1. Becoming the professional: The experiences of final year physiotherapy students on practice placement in the acute setting NAEP Conference 2016 Charlotte Griffin (main author) Sarah-Jane Ryan BSUH NHS Trust School of Health Sciences Brighton University of Brighton

2. Why ask this question? Physiotherapy programmes in the United Kingdom provide graduates with knowledge, skills, values and behaviours that will enable them to practice safely and effectively (CSP, 2010;2015) To qualify as a physiotherapist university based elements and 1000 hours of practice based learning must be completed. Graduate physiotherapists must be able to work in a variety of environments including the acute setting which presents a different set of challenges compared to a non-acute setting (Bartlett et al, 2009; Gilbert 2014) Time in different practice environments can strongly influence future career choices (Shields et al, 2013)

3. The acute environment Complex, rapidly changing and often unpredictable environment (Chesser-Smyth, 2005; Gilbert, 2014; Delany &Bragge, 2009; Thomson et al, 2014) Students expectations of themselves on placement but also as future service providers (Ernstzen et al, 2009) Students experiences and the emotional impact ( Levett-Jones & Lathlean, 2008;Tastan et al 2013; Chesser-Smyth,2005). Practice educator/student relationship (Hall, McFarlane, & Mulholland, 2012; Morris & Stew, 2013; Hall et al., 2012;Morris, 2007; Sedlackova & Ryan, 2013). Patient management in the ‘real world’ setting is highly valued (Ernstzen et al., 2009)

4. Research design An interpretative qualitative approach was taken. Ethical approval was granted by the University of Brighton School Research ethics and governance panel. Individual face to face Semi-structured interviews were used

5. Participants 8 final year pre-registration students were purposively recruited. Eligible participants had successfully completed at least one practice placement in the acute setting Participants were excluded if they have previous paid employment within the acute setting in any clinical role. ParticipantGenderPractice Placement Speciality 1femaleRespiratory; neurology 2maleRespiratory; neurology 3maleRespiratory; neurology 4maleRespiratory; neurology 5femaleneurology 6maleneurology 7female Respiratory; neurology; trauma orthopaedics 8maleOrthogeriatric

6. Data collection and analysis The interviews ranged from 24-45 minutes and were recorded and transcribed verbatim All interviews were supplemented by reflective logs and field notes to question the researchers own assumptions Thematic analysis (Braun & Clarke 2006) was used to analysis the transcripts. Interview Schedule "Tell me about your acute practice placement experience." "What were the benefits of practice placement in the acute setting?" "Describe any challenges you had on practice placement in the acute setting." "How did you feel going into practice placement in the acute setting?" Prompts: What, why, how, when, describe, explain.

7. Findings Reality and challenges of the acute setting ‘the experiences you don’t get at uni’ relationships Becoming the professional The experiences of final year physiotherapy students in the acute setting

8. Reality and challenges of the acute setting ‘ A completely different experience’ (P2) Reality of the acute setting ‘Quite a shock to the system’ (P3) ‘Had to quickly get used to everything’ (P6) ‘Quite a shock to the system’ (P3) ‘Had to quickly get used to everything’ (P6) Challenges of the acute setting ‘Such a good learning environment…learnt so much so quickly’ (P1) ‘Critical care environment…probably one of the safest places to work’ (P4) ‘Such a good learning environment…learnt so much so quickly’ (P1) ‘Critical care environment…probably one of the safest places to work’ (P4) Benefits

9. ‘The experience you don’t get at uni’ ‘ Doing your 1000 clinical hours is to get that experience. To get that understanding…to be a good PT for my patients (P2) Appreciation for working with patients ‘ you don’t know how they will present, you have to adapt on the spot…they may be feeling weaker...stronger today (P6 ) Challenges of patient interactions ‘I needed to kind of judge the situation…gauge that patient...what do they need.. (P1 ) Adapting communication with patients Experience of patient death ‘I actually dealt with it quite well…’ (P3)

10. Relationships ‘ my educator was such a good role model…her clinical skills were so good…being able to emulate her as a therapist would be so beneficial (P6) Facilitation and role modelling Physiotherapy support staff: ‘they are knowledgeable about the hospital...all sorts of things that maybe the physio doesn’t even know’ (P3) ‘ I am embarrassed to say this but I have more respect now for nurses, OT’s, HCA’s….its tough in the acute world… (P7) Physiotherapy support staff: ‘they are knowledgeable about the hospital...all sorts of things that maybe the physio doesn’t even know’ (P3) ‘ I am embarrassed to say this but I have more respect now for nurses, OT’s, HCA’s….its tough in the acute world… (P7) Understanding others roles It felt good to see that by the end of the placement…you were respected...the rest of the teams believed you knew what you were talking about.. (P2) Respect for the role of the Physiotherapist

11. Becoming the ‘professional’ ‘ we did get the theoretical knowledge we needed from the uni…. …’ (P6) ‘….I never felt I knew enough…’ (P7) ‘ we did get the theoretical knowledge we needed from the uni…. …’ (P6) ‘….I never felt I knew enough…’ (P7) Preparedness for the setting ‘every day was a huge learning opportunity…’ (P3) ‘I had to take ownership of my own learning as there was so much more I could always know about’ (P6) ‘every day was a huge learning opportunity…’ (P3) ‘I had to take ownership of my own learning as there was so much more I could always know about’ (P6) Learning and development ‘Sometimes I was seen more as a qualified physio than a student….’ (P1) ‘Always acting in a behaviour that puts the patient first ‘Sometimes I was seen more as a qualified physio than a student….’ (P1) ‘Always acting in a behaviour that puts the patient first Understanding my role

12. Discussion Reality of current practice within the NHS Initial lack of confidence and negative emotions…leading to more positive emotions with successful outcomes Patient interaction key to successful skills development and improved communication Problem based learning programme supports student ability to cope with challenging environments. Practice educator and student relationship Readiness for practice

13. Limitations MSc Rehabilitation Science pre- registration study One cohort from one university Participants were known to researcher Mainly positive experiences reported by all participants

14. Thank you Any questions