Determinants of readiness towards self-directed learning among nurses and midwives: Results from national survey.

An ever-changing and challenging patient care environment requires nurses and midwives to embrace the concept of lifelong learning through a self-directed learning (SDL) approach. This study aims to evaluate nurses and midwives' readiness towards self-directed learning (SDRL) in Brunei Darussalam. A cross sectional descriptive study was conducted. Using a non-proportional quota sampling method, 700 questionnaires were distributed among nurses and midwives working in four District Government Hospitals in Brunei. Fisher's Self Directed Learning Readiness Scale was used to explore readiness towards SDL among nurses and midwives. In total, 616 completed questionnaires were returned (representing a response rate of 88%). Results indicated a high level of readiness towards self-directed learning among the participants with a total mean SDLR score of 158.44 ± 16.00. In overall comparison, the mean score of domains were: self-management (49.21), desire for learning (50.12) and self-control (59.10). This national hospital survey concludes that graduateness, workplace, age and marital status determine readiness towards self-directed learning among nurses and midwives in Brunei. Future research should focus on a theoretical framework for SDL models and the impact of these models on quality nursing practice.

Life after the Liverpool Care Pathway (LCP): a qualitative study of critical care practitioners delivering end-of-life care.

AIM: To explore the experiences, challenges and practices of critical care practitioners since the discontinuation of the Liverpool Care Pathway in critical care settings. BACKGROUND: The Liverpool Care Pathway was widely used with an aim to improve communication and care for dying individuals and their relatives. However, widespread media criticism prompted a review, which resulted in the discontinuation of the Liverpool Care Pathway across all UK clinical settings. DESIGN: A qualitative study. METHOD: The study was carried out in two large acute hospitals in England. Semi-structured interviews were conducted with 14 critical care practitioners, 6 months after discontinuation of the Liverpool Care Pathway. Transcribed verbatim data were analysed using framework analysis. RESULTS: Three key themes emerged: 'lessons learned', 'uncertainties and ambivalences' and 'the future'. Critical care practitioners reported that life after the Liverpool Care Pathway in critical care settings often involved various clinical ambivalences, uncertainties and inconsistencies in the delivery of end-of-life care, especially for less experienced practitioners. Critical care practitioners had 'become accustomed' to the components of the Liverpool Care Pathway, which still guide them in principle to ensure quality end-of-life care. The Liverpool Care Pathway's structured format was perceived to be a useful clinical tool, but was also criticized as a 'tick-box exercise' and for lacking in family involvement. CONCLUSIONS: This study posits two key conclusions. Despite experienced critical care practitioners being able to deliver quality end-of-life care without using the Liverpool Care Pathway, junior nursing and medical staff need clear guidelines and support from experienced mentors in practice. Evidence-based guidelines related to family involvement in end-of-life care planning in critical care settings are also needed to avoid future controversies.