Pain: A content review of undergraduate pre-registration nurse education in the United Kingdom

BackgroundPain is a global health issue with poor assessment and management of pain associated with serious disability and detrimental socio economic consequences. Pain is also a closely associated symptom of the three major causes of death in the developed world; Coronary Heart Disease, Stroke and Cancer. There is a significant body of work which indicates that current nursing practice has failed to address pain as a priority, resulting in poor practice and unnecessary patient suffering.Additionally nurse education appears to lack focus or emphasis on the importance of pain assessment and its management.DesignA three step online search process was carried out across 71 Higher Education Institutes (HEIs) in the United Kingdom (UK) which deliver approved undergraduate nurse education programmes. Step one to find detailed programme documentation, step 2 to find reference to pain in the detailed documents and step 3 to find reference to pain in nursing curricula across all UK HEI websites, using Google and each HEIs site specific search tool.ResultsThe word pain featured minimally in programme documents with 9 (13%) documents making reference to it, this includes 3 occurrences which were not relevant to the programme content. The word pain also featured minimally in the content of programmes/modules on the website search, with no references at all to pain in undergraduate pre-registration nursing programmes. Those references found during the website search were for continuing professional development (CPD) or Masters level programmes.ConclusionIn spite of the global importance of pain as a major health issue both in its own right, and as a significant symptom of leading causes of death and illness, pain appears to be a neglected area within the undergraduate nursing curriculum. Evidence suggests that improving nurse education in this area can have positive impacts on clinical practice, however without educational input the current levels of poor practice are unlikely to improve and unnecessary patient suffering will continue. Undergraduate nurse education in the UK needs to review its current approach to content and ensure that pain is appropriately and prominently featured within pre-registration nurse education.     

Barriers and facilitators to recruiting and retaining men on pre-registration nursing programmes in Western countries: A systemised rapid review

BackgroundThe recruitment of men to pre-registration nursing programmes in many Western countries has remained static at approximately 10% per year.AimTo identify the experiences and attitudes of men on pre-registration nursing programmes in Western countries and the barriers and enablers to their recruitment and retention.DesignSystematized rapid review.MethodsSearches were undertaken in Medline (Ovid), CINAHL (EBSCO) and PsychINFO (EBSCO) databases. Studies in English were included if they were from Western countries, were published since 2000 and related to men's experiences of, or attitudes to, applying for or studying pre-registration nursing. Included papers were quality appraised and findings were thematically analysed and presented in a narrative synthesis.ResultsRecords were de-duplicated and 2063 records were screened and 44 articles assessed for eligibility of which 23 articles relating to 22 empirical studies were included in the review. Findings were categorised into the following themes: recruitment experiences/reasons for studying nursing; gender experiences; barriers, difficulties and challenges with programme; and factors affecting retention.ConclusionEvidence suggests that many men who come into nursing have a family member or acquaintance who is a nurse or that they have had contact with a male nurse as a patient or carer. Motivating factors such as financial security, career mobility and the opportunity to have a job in a caring profession were reported. Improved career advice at school is needed and shortened graduate programmes could be attractive. On programme, some clinical areas were easier for male students, while in others, treatment refusal could cause difficulties. Being in a minority and gender stereotyping can affect experiences. Ensuring equitable treatment, providing additional support and placements in clinical areas with more men could minimise these challenges.     

“Oh,older people,it's boring”: Nurse academics’ reflections on the challenges in teaching older person's care in Australian undergraduate nursing curricula

BackgroundNursing students encounter older people in all health care sectors; however, few choose a career primarily focused on older person's care.AimTo explore the challenges to teaching older person's care to Bachelor of Nursing students and how pre-registration nursing students are prepared to care for older people, part of a large study investigating content on care of older people in Australian nursing curricula.MethodsA purposive sample of Australian nurse academics involved in Bachelor of Nursing curriculum development or delivery completed a telephone-assisted survey. Qualitative content analysis of two open-ended questions was undertaken.ResultsAll Australian schools of nursing participated, and 45 nurse academics were interviewed. Reflecting on the challenges of teaching older person's care to nursing students, most participants felt the curriculum was too crowded and some called for a 4 year degree. In addition, students’ ageist attitudes, fuelled by unrealistic portrayals of nursing in popular culture, were reinforced by curricula being acute care focused and the ageist attitudes of some nurse academics.ConclusionsTeaching older person's care in Australian nursing curricula is challenged by insufficient time and ageism among students and academics. Regulatory bodies need to urgently provide direction so that nursing curricula content aligns with emerging Australian health care priorities, in particular the health care needs of older people.     

Habitus,social capital,leadership, and reflection: insights for early career nurse academics

BackgroundIt has been identified that nurses moving into academia have felt similar experiences of transition shock as those of new nurse graduates entering clinical practice. Moving into higher education, the early career nurse academic can find foreign the notion of different leadership approaches that have less direct supervision, leaving them unsure of their role and what is expected of them.AimTo encourage early career nurse academics to undertake regular reflective practice within their habitus, to enhance their understanding of their social capital and facilitate the use of a transformative leadership approach.MethodsThe discussion draws on the theory of Bourdieu as a lens to explore the notion that if one has access to crucial resources, they will understand how to accrue them through their relationships with others.Findings and discussionEarly career nurse academics are required to have understanding into gaining and maintaining social capital and use this as part of their leadership style. To achieve this, reflection and engaging in peer review is required. The development of an academic identity requires the building of networks and receiving mentorship.ConclusionFrom undertaking a process of reflection, early career nurse academics can take an active role in their development from gaining insight into their leadership style utilising a transformative leader approach. A critical understanding of the levels of social capital nurse academics currently hold within an organisation, will enable them to seek opportunities and areas requiring further development for their professional leadership growth.     

The Cockcroft difference: an analysis of the impact of a nursing leadership development programme

Aim Identifying impact areas of nursing leadership development programmes is needed to determine if there are measureable effects on participants. Background These impact areas help to identify measures to substantiate the benefits of nursing leadership programmes for organization leaders making decisions about support and implementation of such opportunities for their emerging leaders. Method Using mixed qualitative/quantitative methods, the impact of a nursing leadership development programme, the Amy V. Cockcroft Fellowship, is examined to determine if there are measureable influences. Results Themes of four areas of impact: improved conflict resolution/negotiation skills, communication skills, personal development and career action or change were identified through content analysis. Conclusions These themes provide the basis for creating measureable indicators for nursing organizations to use in determining the value of nursing leadership development programmes such as the Amy V. Cockcroft Fellowship. Implications for nursing management Based on the findings established in this research article, nurse managers can focus on developing themselves and their peer groups through nursing leadership development programmes to prepare for leading in the present and future healthcare environment.     

Evidence-based practice and evidence-informed practice competencies in undergraduate pre-registration nursing curricula: A document analysis at a university in England

BackgroundIn response to the heightened emphasis on incorporating the best available evidence into healthcare decision-making, healthcare training institutions have been actively incorporating Evidence-Based Practice (EBP), and/or Evidence-Informed Practice (EIP) competencies into undergraduate healthcare curricula. However, there is a gap in the scientific knowledge about the actual contents, as well as the extent of integration of EBP and EIP in undergraduate pre-registration nursing programmes.MethodA document analysis utilising Rohwer et al.’s (2014) framework was conducted to review and analyse the content of EBP and EIP competencies in the 2018/2019 curriculum of the undergraduate pre-registration nursing programme of a University located in England, United Kingdom.ResultsCompetencies relevant to EBP were included in four nursing modules. However, EIP competencies were not included in the curriculum.ConclusionThere is an urgent need for a more structured and holistic way of teaching and assessing EBP competencies through the integration of the principles of EIP, in order to enhance the effective application of evidence into clinical nursing practice.     

Developing leadership in postdoctoral nurses: A longitudinal mixed-methods study

BackgroundPostdoctoral nurses have an important role in advancing nursing by generating knowledge and building networks in research, practice, and education which requires effective leadership. Therefore, the Leadership Mentoring in Nursing Research programme for postdoctoral nurses was developed.PurposeThis study was to evaluate expectations, experiences, and perceived influence of the leadership mentoring programme on leadership and professional development, professional identity, and research productivity of postdoctoral nurses.MethodsA longitudinal mixed-method study with a concurrent triangulation design was used with data collected through semistructured interviews and online surveys.FindingsThe leadership mentoring programme was found to be valuable by the participants who described strengthened leadership and professional development and development of professional identities. Participants showed increased research productivity and many moved to new/higher positions.DiscussionThe leadership mentoring programme was found to enhance the leadership and professional development of postdoctoral nurses and support them in their academic careers.     

Transformational leadership in nursing: towards a more critical interpretation

HUTCHINSON M and JACKSON D. Nursing Inquiry 2013; 20 : 11–22
Transformational leadership in nursing: towards a more critical interpretation Effective nurse leadership is positioned as an essential factor in achieving optimal patient outcomes and workplace enhancement. Over the last two decades, writing and research on nursing leadership has been dominated by one conceptual theory, that of transformational leadership. This theoretical framework has provided insight into various leader characteristics, with research findings presented as persuasive evidence. While elsewhere there has been robust debate on the merits of the transformational model of leadership, in the nursing literature, there has been little critical review of the model and the commonly used assessment instruments. In this article, we critically review more than a decade of nursing scholarship on the transformational model of leadership and its empirical evidence. Applying a critical lens to the literature, the conceptual and methodological weaknesses of much nursing research on this topic, we question whether the uncritical adoption of the transformational model has resulted in a limited interpretation of nursing leadership. Given the limitations of the model, we advocate embracing new ways of thinking about nursing leadership.     

Developing clinical leadership skills in student nurses

A number of policy documents in recent years have identified the need for strong leadership within the NHS. The NHS Plan (2000) states that nurses need to take a lead role in the running of local health services. It also suggests that strong leadership is needed at a clinical level. The literature identifies a number of skills deemed to be essential for clinical leadership, some of these are difficult to achieve through pre-registration nurse education as they relate to an awareness of the structures and processes of the NHS and the ability to visualise or predict the future. Other skills relate to personal traits and qualities and it is these skills that are discussed. Four skills are identified for discussion; self-knowledge, communication skills, risk taking, and keeping informed. This paper analyses the way these skills are currently developed in one University's pre-registration nursing curriculum and concludes that although many opportunities are available to develop these skills in the classroom environment, there are many pressures that prevent use of these skills in a practice environment.     

Conceptual frameworks and patterns of nursing curriculum

Common concepts of conceptual frameworks and curriculum patterns are identified by studying all 18 English-speaking, generic baccalaureate nursing programmes in Canada. Four identified curriculum patterns use client systems, health-illness, growth and development, and nursing roles as the primary curriculum organizer to sequence programme courses. The nursing programmes commonly use nursing process, followed by growth and development, human needs, and family as secondary organizers to structure contents of programme course. Identifying a curriculum by its organizers is useful to curriculum practice and research. Nursing faculty can use the identified organizers as primary or secondary organizers in designing, changing or evaluating their curriculum. It is also possible to use a nursing model with the identified organizers for an effective curriculum structure. Research studies on conceptual frameworks could use primary and secondary organizers to compare strength and weakness among different nursing curriculum structures.     

The inclusion of cognitive behavioural therapeutic components in the undergraduate nursing curriculum. A systematic integrative review of the evidence

BackgroundDespite the increasing evidence base for the use of cognitive behavioural interventions in nursing, the extent to which therapeutic interventions and their components are included in the undergraduate curriculum in Australia remains unclear.ObjectivesTo explore if and how cognitive behavioural components are being taught to undergraduate nursing students to deliver outcome benefits to students and patients.DesignAn integrative literature review reporting links between CBT components and methods taught in pre-registration nurse education.Findings and conclusionBased on an analysis of current literature, it is suggested that evidence-based cognitive behavioural components are being taught to undergraduate nursing students. The study reports that teaching cognitive behavioural components can bring clinical benefits to positive patient outcome, to student wellbeing and study performance. However, the teaching of cognitive behavioural conceptual models as a therapeutic skill was found to be limited. Recommendations to incorporate a simple, evidence based cognitive behavioural conceptual tool, highlights how nurse educators can address the requirement to teach from the current evidence base.     

Embedding cancer care within pre-registration nurse education programmes: Policy, practice and opportunities for change

This paper discusses policy and professional drivers which outline the need for, and inclusion of cancer education within pre-registration nursing curricula within the UK. It also evaluates arguments in favour of the development of separate and distinctive cancer modules within nurse training programmes against those advocating a more integrated or thematic approach. The authors suggest that there are advantages and disadvantages to each strategy, and argue that the most important factor irrespective of the approach taken, is that cancer learning outcomes are clearly enunciated within all pre-registration nursing curricula and constructively aligned against teaching, learning and assessment strategies which may encompass a single module or entire programme. The authors then discuss their personal experience of teaching cancer care using both approaches and posit one suggestion for an embedded pre-registration cancer-care curriculum developed as the catalyst for a broader debate on the scope and content of cancer-care education within pre-registration nursing curricula.     

Paths to nursing leadership

AIM: The aim was to explore why nurses enter nursing leadership and apply for a management position in health care. The study is part of a research programme in nursing leadership and evidence-based care. BACKGROUND: Nursing has not invested enough in the development of nursing leadership for the development of patient care. There is scarce research on nurses' motives and reasons for committing themselves to a career in nursing leadership. METHOD: A strategic sample of 68 Finnish nurse leaders completed a semistructured questionnaire. Analytic induction was applied in an attempt to generate a theory. FINDINGS: A theory, Paths to Nursing Leadership, is proposed for further research. Four different paths were found according to variations between the nurse leaders' education, primary commitment and situational factors. They are called the Path of Ideals, the Path of Chance, the Career Path and the Temporary Path. CONCLUSION: Situational factors and role models of good but also bad nursing leadership besides motivational and educational factors have played a significant role when Finnish nurses have entered nursing leadership. The educational requirements for nurse leaders and recruitment to nursing management positions need serious attention in order to develop a competent nursing leadership.     

Learning from history: Frances Gillam Holden,a leadership perspective then and now

BackgroundCritical evaluation of leadership styles through a historical lens is uncommon. There could be missed opportunity for current and emerging nurse leaders to critically evaluate the leadership styles of the past in order to discerningly reflect on their own current leadership.AimTo critically examine the work of Australian nurse Frances Gillam Holden as she developed her vision for servant leadership for nursing in Australia in the late 19th century.MethodsExploration of, and critical reflection on, literature outlining Frances Gillam Holden's work.FindingsHolden's work and experience demonstrate the challenges faced by the profession's leaders at the turn of the century as they attempted to negotiate new ‘scientific’ knowledge and integrate this into nursing leadership. An examination of Holden's experience also demonstrates the difficulties faced by Australian nurse leaders during this time and consideration is given to what leadership in nursing looks like in the present day.DiscussionWithin the wealth of historical narratives, along with their complexities, the impact of this knowledge can have a demonstrated effect that can be far reaching and long lasting. This is particularly evident in regard to the role of nurses, nursing, and the development of modern approaches to nursing leadership, particularly with regard to the rise of nurse leaders in the form of ‘e-nurses’ and the use of social media to inform and lead the profession.ConclusionUnderstanding the influence and impact of nursing history, and historical nursing leaders such as Holden, on current leadership practices is being recognised more as contributing to contemporary nursing identity.     

Nurses and midwives teaching in the academic environment: An appreciative inquiry

BackgroundThe past two decades has seen significant change in nursing and midwifery education in Australia. Although, regulatory documents explicate expectations of teaching, and supervising in the context of being a nurse or midwife, the move from hospital-based to higher education learning nessitated a change in how students receive their education and who provides it. The quality of teaching by nurse or midwife academics is subject to the academic's ability to transition from a clinical educator to academic.ObjectiveTo explore the experiences of nurse and midwife academics teaching in the academic environment.DesignAppreciative Inquiry (AI) was used to explore the experiences of academics teaching final year nursing and midwifery students.SettingTwo regional universities in Australia.ParticipantsSeven nursing and midwifery academics teaching a unit of study focusing on mentorship, leadership and teaching.MethodsNarrative data from interviews conducted using AI were collected, transcribed and analysed to produce themes.ResultsThree key themes were identified; ‘Feeling valued’, ‘Feeling safe’ and ‘Having connections’. These themes and related subthemes impacted teaching experiences and role transition from experienced clinician to academic.ConclusionNursing and midwifery academics would benefit from organisational support in their role transition from clinician to academic. Further research is crucial regarding initiatives that can support academics to feel safe, valued and connected when teaching the next generation of nurses and midwives.