Evidence informed generalist palliative care content for undergraduate nursing curriculum: An integrative review.

BACKGROUND: Clinicians delivering palliative care require the specific knowledge, skill and understanding to meet the needs of the dying. Research shows that undergraduate nursing students report feeling inadequately prepared to provide safe and effective palliative care. OBJECTIVES: To identify existing empirical evidence on generalist palliative care content within international undergraduate nursing curricula and to synthesize existing generalist palliative care topics. DESIGN: An integrative systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO). DATA SOURCES: Keywords were searched in six electronic databases CINAHL, Medline, APA PsycINFO, SCOPUS, Cochran Library and ProQuest Nursing & Allied Health Database, between January 2000 and February 2022. REVIEW METHODS: Studies were selected as per a pre-determined inclusion and exclusion criteria. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Tabulation of the author, year, country, aim, participants and setting, method, generalist palliative care content topics, additional findings and limitations were compiled. A thematic analysis of the data was conducted to organise and categorise generalist palliative care topics into an additional table followed by a narrative synthesis. RESULTS: Of the n = 1014 papers retrieved, n = 13 studies of varying methodological quality were included in the analysis (n = 8 quantitative descriptive, n = 5 mixed method). Most studies were published in high income countries with developed economies. Methods used to obtain data include survey, extraction of secondary data and expert consensus. Generalist palliative care topics were presented as a list reporting frequency taught/discussed/cited (n = 10), recommended competencies (n = 2), and teaching modules (n = 1). A large variety of topics were identified with differing levels of detail and clear differences in topics identified globally. Overall, the most frequently mentioned generalist palliative care topics were pain and symptom management (n = 12), grief loss & bereavement (n = 12) and communication (n = 11). CONCLUSIONS: This review demonstrates for the first time that international primary research evidence on generalist palliative care content in undergraduate nursing curriculum is minimal, of varying methodological quality, with visible inconsistencies among studies designed to inform curriculum verses studies reporting what is taught to students. More research is required to create evidence informed generalist palliative care content for undergraduate nursing curriculum. RECOMMENDATIONS: It is recommended for future research to use international consensus-based methods to inform and develop internationally agreed educational topics to optimise patient care at the point of nurse registration.

Exploring the formal assessment discussions in clinical nursing education: An observational study.

INTRODUCTION: According to EU standards, 50% of the bachelor education program in nursing should take place in clinical learning environments. Consequently, this calls for high quality supervision, where appropriate assessment strategies are vital to optimize students' learning, growth, and professional development. Despite this, little is known about the formal assessment discussions taking place in clinical nursing education. OBJECTIVE: The aim of this study was to explore the characteristics of the formal assessment discussions taking place during first-year students' clinical education in nursing homes. METHOD: An exploratory qualitative study was performed. The data consist of passive participant observations of 24 assessment discussions (12 mid-term and 12 final assessments) with first-year nursing students (n=12), their assigned registered nurse mentors (n=12) and nurse educators (n=5). The study was conducted in three public nursing homes in a single Norwegian municipality. Data were subjected to thematic analysis. The findings were reported using the Standards for Reporting of Qualitative Research. RESULTS: Three themes were identified regarding the characteristics of the formal assessment discussions: (1) adverse variability in structuring, weighting of theoretical content and pedagogical approach; (2) limited three-part dialogue constrains feedback and reflection; and (3) restricted grounds for assessment leave the nurse educators with a dominant role. CONCLUSION: These characteristic signal key areas of attention to improve formal assessment discussions to capitalize on unexploited learning opportunities.

Current issues with the identification of threshold concepts in nursing.

While there has been some growth in the body of literature on threshold concepts in health science disciplines, the nature of this discourse and which approaches have proved successful remains unclear. This paper illustrates one of the primary issues facing the development of threshold concepts in nursing education literature specifically - a lack of transparent and rigorous processes for their identification. The paper briefly examines the methods that have been utilised to identify threshold concepts in the nursing education literature, and what issues using these approaches raise. It then considers how the field might further develop in order to best engage the benefits that threshold concept analysis and identification may have for curriculum development and teaching in nursing.

Signature pedagogies: An integrative review of an emerging concept in nursing education.

OBJECTIVES: The aim of this paper is to provide an integrative review of the literature associated with signature pedagogies and to discover what lessons have been learned about unearthing, articulating and applying signature pedagogies across a variety of disciplines, but particularly with respect to nursing. DESIGN: A systematic search of databases using key terms was utilised with a particular focus to papers emerging from nursing disciplines. DATA SOURCES: The databases MEDLINE, CINAHL, ERIC, Web of Science and Google Scholar were searched for literature from 2005 to 2018 inclusive. REVIEW METHODS: An initial examination of titles and abstracts by the authors resulted in the retrieval of 45 papers and following the application of exclusion criteria, 25 papers were included. RESULTS AND CONCLUSIONS: Signature pedagogy literature is a developing area and scholars both in nursing disciplines and beyond, often fail to develop on Lee Shulman's framework in their identification of signature pedagogies, resulting in poorly adapted conceptions. Ways forward include closer linking with the original signature pedagogy framework in research, the development of robust evidence-based signature pedagogy identification processes in disciplines and a reconsideration of the esteem of scholars performing signature pedagogies within disciplines.

Measuring the outcomes of nursing practice: A Delphi study.

AIMS AND OBJECTIVE: To develop nursing-sensitive patient indicators to measure the outcomes of nursing practice. BACKGROUND: Nurses play an important role in the healthcare system, yet there is no consensus on how the impact of nursing work should be evaluated. Limited research has previously examined the views of clinical nurses on the important concepts for measuring nursing practice. DESIGN: A four-round modified Delphi survey sought opinions from patients and nurses about the relevant concepts and their relative priority as indicators of quality nursing practice. METHOD: Round 1 comprised semi-structured interviews with patients and nurses to identify key concepts. Nurses were then asked to participate in three rounds of Delphi survey to identify and rate key concepts from which indicators were developed. Thematic analysis and descriptive statistics were used to analyse the data. RESULTS: By the end of Round 4, the process had generated 103 concepts and participants had agreed on eight overarching constructs, namely care and caring; communication; coordination and collaboration; safety; patient characteristics; workload; Nurses work environment; and organisational characteristics. CONCLUSIONS: Consensus was achieved between nurses on the most important concepts, which can provide the basis for measuring the quality and safety of nursing practice in a comprehensive and holistic way. RELEVANCE TO CLINICAL PRACTICE: The identification of concepts that patients and nurses consider important for measuring nursing practice will guide the development of methods for evaluating nursing in the future. Ensuring that nursing practice is rigorously evaluated has the potential to identify opportunities to improve nursing quality, patient safety and improve health outcomes.

What level of competency do experienced nurses expect from a newly graduated registered nurse? Results of an Australian modified Delphi study.

BACKGROUND: Individuals who have recently completed accredited courses and are eligible to register as a nurse in Australia are often referred to as not being 'work-ready' by clinically based colleagues. This project identified the level of competence that can be reasonably expected of a newly registered nurse (RN) graduating in Australia. The research was undertaken using the necessary skills identified by Crookes and Brown in 2010. METHODS: A consensus methodology using a modified Delphi technique invited experienced nurses to identify the level of competency expected by the new RN in each of the skills areas. RESULTS: More than half of respondents did not believe that new graduates could practice independently in 18 of the 30 skills areas. There were only four skills areas where more than two thirds of the respondents believed the new graduate could operate independently. CONCLUSIONS: There is a lack of clarity about the level of competency of the newly graduating registered nurse in Australia. The profession and employers need clarity regarding the areas and level of competence that can reasonably be expected of a newly graduated RN. Utilising the findings of this research will enable the skills and competencies to be integrated into eligibility to practice programmes. Further research needs to be undertaken to review the foci of nursing preparation programmes to meet the needs of novice practitioners and the health care consumer population.

Clinical leadership and pre-registration nursing programmes: A model for clinical leadership and a prospective curriculum implementation and evaluation research strategy.

AIM: To present for wider debate a conceptual model for clinical leadership development in pre-registration nursing programmes and a proposed implementation plan. BACKGROUND: Globally, leadership in nursing has become a significant issue. Whilst there is continued support for leadership preparation in pre-registration nursing programmes, there have been very few published accounts of curriculum content and/or pedagogical approaches that foster clinical leadership development in pre-registration nursing. A doctoral research study has resulted in the creation of an overarching model for clinical leadership. DESIGN: A multi-method research study using theoretical and empirical literature 1974-2015, a focus group, expert opinion and a national on-line survey. DISCUSSION: A conceptual model of clinical leadership development in pre-registration nursing programme is presented, including the infinity loop of clinical leadership, an integral curriculum thread and a conceptual model: a curriculum-pedagogy nexus for clinical leadership. In order to test out usability and evaluate effectiveness, a multi method programme of research in one school of nursing in Australia is outlined. CONCLUSION: Implementation of the proposed conceptual model for clinical leadership development in pre-registration nursing programmes and a programme of (post-doctoral) research will contribute to what is known about curriculum content and pedagogy for nurse academics. Importantly, for nursing students and the profession as a whole, there is a clearer expectation of what clinical leadership might look like in the novice registered nurse. For nurse academics a model is offered for consideration in curriculum design and implementation with an evaluation strategy that could be replicated.

What are the 'necessary' skills for a newly graduating RN? Results of an Australian survey.

BACKGROUND: There appears to be a sense of disappointment with the product of contemporary nursing programs in Australia in that new graduate RNs are often referred to as not possessing appropriate skills by clinical colleagues. This work identifies the skills that the profession believes that newly graduating RN's should possess at the point of registration. METHODS: A qualitative consensus methodology was used in the form of a modified Delphi survey. Expert panels were used to review and validate data. RESULTS: Consensus was reached on the top 25 skills areas that can be reasonably expected of a new graduate Registered Nurse in Australia. The top ranked skills areas included efficient and effective communication, professional nursing behaviours, privacy and dignity and managing medication administration. CONCLUSIONS: The consensus methodologies used to develop the skills areas indicated broad agreement across the profession in Australia. The complexity and context of practice was highlighted in the comments within the Delphi rounds. Interestingly no new skills were added and none removed from the initial list - some were prioritised over others but the majority agreed that all the skills areas were important for a newly graduating nurse.

Clinical leadership development in a pre-registration nursing curriculum: What the profession has to say about it.

BACKGROUND: In the last decade literature, inquiries and reports into the short comings in health services have highlighted the vital role of leadership in clinical practice and the impact on patient care and effective workplace culture. Whilst there is an abundance of literature on leadership and the registered nursing workforce, an international literature review revealed there is very little known on leadership development in pre-registration nursing programmes. OBJECTIVE: To identify what the profession's views are on proposed indicative curriculum content suggested for clinical leadership development in a pre-registration nursing degree in Australia. DESIGN: This is a multi-method research study. This paper presents the development and results of one aspect of the study, a national online survey. PARTICIPANTS: Nurses: clinicians, managers and academics. METHODS: In the absence of a strong evidence base in the literature review, additional pre-requisite curriculum content was augmented from the work of two published frameworks of leadership and management. From this a 67-item survey was designed to ask the profession whether the aggregated content is a reasonable view of what should be included in a pre-registration programme to develop clinical leadership. The survey sought the views of nurses on whether the proposed content was relevant (yes/no) and their opinion on whether it is significant via a 5-point Likert scale. Descriptive and chi-square analyses were performed in SPSS v.19. RESULTS: A total of 418 nurses completed the survey; there was consensus amongst the profession on what is considered relevant and important in a pre-registration nursing programme. CONCLUSIONS: The content identified could be considered indicative and pre-requisite to include in a pre-registration nursing programme. Members of the nursing profession in Australia have clear views about this. The next step is to design and evaluate a purposeful pedagogical approach and curriculum, leading to the development of clinical leadership knowledge, skills and behaviours in newly graduating nurses.

Clinical leadership as an integral curriculum thread in pre-registration nursing programmes.

BACKGROUND: In recent years there has been a growth in leadership development frameworks in health for the existing workforce. There has also been a related abundance of leadership programmes developed specifically for qualified nurses. There is a groundswell of opinion that clinical leadership preparation needs to extend to preparatory programmes leading to registration as a nurse. To this end a doctoral research study has been completed that focused specifically on the identification and verification of the antecedents of clinical leadership (leadership and management) so they can shape the curriculum content and the best way to deliver the curriculum content as a curriculum thread. OBJECTIVES: To conceptualise how the curriculum content, identified and verified empirically, can be structured within a curriculum thread and to contribute to the discussion on effective pedagogical approaches and educational strategies for learning and teaching of clinical leadership. DESIGN: A multi-method design was utilised in the research in Australia. Drawing on core principles in critical social theory, an integral curriculum thread is proposed for pre-registration nursing programmes that identifies the antecedents of clinical leadership; the core concepts, together with the continuum of enlightenment, empowerment, and emancipation. CONCLUSIONS: The curriculum content, the effective pedagogical approaches and the educational strategies are supported theoretically and we believe this offers a design template for action and a way of thinking about this important aspect of preparatory nursing education. Moreover, we hope to have created a process contributing to a heighten sense of awareness in the nursing student (and other key stakeholders) of the what, how and when of clinical leadership for a novice registered nurse. The next stage is to further test through research the proposed integral curriculum thread.

An audit of skills taught in registered nursing preparation programmes in Australia.

BACKGROUND: A competitive Carrick Institute Competitive Grant (CG7-523) was obtained to explore what skills were taught and what assessment of practice approaches were used in nursing programmes in Australia. The intention was twofold; firstly to identify what skills were being taught which would contribute to the development of an assessment of practice toolkit for eligibility to practice programmes in Australia. This paper specifically reports on the skills taught in nursing programmes in Australia. METHODS: A qualitative research methodology was used through a documentary analysis of university curriculum documents. This was undertaken independently by two researchers; the data was then reviewed by an expert group. The skills taught were explored, listed and categorised using a conceptual framework, then refined and reported. RESULTS: Over 1300 skills were initially identified within nursing programmes across Australia; these were 'clustered' using a framework into 30 skills areas. These included psychomotor skills to skills areas that relate to human factors such as communication, team work, leadership and supervision. CONCLUSIONS: A wide range of skills were referred to in university nursing programme curriculae in Australia. There were some significant variations; some universities taught their student nurses how to manage a client/patient requiring external invasive ventilator support. There were however a number of similar skills areas identified; such as acute care assessment skills (monitoring vital signs) and mental health assessment skills. The range of skills taught within nursing curriculum is challenging as there is only limited time to expose students to those skills and afford the student the opportunity to practice those skills in order to achieve competence prior to registration.

History as reflective practice: A model for integrating historical studies into nurse education.

The role of history in developing professional identity in nursing is well known, and the discipline of nursing history research continues to flourish. Yet this work often struggles to find its way into undergraduate university nurse education courses. We put forward a model for "history as reflective practice" in which we suggest that historical studies can be used as a form of evidence to develop critical thinking and clinical reasoning, as well as situate nursing practice within its social and political context. In this model, we draw on historical scholarship related to the profession, practice and person, focusing on work which demonstrates nursing's contribution to broader systems of health care. Drawing on Lewenson and Lynaugh's 'history by stealth' approach, curriculum mapping and constructive alignment techniques are used to identify the moments in an existing programme where historical scholarship is relevant to an intended learning outcome. We then use an interdisciplinary team to develop learning activities and assessment tasks drawing on both primary and secondary sources that are then embedded within existing subjects. This model encourages students to consider history as a way of knowing and as a form of evidence within their reflective practice. Furthermore, it creates knowledge that continues to foster and acknowledge nurses', and nursing's, contribution to the development of human health.

Clinical leadership in pre-registration nursing programmes--an international literature review.

BACKGROUND: Clinical leadership and the safety, quality and efficiency of patient/client care are inextricably linked in government reports, major inquiries and the professional literature. OBJECTIVES: This review explores the literature on clinical leadership development within pre-registration nursing programmes. METHOD: The literature retrieved from a scoping review was evaluated to identify what is already published on the development of clinical leadership within pre-registration nursing programmes. Twenty-seven publications matched the inclusion criteria and were included in this review, 14 journal articles, one thesis and 11 chapters within one book were analysed and three themes were identified: clinical leadership; curriculum content and pedagogy. RESULTS AND MAIN OUTCOMES: This review identified a paucity of literature specifically relating to clinical leadership and pre-registration nursing programmes and what is available is inconclusive and unconvincing. CONCLUSIONS: Academics, curriculum development leaders and accreditation bodies have a responsibility to influence how nurses are prepared for the profession as such clinical leadership and the new graduate should be considered an area of greater importance.

A model of adaptation of overseas nurses: exploring the experiences of Japanese nurses working in Australia.

PURPOSE: The purpose of the study was to investigate the experiences of Japanese nurses and their adaptation to their work environment in Australia. Using a qualitative research method and semistructured interviews, the study aimed to discover, describe, and analyze the experiences of 14 Japanese nurses participating in the study. DESIGN: A qualitative study. METHOD: Fourteen Japanese registered nurses working in Australian hospitals participated in the study. Individual semistructured interviews were conducted from April to June in 2008. Thematic analysis was used to identify themes within the data. RESULTS: Analysis of qualitative open-ended questions revealed the participants' adaptation process. It consists of three themes or phases: seeking (S), acclimatizing (A), and settling (S), subsequently named the S.A.S. model. DISCUSSION: The conceptual model of the adaptation processes of 14 Japanese nurses working in Australia includes the seeking, acclimatizing, and settling phases. Although these phases are not mutually exclusive and the process is not necessarily uniformly linear, all participants in this study passed through this S.A.S. model in order to adapt to their new environment. IMPLICATIONS FOR PRACTICE: The S.A.S. model of adaptation helps to describe the experiences of Japanese overseas qualified nurses working in Australian hospitals. Future research is needed to examine whether this model can be applied to nurses from other countries and in other settings outside Australia.

Meaningful and engaging teaching techniques for student nurses: a literature review.

Helping undergraduate nursing students to contextualise theory learnt in the classroom to their professional practice can be challenging for nurse educators. This article provides a critical review of contemporary literature that explores strategies and techniques that nurse educators within university settings have adopted to address this challenge. This review was conducted as part of a broader research project that involved interviewing nurse educators to explore how they attempt to make their teaching meaningful and engaging for student nurses. The data was analysed using thematic analysis and the intention is to share the wealth of ideas gleaned with other nurse educators, including in the form of an evidence-based inventory of teaching approaches found to be effective in enhancing the meaningfulness and engagement of content to nursing learners.

Clinical simulation in Australia and New Zealand: through the lens of an advisory group.

Across Australia, innovations in simulation to enhance learning in nursing have been occurring for three decades and nursing is, and needs to be, a leading player in simulation knowledge diffusion. However, expertise is unevenly distributed across health services and education providers. Rather than build on the expertise and achievements of others, there is a tendency for resource duplication and for trial and error problem solving, in part related to a failure to communicate achievements for the benefits of the professional collective. For nursing to become a Leader in the use of simulation and drive ongoing development, as well as conducting high quality research and evaluation, academics need to collaborate, aggregate best practice in simulation learning, and disseminate that knowledge to educators working in health services and higher education sectors across the whole of Australia and New Zealand. To achieve this strategic intent, capacity development principles and committed action are necessary. In mid 2010 the opportunity to bring together nurse educators with simulation learning expertise within Australia and New Zealand became a reality. The Council of Deans of Nursing and Midwifery (CDNM) Australia and New Zealand decided to establish an expert reference group to reflect on the state of Australian nursing simulation, to pool expertise and to plan ways to share best practice knowledge on simulation more widely. This paper reflects on the achievements of the first 18 months since the group's establishment and considers future directions for the enhancement of simulation learning practice, research and development in Australian nursing.

The Study of Nursing Care project: back to the future for contemporary nursing research?

AIMS: To discuss the Study of Nursing Care project, an initiative from the late 1970s in the UK. The article explores the impact of the Study of Nursing Care on nursing research, and considers to what extent it presents a useful model for contemporary nursing research. BACKGROUND: It is acknowledged internationally that the nursing academic workforce is ageing and dwindling. Many possible solutions are being debated with all agreeing that the next generation of evidence based nurse leaders is urgently required. DATA SOURCES: In this article, the authors survey existing workforce schemes, describe the Study of Nursing Care series, published in the 1970s, and draw on interviews and correspondence conducted in 2009 with four of the original Study of Nursing Care research assistants. DISCUSSION: The Study of Nursing Care project poses a potential response to academic workforce issues. This article discusses the evolution of the project, its methods and operation and considers its possible implications for contemporary practice. Implications for nursing. The Study of Nursing Care model demonstrates the clear benefits of fully committed funding, a programmatic approach towards research development, and the importance of selecting the right kind of people for the work, in a national scheme. CONCLUSION: The authors argue that although the clinical outcomes it set out to achieve remain elusive, the project produced a cohort of nurse researchers who went on to give important leadership in nursing, including in nursing academia/research. A contemporary version of the Study of Nursing Care has important potential to generate the next generation of nurse researchers, and leaders, into the twenty-first century.