Undergraduate psychiatric nursing education at the crossroads in Ireland. The generalist vs. specialist approach: towards a common foundation

This paper provides a critical overview of undergraduate educational preparation for psychiatric nursing and proposes the use of a model, which may equip psychiatric nurses to adapt to current and future directions in psychiatric nursing practice. It contends that mental health nursing is a distinct scope of practice and as such requires specialty undergraduate education. A major difference between educational preparation for psychiatric nursing in the Republic of Ireland and the UK, and distinct from most other developed countries, is the existence of separate, specialized pre-registration programmes that, upon graduation, allow the nurse to register as a psychiatric nurse. In other countries such as, Australia, the integration of pre-registration nurse education into the university sector resulted in the wide-scale adoption of a generalist approach to nurse education. In light of the recent changes in pre-registration nursing education in Ireland, and the integration of nursing into higher-level education, this paper examines the generalist vs. specialist approach to nurse education. It contends that neither the generalist nor the specialist model best serve the nursing profession in preparing safe and competent practitioners. Rather, it argues that the use of a model which incorporates both generalist and specialist perspectives will help to redress the imbalance inherent in both of the existing approaches and promote a sense of unity in the profession without sacrificing the real strengths of specialization. Such a model will also facilitate psychiatric nurses to adapt to current and future directions in psychiatric nursing practice.     

Widening participation in nurse education: An integrative literature review

BackgroundWidening participation into higher education is espoused within educational policy in the UK, and internationally, as a mechanism to promote equality and social mobility. As nurse education is located within higher education it has a responsibility to promote widening participation within pre-registration educational programmes. It could also be argued that the profession has a responsibility to promote equality to ensure its' workforce is as diverse as possible in order to best address the health needs of diverse populations.ObjectivesTo undertake an integrative review on published papers exploring Widening Participation in undergraduate, pre-registration nurse education in the UK.DesignA six step integrative review methodology was utilised, reviewing papers published in English from 2013–2016.Data SourcesSearch of CINAHL, Education Source, MEDLINE, PsychINFO, SocINDEX, Science Direct, Business Source Complete, ERIC, British Library ETOS, Teacher Reference Centre, Informit Health Collection and Informit Humanities and Social Science Collection which highlighted 449 citations; from these 14 papers met the review inclusion criteria.Review MethodsBoth empirical studies and editorials focusing upon widening participation in pre-registration nurse education in the UK (2013–2016) were included. Papers excluded were non UK papers or papers not focussed upon widening participation in pre-registration nursing education. Research papers included in the review were assessed for quality using appropriate critical appraisal tools.Results14 papers were included in the review; these were analysed thematically identifying four themes; knowledge and identification of WP, pedagogy and WP, attrition and retention and career prospects.ConclusionsWhilst widening participation is a key issue for both nurse education and the wider profession there is a lack of conceptualisation and focus regarding mechanisms to both encourage and support a wider diversity of entrant. Whilst there are some studies, these focus on particular individual widening participation groups rather than a wider strategic focus across the student lifecycle.     

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.     

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.     

Problem-solving skills of senior student nurses: an exploratory study using simulation

The Stages Model of problem-solving as evidenced in the use of the nursing process is the key vehicle for the operationalisation of problem-solving in current nursing practice. An expanded variant of the model formed the theoretical framework for this study which aimed to explore and compare the problem-solving skills of senior student nurses (n=253) from three pre-registration nurse education programmes (RGN, diploma RN, integrated degree). Students' care planning skills were explored using a video-tape simulation exercise and data were subjected to statistical testing. Findings indicated a large range in the global care plan scores and while performance was similar in a number of areas independent of programme type, certain key differences also emerged. The findings are discussed in the wider context of professional education and practice and the potential for further development of problem-solving skills in pre-registration nurse education is explored.     

Desperately seeking consistency: Student nurses' experiences and expectations of academic supervision

BackgroundAcademic supervision - the support available to students when writing assignments - is a fundamental element in the provision of support within nurse education. Not only can it underpin high levels of academic achievement, but it also has a role in enhancing the retention of students. Despite its importance, there is little investigation of undergraduate academic supervision within the nursing literature.ObjectivesTo explore students' experiences and expectations of academic supervision as part of an undergraduate programme of nurse education.DesignA qualitative approach to explore student perceptions.SettingThe research was undertaken at a Higher Education Institution in the United Kingdom. The institution offers undergraduate nurse education programmes to approximately 800 students.ParticipantsEight pre-registration nursing students from a Bachelor of Science programme participated in a focus group interview. All were in the first semester of their final year.MethodsData were collected using focus group interviewing, based around a semistructured question framework. The focus groups explored students' expectations and previous experiences of academic supervision. The focus group was recorded, responses were transcribed and thematic analysis was undertaken to identify key findings.ResultsThree themes were identified from the data: relationship with supervisor, variation between supervisors, and the link between supervision and marking. Overall, students identified frustration with variability in the provision of academic supervision.ConclusionsEffective academic supervision depends on a strong relationship between student and supervisor - something that can be difficult to achieve if supervision is only for a short period of time. Equally, students crave a consistent approach to supervision, in terms of both the amount and content of feedback. Students are able to identify and articulate a clear link between effective supervision and academic achievement.     

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.     

The pursuit of excellence and innovation in service user involvement in nurse education programmes: Report from a travel scholarship

The involvement of service users and carers in nurse education is increasing, with the new standards for pre-registration nurse education in the UK, which require nurse education providers to demonstrate how they are involving users and carers in the planning, delivery, teaching and evaluation of nursing curricula (Nursing and Midwifery Council, 2010). A travel scholarship provided the opportunity to explore best practice in this area, focussing on identifying support systems and processes that enable user involvement.The scholarship was undertaken in the UK and Ireland during a 4 week study tour between June and July 2011, during which I visited 15 universities, and met with nurse education staff, users and carers involved in nurse education programmes. Prerequisite processes, the spectrum and variety of involvement activities, quality assurance and evaluation; and sustainability of user involvement in nurse education are reported in this paper. Service users and carers are an under-utilised resource, and as experts by experience have much to offer students and staff by increased involvement in nurse education programmes. The importance of values, enthusiasm and relationships, the cornerstones that strengthen user involvement; often sustain such partnerships.     

Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom

The prevalence and burden of pain has long been reported as problematic. Comprehensive pain education in undergraduate programmes is essential for developing knowledgeable, skilled and effective healthcare professionals. This cross-sectional survey describes the nature, content and learning strategies for pain curricula in undergraduate healthcare programmes in major universities in the United Kingdom (UK). Document analysis also highlighted gaps in pain-related standards from professional regulators and a higher education quality assurance body. The sample consisted of 19 higher education institutions delivering 108 programmes across dentistry, medicine, midwifery, nursing, occupational therapy, pharmacy, physiotherapy and veterinary science.Seventy-four (68.5%) questionnaires were returned averaging 12.0 h of pain content with physiotherapy and veterinary science students receiving the highest input. Pain education accounted for less than 1% of programme hours for some disciplines. Traditional teaching methods dominated (e.g. lectures 87.8%) and only two programmes had fully implemented the International Association for the Study of Pain’s (IASP) curricula. Minimal pain-related standards were found from professional regulators and the quality assurance documents.Pain education is variable across and within disciplines and interprofessional learning is minimal. Published curricula for pain education have been available for over 20 years but are rarely employed and pain is not a core part of regulatory and quality assurance standards for health professions. The hours of pain education is woefully inadequate given the prevalence and burden of pain. Recommendations include the introduction of pain-related educational standards across all professions, greater integration of pain content in undergraduate programmes and interprofessional approaches to the topic.     

Pre-registration education: learning communities

Changes in nurse education in the UK and the introduction of a new pre-registration nursing programme have led to developments in education methods. This article describes the creation of learning communities at Thames Valley University as a means of adapting to the new curriculum.     

Undergraduate registered nursing students working as assistants in nursing within the acute care environment: Program development and discussion

BackgroundMost pre-registration nursing students require employment during their studies which may entail undertaking another qualification.This paper describes how one university developed a program whereby undergraduate nursing students complete the national vocational education – HLT33115 Assistant in Nursing qualification through recognition of prior learning, a self-directed education package and completion of an objective structured clinical examination.ObjectiveTo discuss the development of an ‘Assistant in Nursing’ in the acute care environment program for pre-registration undergraduate nursing degree students using the national vocational education framework.DesignThis program maps the national ‘Assistant in Nursing- Acute Care’ vocational qualification to the pre-registration registered nurse degree. Upon successful completion of this program students can work as Assistants in Nursing within the acute care environment.ConclusionsThis program enables student nurses to work as Assistants in Nursing within the acute care environment. This provides employment in a health facility and opportunities for students to immerse themselves in the clinical environment whilst continuing their studies. This may assist students to gain a deeper insight into their future role as a nurse, build networks within the nursing community and assimilate into the clinical environment. This program design may prove useful as a template for other nursing faculties wishing to implement a similar program.     

Nurse prescribing: implications for the life sciences in nursing curricula

The development of new roles, over recent years, for health care professionals, has meant that the boundaries between the different occupations are no longer as clear as they were in the past. For example, the reduction in junior doctors' hours in the United Kingdom (UK), has meant that nurses have had the opportunity to expand their practice into a variety of areas which were once exclusively the responsibility of doctors. One area in which nurses (in the UK) have expanded their practice is prescribing. This paper commences with an overview of the development of nurse prescribing and highlights the important role of the life sciences in the education and training of nurse prescribers. The major findings from studies examining the teaching and learning of these sciences in nursing curricula are presented, and the implications for post-qualifying courses enabling nurses to prescribe, and pre-registration nurse education programmes are discussed.     

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.     

Irish nursing students' changing levels of assertiveness during their pre-registration programme

BACKGROUND: Stress and bullying have been found to be common problems in a number of studies of Irish nursing and midwifery. Victims of bullying need high levels of assertiveness to enable them to withstand the stress of victimization. It was deemed important to measure nursing students' level of assertiveness prior to, and near completion of, their pre-registration education programme. Aim. To ascertain nursing students' perceived levels of assertiveness prior to, and nearing the completion of, their three-year pre-registration programme. METHODS: Ethical approval was given. The students commencing general nurse education programmes in two schools in Southern Ireland agreed to take part (n=72). A questionnaire adapted from a number of assertiveness scales, and tested for validity and reliability in this population, was used to collect data. RESULTS: In general, students' reported assertiveness levels rose as they approached completion of their three-year education programme. DISCUSSION: The resource constrained health service of the 21st century requires nurses who are assertive to meet the needs of its users. Nursing students' assertiveness skills could be augmented through concentrated efforts from nurse educationalists and clinicians to reduce the communication theory practice gap in nurse education today. To address the multi-dimensional nature of assertiveness, strategies to increase assertiveness should operate at the individual, interface and organisational level. CONCLUSIONS: The students in this study reported an increase in levels of assertiveness as they approached completion of their three-year education programme. To function as effective, safe practitioners registered nurses need to be assertive, therefore education in assertiveness should be an integral part of their preparation. The precise composition and mode of delivery of this education requires exploration and evaluation.     

An international exploration of blended learning use in pre-registration nursing and midwifery education

AimTo explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy.BackgroundThe global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for pre-registration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere.DesignCross-sectional, sequential, mixed methods studyParticipants/settingsNursing/nurse education leaders from across International Council of Nurses regionsMethodsExploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants’ knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes.ResultsParticipants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation.ConclusionsBlended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact.Tweetable abstractBlended learning plays an effective part in the education of pre-registration nursing and midwifery students to help tackle global workforce shortages, but further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach.