Postregistration genetics education provision for nurses, midwives and health visitors in the UK

BACKGROUND: Rapid advances in genetics following the sequencing of the human genome will progressively reach all aspects of health care. Developments in genetics will increasingly having a significant influence on the work of nurses, midwives and health visitors. Therefore, these practitioners need to understand the impact that genetics will have for their patients and should be able to incorporate this new knowledge into their clinical practice to ensure that they continue to offer holistic care and influence the strategic development of health care. An earlier survey of higher education institutions in the United Kingdom (UK) offering preregistration courses for nurses, midwives and health visitors showed that the teaching of genetics was very limited in most curricula. AIM: To assess the provision of education on genetics for postregistration and postgraduate nurses, midwives and health visitors in the UK, as these practitioners are mostly likely to influence current health care provision and initiate changes in clinical practice. METHOD: A total of 38 higher education institutions from 11 regions were surveyed via telephone or e-mail, using a semi-structured interview schedule. RESULTS: The findings showed that the inclusion of genetics in the curriculum was highly variable. A small number of institutions (n = 3) offered courses with whole modules on genetics, whereas 19 of the 38 responding did not include any genetics in their curriculum at a postregistration level. CONCLUSION: The findings suggest that there is lack of recognition of the impact genetics is likely to have on health care. It is, therefore, recommended that the profile and relevance of genetics to nurses, midwives and health visitors should be promoted by the major organizations responsible for developing, commissioning and providing health care education.     

Research utilization and attitudes towards research among learning disability nurses in Northern Ireland

Research utilization and attitudes towards research among learning disability nurses in Northern Ireland The current emphasis on evidence-based practice has focused attention once again on the research activities of health professionals in general and their research utilization in particular. While there has been a limited number of studies on research utilization in the United Kingdom, these have tended to concentrate on general nurses and midwives. Little is known about the research activities, research utilization and the attitudes to research of learning disability nurses. This paper reports on data from a survey of a convenience sample of 87 nurses from three learning disability hospitals in Northern Ireland. The results show that while these nurses generally held positive attitudes to research, a substantial minority (18.3%) believed that 'research is not relevant to the day to day work in nursing'. Only a quarter of the sample reported using research 'frequently/all the time' in their practice. The extent of research utilization among these disability nurses must be considerably improved if evidence-based practice is to become a reality in their field of nursing.     

Teamwork in primary care: the views and experiences of nurses, midwives and health visitors

This paper reports on findings from a study of teamwork in primary care in one family health services authority in England It is based on interviews using a semi-structured questionnaire with practice nurses, district nurses, health visitors and midwives in 20 practices Six topics emerged as important in relation to the views of nurses, midwives and health visitors and their experiences of teamwork team identity, leadership, access to general practitioners, philosophies of care, understanding of team members' roles and responsibilities, and, disagreement regarding roles and responsibilities Differences in the various views and experiences of teamwork were identified Midwives and health visitors emerged as the least integrated members of the primary health care team Recent changes to the organization of primary health care services, as well as professional changes, are seen as accounting for the different experiences of the nursing groups The potential for teamwork in the future is discussed     

Spectators & spectacles: nurses, midwives and visuality

AIM: In this paper we reflect on how linear perspective vision influences the practice of nurses and midwives and to advance understanding of clinical practice in technologically intensive environments through examination of drawings by nurses and midwives and through critical analysis. BACKGROUND: There is increasing emphasis on vision in Western culture, and both nurses and midwives spend a great deal of time observing their clinical environment(s). Healthcare practitioners work increasingly in image-based realities and nurses rely on visual skills. Vision and visual representation are central to our practice and are important to examine because we look often at technology to assess people and care. DISCUSSION: The world in which we practise is one of meaning(s). Technological development is transformative in nature and produces changes that alter the way(s) we give care. Amongst all this change, it is unclear how we practise in environments characterized by increasing technology and it is unknown how nursing and midwifery practice alter as a result. CONCLUSION: Simple drawings included in this paper highlight an important and shared experience of clinical practice(s). They emphasize the importance and scope of the visual sense and expose practitioner behaviour that has enormous implications for current and future professional development and person-focussed care provision. Experiences described in this paper require further examination and highlight substantial changes to nurse-patient relationships, health care and the way we practise.     

Utilization of research findings by graduate nurses and midwives

BACKGROUND: There is mounting pressure on nurses and midwives in the United Kingdom to use research findings to inform their practice. However, many still find research difficult to understand and are poorly prepared by education to make use of it. Hence, there is a pressing need to evaluate the research education included in nursing and midwifery curricula. AIM: This paper reports a study assessing the impact of research education on the attitudes towards research and use of research findings in practice by graduate nurses and midwives. METHOD: A cross-sectional survey using a self-completed postal questionnaire was conducted with a sample of 340 nurse and midwife graduates in the South East of England. FINDINGS: A response rate of 51% was obtained. A large number of respondents stated that their critical appraisal (96%) and search skills (87%) had improved following graduation and they reported using research findings in practice (16.8% all the time, 50.5% frequently and 32.6% sometimes). Furthermore, the majority expressed positive attitudes towards research and these were related to the research education received. However, a significant number reported finding statistics difficult to understand, lack of time to read research and limited access to research findings at their place of work. Also, a number of respondents would still like more help with searching the literature, implementing research findings in practice and developing their critical appraisal skills further. CONCLUSION: It is crucial that some of the major barriers to research utilization are addressed at both individual and organizational levels if evidence-based care is to become a reality. Also, health service managers should consider a number of strategies suggested by respondents to increase the use of research findings in clinical settings.     

Nursing science and health policy – opportunities in the year of the nurse and the midwife

The 2020 International Year of the Nurse and the Midwife is an important opportunity to marry nursing science and health policy globally. Nurses and midwives are demonstrating strong intent towards evidence-based practice but often feel they lack the skills to implement it. Examples are provided of ways in which general and advanced practice nurses have succeeded in bringing evidence into practice and then into local and global policy.     

Predicting child abuse and neglect: ethical, theoretical and methodological challenges

Aims. This paper explores the ethical, theoretical and methodological implications of predictive testing in studies of child abuse, neglect and harm. Background. The use of screening instruments to make predictions about children who may later be abused, neglected or at risk of exclusion is promoted in research and policy. The recent UK Action Plan on Social Exclusion suggests that health visitors and community midwives should be trained to use these tools in practice. Method. Position paper. Conclusions. The accuracy of screening instruments to identify children who will be abused or neglected has not been established. Even if the theoretical and methodological challenges of predictive instruments could be overcome, the ethical implications of their use are very difficult for nurses and midwives. Relevance to clinical practice. Nurses, midwives and health visitors require high levels of awareness of risk factors in working with children and families. We have a responsibility to reach professional judgements about risks of harm for individuals. This is best performed through improving skills in working with parents and carers to identify those factors which may impede their ability to offer safe developmental care to their children.     

Entrepreneurial nurses and midwives in the United Kingdom: an integrative review

AIM: This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. BACKGROUND: Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. METHODS: Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$'social enterprise$'mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. RESULTS: Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. CONCLUSION: Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors.     

Nurses' attitudes to evidence-based practice: impact of a national policy

Clinical effectiveness and evidence-based practice should be key cornerstones of current nursing practice. This study used postal questionnaires to explore the impact of a national initiative on nurses' attitudes, knowledge and practice relating to these twin concepts. Results indicated that attitudes can be influenced by national policy initiatives. Influencing behaviour, however, appears to be more difficult; no change was seen in reported application of evidence-based practice. Nurses did, however, report a desire to increase their implementation of evidence-based practice; reasons for not doing so included lack of the necessary skills and time in the working day. It is recommended that these education and training needs must be addressed by allocating sufficient protected learning time and funds. A more difficult issue relates to the burden of clinical work, which may also be preventing greater uptake of evidence-based practice.     

Educational preparation for maternal, child and family health nurses in Australia

KRUSKE S. & GRANT J. (2012) Educational preparation for maternal, child and family health nurses in Australia. International Nursing Review 59 , 200–207 Aim: The study aims to map and critique the current postgraduate educational nursing programmes offered to nurses and midwives in maternal, child and family health in Australia. Background: Nursing specialties that focus on the early years of child health and development are based on international recognition of the developmental needs of the growing infant and of the social, health and economic consequences of failing to support families to raise their children in optimal environments. Little is known whether the educational programmes that prepare maternal, child and family health nurses (MCFHNs) for practice in Australia have kept up with new knowledge and understanding of the early years of life. Methods: A survey of all maternal, child and family health education programmes offered in Australia was undertaken. Findings: Marked variations in course titles, length, content, clinical exposure and award exist across the 12 institutions offering such programmes in Australia. Many institutions provide inadequate preparation in some of the core skills required of the workforce. Conclusion: The establishment of minimum standards for the education of MCFHNs across Australia is required. This study also highlights the need for further research around the scope of practice of MCFHNs, and the role of midwives who are not nurses, in this specialty area.     

Midwives’ and health visitors’ collaborative relationships: A systematic review of qualitative and quantitative studies

ObjectivesInterprofessional collaboration between midwives and health visitors working in maternal and child health services is widely encouraged. This systematic review aimed to identify existing and potential areas for collaboration between midwives and health visitors; explore the methods through which collaboration is and can be achieved; assess the effectiveness of this relationship between these groups, and ascertain whether the identified examples of collaboration are in line with clinical guidelines and policy.DesignA narrative synthesis of qualitative and quantitative studies.Data sourcesFourteen electronic databases, research mailing lists, recommendations from key authors and reference lists and citations of included papers.Review methodsPapers were included if they explored one or a combination of: the areas of practice in which midwives and health visitors worked collaboratively; the methods that midwives and health visitors employed when communicating and collaborating with each other; the effectiveness of collaboration between midwives and health visitors; and whether collaborative practice between midwives and health visitors meet clinical guidelines. Papers were assessed for study quality.ResultsEighteen papers (sixteen studies) met the inclusion criteria. The studies found that midwives and health visitors reported valuing interprofessional collaboration, however this was rare in practice. Findings show that collaboration could be useful across the service continuum, from antenatal care, transition of care/handover, to postnatal care. Evidence for the effectiveness of collaboration between these two groups was equivocal and based on self-reported data. In relation, multiple enablers and barriers to collaboration were identified. Communication was reportedly key to interprofessional collaboration.ConclusionsInterprofessional collaboration was valuable according to both midwives and health visitors, however, this was made challenging by several barriers such as poor communication, limited resources, and poor understanding of each other’s role. Structural barriers such as physical distance also featured as a challenge to interprofessional collaboration. Although the findings are limited by variable methodological quality, these were consistent across time, geographical locations, and health settings, indicating transferability and reliability.     

Seven years on: distance learning courses for first level registered nurses and midwives

There is a recognized need to increase the accessibility and flexibility of post-registration course provision for first level registered nurses and midwives. Distance learning courses were developed and implemented at the University of Dundee in response to this need. The courses provide a range of learning opportunities from single module certificate courses to Bachelor, Honours and Masters level studies. The courses are well received by nurses and midwives and experience, over the last 7 years, has highlighted important aspects for distance learning education for both professional groups. Different educational strategies such as Work-based Learning and Problem-based Learning are incorporated into distance learning course design to facilitate the integration of theory and practice and develop cognitive and meta-cognitive skills. The relationship between course assessment and clinical environment is also a key feature of course design, with assessment methods built around work-based learning opportunities in clinical practice. Experience has shown that students require support throughout the learning process. This is achieved through text-based study guides and a range of other support strategies. It is concluded that distance learning can be individualized to meet the professional and personal needs of students and provide quality, flexible learning opportunities for nurses and midwives, facilitating practice development and benefiting patient care.     

护理人员循证护理知识、态度、行为、技能调查研究

目的；调查了解护理人员循证护理知识、态度、行为、技能状况，为临床开展护理人员的相关培训和循证护理教育的方向及管理灾践提供理论依据。方法：在参考国内外文献基础上自行设计调查问卷，对广州市5所医院的101名护理人员进行循证护理知识、态度、行为、技能状况调查。结果：63．7％的护理人员熟悉循证护理知识（人群集中在本科学历以上的护理人员），31．5％的护理人员对循证护理知识有一定的了解，只有4.8％的护理人员对循证护理一无所知；97．5％的护理人员对循证护理具有正向态度；护理人员的循证护理技能掌握较好的占18.4％，大部分人（58．3％）对检索知识、在实施循证护理过程与患者的沟通能力掌握较好，但在评价研究质量的优劣、决策能力技能方面能力不自信；20．80％的护理人员具有主动寻找解决问题的行为，而且集中在职称较高的人群；56．1％的护理人员会利用业余时间通过互联网获取需求知识，但有23．1％的护理人员墨守成规。结论：护理人员均对开展循证护理具有支持与正向的态度，但相当一部分护理人员对循证护理知识缺乏。     

Attitudes of midwives and maternal child health nurses towards suicide: A cross‐sectional study

Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses (MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross‐sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives (n = 95) and MCHN (n = 86) from south–eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals.     

The health care needs of ethnic minority groups: are nurses and individuals playing their part?

The UKCC Code of Professional Conduct for nurses, midwives and health visitors stresses the need to have an understanding of the social and cultural determinants of health and illness There is as yet little evidence of what might constitute good practice in this area and it is difficult to ascertain why this basic philosophy is not translated into action Indeed, the nursing and midwifery professions' ability to deliver adequate and appropriate health care more generally to Britain's multiracial, multicultural population has been questioned This literature review presents evidence which strongly suggests that although we are living in a multicultural society patients from minority ethnic groups are additionally disadvantaged because the initiatives by nurses, and others working in the National Health Service, to meet their health care needs are inadequate and often inappropriate     

Vision, permission and action: a bottom up perspective on the management of public health nursing

AIM: To explore the opportunities and obstacles that impinge on attempts to advance public health nursing, paying particular attention to the role of, and implications for, nursing management. BACKGROUND: Nurses are to have a central role in the government's drive to re-invigorate the United Kingdom public health agenda. This paper explores the perceptions and support needs of the primary and community nurses, health visitors and midwives charged with meeting that goal. METHOD: Focus group interviews were conducted separately with health visitors, school nurses, district nurses, community midwives and practice nurses from the a single health authority area in Yorkshire. Eight group interviews were conducted involving 31 practitioners in total. All interviews were audio recorded and transcribed in full. Data were analysed using the framework approach. FINDINGS: Workload, resource and time pressures limit the ability of community and primary care nurses to deliver public health work. Furthermore, nurses feel that the leadership required to guide service delivery and optimize deployment of under utilized public health skills at local level is missing, and that public health activity lacks legitimacy. CONCLUSION: If the new public health agenda is to be delivered, nursing managers will have to be clear about what is meant by public health work and decide whether it is to remain a peripheral concern or core activity. Having made that decision they must communicate it to practitioners on the ground through word and deed--that is, by identifying capacity, restructuring workloads and re-prioritizing activity.     

Research based nursing practice--an evaluation of an educational programme

Although research based practice is being increasingly extolled by both the government and the profession, no clear educational strategy exists as to how practitioners should be supported in achieving this goal. Furthermore, the effectiveness of educational interventions in fostering a positive attitude to research, or a change towards a greater prevalence of research based practice, remains unknown. However, research has indicated that practitioners are dissatisfied with their research skills and the opportunities to enhance them.This paper describes a series of nine workshops on research utilization which were undertaken in a range of Trusts throughout England. The primary purpose of the workshops was to help nurses, health visitors and midwives to:The workshops were evaluated by two methods--a written semi-structured questionnaire and a qualitative study focused on three sites which used pre-workshop telephone interviews and post-workshop focus groups.Overall the workshops were effective in reducing fear and lack of understanding of research, alleviating the problem of jargon, and increasing the skills of critical appraisal. Although the participants' attitude to research was not changed by attending the workshops--it was positive before the workshop and remained so-several personal and professional benefits were accrued. The implications of this evaluation for practice, education, and research are discussed.     

Exploring knowledge and skills on HIV in student nurses and midwives

A cross-sectional survey design using a self-administered questionnaire was sent to a sample of 62 final-year student nurses and midwives to describe their knowledge of, skills related to, and attitudes towards, human immunodeficiency virus/acquired immune deficiency syndrome. Out of the 47 respondents who return the questionnaire, only 53% stated that they had received class instruction on the topic and 63.8% claimed to have increased their knowledge mainly from reading professional journals. Although only 32% said that they had cared for a patient or knew of a family member or another person with the disease, 91% indicated that they were willing to care for such patients. Overall, the respondents demonstrated positive attitudes towards this group of patients and a good level of knowledge about the subject, although some gaps were evident. However, a large majority stated that their skills to cater for the physical and psychological needs of this group of patients were deficient and would like further training.     

Genetics education for nurses,midwives and health visitors

Advances in genetic science are leading to new roles for nurses, midwives and other front-line health professionals. But current educational provision on genetics is insufficient to enable practitioners to develop the knowledge and skills they need. The Department of Health and The Wellcome Trust are jointly funding the development of a strategy to address the problem.