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.     

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.     

Student nurses' knowledge and attitudes toward CAM therapies

Hessig et al (2004) highlight that nurses value complementary and alternative therapies (CAM) but lack the knowledge regarding their application. They suggest that education can affect knowledge and application of CAM in nursing practice. Complementary and alternative therapy input into the pre-registration nursing curriculum is sporadic and higher education institutions need to incorporate CAM therapies more fully into professional education (Department of Health, 2003). This study investigated the knowledge and attitudes student nurses have to CAM therapies and their use in cancer and palliative care. Ethical approval was sought from the ethics committee at the University of Hull. A quantitative evaluative study using a convenience sample of student nurses in their final semester of pre-registration nurse education was used. Data were collected via a questionnaire; the findings demonstrate the respondents' acknowledgement of their limited knowledge of CAM therapies and the study has highlighted the need to continue working towards integrated CAM education into the pre-registration nursing curriculum.     

A written assessment is an invalid test of numeracy skills

Nurses need good clinical numeracy skills to aid them in their clinical practice. There is some concern, however, that the calculation skills learned during pre-registration nurse education have little practical application to nurses. This article discusses the Fitness for Practice initiatives from the Nursing and Midwifery Council which aim to ensure new registrants are numerate. The article argues that written numeracy assessment tools are not a valid test of the numeracy skills candidates will require for clinical practice and that nurse education needs to focus on researching and examining how best to support, assess and develop the numeracy skills of nursing students within their clinical practice placements to ensure that at the point of registration they are fit for practice.     

Group clinical supervision for mental health nursing students

Clinical supervision is recognized as important for developing safe professional practice in nursing. Although attention has been given to the development of training and education in clinical supervision for registered nurses, less discussion exists regarding these issues for pre-registration mental health nursing student to the theory and practice of group clinical supervision. In particular, this article raises awareness and promotes discussion of the practical issues involved in such an initiative.     

Supporting pre-registration nursing students in their exploration of death and dying

Student nurses will be exposed to dying patients from the very start of their education. The authors believe that nurse lecturers have a duty of care towards both the student and the patient in preparing them to cope with this experience. End of life care deserves further emphasis within the forum of nurse education. Within this article the authors outline their introduction of a new teaching session at the beginning of the pre-registration nursing curriculum at Birmingham City University to help prepare student nurses from all four fields of nursing to participate in end of life care. This flexible session entitled ‘perceptions of dying’ allows the students to explore their fears, anxieties and expectations of caring for a patient at the end of their life and discusses the mechanisms available for seeking support. The purpose of this article is to raise debate about the teaching of the subject of death and dying within pre-registration nurse education and to show case the lesson concept that the authors believe could be disseminated further to address this student need.     

The biosciences in the pre-registration nursing curriculum: staff and students' perceptions of difficulties and relevance

This paper considers the problematic position of the biological sciences in pre-registration nurse education--'The Bioscience Question'. There is no consensus and little research on the appropriate content and depth of bioscience knowledge required by nurses. Attempts to apportion curriculum time for the biosciences are confounded by the difficulty experienced by nursing students with this area. Within one university department, a survey was undertaken to investigate the perceptions of pre-registration students, and their teachers, of the teaching and learning of biological science, in comparison with other areas of the curriculum. Our findings concur with others that the biosciences are a source of disproportionate difficulty and anxiety to nursing students. Among the students, but not the lecturers, there was some, by no means universal, support for the suggestion that these problems could be reduced by a reallocation of curriculum time in favour of the biosciences. Although it was agreed that bioscience theory should be related more closely to nursing practice, there was no evidence that this lessened the students' difficulties with the subject. In contrast to lecturers, students felt the biosciences to be one of the areas of the pre-registration curriculum most relevant to clinical practice.     

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.     

Patient safety in an English pre-registration nursing curriculum

This study explored patient safety in an English pre-registration nursing curriculum. The need to improve patient safety has been recognised as a key priority, both nationally and internationally. Education has a crucial role in developing the knowledge, skills and attitudes that promote patient safety. However, evidence about how patient safety is addressed in healthcare professional curricula and how organisations develop safe practitioners is limited.An organisational case study identified factors affecting patient safety educational provision. Content analysis revealed what aspects of patient safety featured in the formal pre-registration nursing curriculum. Interviews were conducted with students, lecturers and key education stakeholders from various levels of the educational organisation, to explore their perceptions of patient safety and its location in the curriculum and practice.Patient safety was not explicit in the formal curriculum, but was included in teaching. Students reported gaining most knowledge and experience from clinical practice. The organisational culture of both education and practice was characterised as defensive and closed, and as having an individual versus a systems approach. Findings suggest the need for clarification of the concept of patient safety, as well as revision of curricula and teaching, learning and assessment strategies in order to address patient safety explicitly.     

Assessment of student nurses in practice: a comparison of theoretical and practical assessment results in England

This study was undertaken in response to concerns raised by Duffy (2003) that assessors of practice were reluctant to fail student nurses in assessments. This generated doubts about the fitness to practice of some registered nurses. An investigation was undertaken into whether quantitative evidence supported the view that pre-registration nurses rarely failed practical assessments. Comparative failure rates from theoretical and practical assessments were requested from all 52 universities in England that offered pre-registration nursing programmes. Responses were received from 27. Findings indicated that a very small proportion of students failed practical assessments; failure rates for theory outstripped practice by a ratio of 5:1. A quarter of universities failed no students in practice. Students were most likely to fail in year one and least likely in year three. This study supports the belief that assessors of practice are reluctant to fail student nurses. It raises a number of questions about the influence that the systems and practices of professional bodies and universities have on practical assessment. However it also indicates that some student nurses have failed practical assessments and that some universities do have systems in place to address this issue.     

The snapshot pre-registration assessment tool. Part 2: data, discussion and future directions

This paper is the second of a two-part article presenting a new assessment tool (the snapshot) for pre-registration nurses in clinical practice that is being used at Kingston University/St George's University of London during year 3 of the Diploma and BSc programme. Part 1 of this article presented background to the snapshot tool and the research approach used in the evaluative research study. Part 2 will present the data collection, findings and discussion which show that the snapshot is perceived positively by students in terms of the criteria, documentation and process. However, mentor understanding of these factors varied with some mentors having an inadequate understanding and additional questions of assessment validity also arose and need to be addressed. Both parts of this article make a contribution to the practice assessment agenda and to the continuous clinical assessment methods currently in use that tests students' competence against agreed criteria. The snapshot reflects the reality of practice and assesses skills in a realistic environment.     

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

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

Incomplete holism in pre-registration nurse education: the position of the biological sciences

There is an ongoing debate in nurse education concerning the role and delivery of the biological sciences in the nursing curriculum. One of the fundamental questions raised by this debate asks how best can teachers impart biological knowledge in a manner that can be readily applied by students and qualified nurses to inform their clinical practice. This paper will include a discussion of some of the features of pre-registration education that may have influenced the manner in which biological sciences are perceived, taught and used by nurses. It will be argued that nursing may have developed a form of incomplete holism and that this may be in part responsible for the challenges that remain to be met within this area of the nursing curriculum. As a response to incomplete holism an innovative approach within pre-registration education will be introduced. This development involves the use of linked teaching sessions which aim to develop the analytical skills necessary to apply physiological knowledge to nursing practice.     

What are pre-registration nurses taught about caring for children?

Nurse education curricula have to be continually reviewed to ensure that content remains applicable to contemporary healthcare developments. In this article, the authors report the findings of a research study that investigated the children's nursing component taught in all non-children's BSc Nursing degree programmes in Irish colleges. The aim of the study was to identify how European Union directives and national curriculum guidelines are interpreted in colleges, and to clarify the preparation that non-children's pre-registration nursing students receive with respect to caring for children. The authors explored aspects related to children's nursing in all non-children's undergraduate pre-registration programmes, including curriculum content and its delivery, assessments and practice experiences. Data were collected by a specifically designed questionnaire based on the Requirements and Standards for Nurse Education Programmes (An Bord Altranais, 2005a; b). A university ethics committee provided ethical approval. The response rate was 54%?(n=7), and data were analysed using SPSS 16 and content analysis. The authors' findings illustrated that the requirements and standards of all nursing programmes are interpreted in a variety of ways regarding children's nursing. Nationally, nursing content related to children needs to be reviewed in all nursing programmes to ensure consistency among providers. Healthcare requirements for children and families need to be heightened within curricula for all disciplines.     

Failing underperforming students: the role of grading in practice assessment

Nursing is essentially a practice discipline, informed by a theoretical base. It is crucial that students have a rigorous preparation in both theoretical and practical elements during their pre-registration programme. The aim of educationalists is to produce students fit for purpose and practice, but concerns have been raised internationally regarding students competence at the point of registration. There is evidence that some practice based assessors experience difficulties in failing incompetent students. Assessment of practice is often judged on a pass/fail rather than a graded basis in a number of health professional programmes. It could be argued that pass or fail provides limited feedback to students concerning exactly how well or poorly they have performed. This paper will explore these issues through focusing on selected findings from a service evaluation of a practice assessment tool incorporating grading of practice of pre-registration nursing students from one university in the United Kingdom (UK). Using convenience sampling, a questionnaire survey was completed by 107 adult, mental health and child health nursing students (51% response) and 112 mentors (practice-based assessors) (86% response) from all nursing fields. Amongst other issues, the evaluation identified that whilst mentors valued the opportunity to grade practice and perceived that the tool enabled them to be more discerning in the allocation of pass grades, some lacked confidence in failing students. The findings are discussed in the context of the wider debate around clinical competence in new nurse registrants and it is concluded that whilst assessing 'borderline' students will always be a testing experience, grading systems may help the assessor to be more discriminatory.     

NVQs and practice assessment in a pre-registration course

In response to the government's strategic intentions for nursing outlined in Making a Difference (DoH 1999), the University of Brighton has used national vocational qualification (NVQ) standards to facilitate assessment of practice during the common foundation year of the pre-registration diploma in nursing. The aim of this initiative is to provide 'step on' and 'step off' points using a nationally recognised qualification to meet government requirements for a more flexible approach to nurse education.     

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.     

The snapshot pre-registration assessment tool. Part 1: background, literature and research

This is the first of a two-part article that presents a new assessment tool - the snapshot - for pre-registration nurses in clinical practice, that is being used at Kingston University/St George's University of London during year 3 of the Diploma and BSc programmes. A pilot study of the use of the snapshot in a simulation environment had previously been undertaken and as a result of this, the snapshot was piloted as part of continuous clinical assessment in practice on two cohorts of third-year pre-registration student nurses. An evaluative study was undertaken. This article describes the background to the project, the literature and the research methods used to undertake the evaluative research study. Part 2 will focus on the findings and a discussion of these findings mapped against the literature.     

Acute care teaching in the undergraduate nursing curriculum

Aim:  To incorporate basic aspects of acute care into the undergraduate nursing programme by providing an opportunity for the development of knowledge and skills in the early recognition and assessment of deteriorating patients on general hospital wards.
Background:  Acute care initiatives implemented in the hospital setting to improve the identification and management of 'at risk' patients have focused on the provision of education for trained or qualified staff. However, to ensure student nurses are 'fit to practice' at the point of registration, it has been recommended that acute care theory and skills are incorporated into the undergraduate nursing curriculum.
Practice development initiative:  An 'Integrated Nursing Care' module was incorporated into year 3 of the undergraduate nursing programme to introduce students to acute care theory and practice. Module content focuses on the early detection and management of acute deterioration in patients with respiratory, cardiac, neurological or renal insufficiencies. We used a competency-based framework to ensure the application of theory to practice through the use of group seminars. High-fidelity patient-simulated clinical scenarios were a key feature. The United Kingdom Resuscitation Council Intermediate Life Support course is also an important component of the module.
Conclusions:  Incorporating the Integrated Nursing Care module into the undergraduate nursing curriculum provides pre-registration students the opportunity to develop their knowledge and skills in acute care.
Relevance to clinical practice:  The provision of undergraduate education in care of the acutely ill patient in hospital is essential to improve nurses' competence and confidence in assessing and managing deteriorating patients in general wards at the point of registration.     

A learning resource for developing effective mentorship in practice

This article focuses on mentorship. There is an important professional expectation of registered nurses and midwives to mentor pre-registration nursing students in clinical practice. The article examines ways to evaluate the learning environment and the student experience, and offers practical suggestions to improve the quality of mentorship for mentors and students.