Learning to learn self-regulation in practice: a 2 cohort evaluation.

The transfer of nurse training into higher education following 'Project 2000' dramatically changed the status of student nurses. While the majority received a grant or bursary, students were no longer regarded as belonging to the hospital staffing complement. Elcock et al. (2007), argue that the intended advantage of supernumerary status following the move of nurse education into higher education has not been reflected in the student learning experience. Students have reported difficulties in being accepted into the community of practice, as they are no longer viewed as belonging in the professional sense to the practice environment (Cope et al., 2000). Students must therefore be prepared for their supernumerary role through the development of appropriate skills for learning in practice (Elcock et al., 2007). The Thames Valley University pre-registration nursing curriculum promotes the effective socialisation of students into the professional role (Fitzpatrick et al., 1996) through a 35-day practice orientation programme in the Common Foundation Programme. The results of a 2 cohort evaluation of a 35-day programme facilitated in the Brent and Harrow learning community indicate that novice pre-registration students will not always possess the self-directed ability to spontaneously engage with nursing care in practice. Students must be provided the opportunity to develop the skills that define the self-regulated learner (Langendyk, 2006). Students must be empowered to self-assess what they know and what they do not know. It is argued that in order to learn during practice experiences, the student nurse of today must first learn how to be self-regulated.

Learning to learn in practice: An evaluation of a 35-day practice orientation programme.

The Practice Education Support Unit at Thames Valley University is committed to improving the quality of students' practice experience. Recent changes to the delivery of the Pre-Registration nursing curriculum have included the instigation of a 35-day practice orientation programme for students on the common foundation programme. The Brent and Harrow 'Student Experiences Group' developed and facilitated a 35-day programme for the March 2007 cohort within their learning community. Subsequent evaluation of the programme revealed that students were more positive in relation to taught elements of the programme, as opposed to self-directed elements. These results are significant due to the requirement for students to develop self-direction skills in order to become competent registered nurses. The evaluation results did indicate the need for changes to be made to the subsequent development of the 35-day programme for the September 2007 cohort. In particular, the programme was redesigned to create a better balance between taught and self directed elements. A staged introduction to self-directed learning may promote student acceptance and confidence in this vital skill.

What do mentors find difficult?

AIMS: (i) To assess whether mentors had a positive or negative attitude towards their role; and (ii) to discover what aspects of the role they found easy or difficult. BACKGROUND: The fact that mentorship is an important element in nurse training was recognized by Sir Leonard Peach, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting and the Nursing and Midwifery Council which has recently published new standards to support learning and assessment in practice, which include standards for the preparation of Mentors, to be implemented by September 2007. There are many anecdotal reports of the problems which face mentors, but little firm evidence. METHOD: This paper reports a study of those problems. It used a Thurstone scale to assess role satisfaction among mentors (n = 86, response rate 89%) and two Likert scales to assess where problems, if any, lay. RESULTS: Unlike anecdotal reports, the Thurstone scale found that, overall, mentors regarded the role positively. In addition, a principal components analysis of responses to the Likert scales showed that there were two clearly delineated factors. The first (interpersonal/organisational factors) had been widely discussed in the literature. The second (cognitive/intellectual factors) has been rarely discussed and could with profit be more strongly stressed in mentor training. CONCLUSIONS: (i) Mentors had a positive attitude towards their role and enjoyed it. (ii) When looking at what caused mentors difficulty, in addition to the commonly discussed dimensions of organisational constraints (workload, skill mix) and interpersonal factors, there was clearly an additional cognitive one. Knowledge, not just personality, mattered. IMPLICATIONS FOR CLINICAL PRACTICE: Mentors and those who train them could with profit pay more attention to cognitive components of the role, even if that meant laying a lesser stress on the interpersonal ones.

Predicting who will drop out of nursing courses: a machine learning exercise.

INTRODUCTION: The concepts of causation and prediction are different, and have different implications for practice. This distinction is applied here to studies of the problem of student attrition (although it is more widely applicable). BACKGROUND: Studies of attrition from nursing courses have tended to concentrate on causation, trying, largely unsuccessfully, to elicit what causes drop out. However, the problem may more fruitfully be cast in terms of predicting who is likely to drop out. METHODS: One powerful method for attempting to make predictions is rule induction. This paper reports the use of the Answer Tree package from SPSS for that purpose. DATA: The main data set consisted of 3978 records on 528 nursing students, split into a training set and a test set. The source was standard university student records. RESULTS: The method obtained 84% sensitivity, 70% specificity, and 94% accuracy on previously unseen cases. DISCUSSION: The method requires large amounts of high quality data. When such data are available, rule induction offers a way to reduce attrition. It would be desirable to compare its results with those of predictions made by tutors using more informal conventional methods.

The training needs of health care support workers: results of a study of workers and their managers.

AIMS AND OBJECTIVES: This study was designed to assess the training needs of health care support workers. In the past, opinions on the topic have been varied, but were rarely based on empirical evidence. DESIGN AND METHODS: The study was designed as a self-report questionnaire survey of health care support workers and their managers in six units in health and social care, using as its basis 32 descriptors from the NHS Knowledge and Skills Framework, levels 1 and 2. The achieved sample was 117, giving a 77% response rate. RESULTS: Thirty-five per cent of respondents thought that health care support workers were 'unable' to perform six or more of the 32 descriptors used, whilst on the criterion of being 'less than able', the figure was 64%. Support workers and their managers agreed closely (rho = 0.8) on where the difficulties lay in achieving Knowledge and Skills Framework competencies. Those difficulties lay particularly in two areas: (1) biomedical/physiological knowledge and (2) data-handling. CONCLUSIONS: We concluded that the numbers in need of training were substantial and the areas of need were the two identified above. RELEVANCE TO CLINICAL PRACTICE: The main implications for clinical practice are that (a) for those who supervise or mentor health care support workers, there should be a greater concentration on the more scientific areas of expertise and (b) a similar emphasis is needed for those who train mentors or supervisors. These implications will become more important over time as scientific knowledge about medicine and health care increases.

When is it safer to say nothing? Some considerations on biases in sampling.

In nursing research, once one has a solid design, one has still to think about-.a sampling strategy and implementation. Too often, the paraphernalia of inferential statistical reasoning is inappropriately deployed when the achieved sample can in no way be claimed to represent the drawn sample. Given the traditionally low rates of response in most nursing research (usually well under 90 per cent, and often unknown), there is a danger that perfectionist counsels would lead to an end to serious research. In this paper, Laurence Moseley and Donna Mead argue that such a nihilistic position is not necessary and that, instead, researchers should tailor their inferential analyses to the demands of any particular study. They argue that for many purposes, simple computations of both maximum and minimum population estimates are both defensible and useful.

Reported pain after day surgery: a critical literature review.

BACKGROUND: Despite technological advancements in anaesthesia and analgesia, reported pain levels after day surgery remains high. Whilst it is unrealistic to expect no pain, the level that constitutes 'acceptable' pain remains unclear because of inconsistencies in reporting. These inconsistencies have resulted from different interpretations of what pain is and the use of different measurement tools. AIM: The aim of this paper is to report a study investigating any disparity in reported levels of pain following day surgery, within different specialties and in relation to specific operative procedures. METHOD: Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, postoperative complications, pain after day surgery, day surgery, ambulatory surgery, nursing, operation types, operative procedures, surgical procedures, descriptors of pain, pain intensity, verbal descriptor scale, numerical rating scale, visual analogue scale, validity, reliability, design, sample size, data collection methods and their various combinations. Databases searched were Medline, CINAHL, Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search was restricted to publications in the English language. Findings. Twenty-four papers were identified. Inconsistencies in the reported intensity of pain are highlighted, in relation to different operative procedures and specialties. Data in the papers are based on different descriptors, measurement tools and data collection methods. In many cases, sample size, and validity and reliability can also be questioned. CONCLUSIONS: There is a disparity in reported levels of pain after day surgery. It is important that a unified day surgery pain measurement strategy is established, so that patients can be informed about the intensity of pain that they are likely to experience following specific procedures.