Community mental health nurses' perspectives of recovery-oriented practice

Recovery-oriented practice, an approach aligned towards the service user perspective, has dominated the mental health care arena. Numerous studies have explored service users' accounts of the purpose, meaning and importance of 'recovery'; however, far less is known about healthcare staff confidence in its application to care delivery. A self-efficacy questionnaire and content analysis of nursing course documents were used to investigate a cohort of community mental health nurses' recovery-oriented practice and to determine the extent to which the current continuing professional development curriculum met their educational needs in this regard. Twenty-three community mental health nurses completed a self-efficacy questionnaire and 28 course documents were analysed. The findings revealed high levels of nurses' confidence in their understanding and ability to apply the recovery model and low levels of confidence were found in areas of social inclusion. The content analysis found only one course document that used the whole term 'recovery model'. The findings suggest a gap in the nurses' perceived ability and confidence in recovery-oriented practice with what is taught academically. Hence, nursing education needs to be more explicitly focused on the recovery model and its application to care delivery.     

Developing the credibility of continuing education

The paper begins by acknowledging both the need for nursing to be a research based profession, and the reasons for the well-documented theory-practice gap. It goes on to suggest that what is not so well-documented is an examination of the reasons for the commitment gap between basic and continuing education. The relevance of continuing education to clinical staff will be discussed in relation to the change in the content of nursing theory--from the unwieldy 'certainty-based' medical model, to a more flexible, thus perhaps 'uncertainty-based' medical model. The paper will explore the author's belief that clinical staff need to feel a sense of security in their knowledge base, which therefore leads them at times to reject nursing theory. The paper proposes that a legal framework for nurses practice gives the clinical staff the security in their practice to view the relevance of new nursing theory.     

Physical assessment skills: a descriptive study of what is taught and what is practiced.

The purpose of this study was to investigate physical assessment skills taught in undergraduate baccalaureate nursing programs and the physical assessment skills used by practicing nurses. Twelve educators teaching physical assessment and 51 practicing nurses were surveyed on 120 physical assessment skills listed in standard nursing textbooks. Median scores were computed on all the skills. The educators taught all of the skills, 92.5% of the skills were taught and practiced in class and 7.5% were taught but not practiced. For the practicing nurses, 37% of the skill were never used, 29% were used on a daily/weekly basis, with 34% used on a monthly/occasional basis. Based on these findings, we recommend that the content of physical assessment courses be reevaluated, with courses focusing on what nurses need to know to practice nursing.     

Theory-practice integration in selected clinical situations

The current changes in health care systems challenge knowledgeable, mature and independent practitioners to integrate theoretical content with practice. The aim of this study was to investigate the problems of integrating theory with practice in selected clinical nursing situations. The study focused on rendering of family planning services to clients as a component of Community Nursing Science. Structured observation schedules were used to observe the theoretical content of the curriculum as well as the practical application of what has been taught in the clinical area. The findings of the study revealed that there was a need for an integrated holistic curriculum, which would address the needs of the community. It was concluded that a problem-based and community-based curriculum, intersectoral collaboration between college and hospital managements and student involvement in all processes of teaching and learning would improve the integration of theory and practice. There also appeared to be a need for tutors to be more involved in clinical teaching and accompaniment.     

Miracles take a little longer: Project 2000 and the health-promoting nurse

This paper suggests that the new paradigm for nurse education is being prevented from fulfilling itself because of factors operating within the taught, hidden and wider curriculum. Firstly it is argued that the theoretical components relating to social science, health education/promotion and nursing need to be clearly integrated for nursing students. This integration is demonstrated through the analysis of two nursing models. Secondly it is argued that the taught curriculum needs to be supported by a suitable hidden curriculum both within the educational and clinical setting. Role models which demonstrate integrated theory occurring in practice are a vital component of this. Thirdly it is argued that without the wider social and political context supporting the aims of the ‘new’ nurse education, meaningful success will be very difficult to achieve.     

An examination of the implications of adopting a process approach to curriculum planning, implementation and evaluation

A process may be seen as that which has purpose, organization and structure, facilitating an act of moving forward. Thus, a process reflects Bruner's view of education as facilitating cognitive growth and as a way in which individuals explore and gain mastery over a complex world. A process approach is not without its problems, namely in that some nursing skills require a precise, predetermined outcome best achieved by the use of behavioural objectives. A curriculum promoting growth and continued learning calls for increased funding, which may cause problems in today's financial climate. Exploration of concepts calls for careful planning of practical experience and may be difficult where supernumerary status is not fully implemented. However, a process approach may reduce the theory practice gap and lead to a reflective and proactive practitioner. On-going education of clinical staff is required and increased communication between educational and clinical staff. This approach may lead to a more holistic view of nursing education and achievement measured in not only quantitative but also qualitative terms. Solving the problems that a process approach may present may cause nursing education to be enhanced.     

Clinical decision-making in senior nursing students in Iran

Clinical decision-making is the basis for professional nursing practice. This can be taught and learned through appropriate teaching and clinical experiences. Unfortunately, it has been observed that many graduates are unable to demonstrate suitable clinical decision-making skills. Research and study on the process of decision-making and factors influencing it assists educators to find the appropriate educational and clinical strategies to teach nursing students. To explore the experience of nursing students and their view points regarding the factors influencing their development of clinical decision-making skills. An exploratory qualitative approach utilizing grounded theory methods was used; focus group interviews were undertaken with 32 fourth year nursing students and data were analysed using constant comparative analysis. Four main themes emerged from the data: clinical instructor incompetency, low self-efficacy, unconducive clinical learning climate and experiencing stress. The data indicated that students could not make clinical decisions independently. The findings of this study support the need to reform aspects of the curriculum in Iran in order to increase theory-practice integration and prepare a conductive clinical learning climate that enhances learning clinical decision-making with less stress.     

基于PBL教学法的护理学理论实践一体化教学模式的介绍

改革传统的护理教学中理论、技能和实践之间脱节的教学方法,将PBL学习法和理论实践一体化教学法相结合,融入护理综合能力训练的教学中,通过PBL病案再现临床情景,以护理问题为线索,以护理程序为方法,按时间推进,模拟临床护理工作。激发学生的学习兴趣,锻炼学生的临床思维能力及自主学习、信息管理、团队协作、评判性思维、人际沟通、法律意识等能力。     

The development of a competency-based clinical performance examination model in maternity nursing for BSN graduates]

The purpose of the study was to establish a competency-based clinical performance examination model in maternity nursing for baccalaureate students. Action research was the main research methodology used in the study. A committee, consisting of nursing faculty, students and experienced obstetric nurses, was established to develop the model. Based on intensive literature reviews and standards of nursing practice in Taiwan, the first draft of the model, including the content and process, was created by the committee. The draft then was revised twice after expert review and pilot testing. The revised version of the model was formally implemented into the curriculum to examine the competencies of forty-one BSN students at the end of the perinatal nursing course. Responses from students, clinical examiners, clinical staff and clients were all gathered and integrated to refine the model. The model has content, expert and discriminative validity. The reliability of the model was proven by the high consistency in administration and scoring of the model among clinical examiners.     

New curriculum for a new century: beyond repackaging

A plan to evaluate the effectiveness of the changes is in progress. Focus groups with health care agencies in the community validate the life skills as essential to nursing practice. Evaluation of students and graduates is ongoing to determine the overall effectiveness of this curriculum. Preparing nurses for a new century requires developing a new curriculum. But it requires much more than changing what is taught. The students who are recruited, the teaching methods used, and the academic policies must be rethought. These all are reflected in this model that allows students to learn and practice skills needed for a lifetime in nursing.     

Learning in the field: curriculum issues in a diploma in public health nursing

Illuminative evaluation of a public health nursing curriculum shows that there was a gap between theory and practice, originating in the ways in which public health nursing was understood in the field, and therefore during students' placements, and in the university. The difference was chiefly in how the community staff and the lecturers understood primary health care. The former had a 'medical/professional' understanding of primary health care, implying that the professional knows best and that the client is an individual, a family or a group. The lecturers held a philosophy of primary health care with special emphasis on partnership with clients at all levels: individual, family, group and community; the partnership approach was intended to permeate the entire curriculum. Besides philosophical differences, there were other features of the theory practice gap demonstrated elsewhere. Fieldwork practice is integral to learning public health nursing so these contrasts created a serious disjunction within the curriculum. Actual and potential ways of improving curriculum integration are discussed.     

Teaching undergraduate students community nursing: using action research to increase engagement and learning

Nurses play a pivotal role in responding to the changing needs of community health care. Therefore, nursing education must be relevant, responsive, and evidence based. We report a case study of curriculum development in a community nursing unit embedded within an undergraduate nursing degree. We used action research to develop, deliver, evaluate, and redesign the curriculum. Feedback was obtained through self-reflection, expert opinion from community stakeholders, formal student evaluation, and critical review. Changes made, especially in curriculum delivery, led to improved learner focus and more clearly linked theory and practice. The redesigned unit improved performance, measured with the university's student evaluation of feedback instrument (increased from 0.3 to 0.5 points below to 0.1 to 0.5 points above faculty mean in all domains), and was well received by teaching staff. The process confirmed that improved pedagogy can increase student engagement with content and perception of a unit as relevant to future practice.     

中美护理本科临床实践环节的比较研究

目的通过对中国与美国护理本科临床实践环节的共同点和差异性的比较研究,为密切我国护理本科教学理论与实践的联系提供可借鉴的资料和科学依据。方法采用统计分析法、内容分析法、个案研究法等方法对中国、美国各20所护理院校的全日制(四、五年制)护理本科课程进行横向比较研究。结果中美护理本科实践环节学时数及理论与实践的比值、实践环节安排、实践场所和教学活动方式等方面均存在差异。结论我国护理教育者有必要从护理本科临床实践环节的学时数、安排以及实践场所、教学方式等方面进行全面考虑,密切理论与实践的联系。     

Using clinical skills laboratories to promote theory-practice integration during first practice placement: an Irish perspective

Aims and objectives. This aim of this study was designed to investigate how a select cohort of nursing students experienced their first practice placement in a large Irish teaching hospital. The objectives of this study were to investigate whom do students learn from, what skills they learnt during their first practice placement and to identify if the use of clinical skills laboratories before their first practice placement helped students relate theory to practice during their first practice placement. The aim of this paper is to discuss if the sessions taught in the clinical skills laboratory prior to the first placement helped students integrate theory to practice during their first practice placement. Background. The debate regarding theory–practice integration has been ongoing in nursing for decades. Many studies across Europe have consistently demonstrated that the use of clinical skills laboratories have helped students integrate theory to practice during practice placements. Others have identified the difficulty students have relating theory to practice. However, as there appears to be a gap in current literature, from an Irish perspective, it is essential to highlight if Irish students can integrate theory to practice during their first practice placement. Design. A qualitative method incorporating the Heideggarian approach of phenomenology was utilized. Methods. A purposeful sampling technique was used to select six participants from all first year students. Interviews were conducted using a semi‐structured interview schedule. Data were analysed using the Giorgi method of analysing phenomenological data. Results. The participants identified that sessions taught in the clinical skills laboratory before the first practice placement, which they identified as ‘basic nursing skills such as taking and recording vital signs and hygiene needs of patients were useful and helped them to integrate theory to practice during their first practice placement. These results are relevant to this paper as they identify the use of teaching sessions in the clinical skills laboratories, enabling students to link theory to practice during practice placements. Conclusions. Nursing students must be adequately prepared to carry out clinical skills competently and efficiently. Educators and practitioners must display the knowledge and skills required to promote theory–practice integration, to enhance nursing students education, which in turn will optimize high standards of patient care. Relevance to clinical practice. Clinical skills laboratories are essential to help students develop the collaborative skills required for a profession like nursing. It is essential that students are adequately prepared to carry out clinical skills during their first practice placement, and have the ability to link theory to practice.     

国内外Roy适应模式应用现状对比

阐述了Roy适应模式形成的历史背景、模式所包含的主要内容以及国内外该模式的应用现状对比,指出护理人员在临床实践中应将护理理论与实践充分结合,进而提高护理服务质量。     

The perceptions of nurse teachers, student nurses and preceptors of the theory-practice gap in nurse education

The theory-practice gap has been the subject of much debate within nursing. Issues include: where the gap is, whether it is a positive or negative phenomenon and whether attempts should be made to bridge it. This paper describes a research study adopting an innovative approach to exploring the theory-practice gap by investigating it from the perspectives of three different groups: nurse teachers, student nurses and clinical preceptors. Combining the perceptions of these diverse groups has allowed a more complete picture of the theory-practice gap to emerge than is possible when examining it from one group's perspective alone. Twenty-three group interviews were conducted and content analysed to identify common themes. Mutual concerns were identified by all groups: shortness of clinical placements, sequencing of theory and practice, lack of collaboration between clinical areas and educational institutions and the lack of clarity regarding link teacher roles. All interviewees felt a theory-practice gap does exist, and whilst this could be viewed positively as a means of developing students' problem-solving skills, attempts should be made to minimize its impact. Ways to achieve this include: the development of an innovative curriculum allowing closer sequencing of theory and practice, evaluating the effect length of clinical placement has on knowledge and skill acquisition, improving collaboration between clinical areas and educational institutions and developing preceptors' lecturing roles.     

护理技能教学与临床护理差异原因分析与对策

目的了解和分析护理技能教学与临床护理之间的差异,探讨相应对策以达到理论联系实际的教学效果。方法采用自行设计问卷对110名本科、专科实习护生进行调查,调查内容为护理技能教学与临床护理之间的差异以及产生差异的原因。结果护理本科生与专科生在护理技能教学与临床护理一致性的问题上看法一致(P>0.05)。导致差异的原因主要集中于:护理技能实验室建设落后、技能教学方法单一、技能教学联系临床实际不紧密、教师忽视培养护生的综合能力等。结论护理技能教学与临床护理之间存在一定的差异,根据差异寻找原因,并采用相应对策,不断改进和完善护理技能教学,以满足临床实践要求。     

湖北省社区卫生服务机构护士培养模式现状及对策研究

对湖北省社区卫生服务机构护士的培养对象、培养目标、培训基地、师资力量、培训组织和管理、培训方式和时间、课程设置、培训效果评价和资格认证等现状进行描述;并对社区卫生服务机构护士培养方面存在的培训流于形式、岗位培训占主导、社区实践培训内容单一且培训时间少等问题进行分析;提出发展对策：应继续加大政府政策支持和经费的投入,加快推进社区护理服务和社区护理教育建设;建立社区护理人才队伍培养长效机制,健全和完善社区卫生人才培养体系;加大社区护理实践基地规模与设施的建设,加强临床实践技能.     

Integrating practice into theory in the new nursing curriculum

This article examines the progress made by the University of Central England (UCE) over the last 18 months in implementing Health Service Circular 1999/219; the government document that contains guidance on the main points that had to be included in new pre-registration nursing curricula. Sixteen pilot sites were chosen to implement the new curriculum and UCE was one of these. The key focus of the curriculum being implemented is to draw practice and theory more closely together. Achievement of strong collaboration between practitioners and University staff is a necessary element of such a venture and the resultant empowerment of clinical assessors is highlighted.The article explores the methods employed to ensure that the practical assessment process mirrors the rigour of academic assessment and that there is equity of assessment across all four branches of nursing. A considered discussion of the use of modular assessment, focussed practical assessment documents and assessment of practical nursing skills provide insight into how practice and theory can be equally valued in a pre-registration nursing courses.     

Where is family in the family nurse practitioner program? Results of a U.S. family nurse practitioner program survey

Though recent progress in family nursing science can serve the family nurse practitioner (FNP) to intervene in the regulation of family health, whether those advances are taught to FNP students has been unclear. All 266 FNP programs in the United States were invited to participate in a survey to assess the content and clinical application of family nursing theories in the curriculum. The majority of FNP programs frame family as the context of care for the individual. Though FNP students receive a foundation in family nursing theory in core courses, they are not usually expected to use family assessment methods in clinical practicum courses or to plan interventions for the family as the unit of care. The authors challenge educators to consider family nursing science as an essential component of the FNP program as the Doctor of Nursing Practice (DNP) evolves and becomes requisite for entry into advanced practice.