Grading practice as a strategy to improve proficiencies in undergraduate nurse education: Modelling key areas of competence.

BACKGROUND: In undergraduate nursing grading practice is generally avoided as it is considered educationally flawed. OBJECTIVES: To test an innovative online grading practice tool (GPT) in undergraduate nurse education. To model the determinants of the final practice grade in four areas of clinical competence and in one cohort analysis the relationship between final practice grade and each area of clinical competence and an OSCE grade. DESIGN: A cross-sectional study. PARTICIPANTS: A convenience sample of 782 nursing students from one Higher Education Institution in the North-East of England were included. The sample involved two sequential cohorts of final-year students with 391 students in each cohort. METHODS: A specifically designed online grading practice tool (GPT) composed of thirty-six objectives equally divided across four areas of clinical competence. The GPT was applied to two consecutive student cohorts on completion of their final practice learning placement. RESULTS: There was a statistically significant difference in the mean final practice grade between the two cohorts. In the overall sample, regression modelling showed that all four areas of student assessment contributed equally to the final grade. Analysis by cohort showed that in Cohort 1 clinical thinking and professionalism had the most influence on the final grade with person-centered care and patient safety most strongly impacting on the final grades of Cohort 2. In Cohort 2 there is no statistically significant correlation between final practice grade, each area of clinical competence and an OSCE grade. CONCLUSIONS: Practice learning is fundamental to how students develop professional awareness and learn to nurse. Findings from a novel grading practice tool applied in undergraduate nursing reveal how effectively the tool works. Nurse educators must be responsive to the realities of learning in practice and explore new ways of assessing clinical competence.

The implications of health policy for nursing.

Nursing needs policy, it provides the context to nurses' practice, roles, and knowledge and frames patients' day-to-day lives. This article defines what is meant by policy and what influences its development. With the use of health policy examples, the implications for nursing are explained and ideas on how policy is implemented in practice set out. As health is a devolved issue policy comparisons are made between the four regions of the UK. Finally, the implications of current policy change on nursing roles and skill mix shows how future developments in the nursing profession are being directed.

Current thinking on caring for patients with a wound: a practical approach.

Wound care is increasingly nurse led. This article describes the types and causes of wounds, the six domains needed for systematic wound assessment and the principles nurses can apply to ensure evidence-based wound care. The author argues for the importance of a patient-focused approach in the care of people with chronic and acute wounds. It highlights, when specialist referral may be needed and presents a case study explaining the difficulties of managing a patient with a wound at the end of life. Nurses care for people with wounds in a broad range of clinical settings and it is a real challenge to provide optimum patient outcome (wound healing) and a positive patient experience.