key: cord-1025979-gf281nav authors: Gillett, Claire; Mason, Susan; Fleming, Louise; Mayer, Deborah K.; Bryant, Ashley Leak title: An academic–practice partnership during COVID‐19 pandemic: Transitioning from a clinical to virtual fellowship date: 2021-04-29 journal: J Clin Nurs DOI: 10.1111/jocn.15817 sha: dc34280ef1b3537b2c399b64a2ee53fa819c2ffb doc_id: 1025979 cord_uid: gf281nav AIMS: Discuss the needed modifications that occurred to the academic–practice oncology partnership during the COVID‐19 pandemic. BACKGROUND: To meet the workforce needs of nurses who care for adults with cancer, an academic–practice partnership was created in 2016. The University of North Carolina at Chapel Hill School of Nursing, North Carolina Cancer Hospital and UNC Lineberger Comprehensive Cancer Center collaborated to provide structured clinical and didactic practice experiences for undergraduate nursing students interested in oncology nursing. With COVID‐19, nursing students were not permitted to be in the clinical setting. DESIGN: Discursive paper. METHOD: An innovative and collaborative partnership created reflective and interactive activities. The majority of the learning activities were created at the revised Bloom's taxonomy level of application or higher, with some encompassing multiple levels. Students engaged in a variety of meaningful experiences requiring multiple learning processes that promoted professional development in the interpersonal and critical thinking domains. CONCLUSIONS: Despite the challenges of COVID‐19, the delivery of oncology nurse fellowship was successful because of innovative virtual strategies. RELEVANCE TO CLINICAL PRACTICE: Our academic–practice partnership allowed the nursing students to develop their interpersonal and critical thinking skills without entering the clinical site. This is an approach encouraged by the authors for other schools of nursing. This manuscript is submitted as a Special Issue Discursive Article, and thus, the authors declare that an EQUATOR Checklist has not been used. Nurse educators need to ensure that nursing students with an interest in oncology nursing are approached early in their undergraduate nursing education to foster to professional development in this specialty area (Fleming et al., 2020) . Based on this need, oncology nursing fellowships have been in existence for over a decade and have demonstrated instrumental and valuable support to nursing students as they transition into practice caring for patients with cancer and their families (Coakley & Ghiloni, 2009; Mollica & Hyman, 2016) . Nursing fellowship programmes have been established since the 1980s with benefits of mentored clinical exposure and didactic experiences for the student (Lott et al., 2011; Walker, 1987) . Typically, newly graduated nurses enter their first nursing job with little oncology experiences from their undergraduate nursing curriculum. Most enter nursing with adult focussed medical-surgical experience but lack caring for adults with cancer during and after their treatment. In general and specialty fellowships, nursing students are paired with 1-2 nurses, known as preceptors, who provide a supportive environment conducive to learning for nursing students for several days to weeks. Two benefits of these nursing fellowships are as follows: (a) empowering nursing students to bridge the knowledge and clinical gap in either a general or specialty unit and (b) building workforce capacity in medical-surgical nursing or a specialty area where these students may decide to work upon nursing graduation. Our fellowship programme was modelled after the Carol A. Hospital and the Susan D. Flynn Oncology Nursing Fellowship; both of these fellowships expose nursing students to a variety of clinical and educational opportunities to foster professional development in oncology nursing (Fleming et al., 2020) . Our oncology nursing fellowship programme was initiated in 2016 with the support of Fred Flynn, Jr., who lost his wife in 2013 to ovarian cancer. In her memory, Fred named the Susan D. Flynn Oncology Nursing Fellowship, which has enabled several nursing students to partner with schools of nursing (Flynn, 2015 We had eight applicants, and four students were competitively selected for the 2020 Oncology Nursing Fellowship. Each virtual session was 1.5 hours weekly attended by the four students, SON oncology faculty, clinical staff depending on the session and the oncology Clinical Nurse Education Specialists (CNES's) joined when they were available. The programme was delivered over a 12-week period. Overall, the students were pleased in a virtual fellowship, and we were able to transition it to a meaningful experience. One benefit of the virtual fellowship was seeing each student weekly and learning more about each other personally and professionally which fostered a supportive and collaborative environment. A couple of suggestions for improvement for the virtual fellowship include collaborating interprofessionally with others who care for adults with cancer. For example, we plan to include a pharmacist and nurse practitioner in the future in the unfolding case study as 'near misses' are described. Pre-licensure baccalaureate nursing students are competitively selected for this fellowship. They submit their grade point average (minimum 3.0/4.0 or higher), resume, an essay and two letters of recommendation (one from a faculty member). On average, 10 students apply annually for two to four paid fellowship positions. The selection committee consists of seven oncology staff: two SON faculty, the Nursing Director of Oncology and Medicine, Patient Service Managers for Inpatient Medical Oncology and Blood Marrow and Transplantation, and two certified Oncology CNES's. Those who are not selected for the programme are sent a letter encouraging them to join the Oncology Nursing Society (ONS) as a student (a free membership), attend local chapter ONS meetings and meet with the oncology nursing faculty. We encourage all applicants-both those who were selected and those not selected-to consider a nursing assistant position within the cancer hospital. • Educators in academia and in the clinical setting can work to build partnerships between schools of nursing and acute care hospital settings, and partnerships can be expanded to the community and clinics. • Innovative teaching strategies using virtual platforms can be implemented during the COVID-19 pandemic, even when on-site clinical rotations are limited. • Critical thinking and interpersonal nursing skills can be facilitated in a virtual environment, using activities such as case studies, podium presentations and patient interviews, all of which can be completed online. The COVID-19 pandemic presented unique challenges for the delivery of oncology nursing content and implementation of clinical experiences for oncology fellows. In March 2020, limitations due to conserving personal protective equipment (PPE) and decreasing exposure risk during in-person student experiences were enacted at UNC Hospitals and the LCCC, which limited hands-on clinical practice. The safety of both the students and the oncology patient population were of utmost importance. These limitations, combined with our desire to decrease the potential spread of COVID-19, led us to collectively decide to deliver the oncology clinical fellowship in an entirely online format, which included a blending of reflective learning activities, online meetings and self-paced learning. In 2020, in lieu of face-to-face experiences, the fellowship organisers instead used reflective learning activities that could be implemented virtually to maintain the safety of students and oncology patients alike. The benefits and critical need for use of reflective practices for student learning is central to this part discursive paper, making the approach of this educational programme unique. In traditional nursing student clinical experiences, students typically have the opportunity to develop nursing competencies in the technical, critical thinking and interpersonal domains of learning (Wright, 2005) . At the time of the fellowship, the oncology nursing fellows were in their third semester of nursing clinicals. At this point in their nursing student trajectory, students are usually practising technical skills such as intravenous catheter insertion, administering medications and assisting with activities of daily living. However, because the oncology clinical fellowship was delivered in an entirely online format, we used a range of virtual activities to focus distinctly on the critical thinking and interpersonal domains. Through these activities, the nursing student fellows were pushed to develop their critical thinking, reflective and communication skills, all of which are essential to oncology nursing (Table 1) . Some general nursing technical skills simply could not be demonstrated in the virtual environment. However, fellows will have opportunities to practice and demonstrate these skills in their oncology immersion transition into practice capstone during their last semester of nursing school. The reflective learning activities were also developed using Revised Bloom's Taxonomy (Anderson et al., 2001) . The Revised Bloom's Taxonomy provides a framework for student learning and transfer of knowledge by outlining cognitive processes and knowledge types (Su & Osisek, 2011) . Lower order cognitive processes include remembering and understanding, while more advanced cognitive processes include application, analysing and evaluating (Heer, n.d.) . The majority of the learning activities were created at the level Reflective activity title ONS cancer basics course (provided by ONS at no cost for students) of application or higher, with some activities encompassing multiple levels. Through the reflective learning activities, students were encouraged to apply past knowledge to new situations and to draw connections between content learned in class and previous clinicals to the oncology-focussed material being presented during the fellowship. Table 1 outlines each reflective activity used during the summer oncology nursing fellowship. of chemotherapy-induced oral mucositis in adults with cancer. One advantage of virtual learning is being able to record sessions, presentations and being able to archive these for future use. Another advantage was that the students were able to learn interpersonal and critical thinking nursing skills in a relaxed and welcoming atmosphere, outside of a patient care area. Finally, as demonstrated by the reflective learning activities, students were able to enhance their development of interpersonal and critical thinking nursing skills. By engaging undergraduate nursing students in oncology-focussed content and connecting students with clinical partners, the programme coordinators are hopeful that upon nursing graduation, these students will enthusiastically seek employment in oncology nursing. For future implications after COVID-19, we have considered adding a virtual component to the fellowship in addition to the hands-on experience. Although face-to-face observation and clinical experiences were temporarily halted during the COVID-19 pandemic due to hospital restrictions, it is the hope of the fellowship organisers that in-person experiences will resume in future years. Additionally, since these students were unable to engage in an in-person cancer clinical experiences, these 4 students will be immersed in the oncology transitions to practice capstone their fifth clinical semester (last nursing semester) which includes clinical experiences in inpatient and outpatient oncology areas (Fleming et al., 2020) . Critical thinking and interpersonal skills were the expected outcomes from this fellowship. Critical thinking is essential for nursing students to provide competent and safe care while improving patient outcomes (Sommers, 2018) . Both critical thinking and interpersonal skills were evaluated through these specific examples (Table 1) : students' communication abilities during the initial and follow-up interviews with the survivors and caregivers, book discussion to connect nursing education to clinical realities, and podium presentation of their topic of interest. We provided students both verbal and written feedback on ways to enhance critical thinking and interpersonal skills and students were receptive. The programme coordinators will also incorporate the following practices in future virtual offerings to best facilitate a positive on- Finally, programme coordinators can encourage students to spell out the pronunciation of their name (s) and include their preferred pronouns at the beginning of virtual sessions, such as ASH-LEE, she/ her/hers. Despite the challenges faced during the COVID-19 pandemic, the academic-practice partnership between UNC School of Nursing and NCCH was strengthened in the summer of 2020. The programme coordinators successfully used online learning platforms to deliver the oncology fellowship with positive feedback from fellowship students and project stakeholders alike. Although it is the hope of the programme coordinators that face-to-face clinical experiences will be reinstated in future summers, aspects of the virtual fellowship can be used to supplement hands-on practice and facilitate students' critical thinking and interpersonal nursing skills. The academic-practice partnership demonstrated by the oncology nursing fellowship is relevant to clinical practice as it aims to increase students' interest in working in oncology following graduation. The programme structure described in this paper confirms that students can be engaged in oncology-focussed content and develop their critical thinking and interpersonal nursing skills even when the clinical site is not accessible. This programme structure can be mirrored by academic and clinical-based educators, with aims to foster academic and practice partnerships, and engage nursing students in specialty areas of nursing. We would like to acknowledge Laura Piver (Warren Trent Piver) and Bob Lauterborn (Sylvia Lauterborn) for their generous gifts to support this fellowship. We also thank the leaders from the University of North Carolina at Chapel Hill School of Nursing, North Carolina Cancer Hospital and UNC Lineberger Comprehensive Cancer Center for their ongoing support. The authors declare no conflict of interest. https://orcid.org/0000-0002-9852-8844 A taxonomy for learning, teaching, and assessing: A revision of Bloom's taxonomy of educational objectives One nurse, twelve hours, four patients' lives: The shift A fellowship program preparing students for employment as new graduate nurses in oncology nursing Transitions in care model for a senior-level clinical immersion experience Fellowship program to develop the next generation of oncology nurses A model of learning objectives-based on a taxonomy for learning, teaching, and assessing: A revision of Bloom's taxonomy of educational objectives Summer oncology nursing fellowship program supports undergraduate students. ONS Voice The successful redesign of a student nurse extern program Professional development utilizing an oncology summer nursing internship The revised Bloom's taxonomy: Implications for educating nurses Measurement of critical thinking, clinical reasoning, and clinical judgment in culturally diverse nursing students: A literature review Student nurse internship program Communicating with patients and families around difficult topics in cancer care using the comfort communication curriculum The ultimate guide to competency assessment in health care. , 3rd. edn. Creative Health Care Management An academic-practice partnership during COVID-19 pandemic: Transitioning from a clinical to virtual fellowship