Applying aspects of curriculum studies to the practice of nurse teaching

Developments in the preparation of nurse tutors have been dramatic and farreaching over the past decade. These developments herald a change in emphasis, from an overwhelming clinical orientation to one concentrating solely on educational theory and practice. This change has increased the importance of understanding the nature of curriculum development and its contribution to the enhancement of classroom teaching. To understand the curriculum within which he or she has to operate will enable the nurse tutor to construct educational goals which are integral throughout the whole programme. The fulfilment of these goals will depend largely upon the teaching styles adopted and the learning opportunities created. Through an understanding of curriculum process the tutor is able to identify those factors which inhibit effective learning. This understanding in turn can only be achieved if the nurse tutor is well practised in course planning and curriculum design.Recent trends in nurse education recognise that student nurses are young adults who, in the main, respond well to an educational system based on the principles of andragogy. This approach carries enormous responsibilities for ensuring that curriculum design supports independent learning strategies, continuous assessment and effective course evaluation.     

Assessment of portfolios in professional education

Student-centred methods are increasingly being used to carry out learning, teaching and assessment activities in professional education. These methods underpin current curriculum design, and evidence suggests that they have been successful in reducing the perceived theory-practice gap and making professionals fit for practice in the chosen discipline. A portfolio is a common method of assessment in many programmes. A tripartite approach to assessing the portfolio, involving the student and his or her practice supervisor in the assessment process, brings together the assessment of theory and practice, and makes the process even more transparent. The tripartite approach to assessing portfolio is used in the mentorship preparation programme at the author's university, which also prepares the student to become an assessor. Thus the assessment process becomes part of the learning experience and is valued by the tutor, student and practice supervisor. This article describes a small-scale study carried out with a colleague on the use of portfolios as a tool for assessment in a short programme via a tripartite approach involving the practice supervisor, student and tutor.     

Crossing boundaries: implementing an interprofessional module into uniprofessional Bachelor programmes

In accordance with the curriculum reforms within health education in Norway, the Faculty of Health Sciences at Oslo University College introduced in 1998 an interprofessional module, entitled "VEKS", for eight different professional programmes. A shared module of 30 credits (15 for technically oriented programmes) was introduced into the three-year programmes. A problem-based and project-oriented format was chosen as the teaching and learning model to enhance the interactive, experiential and collaborative learning. This paper describes experience gained during the five-year implementation period. Empirical data were collected through participatory observations, students' and tutors' evaluations and group interviews with tutors and faculty leaders. The innovative project described challenged traditional educational boundaries and structures, frames of thought and habits. It broadened perspectives within the particular professional programmes as well as preparing students for their future professional careers. Lessons learned can be summed up as: Time, resources and a certain staff consensus are needed to deal with and overcome traditions and attitudes, the students' learning is a socialization process which needs to be developed over time; intermittent interprofessional interventions during the three-year period was found to be inadequate, and the tutor role is essential in order to support the students' learning process.     

Skills integration in a simulated and interprofessional environment: an innovative undergraduate applied health curriculum

The objective of our study was to propose an innovative applied health undergraduate curriculum model that uses simulation and interprofessional education to facilitate students' integration of both technical and "humanistic" core skills. The model incorporates assessment of student readiness for clinical education and readiness for professional practice in a collaborative, team-based, patient-centred environment. Improving the education of health care professionals is a critical contributor to ultimately improving patient care and outcomes. A review of the current models in health sciences education reveals a scarcity of clinical placements, concerns over students' preparedness for clinical education, and profession-specific delivery of health care education which fundamentally lacks collaboration and communication amongst professions. These educational shortcomings ultimately impact the delivery and efficacy of health care. Construct validation of clinical readiness will continue through primary research at The Michener Institute for Applied Health Sciences. As the new educational model is implemented, its impact will be assessed and documented using specific outcomes measurements. Appropriate modifications to the model will be made to ensure improvement and further applicability to an undergraduate medical curriculum.     

Increasing student involvement and learning through using debate as an assessment

Assessment has long been recognised as the single most influential factor in shaping what and how students in higher education choose to learn and the quality of learning outcomes depends on the quality of assessment. Within intellectual disability nursing the student are prepared within a biopsychosocial educational model and curriculum address these challenges. Structured student debates have great potential for promoting competence and in-depth knowledge of substantive topics relevant to practice. Like other interactive assignments designed to more closely resemble real-world activities, issue-oriented debates actively engage students in course content. Allowing students to develop and exercise skills that translate to practice activities. Most importantly debates help to stimulate critical thinking by shaking students free from established opinions and helping them to appreciate the complexities involved in practice. This article identifies the use of a debate as an assessment method within an intellectual disability nursing programme and a student's reflective comment on the process, and their experience of a debate as their assessment method.     

Governmentality, student autonomy and nurse education

Title. Governmentality, student autonomy and nurse education. Aim. This paper is a report of a study to explore how governmental practices operated in nurse education. Background. Since the 1980s nurse education internationally has been strongly influenced by educational theories that aim to promote student autonomy by encouraging self‐direction and critical thinking. Newer curriculum models advocate transformative approaches leading to greater emancipation, social equity and inclusion. Although these changes have been positively evaluated there had been limited critical research on how student behaviour is governed. Method. A discourse analytic study was conducted from 2000 to 2004 using interviews (n = 30) with a purposive sample students and teachers in one United Kingdom university. Data were also collated from the course curriculum and student handbook for the students’ programme. Data were analysed to identify how student behaviour is governed. Findings. Two governing practices are described: control and technologies of the self. These practices contribute to an overall system of governing student behaviour that creates tension between the avowed progressive empowerment discourse and taken for granted everyday educational practices. Students are subjected to a range of governmental and disciplinary strategies and, through a process of normalization, ultimately become their own supervisors within the system. Conclusion. The tensions between the demands of a professional outcome‐based nursing programme and notions of empowerment and student autonomy have not been resolved. Instead, present educational practice is characterized by normalizing discursive practices that aim to produce a specific version of a student subject as autonomous learner. Thus, discourses of both empowerment and professional behaviour govern students.     

The approaches to learning of student nurses in the Republic of Ireland and Northern Ireland

The approaches to learning of student nurses in the Republic of Ireland and Northern Ireland In recent years during a period of change in nurse education, there has been an increased interest in educational theory and nurse educators have examined and questioned the fundamental principles upon which the system of education is constructed. In nurse education it is likely that no single theory of learning can account for all aspects of learning and there are reflections of many learning theories in the nursing curriculum. The literature in the area of student learning is complex and wide ranging and is poorly represented in the nurse education literature. In recognition of a lack of understanding and clarity on learning approaches in nurse education during a period of unprecedented change in Irish and United Kingdom (UK) nurse education, this paper aims to highlight the importance of understanding student nurse learning. A study is described which investigated the approaches to learning of student nurses from the Republic of Ireland, who were receiving a traditional apprenticeship training, and student nurses from Northern Ireland in a Project 2000 programme. On comparative statistical analysis significant differences were identified between the two groups in their approaches to learning. It is concluded that students' constructs of learning in nurse education are primarily dependent on their interpretation of the demands of the task, on assessment, teaching and the learning environment. The study provides nurse educationalists with important evaluative information from the students' perspective. It suggests that the way forward is to identify the significant contextual factors influencing student learning and to incorporate them into the nursing curriculum. Such an approach will serve to focus the system on variability in the quality of learning rather than on stability in human attributes.     

Integration tutorials and seminars: examining the integration of academic and fieldwork learning by student occupational therapists

This paper, the second of two companion papers, describes a collaborative research study conducted by academic and fieldwork educators of an undergraduate educational programme in occupational therapy. The study examined the perception of student occupational therapists' ability to integrate and apply academic and theoretical knowledge in fieldwork education sites following the introduction of Integration Tutorials and Seminars to the curriculum. The literature review supports the need to develop educational strategies to improve this integration process. The qualitative research design consisted of guided interviews with preceptors and students during two consecutive fieldwork education experiences. Inductive data analysis revealed three themes that contribute to understanding students' ability to integrate academic learning during their fieldwork education: the fieldwork learning environment; preceptor influence on student learning; and the student learning process over time. The discussion section raises implications for academic and fieldwork education approaches.     

Views of the effectiveness of problem-based learning

AIM: To obtain the opinions of a group of mental health students on the effectiveness of problem-based learning (PBL) within a pre-registration nursing pathway. METHOD: Focus groups were used to generate data and the sample consisted of 14 mental health branch students who, within the pre-registration nursing programme, formed a PBL group. The group met on an annual basis at key junctures during the three-year diploma programme. The focus groups were tape-recorded and the data interpreted and organised by utilising an adapted form of content analysis. RESULTS: Four themes were identified regarding the use of PBL: the students' initial adjustment to PBL; the impact of PBL on their secondment status; the application of PBL in clinical practice; and the students' reflective critique of PBL. CONCLUSION: The discussion of the findings makes suggestions for the utilisation of PBL in future reviews of nursing curricula and outlines the implications for clinical practice. This includes the need to carefully plan the students' initial placement experiences and provide extra support at this stage. In addition, mentor preparation on the use of PBL in practice needs to be extended to ensure flexibility in the PBL process. It should be balanced with formal student support and courses must be planned to incorporate the learning needs of all discipline groups.     

Raising awareness of learning disability needs in acute sector care: A reflective account of a workshop from the guest facilitator perspective

Nurse education has an essential role to play in reducing health inequality for people with learning disability [Michael, J., 2008. Healthcare for All: Report of the Independent Inquiry into Access to Healthcare for People with Learning Disabilities. Aldridge Press, London]. Many nurse education providers will need to use guest facilitators in order to raise awareness of best practice in caring for this client group for non learning disability branch students and their experiences as nurse educators will be of growing interest. This article critically reflects on an educational session for pre-registration adult branch nursing students which used a variety of teaching methods to facilitate a reflective, student centred, experiential learning approach. Self assessment based on the change between two self rating scales was used to assess learning, the session itself was evaluated by students using a feedback form and through the formal assessment of teaching by a nurse tutor. This article critically evaluates the preparation, delivery and evaluation of the session, emphasising the perspective of the guest facilitator – a practicing community learning disability nurse. The conclusion reflects on key learning from the teaching experience.     

The perceptions of students and teachers regarding the introductory module of an enrolled nurse conversion course

This study sets out to explore the perceptions of students' and their teachers' regarding the Introductory Module of a course to convert Enrolled Nurses to Registered General Nurses. The course has been developed as a joint venture with two local Schools of Nursing as an experiment in joint course management. An illuminative evaluation approach has been adopted utilising the techniques of observation, questionnaires and interviews, in order to provide information by a variety of means upon which the course management team can base their future decisions regarding the course. The findings suggest that the introductory module was perceived by the students and teachers as a valuable learning experience. Issues specific to the course which were highlighted included the need for the involvement of the course teachers from each School of Nursing in the teaching programme, the introduction of negotiated student learning, a joint approach to the assessment of theory and practice and a modification of the maternity and community care experience. General issues related to the students as mature learners included the need for pre-course preparation for the students, the assessment of individual learning needs, the inclusion in the content of essay writing skills and stress management and the need for a comprehensive staff development programme for the teaching staff. The study highlighted the need for evaluation of nurse education programmes and teaching methods in order to provide professional accountability and to ensure nurse education practice is research-based.     

Evaluating the use of developmental action inquiry in constructing a problem-based learning curriculum for pre-registration nursing education in Hong Kong: a student perspective

BACKGROUND: Developmental action inquiry (DAI) was chosen as the change strategy for introducing problem-based learning (PBL) in a pre-registration nursing programme. The central task was to transform the tutor and student participants to become collaborators in this curriculum reconstruction project. AIM: This paper expounds the way in which the action inquiry was constructed and in light of students' feedback analysis, the way in which PBL has made a difference in student learning was evaluated. DESIGN: Taking into consideration the change context and different group characteristics, the DAI was conducted in terms of two dynamically interlinked circles that formed partnerships between PBL core group members and tutors, and between tutors and students in coconstructing knowledge useful for PBL curriculum development. FINDINGS: The findings of the student evaluation questionnaire reveal that the majority of students felt PBL made a difference to their expectations of self, the student group and the teacher role in creating a facilitative environment to enhance learning. However, there was a significant difference among individual student group responses. The students' positive and negative PBL experience in self-learning, tutor-student interaction, and group-learning were identified as crucial factors contributing to these group variations. CONCLUSION: The evaluation findings show that a paradigm shift from teacher-centred to student-centred learning, from valuing self-learning to co-operative group-learning, and from theory-based to practice-based learning occurred among the students. DAI was found to be an effective change strategy for transforming participants to become collaborators in searching for useful knowledge and coconstructing the PBL learning context.     

The experiences of a group of pre-registration mental health nursing students

Research that only utilises mental health students as a sample group is quite rare. Yet there are many potential stressors that may impact on the experience of these students including; the theory-practice gap, the learning culture experienced in clinical practice, the effects of the programme's assessment and learning strategies and the intentional and unintentional effects of the curriculum. Therefore the aim of this study was to explore the experiences of a group of mental health student nurses by utilising these four concepts as a framework. Focus groups were used to generate data and the sample consisted of fourteen mental health branch students who, within the pre-registration nursing programme, formed a problem-based learning group. The group met on an annual basis at key junctures during the three-year diploma programme. The focus groups were tape-recorded and the data interpreted and organised by utilising an adapted form of content analysis. Three themes were identified; the conflicting pressures of life as a mental health student nurse, adjustment to problem based learning and experiences in mental health practice and views on mentorship. A discussion of the implications of the findings for the planning of nursing curricula and mental health branch programmes is outlined.     

Innovation in the assessment of nursing theory and its evaluation: a team approach

In response to recent national changes in United Kingdom (UK) nurse education (e.g. devolution of assessment, moves to higher education, revision of the aims) and to local concerns (e.g. fairness to students, validity and reliability of written assessments, helping staff with less experience of assessment, student learning) an initiative has been developed at Southampton based on a team approach to marking and moderating. A five-stage evaluation was designed to accompany implementation of the initiative. The evaluation, carried out by a lecturer and an independent educational evaluator, involved both tutors/lecturers and students. Interviews, questionnaires and observation methods were used. Benefits of the initiative and of the particular model of evaluation included: increased knowledge and confidence in the validity and reliability of the marking and moderating process undertaken by tutor-teams; increased fairness to students; in-service tutor training related to student assessment; knowledge that assessment-promoted learning was taking place. A review of the total assessment programme was an unexpected outcome, including a review of the frequency and timing of assessments and of the written guidelines. The five-stage evaluation developed a feeling of involvement and heightened self-knowledge. Curricular understanding also increased; this helped to achieve the initiative as designed and intended. We recommend this model of evaluation; it promotes involvement of all concerned, students as well as staff, and generates valuable process-knowledge. It can be used in pre- and post-registration nurse education.     

Supporting students in clinical practice: pre-registration nursing students' views on the role of the lecturer

Learning in clinical practice is an essential aspect of student nurse education yet debate persists in the United Kingdom regarding the role of the lecturer in supporting the student within clinical practice. This debate has been rekindled with developments in mentorship and establishment of a clinical role designed to facilitate and support mentors; the Practice Education Facilitator. Hence it is timely to re-examine the role of the lecturer in providing clinical support to students. This article discusses nursing students' views of clinical support provided by lecturers on a Diploma/Degree programme. Qualitative and quantitative data was obtained from an online questionnaire which indicated that students thought the most important part of the lecturers' role was to provide academic support for assignments. The students also appreciated lecturers visiting them in clinical placement to facilitate the student-mentor relationship and to provide personal support. It is argued, that with the enhancement of other supportive mechanisms for students and mentors and the current economic climate, lecturers should work in partnership with mentors and practice education facilitators to avoid duplication of effort. The students in this evaluation suggested that academic support for assignments should be the main focus for lecturers.     

Acute care teaching in the undergraduate nursing curriculum

Aim:  To incorporate basic aspects of acute care into the undergraduate nursing programme by providing an opportunity for the development of knowledge and skills in the early recognition and assessment of deteriorating patients on general hospital wards.
Background:  Acute care initiatives implemented in the hospital setting to improve the identification and management of 'at risk' patients have focused on the provision of education for trained or qualified staff. However, to ensure student nurses are 'fit to practice' at the point of registration, it has been recommended that acute care theory and skills are incorporated into the undergraduate nursing curriculum.
Practice development initiative:  An 'Integrated Nursing Care' module was incorporated into year 3 of the undergraduate nursing programme to introduce students to acute care theory and practice. Module content focuses on the early detection and management of acute deterioration in patients with respiratory, cardiac, neurological or renal insufficiencies. We used a competency-based framework to ensure the application of theory to practice through the use of group seminars. High-fidelity patient-simulated clinical scenarios were a key feature. The United Kingdom Resuscitation Council Intermediate Life Support course is also an important component of the module.
Conclusions:  Incorporating the Integrated Nursing Care module into the undergraduate nursing curriculum provides pre-registration students the opportunity to develop their knowledge and skills in acute care.
Relevance to clinical practice:  The provision of undergraduate education in care of the acutely ill patient in hospital is essential to improve nurses' competence and confidence in assessing and managing deteriorating patients in general wards at the point of registration.     

'Stories' or 'snapshots'? A study directed at comparing qualitative and quantitative approaches to curriculum evaluation

The focus of this paper is a study designed to explore the validity of quantitative approaches of student evaluation in a pre-registration degree programme. As managers of the students' education we were concerned that the quantitative method, which used lecturer criteria, may not fully represent students' views. The approach taken is that of a process-type strategy for curriculum evaluation as described by Parlett and Hamilton (1972). The aim of the study is to produce illuminative data, or students' 'stories' of their educational experiences through use of semi-structured interviews. The results are then compared to the current quantitative measurement tools designed to obtain 'snapshots' of the educational effectiveness of the curriculum. The quantitative measurement tools use Likert scale measurements of teacher-devised criterion statements. The results of the study give a rich source of qualitative data which can be used to inform future curriculum development. However, complete validation of the current quantitative instruments used was not achieved in this study. Student and teacher agendas in respect of important issues pertaining to the course programme were found to differ. Limitations of the study are given. There is discussion of the options open to the management team with regard to future development of curriculum evaluation systems.     

Reflection: a casualty of modularisation?

INTRODUCTION: The use of reflection in nursing and midwifery is well-established and reflective skills are taught on both pre- and post-registration courses as a way of integrating theory and practice, and of developing students' critical and analytical skills. Reflection is generally regarded positively with an assumption that reflective skills benefit both practitioners and patients. The aim of this study was to identify the educational strategies used to develop reflective skills in one pre-registration diploma in nursing curriculum. METHODS: The survey was cross-sectional in design. A questionnaire was designed for the study to explore perceptions of both students and lecturers in one educational establishment. Curriculum documentation was analysed to examine where in the curriculum the development of reflective skills was prominent. The sample consisted of two student cohorts from the adult branch and all senior lecturers within the Institute who taught on the pre-registration programme. RESULTS: The findings revealed a complex picture of students' and lecturers' views of the teaching and learning strategies used to develop reflective skills. Lectures and group work were the strategies cited most commonly by the students, whereas the lecturers felt the strategies used most often were personal tutorials, group work and case scenarios. The documentary analysis revealed that out of the 13 modules, there was explicit reference in only three modules to reflective practice. Furthermore, it was evident that the majority of lecturers were not clear where in the curriculum reflective skills were taught which suggested that an overview of the whole curriculum is not always evident. CONCLUSIONS: Modularisation may have contributed to a fragmentation in the way in which some key health practitioner skills are developed and built upon throughout a curriculum. There needs to be agreement on the nature of the skills which are central to the development of reflective practitioners and clear thinking on how these are developed and assessed within a curriculum.     

Informed consent for blood transfusion as a transfusion medicine educational intervention

SUMMARY. The aim here was to determine the effectiveness of a transfusion medicine educational intervention in a medicine core clerkship program.
Third-year medical students enrolled in their medicine core clerkship rotations at tertiary care hospitals affiliated with our institution underwent a two-part educational intervention that incorporated a transfusion medicine curriculum within the context of the medicolegal, ethical and educational elements of informed consent. Part one was a 1-h didactic session on standards of practice for red blood cell transfusion. Part two was a 90-min multidisciplinary workshop on informed consent. The effectiveness of the educational intervention was analysed by an objective structured clinical evaluation.
The student group receiving the educational intervention scored significantly higher than in the comparison group (65.8 ± 9.2 vs. 54.1 ± 10.56, P <0.001). When student scores were used to determine changes in student response patterns over time, the largest change occurred in identifying possible other options to allogeneic blood transfusion.
These results suggest that a transfusion medicine curriculum using an informed consent model can be used effectively as an educational intervention in a medicine core clerkship programme.