Teaching student nurses how to use electronic patient records through simulation: A case study.

Like any skill in nursing, preparing students for the changes in technology needs to be incorporated into the curriculum. Electronic Patient Records (EPR) are an example of technological innovation in health care. This article presents a case study of how one faculty of healthcare, working collaboratively with a web designer, created and implemented a simulation activity to enable student nurses to develop their skills in using EPRs. An evaluation study was undertaken into students' perceptions of undertaking the simulation activity and using EPRs in the simulation activity. Findings showed that students were positive about the simulation activity and using the EPR app in the simulation, and felt well-prepared for using EPR in practice.

Pressure ulcer prevention is everyone's business: the PUPS project.

Prevention of pressure ulcers is one of the greatest healthcare challenges in terms of reducing patient harm. The literature shows that although numerous reports and policy documents have been published, pressure ulcer prevention remains an ongoing challenge. A number of innovations have been published offering practising nurses and managers ideas for raising awareness of skin care and preventing pressure ulcers. The majority of these have focused on patients in hospital settings with very little in the literature related to care-home and community initiatives. This article reports on an innovative approach to education for pressure ulcer prevention through collaboration between patients, carers and health and social care professionals.

Learning about population-health through a community practice learning project: An evaluation study.

Increasing student nurse numbers requiring community placement learning opportunities has led to insufficient numbers of community nurses being available to support student nurses in the community. Although the study presented in the article is based in the UK this issue is reported widely in the literature across the globe. Universities in many countries have had to find innovative ways of providing community health learning opportunities for student nurses. This article reports on how one university in the UK has approached this challenge through students engaging in a population-based study in the community through group work. A research study was undertaken into this innovation which found that the student nurses engaged well with the project and with their groups and undertaking the project had positive value and impact on them and their understanding of population-health. Issues that arose for them largely focused on unequal participation in the group work by some with many participants perceiving that they had done more work on the group project and presentation than others in their group. However, working in this way was perceived to be a good learning experience for the majority of participants.

Student nurse selection and predictability of academic success: The Multiple Mini Interview project.

BACKGROUND: With recent reports of public enquiries into failure to care, universities are under pressure to ensure that candidates selected for undergraduate nursing programmes demonstrate academic potential as well as characteristics and values such as compassion, empathy and integrity. The Multiple Mini Interview (MMI) was used in one university as a way of ensuring that candidates had the appropriate numeracy and literacy skills as well as a range of communication, empathy, decision-making and problem-solving skills as well as ethical insights and integrity, initiative and team-work. OBJECTIVES: To ascertain whether there is evidence of bias in MMIs (gender, age, nationality and location of secondary education) and to determine the extent to which the MMI is predictive of academic success in nursing. DESIGN: A longitudinal retrospective analysis of student demographics, MMI data and the assessment marks for years 1, 2 and 3. SETTINGS: One university in southwest London. PARTICIPANTS: One cohort of students who commenced their programme in September 2011, including students in all four fields of nursing (adult, child, mental health and learning disability). METHODS: Inferential statistics and a Bayesian Multilevel Model. RESULTS: MMI in conjunction with MMI numeracy test and MMI literacy test shows little or no bias in terms of ages, gender, nationality or location of secondary school education. Although MMI in conjunction with numeracy and literacy testing is predictive of academic success, it is only weakly predictive. CONCLUSIONS: The MMI used in conjunction with literacy and numeracy testing appears to be a successful technique for selecting candidates for nursing. However, other selection methods such as psychological profiling or testing of emotional intelligence may add to the extent to which selection methods are predictive of academic success on nursing.

Active involvement of learning disabilities service users in the development and delivery of a teaching session to pre-registration nurses: Students' perspectives.

A teaching session about service users' experiences of accessing and receiving health and social care was designed and delivered by service users to first year BSc Nursing students. The aim was to enhance students' knowledge, skills and confidence in caring for people with a learning disability. An evaluation research study was undertaking at one university in London into the perceived effectiveness of the teaching session, including students' perceptions of the extent to which the service users' teaching session was useful, the impact of the session, its benefits and challenges and the sustainability of teaching sessions delivered by service users. Data were collected through an online questionnaire. Quantitative analysis was undertaken of Likert-style questions and qualitative analysis was undertaken using the Framework Method. The session impacted on students' knowledge and understanding of people with a learning disability. Students reported that they felt more comfortable and confident interacting with people with a learning disability. In addition, they reflected on their feelings about caring for people with a learning disability.

The experiences of student nurses on placements with practice nurses: A pilot study.

To prepare the registered nurse of tomorrow in the United Kingdom (UK) to care for patients in general practice (GP)-led services, today's student nurses need to have the opportunity to experience placements with practice nurses to enable them to make positive career choices to become practice nurses in the future. The role of the practice nurse is described in the article. As a pilot project, seventeen students undertook placements with practice nurses in one of seven GP practices selected by the London GP Deanery and the university as having fulfilled the criteria to support student nurses in placements. A mentorship preparation programme was provided to prepare practice nurses for mentoring these students. An evaluation study was undertaken of this pilot project. Findings showed that students were highly positive about the experience; the majority rated this placement as being as good as or better than previous placement experiences. The evaluation also explored the impact on student learning and the value that the placement had. There was a positive impact on students' knowledge and skills in certain clinical areas especially related to health promotion. Students also indicated that they would like to have additional placements with practice nurses and would consider a career as a practice nurse in the future.

A programme to reduce acquired pressure ulcers in care homes.

Prevention of pressure ulcers is a major health concern, especially for older people. Much of the literature related to prevention of pressure ulcers focuses on hospital-acquired pressure ulcers. There is less literature related to prevention of pressure ulcers in care homes. This article presents a review of the literature related to prevention of pressure ulcers in care homes and an ambitious project undertaken by one care home provider to raise awareness of pressure ulcers, provide training in prevention and monitor and evaluate pressure ulcers in over 200 care home across the UK. Known as MI SKIN, the project involves ongoing training to all levels of care staff, a robust system of monitoring pressure ulcers and a mechanism to investigate and learn from any incident of pressure ulcer using root cause analysis.

'It's the hearing that is last to go': a case of traumatic head injury.

This article explores the literature related to acquired brain injury (ABI) and is followed by a case study of one patient with ABI, which reflects how the evidence, when implemented by a team of health professionals, can have a positive impact on recovery. Gregor is a middle-aged Polish man who suffered traumatic ABI when knocked down by a car. He spent a number of years in a specialist neurosurgical unit, then a rehabilitation unit, and for the past several years has been cared for in a care home. For most of this time he was in a coma. He began to come out of his coma and during his time in the care home received intensive physiotherapy and speech therapy. At the time of his brain injury Gregor could speak no English yet years later, when he began to regain consciousness, he was able to speak and understand English, a fact that might be attributed in part to 6 years of nurses talking to him in English as part of caring for him. Nurses are always told that hearing is the last of the senses to be lost when a person is unconscious or has a brain injury (Sisson, 1990). The case study presented in this article demonstrates the potential power of talking to a patient when providing care, even when that patient is in a coma, and the impact this may have had on Gregor. It also demonstrates the importance of the need for evidence-based neuro-rehabilitation, including multi-professional working by a team of specialist physiotherapists, nurses, speech therapists, continence specialist nurse and nutritionist.

Nursing students' expectations and experiences of mentorship.

BACKGROUND: The literature related to nursing students' mentorship experiences is surprisingly limited and research findings related to students' experiences of mentorship is often integrated with other components of clinical placement experiences. OBJECTIVES: This study aimed to gain a greater understanding of students' expectations and experiences of mentorship and to identify the kind of support provided by the mentor that is most valued by the student, the role of the link lecturer in mentorship and how the university might further enhance the mentorship experience of their students. DESIGN: Mixed-methods exploratory sequential design was used. SETTING: This study was conducted in one university in south west London. PARTICIPANTS: All final year pre-registration nursing students enrolled on a Diploma/BSc in Health Studies course (n=129) were invited to participate. Participation was voluntary resulting in a convenience sample. Fifty-three students completed the questionnaire (response rate=45%). METHODS: The research involved two stages: a semi-structured focus group in the first stage and an online questionnaire in the second. Quantitative analysis was undertaken of Likert-style questions using SPSS version 18 and qualitative analysis was undertaken using the Framework Method. RESULTS: Students' experiences were largely positive. A picture emerged about the most valued mentor activities which included teaching and explaining, support and supervision and encouragement. Students differentiated encouragement from what they labelled as support. Contrary to the literature, the mentor role in practice assessment was not identified as highly important. Support from link lecturers was less well evaluated and students felt that the university needs to support mentors better. CONCLUSION: Students in this university valued the teaching, support and encouragement they received from mentors but the university needs to address ways of strengthening the link lecturer involvement in mentorship which includes the imperative for the university to explore ways of better supporting mentors in their role.

Students' first year experience of a BSc (Hons) in nursing: a pilot study.

BACKGROUND: All new nurses in England from 2013 will be educated at the point of registration to the degree level. A study was undertaken into the first-year experience of one cohort on the new degree programme at one university. OBJECTIVES: The aim of the study was to evaluate nursing students' experience during the first year of the degree programme in terms of their engagement with the programme, its impact and value and their overall satisfaction. DESIGN: A mixed method qualitative and quantitative survey design was used. SETTINGS AND PARTICIPANTS: One cohort of students at one university in south west London was studied. In total 96 out of 256 students completed the online survey questionnaire (response rate=37.5%). METHOD: Data were collected through an online questionnaire survey comprising Likert-style, demographic and open-ended questions. Data were analysed using SPSS version 19 and through the framework method. FINDINGS: Students' responses were largely positive. Areas of concern expressed included assessment timings and juggling personal/family commitments with academic workload. Although some experienced a degree of stress in year 1 the majority indicated that stress was not a problem; some experienced little or no stress at all. Students were positive about the quality of teaching, support received, and their relationships with academic staff. Satisfaction with year 1 was high. A small percentage considered leaving during year 1. Factors that made them stay included personal motivation to succeed, family support and help from academic staff and mentors. Overall attrition rate is low. CONCLUSIONS: As nursing in England moves to an all-graduate profession at the point of registration it is timely to evaluate issues like attrition, the students' engagement with their academic and practice experience, the impact on them of their assignments/assessments, stressors, their perceptions of quality, what makes them stay and their overall satisfaction.

Leadership development through action learning sets: an evaluation study.

This article examines the use of action learning sets in a leadership module delivered by a university in south east England. An evaluation research study was undertaking using survey method to evaluate student engagement with action learning sets, and their value, impact and sustainability. Data were collected through a questionnaire with a mix of Likert-style and open-ended questions and qualitative and quantitative data analysis was undertaken. Findings show that engagement in the action learning sets was very high. Action learning sets also had a positive impact on the development of leadership knowledge and skills and are highly valued by participants. It is likely that they would be sustainable as the majority would recommend action learning to colleagues and would consider taking another module that used action learning sets. When compared to existing literature on action learning, this study offers new insights as there is little empirical literature on student engagement with action learning sets and even less on value and sustainability.

Students' perceptions of practice assessment in the skills laboratory: an evaluation study of OSCAs with immediate feedback.

Assessment of clinical skills is fundamental to undergraduate nursing programmes. However, enabling assessment to be a good learning experience as well is a challenge to nurse educators. The study presented here presents the change from using an objective structured clinical examination (OSCE) for summative assessment (with feedback given to students after results had gone to the examination board--6 weeks after the OSCE) to one with immediate feedback. Because the previous OSCEs were universally disliked by students, for reasons that included absence of immediate feedback, in making this change the university re-branded the OSCE as an objective structured clinical assessment (OSCA) with immediate feedback provided to students. A survey was undertaken to measure student engagement with the OSCA, its value and impact, and its sustainability from the students' perspectives. There is little in the literature about student engagement with OSCEs and sustainability. Findings show that the OSCA with immediate feedback was perceived positively by students, was valued with regard to a number of factors, had a positively impact on student learning and confidence and was felt to be a form of assessment that this university should continue to use.

Recruiting competent newly qualified nurses in the London region: An exploratory study.

AIM: This paper reports a study commissioned to address concerns that not all newly qualified nurses (NQNs) were perceived to be competent at the point of appointment to their first post. It seeks to understand how competence is interpreted in the context of selection and recruitment, and explore the different expectations and experiences of employing Trusts across the London region. BACKGROUND: Competence is a significant topic in nursing and there is much literature around the concept, what it means and how it relates to behaviours and values with no universally accepted definition. However, there appears to be little evidence about how competence is assessed in practice in the selection and recruitment of NQNs to their first post. METHODS: The study took a three-phase, mixed method approach including a literature review, an electronic survey to map current assessment and selection procedures, and focus groups to identify the competencies perceived essential by senior nurses. FINDINGS: Most Trusts reported assessing core competencies, and could report how they do this with respect to literacy and numeracy. Employers could describe what they required from NQNs, and how applicants both met and did not meet expectations. Several personal attributes were considered as important as key competences, but these are not described in the KSF or NMC frameworks, and it is not clear how these are assessed in selection processes. CONCLUSION: There appeared to be a large variation in the number and types of competence assessments being used for recruitment, with little consistency in the detail of the assessments, although broadly similar assessment exercises are used. There appears to be little evidence as to the validity of the measures being used and whether in fact they are measuring the competences that are being sought or considered most important. It would appear that practical skills are more easily assessable, but there is a lack of clarity regarding the assessment of those competences that are considered equally important but appear to be more elusive to assessment such as communication and teamwork. It is also unclear how a number of 'personal qualities' described as essential for NQNs are being assessed at recruitment.

How first experiences influence newly qualified nurses.

The beginning of a nurse's career can be a challenging time and first experiences can influence the retention of newly qualified nurses and their career progression. Nurses experience anxiety and lack of confidence as they make the transition from student to newly qualified nurse. St George's Healthcare NHS Trust, in collaboration with the Faculty of Health and Social Care Sciences at Kingston University/St George's University of London, embarked on an innovative programme of role and career development for newly qualified nurses that included a Signal Post Development Scheme. The scheme integrated preceptorship, clinical supervision, role development and leadership development together with a set of four periodic review points. At each review point the individual nurse had the opportunity to self-assess her or his own development and then meet with a senior member of nursing staff to receive feedback on development, progress and action planning. The self-assessment and signal post review was undertaken using the role description for band 5 nurses and the role description for band 6 nurses. Each signal post review enables progress, development and feedback to take place against progression along continua from the band 5 to the band 6 role description. An evaluative study of the scheme was undertaken, which demonstrated that band 5 nurses were largely positive about the scheme and the impact it had on their role and career development.

Reducing avoidable harm caused by pressure ulcers.

This article reports on the successful work undertaken within one NHS trust to reduce the incidence of pressure ulcers. The tissue viability nursing team at Medway NHS Foundation Trust devised, implemented and evaluated a strategy to reduce the incidence of pressure ulcers. This involved devising a comprehensive database, intensive monitoring using root cause analysis, writing action plans using high-impact actions (HIAs) and innovative thinking to address and reduce the incidence of pressure ulcers and staff training in the use of the SKIN acronym. This work identified pressure ulcers on the ears of patients receiving oxygen therapy as a particular problem. An evidence-based and multiprofessional strategy was devised to deal with this particular problem, which resulted in no further incidence of pressure ulcers on the ears of patients receiving oxygen therapy. The entire pressure ulcer reduction strategy was positively evaluated and proved to be sustainable.

Personal health budgets: common myths and misconceptions.

Personal health budgets (PHBs) were introduced at 61 sites across England; 20 of which were evaluated in a report published in November 2012. There has been collective resistance to PHBs and negative reporting in the professional healthcare press. However, there is some early evidence that PHBs are proving to be successful. Nurses in the community are having a pivotal role in their implementation. This article addresses a number of negative and often misleading myths about PHBs that have been publicised in some areas of the professional press.

Factors that enhance rates of completion: what makes students stay?

BACKGROUND: This study was one of four projects commissioned by NHS London to examine the readiness for work of nurses upon completion of their pre-registration programmes. The study examined the factors that contribute to students completing their nursing programmes. OBJECTIVES: The objectives of the study were to explore understanding the factors that influence the attrition and completion rates of year 2 students on the adult field of a pre-registration nursing programme. DESIGN: An ethnographic case study methodology was employed in two large London NHS Acute trust hospitals, both partnered with the same Higher Education Institution. Data was collected between 2010 and 2011 through a combination of document review, non-participant observation in practice settings, focus groups and interviews PARTICIPANTS: A self-selected group of 50 year 2 student nurses from a total population of 200 participated in this study. All students were from the same cohort group at one London-based university who undertook practice learning experiences at two NHS Acute Trust hospitals. RESULTS: The study found a number of factors that impacted on retention which included student identify and the organisation, fostering resilience and clinical support. In addition the Higher Education Institute does not appear to be the most significant factor in a student's decision to continue on the programme, but that practice placement mentors and clinical placements have the greatest impact on student retention. CONCLUSIONS: The study is important in that its findings contradict much of the literature on student nurse attrition and retention in that the clinical placement experiences emerges as the most important factor in whether a student chooses to stay or leave the course.

Preceptors' perceptions of a preceptorship programme for newly qualified nurses.

BACKGROUND: A study was undertaken into preceptors' perceptions of a preceptorship programme for newly-qualified nurses. The preceptorship programme is designed to enable newly qualified nurses to make the transition from student to registered nurse. Preceptors undergo a training programme to take on the role of preceptor. OBJECTIVES: To evaluate the preceptors' perception of the preceptorship programme. DESIGN: Mixed method evaluative research design was used. SETTING: This study took place in one National Health Service Healthcare Trust in South West London, UK. PARTICIPANTS: Ninety preceptors were invited to participate in the study and the response rate was 44.4% (n=40). The study took place in 2011. METHODS: Qualitative and quantitative data were collected through questionnaires and one-to-one interviews with a convenience sample of preceptors. Quantitative data were analysed using SPSS, version 18; qualitative data were analysed using the Framework Method. FINDINGS: From the quantitative data seven themes emerged. These were preceptors' perceptions of: the personal development of preceptees; the role development of preceptees; the communication skills development of preceptees; the clinical development of preceptees; the development of professional relationships by preceptees; value of the preceptorship programme to the organisation and value of being a preceptor in terms of their own professional development. Qualitative analysis confirmed many of the findings from the statistical analysis and was used to triangulate those findings. CONCLUSIONS: The preceptors largely viewed the preceptorship programme and their role within this programme positively. Although difficulties in making time to meet with preceptees was an issue, the preceptorship experience was perceived to have a positive impact on several aspects of preceptee development as well as on the organisation and on the preceptors' own development. The study is unique when mapped against other research studies because there is little in the literature about studies into preceptors' perceptions of preceptorship programmes.

A foot in two camps: an exploratory study of nurse leaders in universities.

BACKGROUND: Nursing education was fully absorbed into universities in the United Kingdom in the late 1990s and thus is a relatively young academic discipline. In contrast to a lively literature on clinical nursing leadership, little attention has been given to the leadership of academic nursing as these roles encompass contract management, research and teaching. OBJECTIVES: The purpose of this study was to explore the scope and meaning of leadership from the experience of nurse leaders in universities in the United Kingdom (UK). DESIGN AND METHODS: The qualitative design used open ended telephone interviews. Interview transcripts were checked with participants. Framework analysis was used for capturing and identifying themes. SETTING AND PARTICIPANTS: A convenience sample of academic nurse leaders (responsible for a School, Department or a Faculty) was identified through the UK Council of Deans of Health. RESULTS: All ten respondents were managing health care portfolios and running departments of various sizes and often with a mix of nursing and other health care disciplines. There was regional and country representation (England, Scotland and Wales) and half the respondents were employed at pre 1992 and half at post 1992 universities (the latter institutions that were previously polytechnics and gained university status in 1992). Three core issues emerged from the data: the leadership context; ways in which the deans articulated their leadership skills and the issue of legitimacy of nursing in higher education. CONCLUSION: Two important issues emerged for nursing deans, firstly the university as a knowledge producer and secondly the need to create strong academic and professional identities. The findings highlight role complexity as academic nurse leaders navigate the dichotomy between the different worlds of the university and health care practice. The legitimacy of nursing as a practice discipline in the university continues to be contested territory. There is an opportunity for nurse leaders to do more to develop a collective narrative about the contribution that academic nursing can make to the quality of the workforce.

A preceptorship programme for health visitors and school nurses: a pilot study.

This article presents a pilot study that was undertaken into the perceptions of newly qualified health visitors and school nurses of a structured preceptorship programme. The preceptorship programme involved each participant identifying personal goals and objectives linked to their appraisal, and participating in an action learning set over the first year following qualification. As part of the programme, each participant completed a work-related project. A named senior member of the trust acted as a preceptor facilitator. A mixed-method evaluative study was undertaken into this pilot project. Findings of the pilot showed that the majority of the participants were positive about the impact, value, quality and sustainability of preceptorship and also valued the role of the preceptor facilitator, the project and the action learning sets. The health visitors and school nurses also felt they gained in confidence, competence and leadership skills.