Understanding the information and resource needs of UK health and ...

DOI: 10.1111/j.1471-1842.2008.00769.x

Understanding the information and resource needs of UK health and social care placement students Blackwell Publishing Ltd

Lynne Callaghan, Alan Doherty, Susan J. Lea & Daniel Webster, Centre for Excellence in Professional Placement Learning, Faculty of Health and Social Work, University of Plymouth, Plymouth, UK

Abstract Background: Students on health and social care degree programmes spend 50% of their time on practice placements. Because of the diversity of settings and the need to evidence their work, it is vital to understand the information and resource needs of placement students. Objectives: The aim of this investigation was to understand the needs of placement students in terms of accessing resources whilst they are in the field in order to inform a guide to meet these needs. Methods: Focus groups were conducted with students on midwifery, social work and post-registration health professions degree programmes on three different sites across the region. Data were analysed using Thematic Content Analysis. Results: Three themes emerged from the data: inequality, user education needs and students’ solutions and strategies. Conclusions: It is essential to speak to placement students in order to understand their needs in terms of accessing and using library resources. The timing and content of information skills training is key to meeting student needs while on placement.

Introduction Background The study presented in this paper forms part of the ‘Enhancing Library Access’ development activity within the Centre for Excellence in Professional Placement Learning (Ceppl) at the University of Plymouth (UoP). Ceppl is one of 74 Centres for Excellence in Teaching and Learning awarded by the Higher Education Council for England (HEFCE) in 2005 and is made up of nine development activities involving academics, library staff, researchers, practitioners, students and service users investigating Correspondence: Lynne Callaghan, Centre for Excellence in Professional Placement Learning, Faculty of Health and Social Work, University of Plymouth, Plymouth PL4 8AA, UK. E-mail: [email protected]

a range of issues concerning the placement learning of students on Health and Social Care degree programmes. The focus of this paper is the resource issues and needs of midwifery, social work and post-registration health profession students undertaking placement learning; that is, learning that takes place in the work environment as part of a programme of study.1,2 The needs and issues of students generated by this project will form the basis of a library and resource guide to enable students to access information efficiently whilst on placement. As a result of professional requirements, students on the above programmes spend up to 50% of their time on placement. A diverse range of placement areas are utilized covering a wide geographical area and a varied array of settings with differing levels of resource and equipment availability.

© 2008 The authors Journal compilation © 2008 Health Libraries Group. Health Information and Libraries Journal, 25, pp.253–260

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Needs of UK health and social care placement students, Lynne Callaghan et al.

Access to up-to-date information is vital for health and social care students as evidence-based best practice is the goal for all students and professionals alike.3,4 Consequently, the UoP information and library service is concerned to upgrade its provision to campus based and placement students. Recent developments in service provision at the University include secure electronic delivery to the desktop of requested articles which are not held within the library. Changes in services such as this illustrate the scope for change in the provision of services to placement students. However, it is essential that the perceptions of placement students on health and social work programmes are central to the development of any guide or the implementation of any new services because of the differences in resource needs and learning experiences across professions and between placement settings. Literature review A large proportion of the literature pertaining to the three professions under focus in this study concern the information and service needs of staff and/or students. Recent analyses of nurses’, social workers’ and midwives’ needs take account of both library and information technology resource issues.5 –13 User need that is highlighted by these studies generally falls into two broad categories, that is, ‘user issues,’ (e.g. knowledge, confidence, time/ pressure) and ‘service issues,’ (e.g. access and usability). Each of these issues will be discussed below. ‘User issues’ cover a range of user concerns in relation to accessing and using information and library services. Knowledge and skills in making use of services are vital to enable students and professionals to retrieve and employ up-to-date, accurate information and resources in their study and/or practice. Knowledge can be viewed, first, as that involving searching for and evaluating literature (academic knowledge) and, second, as that regarding the use of computer systems and packages (IT knowledge). Although some studies focus on academic knowledge (e.g.11,14,15), as it is becoming increasingly necessary to use IT to access library resources, a large number of studies centre on IT knowledge.

These papers cover such issues as technical knowledge of computers,6,16–18 computer literacy6,11,13,16,18,19 and using the Internet to find relevant information.20 While some studies present positive steps in introducing technology, for example, into programmes of education (e.g.17,21), most focus on the lack of knowledge, skills and computer literacy of health and social care professionals and students. As De Chazal et al. concluded from their study of social workers’ library and information needs, ‘... a cultural shift is required if social care decisions are to be based on the best available evidence’.7 p.27 If health and social care professionals are to seek relevant information to develop their practice, and likewise students to enhance their learning, it is essential that these services are accessible and usable. These ‘service issues’ will now be discussed below with reference to the needs of health and social care professionals and students. Accessibility to both library and IT resources is the most prevalent topic within the literature of health and social care professional and students’ needs. Access to the library in terms of its physical location8,11,14–16,19,22,23 parking,16 and opening hours,8,13,23,24 are all concerns that require addressing. As many professionals and organizations commonly cover wide, often remote, geographical areas,20,25 access to IT services is essential. Further, although time is an issue in terms of accessing electronic information within the workplace, even if periods were allocated for information seeking, in many instances professionals do not have sufficient access to computers11,13 or are simply unable to use computing equipment at work.13 It has been found in the case of nurses that they often have limited access to passwords to enable admission to computing facilities and locations housing such equipment19,23,26 and that complex hierarchies can limit access to services for some staff.11,19 Although access to libraries and IT facilities is essential for health and social care professionals and students, successful information seeking and retrieval will not be possible unless the services and technologies that can be accessed are usable. Monnickendam27 found that the most significant predictor of computer use among service workers was the usability of the system. If professionals or students are unable to use systems they inevitably



will be less likely to employ them. As Hodgson et al.28 discovered if, for example, where software installation was complicated, nurses’ fears in using systems escalated. Usability is not simply restricted to computing systems in the literature however. Both Adams and Blandford19 and Haldane8 discuss the usability of library systems in general. For example, Adams and Blandford’s19 investigation of the acceptance of a range of health professionals’ and managers’ acceptance of medical digital libraries found that participants perceived the usability of the current library services as poor. Specifically, participants stated that they had difficulty with accessing specialized information and that the supply of source materials and journal access in the library was limited. Additionally, studies have found staff unhelpfulness to be a factor inhibiting effective use of the library.6,23 The user and service issues discussed above appear to provide a clear picture of the library and information service needs of health and social care professionals and staff. Certainly, the literature raises some important topics in terms of accessing and using both library facilities and electronic resources. However, there are three gaps in the literature which need to be uncovered here and which provide part of the rationale for this study. First, the majority of the literature focuses on the needs of qualified professionals or staff rather than students. Although studies concentrating on professionals were included in this review, as their needs in the workplace might have similarities with that of students in practice, placement students may have specific needs that cannot be understood by reference to this literature. Second, despite there being a number of studies investigating placement students’ needs in terms of library and information resources,10,29,30 questionnaires rather than interviews and focus groups were predominantly used by these projects in order to gauge students’ views. Although free response items were included alongside closed or Likerttype items in order to supplement responses with qualitative data, it is proposed here that in order to explore the issues of importance to students it is necessary to speak to them directly in a nonthreatening environment. Further, it could be argued that what is gained in reaching larger numbers is to some extent lost in that responses

are necessarily more closely guided by a questionnaire than in a semi-structured interview or focus group where participants are encouraged to discuss and explore their own issues. Therefore, for the purposes of this study, it was decided to utilize a qualitative design in order to allow exploratory and participant-guided data collection. Finally, although a small proportion of studies combine the views of different health professionals and/or students,19 and one looks at the needs of social workers, health professionals and staff from the voluntary sector,25 the authors have not found a study that has sought the views of both health and social care students in terms of their resource needs. As the ultimate aim of this project is to produce a generic guide suitable for all health and social care students on placement, it is vital that the needs of both sectors are explored. Method Ethics Ethical approval was sought and granted by the Faculty of Health and Social Work Human Ethics subcommittee of the UoP. Participants Participants were recruited from the three professions at UoP sites across the South West Peninsula. Six social work students (Cornwall), two midwifery students (Plymouth) and six postregistration health studies (Somerset) students took part in three focus groups. Groups were homogenous in terms of being uni-professional with the exception of the post-registration group which consisted of Adult Nurses and Ambulance Service staff. All students undertaking these programmes at each site were invited to participate. The researcher travelled to each site and spoke directly to students about the aims of the study during breaks from seminar sessions. Potential participants were provided with an information sheet and asked to return consent forms to the researchers in the freepost envelope provided. It was important that students were given enough information to decide if they wanted to participate but without putting


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them under any pressure to do so. More students than actually took part in the study consented to participate. Despite the face-to-face nature of the recruitment, found to be the most effective if timeconsuming method of recruitment in past studies, the overall participation rate was disappointing. Materials A focus group schedule (refer to Appendix 1) was constructed using the review of the literature and the expertise of the library staff on the research team. The structure of the schedule followed Krueger’s31 recommendations, with questions comprising the following groups: introductory, connecting , core and closing questions. Questions were designed to be as open as possible to enable students’ perceptions to be heard. Procedure Focus groups were held on the sites most convenient for the students in a pre-booked room. Refreshments were provided. The researcher welcomed the students, reiterated the information provided in the information sheet and invited questions. Once all participants had given permission for the discussion to be recorded, the focus group commenced. The researcher acted as facilitator and encouraged the participants to discuss the topics under investigation among themselves, whilst ensuring that all participants were able to express their views. Following completion of the discussion, participants were again asked if they had any questions about the study and were provided with the contact details of the researcher. Discussions were of between 60- and 90-min duration. Analysis All interviews were transcribed verbatim. Transcripts were then coded and analysed using Thematic Content Analysis.32 Results and discussion Three main themes emerged: ‘inequality’, ‘user education needs’ and ‘students’ solutions and

‘strategies’. Each of these themes will be addressed in turn. ‘Inequality’ Inequality was seen as the most important factor affecting participants’ ability to access and use library and information services and resources. The most frequently cited example of inequality was between the resources and services on offer at the main University campus and those on offer at the sites at which participants were based. This issue is of particular importance to placement students who are likely to be closer to partner college campuses than the main University campus. Resources were seen as limited at two of the sites in terms of the number and quality of texts available. Students found great difficulty in accessing resources as texts covering different but related subjects are stored at different sites. Further, travel between sites was not always practicable because of the proportion of time spent on placement: ‘... they didn’t have any midwifery stuff down there—it’s all nursing so they’ve shifted all the midwifery stuff up here ... and it’s not practical at all ...’ Staff cooperation was perceived by students to be very important in successfully accessing resources, but was also viewed as varying between sites. One set of students remarked that, although they found the support staff at their site to be extremely helpful, the resources at this site were limited, whereas, although they found the staff at the main campus library to be more detached, the extent and quality of the available resources surpassed that of their own site: ‘... The attitude to us here [on partner-college site] is it’s very user-friendly as you can go up to somebody ... and they are really nice in the library, whereas probably it’s a bit more detached at [main campus], but you can access the books yourself if you’ve got an idea so it’s kind of catch-22 really, it’s friendly here—approachable, but no books ...’ Inequality was also evident in terms of the accessibility of resources in placement settings,



which is important when placements are not within easy reach of the main UoP campus. Diversity in terms of placement areas to which social work and midwifery students were allocated resulted in variability of access to both hard copy and electronic resources. Although some students stated that they had access to resources in their placement areas, this was not always the case and this access was often limited. Both Walton et al.30 and Mailer10 found that a large proportion of their student participants did not have access to networked PCs in their placement areas. Similarly, although some students were able to use IT resources whilst on placement, this varied across placements and was compounded by issues such as the ‘strictness’ of mentors, who were unwilling in some cases to enable students to utilize such resources. Members of the Ambulance Service staff, for example, were not able to access any resources during their working day, which meant that they were obliged to study solely in their own time. One nurse stated that she was able to use electronic resources on the ward during quiet periods whilst she was on night duty, but other nurses agreed that they were now unable to do this as they used to, as a result of staff shortages. There was further perceived inequality in terms of resource access between those students who preferred hard-copy resources and those who preferred viewing resources electronically and also between those who owned their own IT equipment and those who did not. Although most students understood the need to be able to access electronic resources, some admitted that they still preferred to be able to use hard copies: ‘... There are still a lot of us that like hard copies. Everything is electronically given to us, y’know, there is a lot of on Emily; there is a lot of information everywhere, and it’s all electronic. If you aren’t confident at searching for that information you can miss it, can’t you ... ?’ Although these students could see the advantages of being able to access library and information resources and lecture materials electronically, using electronic-based sources often created anxiety for them. As the study of Choi et al. showed, a negative

relationship can exist between the number of hours of computer use and computer-related anxiety.33 Subsequently, if students are not provided with the opportunity to use computers in placement settings, anxiety regarding electronic information seeking is unlikely to be prevented. Whilst students perceived the need for equality of accessibility of resources to be important, it was also clear that appropriate use of such information requires considerable user education. ‘User education needs’ The need for improved education in accessing and using both library-based and electronic resources emerged from all three focus groups. The timing of the library induction was discussed by participants who saw a need for training in accessing resources during the course (with possible refresher sessions), rather than at the commencement of the programme when students were unaware as to the resources they would require. For example: ‘... We have all had our training on that [library induction], and to be honest I felt that the training, when it happened, was at the beginning of our— of our academic year. We have so much new information going in, that actually I can’t—I don’t remember what we were taught ...’ Student need was further evidenced by gaps in participants’ knowledge in terms of their ability to access and use resources available to them. For example, some students were unsure of library services that were available in their local area (if they were attending courses delivered in another locality) and some were unaware that they were able to use local facilities, not realizing that these were accredited to UoP. Gaps in students’ knowledge of electronic resources were also apparent. For example, one social work student stated that she was unaware that the full UoP library catalogue was available online. Further, similar to Mailer’s study, which found that many students were unaware of electronic journal access, students stated they often had difficulty in accessing electronic journals and came across challenges in acquiring full-text journals because of the need for passwords in order to gain entry:10


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‘... and also the passwords for the journals because it’s really hard ...’ ‘... you get so far and you stop ...’

down here in a day ... It would be cheaper for me to keep a book out than travel down, which costs seven pounds, and hand it in.’

Overall, students perceived that not enough attention was given to induction and training to access and use library based and electronic resources. This was further exacerbated by inequalities based on location, level of support and resources discussed above. In order to balance the perceived inequalities with their own needs, students devised their own strategies and suggested solutions which are detailed below.

A solution offered by several students was that of a postal system, whereby they could return books by post if they were unable to return them in person as a result of work and/or family commitments:

‘Students’ solutions and strategies’ Students across all three groups adopted strategies to circumvent the difficulties they encountered with resource access and use. The most common of these strategies was the purchasing of books that students found to be inaccessible from the library. Both social work and midwifery students stated that they bought books for this reason, but that this strategy is expensive. Book sharing was another strategy that was used. ‘... What we’ve ended up doing, a lot of us, is buying books, which, obviously, we can’t afford to do that, but in order to make sure that you’ve got books you buy them.’ ‘... because we know that there’s limited resources here, one of us has had the book and passed it round.’ Students also discussed the difficulty of restrictive loan periods, particularly as placement students have limited study days on campus during which to return books. Because of the long distances that these students were travelling, it was often more cost-effective for them to incur a fine for an overdue book than to pay to travel to the campus to return it. However, it was recognized that this strategy aggravated access difficulties for other students. This finding supports those of the Liquid Library Project whose participants called for longer loan periods and no recalls on materials.29 ‘... People would rather pay a fine than what it costs—it costs me seven pounds for me to travel

‘... A postal service would be ideal, wouldn’t it? Absolutely ideal, and I for one, living where I live, would be more than willing to pay for the service.’ Although Mailer10 found that less than half of the students in her study would be prepared to pay for this type of service, all of the students in the current study said that they would be willing to use this service for a reasonable fee. Conclusion The themes generated from the analysis of the focus group data illustrate the importance of speaking to placement students in two ways. First, the semi-structured interview schedule used to induce discussion among participants was loosely structured around library based and electronically available resources, allowing students to raise their own issues. Therefore, the central issues reflected in the themes above are generated from what students believed to be of importance, rather than by researcher topics. Second, it was not expected that students would offer their own strategies and solutions to solve resource access issues. These ideas enable the researchers to feed back to Information and Library Services at the University (e.g. regarding postal loans) and influence the content of the guide. They also further reveal the extent of the students needs. Again, it is unlikely that this level of detail would have been achieved through the administration of a questionnaire. Therefore, although this study is limited in terms of the number of students that participated, the researchers believe that what may be lost in quantity of responses has not curtailed the value of the results in terms of quality. Further, this initial study will inform the construction of a wide ranging survey, with items based on the students’ issues.



Finally, this study has revealed the information and resource needs of health and social care placement students. While professions do have specific needs in terms of information required and ability to access that information, many of these needs are generic. In particular, the same knowledge and skills are needed for searching for information. For this reason, a generic guide is a parsimonious solution to the issues experienced across student groups, supplemented with profession-specific information. The provision of this information, with training sessions held at appropriate times for students will ensure that equity in provision will be achieved and student needs will be more successfully met. Key Messages Implications for Policy • The guide that this research informs aims to improve student accessibility to library resources to enhance evidence-based practice. Implications for Practice • The findings suggest the importance of faceto-face contact with students in assessing their needs and listening to their suggestions for enhanced service. • There is a need for equity across health and social care programme and site provision in terms of resource access. • There is a need for timely and appropriate information giving and skills training. References 1 Boud, D. & Solomon, N. Work-Based Learning: A New Higher Education. Buckingham: SRHE/Open University Press, 2001. 2 Hills, J. M., Robertson, G., Walker, R., Adley, M. & Nixon, I. Bridging the gap between degree programme curricula and employability though implementation of work-related learning. Teaching in Higher Education 2003, 8, 211–31. 3 Nursing and Midwifery Council. Requirements for Pre-registration Nursing Programmes. London: Nursing and Midwifery Council, 2002. 4 Topss England. The Care Training Code: A Voluntary Code of Practice for Trainers of Social Care Students, Candidates and Staff, and a Guide for Purchasers of Training. Leeds, UK: Topss, 2001.

5 Bawden, D. & Robinson, K. Information behaviour in nursing specialities. Journal of Information Science 1997, 23, 407–21. 6 Crawford, J. A study of issues in administering library services to nursing students at Glasgow Caledonian University. Health Information and Libraries Journal 2002, 19, 90–7. 7 De Chazal, P., Harrison, J. & Hepworth, M. NHS and social care interface: a study of social workers’ library and information needs. Journal of Librarianship and Information Science 2004, 36, 27–36. 8 Haldane, G. C. Listening to health care students: the impact of new library facilities on the quality of services. Health Information and Libraries Journal 2003, 20(Suppl. 1), 59–68. 9 Lappa, E. Undertaking an information needs analysis of the emergency-care physician to inform the role of the clinical librarian: a Greek perspective. Health Information and Libraries Journal 2005, 22, 124–32. 10 Mailer, L. The UK’s SMARTAL Project: St. Martin’s College health students access to learning resources whilst on placement. Health Information and Libraries Journal 2006, 23, 110–7. 11 Nicholas, D., Williams, P., Smith, A. & Longbottom, P. The information needs of perioperative staff: a preparatory study for a proposed specialist library for theatres (NeLH). Health Information and Libraries Journal 2005, 22, 35–43. 12 Thain, A. & Wales, A. Information needs of specialist health care professionals: a preliminary study based on the West of Scotland Colorectal Cancer Managed Clinical Network. Health Information and Libraries Journal 2005, 22, 133–42. 13 Walker, C. & Thompson, H. The practice nurse project: a partnership approach to information provision in Leeds. Health Information and Libraries Journal 2003, 20, 50–2. 14 Gregg, A. L. & Wozar, J. A. Delivering internet health resources to an undeserved health care profession: school nurses. Journal of the Medical Library Association: JMLA 2003, 91, 398–403. 15 Oehlkers, R. A. & Gibson, C. C. Learner support experienced by RNs in a Collaborative Distance RN-toBSN Program. Journal of Continuing Education in Nursing 2001, 32, 266–73. 16 Dee, C. & Stanley, E. E. Information-seeking behaviour of nursing students and clinical nurses: implications for health sciences librarians. Journal of the Medical Library Association: JMLA 2005, 93, 213–22. 17 Friedman, B. D., Ward, D. & Biagianti, A. Using technology to forge new allegiances in social work education. New Technology in Human Services 1998, 11, 13–8. 18 Griffiths, P. & Riddington, L. Nurses’ use of computer databases to identify evidence for practice—a cross-sectional questionnaire survey a UK hospital. Health Information and Libraries Journal 2001, 18, 2–9.


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Needs of UK health and social care placement students, Lynne Callaghan et al. 19 Adams, A. & Blandford, A. Acceptability of medical digital libraries. Health Informatics Journal 2002, 8, 58–66. 20 Farmer, J., Richardson, A. & Lawton, S. Improving access to information for nursing staff in remote areas: the potential of the Internet and other networked information resources. International Journal of Information Management 1999, 19, 49 – 62. 21 Galambos, C. & Neal, C. E. Macro practice and policy in cyberspace: teaching with computer simulation and the Internet at the baccalaureate level. Computers in Human Services 1998, 15, 111–20. 22 McKnight, M. Hospital nurses—no time to read on duty. Journal of Electronic Resources in Medical Libraries 2004, 1, 13–23. 23 Wakeham, M. What nurses think of library services: a research study. Nursing Standard 1996, 10, 40–3. 24 Gannon-Leary, P., Wakeham, M. & Walton, G. ‘Making a difference’ to nurse education: the impact on HE libraries. Journal of Librarianship and Information Science 2003, 35, 31–46. 25 Blackburn, N. Building bridges: towards integrated library and information services for health and social care. Health Information and Libraries Journal 2001, 18, 203–12. 26 Thomas, J. & Arrowsmith, V. Working in partnership to deliver an innovative pre-registration nursing programme. Health Information and Libraries Journal 2002, 19, 161–3. 27 Monnickendam, M. An examination of predictors of computer use by human service workers. New Technology in Human Services 1996, 9, 18–24. 28 Hodgson, A. L., Rothney, P. & Crumley, E. T. The teachable moment: the nursing intervention at Children’s Hospital, Winnipeg, Manitoba. Bibliotheca Medica Canadiana 2001, 22, 157–9. 29 Health Faculty Team, University of Leeds. The Liquid Library Project: Supporting the Information Needs of Students on Placement. 2002. Available from: http:// www.cilip.org.uk/NR/rdonlyres/1CC09EA5-ED2C-464AB57F-FCA66EF5946C/0/leedsuni_pres.PPT#2 (accessed 12 December 2006). 30 Walton, G., Smith, A., Gannon-Leary, P. & Middleton, A. Supporting learning in practice in the EBL curriculum: pre-registration students’ access to learning resources in the placement setting. Nurse Education in Practice 2005, 5, 198–208. 31 Krueger, R. A. Focus Groups: A Practical Guide for Applied Research. London: Sage, 1994. 32 Smith, C. P., ed. Motivation and Personality: Handbook of Thematic Content Analysis. New York: Cambridge University Press, 1992.

33 Choi, G., Ligon, J. & Ward, J. Computer anxiety and social workers: differences by access, use and training. Journal of Technology in Human Services 2002, 19, 1–12. Received 7 August 2007; Accepted 13 November 2007

Appendix 1 Focus Group Schedule Introductory question: • Now that you are nearing the end of the first year of your degree programme, have you enjoyed your placements so far? Connecting question: • Whilst on placement, how often do you need to access resources? Core questions: • What are the main issues for you in accessing and using library resources whist you are on placement? • What have been the main issues for you in accessing and using IT based resources whilst you are on placement? • How could access and use of • Library resources • IT based resources be improved? • We will soon be producing the first copy of a library resource guide. • How do you think the guide should be presented? • What do you think should be contained in the guide to improve access and use of library and IT resources whilst you are on placement? Closing question: Can you think of any other issues that have affected you in terms of accessing and using resources whilst you have been on placement that have not been discussed so far?
