An exploration into the role of the teacher/lecturer in practice: findings from a case study in adult nursing

How is clinical credibility defined in nursing? A concept mapping study

AIM

To develop a working definition of 'clinical credibility' in nursing science.

METHODS

This is stage 2 of a registered report. Concept mapping methodology, 1. Preparation, 2. Generation of statements (brainstorming), 3. Structuring of statements (prioritising/clustering), 4. Representation of statements, 5. Interpretation of maps and 6. Utilisation of maps were used. Part 1 of our registered report followed the required items on the SPIRIT 2013 checklist. Part 2 was reporting the results of our study adhered to the STROBE reporting guidelines.

RESULTS

Participants (n = 67) from three stakeholder groups participated in this study. Nursing students (n = 23), nurses and other healthcare professionals (n = 23), and patients (within the last 12 months) (n = 21). Participants (n = 62) generated statements (n = 429) in response to the question: 'What does clinical credibility mean to you?'. Following statement reduction, participants (n = 61) prioritised and clustered (n = 80) statements. The data were analysed using the concept mapping software, Ariadne. A visual 'concept map' was produced showing the importance and relationship of each statement as viewed by all participants. The final concept map had nine clusters. In order of importance these are as follows: 1. Safe practice, 2. Communication, 3. Patient-centred care, 4. Accountable, 5. Professional practice, 6. Clinical competence, 7. Teaching attributes, 8. Contemporary expert and 9. Leadership. This study was undertaken over an eight-month period.

CONCLUSION

Clinical credibility is not necessarily about contemporary clinical practice. It is a multidimensional construct of which current clinical practice is one element.

Effective academic-practice partnership models in nursing students' clinical placement: A systematic literature review

OBJECTIVES

This systematic review examines the effectiveness of academic-practice partnership models which include clinical faculty and clinical mentor roles in improving nursing students' clinical learning when compared with traditional models.

REVIEW METHODS

PubMed, CINAHL, PsycINFO and Cochrane Library were searched to locate Randomized Control Trials and quasi-experimental studies published from 1999 to 2020. The Joanna Briggs Institute critical appraisal tools were used to ensure methodological quality.

RESULTS

Fourteen studies were included in the review. The Collaborative Teaching Model and the Dedicated Education Unit model were tested in randomized controlled trials. Dedicated Education Unit, Dedicated Education Centre, Clinical Education Units, Education Partnership model, Collaborative educational-practice model and Collaborative clinical practicum model were evaluated in four experimental studies and ten quasi-experimental studies. Studies did not include patient participation, and staff and faculty had anecdotal presence.

CONCLUSION

There is limited evidence on the effectiveness of academic-practice partnership models. However, the complementary roles of clinical faculty and clinical mentor, in addition to education and health institutions managers commitment could successfully facilitate students' clinical learning.

How is clinical credibility defined in nursing? Protocol for a concept mapping study

AIM

To develop a working definition of the concept of "clinical credibility" in nursing science.

BACKGROUND

In both academic and clinical settings, the phrase "clinical credibility" is used when discussing the education of health professionals. No clear definition for the concept is evident in the academic literature. To date, there has not been a study undertaken to develop a working definition of clinical credibility in nursing science.

METHODS

This protocol is stage 1 of a registered report. We will use concept mapping to compare and organise views of three stakeholder groups: nursing students (n = 20) from years 2 or 3 of a three-year Bachelor of Nursing Programme, nurses and other health professionals (n = 20) still practising within a clinical setting, and people who have recently been inpatients in hospital (n = 20). First, participants will take part in separate stakeholder focus groups to generate statements about "What is clinical credibility?". Second, the same participants will complete two tasks: (1) rank the importance of each statement (prioritising) and (2) put the statements that appear to go together into groups (clustering). The data will then be analysed using a specialised software program called Ariadne. A visual "concept map" will be produced showing the importance and relationship of each statement as viewed by the participants. The projected timeline for the study is one year. The paper complies with the SPIRIT 2013 guidelines for study protocols adapted for mixed methods research.

CONCLUSION

The findings of this study will provide a working definition of the concept of "clinical credibility" in nursing science.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used to develop a measure of clinical credibility to predict student satisfaction and patient safety outcomes.

Effective Clinical Teaching Behaviors Views of Nursing Students and Nurse Educators at University of Gondar, Northwest Ethiopia: Cross-Sectional Institution Based Study

Introduction: Clinical teaching behavior is a critical determinant for quality of clinical learning. Nursing students’ and instructor’s perception of effective clinical teaching behavior (ECTB) is important to modify and facilitate clinical education. Thus, the main purpose of this study was to assess the effective clinical teaching behavior (ECTB) as perceived by students and nursing instructors.

Methods: Facility based cross-sectional descriptive study design was conducted among 178 participants. Data were collected using pre-tested and self-administered questionnaire. Effective clinical teaching behaviors were measured by Nursing Clinical Teacher Effectiveness Inventory. Data were analyzed using descriptive and independent sample t-test. An adjusted odds ratio with 95% confidence interval computed to determine the level of significance.

Results: The most important rated ECTB as perceived by students was teaching ability. For instructors, nursing competences was the most rated ECTB. The overall mean of ECTBs of the students and instructors were 4.26 (0.52) and 3.52 (0.74) respectively. There was statistically significant mean difference between them (t = 5.888).

Conclusion: There was a statistically significant mean difference between the students' and instructors’ perception of ECTBs. Thus, authors suggest nursing instructors to consider the presence of students who prefers different teaching methods.

The Role of the Link Lecturer in the Perioperative Environment

As a result of the demise of the two-tier system of clinical teacher and lecturer, all teachers were assigned to clinical areas in which they facilitate the development of an educational milieu to support student learning in practice. This article highlights the role of the link lecturer within the perioperative environment. It focuses on how this multi-faceted position can assist students to link theory and practice, and addresses key issues relating to mentorship, clinical credibility and educational audit.

The link lecturer role; inconsistent and incongruent realities

BACKGROUND

The United Kingdom (UK) Nursing and Midwifery Council (NMC) suggest that the link lecturer role which is intended to support student nurse practice-based learning should account for 20% of the university-based nurse lecturer's remit. Meantime, a long-standing academic discussion indicates that this role lacks clarity.

OBJECTIVE

Nurse lecturer (provider) and final year undergraduate student nurse (intended beneficiary) experiences and perceptions of the link lecturer role were explored and compared.

METHODOLOGY

Data from four focus groups with nurse lecturers and four with student nurses were thematically analysed. These groups were carried out in a Scottish university where link lecturers visit student nurses in clinical placements.

FINDINGS

Three themes were identified from a multitude of perceived link lecturer responsibilities; information, advice and support, professional development and partnership working. The link lecturer role was experienced as ad hoc and varied, while dialogue about its purpose, objective and contribution to learning revealed inconsistencies and incongruence at an individual level and within and across the homogenous participant groups.

CONCLUSIONS

Narrowing the inconsistent and incongruent realities highlighted firstly in participant dialogue, and secondly in relation to policy directive versus practical application is important for reducing the confusion that surrounds the link lecturer role. Formalising the role in terms of a universally recognised and workable model of practice has potential to reduce future debate.

Problems in the supervision and assessment of student nurses: Can clinical placement be improved?

The assessment and supervision of student nurses during clinical placement remains a complex activity. The student needs to be assessed thoroughly to identify his or her strengths and weaknesses. Further, this assessment should be conducted in circumstances which allow the student to be at his or her best. There are many which continue to impact upon clinical supervisors although documented over the last five to ten years. This paper addresses how assessment and student supervision are still influenced by extraneous factors. Its major suggestion is for universities to place a greater emphasis on all aspects of the clinical placement component within nursing courses.

Exploring how nurse lecturers maintain clinical credibility

The role of the nurse lecturer is changing. There is growing pressure from the government and professionals alike to recruit nurse teachers who posses both practical and recent experience of nursing [Department of Health, 1999. Making a Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Health Care. DOH, London; UKCC, 2000. Standards for the Preparation of Teachers of Nursing, Midwifery and Health Visiting. UKCC, London]. Whilst much of the literature available suggests a growing concern amongst practitioners, students and nurse educationalists themselves about the importance of being ;clinically credible', what is not clear is how tangible it is to maintain currency and clinical credibility. In addition, the term ;clinical credibility' is in itself ill-defined. An exploratory study was undertaken within one higher education institution which sought to seek the views of nurse lecturers. The principles of ethnography were applied to this research. The sample included six of the most recently appointed nurse lecturers within one academic faculty who taught predominantly on pre-registration programmes. Data from individual and focus group interviews was analysed using a thematic content analysis approach. The findings are discussed which embrace the concepts of: working ;hands on' in the clinical area, clinical currency, transferability of skills, clinical visibility and role development. Recommendations for the development of professional practice are offered.

"Relevant and Current": Radiation Therapy Students' Perception of Clinical Credibility in the CSRT as Lecturer

PURPOSE

To examine how radiation therapy students' perceive the clinical credibility of the clinical specialist radiation therapist who is serving as a lecturer. This lecturer is a clinically based radiation therapy staff member.

METHODS

Third-year radiation therapy students (n=16) attended a workshop designed and delivered by the breast-site clinical specialist radiation therapist. A web-based survey was distributed to all students. The survey contained a series of statements that the participants were asked to rate along a 4-point Likert scale. In addition, there was one open-ended question asking "How would you define clinical credibility?" The responses for each question were collated and analyzed for content and theme.

RESULTS

Fifteen of the possible 16 students participated. All of the participants viewed the clinical specialist radiation therapist as clinically credible and that clinical credibility added value to the content being delivered. As well, 53.8% agree and 46.2% somewhat agree that the learning experience would be different if the lecture was delivered by someone non-clinical.

CONCLUSION

Findings from the study indicate that radiation therapy students view current clinical experience as important and relevant, impacting their perception of clinical credibility in the lecturer. The results support further development of lecturing opportunities for clinically based staff.

Systematic Review

The aim of our systematic review was to retrieve and integrate relevant evidence related to the process of formation and implementation of the academic–service partnership, with the aim of reforming the clinical education program. Despite a plethora of research evidence about implementing the academic– service partnership, no one to date has undertaken a robust systematic review about its process. An electronic search was performed to identify published studies between 1995 and 2008. Search strategies adapted from the University of York’s Centre for Reviews and Dissemination were used. Fifteen papers were accepted based on the inclusion criteria and assessed for quality. Data were summarized thematically. Four main stages emerged: Mutual Potential Benefits, Moving From Being Competitors to Collaborators, Joint Practice, and Beneficial Outcomes. This study’s findings can provide practical guidelines to steer partnership programs within the academic and clinical bodies, with the aim of providing a collaborative partnership approach to clinical education.

The who and where of clinical skills teaching: a review from the UK perspective

Over the years, the debate on clinical skill acquisition in Nursing is one that has been subject to constant scrutiny within educational settings, locally and globally. Indeed, the Nursing and Midwifery Council (NMC) have endeavoured to provide some clarity with the publication of the Essential Skills Cluster statements [NMC, 2006. Advance Information Regarding Essential Skill Clusters for Preregistration Nursing Programmes (NMC Circular 35/2006). NMC, London] and the recently updated Standards to Support Learning and Assessment in Practice [NMC, 2008. Standards to Support Learning and Assessment in Practice: NMC Standards for Mentors, Practice Teachers and Teachers, second ed. NMC, London]. In this paper, we seek to provide a review of the evidence and debate produced thus far surrounding skills acquisition in general and the role of the nurse lecturer in particular from a UK perspective.

The clinical role of lecturers in nursing in Ireland: perceptions from key stakeholder groups in nurse education on the role

The clinical role of lecturers in nursing has been a focus of debate since the integration of nurse education into higher education institutions. The purpose of this paper is to report the findings from the preliminary phase of a study, undertaken to investigate the perceptions of key stakeholder groups in nurse education, regarding the current clinical role of nurse lecturers in Ireland. A descriptive exploratory design was used involving focus group and individual interviews, soliciting views of purposefully selected educationalists, clinicians, policy formulators and students. The issue was examined from a policy perspective, aiming to collectively represent views of all participant groups. This approach facilitated a more complete picture of perceptions of the role to emerge, to better inform future decision making. Twenty two focus group interviews and twenty one individual interviews were conducted. Content analysis was used to identify themes. All groups were in agreement that role definition was urgently required to dispel ambiguities surrounding what the clinical role should involve. Conflicting views were evident among groups regarding lecturers' clinical credibility, visibility and teaching effectiveness. Findings highlight the essential nature of nurse lecturers engaging with clinical areas to maintain their skills, demonstrate a value for the practice component of the role and provide a link between education and practice.

An investigation of nurse educator's perceptions and experiences of undertaking clinical practice

Educational policy (DOH, 1999. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Department of Health, London; UKCC, 1999. Fitness for Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London; Nursing and Midwifery Council, 2006. Standards to support learning and assessment in practice. Nursing and Midwifery Council, London) and current nursing literature (Griscti, O., Jacono, B., Jacono, J., 2005. The nurse educator's clinical role. Journal of Advanced Nursing 50 (1), 84-92; Owen, S., Ferguson, K., Baguley, I., 2005. The clinical activity of mental health nurse lecturers. Journal of Psychiatric and Mental Health Nursing 12, 310-316), place increasing emphasis on nurse educators undertaking clinical practice to facilitate their clinical confidence and competence. This study investigated nurse educators' perceptions and experiences of undertaking clinical practice. A qualitative design and descriptive, exploratory approach were used. A purposive sample of 11 nurse educators in one nursing department, took part in two focus group interviews, one with 5 and the other with 6 respondents, to identify and discuss their perceptions and experiences of undertaking clinical practice. A process of thematic content analysis revealed three broad themes relating to the meaning and importance of clinical practice, perceived benefits and barriers which are examined and discussed. The paper concludes that despite policy recommendations, barriers highlighted in this study such as insufficient time, heavy workload and a lack of valuing of the clinical role have been raised over the past few decades. The effect of undertaking clinical practice, particularly on the quality of teaching is argued to be valuable armoury in the battle to secure sufficient resources to support engagement in clinical practice. Financial and organisational commitment; valuing of clinical practice and research evidence are crucial to realising clinical practice for nurse educators. Alternative interpretations of what may constitute the clinical role such as joint research projects and supporting and supervising students are offered, which need to be assessed against clear, specific and realistic aims for the clinical role of the nurse educator.

Substantive theory on commitment to nurse teacherhood

Nurse teacherhood is usually examined from the perspectives of nurse teachers' tasks, roles, skills and managing. The purpose of this study was to discuss how nurse teachers themselves describe their teacherhood. The purpose was also to generate a substantive theory of nurse teacherhood, its development, changes and manifestation. Nurse teachers from different polytechnics (today called universities of applied sciences) in Finland (N=34) were interviewed using a semi-structured interview. The data were analysed by employing the grounded theory method. Nurse teacherhood was found to be a dynamic process influenced by processes of change in the organisation, the operating culture of the health care working community, nurse teachers' professional self-esteem, the focus of nurse teachers' competence, their relationship with students, the future of their profession and requirements for staying in the profession. Commitment emerged as the core feature of nurse teacherhood. It was possible to distinguish eight types of commitment: (1) searching for new content in one's position, (2) being adapted to one's position, (3) trying to advance in one's position, (4) having found one's position, (5) searching for one's position, (6) withdrawing from one's position, (7) being satisfied with one's position and (8) being uncertain about one's position.

Plugging a hole and lightening the burden: a process evaluation of a practice education team

AIM

To investigate the perceptions of clinical and senior managers about the role of practice educators (PEs) employed in one acute hospital in the UK.

BACKGROUND

Producing nurses who are fit for practice, purpose and academic award is a key issue for nurse education partnership providers in the UK. Various new models for practice learning support structures and new roles within health care institutions have been established. To sustain funding and policy support for these models, there is a need for evaluation research.

DESIGN

A process evaluation methodology was employed to determine the current value of a practice education team and to provide information to guide future direction.

METHODS

Data were collected through semi-structured telephone interviews using a previously designed schedule. All senior nurse managers (n = 5) and a purposive sample of Clinical Managers (n = 13) who had personal experience of and perceptions about the role of PEs provided the data. Interview notes were transcribed, coded and a thematic framework devised to present the results.

RESULTS

A number of key themes emerged including: qualities needed for being a successful practice educator; visibility and presence of PEs; providing a link with the university; 'plugging a hole' in supporting learning needs; providing relief to practitioners in dealing with 'the burden of students;' alleviating the 'plight of students;' and effects on student attrition.

CONCLUSIONS

Findings provided evidence for the continued funding of the practice educator role with improvements to be made in dealing with stakeholder expectations and outcomes.

RELEVANCE TO CLINICAL PRACTICE

In the UK, there still remain concerns about the fitness for practice of newly Registered Nurses, prompting a recent national consultation by the professional regulating body. Despite fiscal pressures, recommendations for further strengthening of all systems that will support the quality of practice learning may continue to sustain practice learning support roles.

Student's perceptions of effective clinical teaching revisited

Despite a wealth of research on clinical teaching, the criteria for determining what constitutes effective clinical teaching remain poorly defined [Cholowski, K., 2002. Nursing students' and clinical educators' perceptions of characteristics of effective clinical educators in an Australian university school of nursing. Journal of Advanced Nursing 39 (5), 412-420]. This paper reports on two studies exploring second and third year nursing student's perceptions of effective clinical teaching over 14 years (1989-2003). The aim of the inquiry was to compare student's perceptions in diploma and baccalaureate programs within existing clinical contexts. This research used a generative approach to elicit learner's views of what teacher characteristics and contextual influences impact them in clinical settings. A convenience sample of 30 students at the end of second and third years volunteered to be interviewed in-depth for each study. The first study was conducted in a diploma program, whereas in the second study all but a few students were elected to complete a four year baccalaureate nursing degree. Findings from both studies are remarkably consistent. Students in both studies rated teacher knowledge as most important followed by feedback and communication skills. Teacher knowledge appeared critical in four areas: as it pertains to the clinical setting, the curriculum, the learner and teaching/learning theory. How well students perceived that they were accepted by staff, student-teacher ratios and peer support also appeared to impact student's views of effective clinical teaching. This research has implications for employment and evaluation practices for teachers in applied fields such as nursing. The study raises questions about the recent trend toward temporary employment of clinical teachers and in the separation of academic and clinical roles of nurse educators.

Nurse teacherhood: Systematic descriptive review and content analysis

BACKGROUND

The concept of 'nurse teacherhood' is multidimensional. In this article, 'nurse teacherhood' includes nurse teachers' tasks and different multidimensional roles as well as their personal experiences of being a nurse teacher.

OBJECTIVES

The article examines the topics of nursing research concerning nurse teacherhood, the changes in these topics and the results reported from January 1990 to April 2004.

DESIGN AND METHOD

The material was obtained by conducting a systematic review, and it included nursing research papers and Finnish academic dissertations (N=207). The material was analysed by using content analysis.

RESULTS

The topics of the studies were divided into three thematic categories: the expansion of nurse teacherhood, the skills of nurse teacherhood and their development, nurse teacherhood and membership in working community. The number of studies on the first two themes had increased (1990-1994:43; 1995-1999:57; 2000-4/2004:65), while those on the third theme had decreased (1990-1994:18; 1995-1999:19; 2000-4/2004:5).

CONCLUSIONS

Nurse teacherhood has been studied actively during the past 15 years and approached from several perspectives. Most of the topics of the studies discussed the expansion of nurse teacherhood. The focus of the studies in different years varied depending on the kind of challenges posed to nurse teachers' work in each period of time.

A South West regional survey to identify education staff development needs in clinical skills and practice

This paper reports tentative findings from a survey (undertaken in 2001) of education staff employed to teach nurses and midwives in four highereducation institutions in the South West of England, with specific focus on answers regarding clinical skills and practice within a wider aim of evaluating training needs. A 57 item self-administered postal questionnaire was sent out to 760 educators, 426 were returned with a response rate of 56%. The results were analysed using SPSS version 9, using descriptive statistics focusing on the responses of HE staff and lecturer practitioners on joint appointments. Findings suggest HE staff teach a limited range of (defined) clinical skills, they have varying and wide definitions of clinical skills, less confidence in teaching skills in practice, minimal experience in working in practice settings and difficulties in engagement in practice. They continue to experience role diversity and a wide variation in meeting clinical demands for clinical competence. Definitions of clinical practice and practice skill are explored in relation to the need for nurse teachers to have ‘recent and practical experience of nursing’. A range of education roles are explored.

The Nurse Educator's clinical role

AIM

This paper reports a two-phase descriptive study exploring the clinical role of the nurse educator in Malta.

BACKGROUND

Previous studies indicate a number of similarities and differences in the clinical role of nurse educators by country of practice. These include importance assigned to the role, factors inhibiting/facilitating the role, means to eliminate barriers to the role, and perceptions of the ideal role.

DESIGN AND METHODS

Data were collected using both quantitative and qualitative strategies. The quantitative phase involved asking all educators to fill in a time log of their academic and clinical activities for a 2-week period. In the qualitative phase, the first author interviewed five educators, five nurses and five students about their perceptions of factors which impact the nurse educator's clinical role, as well as what the ideal clinical role of the nurse educator should be.

FINDINGS

Maltese nurse educators allot minimal time to their clinical role. Main reasons cited included workload, perceived lack of control over the clinical area, and diminished clinical competence. Nurse educators who frequented the clinical settings (who were either university or joint university and health service employees) where the study took place perceived that employment inequities among the various categories of nurse educators played an important role in the amount of time dedicated by each group to their clinical roles, and the importance individuals in these groups assigned to that role. The majority of interviewees saw the current role of nurse educators in Malta as preparing students for successful completion of the didactic sections of their programme, rather than preparing them with all the knowledge and clinical skills necessary to be competent practitioners. Participants considered that, when in clinical areas, nurse educators did focus on their students, as they should. However, they also thought that they often did not take the opportunity to forge links with professional staff.

CONCLUSION

The clinical role of the Maltese nurse educator needs to be more multifaceted in approach.

An evaluation of critical care lecturer practitioners

The aim of this study was to evaluate the educational value and impact upon staff of critical care lecturer practitioners. Data were collected through three staff focus groups (n=21) and a questionnaire completed by 70 members of trust or university staff. A majority of respondents felt that the lecturer practitioner roles had considerable effect upon adult critical care services. Six main categories of findings were derived from analysis and integration of both focus group and questionnaire data--development of knowledge; staff support; being a teacher; developing and maintaining the workforce; role improvement plus removal of the lecturer practitioner role. Many of these findings concur with the limited quantity of evaluative literature on the lecturer practitioner role. The authors produced a report recommending continued funding for existing lecturer practitioner posts; introduction of more lecturer practitioner posts should be considered, and further role evaluation should be conducted at both a local and national level.

A South West regional survey of factors affecting the future development and education of nursing and midwifery educators

To ensure that higher education institutions (HEIs) keep abreast of the changes advocated by the NHS modernisation agenda, a regional survey was undertaken to identify and analyse the development needs of individuals involved in the education of nurses and midwives in the South West of England. A total of 760 self-administered postal questionnaires were distributed with 426 returns, giving a response rate of 56%. This paper discusses the qualitative responses from the 57-item questionnaire that reported the factors facilitating (n=79) and inhibiting (n=140) the educators' personal development, and additional responses from those wishing to make further comment (n=125). From a content analysis it was noted that the themes identified as both facilitating and inhibiting development were inter-linked. The data from the additional responses served to reinforce the issues that had already emerged. Discussion revolves around the four refined themes of the need for greater resources, for a supportive organisation, for role organisation and development and for collaborative practice. Recommendations suggest greater clarification is needed of the roles of academics in practice and that they need more resources to support them in their achievement. Finally, the study reinforces the need for collaborative working across HEIs and the NHS if the modernization agenda is to be met.

Clinical learning environment and supervision: testing a research instrument in an international comparative study

The aim of this study was to test a research instrument in a comparative analysis of the experiences of Finnish and English student nurses working in clinical settings. Changes in the organization of nurse education have resulted in a number of changes to the provision of nurse education in both countries, particularly in the areas of clinical teaching and the development of a more 'academic' role for nurse teachers. The data (n=558) were collected from four nursing colleges in Finland (n=416) and two universities in the UK (n=142). All respondents were undertaking clinical placements in a wide variety of clinical specialties. The research instrument used in this study was the Clinical Learning Environment and Supervision (CLES) scale. It consists of background variables and 27 statements that evaluate the learning environment and the supervisory relationship. Data were statistically analyzed, with differences between the groups analyzed using analysis of variance (ANOVA) and cross-tabulated. The instrument (CLES) used in this study was able to indicate the differences between the groups. Finnish students evaluated their clinical placements and supervision more positively than students in the UK. There were no significant differences in how students worked with their mentors but the frequency of nurse teacher/student meetings was much higher within the Finnish sample. The difference is statistically highly significant.

Facilitating the development of clinical skills in caring for dying people in hospital

Research shows that diploma level preparation has resulted in newly qualified nurses with clinical skill deficits (e.g. Macleod Clark et al. 1996, Carlisle et al. 1999). Part of the government's current plan to improve the quality of services delivered by the NHS is to address this problem through the introduction of a new nursing role; a role incorporating both clinical practice and teaching (Department of Health 1999). This paper draws data from a phenomenological study of 28 qualified diplomat nurses. It identifies their self-perceived skill deficits in relation of caring for dying people in acute hospital medical wards, and the ways that they believe that they could best be helped to overcome these deficits. On the basis of these findings, strategies are recommended that a practitioner-educator might adopt, with the intention of facilitating skill development in the care of dying people.

A new paradigm for practice education

This paper explores the complex nature of professional practice. It suggests that educating for all practice disciplines is about to undergo a paradigm shift whereby the value of practical education and experience will be better understood, more rigorously analyzed and integrated with propositional knowledge in the construction of personal professional knowledge and identity. It relates this cross disciplinary position to the present problems of skills deficits which are evident in nurses at the point of registration and demonstrates how routinization and internalization of process and tacit knowledge can create problems for students and newly qualified staff nurses. It also suggests how this can be addressed. It discusses the present culture of 'clinical education by default', unavailability of mentors and resources, and general lack of formal collaborative structures between education and service institutions and suggests that the present system cannot sustain the complex demands, expectations and pace of the clinical context and the evolution of nursing practice. Clinical credibility is an issue as is the current heavy clinical workload of staff nurse mentors, and several collaborative clinical education models are outlined which ensure that staff nurses or resident clinical educators are available and can make clinical teaching their priority. History and the present crisis in nursing suggest that there is a case for mandatory collaborative education/service structures to ensure adequate funding and to monitor the effectiveness of selected models so that staff nurse mentors can work with lecturer colleagues to articulate and teach the complexities of clinical practice through related research. It is predicted that this collaborative approach is capable of addressing both the skills deficits and the wider intellectual challenge of developing a new paradigm of practice education and providing an integrated base for continuing professional development.

Faculty practice: a model to bridge the theory-practice divide

It has been suggested that as a result of nurse education withdrawing from the clinical setting and becoming established in institutions of higher education, there has been a separation of theory from practice. Recognition of the theory-practice gap by clinicians and professional bodies has led to calls for nurse educators to retain a clinical focus. Faculty practice is described and critically discussed as a model of practice to bridge the theory-practice divide. In this article, the author presents the results of a 6-month pilot study to implement such a model within a community trust, and suggests that the development of such initiatives will foster collaborative working and improve nurse education and patient care.

A staff support mechanism: the transformational partnership

There have been many changes in nursing over the past decade, e.g. the movement of nursing education into higher educational sectors and the generation of many new nursing roles. The development of senior roles within nursing could potentially lead to isolation and, consequently, there may be calls for complementary support mechanisms. A transformational partnership is advocated, whereby nurses working in different organizations/specialties can provide mutual support. Existing support mechanisms for senior nursing can be variable and a transformational partnership can complement these as well as providing mutual clinical support. There are many advantages to this form of partnership which include professional and personal development as well as time out to reflect on practice. It requires commitment to the validity of the concept of professional support across traditional boundaries. A framework based on Holt's (1994) change theory is suggested as a method of implementing this initiative more widely within neighbouring organizations.