Pre-registration Nursing Curriculum Research Articles

Repositioning assessment: Giving students the ‘choice’ of assessment methods

Assessment is a feature of all academic courses undertaken for award in the United Kingdom (UK). The nature of the strategies that can be used to assess learning vary a great deal from the traditional unseen examination to more student-centered innovative approaches. A review of a pre-registration nursing curriculum in preparation for re-approval by the University and Nurse Midwifery Council (NMC) provided an opportunity to re-appraise existing assessment strategies. Concurrently a parallel review process was underway with a postgraduate continuing professional development (CPD) programme for registered nurses. Recognising that students have individual strengths, weaknesses, learning styles and preferences concerning mode of assessment, offering choice of assessment was proposed as a strategy for inculcating the values of student centeredness and responsibility for learning. Although recommended in the literature (Race et al., 2005 and Cowan, J., 2006. On Becoming an Innovative University Teacher: Reflection in Action. University Press, Open Maidenhead.) no empirical evidence of benefit in support of this initiative was identified. This paper presents an account of the journey taken by the project team from original idea, navigation of the quality assurance processes associated with curriculum approval to delivery of choice of assessment on two modules embedded in an undergraduate pre-registration and post-registration CPD programmes, and an evaluation undertaken with the students. Offering students choice of assessment appears to be well received and this approach has subsequently been adopted as a feature of other health and social care professional programmes offered in the institution.

Student experiences and mentor views of the use of simulation for learning

This paper presents the findings of a two phase mixed methods study. Phase 1 investigated whether simulation could support the development of a range of clinical skills amongst pre-registration adult and children's nursing students. The second phase of the study gathered mentors' views and experiences of the use of simulation in the preparation of students for practice. Commissioned by the Nursing and Midwifery Council, the United Kingdom (UK) professional body, the study is reported as one of 13 pilot sites using designated practice hours for simulation. The commission resulted from a call to review the current pre-registration nursing curriculum that includes 4600 equally divided theory and practice hours delivered across the programme. Phase 1 included a sample of 69 adult and children's pre-registration students from years one and three of their programme, studying at one UK University. The group attended five simulation sessions including basic life support, manual handling, infection control, clinical decision making and managing violence and aggression. Students completed pre- and post-tests in basic life support and manual handling, and vignettes and objective structured clinical examinations (OSCEs) covering the five areas of simulation. Phase 2 included interviews with six mentors who were supervising students involved in the study. Simulation was positively received by both students and mentors as it was apparent that it offered scope for interdisciplinary learning that could be broadened to inter-professional applications. The study also identified that the use of simulation could provide scope for collaborative working between education providers and clinical staff.

Student nurses' knowledge and attitudes toward CAM therapies

Hessig et al (2004) highlight that nurses value complementary and alternative therapies (CAM) but lack the knowledge regarding their application. They suggest that education can affect knowledge and application of CAM in nursing practice. Complementary and alternative therapy input into the pre-registration nursing curriculum is sporadic and higher education institutions need to incorporate CAM therapies more fully into professional education (Department of Health, 2003). This study investigated the knowledge and attitudes student nurses have to CAM therapies and their use in cancer and palliative care. Ethical approval was sought from the ethics committee at the University of Hull. A quantitative evaluative study using a convenience sample of student nurses in their final semester of pre-registration nurse education was used. Data were collected via a questionnaire; the findings demonstrate the respondents' acknowledgement of their limited knowledge of CAM therapies and the study has highlighted the need to continue working towards integrated CAM education into the pre-registration nursing curriculum.

Situated cognition and cognitive apprenticeship: A model for teaching and learning clinical skills in a technologically rich and authentic learning environment

The acquisition of a range of diverse clinical skills is a central feature of the pre-registration nursing curriculum. Prior to exposure to clinical practice, it is essential that learners have the opportunity to practise and develop such skills in a safe and controlled environment under the direction and supervision of clinical experts. However, the competing demands of the HE nursing curriculum coupled with an increased number of learners have resulted in a reduced emphasis on traditional apprenticeship learning. This paper presents an alternative model for clinical skills teaching that draws upon the principles of cognitive apprenticeship [Collins, A., Brown, J.S., Newman, S., 1989. Cognitive Apprenticeship: teaching the crafts of reading, writing and mathematics. In: Resnick, L.B. (Ed.) Knowing. Learning and Instruction: Essays in Honor of Robert Glaser. Lawrence Erlbaum Associates, New Jersey, pp. 453-494] and situated cognition within a technologically rich and authentic learning environment. It will show how high quality DVD materials illustrating clinical skills performed by expert practitioners have been produced and used in conjunction with CCTV and digital recording technologies to support learning within a pedagogic framework appropriate to skills acquisition. It is argued that this model not only better prepares the student for the time they will spend in the practice setting, but also lays the foundation for the development of a clinically competent practitioner with the requisite physical and cognitive skills who is fit for purpose [UKCC, 1999. Fitness for Practice: The UKCC Commission for Nursing and Midwifery Education. United Kingdom Central Council for Nursing Midwifery and Health Visiting, London].

Embedding cancer care within pre-registration nurse education programmes: Policy, practice and opportunities for change

This paper discusses policy and professional drivers which outline the need for, and inclusion of cancer education within pre-registration nursing curricula within the UK. It also evaluates arguments in favour of the development of separate and distinctive cancer modules within nurse training programmes against those advocating a more integrated or thematic approach. The authors suggest that there are advantages and disadvantages to each strategy, and argue that the most important factor irrespective of the approach taken, is that cancer learning outcomes are clearly enunciated within all pre-registration nursing curricula and constructively aligned against teaching, learning and assessment strategies which may encompass a single module or entire programme. The authors then discuss their personal experience of teaching cancer care using both approaches and posit one suggestion for an embedded pre-registration cancer-care curriculum developed as the catalyst for a broader debate on the scope and content of cancer-care education within pre-registration nursing curricula.

Implementing competency recommendations into pre-registration nursing curricula: Effects upon levels of confidence in clinical skills

The competency based pre-registration nursing curriculum was introduced to address concerns about levels of confidence and competence in skills of newly qualified Project 2000 educated nurses [Department of Health, 1999. Making a Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare. The Stationary Office, London]. This study sought to examine whether the implementation of the competency recommendations has led to improvements in the confidence of nursing students in their clinical skills. A self-administered questionnaire examining ratings of confidence in areas of nursing practice and core competencies as specified by the Nursing and Midwifery Council (NMC) [UKCC, 2001. Requirements for Pre-registration Nursing Programmes. UKCC, London] was administered to 139 final year adult nursing students who were studying with the Project 2000 or competency curriculum. The response rate was 53%, results indicating that the students studying the competency curriculum have higher levels of confidence in all areas of their practice targeted by the competency recommendations than students studying in the Project 2000 curriculum. The positive effect that the competency recommendations had upon levels of confidence in nursing practice, and the implications of such changes to curricula are discussed.

Consumerism 2: preregistration nursing and midwifery curricula.

This article, the second of two parts, presents findings from a four-stage study exploring the extent to which consumerism and its related aspects have been incorporated into the preregistration nursing and midwifery curriculum. The study was undertaken in recognition that NHS policy (as considered in the first article: Vol 12(5): 321-6) increasingly gave emphasis to the development of a health service that was more consumer and user focused. The study involved use of a Delphi panel, postal questionnaire, review of curriculum documentation, and timetables, together with a small focused group discussion. Findings indicate some aspects relevant to consumerism in health care, e.g. communication and ethical principles were included in the curriculum. Other aspects, such as advocacy, quality assurance, and lay health beliefs, were viewed logically from the perspective of the professional role. In essence, no curriculum transparently addressed consumerism in a central and focused way, although midwifery--and to some extent mental health, learning disabilities, and child branches--gave more overt attention to consumerism than adult branches.

Developing clinical leadership skills in student nurses

A number of policy documents in recent years have identified the need for strong leadership within the NHS. The NHS Plan (2000) states that nurses need to take a lead role in the running of local health services. It also suggests that strong leadership is needed at a clinical level. The literature identifies a number of skills deemed to be essential for clinical leadership, some of these are difficult to achieve through pre-registration nurse education as they relate to an awareness of the structures and processes of the NHS and the ability to visualise or predict the future. Other skills relate to personal traits and qualities and it is these skills that are discussed. Four skills are identified for discussion; self-knowledge, communication skills, risk taking, and keeping informed. This paper analyses the way these skills are currently developed in one University’s pre-registration nursing curriculum and concludes that although many opportunities are available to develop these skills in the classroom environment, there are many pressures that prevent use of these skills in a practice environment.

Perceptions of racism in the health service.

The information reported in this article formed part of a large study, which examined how the pre-registration nursing curriculum prepares students to work with minority ethnic groups. Questions on racism were asked as a subsidiary to the main area under study. A questionnaire was sent to student nurses (n = 1035) and lecturers (n = 303) teaching pre-registration students in the North West Region. Participants were also invited to record their qualitative comments. The results showed that a higher percentage of lecturers than students had heard what they perceived to be racist comments in the classroom. Several students commented that racist attitudes were mainly the result of a lack of knowledge and/or ignorance. From the study results, it appears that racism is still evident in the classroom and the clinical placement area.

Mental health service user involvement in nurse education: exploring the issues.

This paper reports on findings and issues arising from a study designed to promote mental health service users' involvement in a preregistration nursing curriculum. Users' views about the knowledge, skills and attributes required by mental health nurses were explored to inform the curriculum design. Strategies that would facilitate long term, active user involvement in the design and delivery of the curriculum were also explored. Findings are presented with concurrent discussion of issues arising from the research process in relation to user involvement in education. The issue of 'conflict' explores findings relating to users' views of a 'good' mental health nurse and inherent conflicts between user and professional views are highlighted. The representativeness of the research participants is explored and debated in relation to service user involvement in nurse education. Finally, the concepts of 'involvement' and 'tokenism' are discussed and recommendations made about how active user involvement in nurse education can be achieved.

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.

The biosciences in the pre-registration nursing curriculum: staff and students' perceptions of difficulties and relevance

This paper considers the problematic position of the biological sciences in pre-registration nurse education — ‘The Bioscience Question’. There is no consensus and little research on the appropriate content and depth of bioscience knowledge required by nurses. Attempts to apportion curriculum time for the biosciences are confounded by the difficulty experienced by nursing students with this area. Within one university department, a survey was undertaken to investigate the perceptions of pre-registration students, and their teachers, of the teaching and learning of biological science, in comparison with other areas of the curriculum. Our findings concur with others that the biosciences are a source of disproportionate difficulty and anxiety to nursing students. Among the students, but not the lecturers, there was some, by no means universal, support for the suggestion that these problems could be reduced by a reallocation of curriculum time in favour of the biosciences. Although it was agreed that bioscience theory should be related more closely to nursing practice, there was no evidence that this lessened the students' difficulties with the subject. In contrast to lecturers, students felt the biosciences to be one of the areas of the pre-registration curriculum most relevant to clinical practice.

Conceptualizing disability in nursing: some evidence from students and their teachers.

This paper reports on part of a larger study which examined the nature and influence of a pre-registration nursing curriculum on the preparation of student nurses to work with disabled people. Following case study methodology it focuses on how 'disability' is conceptualized by teachers and adult branch students involved in a particular curriculum. Definitions and working assumptions concerning disability held by nurses are likely to influence ways in which disabled people are cared for. The experiences of disabled people suggest that their contact with nurses is demeaning and disempowering. Some disabled people support a reconceptualization of 'disability', from a largely medical perspective to one which embraces its social dimensions. The results of thematic analysis of data from 16 semi-structured interviews are reported; these support the need for the social dimensions of disability to be given greater emphasis within nursing. Disability was found to be conceptualized as a form of deviation, a condition of dependency or a notion which defies definition. Language associated with disability was also highlighted as an area of concern. Implications for practice and education are alluded to in the light of increasing recognition of disability as an equality opportunity issue.

User involvement in the nursing curriculum: seeking users' views.

This qualitative study considers the views of users of mental health services on a pre-registration nursing curriculum. Semistructured group interviews were used to gain the (illustrative) views of twenty members of two user groups on nursing knowledge, skills and qualities. Interest in users' views has generally been belated or reluctant. In more recent literature, statements emerge about the need to develop a climate of respect, acceptance and sensitivity. While nurses have a central role in mental health care, a detailed examination from the user's perspective has been lacking. Despite the rhetoric of involvement, commentaries on nursing practice suggest little has changed. Findings suggest an eclectic knowledge base that respects individual differences and the user's experience, knowledge of local communities, and better recognition of physical illness is required. 'Knowledge of life' is seen as important. An emphasis on interpersonal skills is suggested, including flexible responses, information-giving, and sensitive handling of tense situations. This should be balanced against 'practical' nursing. Traditional teaching in relation to 'psychotic' experiences is challenged. It is suggested that caring should be emphasized as much as 'rational knowledge'. Developing responsive qualities that minimize 'distancing' may demand a reevaluation of boundaries between user and professional.