Pre-registration Education Programmes Research Articles

Enhancing the use of Makaton in nurse education and practice.

Makaton is a unique multimodal language programme that uses signs, symbols and speech. It offers a flexible communication system that can be used across settings with a wide range of people, including those with learning disabilities or communication difficulties. This article explains what Makaton entails and how it can be used to aid communication with service users. The authors suggest that Makaton should be integrated in preregistration nurse education for all fields of practice, particularly learning disability nursing. Effective communication skills are essential for all nurses and learning Makaton as part of their preregistration education programmes could improve their competence and confidence in engaging in meaningful dialogue with people who find it challenging to communicate verbally.

Safe medication administration: Perspectives from an appreciative inquiry of the practice of registered nurses in regional Australia.

Registered Nurses (RNs) are regulated health professionals who are educated and accountable for safe medication administration (MA). Binding their practice are standards, policies, procedure and legislation. MA competence is taught and assessed during professional pre-registration education programs. However, different philosophies, theories and models are used by education providers making curriculum content disparate and competency frameworks diverse. Additionally, healthcare contexts are increasingly complex and clinical environments unpredictable. Competency models must respect contemporary practice. This paper focusses on the outcomes of Australian PhD research that combined Appreciative Inquiry (AI) principles with a qualitative study to identify MA safety strategies. In this 2-phase descriptive study, twenty RNs were observed then interviewed about their MA experiences. This paper discusses the interview findings. The participants explained how they assessed patient's needs and implemented strategies to administer medications safely. They presented their actions as being underpinned by a desire to do 'the right thing for the patient' despite their practice going beyond traditional procedural frameworks and not reflecting organisational protocols. Instead, they developed common strategies to enhance safe MA. The participants' described using clinical reasoning and patient-centredness during MA. This study contributes to the knowledge needed for future practice development by highlighting what works.

‘Doing it for real now’ – The transition from healthcare assistant to newly qualified nurse: A qualitative study

BackgroundThere has been increasing international research and policy interest concerning the transition from student to newly qualified nurse (NQN). However, the influence of previous employment as a healthcare assistant (HCA) on students' experiences of this transition is comparatively under-researched. Aims and ObjectivesTo explore the experiences of NQNs also employed as HCAs during their pre-registration education programme and how this prior and ongoing HCA experience influenced their transition experiences. DesignQualitative research design using a descriptive method. Setting and ParticipantsFormer students (n = 14) of a unique four year, part-time, employer-sponsored pre-registration nursing programme, specifically designed for HCAs and delivered by supported open learning, located in different regions and nations of the United Kingdom who had qualified within the last two years. MethodsTelephone interviews, digitally recorded, transcribed verbatim and analysed using NVivo8. ResultsFour themes described participants' experiences of transition: In at the deep end, Changing identities, Coming together and Scaffolding. Findings confirm existing literature that all NQNs appear to experience a similar overarching experience of transition, including those with prior HCA experience. However, familiarity with people, place and routines afforded by this previous experience appeared to ease transition, particularly if the NQNs stayed in their previous HCA work location. However, managing the dual roles of being both HCA and student and adapting to their changing identities were frequently cited as particular challenges. ConclusionsVan Gennep's Rites de Passage and Bridge's work on organisational change were combined to theoretically analyse participants' accounts of transition. This illustrated that transition is not always linear with clearly defined and bounded stages but can also be seen as a more undulating or organic process with curving, slanting and overlapping phases. NQNs can therefore simultaneously occupy more than once phase in their journey of transition. Implications for students, higher education and practice are highlighted.

Connecting intentional learning and cardiac specialty practice: The experiences of bachelor of science in nursing students

Internationally pre-registration education programs have ranged from entirely specialist to entirely generalist with varying degrees of specialty preparation in between. Students in generalist programs with specialty practice options may benefit from novel pedagogical approaches, such as intentional learning, to ease the transition from generalist to specialist practice. The purpose of this qualitative descriptive study was to understand undergraduate students’ experiences of intentional learning in a 4-week consolidated cardiac specialty practicum. Eight students (7 females, 1 male) participated in a combination of weekly Blackboard discussions and an end-of-practicum focus group and completed a competency self-rating. Students had marred expectations about the integration of intentional learning in their specialty practice experience. They reflected advantages and disadvantages of both intentional and total patient care learning models but worked with their instructor to find the right balance that maximized learning. Students identified features that maximized intentional learning including open-ended questions, using learning versus workspaces, receiving feedback, and integrating peer interaction. Despite advancing their confidence and competence in specialty practice students remained anxious about their ability to assume the role of the graduate nurse in a years’ time. Preparing a generalist nurse for the workforce needs to be balanced with meeting students’ needs and increasing professional demands for specialty experiences in undergraduate nurse education programs.

Nurses' perceptions and experiences of mentoring.

Pre-registration education programmes provide nursing students with the skills and knowledge to become safe and proficient practitioners. Assessment of students' competence is a fundamental part of these programmes and mentors play a crucial role. Mentors are registered nurses who have completed an appropriate mentorship programme in an approved higher education institution, and their main role includes teaching, supervising and assessing students' clinical competence. The role can be demanding and stressful, and mentors must maintain their workloads while supporting students. This article reports the results of the qualitative findings of a survey of mentorship practices ( Brown et al 2012 ). The findings suggest that mentors value support from link lecturers and practice education facilitators, especially when they experience difficulties with nursing students who do not have the required competencies to pass their placement.

Supporting New Zealand graduate midwives to stay in the profession: An evaluation of the Midwifery First Year of Practice programme

Backgroundthe transition from undergraduate midwifery student to working as a confident midwife can be challenging for many newly qualified midwives. Supporting a smooth transition may have a positive impact on the confidence and retention of the new graduates within the workforce. In New Zealand the Midwifery First Year of Practice programme (MFYP) was introduced in 2007 as a structured programme of support for new graduate midwives for the whole of their first year of practice. The main components of the programme include support during clinical practice, provision of a funded mentor midwife chosen by the new graduate midwife, financial assistance for education and a requirement to undertake a quality assessment and reflection process at the end of the first year. Aimthe aim of this study was to explore the retention of new graduates in midwifery practice following participation in the Midwifery First Year of Practice programme. Methoddata was obtained from the register of MFYP participants between the years 2007 and 2010. This data was cross referenced with the Midwifery Council of New Zealand register and workforce data for 2012. Findingsbetween the years 2007 and 2010 there were 441 midwives who graduated from a midwifery pre-registration education programme in New Zealand. Of these 415 participated in the MFYP programme. The majority were of New Zealand European ethnicity with 10% identifying as Māori. The mean age of participants reduced from 36.4 (SD 7.3) in 2007 to 33.4 (SD 8.1) in 2010. The overall retention rate for new graduate midwives who had participated in the MFYP programme was 86.3%, with 358 midwives still practising in 2012. Conclusionthere is good retention of new graduate midwives within New Zealand and the MFYP programme would appear to support retention.

Irish nursing students' changing levels of assertiveness during their pre-registration programme

Background. Stress and bullying have been found to be common problems in a number of studies of Irish nursing and midwifery. Victims of bullying need high levels of assertiveness to enable them to withstand the stress of victimisation. It was deemed important to measure nursing students' level of assertiveness prior to, and near completion of, their pre-registration education programme. Aim. To ascertain nursing students' perceived levels of assertiveness prior to, and nearing the completion of, their three-year pre-registration programme. Methods. Ethical approval was given. The students commencing general nurse education programmes in two schools in Southern Ireland agreed to take part ( n=72). A questionnaire adapted from a number of assertiveness scales, and tested for validity and reliability in this population, was used to collect data. Results. In general, students' reported assertiveness levels rose as they approached completion of their three-year education programme. Discussion. The resource constrained health service of the 21st century requires nurses who are assertive to meet the needs of its users. Nursing students' assertiveness skills could be augmented through concentrated efforts from nurse educationalists and clinicians to reduce the communication theory practice gap in nurse education today. To address the multi-dimensional nature of assertiveness, strategies to increase assertiveness should operate at the individual, interface and organisational level. Conclusions. The students in this study reported an increase in levels of assertiveness as they approached completion of their three-year education programme. To function as effective, safe practitioners registered nurses need to be assertive, therefore education in assertiveness should be an integral part of their preparation. The precise composition and mode of delivery of this education requires exploration and evaluation.

Why do student nurses leave? Suggestions from a Delphi Study

The high dropout rate of nursing students is a major concern. However, there is little research available about the reasons why students leave. Universities collect some information from ‘exit’ interviews but, due to ethical sensitivities, it is not made available for research analysis. The purpose of this study was to establish a consensus view of the reasons why student nurses leave their pre-registration education programme. The study was undertaken in two phases. Initially, an exploratory phase using focus groups and one-to-one interviews was used to gather multi-professional views about the reasons why students leave. In the second phase a questionnaire was developed from the themes arising from the data analysis in phase one. The questionnaire was administered to an expert panel of student nurses in the form of a three-round Delphi Study. The consensus level was set at 75%. It is important to clarify that, for reasons stated above, the views expressed in this paper are those of current students about others who had left the programme. From this study, it is apparent that, with the exception of academic failure, there was no single contributing factor that was thought to make students leave. However, there were a number of important issues identified as factors that may result in student nurses leaving. These include communication and operational factors between the university and clinical areas, feelings of not being valued, unmet expectations, and stress. These issues were of concern to students and appeared to have a cumulative effect that led them to question whether they should continue their education programme. On the basis of these findings, several recommendations are made to improve the student nurse experience.

Irish nursing students' changing self-esteem and fear of negative evaluation during their preregistration programme.

Studies on Irish nursing and midwifery professions have demonstrated that stress and bullying are frequent problems that may lead to depression and low self-esteem. Self-esteem is linked to social anxiety and is therefore related to fear of negative evaluation. It is important to study nursing students' feelings about self-esteem and negative evaluation, and to assess whether or not both these constructs change as students progress through their preregistration education programme. This study explored nursing students' perceived levels of self-esteem and their fear of negative evaluation prior to, and nearing the completion of, their 3-year preregistration programme. A descriptive, quantitative, comparative survey design was used. All students in the first intake of 1995 in two general nursing schools in Southern Ireland agreed to take part (n = 72). A questionnaire developed from the Rosenberg Self-esteem Scale and the Watson and Friend Fear of Negative Evaluation Scale was used to collect data at the start of their programme and again 2 months before completion. In general, students' reported self-esteem rose as they neared the end of their education programme and their fear of negative evaluation decreased; however, their overall self-esteem levels at their highest were only average. Many of the studies examining self-esteem have produced contradictory results. An examination of the organizational factors that contribute to self-esteem may increase our understanding of the phenomenon. Self-esteem is a complex, multifaceted phenomenon. While there is no single factor that can increase or decrease a person's self-esteem, this study has explored the potential impact of the fear of negative evaluation on self-esteem. Nursing students' self-esteem might be increased by expansion of intrinsic job characteristics, improving their job satisfaction and providing frequent positive feedback.

The nature and purpose of the role of the nurse lecturer in practice settings

This paper examines the role of lecturers in nursing in pre-registration education. It focuses on the nature and purpose of the nurse lecturer’s contribution in the practice setting, with particular emphasis on the issues surrounding clinical credibility. This is particularly pertinent in the light of current recommendations, which emphasise the importance of clinical learning in pre-registration education programmes. The purpose of the lecturer’s role in clinical practice settings is ill defined. This lack of clear consensus regarding the expected outcomes for lecturers (in practice), leads to difficulty outlining what they should do in practice settings. Although lecturers accept that they have an important part to play in maximizing the learning opportunities for students in both university and practice settings, they are less clear about how this should be achieved in the latter.This paper argues that:It is opportune to examine and realign the lecturers contribution in practice settings given that there has been a shift in the responsibility for clinical learning; nurse education is now embedded in the higher education sector and there is a need for a greater emphasis on practice developmentClinical credibility for lecturers is about the development of nursing practice through education which is not always achieved by ‘hands on’ care. For example, assisting nurses in a ward area to develop expertise in evidence based practice may not involve ‘hands on’ care giving but does involve being conversant with current research and practice issuesThe lecturer’s expertise in practice settings is in teaching and facilitating learning, rather than direct care giving.No one common model for practice may be either feasible or desirable. However, it is important that nurse lecturers do not follow a particular approach because the debate about the nurse lecturer’s role in practice settings fails to acknowledge the strengths and weaknesses of each model. It is important that the approach is based on sound rationale.

Project 2000 students' perceptions of their training.

This paper reports on the findings of a study conducted into the perceptions of final year Project 2000 pre-registration students towards their pre-registration education programme. The aim of the research was to discover how students perceive their training in terms of value, relevance, intellectual potency, teaching methods and organization. Data were collected using the Hoste scale which has been developed for the evaluation of educational courses. A convenience sample of students (n = 131) within one college of nursing were invited to participate. Findings include a particularly high level of satisfaction with Project 2000 in terms of value, breadth and relevance. Organization and liveliness of the course were perceived much less satisfactorily. There was a trend for a statistically significant difference between the mean scores of the theoretical and practical components of the course. The findings are discussed with particular reference to the perceptions of theory and practice within the educational programme.