Post-registration Education Research Articles

Nepal needs Continuing Professional Development for Re-registration in Nursing and Midwifery.

The nursing and midwifery profession needs to stay up to date with the latest developments. In this Viewpoint, we shall be referring to 'nurses' and 'nursing' to mean 'nurses and midwives' and 'nursing and midwifery' respectively. Nurses must continue to update their skills and competences to meet changing future population health needs effectively and safely. However, the reality is that many staff are reporting difficulty accessing and completing Continuing Professional Development (CPD) in all settings. Keywords: CPD; midwifery; nursing; post-registration education; training.

THE ROLE OF THE MIDWIFE IN CARING FOR WOMEN WITH ADDITIONAL NEEDS

In our standards of proficiency for midwives published in 2019¹ there was a clear shift in how the role of the midwife was described. In our previous standards, the emphasis was not on women with additional needs; this was reserved to post registration education. We recognised the changing context of women using maternity services and that midwives need to be able to care for them holistically.

Stakeholder perspectives on co-designing a post-registration mental health nursing curriculum: A case study.

Globally, healthcare regulatory bodies require providers of academic programs to involve service users in the design and delivery of education, yet concrete and tested directions for operationalising this are lacking. Service users' involvement in education is often passive, ad-hoc and tokenistic, with limited input at the program development level. To explore the co-design processes and outcomes of a collaborative revision of an Australian post-registration mental health nursing curriculum. Using qualitative case study design, the experiences and collaborative practices of five stakeholders (one mental health service user, two carers and two academics) co-designing a post-registration mental health nursing curriculum were explored. Commonly identified barriers to meaningful involvement were overcome through planning and collaborative execution of the group's work. Participants reported a strong sense of successful collaboration in reviewing the curriculum, trusting relationships and mutual respect. While it was possible to support and augment stakeholder knowledge in the context of post-registration education, co-design processes were ultimately bound by the university's relatively inflexible bureaucratic context. To ensure effective stakeholder collaboration beyond classroom teaching, mental health nurse academics must prepare service users for the role, explaining the language and practices of the tertiary health education and nursing context. As part of co-design processes, organisational mandates must be explored and negotiated, and mutual clarity regarding expectations and roles must be established. A Design Thinking approach can support meaningful engagement of stakeholders in curriculum development.

The integration of simulation into a post registration neurological course: a phenomenological research study

Background: Simulation in healthcare education is becoming increasingly popular. However, there is limited evidence of simulation in post registration education or in neurological practice. This article reports on the introduction of simulation into a neurological course for registered nurses and the value of this from the learner perspective. Aim: To explore the experiences of nurses who participated in a neurological simulation activity. Methods: A phenomenological research design was used to explore the experiences of 10 registered nurses using semi-structured interviews. Findings: A total of four key themes were generated from the analysis: being in the spotlight, reality of simulation, theory to practice interface, and learning and working with others. Conclusion: The lived experience of the participants of this study has shown that neuro-simulation is valued as a teaching strategy to consolidate learning, with low-fidelity simulation receiving the most positive feedback owing to its authentic nature. A review of the high-fidelity session, where the simulation should become more realistic and use smaller, interprofessional groups, needs to be considered.

Community children's nursing: developing a bespoke model of post-registration education.

Community children's nurses provide a vital service between the hospital and home environment, supporting children, young people and families with their health needs. In the UK, the number of educational pathways providing a specialist practitioner qualification in community children's nursing has declined significantly in recent years. This has left many community children's nursing services with little or no access to educational programmes, despite the rising demand. The four UK governments, together with regulatory bodies such as the Nursing and Midwifery Council, have embarked on ambitious transformation of post-registration career frameworks and standards, the long-term impact of which is uncertain. This article discusses an approach that one community children's nursing service in Scotland took to address these challenges by liaising with a local university and accessing a bespoke advanced practice programme.

Registered Nurses’ Perspectives of the Impact of a Post-registration Education Qualification on Patient Care and Clinical Practice in Cancer Care: a Qualitative Study

Student evaluation of teaching is routinely completed as modules and programmes of study at higher education institutions conclude. The evaluations are often focused on the educational value and experience. For programmes with healthcare professionals as students, the impact of the learning on patient care and clinical practice is not routinely captured in these student evaluations. These insights are crucial as the definitive impact of learning for many educational programmes of study for healthcare professionals is to enhance patient outcomes. The aim of this qualitative research study was to capture the impact of a post-registration Specialist Practice in cancer pathway for registered nurses in the context of Northern Ireland following completion of the programme. Eleven participants engaged in interviews in 2021 who had completed the education programme from 2013 to 2021. Two themes inductively emerged from the data which provided insights into the specific impact of the education programme on patient care and clinical practice. Theme one identified patient outcomes improved, and was related to five sub themes; development of nurse’s clinical knowledge; enhanced awareness of the holistic impact of cancer; greater understanding of patient services available; development of clinical networks; and greater decision-making ability. Theme two related to the impact of the qualification on clinical practice through an increase in their professional credibility within the multidisciplinary team in cancer services. The debate on how to capture the impact of education on patient care and clinical practice in cancer care, should consider how to routinely capture this data.

Preparing children's nurses for working with children and adolescents who self-harm: Evaluating the 'our care through our eyes' e-learning training package.

Rates of self-harm among children and adolescents have risen significantly over the past decade and clinical guidelines place children's nurses at the heart of their care. This article reports on the evaluation of 'Our Care Through Our Eyes', an online self-harm learning programme for children's nurses. A self-selected, convenience sample of registered children's nurses (n = 42) completed scales pre- and postlearning programme that captured their attitudes, beliefs, empathy, anxiety, and confidence. Mean change scores were assessed, and qualitative comments captured postintervention were thematically summarized. There were small improvements in participants' attitudes, empathy and confidence were reported. Anxiety scores increased in a small number of items. Qualitative comments confirmed the value of the online learning programme for improving children's nurses' knowledge and understanding of self-harm among CYP. Our findings demonstrate that children's nurses agree on the importance of mental health training in self harm, and this could be a catalyst for renewal of both pre- and postregistration education including support structures within the National Health Service. This study is the first to explore the feasibility of evaluating 'Our Care Through Our Eyes' delivered using e-leaning and could be used to inform further investigations.

Stressors experienced by nurses providing end-of-life care in intensive care unit (ICU): A Qualitative study

Background of Study: Palliative care is unique in that the service focuses on the needs of dying patients and their families as opposed to focusing on maintaining critical bodily functions, as in critical care nursing, or on improving functional capacity, as in rehabilitation nursing (Martens, 2009). The philosophy of palliative care nursing includes providing care to patients using medical science combined with compassion and caring. Patients may be cared for in hospital wards in acute care settings, in specialist hospice or palliative care units, in aged care homes, or in their own home. Palliative care specialist nurses primarily have generalist nursing skills with various levels of specialisation and post-registration education, including palliative care certification. (International Journal of Palliative Nursing 2012).Aims and Objectives: Purpose of the study is to gain a deeper understanding of the stressors experienced by ICU nurses providing End of Life Care and to describe stressors experienced by nurses working in ICU providing End of Life Care.Materials and Methods: Phenomenological research design was used.10 nurses working in ICU and giving End of life Care were selected using purposive sampling technique as per the pre-determined inclusion criteria. Semi-structured interview schedule was used for data collection. Voice recording of the conversation was done, the transcript was then thematically analysed using Open Code Software.Results: By the findings of the study themes emerged as Emotional Stressor, Personal Stressor, Professional Stressor, Anticipatory Stressor and Experiential Stressor.Conclusion: Limited research has been undertaken on the provision of End of Life care by nurses in the Intensive care setting and thus a need arises to conduct a study in this area. Identification and development of strategies to support nurses in the provision of End Of life care is required to ensure quality care and to minimise stress and eliminate burnout.

Ambulance nurses’ experiences of using prehospital guidelines for patients with acute chest pain - A qualitative study

BackgroundAmbulance nurses have an important role in early recognition and treatment often being the first medical contact for patients with acute chest pain. However, there is sparse knowledge on the experiences of ambulance nurses with regard to use of Prehospital Guidelines for patients with Acute Chest Pain. AimTo explore ambulance nurses’ experiences of using prehospital guidelines for patients with acute coronary syndrome. MethodA qualitative descriptive study design. Semi-structured interviews with 22 ambulance nurses recruited through purposive sampling strategy. The material was transcribed and analysed using content analysis. ResultsTwo main categories emerged from the results. The first category Sense of professional obligation included experiences of having an important role in caring for patients with acute chest pain. Understanding this role and the collaboration in the chain of care prompted ambulance nurses to adhere to the guidelines. However, not receiving enough feedback on the provided care made them uncertain whether to use guidelines. The second category Clinical difficulties using guidelines consisted of experiences of being surrounded by practical challenges while using guidelines. Ambulance nurses meet these challenges by relying on their clinical experience, which sometimes led to them deviating from the guidelines. ConclusionsThe ambulance nurses experienced a mixture of feeling secure and insecure when using the guidelines. Foremost, when encountering patients with unspecific chest pain, they felt a lack of feedback and an insufficient collaboration within the chain of care, which made them deviate from guidelines. To increase adherence in guidelines, post-registration education to update the knowledge and skills about guidelines for acute chest pain is needed followed by formal inter-disciplinary feedback on the care provided.

Critical elements in nursing graduates’ transition to advanced practice roles and their perceived impact on patient care: an exploratory, descriptive study of graduates’ and their managers’ perceptions

BackgroundWhile there is a growth in the number of advanced practice nurses, there is a dearth of research examining their role transition from registered nurses. This study aimed to identify critical elements in the career path of nursing graduates who have taken up advanced practice roles and examine their perceived impact on patient care.MethodsAn exploratory descriptive study was performed. Individual semi-structured interviews were conducted face-to-face with 10 nursing graduates now in advanced practice roles, and their ten respective managers. All interviews were audio-recorded and transcribed verbatim for latent and manifest content analyses.ResultsThe nursing graduates, six of whom were male, had a mean age of 35 years. All possessed a master’s degree and formal post-registration education and/or training. Six had at least three years’ experience as an advanced practice nurse. The managers, all female, had a mean age of 49 years. Eight had at least one year’s experience in their current position. Six key themes emerged: prior enhancement of personal and professional knowledge and skills; active participation in clinical roles and knowledge translation in preparation for advanced practice; adapting to new and diverse advanced practice nursing responsibilities; role of advanced practice nurses in leadership; personal qualities crucial for success in advanced practice; and provision of evidence-based patient-centered care.ConclusionsPostgraduate education, management knowledge and leadership skills, and active participation in clinical roles and knowledge translation appear crucial ingredients for promotion of nursing graduates to advanced practice roles. Other ingredients include a positive outlook, flexibility and adaptability, and good interpersonal, communication and problem-solving skills.

Developing a competency framework for early career nurses undertaking post-registration education in care for older people.

Within gerontological nursing as a postgraduate nursing specialty, there is a lack of consensus regarding the standardised competencies and education development required, particularly in the UK. To develop and evaluate a competency framework for early career nurses undertaking post-registration education in a UK university in care for older people living with frailty. The competency framework was developed as part of a broader gerontological education-career pathway intervention to improve competence and retention among early career nurses. A four-step process was used to develop the framework guided by a consensus building approach. A mixed-methods approach to the evaluation was adopted, with an online survey, one-to-one interviews and focus group interviews with students and organisational stakeholders. A total of 33 students completed the competency framework as part of an academic module, 30 of whom took part in the evaluation. There was consensus among interviewees that the competencies confirmed 'what they knew already' and identified areas they needed to develop. Survey respondents reported that the competency framework was a useful part of the education-career pathway. The competency framework was acceptable to students and feasible to complete. It also enabled students to appreciate the unique knowledge and skills that underpin gerontological nursing and to evidence their expertise using a structured approach.

Experiences and perspectives of nursing students on self-management promotion in patients with coronary heart disease

Background/aims Self-management in patients with coronary heart disease is essential to the prevention of cardiac complications and the minimisation of morbidity and mortality. The aim of this study was to explore the knowledge and perceptions of student nurses on promotion of self-management and lifestyle changes in patients with coronary heart disease. Methods A qualitative methodology was adopted using semi-structured face-to-face interviews with undergraduate nursing students in their third and fourth year of studies. Through purposive sampling, eight participants were recruited from a higher education institute in Scotland. Interviews were transcribed verbatim and analysed by thematic analysis. Results Three themes emerged: self-management, barriers to effective self-management and health promotion. The perceived barriers included lack of effective communication, patients' perception of their illness and lack of time and identified motivators to good delivery of health promotion. Conclusions Pre-registration healthcare students may benefit from more education on patient self-management from a theoretical and practical perspective. Post-registration education might also be useful to nurses to increase their knowledge and confidence in the delivery of health promotion to patients.

'The Lynchpin of the Acute Stroke Service'-An envisioning of the scope and role of the advanced nurse practitioner in stroke care in a qualitative study.

Stroke prevalence is rising internationally. Advanced practice nursing is established across many jurisdictions; however, its contribution to stroke services is under research. To gain insights into the future scope and role of future advanced nurse practitioners in stroke care from the perspectives of key stakeholders. A qualitative descriptive approach. Interviews were conducted in 2019 with a purposive sample of 18 participants, comprising stroke nurses, stroke unit managers, stroke survivors and their family carers, recruited in one UK healthcare trust. The research is reported in line with COREQ. Data were analysed in accordance with an inductive content analysis approach. The abstraction process generated four main themes. These were 'The lynchpin of the acute stroke service', 'An expert in stroke care', 'Person and family focussed' and 'Preparation for the role'. These findings offer new perspectives on the potential scope and role of advanced nurse practitioners in stroke service delivery. Further research should focus on how to address the challenges confronted by advanced nurse practitioners when endeavouring to engage in autonomous clinical decision-making. Study findings may advance postregistration education curricula, clinical supervision models and research directions. There is support for the implementation of advanced practice nursing in the hyperacute and acute stroke phases of the care pathway. An interprofessional model of clinical supervision has potential to support the developing advanced nurse practitioner in autonomous clinical decision-making.

Anaesthesia nursing competence: Self-assessment of nursing students

BackgroundThe importance of competence assessment in anaesthesia nursing education has increased since nurse educators and anaesthesia care employers have identified the gap between nursing education and nursing practice. In order to ensure nursing students' preparedness for entry into anaesthesia nursing practice, it is necessary to measure whether nursing students have achieved the required competence to practice as anaesthesia care providers. ObjectivesTo assess the anaesthesia nursing competence of nursing students and to describe factors related to their anaesthesia nursing competence. This study will provide new knowledge to support the curricula of nursing education and new nurses' practice in anaesthesia care. DesignCross-sectional survey design. MethodsData from a sample of Finnish nursing students (n = 205) were collected by using an on-line/paper and pencil survey (the Anaesthesia Nursing Competence Scale, 7 categories) in 2017. The assessment was based on self-assessment and used a Visual Analogue Scale (0−100). Descriptive statistics, a Pearson correlation coefficient, independent sample t-tests and a multivariable regression were used to analyse the data. ResultsThe self-assessed overall competence of graduating nursing students was 59 (range 43–73). Approximately half of the students reached an acceptable level (60≤) and half did not. The highest self-assessed category was collaboration within patient care, and the lowest was knowledge of anaesthesia patient care. The number of credits, anaesthesia courses, and experience of clinical practice in anaesthesia nursing were significantly related to anaesthesia nursing competence. ConclusionsCompetence development in the knowledge of anaesthesia patient care should be considered in general nursing education. Student nurses' competence could be developed by providing more opportunities for theoretical studies and clinical practice in anaesthesia nursing. A specialised post-registration education in anaesthesia nursing might be one solution to overcome the limitations in the competence that general nursing education is not fully able to cover for anaesthesia nursing.

Critically Appraised Topics (CATs) in Veterinary Medicine: Applying Evidence in Clinical Practice.

Critically appraised topics (CATs) are evidence syntheses that provide veterinary professionals with information to rapidly address clinical questions and support the practice of evidence-based veterinary medicine (EBVM). They also have an important role to play in both undergraduate and post-registration education of veterinary professionals, in research and knowledge gap identification, literature scoping, preparing research grants and informing policy. CATs are not without limitations, the primary one relating to the rapid approach used which may lead to selection bias or restrict information identified or retrieved. Furthermore, the narrow focus of CATs may limit applicability of the evidence findings beyond a specific clinical scenario, and infrequently updated CATs may become redundant. Despite these limitations, CATs are fundamental to EBVM in the veterinary profession. Using the example of a dog with osteoarthritis, the five steps involved in creating and applying a CAT to clinical practice are outlined, with an emphasis on clinical relevance and practicalities. Finally, potential future developments for CATs and their role in EBVM, and the education of veterinary professionals are discussed. This review is focused on critically appraised topics (CATs) as a form of evidence synthesis in veterinary medicine. It aims to be a primary guide for veterinarians, from students to clinicians, and for veterinary nurses and technicians (hereafter collectively called veterinary professionals). Additionally, this review provides further information for those with some experience of CATs who would like to better understand the historic context and process, including further detail on more advanced concepts. This more detailed information will appear in pop-out boxes with a double-lined surround to distinguish it from the information core to producing and interpreting CATs, and from the boxes with a single line surround which contain additional resources relevant to the different parts of the review.

Does post-registration palliative care education for nurses improve practice? A systematic review.

We aimed to answer the question: what is the evidence that post-registration palliative care education for nurses improves practice? The 2008 End of Life Care Strategy emphasised the need for a workforce equipped to provide high-quality end-of-life care for patients and their families. As registered nurses are the healthcare professionals spending most time with patients and families at the end of life, associated policy documents stress the importance of educating nurses to equip them with the necessary knowledge and skills to provide effective care. Despite education being a consistent recommendation, the ability of education to influence nursing practice is uncertain. We undertook a systematic review of literature using Joanna Briggs Institute Methodology for Mixed Methods by searching the Medline, Embase and CINAHL databases between January 2006 and December 2018. Ten studies met the inclusion criteria, seven contained quantitative data. Six demonstrated improvements in outcome measures, but not all results were statistically significant. Most quantitative data related to self-reported measures of confidence. Six studies contained qualitative findings that were categorised into themes: confidence, practice change, skills and proactivity. Little research exists exploring the impact of post-registration palliative care education for nurses. Existing outcome measures do not clearly demonstrate changes to end-of-life practice. Research is suggested to establish links between self-reported confidence and improvements to practice. Evaluation of the impact on practice should be an integral component of end-of-life education initiatives.

Medication safety problems priorities in community pharmacy in Saudi Arabia: a multi-stakeholder Delphi study using the human factors framework

AimTo achieve multi-stakeholder consensus and prioritisation of medication safety problems in community pharmacies in Saudi Arabia.Design and interventionA theoretically-underpinned, three-round Delphi study.SettingSaudi Arabia.ParticipantsPatients and public (pharmacy users), pharmacy-related professionals (policymakers,...

Withdrawal of treatment from critically ill children: legal and ethical issues.

Withdrawal of treatment from critically ill children is a contentious and ethically difficult area. The principle of best interests was central to three recent high-profile legal cases and raised questions about how this is demonstrated in healthcare for children whose treatment may be of no benefit to them. This article discusses the legal and ethical aspects of caring for such children. Nurses are important advocates and should balance their obligation to deliver holistic and family-centred care with that of keeping the child as the central focus, particularly with decision-making. In cases of disagreement between families and clinicians, children's voices are particularly vulnerable to being lost. Pre- and post-registration education, research and a higher profile for nurses in multidisciplinary decision-making are suggested as ways to improve the nursing contribution to this important debate.

Impact of postgraduate education on advanced practice nurse activity - a national survey.

There is a wealth of international evidence concerning the contribution post-registration master's level education makes to advancing the discipline of nursing. There are approximately 277 nurse practitioners registered in NZ, but they account for only a small portion of nurses who have undertaken master's level education. The additional contribution these nurses make to the work environment through advanced practice activities has not, hitherto, been documented. To report the extent of advanced practice nurse activity associated with various levels of nursing education in a sample of nurses working in clinical practice in New Zealand. A replication of recent Australian research was done via a national cross-sectional survey of 3255 registered nurses and nurse practitioners in New Zealand using an online questionnaire to collect responses to the amended Advanced Practice Delineation survey tool. In addition, demographic data were collected including position titles and levels of postgraduate education. A positive association was found between postgraduate education at any level and more time spent in advanced practice activities. Independent of level of postgraduate education, the role a nurse holds also effects the extent of involvement in advanced practice activities. There is an additional contribution made to the work environment by nurses with master's level education which occurs even when they are not employed in an advanced practice role. These findings are of significance to workforce policy and planning across the globe as countries work to sustain health services by increasing nursing capacity effectively within available resources.

To what extent are midwives adapting antenatal information for pregnant women with intellectual disabilities? A survey of NHS trusts in England

ObjectivesTo identify the existing antenatal information provision practices for pregnant women with intellectual disabilities in England. To identify how practices between and within local supervising authorities differed, and if midwives were adapting standard antenatal information for pregnant women with intellectual disabilities, including examples of accessible information being used. Study designCross-sectional survey. MethodsAll contact supervisors of midwives from acute trusts with maternity services were accessed via the local supervisor of midwives officers' databases and sent a questionnaire. Quantitative data were collated. Associations between trust size, geographical location, antenatal provision and National Institute for Health and Care Excellence guidelines alongside National policy were examined using Fischer's exact test of association. ResultsContact supervisors of midwives returned a questionnaire on behalf of their trust (74, 53%). The majority worked in maternity units with more than 4000 births a year (50, 66%). Few trusts had a specialist or lead midwife in post for pregnant women with intellectual disabilities (17, 22.9%) but over half (39, 52.7%) reported that their trust had a specialist learning disability nurse in post. Only 28.3% reported availability of post registration training and even fewer (8, 10.8%) had access to written protocols. Less than half reported extra time being offered at the booking (29, 39.1%) or routine antenatal appointments (30, 40.5%). Less than a quarter (17, 22.9%) reported that their trust had routine antenatal written information available in accessible formats. ConclusionReasonable adjustments to standard antenatal information for pregnant women with intellectual disabilities were not common practice. Most trusts did not have local guidelines in place or offer midwives post registration education to help support them in this requirement.