Inter-professional learning: discussion groups in a minor surgery skills course for nurses

Inter-professional teaching and learning takes many forms. This paper describes an inter-professional educational intervention using structured discussion groups of nurses and medical students within an innovative course on minor surgery for nurses. During an initial course, nurses were required to demonstrate competence in technical and communication skills by undergoing scenario-based assessments. Unhelpful levels of anxiety before and after these assessments interfered with learning and performance. Semi-structured discussion groups facilitated by medical students were introduced during a second course, running parallel with assessments and replacing the self-directed activities scheduled in the pilot course. Written evaluations and group interviews explored participants’ experiences of taking part in these discussion groups. Results indicate that the groups were successful in reducing unhelpful anxiety and that they conferred additional benefits for both nurses and medical students. Future courses incorporating these inter-professional learning opportunities will evaluate immediate and longer-term benefits in greater depth.     

Breaking bad news: evaluation study on self-perceived competences and views of medical and nursing students taking part in a collaborative workshop

Goals of the work To identify possible effects of an interprofessional breaking bad news course for medical and nursing students on perceived key communication skills and to elicit the views of participants on interprofessional aspects of breaking bad news.Participants and methods Medical and nursing students attending an optional course on breaking bad news received a structured questionnaire on self-perceived communication skills and views on interprofessional aspects at the beginning and end of the course.Main results Forty-seven out of 54 students completed the evaluation questionnaires (response rate=87%). Medical students and nursing students rated their key communication skills after the course as significantly better compared with the beginning of the course. Medical students and nursing students disagreed with the statement that a course format for only one of the professional groups would have been more effective than the interprofessional course concept.Conclusions Students valued the concept of the interprofessional course positively. The improvement of self-perceived communication skills may be interpreted as a positive effect of the teaching session. Further research is necessary to develop strategies to implement a collaborative approach in breaking bad news in clinical practice.     

Teaching communication and stress management skills to junior physicians dealing with cancer patients: a Belgian Interuniversity Curriculum

BACKGROUND: Ineffective physicians' communication skills have detrimental consequences for patients and their relatives, such as insufficient detection of psychological disturbances, dissatisfaction with care, poor compliance, and increased risks of litigation for malpractice. These ineffective communication skills also contribute to everyday stress, lack of job satisfaction, and burnout among physicians. Literature shows that communication skills training programs may significantly improve physicians' key communication skills, contributing to improvements in patients' satisfaction with care and physicians' professional satisfaction. This paper describes a Belgian Interuniversity Curriculum (BIC) theoretical roots, principles, and techniques developed for junior physicians specializing in various disciplines dealing with cancer patients. CURRICULUM DESCRIPTION: The 40-h training focuses on two domains: stress management skills and communication skills with cancer patients and their relatives. The teaching method is learner-centered and includes a cognitive, behavioral, and affective approach. The cognitive approach aims to improve physicians' knowledge and skills on the two domains cited. The behavioral approach offers learners the opportunity to practice these appropriate skills through practical exercises and role plays. The affective approach allows participants to express attitudes and feelings that communicating about difficult issues evoke. Such an intensive course seems to be necessary to facilitate the transfer of learned skills in clinical practice. CONCLUSIONS: The BIC is the first attempt to bring together a stress management training course and a communication training course that could lead not only to communication skills improvements but also to burnout prevention.     

'A caring professional attitude': What service users and carers seek in graduate nurses and the challenge for educators

With the publication of the new NMC standards for pre-registration nursing education, undergraduate curricula are being written in universities across England. There are many drivers for the curricula but one that has until recently received scant attention is the service user's and carer's voice. This paper discusses the findings of a qualitative study that asked 52 service users and carers about the qualities they sought in nurses and their views on nurse education. Eight focus groups were conducted with a broad range of service users and carers from primary and secondary care, and voluntary organisations. Data were analysed using the framework approach facilitated by a qualitative analysis software programme. The sample was diverse, but there were similarities in the qualities they valued in nurses. They sought technical competence, knowledge and willingness to seek information, but overwhelmingly prioritised 'a caring professional attitude'. This was articulated as empathy, communication skills and non-judgmental patient centred care: major themes in the new NMC standards. Our participants also expressed concern about whether the educational preparation of nurses can develop these caring qualities. We discuss this concern, the challenges for nurse educators it presents and how we can engage service users and carers in shaping and delivering our new curricula.     

Teaching senior nurses how to teach communication skills in oncology.

Many nurses acknowledge that their nursing practice is hampered by inadequate teaching about communication skills during their nursing education. Ineffective communication has negative effects on patient care and causes stress when nurses interact with each other, with medical colleagues, with patients and their relatives. Many senior nurses teach junior staff about communication and feel uncertain about their competence to do so despite recognition of its importance. This article reports data from a training initiative endorsed by the Royal College of Nursing in the United Kingdom (UK) aimed at helping senior nurses to identify their personal strengths and weaknesses when communicating, learn new teaching methods and encourage new teaching initiatives. A residential 2-day course, based on learner-centered methods was employed. One hundred and twenty nine nurses from UK cancer centers worked on personal communication problems via group discussions, video demonstrations, small group teaching exercises and role-plays with professional actors. Post-course, participants reported significantly greater confidence in handling 14 common communication problem areas in cancer (p < .0001) and in 8 different areas of teaching. Participants were very enthusiastic about the course overall and especially valued the training approach and teaching materials provided. Three months post-course 91% reported changing their own teaching practice and 85% had initiated new communication skills teaching.     

Advanced cardiac life support education: a self-directed, scenario-based approach

BACKGROUND: The American Heart Association adopted new curriculum guidelines for Advanced Cardiac Life Support (ACLS) education. Requirements include the incorporation of case-based learning strategies in the course format. METHOD: A self-directed, scenario-based course format was developed to incorporate principles of adult learning and to meet the newest curriculum guidelines of the American Heart Association. A post-course survey was used to evaluate the participants' perceptions of the course format and its effects on their learning. RESULTS: Twenty-seven participants completed the course. Analysis of the post-course survey responses indicated participants favored the self-directed, scenario-based design and felt the format contributed to their learning. Additionally, this format was more cost-effective than the traditional 2-day course design. CONCLUSION: The use of a self-directed, scenario-based format creates an optimal environment that fosters the complex cognitive and psychomotor skills learning required to perform ACLS. This format meets the expectations of the American Heart Association curriculum guidelines and should be considered a viable and valuable option for providing ACLS education.     

Nurses' communication skills: an evaluation of the impact of solution-focused communication training

AIMS: This paper describes the evaluation of a short training course in solution-focused brief therapy (SFBT) skills. This evaluation examined the relevance of SFBT skills to nursing and the extent to which a short training course affected nurses' communication skills. BACKGROUND: Nurses' communication skills have been criticized for many years, as has the training in communication skills that nurses receive. The absence of a coherent theoretical or practical framework for communication skills training led us to consider the utility of SFBT as a framework for a short training course for qualified nurses, the majority of them are registered nurses working with adults. DESIGN AND METHODS: Quantitative and qualitative data were collected: the former using pre- and post-training scales, the latter using a focus group conducted 6 months after the training. Data were analysed using the Wilcoxon signed-rank test and content analysis. RESULTS AND FINDINGS: Quantitative data indicated positive changes in nurses' practice following the training on four dimensions, and changes in nurses' willingness to communicate with people who are troubled reached levels of significance. Qualitative data uncovered changes to practice, centred on the rejection of problem-orientated discourses and reduced feelings of inadequacy and emotional stress in the nurses. CONCLUSIONS: There are indications that SFBT techniques may be relevant to nursing and a useful, cost-effective approach to the training of communication skills. Solution focused brief therapy provides a framework and easily understood tool-kit that are harmonious with nursing values.     

A comparison of the cooperative learning and traditional learning methods in theory classes on nursing students' communication skill with patients at clinical settings

The purpose of this study was to compare the effect of traditional learning and cooperative learning methods on nursing students' communication skill with patients. This was an experimental study in which 34 nursing students in their 2nd semester of program participated. They were divided randomly into two groups, a control group who were taught their medical/surgical nursing course by traditional learning method and an experimental group, who were taught the same material using cooperative learning method. Before and after the teaching intervention, the students' communication skills with patients at clinical settings were examined. The results showed that no significant difference between the two groups in students' communication skills scores before the teaching intervention, but did show a significant difference between the two groups in the interaction skills and problem follow up sub-scales scores after the teaching intervention. This study provides evidence that cooperative learning is an effective method for improving and increasing communication skills of nursing students especially in interactive skills and follow up the problems sub-scale, thereby it is recommended to increase nursing students' participation in arguments by applying active teaching methods which can provide the opportunity for increased communication skills.     

A work-based educational intervention to support the development of personal resilience in nurses and midwives

A work-based educational programme was the intervention used in a collective case study aiming to develop, strengthen and maintain personal resilience amongst fourteen nurses and midwives. The participants attended six, monthly workshops and formed a participatory learning group. Post-intervention, participants reported positive personal and professional outcomes, including enhanced self-confidence, self-awareness, communication and conflict resolution skills. They strengthened relationships with their colleagues, enabling them to build helpful support networks in the workplace. The intervention used new and innovative ways of engaging nurses and midwives exhibiting the effects of workplace adversity - fatigue, pressure, stress and emotional labour. Participants were removed from their usual workplace environment and brought together to engage in critical reflection, experiential learning and creativity whilst also learning about the key characteristics and strategies of personal resilience. Participants' experiences and skills were valued and respected; honest airing of the differences within the group regarding common workplace issues and concerns was encouraged. The new contribution of this intervention for nursing and midwifery education was supporting the learning experience with complementary therapies to improve participants' wellbeing and reduce stress.     

Effectiveness of a simulation-based educational program in a pediatric cardiac intensive care unit

Optimal staff performance of resuscitation skills is best achieved through regular effective training. However, providing this teaching in a busy high-acuity pediatric cardiac intensive care unit (ICU) had become a challenge due to time and logistical constraints. A program to effectively and efficiently teach ICU nurses the skills necessary in patient resuscitation was developed using simulation training to better meet staff learning needs. Training via simulation provides an ideal learning environment with hands-on experience with the roles required in patient resuscitation. A simulation training program incorporating simulation training was developed for ICU nursing staff. All staff nurses in the ICU were required to attend over a year's time. The program involved mock resuscitation scenarios in which participants performed various resuscitation roles, followed by video review and group debriefing. All participants completed a survey prior to and immediately following participation in the training and again at 1 year. Data collected included self-report of knowledge, skill, and comfort related to patient resuscitation. Data revealed statistically significant improvement in scores pre and post training and at 1 year for self-reported knowledge, skills, and comfort related to resuscitation. Nursing staff reported that simulation training in resuscitation skills was helpful and positively impacted their knowledge, comfort, and skills. Feedback from nursing staff continues to be very positive, and performance of actual resuscitations on the unit has improved anecdotally.     

Advancing evidence-based practice: a program series

The call to evidence-based practice (EBP) is evolving and empowers nurses to form innovative learning partnerships with colleagues to nourish wisdom, strengthen critical thinking, integrate research knowledge, and celebrate contributions in leading best practice. Based on clinician interest, Advancing Evidence-Based Practice: A Program Series was designed for nurses to showcase initiatives using Mercy Nursing's EBP Model. Mentoring guides their efforts. This opportunity creates learning partnerships that encourage participants to reflect about their practice and network with colleagues about what is important for clinical excellence. It also nurtures professional growth in research development and formal presentations.     

The development and implementation of an inter-professional simulation based pediatric acute care curriculum for ward health care providers

Abstract

An interprofessional, simulation based, acute care course for ward health care providers was developed and implemented with the objectives of teaching identification of deteriorating patients, practicing crisis resource management and basic life support skills, and using the SBAR (Situation Background Assessment Recommendation) communication tool. Thirty-eight physicians and 51 nurses attended the four separate courses. Nine questions on a 5-point Likert scale and two open-ended questions revealed that over 95% of respondents strongly agreed/agreed that facilitators encouraged active participation, lectures were presented in an interesting manner, and that simulations were useful for practical skills and for practicing communication. Open-ended questions revealed that participants felt more confident, understood the importance of communication, roles, teamwork and valued the day. Based on this evaluation, the program was regarded as feasible and acceptable to all health care providers.     

Caring in nursing: perceptions of Hong Kong nurses

Ten registered nurses in Hong Kong were interviewed on their perceptions of caring behaviours in their clinical settings, barriers to these behaviours, and possible ways to overcome those barriers. Findings showed that respondents valued the importance of expressive behaviours and interpersonal communication skills in providing holistic patient care. They felt constrained by social, economic, cultural, and personal variables such as staff shortages, the traditional task-orientated approach of nursing, the dominance of medicine in the healthcare system, the influence of Chinese culture on work attitudes, and their limited skills and lack of education. The situation could be improved through better staff education, colleague support, effective human resources allocation, and promotion of a democratic working environment. A creative approach is necessary to integrate these strategies into a healthcare system dominated by technology and economic constraints.     

护理人员对护理技术操作认知状况的调查分析

目的了解临床护理人员对护理技术操作认知状况,并提出对策。方法采用方便抽样的方法,自行设计护理人员对护理技术操作认知状况调查表,随机对本院168名护士进行调查。结果60%以上的护理人员的技术服务理念正确。85%以上护理人员认为护理操作学习和考核地点最好选择在临床;任何护理技术操作及措施实施都必须从评估开始;护理评估不仅要贯穿于病人住院的全过程,而且还要贯穿技术操作全过程。结论护理管理者需进一步更新临床护理人员的护理技术服务理念,强化岗位训练,提高护理人员服务技能。     

Learning pathways in contemporary primary care settings – Student nurses’s views

Workforce planning to address nursing supply along with curriculum change affecting practice placements has acted as key drivers shaping learning resources for student nurses within Aberdeen Community Health Partnership. As part of their learning, students are afforded the opportunity to visit a range of contemporary primary care settings such as public health, specialist nurses and NHS 24 on what are known as ‘pathway experiences’. This research adopted a qualitative approach using focus group interviews to discover students’ learning as a result of this initiative. Two main themes emerged, these being ‘Healthcare contexts’ and ‘Nursing know-how’. Students developed a greater awareness and understanding about the delivery of healthcare in primary care settings and they expanded their nursing knowledge and skills. While students valued the experience, they also thought pathways fragmented their time at the base placement and detracted from gaining the practical nursing skills they considered of prime importance in their transit towards qualifying and working within a clinical setting. Implications for the future development of the pathway initiative are discussed.     

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.     

Exploring qualified nurses' perceptions of the relevance of education in preparation for their role in rehabilitation

The increasing importance of rehabilitation in the health sector and the nurses' critical role therein make it essential that nurses have the right skills and knowledge to work effectively in rehabilitation settings. Drawing from a wider qualitative investigation of the role of the nurse within the multi-professional rehabilitation team, gaps in the skills and knowledge of qualified nurses working in rehabilitation settings are presented and ways to address them are proposed. Both pre- and post-registration education were found wanting. Only one third of nurses thought, in retrospect, that their pre-registration education had provided them with adequate skills and knowledge for their role in rehabilitation. A need for greater focus on rehabilitation per se and associated clinical skills was identified. Whilst post-registration education was highly valued, substantial difficulties accessing relevant courses were noted. In-service training and ad hoc learning 'from experience' and colleagues formed additional ways to develop hands-on skills. Benefits of better education included enhancing confidence, promoting inter-professional equality and improving client care. Potential ways to address some of these concerns included: adoption of a 'thread and module' approach and dedicated rehabilitation student placements, a nationally recognized multi-professional post-registration course, and an integration of work based learning with formal educational provision.     

A newly designed portable ergonomic laparoscopic skills Ergo-Lap simulator

Abstract

Objective: The cost of laparoscopic simulators restricts the wide use of simulation for training of basic psychomotor skills. This paper describes the scientifically-based development of an inexpensive and portable Ergonomic Laparoscopic Skills (Ergo-Lap) simulator with multiple tasks. Material and methods: The design of this Ergo-Lap simulator and related training task panel was based on scientific research regarding the representative skills and the ergonomic guidelines for laparoscopic surgery. A user-centred design approach was followed. Fifty-three surgical participants with variable laparoscopic experience (14 medical students, 27 surgeons in training, and 12 experienced laparoscopic surgeons) performed several tasks on the prototype and gave their feedback by filling out a 5-point scale Likert scale questionnaire. Results: The results of the usability evaluation showed that the participants regarded the Ergo-Lap simulator as a useful device to practice the basic and advanced skills effectively. Forty-three of the 53 participants indicated they would like to purchase this simulator since it is easy to use and challenges their laparoscopic skills. Conclusions: For laparoscopic skills training, this inexpensive Ergo-Lap simulator with diverse task choices offers a simple training opportunity for trainees who want to practice laparoscopic skills at home or at the office.     

新上岗护士护理操作培训需求调查分析及对策

目的探讨新上岗护士护理操作培训的方法。方法拟定护理操作培训需求调查表,调查新上岗护士67名。结果87.5%的新上岗护士在操作上存在困难,95.31%的护士认为操作培训重要,100%的护士认为全部操作需要进行示范,96.87%的护士认为需要情景模拟,67.19%的护士要求培训地点在临床。操作上存在困难的原因有:18.75%的护士操作中的沟通交流存在困难,14.06%的护士对仪器设备的操作不熟悉,23.44%的护士操作的流程不熟悉,9.38%的护士对流程中的重点掌握不好,34.37%的护士认为在工作中练习的机会很少。结论编写适合本院的护理操作手册、急救流程手册;基础护理操作考核;专科护理操作培训;建立院内进修制度;急救技术的专项培训;沟通交流能力的培养;仪器使用的培训。