Service user involvement in pre-registration mental health nurse education classroom settings: a review of the literature

ACCESSIBLE SUMMARY: ? Service user involvement is an important part of pre-registration nursing programmes, as it can give students the opportunity to learn from users about their experiences of health and illness, but so far there have been limited studies in this area. ? This literature review provides an opportunity to explore how service user involvement in classroom settings can impact on student learning, and describes methods of best practice. ? Further research is needed to understand the influence of service user involvement on student nurses' clinical practice. ABSTRACT: Service user involvement in pre-registration nurse education is now a requirement, yet little is known about how students engage with users in the classroom, how such initiatives are being evaluated, how service users are prepared themselves to teach students, or the potential influence on clinical practice. The aim of this literature review was to bring together published articles on service user involvement in classroom settings in pre-registration mental health nurse education programmes, including their evaluations. A comprehensive review of the literature was carried out via computer search engines and the Internet, as well as a hand search of pertinent journals and references. This produced eight papers that fitted the inclusion criteria, comprising four empirical studies and four review articles, which were then reviewed using a seven-item checklist. The articles revealed a range of teaching and learning strategies had been employed, ranging from exposure to users' personal stories, to students being required to demonstrate awareness of user perspectives in case study presentations, with others involving eLearning and assessment skills initiatives. This review concludes that further longitudinal research is needed to establish the influence of user involvement in the classroom over time.     

Problem based learning in mental health nursing: the students' experience

Problem based learning (PBL) is well established within the field of health-care education for professionals worldwide, although little has been done to explore the experiences of students undertaking a PBL course in mental health nursing. Without firm evidence of the benefits of PBL, educationalists in mental health might be reluctant to view it as an option in curricula design. This U.K. study examined the experiences of pre-registration post-graduate mental health student nurses undertaking a 2-year educational course in which all teaching and assessment followed a PBL philosophy. Focus groups were used throughout the course to elicit in-depth qualitative data that was analysed by applying a constant comparative method. The analysis of the data uncovered the following broad themes: 'moves to autonomy, 'surviving the groups' and 'the impact of PBL'. The findings show that participants had mainly positive experiences and gained a range of study and interpersonal skills central to mental health nursing. Participants described initial anxieties resulting from engagement in PBL. However, they increasingly gained confidence in this approach, exercising increasing control over the PBL process. Despite this increased autonomy, participants continued to value the input of skilled facilitators. A recurring issue centred on the potential for interpersonal conflict within the student group and its impact on their learning. It is suggested that more research is needed examining the use of PBL in mental health nursing.     

In search of evidence: a small scale study exploring how student nurses accessed information for a health needs assignment

To help students develop the knowledge and skills necessary to provide evidence-based practice in nursing, a health needs analysis assignment is incorporated within a pre-registration nursing programme. As student nurses have reported difficulties in accessing and utilising some of the information needed for this assigned task, the aim of the study was to explore their experiences of undertaking this assignment. Using a qualitative methodology data was collected from focus groups and categorised under three main themes: the challenge of evidence gathering; the nature of the support students needed and understanding the importance of evidence for practice. This paper illustrates that although accessing and utilising material was demanding and required more guidance, the biggest challenge lay in making judgements about it and there was a clear indication of the need for further support in developing their critical and evaluative skills. The quality of debate within the focus groups also led the research team to question whether educationalists are making the most of capitalising on the rich learning gained from students sharing their experiences of undertaking assignments.     

Failing underperforming students: the role of grading in practice assessment

Nursing is essentially a practice discipline, informed by a theoretical base. It is crucial that students have a rigorous preparation in both theoretical and practical elements during their pre-registration programme. The aim of educationalists is to produce students fit for purpose and practice, but concerns have been raised internationally regarding students competence at the point of registration. There is evidence that some practice based assessors experience difficulties in failing incompetent students. Assessment of practice is often judged on a pass/fail rather than a graded basis in a number of health professional programmes. It could be argued that pass or fail provides limited feedback to students concerning exactly how well or poorly they have performed. This paper will explore these issues through focusing on selected findings from a service evaluation of a practice assessment tool incorporating grading of practice of pre-registration nursing students from one university in the United Kingdom (UK). Using convenience sampling, a questionnaire survey was completed by 107 adult, mental health and child health nursing students (51% response) and 112 mentors (practice-based assessors) (86% response) from all nursing fields. Amongst other issues, the evaluation identified that whilst mentors valued the opportunity to grade practice and perceived that the tool enabled them to be more discerning in the allocation of pass grades, some lacked confidence in failing students. The findings are discussed in the context of the wider debate around clinical competence in new nurse registrants and it is concluded that whilst assessing 'borderline' students will always be a testing experience, grading systems may help the assessor to be more discriminatory.     

Management an experimental approach.

An experimental teaching procedure was devised and tested for integrating the nursing process, nursing care plans, the research process and management principals. The integration defined as the problem oriented process (POP) was tested with 16 students over two semesters. The results indicated that the POP was a successful integration that aided the student in "getting it all together." As one of the students put it: This experience will give future students, as it did me, a better understanding of how research is best utilized. The students can use almost all their past learning experiences, bringing it all together in one situation. He (the student) can use his communication skills to detect a problem, his research skills to design planned intervention and evaluation and his interpersonal skills to measure his effectiveness as a change agent. Finally, he can use his nursing skills and knowledge of pathophysiology in a setting most like what he will find upon graduation.     

Student experiences of medicines management training and education

Nurses on registration are expected to have sufficient knowledge and skills in medicine management to practice safely and competently. This article reports on research involving midwifery and nursing students, who were asked to complete a questionnaire related to their experiences of medicines-related training and education, and how it prepared them for practice. The results showed an overall satisfaction with the pre-registration delivery, but differences emerged in the perceived efficacy of different educational strategies. Clinically-based and simulated aspects of the programme delivery were highly rated, with theoretical delivery scoring poorly in contrast. A stepped approach is suggested, with medicine course delivery needing to be strongly highlighted as a lead up to safe and competent nursing interventions when administering medication and all other related interventions. A grant from the innovation fund at the University of Huddersfield funded an evaluation of students' experiences of medicines management education and training using a self-administered questionnaire.     

Exposing the tensions of implementing supervision in pre-registration nurse education

This discussion will examine the complexities of implementing group clinical supervision in pre-registration nurse education. Exploration is based upon the authors’ experiences of facilitating clinical supervision with mental health branch students on the Diploma/BSc program at one higher education institution in the UK. It will provide the history and context of clinical supervision in nursing and apply this to the educational setting.This discussion aims to move beyond the rhetoric surrounding clinical supervision to expose the underlying tensions which we propose influence the clinical supervision process in pre-registration nurse education. These include the potential confusion of role for the supervisor, conflict of responsibilities and the potentially vulnerable position they may adopt. However, despite these tensions it is proposed that clinical supervision has a key role within graduate pre-registration nursing education.     

Supporting pre-registration nursing students in their exploration of death and dying

Student nurses will be exposed to dying patients from the very start of their education. The authors believe that nurse lecturers have a duty of care towards both the student and the patient in preparing them to cope with this experience. End of life care deserves further emphasis within the forum of nurse education. Within this article the authors outline their introduction of a new teaching session at the beginning of the pre-registration nursing curriculum at Birmingham City University to help prepare student nurses from all four fields of nursing to participate in end of life care. This flexible session entitled ‘perceptions of dying’ allows the students to explore their fears, anxieties and expectations of caring for a patient at the end of their life and discusses the mechanisms available for seeking support. The purpose of this article is to raise debate about the teaching of the subject of death and dying within pre-registration nurse education and to show case the lesson concept that the authors believe could be disseminated further to address this student need.     

The perceived benefits of belonging to an extra curricular group within a pre-registration nursing course

This study describes a qualitative research design that focuses on nursing students who were aligned to different extra-curricular groups (a student representative committee, a Nurses' Day Committee and a magazine editorial team) within the School of Health. The study explores the nursing students' experiences and perceptions of belonging to an extra-curricular group within a pre-registration nursing course. Data were collected using focus groups.The findings of this study suggest that students who are members of extra-curricular groups perceive group membership to have many positive benefits. The findings were grouped into three main themes namely: employability, retention and personal gain. The findings suggest that students are clearly aware of their career development and expressed how group membership meant they were able to develop skills around employability. Students highlighted that they gained support and built lasting relationships through the groups which supported and reassured them which it was felt enabled them to progress successfully through the course. These themes reinforce the value of having established groups within a pre-registration curriculum.     

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.     

Incomplete holism in pre-registration nurse education: the position of the biological sciences

There is an ongoing debate in nurse education concerning the role and delivery of the biological sciences in the nursing curriculum. One of the fundamental questions raised by this debate asks how best can teachers impart biological knowledge in a manner that can be readily applied by students and qualified nurses to inform their clinical practice. This paper will include a discussion of some of the features of pre-registration education that may have influenced the manner in which biological sciences are perceived, taught and used by nurses. It will be argued that nursing may have developed a form of incomplete holism and that this may be in part responsible for the challenges that remain to be met within this area of the nursing curriculum. As a response to incomplete holism an innovative approach within pre-registration education will be introduced. This development involves the use of linked teaching sessions which aim to develop the analytical skills necessary to apply physiological knowledge to nursing practice.     

本科生《护理科研方法》考试的改革

目的 :探索符合素质教育要求的《护理科研方法》考核方式。方法 :以 97、98、99级 82名护理本科生为对象 ,以实践考核方式对《护理科研方法》课程进行评价 ,并自编调查问卷对该方法的效果进行反馈调查。结果 :实践考核对学生素质培养具有积极作用 ,有 91.4 %的同学认为有利于科研能力的真正提高 ,87.7%的同学认为利于自主性的发挥 ,77.8%的学生认为促进了独创性思维的培养 ,对教师改进今后教学具有一定指导作用。结论 :《护理科研方法》采取实践考核方式是有益的尝试。     

Group clinical supervision in pre-registration nurse training: the views of mental health nursing students

In 1994 the Department of Health recommended that nurses be introduced to the process of clinical supervision during pre-registration training. In response to this recommendation, the now defunct English National Board (ENB) stated that: "It will be a requirement that all students of pre-registration nursing programmes receive preparation in what to expect from clinical supervision" (ENB, 1995, p. 4). Despite the fact that no further guidance was issued there is an emerging body of literature exploring this area. This paper reports findings from the initial phase of a three-year prospective longitudinal study examining students' experiences of group clinical supervision undertaken as part of their pre-registration training. In this part of the study 32 mental health nursing students participated in focus groups in which they discussed their expectations of clinical supervision. Content analysis of the data produced five major categories: 'the nature of clinical supervision'; 'roles and responsibilities'; 'staying safe and doing no harm'; 'being in a group'; and 'being a student'. The findings suggest that the idea of supervision is attractive to students, although there are significant anxieties both about supervision in general and of group supervision in particular.     

Exploring student's perceptions and experience of personal tutors

There are a variety of arrangements to support pre-registration nursing students whilst they engage with the theoretical and practical elements of their course; these includes academic supervisor and a personal tutor. The personal tutor system is recognized as an effective method of ensuring that each student has access to a wide range of support services and that the individual's academic progress and personal development are monitored by a skilled member of academic staff (Harrison, 1990). However, there is a dearth of studies relating to the role of the personal tutor in nurse education from the students' perspective. This study set out to explore the pre-registration students nurse's experience of personal tutoring at one School of Nursing and Midwifery in a Higher Education Institution (HEI) in the UK. Focus groups and a semi-structured questionnaire were used to collect data from pre-registration nursing participants. Data analysed revealed both positive and negative experiences; most rated their advice and support good with many positive aspects to their personal tutoring expressed however many felt the need for more contact time, more support academically and whilst on clinical placements, and more structured support with their personal development planning. This paper also describes how the study was conducted, the importance that students place on the role, and the need for further research and areas for improvement.     

Pre-registration nursing students' experience of caring for cancer patients.

The preparation of nurses caring for cancer patients remains a topical subject. The recent emphasis on the preparation of an effective and informed workforce for cancer care at all nursing levels is significant, particularly as the majority of previous studies have traditionally focused on post-registration preparation of qualified nurses. Currently, there is limited information on the preparation of pre-registered nursing students and little is known about the experiences of these students, especially during their initial exposure to cancer patients. Recently, changes have also been made to the pre-registration nursing programmes in the UK in line with national recommendations leading to much earlier exposures to patient care in practice. This study provides information about nursing students' experiences of caring for cancer patients. Using self-report questionnaires each comprising of 21 Likert scale items, a survey was conducted on a total of 134 students (response rate: 88%) enrolled on the common foundation programme at the end of the first year of their undergraduate nursing programme. Data collected included information about the types of clinical settings where students were exposed to cancer patients, perceptions of their experiences with cancer patients and aspects of educational and clinical inputs perceived as helpful in preparing them to care for cancer patients. Additional insight into the students' experience was further obtained from semi-structured interviews conducted from a total of nine students drawn from the three categories of experiences they identified: positive, non-positive and mixed. The findings and implications for the preparation of pre-registration nursing students in caring for cancer patients were discussed in relation to the theoretical input, clinical support and the use of reflection in practice.     

Clinical leadership and pre-registration nursing programmes: A model for clinical leadership and a prospective curriculum implementation and evaluation research strategy

AimTo present for wider debate a conceptual model for clinical leadership development in pre-registration nursing programmes and a proposed implementation plan.BackgroundGlobally, leadership in nursing has become a significant issue. Whilst there is continued support for leadership preparation in pre-registration nursing programmes, there have been very few published accounts of curriculum content and/or pedagogical approaches that foster clinical leadership development in pre-registration nursing. A doctoral research study has resulted in the creation of an overarching model for clinical leadership.DesignA multi-method research study using theoretical and empirical literature 1974–2015, a focus group, expert opinion and a national on-line survey.DiscussionA conceptual model of clinical leadership development in pre-registration nursing programme is presented, including the infinity loop of clinical leadership, an integral curriculum thread and a conceptual model: a curriculum-pedagogy nexus for clinical leadership. In order to test out usability and evaluate effectiveness, a multi method programme of research in one school of nursing in Australia is outlined.ConclusionImplementation of the proposed conceptual model for clinical leadership development in pre-registration nursing programmes and a programme of (post-doctoral) research will contribute to what is known about curriculum content and pedagogy for nurse academics. Importantly, for nursing students and the profession as a whole, there is a clearer expectation of what clinical leadership might look like in the novice registered nurse. For nurse academics a model is offered for consideration in curriculum design and implementation with an evaluation strategy that could be replicated.     

Back to basics: exploring the conceptual basis of nursing

It has long been recognized that nursing is essentially a practice-based discipline, underpinned by fundamental concepts which inform practice. The purpose of this paper is two-fold: first, to discuss the need for an exploration of these concepts of nursing as a foundation to pre-registration nursing programmes. Second, by utilizing a continuous quality improvement perspective, an evaluation of teachers' experiences with a cohort of adult and child health branch students is considered. It is concluded that a significant proportion of students found that a raised conceptual awareness served to promote theory-practice links.     

Project 2000 students' perceptions of their training

This paper reports on the findings of a study conducted into the perceptions of final year Project 2000 pre-registration students towards their pre-registration education programme The aim of the research was to discover how students perceive their training in terms of value, relevance, intellectual potency, teaching methods and organization Data were collected using the Hoste scale which has been developed for the evaluation of educational courses A convenience sample of students (n = 131) within one college of nursing were invited to participate Findings include a particularly high level of satisfaction with Project 2000 in terms of value, breadth and relevance Organization and liveliness of the course were perceived much less satisfactorily There was a trend for a statistically significant difference between the mean scores of the theoretical and practical components of the course The findings are discussed with particular reference to the perceptions of theory and practice within the educational programme     

Peer bullying in a pre-registration student nursing population

Peer bullying is a major problem in schools and workplaces including the National Health Service. Although there are a few published studies exploring the incidence of peer bullying among university students, none is specific to pre-registration nursing students. Nursing programmes are delivered across two campuses of the university however students registered at individual campuses do not mix which makes the experiences of each campus individual. The aim of this study was to explore the incidence and manifestation of peer bullying amongst pre-registration nursing students in the university setting. The study describes the reported incidence of the three types of peer bullying behaviour: physical, verbal and non-verbal bullying. Participants in their final year of adult nurse education were asked to explore their perceptions of peer bullying, the frequency of witnessed or experienced behaviour and the location of where this behaviour occurred on the university campuses via a quantitative questionnaire. In total 190 students were surveyed with 156 (82%) responding. Participants reported peer bullying is experienced by student nurses on university premises and that academic members of staff are sometimes present when this behaviour is demonstrated. Reported levels of bullying decreased during their 2nd and 3rd years of the course compared to the foundation year. This decrease may have been in response to the university's strong anti-bullying stance.