Pharmacology education: a theoretical framework of applied pharmacology and therapeutics

United Kingdom Government initiatives such as The NHS Plan (DoH 2000) identified the need for nurses to undertake multi-skilled professional roles. In the United Kingdom, the transition to a larger graduate nurse workforce continues, as Universities offer nurse pre-registration courses at diploma and degree levels. Concomitant with the change in educational standard is the need to teach student nurses the theoretical principles of medication management and to develop skills in clinical reasoning skills. Both elements are limited in current educational pre-registration nurse programmes, in order to develop the future, multi-skilled workforce such courses should incorporate the theory and skills of health assessment, physical examination, applied pharmacology and clinical reasoning. This paper aims to examine how knowledge of applied pharmacology and therapeutics can be integrated into an undergraduate pre-registration nursing programme. Discussion focuses on how this generic framework can provide educators with an outline of the theoretical constructs, their application, the teaching strategies involved and instruction on how to prepare nurses to clinically reason with regard to medication management issues. This framework can be adapted to accommodate nurses studying for all parts of the register.     

Preparing leaders for safeguarding children

The purpose of child safeguarding is to identify children at risk of abuse or neglect and to reduce this risk. NHS trusts are required to have named and designated safeguarding children clinicians, who need strong leadership skills. This article presents the design and implementation of a leadership training programme developed for these professionals, and an evaluative research study of the programme.     

The use of simulation to address the acute care skills deficit in pre-registration nursing students: a clinical skill perspective

The increase in patient acuity in primary and secondary settings is continuing, with a corresponding increase in the need for technological competence in these areas. Evidence, however, both nationally and internationally, suggests that these expectations are not being met. This paper offers a review of the literature on acute care, with a specific focus on pre-registration nursing students and the development of acute care skills. Three themes are discussed: factors contributing to the acute care skills deficit, the knowledge and skills required to work in acute care and strategies used to support the acquisition of acute care skills. In response to the review, and based upon the evidence-based solutions identified, the clinical skills team at Bournemouth University designed and developed two teaching sessions, using simulation and role play to support the acquisition of acute care skills in pre-registration students. Student evaluations identify that their knowledge, competence and confidence in this area have increased following the teaching sessions, although caution remains regarding transferability of these skills into the practice environment.     

Improving clinical effectiveness: a practical approach

The publication of the government white paper ' Working for Patients ' (1989, HMSO) and implementation of subsequent NHS reforms has led to the development of a great number of initiatives designed to improve the quality of patient care and to make the provision of care more clinically and cost effective. Many of these initiatives, whilst laudable, have been developed in isolation and often without proper consideration of how they relate to one another or might practically be implemented throughout the NHS. It has commonly been the case that attempts to transfer the initiative from an environment of high enthusiasm and, often, high resource to the NHS in general has either failed or led to poor application. Strategies to improve clinical effectiveness have not become a feature of the everyday practice of many, let alone most or all, clinicians in the NHS. The result has been their failure significantly to raise standards of care across the NHS as a whole.
It is suggested that many of the initiatives are closely related, and more effective implementation in the NHS as a whole may follow attempts to integrate them in a more practical approach to care management within an organization-wide clinical effectiveness strategy. It is further suggested that this is best achieved by a continuous quality improvement approach focusing on the care process as the centrepiece of the initiative, and that this method will lead to significant improvements not only in clinical effectiveness but also in cost effectiveness. This paper describes a proposed method of achieving these goals.     

Quantifying emerging drugs for very rare conditions

BACKGROUND: EU legislation is encouraging pharmaceutical companies to develop drugs for rare conditions, but their often high cost, and potential for long-term administration has led to debate about their affordability and cost-effectiveness. AIM: To investigate how many drugs are in development for very rare conditions. METHODS: We defined very rare conditions as having a prevalence of <1:50,000, and identified pharmaceuticals in phase II, phase III trials or pre-registration for these conditions using commercial databases. RESULTS: We identified 42 very rare conditions with at least one drug in late-stage clinical development, with a total of 113 drugs in development (17 for at least two indications). Sixteen drugs were pre-registration, 29 were in phase III development, 65 were in phase II development, one drug was both pre-registration and phase II for different indications and two drugs were in both phase II and phase III trials for different indications. DISCUSSION: Not all the drugs in development will reach the market, but it is likely that a significant number will do so. Affordability and methods to assess cost-effectiveness will need debate and clear national policy for decision-makers to follow.     

Developing interprofessional education in the pre-registration curricula: mission impossible?

Interprofessional education has long been cited in health and social care policy as a remedy to improve many of the problems faced by the National Health Service (NHS) around co-ordination and collaboration of staff. More recently, this form of education has been acknowledged as having a key role in delivering the government’s modernisation agenda to produce a more ‘flexible’ workforce. Given the large number of logistical problems connected to developing interprofessional education before registration, this type of activity more often occurs after registration. It is interesting, therefore, to note that pre-registration interprofessional education has recently been hailed by NHS policy as a primary method for enhancing collaboration. However, these policy documents have both contributed to the conceptual confusion in this area and also overlooked the range of factors (educational, organisational and cultural) connected with implementing and sustaining this type of education in the pre-registration sector. In posing the question, ‘pre-registration interprofessional education: mission impossible?’ this paper examines the cultural, organisational and educational factors that affect the development of this activity. It also considers attempts to build an evidence-base for interprofessional education. This paper finally outlines how the implementation of interprofessional practice-based placements can be an achievable goal for the pre-registration curricula.     

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.     

Exploring the contribution and impact of master’s education for leadership development in adult general nursing: A scoping review

AimThe aim of this scoping review was to explore the evidence relating to master’s education for leadership development in adult/general nurses who are not in advanced practice or leadership roles and its impact on practice.BackgroundThe importance of effective, clinical leadership in nursing and health care, has been highlighted following failings reported by Public Inquiries both nationally and internationally. While initiatives have been implemented to address these, the provision of safe, quality care remains problematic. Complex care requires highly skilled professionals to challenge and lead improvements in practice. Master’s education results in graduates with the skills and confidence to make these changes and to become the clinical leaders of the future.MethodsAn a priori scoping review protocol was developed by the review team. This was used to undertake searches across CINAHL Ultimate; Medline (Ovid), Scopus and ProQuest Complete databases, chosen due to their relevance to the subject area. Articles were limited to those in the English Language, peer reviewed and published since 2009. Citation chaining via the reference lists of frequently identified articles were also searched. A further search for relevant grey material using the same relevant keywords and phrases was performed using the limited, Trip Database and Google Scholar.ResultsEight articles were selected for data extraction, and these were published between 2011 and 2019. The articles were predominantly from the UK and Europe, with a focus either on master’s education or on aspects of leadership in nursing and healthcare. Themes identified: a) The need for clinical leadership; b) master’s education for clinical leadership skills; and c) master’s education for professional and organisational outcomes.ConclusionsThe scoping review identified that there is a need for strong clinical leadership in the practice setting. Evidence shows that effective nursing leadership can improve patient outcomes as well as enhancing workplace culture and staff retention. The review has shown that the skills required for clinical leadership are those produced by master’s education. Studies of the impact of master’s education are often self reported and tend to focus on nurses in advanced practice roles. More research is required into master’s education for adult/general nurses not in advanced roles and in examining the link between master’s education and improved patient, professional and organisational outcomes.     

Evaluating nurse consultants' work through key informant perceptions

AIM: To evaluate the work of nurse consultants in the NHS by exploring the views of key informants and nurse consultants. METHOD: A multi-site evaluative study commissioned by and undertaken in four trusts. The evaluation was based on the 360 degree feedback process and used case study methodology, inviting key informants to provide information on their work with nurse consultants. FINDINGS: The findings are discussed in relation to the following themes: role aspirations and lived reality; challenging boundaries; impact and outcomes and leadership. The findings concur with previous studies demonstrating a series of common themes associated with leadership, clinical expertise, research and educational activity. These findings express the ways in which nurse consultants are working to develop unique services to meet patient needs. CONCLUSION: The nurse consultant has an important role in the modernisation of the NHS. The role's impact, in terms of the informants, is in leadership, clinical expertise, research and educational activity. The findings reveal an urgent need to support consultant nurses in developing their leadership potential and skills in researching practice.     

An exploration of tripartite collaboration in developing a strategic approach to the facilitation of practice learning

Pre-registration nurse education in United Kingdom has to be delivered within a complex system. Theoretical components are delivered by a Higher Education Institution and the practice components, facilitated and assessed by clinical practitioners within a health service provider institution. The previous decade witnessed a gradual divorce between these two institutions, leading to a confidence and competence deficit in the newly qualified practitioner. The new national agenda for pre-registration nursing was set out in the fitness for practice document, [UKCC, London, 1999]. It required a refocus on the practice aspects of nurse education. It identified the need to strengthen the links between higher education providers and service providers to ensure the delivery of a seamless curriculum. The report recommended closer collaborative working to bridge the theory–practice gap and develop nurses that were competent and fit for purpose at the end of the course. Several pilot sites were identified throughout the country to deliver the new practice focussed curriculum; The University of Wolverhampton was one of these. The focus of this paper will identify the multifaceted developments that facilitate effective practice learning for students, which have been achieved through partnership working and will include the following areas; creation of new practice support roles, communication systems, modes of learning (technology supported learning, problem based learning, experiential learning and simulation), the learning environment, learning opportunities and resources. It is clear that practice learning has many influences, which can either enhance or undermine the student's ability to assimilate knowledge and experience into personal, professional practice. We acknowledge that there are still many areas to be developed and anticipate that these will be informed by the findings of research currently being undertaken within the University and NHS service providers.     

Supporting and mentoring nursing students in practice

Decision making is a fundamental skill required by the Nursing and Midwifery Council (NMC) for entry to the nurse register. It is required for the completion of the essential skills clusters - skills identified by the NMC that must be achieved in pre-registration nursing programmes. Often students do not recognise that many of the tasks they perform on clinical placement involve decision-making skills and therefore find it difficult to show their attainment in their record of achievement. This article explores how students can demonstrate their decision making and suggests techniques for mentors to support students.     

Knowledge is power: using nursing information management and leadership interventions to improve services to patients, clients and users

Aim This paper examines the purpose, role and function of information and information management within health care today. It is set within the context of a specialist forensic learning disability setting. Background Changes in politics, government legislation and reforms of the National Health Service (NHS) have created a need to equip managers with the necessary tools and skills to be able to lead and manage effectively. As such there has been a great emphasis upon specialist training, such as the government-driven Leading an Empowered Organisation courses, for nurse managers and nurses with leadership potential. Yet with the drive to generate a new wave culture within the NHS of inspirational leaders, are we still overlooking a critical and key area which is fundamental in achieving and delivering cost effective, quality health care – the area of information management within health care today? Methods The processes presented in this paper are structured through a strategic nursing management and leadership performance implementation model, the Clinical Nursing Leadership Learning and Action Process (CLINLAP) model, which facilitates work-based learning and capability development in the reality of everyday clinical activities. Through the model, the emphasis is to make clinical goals specific, roles explicit, processes clear and encourage these activities to be carried out within an environment of open relationships. Results The use of CLINLAP model assisted as a management and leadership technology to manage change in the workplace so as to improve services to patients in Yelday Lodge. Structured management and leadership interventions led to observable positive change in information management on Yelday Lodge. Conclusions The conclusion is that sustained quality information could be embedded in nursing practice at Yelday Lodge or elsewhere by evaluating and discussing the different information management approaches within the practice area through the use of structured management and leadership interventions. The use of the CLINLAP model is recommended for use as a model for managing information, knowledge and communication for results within nursing and health care services.     

A dignified approach to improving the patient experience: promoting privacy, dignity and respect through collaborative training

Globally there is a plethora of literature surrounding patients' privacy, dignity and respect, consequently highlighting the need for healthcare professionals to ensure such basic human rights are upheld when delivering care. For qualified practitioners this is further emphasised through the professional bodies and their varying codes of practice. To ensure privacy, dignity and respect move from rhetoric to reality in professional practice many pre-registration programmes promote service user involvement. Evidence suggests that involving service users in the delivery of educational programmes by directly telling their own stories enhances patient centred care. However given a number of recent patient surveys and/or audits reporting the lack of privacy, dignity and respect in health and social care settings there seems to be a growing need to reaffirm practitioners' knowledge, skills and values once qualified and practising in healthcare organisations. This paper reports on a project in a UK NHS Mental health Trust where service users, in collaboration with Trust staff, planned and delivered a series of privacy and dignity workshops to healthcare practitioners with the aim of improving the patient experience. Although the project took place within a Mental Health Trust the issues of privacy, dignity and respect apply to all healthcare sectors.     

Partnership working between a higher education institution and NHS TRUSTS: developing an acute and critical care module

The underpinning philosophy of preparing nurses to work within a modern National Health Service (NHS) is to ensure patient safety and quality of clinical care. There is increasing recognition that post-registration education should become more clinically focused and adopt a more work-based approach. Critical to the success of such an approach is partnership working between education providers and NHS Trusts. Changes in the delivery of acute care in the NHS have resulted in an increased number of highly dependent patients in both critical and non-critical care areas. This article describes a partnership approach between a Higher Education Institution (HEI) and two NHS Trusts to deliver a degree level module to address the subsequent educational implications of these changes. This approach ensured module credibility and clinical focus. Student feedback confirms the clinical relevance of the module. Staff from the NHS had the opportunity to develop teaching skills by preparing teaching materials, delivering teaching sessions and receiving feedback on these. Areas of good practice were identified and there was sharing of skills, knowledge and expertise between both institutions. Joint working can enhance clinical relevance of educational provision and ensure consistency between theory and practice. In addition, there were a number of wider benefits to both institutions that resulted from this initiative.     

Nursing leadership within the NHS: an evolutionary perspective

Effective leadership is crucial to the delivery of quality NHS care, particularly in the current economic climate. These are unprecedented times for the NHS; at no other time in its life has the need for leadership been greater. It is hard to define nursing leadership, with roles becoming increasingly complex. Although there has been much invested in leadership training, NHS guidance has suggested the service has only just begun to understand the importance of leadership. There is unparalleled change in the NHS; nurses are being asked to be innovators and entrepreneurs. In this article, the author considers what leadership is, and stresses the need for it to continue evolving to meet the changing demands of the NHS.     

Public health nurses perception of clinical leadership in Ireland: narrative descriptions

Aim  The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses' in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery.
Background  Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles.
Method  Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery.
Results  Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective.
Conclusions  Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor.
Relevance to nurse managers  Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.     

Intentional Modelling: A Process for Clinical Leadership Development in Mental Health Nursing

Clinical leadership is becoming more relevant for nurses, as the positive impact that it can have on the quality of care and outcomes for consumers is better understood and more clearly articulated in the literature. As clinical leadership continues to become more relevant, the need to gain an understanding of how clinical leaders in nursing develop will become increasingly important. While the attributes associated with effective clinical leadership are recognized in current literature there remains a paucity of research on how clinical leaders develop these attributes. This study utilized a grounded theory methodology to generate new insights into the experiences of peer identified clinical leaders in mental health nursing and the process of developing clinical leadership skills. Participants in this study were nurses working in a mental health setting who were identified as clinical leaders by their peers as opposed to identifying them by their role or organizational position. A process of intentional modeling emerged as the substantive theory identified in this study. Intentional modeling was described by participants in this study as a process that enabled them to purposefully identify models that assisted them in developing the characteristics of effective clinical leaders as well as allowing them to model these characteristics to others. Reflection on practice is an important contributor to intentional modelling. Intentional modelling could be developed as a framework for promoting knowledge and skill development in the area of clinical leadership.