Learning and assessing competence in reflective practice: Student evaluation of the relative value of aspects of an integrated, interactive reflective practice syllabus.

Although the literature is rich with information on the value of reflective practice, there is a paucity of information on techniques to assess whether professionals have learnt this essential skill. In this article, we describe the introduction and evaluation of an innovative, integrated, interactive approach to teaching and assessing competence in reflective practice using an online self directed learning package. As part of a new staff start up scholarship of teaching and learning grant project in an Australian university, we converted an existing one day reflective practice workshop for undergraduate nursing students to an interactive online learning package that could also be applicable for students in other health professions. The assessment of learning in the package was integrated with overall clinical competence assessment using Tanner's Clinical Judgement Model and Lasater's Clinical Judgement rubric to enable immediate online feedback to students on their progress. In this article, we focus on those aspects of the package that students evaluated as most beneficial to their learning, specifically immediate feedback by lecturers guided by Lasater's rubric.

A pilot project in distance education: nurse practitioner students' experience of personal video capture technology as an assessment method of clinical skills.

This paper reports on a pilot project aimed at exploring postgraduate distance students' experiences using personal video capture technology to complete competency assessments in physical examination. A pre-intervention survey gathered demographic data from nurse practitioner students (n=31) and measured their information communication technology fluency. Subsequently, thirteen (13) students were allocated a hand held video camera to use in their clinical setting. Those participating in the trial completed a post-intervention survey and further data were gathered using semi-structured interviews. Data were analysed by descriptive statistics and deductive content analysis, and the Unified Theory of Acceptance and Use of Technology (Venkatesh et al., 2003) were used to guide the project. Uptake of the intervention was high (93%) as students recognised the potential benefit. Students were video recorded while performing physical examinations. They described high level of stress and some anxiety, which decreased rapidly while assessment was underway. Barriers experienced were in the areas of facilitating conditions (technical character e.g. upload of files) and social influence (e.g. local ethical approval). Students valued the opportunity to reflect on their recorded performance with their clinical mentors and by themselves. This project highlights the demands and difficulties of introducing technology to support work-based learning.

The perspectives of Australian midwifery academics on barriers and enablers for simulation in midwifery education in Australia: a focus group study.

OBJECTIVE: to describe Australian midwifery academics' perceptions of the current barriers and enablers for simulation in midwifery education in Australia and the potential and resources required for simulation to be increased. DESIGN: a series of 11 focus groups/interviews were held in all states and territories of Australia with 46 participating academics nominated by their heads of discipline from universities across the country. FINDINGS: three themes were identified relating to barriers to the extension of the use of simulated learning environments (SLEs) ('there are things that you can't simulate'; 'not having the appropriate resources'; and professional accreditation requirements) and three themes were identified to facilitate SLE use ('for the bits that you're not likely to see very often in clinical'; ['for students] to figure something out before [they] get to go out there and do it on the real person'; and good resources and support). KEY CONCLUSION: although barriers exist to the adoption and spread of simulated learning in midwifery, there is a long history of simulation and a great willingness to enhance its use among midwifery academics in Australia. IMPLICATIONS FOR PRACTICE: while some aspects of midwifery practice may be impossible to simulate, more collaboration and sharing in the development and use of simulation scenarios, equipment, space and other physical and personnel resources would make the uptake of simulation in midwifery education more widespread. Students would therefore be exposed to the best available preparation for clinical practice contributing to the safety and quality of midwifery care.

Simulation based learning in Australian midwifery curricula: results of a national electronic survey.

OBJECTIVE: The primary aim of this paper is to describe the extent, nature and types of simulation used as a learning method in contemporary Australian midwifery curricula. METHOD: An electronic survey was developed using Graduate e-Cohort Pro and administered to key midwifery academics who had responsibility for 38 curricula leading to initial midwifery registration in Australia. FINDINGS: Engagement of midwifery academics in the survey was high with a response rate of 82%. There is a range of midwifery programs by type and level of award across Australia that vary in duration, enrolments, and by component theoretical and clinical hours. The proportion of simulation hours in curricula varied across programs accounting for up to 17% of clinical program hours. However simulation was used extensively to teach all identified generic technical skills (n=16) midwifery technical skills (n=51) and generic non-technical skills (n=6). Most commonly used simulation types were scenarios, peer-to-peer learning, partial task trainers and standardised patients. Simulation types were suited to the learning tasks. CONCLUSION: Simulation is used extensively in midwifery education in Australia. Further research is required to understand the curriculum development imperatives of simulation and there is a need to adequately resource and support staff in the use of simulation to provide high quality simulation learning experiences for students.

Simulation based learning in midwifery education: a systematic review.

AIM: To critically examine the evidence for simulation based learning in midwifery education. BACKGROUND: Simulated Learning Programs (SLPs) using low to high fidelity techniques are common in obstetric professionals' education and focus on the development of team work, labour and obstetric emergencies. REVIEW METHODS: A systematic review incorporating critical appraisal approaches, setting clear objectives and a defined search and analysis strategy. Evidence from obstetrics, neonatology, technical and non-technical skills (teamwork) was included where it informed the development of midwifery curricula. Studies in English from 2000 to 2010 were included searching CINAHL Plus, OVID Medline, Cochrane, SCOPUS and ProQuest and Google Scholar. RESULTS: Twenty-four papers were identified that met the inclusion criteria. All were quantitative reports; outcomes and levels of evidence varied with two notable papers indicating that simulation had an impact on clinical practice. Benefits of SLP over didactic formats were apparent, as were the development of non-technical skills confidence and competence. The study outcomes were limited by the range of evidence and context of the reports which focussed on obstetric emergency training using a number of simulation techniques. CONCLUSION: There is evidence that simulated learning of midwifery skills is beneficial. Simulation learning has an educational and clinical impact and advantages over didactic approaches. Where clinical practice is infrequent i.e. obstetric emergencies, simulation is an essential component of curricula. Simulation enhances practice and therefore may reduce the time taken to achieve competence; however there is no evidence from the literature that simulation should replace clinical practice.

Is simulation a substitute for real life clinical experience in midwifery? A qualitative examination of perceptions of educational leaders.

This paper describes the perceptions of midwifery educational leaders concerning the potential for simulation to provide a realistic experience in midwifery education. A qualitative design was employed using focus groups which were audio-taped and transcribed verbatim. Data were analysed using thematic analysis. Eleven focus groups were conducted with 46 key midwifery academics across Australia. Three main themes emerged relating to realism and simulation in midwifery practice: 'we already use a lot of simulation', 'level of realism of manikins', and 'some things cannot be simulated'. Simulation is currently widely used in midwifery education, but this is limited due to realism of available models and equipment. Despite this, within a woman-centred, holistic approach to care there are many aspects of midwifery practice that cannot be easily simulated. There is a need for research and development of realistic simulation approaches to support the enhanced use of simulation. Furthermore, strategies for developing approaches that reflect midwifery care provision need to be developed.

Developing an Australian framework for scope of practice decisions by nurses and midwives - lessons for cross-border standards development.

AIMS AND OBJECTIVES: Lessons for cross-border standard development learned in the consultation to create the Australian National Framework for the Development of Decision-Making Tools for Nursing and Midwifery (National DMF). BACKGROUND: Although existing tools are broadly consistent, no cross-border or internationally accepted version exists of scope of practice decision-making guides. Development of a national framework in Australia's federated political system required commitment to wide consultation and consensus. Concurrent moves towards national registration stimulated timely completion of the work. Contextual factors such as differentiation of the profession of midwifery from nursing and varying understanding of scope of practice concepts in eight Australian jurisdictions were challenges. DESIGN: A consultative policy development framework was used. METHODS: Thematic analysis of written responses to a draft document and of focus group feedback informed the production of the National DMF. RESULTS: A widely accepted National DMF allowing nurses and midwives in Australia to engage in planned changes to professional practice, grounded in the professional judgement of the individual nurse or midwife, and collaboration with the consumer. CONCLUSIONS: The project's grounding in consensus influenced the process and outcomes of consultation. A nationally consistent framework, incorporating useful decision-making tools for two professions and principles to guide implementation and evaluation, was a distinct achievement. The article adds to accumulated knowledge by: * identifying the professional and political factors influencing consultation and outcomes in cross-border standard development and * exploring key considerations for future projects to produce national or international professional standards that are relevant across borders and across professions. RELEVANCE TO CLINICAL PRACTICE: Decision-making tools that assist nurses and midwives in determining their scopes of practice and guide them in delegating aspects of consumer care to other health care workers are an essential component of any suite of professional practice standards.

Collaborative voices: ongoing reflections on nursing competencies.

In a rapidly changing Australian health care environment, providers of undergraduate nursing programs are continually upgrading their assessment methods to ensure that graduates are competent and safe to practice. Competence assessment is based on the existing Australian Nursing and Midwifery Council (ANMC) Competency Standards for Registered Nurses. It is acknowledged that there are issues surrounding the validity and reliability of current assessment methods, primarily due to organisational constraints both at the University and the service provider level. There are a number of highly reliable tools available that enable assessment of nursing students in the psychomotor domain. Assessment in other domains is less precise. This paper explores some of the issues relating to competence assessment processes in order to promote discussion and discourse between educators, facilities and policy makers. It is envisaged that increased debate will result in an enhanced level of academic and clinical preparation for the upcoming nursing workforce in this country.

"Holding the child down" for treatment in paediatric haematology: the ethical, legal and practice implications.

Very little has been written about involuntary treatment for adult patients and even less about such treatment for paediatric patients. Ethical dilemmas for nurses in such situations have not been clearly articulated and there are no clear guidelines available in this area. The following findings from a qualitative, longitudinal study on the psycho-social aspects of treatment for childhood leukaemia and related diseases are offered as preliminary work on this important professional issue. The feelings of parents when confronted with the necessity of holding their child down so that they may receive probably curative treatments for acute lymphoblastic leukaemia are described and some of the ethical and legal issues confronting nurses who provide these treatments are explored.

Validating a scope of nursing practice decision-making framework.

This paper describes processes used to validate the Scope of Nursing Practice Decision-Making Framework developed and implemented by the nurse regulatory authority in Queensland, Australia. Various components of the Framework are also outlined. The validity and usefulness of the Framework were tested through survey research and validation in practice. The majority of participants in both validation processes found all components of the Framework completely or mostly understandable, useful and applicable in practice. Results confirmed that education and experience are used by nurses to explain the advancement in their practice and that the context of nursing practice influences roles and relationships with other health professionals.