonstrate the ability to create a therapeutic Collaborative and Effective People skills Demonstrate professional behaviours
relationship with acknowledgement of professional therapeutic practice Communicator
requirements.
Engage in reflexive nursing practice contributing to Critical thinking and Informed Thinking skills Reflect on current skills, knowledge, attitudes, and
personal and professional development. analysis Personal skills plan ongoing personal and professional development
 National Competency Standards for Registered Nurses
Australia of Nursing & Midwifery Board (2006)

Professional Practice
1. Practises in accordance with legislation affecting nursing practice and health care
2. Practises within a professional and ethical nursing framework
Critical Thinking & Analysis
3. Practises within an evidence-based framework
4. Participates in ongoing professional development of self and others
Provision and Coordination of Care
5. Conducts a comprehensive and systematic nursing assessment
6. Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team
7. Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes
8. Evaluates progress towards expected individual/group health outcomes in consultation with individuals / groups, significant others and
the interdisciplinary health care team.
Collaborative and Therapeutic Practice
9. Establishes, maintains and appropriately concludes therapeutic relationships
10. Collaborates with the interdisciplinary health care team to provide comprehensive nursing care
 PERSON CENTRED LEARNING
Learning that focuses on the student and develops a culture of critical inquiry and questioning
Facilitation of learning rather than teacher driven education model
Utilises experiential learning opportunities
 Learning Theory
“Learning is the process whereby knowledge is created through
the transformation of experience” (Kolb, 1984, p. 38).
Learning Styles
Activist Activists are those people who learn by doing. Activists need to get their • brainstorming
hands dirty, to dive in with both feet first. Have an open-minded approach • problem solving
to learning, involving themselves fully and without bias in new experiences. • group discussion
• puzzles
• competitions
• role-play
Pragmatist These people need to be able to see how to put the learning into practice in • time to think about how to apply learning in reality
the real world. Abstract concepts and games are of limited use unless they • case studies
can see a way to put the ideas into action in their lives. Experimenters, trying • problem solving
out new ideas, theories and techniques to see if they work. • discussion
Reflector These people learn by observing and thinking about what happened. They • paired discussions
may avoid leaping in and prefer to watch from the sidelines. Prefer to stand • self analysis questionnaires
back and view experiences from a number of different perspectives, • personality questionnaires
collecting data and taking the time to work towards an appropriate • time out
• observing activities
conclusion.
• feedback from others
• coaching
• interviews
Theorist These learners like to understand the theory behind the actions. They need • models
models, concepts and facts in order to engage in the learning process. Prefer • statistics
to analyse and synthesise, drawing new information into a systematic and • stories
logical 'theory'. • quotes
• background information
• applying theories

Honey & Mumford (1982)

A Typology of Learning Modes (Eraut 2000)
Work Processes with learning as a Agentic Activities located within Learning Processes
by-product work or learning processes at or near the workplace
Participation in group processes Asking questions Being supervised
Working alongside others Getting information Being coached
Consultation Locating resource people Being mentored
Working with clients Listening and observing Shadowing
Tackling challenging tasks and roles Reflecting Visiting other sites
Problem solving Learning from mistakes Conferences
Trying things out Giving and receiving feedback Short courses
Consolidating, extending and Use of mediating artefacts Working for a qualification
refining skills Independent study

Working alongside others allows students

• to observe and listen to others at work
• to participate in shared activities
• to learn new practices and perspectives
• to become aware of different kinds of knowledge and expertise
• to gain some sense of other people’s tacit knowledge
This mode of learning is important for acquiring the tacit knowledge that underpins
routines and intuitive decisions and is difficult to explain
Learning goes beyond the classroom and the future employer has a role to play
 A Typology of Learning Trajectories (Eraut 2008)
Task Performance
Speed and fluency; Complexity of tasks and problems;
Communication with a wide range of people; Collaborative work
& Range of skills required
Role Performance
Prioritisation; Range of responsibility; Supporting other people’s
learning; Leadership; Accountability; Supervisory role; Delegation;
Handling ethical issues; Coping with unexpected problems; Crisis
management & Keeping up-to-date
Academic Knowledge and Skills
Use of evidence and argument; Accessing formal knowledge;
Research-based practice; Theoretical thinking; Knowing what you
might need to know; Using knowledge resources (human, paper-
based, electronic) & Learning how to use relevant theory (in a range
of practical situations)
Teamwork
Collaborative work; Facilitating social relations; Joint planning and Quality of performance, output and outcomes; Priorities;
problem solving & Ability to engage in and promote mutual
learning
Awareness and Understanding
Other people: colleagues, customers, managers, etc; Contexts and
situations; One’s own organization; Problems and risks; Priorities and
strategic issues & Value issues
Personal Development
Self evaluation; Self management; Handling emotions; Building and
sustaining relationships; Disposition to attend to other perspectives;
Disposition to consult and work with others; Disposition to learn and
improve one’s practice; Accessing relevant knowledge and expertise &
Ability to learn from experience
Decision Making and Problem Solving
When to seek expert help; Dealing with complexity; Group decision
making; Problem analysis; Formulating and evaluating options;
Managing the process within an appropriate timescale & Decision
making under pressure
Judgement
Value issues & Levels of risk
Modes of Learning

• Classroom
• Group work
• Simulated Learning
• Case Studies
• Labs
• Reflective Practice
• OSCE
• Clinical Placements
Simulated Learning & Assessment
• Simulation for skills development
Use of clinical scenarios
High and low fidelity simulation

• Simulation Assessment e.g.

Part 1 - Medication Administration: (15 minutes)
The student will be required to demonstrate
competency in effectively and safely managing a
simple oral medication administration of a single
client within a simulated environment. All
components of the skill will be assessed using the
NCAS Medication Administration tool.
 5 D’s Reflective Model (Wanda D 2016)
Doubt/differences - Start with, did you find any doubt in your
practice? Or did you spot any differences in what you had
Culture Dimensions and done in the clinical setting with what you had found in the
literature? Write in a simple sentence, just like a topic title
Reflective Practice
Doubt/
Differences
Power distance Disclosure - Write about the
Decision - In this section,
situation or experiences you had
you will write your plan
regarding the topic you
for the future, what would
Decision Disclosure mentioned above. Please make it
you do if you found
simple and provide only the
Uncertainty avoidance yourself in a similar
description related to the topic.
situation?

Dissection - Write your

Discover - Following your
Individualism and analysis, find additional
information from the
collectivism literature to support your
analysis and discussion of
the topic.
The 5Ds structured reflection (p90)
Masculinity versus Femininity
analysis and consider
several aspects such as:
Discover Dissection why did it happen?; what
was the impact of the
situation or experiences for
you or other people
involved?
D Wanda (2016)
Clinical Practice - Supporting Learning in Practice

• Clinical Placements
• Academic/clinical collaboration
• Applying skills & knowledge in practice
• Informal Learning
• Facilitated Learning approach
• Attitudes & Behaviours
• Achieving Competency
• Reflective Practice
• Learning to be a Professional
 Informal Learning
Time of focus Implicit learning Reactive learning Deliberative learning

Past episode(s) Implicit linkage of Brief near-spontaneous Discussion and review of

past memories with refection on past episodes, past actions,
current experience events, incidents, experiences communications,
events, experiences
Current A selection from Noting facts, ideas, opinions, Engagement in decision
experience experience enters impressions; asking questions; making, problem solving,
episodic memory observing effects of actions planned informal learning

Future Unconscious Recognition of possible Planning learning

behaviour expectations future learning opportunities; rehearsing for
opportunities future events

• Informal learning is largely invisible, because much of it is either taken for granted or not recognized
as learning; thus, respondents lack awareness of their own learning;
• The resultant knowledge is either tacit or regarded as part of a person's general capability, rather than
something that has been learned;
• Discourse about learning is dominated by codified, propositional knowledge, so respondents often
find it difficult to describe more complex aspects of their work and the nature of their expertise.
Eraut (2004) p 249
Achieving Competency
Competence is the ability to perform the tasks and roles required to the expected standard
and applies at any career stage. Evidence of competence is determined by a series of
performances, each of which needs to be situated in terms of its context, the prevailing
conditions and the situations being addressed. (Eraut 1998)
– Person Centred Learning
– Assessments through the 3year program linked to:
• learning objectives
• ANMC competencies and
• UOW graduate qualities
– Linking theory in practice through clinical placements
• informal as well as formal learning and learning how to be a professional
– Nursing Competency Assessment Schedule
 Nursing Competency Assessment Schedule (NCAS)
• The NCAS document was developed
through a consortium of Australian
Universities which was funded by
the Australian Learning & Teaching
Council (2010).
• There are two inter-related components
to this schedule;
– Regulatory or ANMC (2006)
competencies*
– Employer or Role Competencies

*changed in June 2016 currently being embedded

within the new curriculum
Modified Bondy (1983) criteria used with NCAS

Refers to being safe & knowledgeable; proficient & coordinated and appropriately confident and timely.
Independent: (I) Does not require supporting cues

Refers to being safe & knowledgeable; efficient & coordinated; displays some confidence and undertakes
Supervised: (S) activities within a reasonably timely manner. Requires occasional supporting cues.

Refers to being safe and knowledgeable most of the time; skilful in parts however is inefficient with some
skill areas; takes longer than would be expected to complete the task. Requires frequent verbal and some
Assisted: (A)
physical cues

Refers to being safe when closely supervised and supported; unskilled and inefficient; uses excess energy
Marginal: (M) and takes a prolonged time period. Continuous verbal and physical cues.

Refers to concerns about being unsafe and being unable to demonstrate behaviour or articulate intention;
lacking in confidence, coordination and efficiency. Continuous verbal and physical cues/interventions
Dependent: (D)
necessary.
 Example of
competency
assessment tool
used in clinical
In addition to the
practice performance measures:
• the student completes
a practice reflection
• the preceptor nurse
completes a written
review of the students
performance
 100 Level 200 Level 300 Level

NMIH104

NMIH107

NMIH202

NMIH207

NMIH208

NMIH301

NMIH302

NMIH308

NMIH320

NMIH321

NMIH322

NMIH323
NMBA (2013)

BNOQN only

BNOQN only
BNA only

BNA only
1. Practices in accordance with legislation affecting nursing practice and health
M A S S S I I I I I I I
Professional care
Practice
2. Practices within a professional and ethical nursing framework M A S S S I I I I I I I

Critical 3. Practices within an evidence-based framework M A A S A I I I I I I I

Thinking &
Analysis 4. Participates in ongoing professional development of self and others M M A S A S S S S S S S

5. Conducts a comprehensive and systematic nursing assessment A A S S A I I I I I I I

6. Plans nursing care in consultation with individuals/groups, significant others

M M A A A S S S S S S S
and the interdisciplinary health care team
Provision and
7. Provides comprehensive, safe and effective evidence-based nursing care to
Coordination of A A A S A I I I I I I I
achieve identified individual/group health outcomes
Care
8. Evaluates progress towards expected individual/group health outcomes in
consultation with individuals / groups, significant others and the M M A A A S S S S S S S
interdisciplinary health care team.

9. Establishes, maintains and appropriately concludes therapeutic relationships A A S S A I I I I I I I

Collaborative &
Therapeutic
Practice 10. Collaborates with the interdisciplinary health care team to provide
M A S S S I I I I I I I
comprehensive nursing care

Legend: Independent:(I)/Supervised:(S)/Assisted:(A)/Marginal:(M)/Dependent(D)
Bondy 1983
Standard 1: Thinks critically and
analyses nursing practice
RNs use a variety of thinking strategies
and the best available evidence in making
decisions and providing safe, quality
nursing practice within person-centred
and evidence-based frameworks.
Standard 2: Engages in therapeutic
and professional relationships
RN practice is based on purposefully
engaging in effective therapeutic and
professional relationships. This
includes collegial generosity in the
context of mutual trust and respect
in professional relationships with
significant others and the
interdisciplinary health care team.
Standard 3: Maintains the
capability for practice
RNs, as regulated health professionals,
are responsible and accountable for
ensuring they are safe, and have the
capability for practice. This includes
ongoing self-management and responding
when there is concern about other health
professionals’ capability for practice.
RNs are responsible for their professional
development and contribute to the
development of others. They are also
responsible for providing information and
education to enable people to make decisions
and take action in relation to their health.
Registered nurse standards for practice
Nursing & Midwifery Board of Australia (2016)
Person Centred Practice Framework
McCormack & McCance 2016
Standard 4: Comprehensively
conducts assessments
RNs accurately conduct comprehensive
and systematic assessments. They
analyse information and data and
communicate outcomes as the basis for
practice.
Standard 5: Develops a plan for
nursing practice
RNs are responsible for the planning
and communication of nursing practice.
Agreed plans are developed in
partnership. They are based on the RNs
appraisal of comprehensive, relevant
information, and evidence that is
documented and communicated.
Standard 6: Provides safe,
appropriate and responsive
quality nursing practice
RNs provide and may delegate, quality
and ethical goal-directed actions. These
are based on comprehensive and
systematic assessment, and the best
available evidence to achieve planned
and agreed outcomes.
Standard 7: Evaluates outcomes
to inform nursing practice
RNs take responsibility for the
evaluation of practice based on agreed
priorities, goals, plans and outcomes
and revises practice accordingly.
 Learning to be a Professional
The Nature of Professional Practice
• ASSESSING CLIENTS, AND SITUATIONS
Sometimes briefly, sometimes involving a long process of
investigation, on your own or as part of a group
• DECIDING WHAT, IF ANY, ACTION TO TAKE
Both immediately and over a longer period (either individually or as
a member of a team)
• PURSUING AN AGREED COURSE OF ACTION
Individually or collectively; and modifying, consulting and reassessing
as and when necessary
• META-COGNITIVE MONITORING OF THE PEOPLE INVOLVED
Whether colleagues or clients, individually or collectively, and following the
general progress of the problem, project or situation
Eraut (2008 p6)
Transition to Practice Framework for
New Graduate Registered Nurses, Enrolled Nurses and Midwives in Australia
Principles to support transition
Successful transition requires a safe
working environment which respects the
individual’s experience and professional
scope of practice
Successful transition requires support
from skilled preceptors and colleagues,
who are enabled to participate in this
process
Successful transition requires
consolidation of clinical practice as the
focus, within a positive, collaborative
environment, where opportunities for
experiential learning are maximised
Successful transition requires constructive
feedback to be used as a positive tool to
facilitate professional growth
Enablers
• Employers support new graduates by providing a safe environment that meets relevant workplace safety
legislation and articulates with organisational clinical governance and risk management frameworks
• Employers provide processes to safe guard safety and quality in healthcare by acknowledging the
individual scopes of practice of novice clinicians
• Employers encourage excellence from graduates by promoting standards of care which reflect best
practice principles
• New graduates are able to articulate their individual scope
• Participation in the transition to practice process is acknowledged and supported by the employer
• Employers have processes to provide professional and social support to new graduates and those who are
mentoring and supporting them
• Employers have processes to accommodate the clinical practice and learning requirements of new graduates
• Transition to practice is delivered by organisations that value lifelong learning
• Employers utilise a range of internal and/or external resources to maximise learning opportunities and to meet
workforce needs
• The employer promotes evidence based practice
• The employer provides processes for measuring competence
• The transition to practice process is integrally linked with internal and external learning experiences in order to
maximise learning opportunities and innovation
• The transition to practice process is offered in an environment that promotes respect and values experience
• The employer provides support, flexibility and constructive feedback to new graduates
• Evaluation processes are in place which reflect organisational and graduate considerations
Supporting transition Preceptorship
A period of structured transition for the newly registered practitioner
and Lifelong Learning during which he or she will be supported by a preceptor, to develop his
or her confidence as an autonomous professional, refine skills, values
and behaviours and to continue on the journey of life-long learning
(DOH, UK 2009)

Support
A ‘process that aids, encourages, and strengthens and thereby gives
courage and confidence to a new graduate nurse, or group of new
graduates to practice competently, safely and effectively in the levels
and areas they have been educationally prepared to work.’
(Johnstone, Kanitsaki and Currie, 2008)

Mentoring
A personal development relationship in which a more experienced or
knowledgeable person helps a less experienced or less knowledgeable
person. (Edwards, Hawker, Carrier and Rees, 2011)

Clinical Supervision
Focuses on progressing clinical practice through reflection and the
provision of guidance and support (Mills, Francis & Bonner 2005)
 References
• Australian Nursing & Midwifery Accreditation Council (ANMAC) (2012) Registered Nurse Accreditation Standards 30 June 2012 Version #2 (15
August 2012) accessed: 31ST March 2017. Available: http://www.anmac.org.au/sites/default/files/documents/ANMAC_RN_Accreditation_Standards_2012.pdf
• Australian Nursing & Midwifery Council (ANMC) (2006) National competency standards for the registered nurse, 4th edition Dickson ACT, 8 p.,
accessed: 30th December 2012, Available:
http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2F1342&dbid=AP&chksum=N5ws04xdBlZijTTSdKnSTQ%3D%3D
• Australian Learning and Teaching Council (2011) Learning and Teaching Academic Standards Project Health, Medicine and Veterinary Science
Learning and Teaching Academic Standards Statement Australian Government Department of Education, Employment and Workplace Relations.
• Bondy, K.N. (1983). 'Criterion - referenced definitions for rating scales in clinical evaluation', Journal of Nursing Education, vol.22, 9, p. 376-382.
• Department of Health & CNO Directorate (2009) Preceptorship Framework for Nursing. In: Department of Health (ed.). London: Crown
Copyright.
• Edwards D, Hawker C, Carrier J & Rees C (2011) The effectiveness of strategies and interventions that aim to assist the transition from student to
newly qualified nurse. JBI Library of Systematic Reviews, 9 (53), 2215-2323.
• Eraut M (1998) Concepts of Competence, Journal of Interprofessional Care, Vol 12, pp127-139.
• Eraut M (2000) Non formal learning and tacit knowledge in professional work. British Journal of Educational Psychology, 70, 113-136.
• Eraut M (2004) Informal Learning in the Workplace. Studies in Continuing Education, Vol 26, No 2, pp247-273.
• Eraut (2008) How professionals learn through work. Accessed 30th March 2017. Available
http://surreyprofessionaltraining.pbworks.com/f/How+Professionals+Learn+through+Work.pdf
• Honey, P. & Mumford, A. (1982) Manual of Learning Styles London: P Honey.
• Johnstone M, Kanitsaki O & Currie T (2008) The nature and implications of support in graduate nurse transition programs: an Australian study.
Journal of Professional Nursing, 24(1), 46–53.
• Kolb DA (1984) Experiential Learning: experience as the source of learning and development New Jersey: Prentice-Hall
• Mills J, Francis K & Bonner A. (2005) Mentoring, clinical supervision and preceptoring: clarifying the conceptual definitions for Australian rural
nurses. A review of the literature. Available: http://rrh.deakin.edu.au
• McCormack B & McCance T (2016) Person Centred Practice in Nursing and Healthcare: Theory & Practice 2nd Edn. Wiley Blackwell: London
• Nursing and Midwifery Board Australia (2013 & 2016) Registered Nurse Standards for Practice. Accessed 31 st March 2017. Available
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
• Roper N, Logan W & Tierney A (1996) The elements of Nursing: A Model for Nursing. Based on a Model of Living 4th Edn. Churchill Livingston,
London.
• Wanda D (2016) The development of a clinical reflective practice model for paediatric nursing specialist students in Indonesia using an action
research approach. Unpublished Thesis, UTS.
Questions?

vwilson@uow.edu.au