Pathways to fitness for practice: National Vocational Qualifications as a foundation of competence in nurse education

Current teaching of psychology in undergraduate adult and comprehensive nursing curricula

The need for nurses to understand human behaviour in the context of effective caring has long been established; however, there is no consensus over the teaching and learning of psychology. Recent reported failures in compassionate care have prompted academics and clinicians to revisit this discussion and examine the challenges this poses to education. The author therefore recognises the need to take stock to see if we are any closer to answering the critical question of how to help students use psychology to understand themselves and the people they will be caring for. A literature review was conducted to examine current research and texts that address the teaching of psychology to undergraduate adult nursing students. The aim was to frame recent discussion in the context of current pre-registration education, rather than revisit the historic argument. Three common themes emerged from the review: the content of psychology taught; the methods of teaching psychology to nurses; and the application of psychological theory to nursing practice. These themes became the focus of further content analysis. A consensus is emerging from the traditionally opposed skills and theory camps that psychological literacy is essential to caring. Psychological content must not be diluted, neglected or eroded, and the essentials of this need to be defined and taught in a manner that is simple to understand and can be applied to real people. In undergraduate education, there is an increasing emphasis on structured reflection, which is used to forge links between student cognition, emotion and behaviour to reinforce theoretical psychological concepts. The similarities between models of reflection and cognitive behavioural psychological conceptualisation are a possible area for future investigation.

Seconding health care assistants to a pre-registration nursing course: Evaluation of a novel scheme

Traditionally in the United Kingdom, reliance has been placed on unqualified support workers, such as student nurses, to deliver a high proportion of patient care. However, the move of nurse education into higher education and the accompanying supernumerary status of student nurses in the 1980s resulted in a shortfall of staff to deliver that care. The government has made a number of suggestions for increasing recruitment. One possible solution regarded as very promising is to encourage health care assistants (HCAs) with at least 12 months' experience in the National Health Service to enrol on existing pre-registration programmes, providing them with financial incentives to do so. Very little literature directly concerned with training opportunities for HCAs could be traced, but it was evident that financial constraints and family commitments had, in the past, operated as disincentives to training, although some HCAs would otherwise be keen to register.

In 1999 one of the workforce development confederations in London responded to government policy by seconding HCAs onto a pre-registration programme operated by the local university. Plans for evaluation were made at the outset. Interviews were conducted with two consecutive intakes of secondees at three time intervals: after three months; after 12 months and during the final placement of the 36-month course. Interviews with other stakeholders were conducted just before the course ended. A qualitative approach was taken and the data were analysed employing the sequence recommended by Miles and Huberman (1994).

Evaluation highlighted important features of the secondment process contributing to its success and indicated pitfalls attached to introducing such schemes. It is recommended that evaluation should be extended to explore how the new staff nurses prepared by this novel scheme continue to develop their career trajectories. Given the emphasis now being placed on the 'skills escalator' model of staff development in the NHS, such approaches will assume even greater importance in future, and more extensive evaluations will be needed.

Implementation of competency-based medical education: are we addressing the concerns and challenges?

CONTEXT

Competency-based medical education (CBME) has emerged as a core strategy to educate and assess the next generation of physicians. Advantages of CBME include: a focus on outcomes and learner achievement; requirements for multifaceted assessment that embraces formative and summative approaches; support of a flexible, time-independent trajectory through the curriculum; and increased accountability to stakeholders with a shared set of expectations and a common language for education, assessment and regulation.

OBJECTIVES

Despite the advantages of CBME, numerous concerns and challenges to the implementation of CBME frameworks have been described, including: increased administrative requirements; the need for faculty development; the lack of models for flexible curricula, and inconsistencies in terms and definitions. Additionally, there are concerns about reductionist approaches to assessment in CBME, lack of good assessments for some competencies, and whether CBME frameworks include domains of current importance. This study will outline these issues and discuss the responses of the medical education community.

METHODS

The concerns and challenges expressed are primarily categorised as: (i) those related to practical, administrative and logistical challenges in implementing CBME frameworks, and (ii) those with more conceptual or theoretical bases. The responses of the education community to these issues are then summarised.

CONCLUSIONS

The education community has begun to address the challenges involved in implementing CBME. Models and guidance exist to inform implementation strategies across the continuum of education, and focus on the more efficient use of resources and technology, and the use of milestones and entrustable professional activities-based frameworks. Inconsistencies in CBME definitions and frameworks remain a significant obstacle. Evolution in assessment approaches from in vitro task-based methods to in vivo integrated approaches is responsive to many of the theoretical and conceptual concerns about CBME, but much work remains to be done to bring rigour and quality to work-based assessment.

Educator as shaman and the sublated space

This paper seeks to identify and explore some of the tensions that nurse educators face when engaging in the competing internal and external demands that are made on their delivery of curricula. It offers that one of the ways to explore these tensions constructively is to see them dialectically. It seeks to identify three archetypal dialectical themes that can be present in our teaching and offers that the educator's role can be understood to be one of a shaman as they seek to resolve these dialectical tensions skillfully.

A critical time for medical education: the perils of competence-based reform of the curriculum

Rapid expansion in scientific knowledge, changes in medical practice, and greater demands from patients and society necessitate reform of the medical curriculum. In recognition of this, medical educators across the world have recommended the adoption of competence-based education. This is intended to increase the rigour and relevance of the curriculum, move students beyond a focus on the memorisation and regurgitation of scientific facts, and better enable them to understand scientific principles and apply them to the practice of medicine. Experience from 40 years' use of competence-based curricula across the world suggests that the uncritical application of this approach to the medical curriculum may not achieve its intended aims. There are valuable lessons to be learnt from the history of competence-based education. By taking on board these lessons, confronting the pitfalls of this approach, and devising new and creative solutions to the problems inherent in this methodology, medical educators can better achieve their aim of providing a strong foundation for the practice of medicine in the twenty-first century. It is only through such a strategy-rather than the uncritical adoption of this educational approach-that we will have real movement and progress both in competence-based education in general, and in its applications to medicine in particular.

The first year as a graduate nurse--an experience of growth and development

AIM

The aim of this paper was to illuminate how recently graduated nurses experience their first year as a nurse.

BACKGROUND

Graduate nurses are expected to identify themselves as members of an interdisciplinary team, to feel comfortable in chaos and to make and defend decisions. By graduation nurses expect to have the necessary competence to perform nursing. Recently graduated nurses lack competence, especially relating to leadership.

DESIGN

A qualitative design was chosen and 12 nurses working in hospitals and home care were individually interviewed.

METHOD

The interviews were transcribed verbatim and the texts were analysed using manifest and latent content analysis.

RESULTS

The nurses gave descriptions covering numerous experiences, interpreted and categorised in the following eight subcategories: uncertainty and chaos; need for induction; need for a supportive environment; need for recognition; awareness of responsibility; need for positive experiences; becoming experienced; and managing challenges. These subcategories gave reason for the three categories: experience of being new; gaining nurse experience; and gaining competence. The nurses described a tough start as a nurse, but they most of all gave descriptions interpreted as an experience of growth and development, which constituted the theme in this study.

CONCLUSIONS

Recently graduated nurses have a positive attitude to the challenges of being a new nurse. Although the initial period as a nurse was tough, the nurses appreciated their experiences because they learnt from them.

RELEVANCE TO CLINICAL PRACTICE

Recently graduated nurses should be spared from being the only nurse on duty. Employers both in hospital and home care should facilitate induction programmes for new graduate nurses.

Concerns about numeracy skills of nursing students

Accurate mathematical calculation is a critical skill that nurses must demonstrate in order to administer medications safely. The ability of undergraduate nurses to calculate the correct dosage of medication consistently has been a concern of schools of nursing for a long time. This study explores the ability of a group of nursing students to calculate mathematical drug problems within an English University. A convenience sample of 37 second year nursing students volunteered to complete a 10-item drug calculation test, requiring understanding of simple division and multiplication, percentages, ratio and proportion, conversion of units and multiple-stage procedures. The students' median correct score was 6 out of 10 (range 0-9). No one achieved full marks. Only 3 were able to achieve 9 out of 10, indicating that, on average, students were unable to achieve 90% mastery. This finding supports past literature and is of concern. It is of concern that these student nurses did not have the ability to perform drug calculations at a 90% mastery level. It has been recommended that admission requirements be reviewed, and that students are tested throughout their programme and that skills are reinforced both in the classroom and practice setting. This could be achieved using a variety of methods, supporting a teaching and learning framework to integrate analytical and procedural competence underpinned by the creation of national standards. Also, both educators and practitioners must take responsibility for ensuring adequate support and guidance are available to student nurses.

Cadets and nursing students: same destination - different route

BACKGROUND

In response to the policy initiatives in England to secure recruitment and retention in the nursing and midwifery professions, strategies to improve and extend access to preregistration education and training in England have been developed. The relatively recent development of modern cadet schemes is an example of such a strategy. Despite the increasing interest in and proliferation of cadet schemes, there is as yet little evidence for their effectiveness. Reporting on an evaluation of a scheme in England, this paper makes some contribution to this evidence.

AIMS AND OBJECTIVES

The project explored former nurse cadets' experiences of the cadet scheme 9 months after their transition to nurse education. The aims of the project were to evaluate the extent to which former cadets and university staff considered the scheme to prepare students effectively for access to university nurse education.

METHODS

The first cohort of former cadets entered nurse education in September 2000. After 9 months they were invited to contribute to an evaluation of the cadet scheme and their present experience. The evaluation consisted of a structured questionnaire sent to all the former cadets, a focus group interview with the former cadets, informal discussions with university staff and brief documentary analysis.

CONCLUSION

Tensions were apparent between the worlds of education and clinical practice: the cadets felt better prepared clinically than academically and found an element of repetition in the nursing programme. They valued their preparation, which they felt put them at an advantage over other nursing students. However, some of them experienced difficulties in the transition to higher education and further review is therefore required to establish the success of cadet schemes.

Education and training of complementary therapists: the role of higher education

This paper is intended to inform the reader of key issues relating to education and training of complementary therapists. It discusses the role of higher education in the training of complementary therapists in light of changing policy and patterns of course delivery. It highlights the need for professional standards in clinical practice and for training underpinned by an evidence base. The paper presents the need for collaborative working with professions for complementary medicine, indicating some areas of good practice established at the University of Central Lancashire.