Accreditation of prior learning: andragogy in action or a ‘cut price’ approach to education?

The rapid changes in nurse education are proceeding within the wider context of developments in adjacent educational fields, which are themselves subject to external influences, and one such development is the accreditation of prior experiential learning (APEL) In order to be critically aware of the potential involved in embracing this concept, it is necessary to clarify and examine the influencing factors which guide the current andragogical climate of nurse education, and those which predispose to the recognition of APEL Utilizing a case-study approach, this paper will examine the relevant issues as they relate to experienced students pursuing the learning outcomes of Project 2000, and will address the question of value for all parties concerned     

An investigation into why qualified nurses inappropriately describe their own cardiopulmonary resuscitation skills

Recent studies have indicated that significant numbers of nurses are ineffective in performing cardiopulmonary resuscitation (CPR). Furthermore, the studies indicate that many nurses are unable to appraise realistically their own CPR performance. This study sought to ascertain the reasons why qualified nurses are unable or unwilling to appraise themselves realistically with regard to resuscitation skills. The investigation employed both quantitative and qualitative methods to establish the existence of the phenomenon and facilitate its analysis. The findings of the study suggest that unrealistic self-appraisal arises out of poor and infrequent resuscitation training, nurses' attempts to identify with roles which they perceive they should fulfill and past experience of cardiac arrests. The data suggest that current resuscitation training is inadequate, inappropriate and inconsistent for the needs of practising nurses.     

Expert: a discussion of the implications of the concept as used in nursing

The concept'expert' has become common in the nursing literature since Benner's (1984) work more than a decade ago Whilst the term has a common meaning, it is apparent that when used in nursing it refers to a multitude of attributes and lacks clear definition This paper uses the strategy for concept analysis developed by Walker & Avant (1988) to seek an operational definition for the concept of 'expert', and suggests the denning attributes of possession of a specialized body of knowledge and skill, extensive experience in a field of practice, highly developed levels of pattern recognition, and acknowledgement by others These are discussed in relation to nursing practice and the circumstances under which the concept is used Development of cases is carried out to exemplify the concept, and the antecedents and consequences of the attributes are discussed, suggesting that the concept lacks clarity, both in conceptualization, and in use A first definition of the concept is posed to open debate concerning the relevance of the term for the future The conclusions reached suggest that whilst an operational definition is unlikely to be found, because of the problems of definition and measurement, it is possible, through various strategies, to recognize expert practice and use it to further develop nursing Furthermore, it is likely to become increasingly important to recognize and reward expert practitioners, given the political and economic constraints in health care today     

Client education experiences in professional nursing practice — a phenomenological perspective

This paper reports a small-scale phenomenological study of registered nurses' experiences with their client education role. Its purpose was to investigate phenomena associated with actual experiences as they were encountered by participants. A review of the literature provides an overview of client education in terms of its definition and utility, and draws attention to the notion of compliance and the influence of power in health provider–client relationships. Phenomenology offers an appropriate methodological framework for investigating symbolic experiences, and three central concepts are yielded from aggregate data in the form of confirming experiences, disconfirming experiences and educational processes. Findings indicate that nurses' value the uniqueness of the client and, where possible, tend to initiate educational processes that actually empower individuals. However, disconfirming experiences are associated with demands on nurses' work schedules, low client motivation and non-compliance. Physician interjection is also perceived as problematical, resulting in feelings which undermine the nurses' professional integrity, and which lead to a diminished sense of self-worth.     

Methodological issues in the evaluation of the quality of public health nursing: a case study of the maternal and child health centres in Hong Kong

The demand for the evaluation of the quality of patient and client care has increased in public health nursing as in all disciplines of nursing. In Hong Kong this demand led to the development of a collaborative study with the Department of Health to evaluate the quality of public health nursing in the maternal and child health centres. A multiple case study design was developed to undertake the research using both qualitative and quantitative methods of data collection. The findings from the study demonstrated not only implications for clinical practice which have been reported elsewhere, but also methodological issues for the evaluation of care. These findings indicate three major issues for consideration. The first issue is that of the cultural context of care which includes perceptions of care such as demands on the service and expectations of care. The second issue is the use of health data, including both the methods of recording as well as the sources of data. The final issue is that of the method of data collection, in particular the implications of the use of language in data collection tools. The findings suggest that both the use of professional language and the need for translation have implications for data collection methods. Indeed in the author's view the development of methodologies for the evaluation of care must address culturally specific issues, particularly where English is not the first language of subjects in the study. In addition the use the use of language in the method of data collection highlights more general issues raised by the use of translation in the collection and analysis of qualitative data.     

Characteristics of effective nursing interventions in the management of challenging behaviour

A combination of semi-structured interviews and participant observation were used in order to investigate the interventions used by psychiatric nurses when faced with challenging behaviour. The study described 10 such categories of effective interventions: confirming messages, personal control, staff honesty, providing face-saving alternatives, setting limits, use of structure, facilitating expression, monitoring, timing and calming, and non-verbal skills. The report concludes by suggesting that these categories can be used to provide a structure for the analysis of critical incidents from a nursing perspective.     

The first year as a staff nurse: the experiences of a first cohort of Project 2000 nurses in a demonstration district

This paper describes the experiences of eight staff nurses who were students in the first cohort of a Project 2000 course in a pilot district during their post–qualification year A qualitative approach, informed by phenomenological methodology, was adopted in order to present these experiences alongside the meaning attributed to them by the nurses Taped, focused group discussions, using semi-structured interviews, were analysed This yielded five themes which describe the structure of these experiences from'coming out of school' through to the acknowledgement and confidence in themselves as a different kind of nurse to those trained on previous traditional courses The findings suggest that the vision of the United Kingdom Central Council in proposing Project 2000 courses is likely to be realized These nurses had gained the competent technical and clinical skills expected of any nurse However, they also displayed skills previously absent in newly–qualified nurses, such as evidence of analytical decision–making and confident interpersonal skills, which are likely to enable them to take an equal place amongst other members of the multindash;professional team in the future Although competent practitioners, the process they had undergone to reach this had, at times, been traumatic The implications arising from the study are that more attention needs to be paid to the personal and professional development needs of Project 2000 nurses, both at the end of the course and in their first post-qualifying year     

The evaluation of the effectiveness of health education interventions in clinical practice: a continuing methodological challenge

AIM: This paper examines the methodological issues arising from an evaluation of the effectiveness of a health education project undertaken to increase Hong Kong Chinese women's knowledge of the prevention of cervical cancer and the uptake of screening. BACKGROUND: The significance of health promotion to the prevention of diseases currently affecting contemporary society has become increasingly recognized. Within the context of health promotion health education continues to provide an important preventive strategy. Indeed the leading causes of mortality such as coronary heart disease and cancer lend themselves well to health education interventions. However the evaluation of the effectiveness of health education remains complex and raises some important methodological issues. DESIGN: The project used a health education intervention as the major preventive strategy and employed multiple methods of evaluation to assess its effectiveness. Outcome evaluation consisted of a confidential questionnaire administered at two points in time to measure changes in health-related behaviour and knowledge. It also included the collection of data from service providers to assess changes in the uptake of cervical cancer screening. Process evaluation involved the use of focus groups with randomly selected groups of women who had participated in the health education intervention and a diary kept by the project nurse. FINDINGS: Methodological issues identified in the evaluation of the project included the extent to which changes in health-related knowledge and behaviour could be attributed to the intervention, the sensitivity of outcome measures and challenges in developing methods of process evaluation appropriate to the target population. CONCLUSIONS: The findings highlight the complexity of designing effective evaluation strategies for health education and the need to consider these issues in the development of both process and outcome evaluation.