Pre-registration Courses Research Articles

Call for initiatives to boost number of cancer nurses

Pre-registration courses and cancer-based placements are key to improving care

Bullying in the nursing profession.

Self-esteem is a major predictor of behaviour. Nurses with healthy self-esteem are likely to deliver therapeutic patient care, while those with low self-esteem are less likely to do so. The aim of the 3-year study discussed here was to explore students' self-esteem and how their experiences of preregistration education influenced its development over the period of the programme. Students participated in unstructured qualitative interviews at the beginning and end of their 3-year preregistration course and a grounded theory approach was used for data collection and analysis. Bullying was found to be commonplace in the transition to becoming a nurse. Students were bullied and also witnessed patients being bullied by qualified nurses. The internalization of nursing norms meant that students then bullied others. Students' self-esteem was low. Bullying, and its effects on self-esteem, are perpetuated by practices within nursing. This situation will only be changed if nurses and educators transform their practice and the context in which bullying occurs. Otherwise, each new generation of nurses will continue to be socialized into negative practices which undermine both their own feelings of self-worth and standards of nursing care.

Pharmacology education: a theoretical framework of applied pharmacology and therapeutics

United Kingdom Government initiatives such as The NHS Plan ( DoH 2000) identified the need for nurses to undertake multi-skilled professional roles. In the United Kingdom, the transition to a larger graduate nurse workforce continues, as Universities offer nurse pre-registration courses at diploma and degree levels. Concomitant with the change in educational standard is the need to teach student nurses the theoretical principles of medication management and to develop skills in clinical reasoning skills. Both elements are limited in current educational pre-registration nurse programmes, in order to develop the future, multi-skilled workforce such courses should incorporate the theory and skills of health assessment, physical examination, applied pharmacology and clinical reasoning. This paper aims to examine how knowledge of applied pharmacology and therapeutics can be integrated into an undergraduate pre-registration nursing programme. Discussion focuses on how this generic framework can provide educators with an outline of the theoretical constructs, their application, the teaching strategies involved and instruction on how to prepare nurses to clinically reason with regard to medication management issues. This framework can be adapted to accommodate nurses studying for all parts of the register.

Selection of Pre-registration Physiotherapy Students: Changing to a more objective process

Summary Selection interviews and the use of grade achievement via a points system continue to be used as the fundamental criteria for admission to most pre-registration physiotherapy courses in the United Kingdom. This traditional process has not always been shown to be effective in terms of student attrition rates and resources. Important policy drivers such as widening participation in higher education do not sit well with the many problematic issues that are emerging from the interviewing process, such as inadvertent bias and the potential for disadvantaging the very applicants (for example, those from minority ethnic groups), which the profession as a whole may wish to encourage. Many educators are questioning this process and recognise that the existing system is problematic and not conducive to promoting widening access and equal opportunity policies. This paper describes the changes in this traditional selection process undertaken by the BSc(Hons) Physiotherapy course team at Leeds Metropolitan University. The pre-1999 admissions process is described. The authors then outline the new process, which mainly involved the changing of two key issues: ▪ Elimination of interviewing as a means of selecting prospective undergraduate students. ▪ Development of an objective random selection process which would represent more accurately the diverse eligible applicant pool and be more representative of the population as a whole. This paper surveys a wide range of literature that explores the challenges of meaningful selection for health-related courses. A rationale for the case for change is offered. Data are presented as an interim audit, comparing student progression, achievement and outcome from the new non-interviewing process with the old system. There is an increase in the number of mature applicants, which may be a fairer reflection of the applicant pool. Applicants are also being selected with a greater range of entry qualifications. Further work needs to be undertaken on resources for staff. Confounding factors are discussed. The wider implications of equal opportunities for all those interested in a career in physiotherapy and the diverse nature of the total applicant pool are considered in relation to the new process and the needs of the profession.

Looking to the Future

Developments in the organization of work generally, and in learning disability nursing specifically, suggest an increased impetus for the provision of career guidance. Such support, to enable nurses to develop fulfilling careers, may benefit both recruitment and retention. This article presents findings from a Department of Health funded study of nurses' careers. Two hundred and twenty-five learning disability nurses completed a questionnaire at qualification, which included questions about career guidance received during the pre-registration diploma course. Three aspects of guidance were investigated: information and advice received about applying for a first job, continuing education, and career pathways; discussions about career planning; and awareness of strategies to inform career planning. Findings indicate that a substantial proportion of learning disability diplomates did not receive guidance about many aspects of career planning and that considerable unmet demand existed. The need for career development programmes is discussed.

Sign of the times or the shape of things to come? A 3-day unit of instruction on ‘aggression and violence in health settings for all students during pre-registration nurse training’

In the UK, figures based on a recent survey of NHS Trusts suggest that health-care workers are at greater risk (four times higher than normal) from work related violence than the general population. Studies also show that, of all health professions and grades, student nurses are at the greatest risk of being the victim. Yet, training in self-protection and pro-active management of aggression and violence remains predominantly a post-registration preserve.Despite English National Board (1993) recommendations recognizing that all pre-registration courses for nurses and midwives should contain material on aggression and violence delivered by appropriately qualified trainers and teachers, this input is still likely to be uncoordinated and disparate within curricula.This paper reports the design, and early experience of delivery, of an integrated, 3-day unit of instruction for pre-registration students within a Common Foundation Programme of a diploma-level course. The unit designer/leader is a University Lecturer and Royal College of Nursing (RCN) Institute Registered Trainer in the management of actual and potential aggression. Consequently, all aspects involving teaching physical skills (breakaway skills) adhere to the recently published RCN training standards. In addition, initial student feedback on the delivery and suitability of the unit will be presented, along with a discussion of related issues.

A survey of pressure ulcer education within pre-registration radiography courses

The prevention of pressure ulcers and the management of people with pressure ulcers is multi-disciplinary, though in many places it is considered a nursing problem. Radiography environments are a potential cause of pressure ulcers. This paper describes the results of a survey of pre-registration radiography education institutions regarding the education provision on the prevention of pressure ulcers within radiography environments. The survey comprised two parts — a desk top review of course prospectuses and a postal questionnaire. Course prospectuses for 23 of the 24 institutions were examined for specific mention of prevention and management of pressure ulcers but none was found. All 24 institutions in the United Kingdom were invited to respond to a questionnaire survey, and 14 replied (58% response rate). Responses covered both diagnostic and therapeutic radiography programmes. Nine institutions specifically identify teaching on pressure ulcers, with the majority of education appearing in year 1 of the course, with some courses providing further material later in the programme. The survey confirms anecdotal evidence reported in a previous study that radiographers have little training in the prevention and management of patients at risk of developing pressure ulcers during radiographic procedures. Thirteen out of 14 institutions stated that no final year student project had considered the prevention and management of pressure ulcers in radiography environments.

Student nurse attrition from pre-registration courses: investigating methodological issues

There has been increasing recent interest in student nurse attrition. Despite a long history of research into the problem, attrition rates remain a cause for concern. This paper presents a review of the research undertaken in the UK, together with an international comparison. The foci of previous studies have been diverse and have included investigation of students’ leaving reasons, their experience of stress, and course-related difficulties of students in progress. This review illustrates the complexity of issues surrounding student nurse discontinuation, highlighting a number of methodological limitations of prior research. These include the lack of a common definition of attrition, low response rates in surveys, and the imprecise definition of categories of leaving reasons. There is also a dearth of studies based on the perspectives of students. In the UK there is little documentation of whether measures have been adopted to reduce attrition and there is no evidence of evaluation. If future research is to be aimed at reducing attrition, these conceptual and methodological issues need to be addressed.

Achieving consensus about pain content for child branch curricula.

The aim of the study was to identify nurse educators' and nurse managers' perceptions of the educational needs of children's nurses in relation to pain management. Children continue to suffer unnecessary pain during hospitalization. This has been attributed, in part, to inadequate education among paediatric nurses with a number of studies demonstrating that nursing curricula need re-evaluating with respect to the content relating to pain management. In order to equip nurses to manage pain within clinical practice nurse education needs to provide them with the knowledge and skills required. It is apparent that nurse education is currently failing students in this regard. In order to evaluate nursing curricula with respect to pain management it is necessary for there to be a degree of consensus, among paediatric nurses, regarding appropriate content. A two-round Delphi study was used to ascertain the appropriate pain content for pre-registration child branch courses. When undertaking a Delphi study a number of 'experts' in the field are identified, who complete a series of questionnaires. The first round is used to generate ideas, which are reconsidered in subsequent rounds (Hicks 1999, Reid 1988). Following analysis of the responses to each questionnaire anonymous feedback is sent to the respondents together with the next questionnaire (Walker 1994). Participants were either senior nurse educators or senior nurse managers. Positive correlations were found within the two groups as well as between the educators' and managers' rankings for the 14 categories identified. The results of this study suggest that nurse educators and nurse managers have similar views about the pain management knowledge they would expect a newly qualified child branch nurse to have. The list of appropriate pain content derived from the results of this study provides a useful tool with which to evaluate the content of child branch curricula.

Confidentiality within physiotherapy: perceptions and attitudes of clinical practitioners

Objectives—This study examined the issue of confidentiality in relation to i) undergraduate curriculum content in physiotherapy, and ii) the awareness, experiences and attitudes of clinical physiotherapists. Design—Postal survey of universities...

Sampling for a longitudinal study of the careers of nurses qualifying from the English pre-registration Project 2000 diploma course.

This paper describes the processes involved in selecting a sample, from the eight English regional health authorities, of nurse qualifiers from all four branches of the Project 2000 pre-registration diploma course, for a longitudinal study of nurses' careers. A simple random sample was not feasible since accurate information about the population could not be obtained and the study design involved recruiting participants by personal visit. A multi-stage approach was therefore adopted in which 'college of nursing' was taken as the primary sampling unit. Sampling was further complicated by the fact that adult branch students could generally only be visited in larger groups than was ideal. Information obtained during pilot work about the accuracy of data about the population, course completion rates and the proportion of students who were likely to agree to participate was used to calculate required sampling fractions. The final sample was therefore a function of this information and the practicalities of recruiting nurses into the study.

Using questionnaires to ask nurses about working in the community: problems of definition.

Given the emphasis on providing services in the community, it is likely that there will be an increase in research into various aspects of the community. It is important that the way in which 'community' is defined in research will provide valid and reliable data and facilitate comparisons with other work on the subject. This paper discusses how the problems of defining the community were approached in a longitudinal study of the careers of people qualifying from the pre-registration diploma course in nursing.

Sign of the times or the shape of things to come? A 3-day unit of instruction on ‘aggression and violence in health settings for all students during pre-registration nurse training’

In the UK, figures based on a recent survey of NHS Trusts suggest that health-care workers are at greater risk (four times higher than normal) from work related violence than the general population. Studies also show that, of all health professions and grades, student nurses are at the greatest risk of being the victim. Yet, training in self-protection and pro-active management of aggression and violence remains predominantly a post-registration preserve.Despite English National Board (1993) recommendations recognizing that all pre-registration courses for nurses and midwives should contain material on aggression and violence delivered by appropriately qualified trainers and teachers, this input is still likely to be uncoordinated and disparate within curricula.This paper reports the design, and early experience of delivery, of an integrated, 3-day unit of instruction for pre-registration students within a Common Foundation Programme of a diploma-level course. The unit designer/leader is a University Lecturer and Royal College of Nursing (RCN) Institute Registered Trainer in the management of actual and potential aggression. Consequently, all aspects involving teaching physical skills (breakaway skills) adhere to the recently published RCN training standards. In addition, initial student feedback on the delivery and suitability of the unit will be presented, along with a discussion of related issues.

Use of experiential methods to teach research in a pre-registration nursing curriculum

For nursing to become firmly established as a research-based profession, it is essential that all nurses are equipped with the skills to critique research literature. This demands the integration of research application into nursing curricula at all levels. In order for nursing problems to be effectively illuminated, it is important that a range of quantitative and qualitative approaches are utilised. This necessitates teaching material from across the range of relevant research paradigms. Many students commencing pre-registration courses have a limited knowledge of either nursing or research. Others have had a variety of previous experiences of research as a subject, some of which have generated negative stereotypes and disinterest. This paper will explore the challenges encountered when teaching research to students on a pre-registration advanced diploma course.The authors have developed a range of experiential exercises which attempt to explore research concepts in a meaningful way. The presentation of research principles is followed up by formative work linked to clinical placements. Discussion during feedback sessions allows for sharing of ideas and experiences within the group and facilitates critical reflection.The evaluation from this initiative has been positive and encouraging. A selection of the methods used and evaluation material will be presented.

Parenting by people with learning disabilities: the educational needs of the community nurse

This article discusses some of the findings of a research project which was designed to examine the role of community learning disability nurses in supporting people with learning disabilities who become parents. The need for information and help with the experience of pregnancy, childbirth, becoming parents and bringing up children has been highlighted in a recently issued guide for commissioning and providing services for people with learning disabilities (NHS Executive 1998). This research, however, indicates that nurses do not feel themselves to be adequately prepared for their role in supporting parenting. Responses from a questionnaire survey of 266 practitioners revealed little coverage of key issues relating to parenting on either pre-registration or post-basic courses and suggests, therefore, that some courses may not be meeting the perceived needs of these nurses in this crucial aspect of their role. This is likely to have significant consequences for this client group and suggests that educationalists need to consider ways of including more extensive discussion of parenting in educational provision for the multiplicity of professional groups who support and care for adults with learning disabilities.

A service in crisis? Reflections on the shortage of nurses in the British National Health Service

A service in crisis? Reflections on the shortage of nurses in the British National Health Service

Intellectual development and research: student nurses' and student midwives' accounts.

The way in which student nurses and midwives experience research in practice is described here through accounts from in-depth interviews with 10 student midwives and nine student nurses while they were in the rostered service component of their pre-registration diploma courses. Also reported here is an impressionistic model of their intellectual development in relation to research which has been created inductively from the same data and which offer a new line of inquiry on the research to practice problem. Although this research is primarily concerned with these particular students it is of general interest since there may be a level of intellectual development which is a necessary condition to being able to initiate and use research in practice.

RCN to begin research on high attrition rates

The ANS submitted a resolution asking for research into reasons for the increasing numbers of students leaving preregistration courses.

Clinical supervision for the development of nursing practice.

Nursing practice demands a range of problem-solving skills and abilities, and preregistration courses may only provide limited preparation. Clinicians need to draw on the skills and expertise of experienced colleagues in order most effectively to use their time and energies in a new role or clinical area. Experienced staff may enhance both their clinical expertise and their support of colleagues through the role of clinical supervisor. Clinical supervision has benefits for the supervisor in terms of professional development and for the supervisee as regards identifying and addressing clinical problems. According to the position statement on clinical supervision for nurses and health visitors published by the UKCC (UKCC, 1996) clinical supervision aims to identify solutions to problems, improve practice and increase understanding of professional issues. This article examines roles and responsibilities in clinical supervision and discusses the benefits for individuals and for health services.

The Educational Needs of Occupational Therapists Who Work with Adult Survivors of Childhood Sexual Abuse

This study aimed to examine the education and training needs of occupational therapists who work with adult survivors of childhood sexual abuse (CSA). Two sample groups were used: occupational therapy pre-registration courses and occupational therapists working in mental health settings. Two postal surveys were designed in order to elicit both quantitative and qualitative data. Seventeen courses and 43 occupational therapists responded from around the United Kingdom. The results indicated that although most of the occupational therapy courses offered some form of education around CSA issues, this had been available for a relatively short period of time (generally for less than 5 years). However, the majority of occupational therapists who responded were senior staff with more than 5 years' clinical experience who had not received such education as students. Consequently, the education offered differed greatly from that of 5 years ago. All the occupational therapists felt that their current level of knowledge could be improved. Recommendations regarding prospective educational requirements and further research are made.