In 2007 the Nursing and Midwifery Council (NMC) endorsed the use of simulation to replace up to three hundred hours of practice learning in the pre-registration nursing programme (NMC, 2007a). This decision was the impetus for this study as it raised questions regarding whether simulation could replace practice and whether simulated learning transferred to the practice setting. For the first time, the NMC proposal to replace practice hours with simulation has been critically analysed and the implications of this decision explored. A literature review demonstrated a lack of robust evidence to support the use of simulation in this way. This informed the development of this study’s research question and aims. A qualitative collective case study was chosen as the optimum research design to facilitate in-depth exploration of the use of simulation at a selected university in the North West of England. The in-depth qualitative case study incorporated multiple models of simulation, student cohorts, nurse educators and key informants which provided the most comprehensive analysis of viewpoints in any published research in the UK to date. Deeper understanding of the case arose from the use of multiple data collection methods: documentary analysis, participant observation and interviews which enabled findings to be triangulated and corroborated. Most importantly, because the simulation models used were comparable to those used by other education providers in the UK; there is a possibility of the transferability of findings which could be used to inform the development of simulation in the under-graduate nursing curriculum. This thesis develops an argument that there were three key assumptions made by the NMC when they endorsed the replacement of practice hours with simulation. The first is that there is a shared understanding in nursing regarding what simulation is. Secondly; that simulation is delivered in a ‘safe environment’ and finally that competence demonstrated in simulation transfers seamlessly to practice. This thesis has presented new knowledge and developed an argument for caution regarding the use of simulation in pre-registration nurse education. These findings challenge the assumptions made by the NMC and highlight issues for further consideration and exploration namely: the ambiguity regarding the concept of simulation, student safety during simulation, student perceptions of authenticity and finally the transfer of simulated learning to practice.

No description available.

No / Aim. To determine the adequacy of initial nurse independent prescribingeducation and identify continuing professional development and clinicalgovernance strategies in place for non-medical prescribing.Background. In 2006, new legislation in England enabled nurses with anindependent prescribing qualification to prescribe, within their competence. In 2006,non-medical prescribing policies released by the Department of Health outlinedthe recommendations for education, continuing professional development andgovernance of non-medical prescribing; however, there was no evidence on a nationalscale about the exte nt of implementation and effectiveness of these strategies.Design. National surveys of: (i) nurse independent prescribers; and (ii) non-medical prescribing leaders in England.Methods. Questionnaire surveys (August 2008–February 2009) coveringeducational preparation, prescribing practice (nurse independent prescribers) andstructures/processes for support and governance (non-medical prescribing leaders).Results. Response rates were 65% (976 prescribers) and 52% (87 leaders). Mostnurses felt their prescribing course met their learning needs and stated courseoutcomes and that they had adequate development and support for prescribing tomaintain patient safety. Some types of community nurse prescribers had less accessto support and development. The prescribing leaders reported lacking systems toensure continuity of non-medical prescribing and monitoring patient experience.Conclusion. Educational programmes of preparation for nurse prescribing werereported to be operating satisfactorily and providing fit-for-purpose preparationfor the expansion to the scope of nurse independent prescribing. Most clinicalgovernance and risk management strategies for prescribing were in place inprimary and secondary care. / Department of Health (UK)

Several issues have impacted on district nursing practice and education within the UK, which can be conceptualised within four main areas: national policy; local organisational structures and practice; professional and disciplinary theory; and practice of individuals (Bergen and While 2005). However, there has been a lack of direction in district nursing in recent years within the UK, with a decline in the number of district nurses being educated (Queen’s Nursing Institute 2014a) and the educational standards supporting district nurse education being over 20 years out of date (Nursing and Midwifery Council 2001). In addition to this, the standards of education for pre-registration nursing (Nursing and Midwifery Council 2010) have supported a graduate workforce with an increasing focus on nursing in the community. This was identified as a consideration for me as an educator when examining the future educational requirements of nurses beyond the point of registration in the community, and became the focus of this study. Knowing in practice is a key concept within this thesis, that is, the particular awareness that underpins the being and doing of a district nurse in practice (Chinn and Kramer 2008). This study explores the unique knowing of district nursing in practice, and how this professional knowing is developed. Understanding the knowing of district nurses and how this is developed will contribute to future educational frameworks and ways of supporting professional development within community nursing practice. A question that is often asked is what makes district nurse knowing different from nursing in inpatient settings, and this emerges in this thesis. A qualitative study using an interpretative approach within a case study design was adopted using three Health Boards within Scotland as the cases. Within each Health Board area, interviews were undertaken with key informants and also, group interviews with district nurses were undertaken using photo elicitation as a focussing exercise. The data were analysed using framework analysis (Spencer et al. 2003). This approach illuminated a depth and breadth of knowing in district nurse practice and how this knowing is developed. The study findings depict the complexity of knowing in district nursing, acknowledging the advancing role of district nursing practice, where the context of care is an essential consideration. The unique knowing can be described as a landscape that the district nurse must travel: crossing a variety of socio-economic areas; entering the private space of individuals, and the public space of communities; as well as acknowledging professional practice; navigating the policy agenda while maintaining clinical person-centred care; and leading others across the terrain of interprofessional working. The unique knowing in practice that characterises the expertise of district nurses is a matrix of elements that incorporates different aspects of knowing that contribute to leadership, as suggested by Jackson et al. (2009). The participants in this study recognised that due to the complexity of the district nurse role, and its continuing advancements, that district nurse education needs to move to a Master's level preparation and it needs to continue to be supported by a suitably qualified practice teacher. Furthermore, the findings within this study demonstrate that the development of the unique knowing in district nurses does not happen in isolation and it is very complex. It consists of networks, conversations, engagement with policy, understanding of professional contexts, adhering to organisational boundaries, and interaction with complex and challenging situations. Theory and practice are mutually dependent on each other; change is inevitable and is unpredictable; and practices change by having experiences, therefore change is integral to practice. Consequently, it was concluded that the interdependent elements, which interact, develop the unique knowing of district nurses in practice. Finally this thesis makes recommendations and discusses future implications for policy, practice and research.

This research is concerned with the assessment of student nurses' practice, implementation of which has been considered problematic since the move of initial training into higher education. It examines clinical nurses' accounts of assessment, and rejects an approach based on identification of competencies as too rationalistic for a situated practice. Insights from, in particular, Foucault, Deleuze, and Derrida were used to analyse practitioners' alternative discourse of practice, and the processes of self-constitution and decision-making. Eighteen practitioners from different settings were interviewed in depth about how they determine acceptable performance. Three participants were interviewed twice to develop ideas arising from the first round of conversations. Practitioners' accounts challenged the conventional understanding of assessment, and the construction of practice implicit in current policy. The analysis suggests a more fluid, un-predetermined understanding, characterised by hesitation and uncertainty, though without losing a concern with safe practice. Several implications for policy and practice are presented. These require a shift of authority towards practitioners' situated judgements and away from predetermined outcomes, both in respect of programme planning and policy guidelines on the specification of standards. A new alliance is proposed to encourage a more authentic engagement with the process from both clinical and educational practitioners.

Background: Post anesthesia care unit (PACU) nurses provide patient care during the vulnerable postoperative period when patients are at greatest risk of experiencing respiratory management issues and postoperative pulmonary complications (PPCs). In rural facilities such as Canyon Vista Medical Center (CVMC) in Sierra Vista, Arizona, limited staff and resource shortages can lead to suboptimal patient care conditions in the PACU setting. To compound the issue, PACU nurses in rural facilities rely on facility training and have little guidance on important patient care issues such as post anesthesia respiratory management. Quality improvement initiatives aimed at resolving knowledge deficits in settings such as these can improve both quality and patient safety via a more competent and educated PACU nursing staff. Purpose: To address an educational need among the CVMC PACU nursing staff with the implementation of a post anesthesia respiratory management educational intervention. Methods: A quasi-experimental one group pretest-posttest design using a targeted intervention based upon the knowledge to action (KTA) framework. The PACU setting was used to conduct the intervention with the nurse participants (N = 9). Descriptive statistics and the Wilcoxon signed rank test were used to determine intervention efficacy. Intervention: One 75-minute educational intervention divided into three consecutive phases. Results: A significant improvement in the nurses’ knowledge (p < .05) and perception of understanding of PACU respiratory management following the intervention (p < .05).

Nurse academics are constantly facing new challenges from governmental and professional groups calling for the preparation of students to be able to work with increasing complex patient cases at a time of reduction in clinical placements (NMC, 2010a and b). Simulation is a method that has been embraced, by some, for preparing for these challenges, with the potential to escalate student skills and knowledge in a meaningful way (Benner, 1984). The aim of this study was to explore and make explicit the characteristics that make simulation effective within nurse education. An explorative, qualitative case study was chosen to collect spoken data from twenty-four participants through focus groups. Participants included both students undertaking nurse training, and academics involved in the delivery of simulation. Content analysis facilitated exploration of each participant's contribution resulting in the emergence and construction of three themes (Creswell, 2007; Polit and Beck, 2014). 1. The approaches that academics use to integrate simulation into the curriculum; 2. The influences and decisions academics make to deliver simulationbased education, and their impact upon the student learning experience; 3. Evidence for the transference of skills to the realities of clinical practice. A conceptual framework has been developed and presented through the data analysis process (Saldana, 2012), which has culminated in the presentation of a unique model for 'Developing Simulation Practice in Nurse Education' (DSPiNE). The model relates to two key processes derived both during and following simulation activities (1) the preparedness for clinical practice, described as the process whereby the student gains insight into their current practice abilities; and (2) the transference to clinical practice, described as the process whereby the student gains insight into their readiness for future practice requirements. This study concludes that purposeful positive behavioural change could be achieved with the implementation of the DSPiNE model within nurse education.

Since the introduction of the Internet, there has been an increase in the adoption of this technology for educational purposes. This development and widespread availability of Internet technologies, alterations in the needs of clinical practice and the characteristics of students, have all inspired changes in nursing education (Mallow & Gilje, 1999). In response, nursing education has embraced the opportunity this communication medium offers to the diverse groups of students in nursing. These students may be studying at a distance, or due to other constraints such as time or professional commitments, studying in flexible ways where students may or may not be in the classroom. In other instances, Internet technologies are being used with the aim of enriching learning in nursing. However, despite widespread development and implementation of these innovations, the effects on nursing education have not been extensively researched (Cheek, Gilham & Mills, 1998; Gillham, 2002; Mallow & Gilje, 1999) and little is known about how the Internet contributes to teaching and learning, what learning outcomes are, or what support is required by teachers and students (Billings, 2000). At this time of rapid development of Internet-based and Internet-supported courses in the Australian nursing education system, there is a need to ensure such courses are educationally effective, clinically relevant, and that resources are appropriately assigned. This exploratory study aimed to contribute to effective discipline-specific use of internet learning environments through increased understanding of students’ and academics’ experiences of teaching practices and learning processes. There were two phases to this mixed-method study, a survey of course coordinators, and secondly, interviews with eleven students and sixteen academics. The survey of diverse schools of nursing across Australia provided foundational information about the ways the Internet was integrated into nursing education, and the preparation and supports that were offered to students for Internet-based or Internet-supported learning. Guided by a constructivist theoretical framework, and analysed thematically, the key findings of this study were drawn from the academics’ and students’ experiences in a variety of nursing courses in universities located across Australia. The Internet was employed in these courses in a variety of ways. At the time of data collection for both the survey and the interviews, more courses were Internet-supported than Internet-based. A variety of Internet information and communication features were used in courses. The survey findings provided both a context for the interview findings, and a degree of confirmation of these findings. The context reported was diverse, consistent with an emergent educational environment that has few precedents to guide its implementation. The academics’ experiences revealed that teaching in online environments was vastly different to face-to-face teaching and required different practices of teaching and learning that took into consideration the separation of teachers from learners, and learners from each other. While often enthusiastic about the new environment, many teachers needed specific preparation, support, and adequate resources to teach in this new environment. Similarly, students experienced a dislocation from the learning environments to which they were accustomed. Significant shifts were apparent in the students’ constructions of both individual and collaborative learning that were contingent upon the separation of teachers and learners, and the necessity of communicating in a written medium. Both teachers and learners revealed how, consequent upon their dislocation, they were relocating to a new interpretation of time, place and relationships in Internet learning environments, and were reconstructing teaching and learning. The reconstructions of learning included ways of relating that built learning communities predicated on a shift in focus from teaching to learning. These included both a shift in individual student’s learning, and a constructed understanding that arose variously from shaping a fundamental comprehension or challenging thinking, to expand comprehension in the group. Through new understandings and practices, the participants were beginning to construct a place for students and teachers to realise the possibilities for enriched learning that online communities can provide. The findings of this study are discussed in terms of the possibilities for teaching and learning in nursing education, and recommendations are made.

This study investigates the uniqueness and importance of the Australian National Competency Committee (ANCI) competencies to nurses and other health professionals. Very few Australian studies (Battersby, 1994; Hearn, Smith, Southerly & Close, 1995) have addressed this issue. Although there is widespread confusion of the term "competency", professional bodies regard competency standards as a process for supporting the integrity and control of their respective professions. The problem is that there is confusion across the health professions about competencies and their agenda. ANCI suggest that the nursing competencies reflect unique characteristics of nursing as well as those common with other professions. However, competencies that are unique to nursing have not been identified. ANCI have also not identified how competencies can enhance the development of nursing as a profession. The identification of differences in perceptions of uniqueness and importance of the ANCI competencies within nursing and across health professional groups may contribute to the debate on what is needed to achieve competence and those factors that may influence nursing autonomy, education, and future professional development. This study is important to assist in the identification of nursing as a profession in its own right. It will assist the arguments for and against economic reform in professional education courses and transfer of skills and competence across professions. This study compares the perceptions of nurses, physiotherapists, speech pathologists, and occupational therapists about the uniqueness and importance of the ANCI competencies to their professions. Participants completed a questionnaire that listed the ANCI competencies. They were asked to rate each competency first on uniqueness to their profession, and second, on importance to their profession. Two surveys were conducted; one in 1997 and the second in 2000. Surveys examined any change in perception over time by different cohort groups. The study takes a quantitative approach to data collection and analysis. Inferential analysis determined statistically significant differences and similarities of the four participating health professional groups. The differences are examined in relation to the characteristics that define a profession and implications for nursing are examined in relation to research, autonomy, and patient advocacy within an evidence-based practice framework. Eight hundred and thirty-one of questionnaires distributed were used in this study. The results showed that nursing emerged as significantly different to the other three health professions on perception of uniqueness of the competencies. Nineteen of the sixty-five competencies were perceived by nurses to be more unique to the nursing profession. This perception of uniqueness was found across all the four domains of the ANCI competencies. Although ANCI (2000) claimed that the competencies reflect the unique characteristics of nursing these characteristics have not previously been identified. This finding provides some support for the claim made by ANCI by identifying those competencies nurses perceive as more unique. The study findings showed also that the four participating health professions rated the ANCI competencies as important. However, there was a significant difference between nurses and the other three professional groups on the ratings of importance of the competencies of professional and ethical practice. The study found that nurses rated the competencies of this domain as more important than the other three professions rated these competencies. The findings indicate that the rank orders of importance of the competencies are different across the four professions. This reflects and indicates the different priorities and work roles of each of the four professional groups. It is interesting as well as being of concern to nursing that the participating nurses ranked research and management of care as being the least important of all of the competencies. This finding may help to explain why nursing research has been slow to develop in spite of changes to nursing education. Nurses have a subordinate past and are often described as doers rather than thinkers. It appears that this may not have changed. Current practice also reflects a dependency on other health professions such as the medical profession (Adamson & Harris, 1996). Finally, the study found that there was no change in nurses' perceptions of uniqueness over time. However, there was a slight increase in the nurses' ratings of importance of Critical Thinking and Analysis. There were no statistical significant differences for age, gender, year of graduation, state of residence, and employment status. The discussion chapter commences with an outline of the perceived importance of the competencies across the different health professions. Discussion compares the findings and methods of two important Australian studies of competencies (Battersby, 1994; Hearn et al. 1995, 1996) to this study. Discussion examines professionalism and identifies areas where nursing's perceptions of the competencies meet the criteria of a profession and where the four health professions have similar and different perspectives and qualities. Six characteristics of a profession that are discussed in relation to the perceptions of the ANCI competencies are: high intellectual functioning, special body of knowledge, responsibility and accountability, code of ethics, autonomy, and collegiality. The third part of the discussion highlights the implications of this studies' findings in relation to ANCI competencies as an evaluation tool, the empowerment of nurses, generic courses, scope of nursing, professional development, and curriculum development. The thesis concludes by arguing that 1) The ANCI competencies have the potential to increase the professionalism of nursing; 2) Nurses value accountability and responsibility, the code of ethics, and collegiality; 3) Nurses appear uncomfortable with the concept of autonomy; 4) Nurses undervalue high intellectual functioning and the importance of a body of knowledge; and 5) Perceptions are influenced by the context of competencies. The final chapter highlights a number of recommendations for nursing practice that include the need for further investigation of the uniqueness of the ANCI competencies. It is argued that there is a need for a number of changes to the ANCI competency list as well as a greater emphasis on research and management of care and support for discipline specific courses.It is apparent from the findings of this study that nursing education and clinical practice would benefit from the placement of more emphasis on the importance of research. Furthermore, nurses need to take better responsibility for pursing opportunities and funding for research and practice management. It is concluded that nursing research will increase the body of knowledge for the profession and will also increase professional autonomy with an outcome of better client care. Nurses need encouragement from administrators and educators to value management of care and the nursing process, as this will also encourage independence and quality of care provision. It is argued that commonalities in the perception of uniqueness and importance of competencies are not grounds for politicians to suggest the implementation of generic health professional courses. The commonality of the competencies being important to all four professions can be attributed to the complex nature of nursing practice, which captures aspects of other health professional roles and many of the competencies contribute to the characteristics that define a profession. There are differences in the rankings that can be attributed to the nature of knowledge, context, and priorities of the different professions. Each profession has its own governing body that ensures its members obtain an acceptable standard of professional competence and education. It has, and always will be, the responsibility of the profession to shape the service it provides (Pyne, 1998). This study highlights nurses' perceptions of competencies. The recognition of these perceptions could be used to guide nursing's strive toward autonomy, professional development, and recognition as a profession in its own right.

Thirty years after the concept of primary health care (PHC) was declared the path to health for all, a crisis continues in human resources for health in Africa. This involves the low prioritisation of education and training for primary health care personnel (PHCP) which is crucial to effective practice in severely under-resourced settings. The curriculum required for this education, involving pictures and textual materials, must meet the needs and capacities of the learners so that learning transfer can occur and community health needs are met. This research set out to establish the basis upon which text and pictures should be incorporated into curriculum to address the requirements of community health nurses (CHNs) in The Gambia. A pragmatic, three phased, mixed methodological design was selected for this study. Curricula for African PHCP were first collected and examined using content analysis to determine the rationale for pictures and text. The second phase employed psychometric testing and statistical analysis to establish if learning style preferences for pictures and text were important in Gambian CHN learning. In the final phase, interviews with CHN students explored their preferences for pictures and text and how these preferences should be accommodated in curriculum. The research found that much of the PHCP curriculum analysed was generic, used traditional didactic approaches and focused on written knowledge-based assessment. Learning style preferences were not found to be a consideration and were unidentifiable in this context. Socio-cultural factors significantly impacted upon student CHN learning, but were not adequately addressed in the curriculum materials examined. In addition, CHNs preferred practical learning through primary, multi-sensory experiences. These findings support the conclusion that the localisation of CHN curriculum is required in order to provide a socio-cultural context for learning that is meaningful, rich, interactive and responsive to learner needs. This demands a reconnection with PHC principles of equity and participation which should underpin this curriculum. The thesis argues that an ecological framework better articulates the link between PHCP education and training, practice, and community needs, and should serve to guide curriculum design. Six strategies are identified that could be extended to African PHCP course design.