Pre-registration Nursing Education Research Articles

Evaluating the preceptor role for pre-registration nursing and midwifery student clinical education

The aim of this research is to evaluate the perceptions of the Registered Nurse (RN), Registered Midwife (RM) and Enrolled Nurse (EN) about their experience of preceptoring an undergraduate student within a large Local Health District in New South Wales (NSW) Australia. In the current Health Workforce Australia (HWA) literature, the term 'Clinical Supervisor' has subsumed the role of mentor, preceptor, buddy and facilitator of clinical practice. Preceptor in this paper describes the supervisory, facilitating and teaching role of the registered nurse in the clinical practice undergraduate nursing and midwifery educational pairing. A quantitative cross sectional design was used and data collected using the Clinical Preceptor Experience Evaluation Tool (CPEET), a previously validated and reliable survey tool. Nurses and Midwives across nine acute care facilities that preceptor undergraduate students were invited to complete the survey between March and May 2012. There were 337 survey respondents across nine acute hospitals included in this study (22.5% response rate). Differences were observed between preceptors who had training in precepting in three of the subscales. Differences were observed in all four subscales between those preceptors with access to university facilitators in their location and those without immediate access. The majority of preceptors score highly on all subscales indicating they are generally satisfied with the role of precepting. Significant differences on several items suggest that some aspects of the role are more challenging and less satisfying than others.

Deciding to fail

Within pre-registration nursing education programmes, clinical competence is verified via continuous assessment in practice. Registered nurses who have undertaken mentor preparation assess competence in practice and have a responsibility to confirm that nursing students are capable of safe and effective practice prior to registration. This requires mentors to identify underperforming students and manage the situation appropriately. Drawing on interview data from 10 mentors who had failed a student in practice this paper will highlight the processes, alongside, the difficulties and dilemmas associated with managing a failed assessment successfully. Three key concepts emerging from the data will provide the framework for this paper, namely: identifying the weak student; creating possibilities for success; deciding to fail. Within the concept of ‘Identifying the weak student’ participants discuss how they recognised the early indicators of possible failure. While, ‘Creating possibilities for success’ reveals the strategies mentors used to attempt to facilitate students’ progress. The final concept ‘Deciding to fail’ exposes the emotional consequences for both the mentor and the student of a failed assessment and the importance of debriefing following the event. The paper concludes by discussing the support needs of mentors as this emerged as crucial in the process of managing a failed assessment.

Pre-registration nurse education: building the foundations of a nursing career and profession?

All nursing careers are built on the foundation of one’s pre registration nurse education: it is from these foundations that student nurses (and later Registered Nurses) develop their understanding of what it is to be a nurse and to be part of the nursing profession. These foundations lead to aspirations about where careers in nursing may lead (e.g. Barton and le May, 2012) and these, in turn, influence the development of the profession of nursing. As a result of the introduction of the latest Standards for Pre-registration Nurse Education by the Nursing and Midwifery Council (NMC) (2010), all pre-registration nurse education programmes in the United Kingdom, like many others across the world, will have to be at degree level from 2013. There have been many differing views expressed in reaction to this requirement, at one end of the continuum is the view that this is nothing new as degree level courses in nursing have existed in the United Kingdom and internationally for over 30 years, indeed some post-graduate courses exist within pre registration nurse education – a point of view explored by Kathryn Jones in her editorial on this topic. At the other end of the continuum, is the somewhat spurious notion that a move to degree level preparation for nurses will distract them, during their studies and once qualified, from their core role of competently nursing people. Much media attention, public debate and professional re-focussing activities – e.g. the Willis commission on nurse education (Education Commission, 2012) and no doubt the Nursing and Care Quality Forum (Department of Health, 2012) – has become entwined with this change, so much so that one could be forgiven for thinking that obtaining graduate status for nurses is the only important change introduced within the new standards. This, of course, is not the case – the NMC standards show all of us involved in educating nurses, be that in the lecture room, the simulation suite or at the patient’s side, the key components of this endeavour required to build a 21st century workforce. The standards show prospective nurses what contemporary nursing involves, they show practising nurses areas for updating

Untangling a complex issue: An overview of initiatives to support nursing and midwifery student recruitment, selection and retention in Scottish Universities

The reasons behind attrition rates in nursing and midwifery are many and complex. However, of the four UK countries, Scotland has been consistently cited as having the highest attrition rate from its pre-registration nursing and midwifery education programmes. This paper provides an overview of a nationally coordinated programme of work to support evidence-based intervention and identifies both opportunities for further national and international initiatives and presents early indicators of improvement in retention and completion.

Unfolding case studies in pre-registration nursing education: Lessons learned

Nursing education is undergoing radical change worldwide. There is criticism surrounding the content of education and the delivery. As a result, traditional methods of teaching and learning have been replaced by strategies that place greater emphasis on active learner interaction, critical thinking, and decision-making. Assisting pre-registration nurses to become competent and confident in clinical practice requires immersion in practice with sufficient support and coaching based on real life scenarios. Simulation via an unfolding case study approach is one way to provide interactive learning experiences where students acquire new skills that advance their clinical judgment with the aim of becoming safe, competent practitioners. Lessons learned from implementing an unfolding case study are discussed in this paper.

The role of simulation for learning within pre-registration nursing education — A literature review

Simulated learning in a clinical skills centre has become more popular within undergraduate nursing education and is increasingly used to teach and assess clinical skill acquisition. Current literature suggests that there is some validity in teaching psychomotor skills in a designated simulated clinical skills centre, whilst other sources still question its value in terms of experience. Such contradictions demand further exploration and appraisal of the current literature. The findings show that simulated learning in a clinical skills laboratory is reported to increase student confidence and prepares students for real clinical setting, however, this acquisition of skill is often achieved at different rates by different students. A standardised approach to simulated learning in nursing education and the development of further holistic clinical scenarios which are linked to related theory and lectures, would offer measurable learning outcomes to meet professional and regulatory requirements. Therefore, further evaluation of the current learning methods within simulation may offer appraisal of the preparation of students for clinical practice, to ensure that students are offered quality-learning opportunities that are flexible and responsive to both their needs and the demands of the Health Care Services.

The role of the nurse specialist in placement education

Changes in health service provision have created a shortage of practice placements for pre-registration nursing students on acute hospital wards. However, high quality practice learning opportunities are essential in pre-registration nursing education. An initiative to allocate nursing students to short placements with nurse specialist teams increased student learning opportunities and placement capacity. Student evaluations indicate that students allocated to nurse specialist placements receive effective mentoring and are supported in developing nursing skills and knowledge relevant to the varied and often complex needs of patients.

Student nurses’ de-escalation of patient aggression: A pretest–posttest intervention study

Background Experts recommend staff training to prevent and manage aggressive situations involving patients or their relatives. However, in many countries this subject is not covered in pre-registration nursing education. In addition, the evidence regarding its impact on practical placements remains weak. Objective This study examines the influence of an aggression management training programme for nursing students on their performance in de-escalating aggressive patients. Design Pretest–posttest within-and-between-groups design. Setting A School of Nursing in Germany. Participants Convenience sample out of six classes of nursing students at differing educational levels (10th to 28th month of nursing education, n = 78, mean age = 22). Methods In a cross-sectional and longitudinal two groups before and after design nursing students encountered two scenarios (A or B) with simulation patients. After completing the training, each student was confronted with the unknown other scenario. De-escalation experts from three German-speaking countries evaluated 156 video scenes using the De-escalating Aggressive Behaviour Scale (DABS), not knowing whether the videos had been recorded before or after the training. Mean values and statistical significance tests were computed to compare the results. Results The performance levels of students who had been trained rose significantly from 2.74 to 3.65 as measured by the DABS on a 5-point Likert scale (Wilcoxon test p < .001). The trained students managed scenario A significantly better than the untrained students (untrained 2.50, trained 3.70; Mann–Whitney- U-test p < .001,). Similar results were found for scenario B (untrained 3.01, trained 3.61; Mann–Whitney- U-test p < .001). No significant differences were found in the pretest results irrespective the students’ age or duration of previous nursing education. Conclusions Aggression management training is able to improve nursing students’ performance in de-escalating aggressive behaviour. A maturation-effect on the de-escalating performance due to general nursing education or age is unlikely.

A degree of success? Messages from the new social work degree in England for nurse education

In September 2008 the Nursing and Midwifery Council (NMC) approved plans to change pre-registration nursing education in England to an all-graduate qualification in 2015. In 2001 the Department of Health announced a similar decision for social work qualifying education and the first graduate-only qualifying programmes began in 2003-2004. This article presents findings from a national in-depth evaluation of the social work degree in England and describes ways in which efforts have been made to improve the quality of social workers, raise the status of the profession and link practice and theory as part of the transformation to a degree level qualification. Messages for nurse educators are drawn in the light of the professions' commonalities.

The impact of clinical simulation on learner self-efficacy in pre-registration nursing education

Clinical simulation is becoming increasingly popular in pre-registration nursing education. Incorporating teaching and learning strategies that enhance learner self-efficacy will theoretically improve clinical competence (Bandura, 1986, 1997). This paper presents the findings of a study that aimed to explore the impact of clinical simulation on self-efficacy beliefs amongst pre-registration nurses. A preliminary study (Pike, 2008) used a pre- and post-test design to measure learner self-efficacy before and after a clinical simulation session. Qualitative responses to questions on the post-test questionnaire provided themes to explore in a focus group interview with a convenience sample of nine participants. Thematic content analysis of the interview highlighted two principal findings. Firstly, students described low levels of self-efficacy with regards to communication skills, an area identified as a priority within pre-registration nursing education (NMC, 2007a). Second, students highlighted the need for learning experiences within clinical simulation to be more authentic, to improve the theory to practice gap. It is argued by incorporating strategies within clinical simulation that enhance learner self-efficacy, overall clinical competence will be improved. Suggestions for how pedagogical approaches may be developed within clinical simulation are discussed, whilst acknowledging the limitations of the small scale nature of the study.

An exploration of the current use and benefit of nursing student portfolios

This study aims to identify the structure and of student portfolios and to ascertain their views on their usefulness. Portfolios are in common use in undergraduate nursing programmes although there are considerable variations in approaches. As a result a wide variety exists in the quality of work presented and students are often unclear as to constituent contents. This latter, while a reflection of the current status and development of portfolio use within the discipline is a source of dissatisfaction for students, and warrants further investigation. This project aimed to quantitatively capture student views using an on line survey approach utilizing a previously validated questionnaire (McMullen, 2006) [McMullen, M. 2006. Students' perceptions on the use of portfolios in pre-registration nursing education: A questionnaire survey. International Journal of Nursing Studies 43 (3), 333-343]. A survey tool is used to examine the structure, process and content of portfolios (n=481) in current use in one school. The study provides an evidence base for hitherto anecdotal comments and provides useful information for future development. While students see potential value in the portfolio use there are several areas of dissatisfaction including lack of clear guidelines. As an evolving structure within universities and practice there is much room for process improvement.

Can an all-graduate profession work?

In September the Nursing and Midwifery Council (NMC) approved plans to change pre-registration nursing education to an all graduate qualification in 2015. This decision follows an extensive consultation as part of the Government's ‘Modernising nursing careers’ initiative and has not been universally welcomed. Many nurses hold the view that a degree doesn't necessarily make a good nurse and that academic achievement cannot replace clinical experience. Others are concerned that the degree entry requirements will prevent sufficient numbers of nurses entering the profession, which will put a further strain on the existing workforce.

An evaluation of fitness for practice curricula: self‐efficacy, support and self‐reported competence in preregistration student nurses and midwives

This element of the larger Scottish evaluation aimed to explore differences between access routes, cohorts and higher education institutes (HEI) (universities and colleges) in levels of self-efficacy, student support and self-reported competence in a nationally representative sample of student nurses and midwives. This paper reports findings from the National Review of Pre-Registration Nursing and Midwifery Programmes in Scotland. Fitness for practice curricula have been the heart of many recent developments in nurse and midwifery education. Fitness for practice set out to map out the future direction of preregistration nursing and midwifery education with the aim of ensuring fitness for practice based on healthcare need. There have been no national evaluations of the effectiveness of this strategic objective. Previous major evaluations in the 1990s suggested that students may not have had the skills needed to be fit for practice. The study design was a cross-sectional survey of a stratified random sample of student nurses and midwives (n = 777). Data collected included demographic information, generalised perceived self-efficacy, student support and self-reported competency. Students reported high levels of self-reported competency. There were no significant differences between two cohorts or between students with different access routes. Students rated support from family and friends highest and support from HEI lowest. There was a significant difference in support levels between HEI. Self-efficacy scores were similar to other population means and showed small-moderate correlations with self-report competence. Similarly, self-reported competency appears to be at the higher end of the spectrum, although older students may have a more realistic perception of their competence. However, support from HEI was seen as less satisfactory and varied from one institution to another. This study portrays a relatively positive picture of preregistration fitness for practice curricula. Questions are raised about the relative value students place on support from educationalists and mentors and whether support from family and friends and from peers needs to feature more prominently in curricula. The study provides modest support for social cognitive theory. The major drivers for changes in preregistration curricula stemmed from fears about the competence of students. This study did not provide support for this viewpoint, and students' self-reports suggest that curricula are, in this respect, meeting their objectives. Nevertheless support from mentors and from educational institutes may need to be improved.

High Stakes: Assessing Numeracy for Nursing

The importance of for professional in nursing is increasingly recognized in the USA, UK and elsewhere, but there is no consensus on what is meant by for nursing, nor on how it should be taught, learned and assessed. Meanwhile, studies in various countries indicate a lack of proficiency in of some students and qualified nurses (Hutton, 1997; Meyer, 2004; Sabin, 2001). Against this background, we are undertaking an exploratory interdisciplinary (nursing and education) study to evaluate the teaching, learning and assessment of for nursing in a large pre-qualification program at a school of nursing in England (referred to here as 'the school') and drawing out implications for the teaching, learning and assessment of for nursing in the school and elsewhere. The program leads to registration as a qualified nurse through its recognition by the UK Nursing and Midwifery Council (NMC). Since September 2008, students on such programs must achieve 100% in a test of numeracy in practice (NMC, 2007). However, no national standards for for nursing are specified in the UK (nor elsewhere, as far as we are aware). The body tasked by government with providing educational solutions for workforce development for the National Health Service (NHS) workforce in Scotland, NHS Education for Scotland (NES), is seeking to remedy this situation through the establishment of a benchmark for for nursing at point of registration (Coben et al., 2008). Meanwhile, throughout the UK, Higher Education Institutions (HEIs), including the one in our study, are incorporating tests into their pre-registration nurse education programs in order to meet the NMC requirement. We are concerned that these tests may be of variable quality and, at worst, some may be mathematically and/or professionally inappropriate. In a safety-critical context such as nursing, this could have serious negative consequences for all concerned, not least the patient. Numeracy in Pre-registration Nurse Education in the School The school in our study offers an integrated program in undergraduate nursing studies leading to professional registration after three years full-time study. Numeracy features strongly throughout, in particular through the mandatory 'Calculations for Nursing' element. This focuses on the development of mathematical skills, reviewing some basic mathematics principles and applying these to calculations encountered in clinical practice. Summative assessment of 'Calculations for Nursing' comprises ten multiple-choice questions randomly chosen from the school's item bank and attempted online under examination conditions. Students have 30 minutes to complete the assessment and three opportunities to achieve 100%. In this article we focus on our analysis of the summative assessment. Initial Analysis of Summative Assessment Data We analyzed data from summative tests undertaken by Year One students as part of their normal program: (N [Candidates]=378; N [Items]=41 items). Of the total candidates, 199 (53%) were unsuccessful on their first attempt. In our preliminary analysis, we have examined items facilities (i.e., the percentage of correct answers). These are generally high (between 0.59 and 1; mean: 0.89; median: 0.93), but the tests taken by individual candidates vary considerably in difficulty depending on the 10 items drawn from the item bank. Hence, for purposes of comparison, we have additionally conducted a Rasch analysis. Briefly, the Rasch model is a probabilistic model based on an item response theory (IRT) model (Hambleton, 1993).It can be used to estimate candidate 'abilities' and item difficulties. It assumes that latent variables, ability and difficulty can be measured on the same uni-dimensional interval scale. Given the limitations of both dataset and items, the Rasch model is a good fit. Figure 1 shows the distribution of candidates' ability estimates for pass and fail groups. …

The personal tutor’s role in pre-registration nursing education

Providing support for students has always been an inherent part of the lecturer's role. Widening access to students from backgrounds not traditionally associated with higher education has necessitated a review of the personal tutor system, as potential students may not be equipped with the academic skills to meet the demands of higher education. Ten randomly selected lecturers in one institute of higher education were interviewed to elicit their views and experiences of the personal tutor's role. The findings showed that the role of the personal tutor was considered both demanding, as students have increasingly different needs, but also fulfilling. The provision of pastoral care was viewed as integral to the role of the personal tutor, although most lecturers reported that they adopted an all-encompassing model of support that ranged from providing academic, professional, psychological and financial advice. Time factors and workload were identified as important structural constraints.

Changes in nurse education: Delivering the curriculum

The aim of this study is to examine changes in pre-registration nursing education through the personal accounts of nurse teachers. This paper is based on 37 in-depth interviews within a central London Healthcare Faculty. Each interview was subjected to a process of content analysis described by Miles and Huberman. The interviews took place between August 2003 and March 2004 and totalled 34.4 hours or 305,736 words. There were thirty female and seven male participants, who shared 1015 years of nursing experience, averaging at 27.4 years (min 7-max 42). These were supplemented by 552 years of teaching practice, the average being 15 years (min 0.5-max 29). This paper--delivering the nursing curriculum--identifies that the nature of nursing has changed as it has both expanded and contracted. Participants identified three major changes; the nature of nursing, selection of future nurses and the current impact that large cohorts have on our traditional model of person-centred education. The practice placements remain central to nursing education and it is the nursing role that should define the curriculum and the values of higher education should be supportive of this identity.

The debate in favour of using simulation education in pre-registration adult nursing

The purpose of this paper is to have a fresh look at the literature on the advantages and disadvantages of simulation education as a teaching, learning and assessment methodology within pre-registration nurse education. It will highlight the reasons why simulation education has been re-introduced into nurse education within many Higher Education Institutions (HEI) in the United Kingdom (UK). This is in an attempt to enable the student nurse to develop competence in the clinical skills required for fitness for award, practice and purpose. This comes at a time when the Nursing and Midwifery Council (NMC) are conducting further research on simulation education and whether it can replace practice hours.

Undergraduate psychiatric nursing education at the crossroads in Ireland. The generalist vs. specialist approach: towards a common foundation

This paper provides a critical overview of undergraduate educational preparation for psychiatric nursing and proposes the use of a model, which may equip psychiatric nurses to adapt to current and future directions in psychiatric nursing practice. It contends that mental health nursing is a distinct scope of practice and as such requires specialty undergraduate education. A major difference between educational preparation for psychiatric nursing in the Republic of Ireland and the UK, and distinct from most other developed countries, is the existence of separate, specialized pre-registration programmes that, upon graduation, allow the nurse to register as a psychiatric nurse. In other countries such as, Australia, the integration of pre-registration nurse education into the university sector resulted in the wide-scale adoption of a generalist approach to nurse education. In light of the recent changes in pre-registration nursing education in Ireland, and the integration of nursing into higher-level education, this paper examines the generalist vs. specialist approach to nurse education. It contends that neither the generalist nor the specialist model best serve the nursing profession in preparing safe and competent practitioners. Rather, it argues that the use of a model which incorporates both generalist and specialist perspectives will help to redress the imbalance inherent in both of the existing approaches and promote a sense of unity in the profession without sacrificing the real strengths of specialization. Such a model will also facilitate psychiatric nurses to adapt to current and future directions in psychiatric nursing practice.

Students’ perceptions on the use of portfolios in pre-registration nursing education: A questionnaire survey

Background Portfolios encourage both personal and professional development through the process of reflective practice and critical analysis. In clinical placements portfolios are used both as a learning tool and as an assessment tool. Objectives To determine nursing students’ perceptions on the use and effectiveness of portfolios in their education as well as their perceptions on the use of the portfolio as both an assessment and learning tool in clinical placement. Design Postal questionnaire survey. Settings Higher Education Institute in the UK. Participants 90 first and 84 third year pre-registration diploma of nursing students. Methods Postal questionnaires were sent to 131 first year and 122 third year students, with a reminder 3 weeks later. The total response rate was 69% (174/253), with a response rate of 69% (90/131) for first year students and a response rate of 69% (84/122) for third year students. Results Students felt that portfolios were very time-consuming, causing them a great deal of anxiety, and were not very effective in developing and assessing their learning and competence. Using portfolios for both assessment and learning creates a conflict. Any assessment reduces the honesty and learning value of reflective writing and of the portfolio. Additionally, students become increasingly demoralised with portfolio use over time with experience. The study suggested three main linked reasons for this, namely the conflict between using portfolios for both assessment and learning, the design of the portfolio and the amount of support and guidance students feel they receive with their portfolio use. Conclusions Portfolios can be very effective as an assessment and learning tool, but it is essential that both students and mentors receive clear guidelines on and comprehensive support with their use. They should be designed in such as way that they are relevant, clear and user-friendly for both students and mentors.

Consumerism 1: the different perspectives within health care.

This is the first of two articles which collectively consider the evolving concept of 'consumerism' within the NHS and the degree to which this can be seen as having informed preregistration nursing and midwifery education within England. The impact upon preregistration education is the focus of the second article within which findings from a four-stage study will be explored. This first article considers the nature of consumerism in relation to the health service. It seeks to explore the place of consumerism within the NHS reforms heralded in 2000, while acknowledging that as a concept it remains problematic. The potential distinction between the individualistic and more collectively based notion of consumerism is highlighted. Finally, the article suggests that in order to adopt fully the consumer ethos in the NHS - more latterly redefined as a user- or partnership-based service - appropriate resources and education are required.