Practice-based learning: the role of practice education facilitators in supporting mentors.

Central to the provision of high quality clinical placements for nursing and midwifery students are mentors who help engender a positive learning environment. In 2004 the Scottish Executive Health Department (now Scottish Government Health Directorates), NHS Scotland, NHS Education for Scotland, NHS Boards and Higher Education Institutions initiated and supported the establishment of the Practice Education Facilitator (PEF) role whose purpose is to ensure that the student experience, at both pre- and post-registration level, is of the highest quality, primarily through the support of mentors. A 3-year project evaluated the implementation and impact of the PEF role across Scotland. The study utilised both quantitative and qualitative data collection, with a sample comprising mentors, PEFs, students and other key stakeholders. This paper reports on selected findings from that study, specifically the perceived impact of the PEF in supporting mentors. Findings indicate that the PEF role has been accepted widely across Scotland and is seen as valuable to the development of quality clinical learning environments. PEFs provide support and guidance for mentors when dealing with 'failing' students, and encourage the identification of innovative learning opportunities. PEFs play an active part in student evaluation of their placements, but further work is needed in order that the feedback to clinical areas and mentors is timely.

The opinions of students of the first cycle of undergraduate pre-registration bridging nursing teaching programme at the Medical University of Lublin.

OBJECTIVES: Determination of the scope and character of the opinions of investigated students in the organizational and substantial dimension concerning bridging studies carried out in the first experimental cycle of this form of education in Poland. STUDY GROUP: The study covered 116 students of nursing supplementing their nursing vocational education to licentiate level. METHOD: The study was carried out by the method of diagnostic poll based on own version of questionnaire inquiry. Study results were assessed by a team of competent arbitrators in order to precisely determine their category, positive or negative opinions, and also subjected to statistical analysis using chi(2) test. RESULTS: Study results point to a greater number of positive than negative opinions pertaining to bridging education. The type of nursing or midwifery school completed and period of occupational experience, irrespective of its duration, positively correlated with the respondents' opinions on the sense of 'bridging education' and the choice of satisfying syllabus content.

Impact of exudate and odour from chronic venous leg ulceration.

AIMS: To explore depression in people treated for chronic venous leg ulceration, and to assess the impact of excessive exudate, leading to leakage and odour, on their daily lives, overall health and quality of life. METHODS: Completion of a questionnaire and Hospital Anxiety and Depression Scale to determine the prevalence of anxiety and depression in people with chronic leg ulceration (n = 196), and interviews with 20 people living with chronic leg ulceration. FINDINGS: Odour and excessive exudate leading to leakage had an adverse effect on patients' psychological state, leading to feelings of disgust, self-loathing and low self-esteem. CONCLUSION: Chronic leg ulcers disrupt patients' lives and restrict their social lives, leading to social isolation and depression. Healthcare professionals should better understand the impact of symptoms such as odour and exudate leakage on patients' mental health, physical health and healing.

The expectations and experiences of blended learning approaches to patient safety education.

E-learning facilitates access to educational programmes via electronic asynchronous or real time communication without the constraints of time or place. However, not all skills can be acquired via e-learning, thus blended approaches have emerged, where traditional academic processes have been combined with e-learning systems. This paper presents qualitative findings from a study evaluating a blended approach to patient safety education. The 3-day face-to-face training in Root Cause Analysis supported by e-learning resources was designed by the National Patient Safety Agency. The study evaluated the efficacy of the blended learning approach, and explored how operational practices in NHS organisations supported staffs' skill in using electronic resources. Data collection techniques included pre and post-course Confidence Logs, Individual Interviews, Focus Groups and Evaluation Questionnaires. Students' views on blended learning varied. Some were positive, while others felt e-learning did not suit their preferred learning style, or the subject matter. Many students did not engage with the e-learning resources. Lack of awareness regarding the e-learning component, combined with inconsistent access to computing facilities may have contributed to this. For this reason a series of recommendations are outlined to guide those wishing to adopt blended learning approaches in the future.

Depression in patients with chronic venous ulceration.

As leg ulcer research has generally focused on aspects of treatment, the psychosocial impact of leg ulceration remains understudied. This article reports the findings of a study exploring the prevalence of anxiety and depression in 190 patients with chronic venous ulceration across 9 Trusts in the northwest of England. The hospital anxiety and depression scale (HADS) was used to screen patients for the presence of anxiety and depression using a cut-off point of 9 for level of "caseness". A total of 52 (27%) people scored as depressed while 50 (26%) scored as anxious. The two symptoms which appeared to be associated with anxiety and depression were pain and odour, while there was no association found between living alone, mobility and exudate. These findings suggest that the focus of care needs to be redirected for many patients for whom cure is not an option, but who are left to live with a chronic wound. Furthermore, psychological factors, including depression, should be a focus in assessment and ongoing review of patients with leg ulceration.

Introducing problem-based learning into research methods teaching: student and facilitator evaluation.

The evidence base for the effectiveness of problem-based learning (PBL) has never been substantively established, although PBL is a generally accepted approach to learning in health care curricula. PBL is believed to encourage transferable skills, including problem-solving and team-working. PBL was used to deliver a postgraduate research methods module and a small evaluation study to explore its efficacy was conducted amongst the students (n = 51) and facilitators (n = 6). The study comprised of an evaluation questionnaire, distributed after each themed group of PBL sessions, and a group discussion conducted 4 weeks after the conclusion of the module, which was attended by student representatives and the facilitators. Questionnaire data was analysed using SPSS, and a transcript of the interview was subjected to content analysis. The results indicated that students felt that a PBL approach helped to make the subject matter more interesting to them and they believed that they would retain knowledge for a longer period than if their learning had used a more traditional lecture format. Students also perceived that PBL was effective in its ability to enhance students' understanding of the group process. All those involved in the PBL process reinforced the pivotal role of the facilitator. This study indicates that there is potential for PBL to be used beyond the more usual clinical scenarios constructed for health care professional education and further exploration of its use in areas such as building research capability should be undertaken.

Patient safety: do nursing and medical curricula address this theme?

In this literature review, we examine to what extent patient safety is addressed within medical and nursing curricula. Patient safety is the foundation of healthcare practice and education both in the UK and internationally. Recent research and policy initiatives have highlighted this issue. The paper highlights the significance of this topic as an aspect of study in its own right by examining not only the fiscal but also the human costs such events invite. In the United Kingdom patient safety issues feature prominently in the (Department of Health, 2000a. An organisation with a memory. The report of an expert group on learning from adverse events. The Stationery Office, London, Department of Health, 2000b. Handling complaints: monitoring the NHS complaints procedures (England, Financial year 1998-99). The Stationery Office, London.) policy documentation but this is not reflected within the formal curricula guidelines issued by the NMC and GMC. Yet if healthcare educational curricula were to recognise the value of learning from errors, such events could become part of a wider educational resource enabling both students and facilitators to prevent threats to patient safety. For this reason, the paper attempts to articulate why patient safety should be afforded greater prominence within medical and nursing curricula. We argue that learning how to manage errors effectively would enable trainee practitioners to improve patient care, reduce the burden on an overstretched health care system and engage in dynamic as opposed to defensive practice.

"Do none of you talk to each other?": the challenges facing the implementation of interprofessional education.

There is a growing interest internationally in the development of interprofessional education (IPE), with the potential goal of achieving more effective healthcare delivery. The aim of this study is to explore the feasibility of introducing IPE within undergraduate health professional programmes, using a systematic review of the evidence and focus-group interviews. This paper reports findings from the focus-group interviews. Three focus-group interviews, each lasting two hours, were conducted. Participants (n = 34) were drawn from the clinical and academic environments, from health service consumers and from health professional students. Two areas were explored: (1) the feasibility of IPE and (2) perceptions of its effects. Each focus group had a primary facilitator who led the group discussion and a second facilitator audiotaping discussions and writing observational notes. Three main themes emerged: the advantages of IPE, the challenges of initiating IPE, and the role of IPE in the creation of professional identification. There was consensus in the view that IPE had much potential in breaking down traditional barriers to team working, including professional 'tribalism'. It is important for IPE to be integrated with interprofessional experiences in clinical practice. Further empirical work, focusing on student and patient outcomes in IPE, is needed.

Patients' perceptions of "uncertainty" in nurse practitioner consultations.

The aim of this qualitative study was to explore patients' perceptions of consulting with a nurse practitioner in situations of clinical uncertainty. Uncertainty in this context is defined as one where there is no obvious diagnosis, treatment or where the outcome of the consultation is not definite. Three general practice sites were recruited to participate. 43 patients who consulted with one of three nurse practitioners were interviewed using a semistructured schedule. The nurse practitioners identified uncertainty in 30 of these consultations; only two patients expressed any awareness of uncertainty with the consultation. The results showed that patients appear to accept that there will be a level of uncertainty in some consultations. Recognition of uncertainty within the consultation does not appear to have a negative effect on patients' perception of the nurse practitioner as they feel that the nurse will refer to a doctor if necessary.

Opportunistic screening for Chlamydia in general practice: the experience of health professionals.

Chlamydia trachomatis is the most common curable bacterial sexually transmitted infection in the UK. The infection is asymptomatic in up to 70% of women, and if untreated, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydial infection can be diagnosed using urine testing and is easily treated with antibiotics. In 1999, the UK Department of Health funded a pilot opportunistic Chlamydia screening programme in two health authorities. All sexually active women between the ages of 16 and 24 years attending general practices and other healthcare settings, such as family planning clinics, antenatal clinics and genito-urinary medicine services, were offered the opportunity to be screened for Chlamydia, regardless of the purpose of their visit. This evaluation was funded to assess the feasibility and acceptability of opportunistic screening. The evaluation was conducted using both qualitative and quantitative methods. The present paper describes findings from the qualitative evaluation study arising from the health professionals' experience of opportunistic screening in general practice. Receptionists were central to the opportunistic screening model in general practice and it was this aspect of the model that raised most concerns. Whilst general practitioners reported that the involvement of receptionists saved them time, the receptionists themselves were sometimes drawn into discussions for which they felt ill equipped and unsuitably located. This research suggests that a call-recall national screening programme would provide a better model to undertake Chlamydia screening in general practice. The advantages of this model are threefold. First, each individual within the target age range can receive information about Chlamydia through the post. Secondly, the test and more detailed information can be managed by a practice nurse in a private and confidential setting. Thirdly, individuals are not repeatedly offered the test when visiting the surgery.