Combining qualitative and quantitative methods in assessing hospital learning environments

Clinical education is a vital component in the curricula of pre-registration nursing courses and provides student nurses with the opportunity to combine cognitive, psychomotor, and affective skills. Clinical practice enables the student to develop competencies in the application of knowledge, skills, and attitudes to clinical field situations. It is, therefore, vital that the valuable clinical time be utilised effectively and productively. Nursing students' perception of the hospital learning environment were assessed by combining quantitative and qualitative approaches. The Clinical Learning Environment Inventory, based on the theoretical framework of learning environment studies, was developed and validated. The quantitative and qualitative findings reinforced each other. It was found that there were significant differences in students' perceptions of the actual clinical learning environment and their preferred learning environment. Generally, students preferred a more positive and favourable clinical environment than they perceived as being actually present.     

Studying abroad: a multiple case study of nursing students' international experiences

This paper examines the experiences of nursing students undertaking an international placement during their pre-registration education. The study took place in two schools--one in the United Kingdom, and one in Sweden. The move of nursing education into higher education enabled students to participate in international exchange programmes. Previous research demonstrates that students participating in such programmes may gain enhanced cultural awareness and experience personal and professional growth. The study comprised a multiple case study, utilising semi-structured individual and group interviews and documentary analysis. Eighteen students from the UK and 14 from Sweden participated. Participants described an increase in confidence, self-reliance and professional knowledge and skills resulting from their international placement. There was an awareness of how healthcare roles differ between countries and a change in attitudes to others from different backgrounds and cultures. The differences between the two cases were marginal. Whilst there was support from both home and host universities this varied between the international placement providers. The international placements were beneficial; however, there is a need for change in the preparation, support and monitoring of students, greater engagement with the partner institutions, and more effective mentoring of staff.     

Nursing for change: the orientations and values of Project 2000 diploma and undergraduate nursing students

The introduction of pre-registration nursing degree and diploma programmes in the United Kingdom has provoked considerable scrutiny of a range of issues such as funding arrangements, links between colleges of nursing and midwifery and higher education and the impact of the new courses on education and service provision Less attention has been devoted to the changing orientations and values of diploma and undergraduate students during their courses of study The parallel commencement in 1991 of 3-year undergraduate and diploma programmes in Leicestershire provided an opportunity to chart the changing orientations (personal, political, ethical, professional and academic) of two cohorts of students matched by age, gender and branch programme Research is being undertaken, a primary aim of which is to assess the changes that occur in these orientations over time and to relate these to the educational progression of the students through successive phases of their respective courses The focus of the research concerns the student's personal experience and developing insights into health, nursing and care delivery This paper seeks to provide an overview of the literature relevant to the study     

Student experiences and mentor views of the use of simulation for learning

This paper presents the findings of a two phase mixed methods study. Phase 1 investigated whether simulation could support the development of a range of clinical skills amongst pre-registration adult and children's nursing students. The second phase of the study gathered mentors' views and experiences of the use of simulation in the preparation of students for practice. Commissioned by the Nursing and Midwifery Council, the United Kingdom (UK) professional body, the study is reported as one of 13 pilot sites using designated practice hours for simulation. The commission resulted from a call to review the current pre-registration nursing curriculum that includes 4600 equally divided theory and practice hours delivered across the programme. Phase 1 included a sample of 69 adult and children's pre-registration students from years one and three of their programme, studying at one UK University. The group attended five simulation sessions including basic life support, manual handling, infection control, clinical decision making and managing violence and aggression. Students completed pre- and post-tests in basic life support and manual handling, and vignettes and objective structured clinical examinations (OSCEs) covering the five areas of simulation. Phase 2 included interviews with six mentors who were supervising students involved in the study. Simulation was positively received by both students and mentors as it was apparent that it offered scope for interdisciplinary learning that could be broadened to inter-professional applications. The study also identified that the use of simulation could provide scope for collaborative working between education providers and clinical staff.     

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.     

Effect of PETTLEP imagery training on performance of nursing skills: pilot study

Title.  Effect of PETTLEP imagery training on performance of nursing skills: pilot study.
Aim.  This article is a report of a study to evaluate the effect of PETTLEP-based imagery training on nursing skill performance.
Background.  Imagery structuring has been demonstrated to facilitate the development of psychomotor skills in sporting performance. A form of imagery structuring known as PETTLEP was employed in this study. PETTLEP (an acronym for its procedures) involves preparation through focussing on physical characteristics, the environment, the task itself, timing, learning, emotion and perspective.
Methods.  A pilot study was conducted, using experimental design, and the data were collected in 2005. Participants in the experiment were 56 pre-registration students from one university in the United Kingdom. Half of the students received training for two basic nursing skills using PETTLEP procedures, and scores were compared for two objective structured clinical examinations.
Results.  Students who received PETTLEP training for blood pressure measurement performed statistically significantly better than those who did not ( F  = 4·62 P  = <0·05). The training did not have a statistically significant effect for aseptic techniques. We suggest that the psychomotor element in aseptic techniques was not as important as that involved in blood pressure measurement.
Conclusion.  PETTLEP imagery should be explored further as a method to help nursing students acquire skills that have a psychomotor component.     

Clinical placements in Australian general practice: (Part 1) the experiences of pre-registration nursing students

An international shift towards strengthening primary care services has stimulated the growth of nursing in general (family) practice. As learning in the clinical setting comprises a core component of pre-registration nursing education, it is logical that clinical placement opportunities would follow the workforce growth in this setting. Beyond simply offering placements in relevant clinical areas, it is vital to ensure high quality learning experiences that meet the educational needs of pre-registration nurses. Part 1 of a two part series reports on the qualitative study of a mixed methods project. Fifteen pre-registration nursing students participated in semi-structured interviews following a clinical placement in an Australian general practice. Interviews were transcribed verbatim and underwent a process of thematic analysis. Findings are presented in the following four themes; (1) Knowledge of the practice nurse role: I had very limited understanding, (2) Quality of the learning experience: It was a fantastic placement, (3) Support, belonging and mutual respect: I really felt part of the team, (4) Employment prospects: I would really, really love to go to a general practice but …… General practice placements exposed students to a diverse range of clinical skills which would equip them for future employment in primary care. Exposure to nursing in general practice also stimulated students to consider a future career in this clinical setting.     

Rethinking theory and practice: pre-registration student nurses experiences of simulation teaching and learning in the acquisition of clinical skills in preparation for practice

In the United Kingdom (UK) simulation learning has been recognised in the form of a regulatory agreement that may replace hours from clinical practice. This integration has become an embedded feature of the pre-registration nursing programme at a University in the North of England, along with strategic investment in staff and simulation suites developed to underpin this curriculum change albeit in the absence of sparse empirical evidence, hence the rationale for the study which was designed to explore the relationship between simulation, theory and practice. The study features a thematic analysis of evaluation questionnaires from pre-registration student nurses (n=>500) collected over a 2 year period which informed subsequent focus group interviews to explore the themes in more detail. Consistent data findings were the students' positive response to simulation as a learning approach facilitating the application of theory in a safe controlled environment. Students reported that they felt prepared for practice, recognising that simulated learning improved their humanistic and problem solving abilities as well as the development of psychomotor, technical skills, and overall confidence. The theory-practice gap is a recurring narrative in the nursing literature, the findings of this study recognises that simulation offers an opportunity to enact the integration of theory and practice illuminating this relationship in a controlled environment thus, reinforcing the theory-practice relationship for nursing students.     

I felt like a real nurse - student nurses out on their own

In the United Kingdom, the education of nurses to be 'fit for practice' has received considerable attention having a catalytic effect on the way nursing programmes are organised. A period of clinical practice is now recommended in the final stages of nurse education to help prepare students for the role of registered practitioner. In the study area, the opportunity for student nurses in the final stages of their programme to visit patients and clients on their own in the community is given to facilitate achievement of the competencies required for entry to the nursing register. The aim of the study reported here was to discover what this experience meant for students in their final year. A qualitative methodology utilising one-to-one, semi-structured interviews was adopted. The tape-recorded interviews were transcribed and the content analysed to reveal codes, categories and themes. The findings revealed that being 'out on their own' was valued by students who felt they were taking on the role of a 'real nurse'. The main themes to emerge were: building confidence, developing professionalism in relationships, learning to manage care, developing knowledge and gaining insight, and being included and supported. The opportunity for final stage students to work independently in whatever setting they are placed is recommended as important for their professional development.     

Implementation and evaluation of peer assessment of clinical skills for first year student nurses

Enabling student nurses to learn and develop evidence-based clinical skills is the cornerstone of nursing education programmes. This article describes the implementation of a peer assessment scheme for clinical skills within a skills laboratory in a university school of nursing, and the link between peer assessment and clinical skills development. This was a qualitative evaluative study that used questionnaires for data collection and was undertaken on one cohort of students. Findings showed that nearly half of all the statements made by students were about the positive impact of PACS on their skills learning. Students identified giving and receiving peer feedback, reflection and working with peers in small groups as being particularly valuable in clinical skills learning. Increased confidence was also a dominant finding as was the value of repeated practice in a simulation setting on skills development. This study supports some of the previous literature related to use of simulation and peer assessment but the discussion presented in this article also highlights that the findings of this study contradicts other findings in the literature. What makes this study unique is its contribution to the literature is the link that was established by students between the peer-assessment process and clinical skills learning.     

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.     

Enhancing students learning experiences in nursing programmes: An integrated review

Nursing as a profession is both fragmented and complex. The education setting is demanding, and prepared students are more clinically and academically robust. Therefore, nursing programmes should implement high-quality teaching based on the best available scientific evidence to improve learning quality and students’ experience. This study aimed to identify the teaching tools used to enhance students’ perceived experiences in undergraduate nursing programmes. Nine databases were systematically searched to identify quantitative and qualitative studies regarding the teaching tools utilised across nursing education programmes. Results were summarised following a systematic integrated review framework. The searches identified 15,886 citations, and after title/abstract/full-text screening, 66 primary research studies were included comprising data from 4,411 participants with a mean sample size of 66 (range 6–447). Educators utilising a student-centred wrapping approach exploiting knowledge building and self-development were found to improve students’ experiences; however, consensus on success factors was lacking. The findings indicate that educators’ knowledge and pedagogical skills used in a flexible way, tailored and sensible to students and the learning context, enhance student experiences. Nursing educators should identify learning situations that make students vulnerable and pay particular attention to the students’ learning experiences. We identified several tools accommodating the students' experience.     

The views and experiences of midwifery academics regarding LGBTQ+ health education in pre-registration programmes in the United Kingdom and Ireland: Qualitative findings from a mixed-methods study

AimThe purpose of this study was to identify the current LGBTQ+ health content within midwifery pre-registration programmes and identity education best practice and innovation.BackgroundThere have been significant developments in some countries in protecting the rights of LGBTQ+ people. LGBTQ+ people are and do become parents and require access to maternity services. Yet some report heteronormative assumptions, negative and discriminatory attitudes from midwives that results in barriers to service access and feelings of exclusion.DesignThis mixed-methods study involved a quantitative and qualitative design. The qualitative findings are reported here.MethodsAll 135 Schools of Nursing and Midwifery across the United Kingdom and Ireland were invited to participate in an online survey and qualitative interview. Thematic analysis of the qualitative data from 29 survey responses and seven midwifery follow-up interviews were conducted.ResultsThree themes identified following data analysis: (i) preparing midwifery students for practice; (ii) the diverse family unit; and (iii) safety, privacy and respect.ConclusionsThe findings provide insights into the challenges of meeting the education needs of midwifery students, with an opportunity to develop and implement a curriculum that is reflective of the needs and concerns of LGBTQ+ people within pre-registration midwifery programmes.     

Evaluating a problem based learning course: an action research study

Problem based learning (PBL) has been widely used in the United States, United Kingdom and Australasia in undergraduate nursing education to develop critical thinking and problem solving skills. PBL has been used since 1996 in a Bachelor of Nursing course at a New Zealand tertiary institution, and several modifications have been made to foster effective learning. The 'pure' PBL process has been adapted to move students gradually from teacher direction to taking responsibility for their learning. This has provided the opportunity for students to develop critical thinking, problem solving, information retrieval and evaluation skills, and group process skills over an 18-week period. Because rigorous evaluation of these changes had not been formally undertaken, the purpose of this study was to evaluate how the current format was developing students' understanding and integration of knowledge. Two cycles of the action research method (Cardno and Piggot-Irvine, 1994) were used, involving 4 lecturers and 17 students. Data was collected both quantitatively and qualitatively over a 16-week period. Findings indicated the importance of: explaining the purpose and process of PBL; communicating in detail the role of both students and lecturers; keeping communication lines open; addressing timetabling issues and valuing this method of learning for nursing practice. Implications for nursing education are addressed.     

Developing nursing practice through work-based learning

Developing nursing practice in any area demands skills, knowledge, support and a long term commitment to the achievement of best practice. It is easy to become overwhelmed by the competing demands for client care and service delivery. It is not always easy to see how good ideas, clinical concerns and professionally led objectives, can be realised in practice. Ongoing professional development activities, including formal educational programmes can contribute to individual staff members’ ability to take on practice development projects. Too often however, educational programmes are seen as making little real difference to clinical practice. Work-based learning, a relatively new approach in higher education in the United Kingdom, presents opportunities for Universities and healthcare providers to work in partnership to realise the shared aims of developing nursing practice. Specific examples, drawn from the personal experiences of one of the authors, will examine the contribution of a work-based learning approach to integrating learning and developing practice in the field of cancer care. The work-based learning approach can bring about tangible benefits for patients, practitioners and organisations, but only if the organisational and contextual factors which impact on practice and its development are properly considered and managed through effective partnerships.