Pre-registration Nursing Curriculum Research Articles

Informing the development of a fit-for-purpose mental health nursing curriculum: A survey of mental health nurse academics in Australia.

Inadequate mental health nursing content in pre-registration nursing curricula has been the topic of debate and concern since the introduction of comprehensive nursing education in Australia. Government-initiated inquiries and the efforts of mental health professional organizations and leaders have not successfully addressed this problem. The aim of the current study was to garner the perspectives and experiences of mental health nurse academics regarding the adequacy of mental health content in producing graduates able to work effectively in mental health settings and identify barriers and enablers to implementing and sustaining sufficient mental health content in pre-registration programs. A survey was distributed to mental health academics in Australian universities offering pre-registration nursing degrees. In total, 44 complete responses were included in the analysis. The results demonstrated the following: Most participants considered the current mental health content, theory and clinical hours insufficient to prepare graduates for practice in mental health settings. They reported a scarcity of tenured mental health nurse academics to deliver content effectively. Most participants were dissatisfied with the comprehensive approach to nurse education and preferred a double degree (nursing and mental health nursing), or a direct entry mental health nursing program. These findings provide further evidence for the current crisis in mental health nursing education and highlight the need for urgent action. People accessing health services have the right to receive high-quality care from appropriately qualified nurses. The inadequacy of mental health content in these programs effectively denies vulnerable people the standard of care and treatment they should be entitled to.

Community nurse lecturers' experiences of pre-registration nurse education: a phenomenological study.

The aim of this study was to explore the lived experiences of community nurse lecturers in pre-registration nurse education and to gain insight into the nature of community nursing and its profile within pre-registration nursing. A qualitative phenomenological approach explored pre-registration, adult field nurse lecturers' experiences of being community nurses and subsequently their experiences of being community nurse lecturers. Three participants audio recorded answers prompted by three questions that allowed for storytelling and prompted memory recall. The results were analysed, and the themes identified were: community nursing is vastly different to hospital nursing, with a notable heightened sense of accountability, lone working and a recognition of experience needed to be a community nurse. When reflecting on their role as lecturers, research participants recalled responses that informed the second theme: the pre-registration adult nursing curriculum was acute care focused and this was also the expectation of students. Results identified tensions between community nursing and critical care nursing, and a loss of identity to which each of them embraced in different ways.

Factors in integrating academic electronic medical records in nursing curricula: A qualitative multiple case studies approach

BackgroundAcademic electronic medical records are useful simulation-based educational tools that assist health professional students develop their skill sets for digital health practice. Despite this, their utilisation in pre-registration nursing curricula is uncommon in Australia and New Zealand. AimTo explore factors surrounding integration of academic electronic medical records into pre-registration nursing curricula in Australia and New Zealand. DesignExploratory qualitative multiple case studies approach with purposive sampling set within a larger research project. MethodsSemi-structured interviews conducted with course leaders from six nursing schools. Data were analysed in an iterative content-driven deductive and inductive process using open-coding and categories. Case analysis involved within case and cross-case analysis. ResultsFindings revealed different factors that impacted the utilisation of academic electronic medical records in nursing curricula including factors influencing adoption, barriers and challenges with implementation, enablers for integration and perceived benefits for students' clinical practice preparation. Reasons for not using academic electronic medical records, barriers for implementation, and preparation of students for clinical practice in the absence of these simulation tools were also highlighted. ConclusionOur findings suggest that use of academic electronic medical records in nursing curricula is still evolving and that their adoption and application within programs is not straightforward. While there are many factors unique to the schools using such resources, factors including decisions around curriculum incorporation, optimising available resources to support students' learning, and developing faculty capability to teach with academic electronic medical records were common considerations. Lack of funding and access to local educational tools were ongoing barriers for adoption. Further research examining curriculum timing and preparation, possibilities of partnerships to share resources, and evaluation in meeting students' needs is necessary.

Student Perception of Skills and Simulation Delivery within an Undergraduate Nursing Curriculum.

Introduction
 The existing delivery method for skills training is very task focused and delivered in large groups with limited time for actual ‘hands on’ practice of skills. Simulation was only included, sporadically, within the curriculum. 
 Methods
 A questionnaire was designed to ascertain the student’s existing level of experience in skills and simulation, in addition to their opinion as to how effective the current method of delivery was in relation to a positive learning experience, and generation of knowledge. Their viewpoint was also sought as to any thoughts they may have in relation to changing the delivery of skills and simulation.
 Results
 The results demonstrated that, overall, there was a negative response from the students in relation to the current delivery of skills and simulation.
 Conclusion
 The study identified further areas for research in relation to the delivery and integration of skills and simulation within a pre-registration nursing curriculum.
 Key Words
 Nursing education, simulation-based education

Informing future nursing: An exploration of respiratory teaching in the pre-registration nurse curriculum

Aim/objectiveThe aim is to examine and map the respiratory skills taught in the pre-registration nursing curriculum (2010). BackgroundRespiratory assessment and care are fundamental clinical skills enabling nurses to treat and care for people with acute and chronic respiratory diseases. The incidence of respiratory disease is rising, globally and most nurses will care for respiratory patients during their career.The extent of pre-registration respiratory specific education delivered in UK NMC (Nursing and Midwifery Council) approved education institutions (AEIs) is currently unknown. The move to the 2018 revised NMC standards for pre-registration nursing offers AEIs the opportunity to review provision of respiratory education. This study describes respiratory education delivered to pre-registration nurses in UK AEIs prior to implementation of the new NMC standards. Curriculum re-design can be adapted for the global nursing community. DesignThis is a freedom of information survey; to gather, examine and map curriculum content. MethodsA survey of UK AEIs was conducted to initially scope provision of respiratory education for pre-registration nursing programmes. AEIs were emailed a freedom of information (FOI) request and provided information about the curriculum between April-June 2019. ResultsSeventy-five UK AEIs providing pre-registration nursing programmes responded. Over half of AEIs dedicated over 4 h of teaching respiratory anatomy and physiology (60.8%), respiratory pathophysiology (75.3%) and long- term respiratory conditions (60.3%). Less than half (44.4%) spent over 4 h teaching respiratory health and prevention of respiratory disease. Just over a third spent over 4 h on respiratory pharmacology (33.8%), local and national respiratory guidelines (33.3%) and information on pulmonary rehabilitation and other interventions for the management of respiratory conditions (35.2%). In most AEIs, skills laboratories were used to teach respiratory skills. Student competence was not always assessed. Respiratory learning was reported to take place during practice placements, but this was variable. ConclusionsVariation exists in provision of respiratory education in pre-registration nursing programmes across the UK. Whilst some respiratory topics appear to be covered adequately, others have limited time on knowledge and skills teaching. New standards and curricula offer AEIs the opportunity to enhance this provision. Adaptations can be made and the curriculum transferred to the global nursing workforce. Tweetable abstractGaps have been identified in respiratory teaching pre-registration nurse education. Curriculum redesign to focus on respiratory care.

National cross-sectional survey to explore preparation to undertake aseptic technique in pre-registration nursing curricula in the United Kingdom

BackgroundAseptic technique is a core nursing skill. Sound preparation is required during pre-registration nursing education to enable student nurses to acquire the knowledge and skills necessary to prevent and control healthcare-associated infection and promote patient safety. Few studies have explored nursing students' education and training in aseptic technique. ObjectivesTo investigate what, when and how pre-registration nursing students are taught aseptic technique and how they are assessed in undergraduate, pre-registration nursing programmes in the United Kingdom. DesignNational cross-sectional survey exploring preparation to undertake aseptic technique in pre-registration nursing curricula in the United Kingdom. SettingUniversities providing undergraduate, pre-registration adult nursing programmes in the United Kingdom. ParticipantsNurse educators. MethodsStructured telephone interviews were conducted with nurse educators. Descriptive and inferential statistical data analyses were undertaken. ResultsResponse rate was 70% (n = 49/70). A variety of different learning and teaching methods were reported to be in use. Teaching in relation to aseptic technique took place in conjunction with teaching in relation to different clinical procedures rather than placing emphasis on the principles of asepsis per se and how to transfer them to different procedures and situations. Wide variation in teaching time; use of multiple guidelines; inaccuracy in the principles identified by educators as taught to students; and limited opportunity for regular, criteria based competency assessment were apparent across programmes. ConclusionsPre-registration preparation in relation to aseptic technique requires improvement. There is a need to develop a working definition of aseptic technique. The generalisability of these findings in other healthcare students needs to be explored.

Enhancing physical assessment skills in the preregistration nursing curriculum

This month's issue of BANCC looks at the expansion of physical assessment skills for registered nurses.

Perinatal mental health: preparing the future nursing workforce

Perinatal mental health (PMH) problems occur during pregnancy and up to a year after giving birth. They can have a significant effect on the mother and family, and can affect the social, emotional and cognitive development of the child. PMH nursing is gaining increasing recognition in national policy; additional funding has been announced to align national perinatal services with agreed standards and the perinatal workforce has been identified as an area of growth. The PMH competency framework published by Health Education England and the Tavistock and Portman NHS Foundation Trust, London, is aimed at training staff to deliver high-quality care to women who experience mental health problems during the perinatal period. However, the framework does not address the competencies required from the emerging workforce: nursing students. The pre-registration nursing curriculum must align with PMH competencies to ensure that nursing students become competent practitioners who are adequately prepared to care for the PMH needs of the mother and family.

Post mortem computed tomography: An innovative tool for teaching anatomy within pre-registration nursing curricula

BackgroundThere is significant change throughout the world regarding Post Mortem Computed Tomography (PMCT) as an adjunct or a replacement to the traditional invasive autopsy. Of interest, is the ability to demonstrate visually two and three dimensional normal soft tissue, organ and skeletal anatomy, as well as natural disease and trauma pathology. ObjectivesThe objective was to compare formal traditional methods of teaching anatomy and pathology (pictures and diagrams) to pre-registration student nurses with supplementary PMCT 2/3D generated images, videos and printed anatomical models. The specific objective was to determine if these tools would increase the students' perception of their understanding and learning experience of the subject area. DesignA quasi-experimental within-subject design was chosen. SettingA School of Nursing and Midwifery within a Higher Education Institution in the UK. ParticipantsPurposeful sampling of 57 voluntary informed consented pre-registration student nurses. MethodStudents were initially exposed to teaching of normal anatomy and common fractures using traditional methods. Data was then collected following the teaching session using a questionnaire entailing both quantitative and qualitative elements. The teaching session was then repeated with the same students but with the inclusion of PMCT of all the same normal anatomy and fractures. Data was then collected again using the same questionnaire. Both questionnaires were then compared. ResultsThe quantitative findings proved highly significantly proving (p <0.01) that the inclusion of Post Mortem Computed Tomography when teaching normal anatomy and pathology increases pre-registration nursing students' perception of their understanding and learning experience. The qualitative results revealed three positive themes concerning visual learning, realism and patient empathy. ConclusionIncluding Post Mortem Computed Tomography imagery enables nurse academics to provide students with a virtual tour of the human body and a rich, authentic learning experience of a real individual who experienced a relevant clinical scenario that nurses are likely to encounter in their careers.

Perspectives on Patient Safety Education in the Kenyan Preregistration Nursing Curriculum

Patient safety education is recognised as a key ingredient in the development of safety competencies in healthcare professionals. To ensure that patient safety is emphasised in the preregistration education, it is important that it be integrated explicitly in the curriculum. This study aimed at identifying explicit patient safety concepts in the Kenyan nursing curriculum and exploring the perspectives of the nursing faculty members and clinical nurses on the integration of patient safety in the curriculum. A qualitative content analysis was conducted on the relevant curriculum documents from two universities. In-depth, semi-structured interviews were conducted on a purposive sample of 13 staff members of the nursing faculty from the university and 14 clinical nurses from the hospitals where the students undergo clinical instruction. A thematic analysis was carried out on the transcribed interviews from which four themes and subthemes emerged. The curriculum content analysis did not identify any explicit patient safety content but the content was rather implicit within the curriculum as a series of statements and inferences to patient safety. The themes included curriculum issues, student characteristics, a patient safety culture, clinical education issues, and the academic-clinical relationship. To ensure training of a nurse who is competent in patient safety, the concepts must be integrated in the curriculum, the academic and clinical faculties need to be well equipped to teach and assess these concepts, the patient safety culture in clinical placement sites should be conducive to allow for learning about patient safety, and better collaboration between the academic and clinical settings for integration of patient safety in nursing education should be realised.

Intellectual disability content within pre-registration nursing curriculum: How is it taught?

BackgroundDespite experiencing higher rates of physical and mental health conditions compared with the general population, people with intellectual disability face inequitable access to healthcare services. Improving education of healthcare professionals is one way to reduce these inequalities. ObjectiveTo determine how intellectual disability content is taught within Australian nursing schools. DesignA two-phase audit of Australian nursing curricula content was conducted using an interview and online survey. SettingNursing schools Australia-wide providing pre-registration courses. ParticipantsFor Phase 1, course coordinators from 31 nursing schools completed an interview on course structure. Teaching staff from 15 schools in which intellectual disability content was identified completed an online survey for Phase 2. MethodsMethods used to teach intellectual disability content and who taught the content were audited using an online survey. ResultsAcross the 15 schools offering intellectual disability content, lectures were the most common teaching method (82% of units), followed by tutorials (59%), workshops (26%), then other methods (e.g. e-learning; 12%). Approximately three-quarters of intellectual disability teaching used some problem-and/or enquiry-based learning. Only one nursing school involved a person with intellectual disability in delivering teaching content. Six (19%) participating schools identified staff who specialise in intellectual disability, and seven (23%) identified staff with a declared interest in the area. ConclusionWhile some nursing schools are using diverse methods to teach intellectual disability content, many are not; as a result, nursing students may miss out on acquiring the attributes which enable them to address the significant health inequalities faced by this group. A specific deficit was identified relating to inclusive teaching and clinical contact with people with intellectual disability.

Embedding fundamental care in the pre-registration nursing curriculum: Results from a pilot study.

International evidence suggests nursing is not providing fundamental care consistently or adequately, resulting in poor outcomes for patients and healthcare systems. One possible reason for this inadequate care delivery is nursing education, with fundamental care often implicit or invisible in nursing curricula. To understand how best to teach fundamental care to pre-registration (pre-licensure) students, we developed and piloted a six-week intervention that incorporated into the first-year curriculum a more explicit focus on fundamental care. A conceptual fundamental care framework was used to guide students' learning, and clinical skills sessions were structured to reinforce the framework's conceptual understanding and enable students to practice delivering fundamental care in an integrated manner. The intervention's impact was explored via a pre-post survey and focus groups. The survey demonstrated that the intervention did not affect students' ability to identify patients' fundamental care needs; however, focus groups showed the intervention assisted students in understanding the complexity of fundamental care and its importance to patients' experiences. The pilot provides preliminary evidence on the importance of embedding fundamental care into nursing curricula early and explicitly, and emphasising the integrated nature of such care, particularly through structured debriefs, consistent terminology, and opportunities for students to experience care as a patient.

A call to action to improve the visibility of research by nursing, midwifery and care staff.

A call to action to improve the visibility of research by nursing, midwifery and care staff.

Learning to deal with crisis in the home: Part 2 - preparing preregistration students.

The global shift of health care is from acute services to community and primary care. Therefore, registrants must be prepared to work effectively within diverse settings. This article is the second in a series discussing the preparation of nurses for contemporary health-care challenges in the community. In it, we outline the design, implementation, and evaluation of simulated emergency scenarios within an honours degree-level, pre-registration nursing curriculum in Scotland. Over 3 years, 99 final-year students participated in interactive sessions focusing on recognition and management of the deteriorating patient and emergency care. Clinical scenarios were designed and delivered collaboratively with community practitioners. Debriefing challenged the students to reflect on learning and transferability of skills of clinical reasoning and care management to the community context. Students considered the scenarios to be realistic and perceived that their confidence had increased. Development of such simulation exercises is worthy of further debate in education and practice.

Clinical leadership development in a pre-registration nursing curriculum: What the profession has to say about it

BackgroundIn the last decade literature, inquiries and reports into the short comings in health services have highlighted the vital role of leadership in clinical practice and the impact on patient care and effective workplace culture. Whilst there is an abundance of literature on leadership and the registered nursing workforce, an international literature review revealed there is very little known on leadership development in pre-registration nursing programmes. ObjectiveTo identify what the profession's views are on proposed indicative curriculum content suggested for clinical leadership development in a pre-registration nursing degree in Australia. DesignThis is a multi-method research study. This paper presents the development and results of one aspect of the study, a national online survey. ParticipantsNurses: clinicians, managers and academics. MethodsIn the absence of a strong evidence base in the literature review, additional pre-requisite curriculum content was augmented from the work of two published frameworks of leadership and management. From this a 67-item survey was designed to ask the profession whether the aggregated content is a reasonable view of what should be included in a pre-registration programme to develop clinical leadership. The survey sought the views of nurses on whether the proposed content was relevant (yes/no) and their opinion on whether it is significant via a 5-point Likert scale. Descriptive and chi-square analyses were performed in SPSS v.19. ResultsA total of 418 nurses completed the survey; there was consensus amongst the profession on what is considered relevant and important in a pre-registration nursing programme. ConclusionsThe content identified could be considered indicative and pre-requisite to include in a pre-registration nursing programme. Members of the nursing profession in Australia have clear views about this. The next step is to design and evaluate a purposeful pedagogical approach and curriculum, leading to the development of clinical leadership knowledge, skills and behaviours in newly graduating nurses.

Embedding simulated practice in a pre-registration nursing curriculum

Embedding simulated practice in a pre-registration nursing curriculum

'Not a job for a man': factors in the use of touch by male nursing staff.

While the numbers of male nursing staff are growing in both the UK and the USA, there remains a significant imbalance both in terms of the total number and the specialities in which male staff choose to work. Management, education and technology-dominated roles, characterised as 'high-tech, low-touch' specialities attract disproportionately larger numbers of male nursing staff. The aim of this narrative literature review was to explore and critically review the factors that influence the perception and use of touch by male nursing staff in contemporary healthcare settings. A comprehensive review of the literature was undertaken using significant online databases focusing on evidence from peer-reviewed journals published in English. Key influential factors arising from 11 selected studies included male nurses' definitions of touch; fear of touch misinterpretation; coping strategies employed; the assessment of certain groups of patients; gender-derived stressors; the emotional experiences of male staff; and the limited consideration of these issues in the pre-registration nursing curriculum. A range of factors regarding touch impact on the way male nurses use touch when caring for patients. A lack of research-based education in the preparation of male students leads to the development of various protective strategies. There is a need for the particular challenges facing male students and staff to be explicitly addressed within undergraduate and post-qualifying education and training programmes.

Skills for nursing practice: Development of clinical skills in pre-registration nurse education

Rapid changes during the past two decades have seen a growing challenge to prepare newly qualified nurses who are clinically competent and confident to meet the demands of contemporary healthcare. Recent publications emphasise the need to prioritise clinical skills in nurse education (DH 2012a, Francis, 2012). This discussion reports on a project scoping the clinical skills required within pre-registration nursing curricula and considers how this has influenced curriculum development at one Higher Education Institution in the UK.This paper reports on the project analysis of nursing and healthcare policy, identifying six core themes of skills relevant for nursing practice. Furthermore it explores the findings of a series of focus groups with nursing practitioners and managers identifying priorities for clinical skills in the pre-registration curriculum. These highlighted a broad range of skills required of newly qualified practitioners, which pose a challenge for integration within nurse education. How this challenge has been addressed through the incorporation of these skills themes throughout a new pre-registration curriculum is also examined.

Survey of Australian Schools of Nursing Use of Human Patient (Mannequin) Simulation

Rapid adoption of high-fidelity human patient (mannequin) simulation has occurred in Australian Schools of Nursing in recent years, as it has internationally. This paper reports findings from a 2012 online survey of Australian Schools of Nursing and builds on findings of earlier studies. The survey design allowed direct comparison with a previous study from the USA but limited its scope to the pre-registration (pre-service Bachelor of Nursing) curriculum. It also included extra mental health specific questions. Australian patterns of adoption and application of high-fidelity human patient (mannequin) simulation in the pre-registration nursing curriculum share features with experiences reported in previous US and Australian surveys. A finding of interest in this survey was a small number of Schools of Nursing that reported no current use of high-fidelity human patient (mannequin) simulation and no plans to adopt it, in spite of a governmental capital funding support programme. In-line with prior surveys, mental health applications were meagre. There is an absence of clearly articulated learning theory underpinnings in the use of high-fidelity human patient (mannequin) simulation generally. It appears the first stage of implementation of high-fidelity human patient (mannequin) simulation into the pre-registration nursing curriculum has occurred and the adoption of this pedagogy is entering a new phase.

Factor analysis of nursing students' perception of patient safety education

The aim of this study is to investigate the factor structure of the Health Care Professionals Patient Safety Assessment Curriculum Survey (HPPSACS) when completed by a group of nursing students from one University in the UK. The quality, content and delivery of nursing education can have a significant impact on the future students' safety behaviours in clinical settings. The Health Care Professionals Patient Safety Assessment Curriculum Survey HPPSACS has been developed in the US to establish undergraduate nursing students' perceived awareness, skills, and attitudes toward patient safety education. The instrument has not been reported to be used elsewhere; therefore, some psychometric properties remain untested. Pre-registration nursing students (n=272) from three campuses of a university in East of England completed the HPPSACS in 2012. Principal component analysis was conducted to explore the factors emerging from the students' responses. 222 students (82%) returned the questionnaires. Constraining data to a 4-factor solution explained 52% of the variance. Factors identified were: "Willingness to disclose errors", "Recognition and management of medical errors", "The Perceived interprofessional context of patient safety" and "The perceived support and understanding for improving patient safety". The overall Cronbach's alpha was 0.64, indicating moderate internal consistency of the instrument. Some demographical and descriptive questions on the HPPSACS instrument were modified to accommodate the participants' educational context. However, all items in the HPPSACS which were included in the factor analysis remain identical to the original tool. The study offers empirical findings of how patient safety education is contextualised in the undergraduate, pre-registration nursing curriculum. Further research is required to refine and improve the overall reliability of the Health Care Professionals Patient Safety Assessment Curriculum Survey (HPPSACS' instrument).