Learning from abroad: the benefits for nursing

Contemporary curriculum guidelines for nurse education advocate the development of a broader European or international perspective. This is enhanced by curriculum changes which now enable student nurses to undertake clinical experience overseas, either for observation or direct participation in health care. Such initiatives are to be welcomed, given the implications of the Maastricht Treaty and the transition to a single European market. Furthermore, changes within Europe and further afield may have an impact on nursing practice at a time when those involved in health care may be facing similar challenges in the UK in terms of diminishing health resources and demographic trends. If nurses are to adapt to these socio-economic challenges and develop pro-active nursing practice they need to be tolerant of cultural issues, and have an understanding of health care in the wider European and international context. The aim of this paper is to discuss the evidence for incorporating a European dimension into nurse education, before examining the benefits for nurses with reference to activities within one department of nursing.     

Nursing shaping and influencing health and social care policy

Aim  This paper seeks to consider how nursing as a profession in the United Kingdom is developing its role in shaping and influencing policy using lessons learnt from a policy study tour undertaken in the United States of America and extensive experience as a senior nurse within the government, the health service and more recently within a Professional Organization.
Background  The nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care.
Methods  This paper critically reviews recent UK and USA literature and policy with relevance to nursing.
Results  Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solutions that promote and increase the participation of nurses in the political process and health policy. There are lessons to be learnt in the UK from the US nursing experience. These need to be considered in the context of the UK and devolution.
Conclusions  Although much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making, there is a need for greater co-ordination of action to ensure that nursing is actively supported in influencing and shaping health and health care policy.
Implications for Nursing Management  All leaders and other stakeholders require to play their part in considering how the actions set out in this article can be taken forward and how gaps such as education, fellowship experience and media engagement can be addressed in the future.     

Can nurses rise to the public health challenge? How a novel solution in nurse education can address this contemporary question

This paper raises the problem of how improvements in health outcomes, a key component in many governments' strategies, can be achieved. The work highlights a novel undergraduate educational approach which offers solutions to public health challenges within nursing. Against the backdrop of one UK university institution it discusses approaches that can guide nursing students towards a deeper understanding and engagement within the principles of public health. It then proposes how nurses can use their learning to become leaders of health improvement.     

Conceptualizing advanced nursing practice: curriculum issues to consider in the educational preparation of advanced practice nurses in the UK

The findings from a Florence Nightingale Scholarship to the USA and Canada, investigating the educational preparation of advanced practice nurses, are reported. The author considers a number of issues facing curriculum designers who might wish to develop clinically based advanced practice nurse programmes in the UK. Utilizing the experiential nature of personal visits, along with the available literature, the strategy adopted by some American and Canadian universities is highlighted to exemplify curriculum issues likely to be encountered in the UK. A definition of advanced nursing practice is provided as a foundation for discussion on curricular construction. This is followed by a discussion on advanced role nomenclature and components and characteristics of the 'nurse practitioner', 'clinical nurse specialist', 'nurse consultant' and 'nurse clinician', in order to clarify terminology and disentangle different advanced practice roles. The issues examined include the academic level of advanced practice nurse programmes; the determination of curricular content based on both a 'generalist' and 'specialist' model of practice; factors considered when exploring advanced practice competencies; and the resource implications for delivering opposing curriculum models. The paper suggests that there is a unique opportunity for advanced practice nursing to establish a key collaborative relationship in the delivery of health care, based on a nursing model, graduate study and the integration of key nursing and related concepts into clinical practice.     

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

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

Four parts or one whole: The National Health Service (NHS) post-devolution

Aim(s) There is a need for nurse and midwifery managers to have an understanding of devolution and its implications for them and their colleagues. This paper will explain devolution, consider some health and social care policy including similarities and differences, and assess the impact of devolution on the nursing workforce and the regulation of nursing across the four countries of the United Kingdom (UK). Background If managers are to manage effectively it is critical that they remain aware of emerging policy development and outcomes across the UK. It is now more important than ever that nurses maintain a keen eye on the impact divergent policy is having on practice as well as the UK nursing workforce. Evaluation The impact of devolution across the UK will be explored using convergence and divergence as a framework; commencing by providing an overview of devolution and health, moving on to examine health policy in action across the four countries. Key issues Healthcare is highly political in nature. Devolution has implications for all, and adds to the complexity of health and social care provision. If managers are to manage effectively it is critical that they remain aware of emerging policy development and outcomes across the UK. Conclusion It is equally important that nurses, and nurse managers, develop and draw upon their political leadership skills, actively engaging in policy debates to ensure that when policies are translated into practice their outcomes are optimal in terms of quality, efficiency and sustainability. Implications for nursing management There is a need for nurse and midwifery managers to have an understanding of post‐devolution structures and how they operate in order to work effectively, as well as to learn from the experiences of other parts of the UK.     

Transition to mental health nursing through specialist graduate nurse programs in mental health: a review of the literature

Specialist graduate nurse programs (GNPs) in psychiatric/mental health nursing have been widely implemented across public healthcare services throughout Victoria, Australia. Broadly, these programs aim to assist newly graduated nurses during the transition from nursing student to registered nurse. This paper presents a review of the literature relevant to GNPs; specifically focusing on graduate transition. An adequate orientation to clinical areas and ongoing support throughout the transition process were identified as significant determinants of new graduates" satisfaction with the initial post-qualification period. However, the literature suggests that the inadequacy of psychiatric/mental health nursing content in undergraduate nursing courses creates additional difficulties within this specialty area of practice. Moreover, the current literature review emphasises the need for further research to evaluate the effectiveness of GNPs for nursing in general and for psychiatric/mental health nursing in particular.     

Integrating simulation training into the nursing curriculum

The use of simulation is gaining momentum in nurse education across the UK. The Nursing and Midwifery Council is currently investigating the use of simulation in pre-registration nursing. This article gives a brief history of simulation, discusses competence issues and why simulation is best placed to teach nurses in today's health service. An innovative approach to implementing simulation into the nursing curriculum is introduced.     

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.     

Drivers for renewal and reform of contemporary nursing curricula: a blueprint for change

The creation of a curriculum blueprint appropriate to the development of a professional nurse who is practice-ready for the current and future context of health service delivery must take account of the extant context as well as an unpredictable and sometimes ambiguous future. The curriculum renewal process itself ought to challenge existing long held ideals, practices, and sacred cows within the health and higher education sectors. There is much to consider and importantly curriculum developers need to be mindful of reform within the health sector and health workforce education, as well as the concomitant vision and requirements of the nursing profession. Curriculum must develop more than discipline knowledge and skills: it must provide an infrastructure for generic abilities both social and intellectual in order to better prepare students for the registered nurse role. This paper discusses a number of forces that are essential to consider in curriculum development in undergraduate nursing education.     

Measuring the workload of community nurses in Ireland: a review of workload measurement systems

BACKGROUND: The primary community nursing service in Ireland is public health nursing and this unique healthcare role incorporates activities and responsibilities undertaken by a variety of health professionals in other countries. Capturing and comparing a measure of the work of any community nurse is complicated due to the difficulty in standardizing the nature of community nursing across care settings. AIM: The aim of this paper was to review the varied approaches to measuring the workload/caseload of community nurses to evaluate how they may be applied to measure the workload of the public health nurse in the Irish Republic. CONCLUSION: Many of the systems designed to measure nursing workload are reliant on measuring tasks and fail to capture the less tangible but core aspects of the public health nursing role like decision-making, assessment and case management. IMPLICATIONS: There is a need to develop a workload measurement system for use by public health nurses in Ireland that is capable of measuring the uniqueness of the role.     

School nursing role and competence.

How will school nurses attain, maintain and advance their professional competence in an evolving school nursing and school health environment? This article is designed to assist school nurses to understand competence and nursing competencies and related issues affecting their role. The Southern Regional Education Board/Council on Collegiate Education for Nursing (SREB/CCEN) is exploring a linkage of undergraduate nursing curriculum to school nursing competencies. In addition, a method now used to evaluate school nurse competence in one school district is included.     

Nurse practitioner: redefining the role of the community nurse?

Currently there is considerable uncertainty regarding the future for community nurses in the United Kingdom (UK). Within the present social and political context the development of the nurse practitioner is examined as one possible means of redefining the role of some community nurses. The historical development of the nurse practitioner in the United States of America (USA) and the UK reveals that such a role has, previously, been a response to changing health trends and to deficits in the provision of care to communities. The evolution of an independent nurse practitioner role is suggested as a way forward for different groups of community nurses and should enable them to meet the health demands of people in a variety of settings. The 'needs' of patients and clients and a multidisciplinary approach are emphasized as being important to the redefinition of community nursing roles. The preparation of community nurses as nurse practitioners would have obvious implications for community education; this matter is briefly discussed. The future of nursing as a whole is set to change; it is imperative that all nurses delivering patient care in this arena should examine the changing needs of society in the context of political reform, and consider how their roles may be developed and redefined.     

Meeting the policy agenda, part 2: is a 'Cinderella service' sufficient?

This is the second of two papers that examine district nursing within a changing health policy and service environment. The first paper explored the current UK policy context and the way in which district nursing and community nursing services within each country are changing to meet the challenges posed. This article considers the current district nurse (DN) role, which has constantly evolved over the past 150 years, and considers the educational framework that underpins the preparation of these specialist community practitioners in relation to community colleagues such as specialist community public health nurses (SCPHNs). In the context of the current economic climate, there is concern that the apprenticeship model of staff development is replacing specialist practitioner education for DNs, solely on the basis of resource. This article explores the current challenges for DN education within the UK. The underpinning educational preparation of DN programmes is examined and key issues such as safeguarding the public are discussed. The need to develop a cohesive approach to education for post-qualification nurses in the community is advocated. These are important considerations for the future of a discipline which currently feels under threat.     

Nursing students' attitudes to health promotion to: implications for teaching practice

For several decades now the World Health Organization has indicated the need for a reorientation of the health services away from focusing solely on illness and disease to one that considers both disease prevention and health promotion. Successive publications that guide public health policy both nationally and internationally reiterate the need for health promotion and the principles of health for all to become integral to the fabric of health care delivery. The role of the nurse as health promoters is well recognized. However despite acknowledgement by professional nursing bodies and nurse educators that health promotion forms a central tenet of undergraduate nurse education curricula, there are varied approaches to teaching and learning and little formal evaluation of the consequences of approaches taken. The aims of this study are to identify current health promotion curricular content within the Irish undergraduate nursing programme context; to measure nursing students' attitudes towards health promotion and to examine nursing students' reported lifestyle behaviours.     

Supporting food literacy among children and adolescents: Undergraduate students apply public health nursing principles in clinical practice

Effective public health nurses excel in partnership building and program planning to address priority health concerns, such as childhood obesity and disordered eating. Worldwide, children are at risk for low food and nutrition literacy with associated patterns of low fruit and vegetable consumption. This report focuses on the application of public health nursing principles by undergraduate nursing student teams in the design and delivery of food literacy interventions among a population of children and adolescents. Over a four-year time period, the cumulative intervention reach was 640 children/adolescents. Over 75 nursing students implemented the public health nursing process in support of food literacy, gaining skills across multiple practice domains. Lessons learned from academic-community partnerships to promote food literacy among children and adolescents have direct implications for undergraduate nursing education. Chief among these implications include the growing significance of integrating nutrition in the nursing curriculum and the need for scaffolding to support clinical application of interventions beyond health teaching to address broad determinants of health.     

Tackling drug and alcohol misuse in Brazil: priorities and challenges for nurses

AIMS: To provide an overview of the extent of drug and alcohol misuse in Brazil and the policies and approaches in tackling substance misuse. An examination of the challenges facing the nursing profession in working with substance misusers is presented. BACKGROUND: Alcohol, cocaine, and cannabis are the most commonly misused psychoactive substances in Brazil. One of the biggest public health problems is the interface between the misuse of psychoactive substances and HIV prevalence and other sexually transmitted diseases. Findings from a recent study suggest that undergraduate nurses in Brazil are not adequately prepared in the care and management of substance misuse problems. The nursing profession in Brazil faces numerous challenges in the development of professional competence of nurses in this field. CONCLUSION: A strategy proposed is the creation of regional centres in Brazil to study the integration of substance use and misuse in the nursing undergraduate curriculum and the giving of specific support in teaching and research to nurse teachers. Nurses have a key role to play in the early recognition, assessment, prevention, and treatment of substance misuse.     

Graduate education for advanced practice public health nursing: at the crossroads

The complexity of public health problems and advancement of science framing public health demand an expansion of traditional educational approaches and curriculum to prepare a futuristic advanced practice public health nursing (APPHN) workforce. This position paper sponsored by the Association of Community Health Nursing Educators challenges nurse educators to apply innovative strategies in preparing public health nursing (PHN) professionals and to expand curriculum paradigms to promote PHN's ecological approach to solving problems. To meet the challenges of ensuring public health in the 21st century, advanced practice public health nurses must have greater foundational knowledge in critical content areas discussed in this document. Competence in these areas will enable advanced practice public health nurses to address future health care challenges such as rapidly changing social structures, escalating knowledge explosion, globalization, and growth of new technologies. This education will prepare nurses to forge new knowledge and establish health care teams to create effective solutions.     

Professional Learning Partnerships: A Collaboration Between Education and Service

Escalating mental health care needs coupled with a decreasing nurse labor force demand a fundamental paradigm shift in undergraduate education and service partnerships among psychiatric-mental health nursing students and practicing nurses. The purpose of this two-group comparative study was to identify factors that contribute to a successful learning partnership between nursing students and practicing nurses engaged in a clinical specialty partnership program within an acute psychiatric-mental health setting. The convenience sample consisted of 51 partners: 33 undergraduate students and 18 practicing nurses. The Learning Partnership Survey was administered to all partners allowing comparison of ranking among factors important to the partner relationship. Contrary to previous research, student and nurse partners were more similar in their factor ranking in the present study. Statistically significant differences were noted in the ranking of 2 of the 15 factors that fostered successful learning partnerships. Implications for professional learning partnerships between nursing academia and service institutions are discussed.