Peer reviewed article: Using Cellphones for Work Placement Support.
Merrolee Penman (right) is Academic Leader, Postgraduate Programmes, and at the time of this study was also Associate Fieldwork Co-ordinator, with the School of Occupational Therapy, Otago Polytechnic, Dunedin, New Zealand.
Kaye Cheetham is the Fieldwork Coordinator at the School of Occupational Therapy at Otago Polytechnic, Dunedin.
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Abstract
Successful completion of fieldwork placements is an important part of undergraduate health based professions, given that fieldwork provides students not only with the opportunities to learn in the ‘real world’ but also to develop the knowledge and skills for contemporary practice. This article outlines the process of a trial undertaken, at the School of Occupational Therapy, Otago Polytechnic, Dunedin, New Zealand, in which, in collaboration with a telecommunications company, students went on two different fieldwork placements with cellphones. The article describes the use to which the cellphones were put and examines the effectiveness of cellphones as a medium for seeking support. While students valued the cellphones, technological issues, along with a lack of certain functions, led to the Fieldwork Team’s decision to discontinue the funding of free cellphones for use on placement. Insights into what students are seeking and when, in relation to emotional support are presented, along with areas to consider for future research.
Introduction
Fieldwork is an integral part of the learning of health based professions, with students expected to complete one or more ‘placements’ in the practice setting during their academic program, usually under the direction of a practitioner of that discipline. For Occupational Therapy, fieldwork is a key component of the academic program. The World Federation of Occupational Therapists (WFOT) states that the purpose of fieldwork is to ‘…integrate knowledge, professional reasoning and professional behaviour within practice, and to develop knowledge, skills and attitudes to the level of competence required of qualifying occupational therapists’ (Hocking & Ness 2002:24). Thomas, Penman and Williamson (2005) concur, stating that fieldwork provides opportunities for students to develop a concept of what their role will be in the future; indeed fieldwork is the place where graduates develop the ‘…skills and competencies to meet the challenges of contemporary practice’ (2005:78).
Given the strong emphasis placed on the value of learning through fieldwork by the profession, it is not surprising that the WFOT sets high standards for those institutions applying for accreditation. The WFOT states that students must experience a range of placements, with a range of people in a range of different circumstances, and that students must each have a minimum of 1000 hours ‘…implementing an occupational therapy process, or an aspect of an occupational therapy process with, or for, a real live person’ (Hocking & Ness 2002:24).
To enable achievement of this high standard, a number of models for fieldwork, such as role emerging, collaborative, or interagency have been proposed (Thomas, Penman & Williamson 2005). However, in the main, the profession of Occupational Therapy has continued to use the apprenticeship model (Thomas & Storr 2005), with one student being placed with one or two supervisors, for the fieldwork placement. It would seem that this model is the most valued by the profession (Bonello 2001), yet it can also mean that students can come to rely heavily on the supervisor(s), not only for their professional learning needs, but also for other needs such as emotional or social support (Mitchell & Kampfe 1993). While many supervisors (especially in rural areas) can, and do, accommodate these needs, some do not, which leads to students feeling isolated from peers, family and school.
The context
The staff of the three year Bachelor of Occupational Therapy program at the School of Occupational Therapy, Otago Polytechnic, New Zealand value the importance of fieldwork. Fieldwork in this program provides ‘…students with opportunities to apply and consolidate their knowledge and skills gained in academic campus papers and develop practice knowledge, skills and attitudes’ (School of Occupational Therapy 2006:14). Consisting of nearly 30% of the total hours of the program, students are expected to complete 1057 hours on placement working under the supervision of registered occupational therapists across a wide range of settings (School of Occupational Therapy 2003). These hours are distributed across six placements of varying length (four to eight weeks), five of which occur anywhere throughout New Zealand, to ensure that the students have the breadth of placements as outlined in the WFOT standards (Hocking & Ness 2002).
With up to 65 students to place, and offers made for placements coming from throughout New Zealand, students can either find that there are several of them placed in the same city, or that, in the smaller regions, they may be the only one in that location. This potential geographical isolation is but one of a number of stressors for the student (Mackenzie 2002; Steward 1994; Wooster 2004). The list can also include for example, changes in their roles from student to student therapist (Steward 1994), dealing with challenging client behaviours or different situations (Lieberman 1998; Mackenzie 2004; Sychev 1998), and feeling unsure of their supervisor and their expectations (Mackenzie 2004; Mamchur & Myrick 2003). In an early study Mitchell and Kampfe (1993) posted a written questionnaire to 101 Occupational Therapy students on their final placements. Over half of these students stated that fieldwork was stressful. A similar finding was found in a later study by Tyrrell (1996) with Occupational Therapy students experiencing higher levels of psychological distress in the weeks just preceding fieldwork, as well as while on fieldwork, compared with attendance at classes on campus.
In understanding that fieldwork is stressful, researchers have attempted to identify the types of coping strategies students utilise. For example, Mitchell and & Kampfe (1993) identified several positive strategies that Occupational Therapy students in their final fieldwork placement used to manage the stresses of placement. These strategies were ‘Problem-Focused’, described as identifying a plan of action for the problem identified and ‘Seeks Social Support’, described as ‘…involving efforts to obtain information, advice or emotional support’ (Mitchell & Kampfe 1993:545). Seeking social support was also a key support system for nurses (Lo 2002), more so in their final years when the students are assuming the most responsibility for the safety and wellbeing of the people they work with.
An investigation of students’ reflective accounts (Lieberman, 1998; Sychev, 1998) also demonstrates that students believe that the support of their peers is essential to managing some of the stressors of placement. Both Lieberman (1998) and Sychev (1998) describe feelings of anxiety as they enter the mental health facility for the first time. Sychev goes on to state that it is crucial for students to support each other and to discuss concerns, as this will ensure that each student feels less overwhelmed by the experience. This is made possible, in Sychev’s experience, as there was more than one student in the facility. However, this is not always the case for all, with students who are geographically isolated needing to find other media to gain peer support.
The types of behaviours that students define as emotionally supportive are less clear. In a study of a web-based support system for students on placement, researchers identified behaviours such as personally supportive emails using words of encouragement or those indicative of a ‘can do’ attitude (Wooster, 2004). Students in this study also noted that they were keen to participate in this online support system as they wanted to both hear from their classmates and keep in touch with them, and that they felt encouraged by their peers. Specific comments included:
[The] group helped me feel more supported, when I had difficulties on fieldwork, I knew I had a support and resource group to access for emotional help and information, and that the group helped me feel less lonely and isolated on fieldwork (Wooster 2004: 27).
Lieberman (1998) describes how being on placement with another student was good as they could ‘…give each other support and shar[e] how each felt the other performed and could improve’ (1998: 150) by helping each other to work towards reaching higher levels of achievement for the goals they had set themselves for the placement.
The experience of Otago Polytechnic students reflects that of the international literature. In an action research study a group of Otago Polytechnic first, second and third year students were asked to identify key issues regarding fieldwork placements that were not related to learning outcomes, teaching/learning methods or the evaluation of their performance on fieldwork (Penman 1998). When ranked, the second highest on the list was about how to find ways of meeting their needs for emotional/social support while on placement. Although this study was also carried out some time ago, anecdotal evidence suggests that this is an ongoing issue for our current students, as well as those of other Occupational Therapy programs where students are expected to travel to locations outside of their home towns (McLeod & Barbara 2005; Paterson, McColl and Paterson 2004; Thomas & Storr 2005).
As emotional support provided by peers and significant others appears to be very important for students’ success on placement both in New Zealand and elsewhere, what formal mechanisms have been put in place by Occupational Therapy programs? Apart from the support that happens on an informal basis where there is more than one student in the same location, fieldwork staff have trialled online communication forums as well as teleconferencing.
Thomas and Storr (2005) investigated the use of an online learning tool for students to use while on placement. Although they did not report on the use of the online discussion forums for peer support, they did note that students explored their feelings towards the experience of fieldwork. McLeod and Barbara’s (2005) study also supports the notion of the need for emotional support from peers. They investigated the use of online technology to support students’ learning while on rural and urban placements in Australia, the United Kingdom and Vietnam, with 59% of students (n= 97) noting that peer support was the major advantage for using online synchronous chat. In fact nearly a quarter of the students went online to talk with their peers at times other than those timetabled with fieldwork staff. With further analysis, the authors noted that online chat was predominately used for social support rather than as a tool to facilitate learning, leading to the conclusion that online chat reduced social isolation. The findings of this study are supported by Wooster’s (2004) study of students on placement in the United States’ state of Alabama, where 54% of the online communication (occurring through a Learning Management System -LMS- or email) was coded as being the sharing of personal experiences, or actual support of classmates or use of the system to organise get-togethers etc. Like McLeod and Barbara (2005), Wooster (2004) also found that students used what was originally intended to be a mechanism for fostering learning, to also stay in touch with their classmates. The most frequent users were those who were placed by themselves in a remote location.
Other technologies such as teleconferencing have been explored. A short study using post course questionnaires was undertaken by Paterson et al (2004). In analysing the results, the authors determined that a weekly teleconference with students on fieldwork placements in smaller communities in Ontario, Canada was useful in alleviating students’ sense of isolation and need for support.
This review of the literature suggests that Occupational Therapy students who are on placement value the opportunity to gain or offer emotional support to their peers. The media used in these studies were either web based, enabling students to communicate in their own time and place or via teleconference which is time bound, but not necessarily place bound. However, in the studies reviewed, the daily interactions were open to staff and all other students’ view, and in the case of teleconferencing could only be set up by staff. While students may seek support from an academic on the Fieldwork Team, there may also be aspects of their placement that they would prefer to only talk over with a peer initially. Both web based discussion forums or telephones do not necessarily allow this element of privacy.
An alternative medium to enable peer support to meet emotional needs is that of the cellphone which allows for communication at any time, any place (along as coverage is available), and anywhere through voice or text. The use of cellphones to support students during fieldwork placements does not appear to have been offered previously by an Occupational Therapy school, although their use in education has been investigated more extensively. For example, Low and O’Connell (2006) identify ‘relate’ as one of the four building blocks of mobile activity, with cellphones providing opportunities for the learner to feel part of a social context and have easy access to a network of knowledge.
Kukulska-Hulme and Pettit (2006) discuss the value of cellphones in enabling individuals to feel part of a community where they not only keep in touch, but both offer and receive support from their peers. The communication can happen in real time, through voice interaction, or on an asynchronous basis, in that peers can text each other. With texting, the phone may be turned off but at a later point the recipient can read the text message and feel that they are ‘cared for and remembered’ (Ellwood-Clayton 2006:360). Respondents in this research reported that receiving texts provided them with great emotional support, with Ellwood-Clayton suggesting that texting is a ‘…form of social or emotional hospitality: as goodwill enacted on a micro level through cyber means’ (Ellwood-Clayton 2006:360).
Meeting the support needs of students at Otago Polytechnic
The Fieldwork Team at Otago Polytechnic have continually sought ways to provide better mechanisms for student placement support. Since the beginning of the program in 1993, students have always been able to get support from the Fieldwork Team through the use of a freephone number. While every effort is made to encourage students to use this system, there are a number of problems with usage, for example, where phones are only available in public areas where conversations can be overheard. Students also stated that the Fieldwork Team could be difficult to track down as staff were not always at their desks when the phone call was made.
To enable easy contact between peers, the Fieldwork Team provides a contact list which lists every student, their placement address and work phone number. Again, while students find this resource useful, they noted that it was difficult to know when to ring, and they were also conscious that these were private calls being made in work time. Often it was difficult to contact each other in the evenings, as some students stayed in residential facilities or ‘backpackers’ for the duration of the placement, making phone contact problematic.
With the introduction of a new Learning Management System (LMS) Blackboard ™ in 2003, the team instigated the use of asynchronous discussion forums for use by students while on placement. Students were divided into groups according to practice areas and had one forum for discussion on issues arising from their learning on placement. The discussion in this forum was facilitated by one member of the Fieldwork Team. A second forum was also provided for students to use for social support and ‘chit chat’ with assurances given that these chats were not accessed by staff. Often the number of messages in this ‘cafe forum’ outstripped those in any other forum suggesting the students used this format as an informal support mechanism. For a recent placement 76.8% (n = 33) of students accessed the online forums. In the cafe forum, 25 students posted 117 messages with an average of 4.6 postings made by each student. In the staff led forums (n = 4) the number of postings in the main were fewer, varying from 1.7 to 3.7 per student. In addition, although the numbers of students posting in staff led forums (n = 30) was slightly more than in the cafe forum (n = 25), the number of postings was higher in the cafe (n = 117) than in the staff led forums (n = 76).
Although a number of students accessed Blackboard™, the Fieldwork Team were aware that some students were unable to do so and were therefore unable to take advantage of this means of support. Being aware that support from peers and the staff of the school was an ongoing issue, the school continued to look for alternative options.
Partway through 2005, Otago Polytechnic was approached by a cellphone telecommunications company (hereafter referred to as the Company) to explore the possibility of providing free cellphones to support students’ learning. The Fieldwork Team was keen to take up the offer believing that the use of cellphones may be the means by which students could more easily access the support they needed, when they needed it.
As part of the agreement with the Company, the School of Occupational Therapy undertook to explore the effectiveness of cellphones in supporting the students while on placement. The aims of the trial were to:
- provide students with another tool for communication (with their peers and staff of Otago Polytechnic)
- provide supervisors with another tool for communication with staff of Otago Polytechnic
- evaluate the benefits and limitations of the use of cellphones from the perspective of the Fieldwork Team and students.
The Fieldwork Team engaged in this project for a two primary reasons.
1) The Fieldwork Team were increasingly aware that many of the students use cellphones as their primary means of communication, especially to text each other. The team were interested in exploring whether free cellphones that enabled students to talk with each other would assist students to feel more supported by their peers and staff on placement.
2) Although a number of support mechanisms had been put in place, the Fieldwork Team acknowledged that each had advantages and disadvantages and was therefore keen to continue exploring other means of communication.
Methodology
The methodology selected for gathering feedback about the use of cellphones as tools to enable easy support for students was qualitative. A short written questionnaire was completed by the students after their placement and the Fieldwork Team members also contributed their impressions of the value of the cellphones for communication. At a later stage, a focus group was held with a small group of students to explore, in more depth, how the phones might have met their needs for emotional support.
Process of data collection
Students completing their second (Fieldwork 3) and final (Fieldwork 6) fieldwork placement, of six and eight weeks duration respectively, participated in the trial. These two groups were chosen for a number of reasons. Fieldwork 3 is often the first placement where students are placed in geographical locations that they have not previously been and where they have to find accommodation. In addition the placement expectations increase as students are asked to take part in all parts of the occupational therapist’s role. Fieldwork 6 was also selected as this is the last and longest placement for the students. These students were familiar with all our support systems and it was envisaged that they could give objective views as to the value of cellphones as tools for student support, given that their views would not impact on whether they continued to have cellphones for their next placement.
Students in Fieldwork 3 received their phones in the second week of their six week placement. This delay was unavoidable. The plan had been for the students to be provided with the phones before the placement started. Students in Fieldwork 6 received the cellphones before going on placement. The cellphones provided were either a Nokia 1100 (80% of total) or Sony Ericsson J200i (20% of total). Usage of the phones and phone accounts was determined by the Company as they provided the phones and phone accounts.
Students were not able to use the texting function, but were able to talk to each other or to the Fieldwork Team for unlimited minutes at no cost. Students were unable to contact friends or family who had accounts with the same Company, although the friends and family could phone the student. To ensure professional and appropriate use while on placement, the Fieldwork Team asked students to discuss with their supervisors when and where the phone could be used and when they should be switched off.
Students were also reminded that as there was no message minder service available, they would need to check their missed calls list in order to know when they had missed a call. There were no restrictions on evening use of the phones, but again they could only call other students on the same placement, not family or other social supports.
At the post-placement debriefings, students were invited to complete a written questionnaire. As the use of cellphones for students on placement was at this stage exploratory, only three questions were asked. The questions included:
1) On average how often did you use the cellphone?
2) What did you primarily use the cellphone for?
3) What difference did having the cellphone make to your placement?
These were completed by students present and no identifying data was collected. Once collected the Fieldwork Administrator, who was not involved in the project, typed all comments. These comments were then analysed by the Fieldwork Team. Four key areas emerged from the data collected. These were:
- having the phone made no difference
- the phone was used for contact with friends
- the phones were used for contact with school and
- the quality of the phones.
The staff members supporting the students during this placement also provided verbal comments related to their experiences of using the cellphones to contact students and their supervisors. Consent to collect and analyse the data was sought and granted from the Ethics Committee of Otago Polytechnic.
Eighteen months after the phones were trialled, students who had completed Fieldwork 3 in their second year were invited to take part in a focus group which was held after their debrief for the final placement (Fieldwork 6) at the end of their third year. The group was asked to reflect on what the phrase ‘emotional support’ meant to them, whether they used the phones for emotional support, and if they did, how did having the phones meet their emotional support needs. The focus group timing proved to be fortuitous, as students had just completed their final placement and could also reflect on what it was like to have a placement where cellphones had not been provided, versus the placement they had 18 months before, when the cellphones were provided.
Results
Student perspectives on the use of cellphones while on placement
Eighty-five percent (n = 44) of Fieldwork 3 and 100% (n = 47) of Fieldwork 6 students completed the questionnaires. How often the students used the phones varied across both the student group and between the two placements.
Figure 1: Frequency of Cellphone Use
Figure 1 shows this variance with both Fieldwork 3 and Fieldwork 6 students using the phone either daily or weekly. Of interest is the data that suggests that while the Fieldwork 6 (third year students) were more likely to use the phone weekly or less than weekly, the Fieldwork 3 (second year students) were more likely to use the phone daily or at least weekly. Why this pattern may have occurred will be discussed in more detail in the discussion section.
The primary use of the phone by both student groups is outlined in Figure 2 with both second and third year students primarily using the phones to talk with each other, rather than with the staff of the school.
Figure 2: Primary Groups Contacted
The third, open-ended question provided students with more opportunity to expand on their ratings. The question asked: What difference did having the cellphone make to my placement? Analysis of the comments led to the identification of the following themes:
• the phones made no difference
• the phones were good to catch up with friends
• the phones were good to contact the school
• the quality of the phones.
The cellphone made no difference to my placement…
Fourteen percent of Fieldwork 6 and nine percent of Fieldwork 3 students stated that the phones made no difference to their placement. Fieldwork 6 students suggested that either the cellphone made little difference to them, or that the phone was nice but not necessary or essential, or that it was annoying as they had to carry two cellphones. Fieldwork 3 students on the other hand, were more likely to state that it made no difference as they had difficulty either with getting a signal, or with the fact that the phones were not good quality, or that the phones arrived too late to make a difference on placement.
The phones were good to catch up with friends…
The Fieldwork 3 students appeared to use the phones more for contact, with only one of the 15 students stating that the phone was useful for gaining support. One student noted that it was valuable for keeping in contact because he/she didn’t have Internet access and therefore couldn’t use the fieldwork discussion forums. Fieldwork 3 students also commented on the ‘no-cost’ benefit which facilitated their use. It must be remembered that the Fieldwork 3 students did not receive their phones until part way through the placement, with one student noting that it would have been useful earlier in the placement, when he/she was feeling more unsettled.
The phones were good to contact the school on placement…
The purpose of the phones was not only to make contact between peers easier, but also between the students and the Fieldwork Team. For Fieldwork 6 students who made comments around this theme, the value of being able to contact the school more easily was identified. Several students noted that they felt more supported by the school, and that the cellphones were almost a ’security blanket’ in that they knew they could get in touch anytime. One student noted that he/she would not have rung so often if they hadn’t had the phone.
The quality of the phones…
Unfortunately the quality of the phones provided by the Company meant that some students had great difficulty in using the phones and this impacted on their comments regarding the difference having cellphones made to their placement. Fieldwork 3 were the first group of students to use the cellphones and they experienced a number of issues in that either the SIM card was not working, or the phones shut down midway through a call. The Fieldwork 3 students commented on the need to be able to text, and/or to have voicemail so that messages could be left. Texting was seen by some as an important function as they could text without disturbing the recipient or ringing at the wrong time. Several students (perhaps reflective of their generation) stated that texting is useful as it is the easiest form of communication.
Some of the issues with the individual phones were addressed by the time the phones were issued to the Fieldwork 6 students. Few of these students had comments to make about the quality of the phone, and having either a voicemail or text option was not mentioned by this group. The absence of comments may be because these students were aware that the possibility of a texting option had been pursued with the Company after the Fieldwork 3 placement, but had not been granted under the terms of the agreement.
Fieldwork Team perspectives on the use of cellphones while on placement
The Fieldwork Team’s perspectives of the value of cellphones for supporting students and their supervisors on placement was gathered through an informal discussion. Overall the Fieldwork Team felt that the cellphones were less effective for providing support for students than other means of communication. As the students have identified, the quality of the phones was an issue. The Fieldwork Team found that phone calls often cut off after approximately 15 minutes. If this occurred during a call where staff were supporting students who were ’struggling’ on placement, this was very disruptive, and they ended up asking the student to find a landline where disruptions were less likely.
Staff also found that while it was potentially easier to contact the student midway through the placement, it was not so easy to talk to the supervising therapist, requiring that they then completed two calls - one by cellphone to the student and the other by landline to the supervising therapist. In addition, students often had the cellphone turned off during the day (as requested by their supervising therapist), meaning that they missed the calls from the Fieldwork Team. Although students were encouraged to check their missed calls list, this did not always happen. In the main, staff tended to revert to landlines to enable these support calls to happen.
Students did use the cellphones to call the Fieldwork Team, but often the topic of the call was not for support, but to gain information or to make a request of the Fieldwork Team such as requesting permission for references. This was more evident in the third year placement as the students were applying for positions as new graduates.
Student perspectives on the use of cellphones for accessing emotional support
Students’ (n = 5) comments, gained through the focus group, provided more insight into what students meant by emotional support, and how having cellphones provided opportunities to gain this type of support. Students noted that emotional support was about knowing someone else was concerned about them and there to provide help. Help could be as simple as talking to someone who was in a similar situation, or having someone to ‘pick you up’ at the end of a day when things hadn’t gone well. One student noted that others can provide an immediate debrief, helping the student to work through the issues and be able to return to work the next day with a clear head and feeling refreshed. Students described how being able to hear a familiar voice also provided them with emotional support. Following conversations with friends, they described how their confidence was boosted or they felt less isolated as the cellphone ‘connected you to your other life’.
When asked how the cellphones facilitated feeling emotionally supported, students’ comments could be clustered under several themes. They stated that communication was instant and free so they were less likely to hesitate to call. It was easier to put their thoughts into words when talking versus typing in online forums, and that mis-communication was less likely to happen when compared with using online forums, when comments can be misinterpreted. Students could also see when they had missed a call, so even if they didn’t connect, they knew that someone else was thinking about them. In calling each other, it was possible to be more open with friends, and to be themselves, whereas to talk about the same issue with a supervisor or School of Occupational Therapy staff member could be more difficult. A comment made by one, which all agreed with, that sums up the use of the phones to meet their emotional needs was that ‘on campus you have a lot of contact with peers five days a week and gain a lot of emotional support, then you go away and in doing so you experience emotional loss’. Students also talked about how talking with their friends just helped their days go better and helped them to cope with the pressures or stressors of placement.
Discussion
It is clear from the analysis of the results that students did use the cellphones while on placement. As research with other means of communication has shown, students value having easy contact with each other as this provides them with the needed emotional support that otherwise can be lacking on fieldwork placement, especially for those geographically isolated. Students stated that the key reasons for using the phones included having the opportunity to give or receive support; to share information; or to gauge their progress. Those who used the phones for the above reasons agreed that having cellphones did make a difference to how they felt on placement. Students expressed how being able to hear someone helped them to sort through the issues arising from their day. This was easier as the listener was often in a similar situation and could understand the issues, but could also help to reframe issues in a way that allowed the caller to put the issue in perspective, or feel his/her confidence boosted again, or even just feel that he/she had been listened to. Students felt that the phone connected them with their ‘other life’ in ways that other media such as online discussion forums or discussions with academic fieldwork staff did not. Cellphones were also useful as students could select who they talked to about what. The conversation was one to one and not seen or heard by the rest of their peers. It seems that cellphones offer privacy and opportunities to explore without feeling that they might be judged by the listeners, or in the case of online forums, the viewers.
This need for a level of support from peers and family is evident in literature both in Occupational Therapy (McLeod & Barbara 2005; Penman 1998; Wooster 2004) and other allied health fields. This small study clearly shows that some students have a need to feel supported while on placement. However, the question must be asked as to whether cellphones are the best medium for providing this support?
From the students’ perspective, cellphones would appear to be the best solution. As noted by eminent authors in the learning technology world, younger students are Generation Y (Murray 2005) or ‘Digital Natives’ (Prensky 2001) These students are confident and comfortable with technology (Murray 2005) with ‘…cellphones and instant messaging integral parts of their lives’ (Prensky 2001:1). Some of the characteristics of this generation are their ability to multi-task, to want to receive information fast, and to benefit from being able to collaborate or network (Prensky 2001; Murray 2005). Technology is ‘…assumed to be a natural part of their environment’ (Murray 2005:1) and cellphones appear to be a natural extension of who they are. This is evident in New Zealand, where it has been reported that 85% or 3.6 million people own a cellphone, with many of the younger generation having two phones (Nowak & Dye 2006). Students in this group also liked the cellphone as they could see missed calls.
If, from the students’ perspectives, cellphones are good tools for supporting each other, the question to ask is which type of communication is best? Students in this study were only able to call each other, yet it was clear in the responses that the students would have preferred to also have been able to text each other. This is not surprising given New Zealanders’ frequent use of texting for personal communication. The structure of telecommunications contracts supports the high use of texting rather than calling, as is the case in other countries (Nowak & Dye 2006). While students may prefer to text, would texting provide the level of support they value which was often more than just ‘touching base’? One of the drawbacks of texting noted by Kukulska-Hulme and Pettit (2006) is that text based messages lack intonation or inflection, and that as messages need to be short, can interaction truly be meaningful? Depth of thinking is difficult to elicit through short text messages.
The last question arising is related to how much and what type of support is needed and when by the students. As noted in the results, the second year students received their phones after placement had started. Even with this delay they tended on average to use the phone daily or at least weekly, while the third year students who took the phone on placement with them were likely to use the phone weekly or less. Higher use by second year students is not surprising given that for many this is the first placement where they may have had to travel to an area where they know no-one. In addition, the expectations have risen from the first placement, with the students taking more responsibility for parts of the Occupational Therapy process (under the guidance of a supervisor). Their perceived level of stress or potential stress may be higher (Tyrrell 1996), hence the increased use of phones for support.
The third year students were completing their final placement. They may have had at least two other placements where they were geographically isolated and may have perhaps become a little more resourceful in terms of how and where they sought support. In addition, although the expectations for this placement have also risen, these students were almost at the end of their education and were aware that they would be expected to function at a similar level on securing a new graduate position perhaps only two weeks after finishing placement. They may have felt more secure and resourceful than the second year students, and thus not needed to reach out to their peers as much for support.
Conclusion
The aim of this study was to explore the use of cellphones as an additional support mechanism for students on placement. One of the key areas was to explore whether cellphones were a more effective tool than other mediums used previously i.e. a freephone number and discussion forums online. Analysis of the data would suggest that despite the quality of the phones and the lack of texting options, students in both the second and third year found the cellphones valuable in enabling peer support for emotional needs, whether this was just ‘touching base’ or the seeking or providing of a much deeper level of support. As noted in the review of the literature the need for support by peers in times of high levels of stress is considered vital by students and the cellphone appears to be a valuable mechanism to aid this, as it allows one on one discussion with a person of the student’s choice. The opportunity to explore their thinking with a trusted friend was very important to the students seeking emotional support.
While the Fieldwork Team recognise the value of peers for emotional support, there were a number of outstanding issues/questions which meant that the provision of cellphones for students while on placement was not continued in subsequent years. There were a number of reasons for this.
Firstly, many of the students valued the ability to ‘text’ each other. This was not offered in the Company contract, and was not likely to be offered given that many young people choose the texting option for their contracts with cellphone companies. The students can already ‘text’ each other on their personal cellphones. In addition, the literature suggests that students seek support both from their peers but also their family and friends outside of the program. The contract offered by the Company restricted access only to those currently on fieldwork, thus excluding others that also provide valuable support.
Secondly, the quality of some of the cellphones provided by the Company meant that communication was interrupted or difficult. While some of these issues were addressed between the second and third year placements, difficulties were ongoing. Without excellent quality, students would soon become frustrated with the technology and stop using it.
Thirdly, as this was a trial, the costs of the cellphones were sponsored by the Company. If the provision of free cellphones to students was to continue then the ongoing costs would have needed to be absorbed in the school budget. The Fieldwork Team, in reviewing the students comments as well as the staff experience of using the phones to contact students, felt that the benefits did not outweigh the costs. It is possible for students to use their own phones to both seek and provide support, as well as using landlines available in their workplaces or in their home locations. If landlines are not available, students could also use Blackboard™ (the chosen learning management system) as a communication medium. While it is clear that access to these communication tools can be restricted for some students and that in the case of online forums, the discussions can be read by all, the Fieldwork Team felt that students could access at least one of these tools at any point in time while on placement. While the cellphones were a ‘nice’ addition, the phones could not effectively replace the other mediums. In times of scarce resources, the benefits of cellphones did not outweigh the cost of providing them.
Recommendations for the provision of emotional support
It would appear from this small study that for some students, at some points in their placement, support from peers is essential. Indicators in this study suggest that those who are more geographically isolated (i.e. the only student in that facility) are more likely to seek emotional support from their peers which can be as simple as ‘touching base’ through to in depth discussions. This support seems to be needed earlier in their program of education rather than later when support networks may have been strengthened.
In planning to provide a medium for support, academic staff need to consider flexibility. Students need to:
- be able to select who they want to contact,
- know that the conversation can be private if required, and
- not only connect with the person, but know that even if the connection doesn’t happen that the other person is thinking of them.
This need for flexibility means that academic staff may need to consider providing more than just one medium for support. Most tools used for flexible learning have inherent issues in relation to communication. As noted earlier, texting is quick, used by this generation extensively, private and can be asynchronous, but can the depth of understanding that may be important for emotional support be provided? Ellwood-Clayton’s (2006) research suggests so when considered for informal use, but further research is required.
Calls to each other can be made via cellphones, but flexibility can be compromised. The person seeking the support needs to call when the listener is available. Poor reception, low batteries, or lack of money on the phone may impede the student’s ability to seek the support when it is most needed.
Online discussion forums are also offered, but again while more flexible in that students can post their thoughts at a time and place that suits them, and the recipient can also respond in their own time and place, with current LMSs, private conversations are more difficult to manage. The student seeking emotional support needs to feel comfortable with the message they are, in essence, broadcasting to all their peers and to the academic fieldwork staff who read, manage or moderate the forums. The openness of such communication may prevent a student seeking emotional support in this way. Students have also noted (as others have) the possibility of meaning being misinterpreted due to the lack of visual or auditory cues.
It would seem then that perhaps more than one medium needs to be offered to students who are seeking emotional support while they are on fieldwork placement. At different times, with different groups of students, different media might be used. Being able to access a range of media would give students the flexibility they desire.
Directions for Future Research
The design of this study was to initially provide data from which the Fieldwork Team would be able to recommend the ongoing purchase of the cellphones for use on placement. The questionnaire used was simple, but in being simple, other means of data collection were not undertaken at the time. Since completing the data analysis and writing this article, the Fieldwork Team have identified that the following information could also have been sought in order to provide more detailed data on which to base decisions on the effectiveness of cellphones as a support mechanism. The students provided their subjective impressions of how often they used the phones, which may or may not have been accurate. A record of calls made, when, for how long and to whom, would have provided more accurate data of cellphone use between peers, as well as between the Fieldwork Team and the students. This record would have more accurately captured whether a pattern of cellphone use occurred, for example, earlier in the placement, or evenly throughout the placement.
The impact of cellphones on the use of other means of communication such as the discussion forums or their own phones was also not captured. For example, did the ‘cafe forum’ accessed only by students decrease in the number of postings, stay the same or increase? Would students have used their own cellphones to communicate via text or to call if they did not want others to read what they wished to communicate?
Finally, the perspective of the supervising occupational therapists was not captured. Supervising therapists are equal stakeholders in the fieldwork process. They may have been able to provide a different viewpoint about the use of cellphones as a support mechanism than that provided by the Fieldwork Team or the students.
Acknowledgements
Stage 2 and 3 students, School of Occupational Therapy, Otago Polytechnic for your enthusiastic adoption of the cellphones, and your willingness to share your experiences via the written questionnaire.
Mobile First for providing the opportunity to trial the phones.
Otago Polytechnic for providing the support to enable the trial to be undertaken.
Jo Murray for her support in the writing of this article.
References
Bonello, M. 2001, ‘Fieldwork within the context of higher education: a literature review’, British Journal of Occupational Therapy, vol. 64. no. 2, pp. 93-99.
Hanks, P. (ed) 1989, Collins Concise Dictionary Plus, Collins, London.
Hocking, C. & Ness, N. E. 2002, World Federation of Occupational Therapists. Revised minimum standards for the education of occupational therapists, The Council of the World Federation of Occupational Therapists 1958, Perth, Western Australia.
Knowles, M.S. Holton, E.F. & Swanson, R.A. 2005, The adult learner. The definitive class in adult education and human resource development (6th ed.) Elsevier, Amsterdam.
Lieberman, S.S. 1998, ‘Inspirational beginnings in an occupational therapy mental health setting’, Occupational Therapy in Mental Health, vol. 14, no. 1/2, pp. 143-154.
Lo, R. 2002, ‘A longitudinal study of perceived level of stress, coping and self-esteem of undergraduate nursing students: An Australian case study’, Journal of Advanced Nursing, vol. 39, no. 2, pp. 119-126.
Mackenzie, L. 2002, ‘Briefing and debriefing of student fieldwork experiences: Exploring concerns and reflecting on practice’, Australian Occupational Therapy Journal, vol. 49, pp. 82-92.
Mamchur, C. & Myrick, F. 2003, ‘Preceptorship and interpersonal conflict: a multi-disciplinary study’, Journal of Advanced Nursing, vol. 43, no. 2, pp. 188-196.
McLeod, S. & Barbara, A. 2005, ‘Online technology in rural health: Supporting students to overcome the tyranny of distance’, Australian Journal of Rural Health, vol. 13, pp. 276-281.
Mitchell, M.M. & Kampfe, C. M. 1993, ‘Student coping strategies and perceptions of fieldwork’, American Journal of Occcupational Therapy, vol. 47, no. 6, pp. 535-540.
Murray, C. 2005, ‘M-learning and the new students’ thinking’, The Knowledge Tree Edition 7. Retrieved 20 May 2006 from http://knowledgetree.flexiblelearning.net.au/edition07/html/pra_murray.html
Nowak, P. & Dye, S. 2006, ‘Doubling up the trend for text messaging’, New Zealand Herald, 28 January, 2006. Retrieved 28 January 2006 from http://tinyurl.com/23gk9a
Paterson, M.L. McColl, M.A. & Paterson, J.A. 2004, ‘Preparing allied health students for fieldwork in smaller communities’, Australian Journal of Rural Health, vol. 12, pp. 32-33.
Penman, M. 1998, Action Research Project. Unpublished assignment submitted in partial fulfillment of the Diploma of Teaching (Tertiary), Christchurch College of Education, available from the author.
Prensky, M. 2001 ‘Digital natives, digital immigrants?’. Retrieved 20 May 2006 from http://tinyurl.com/2ufz3o
School of Occupational Therapy, 2006, Bachelor of Occupational Therapy Programme Document, Otago Polytechnic, Dunedin, New Zealand.
School of Occupational Therapy, 2003, Bachelor of Occupational Therapy manual for therapists supervising students, Otago Polytechnic, Dunedin, New Zealand.
Sychev, V. 1998, ‘Memoirs from a mental health affiliation’, Occupational Therapy in Mental Health, vol. 14, no. 1/2, pp. 129-141.
Thomas, Y. Penman, M. & Williamson, P. 2005, ‘Australian and New Zealand fieldwork: Charting the territory for future practice’, Australian Occupational Therapy Journal, vol. 51, no. 1, pp. 78-81.
Thomas, A. & Storr, C. 2005, ‘WebCT in occupational therapy clinical education: Implementing and evaluating a tool for peer learning and interaction’, Occupational Therapy International, vol. 12, no. 3, pp. 162-179.
Steward, B. 1994, ‘Researching fieldwork practice in occupational therapy’, Educational action research, vol. 2, no. 2, pp. 259-265.
Tyrrell, J. 1996, ‘Levels of psychological distress among occupational therapy students’, British Journal of Occupational Therapy, vol. 59, no. 8, pp. 365-371.
Wooster, d. 2004, ‘An exploratory study of web-based supports for occupational therapy students during Level II fieldwork’, Occupational therapy in Health Care vol. 18, no. 1-2, pp. 21-29.
