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.

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.

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.

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.

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.

Scholarship reconsidered: implications for reward and recognition of academic staff in schools of nursing and beyond.

AIMS: This paper discusses the issues facing the nursing academic workforce and the development of a project at the University of Wollongong in Australia which attempts to address this problem. BACKGROUND: The project draws on Boyer's work around 'scholarship reconsidered' to enable new ways of thinking about the nature of 'research' and how the work of a diversifying workforce can be recognized and rewarded within institutions. METHODS: We conducted a series of interviews with senior university staff to identify key issues around academic promotion processes. Feedback from these interviews, along with extensive internal and external consultation and benchmarking, will be used to redraft promotion documentation that includes discipline-specific performance expectations. RESULTS: Interviews revealed a number of perceived and actual barriers to promotion of academic staff who did not conform to a 'traditional' view of research expectations. It was widely felt that unspoken expectations about research performance were being used to judge applications for promotion, and that this disadvantaged people from practice or professional backgrounds, or people who had heavy administrative or clinical roles. CONCLUSIONS: Internal university processes need to reflect the reality of a diversified workforce. Practice and professional disciplines have responsibilities beyond meeting traditional research output measurements. More flexible and transparent expectation guidelines and career development pathways are needed to build holistic schools and faculty and enable maximum staff productivity. IMPLICATIONS FOR NURSING MANAGEMENT: By redefining scholarship, schools and faculties are able to meet the multiple demands of the government, the institution, individual staff, students and the profession. Not everyone can do traditional research all the time, and staff involved in other scholarly work should be able to rewarded and promoted. By taking the lead in this issue, nursing as a discipline can set its own agenda, and pave the way for other disciplines. It can also go a long way to solving issues around the dwindling academic workforce.

Teaching critical appraisal skills for nursing research.

BACKGROUND: Evidence-based practice is a major focus in nursing, yet the literature continues to document a research-practice gap. Reasons for this gap stem partly from a lack of skills to critique and synthesize the literature, a lack of search skills and difficulty in understanding research articles, and limited knowledge of research by nursing professionals. METHOD: An innovative and quality driven subject to improve critical appraisal and critical thinking skills was developed for the School of Nursing, Midwifery and Indigenous Health at the University of Wollongong, based on formative research with postgraduate students and supervisors. Through face-to-face and online teaching modules students worked through a structured process of analysing the key aspects of published papers using structured analysis tools for each study design. RESULTS: Pre and post surveys of students found improvements in perceived knowledge of all key skills of critical appraisal. External independent evaluation determined that it was a high quality subject showing many hallmarks of good assessment practice and good practice in use of information and communication technology (ICT) in support of the learning outcomes.

Multidisciplinary Team Care Arrangements in the management of patients with chronic disease in Australian general practice.

OBJECTIVE: To explore factors associated with the frequency of multidisciplinary Team Care Arrangements (TCAs) and the impact of TCAs on patient-assessed quality of care in Australian general practice. DESIGN AND SETTING: Data were collected as part of a cluster randomised controlled trial conducted in 60 general practices in New South Wales, the Australian Capital Territory and Victoria between July 2006 and June 2008. Multilevel logistic regression analysis evaluated factors associated with the frequency of TCAs recorded in the 12 months after baseline, and multilevel multivariable analysis examined the association between TCAs and patient-assessed quality of chronic illness care, adjusted for patient and practice characteristics. MAIN OUTCOME MEASURES: Frequency of TCAs; Patient Assessment of Chronic Illness Care (PACIC) scores. RESULTS: Of 1752 patients with clinical audit data available at 12-month follow-up, 398 (22.7%) had a TCA put in place since baseline. Women, patients with two or more chronic conditions, and patients from metropolitan areas had an increased probability of having a TCA. There was an association between TCAs and practices with solo general practitioners and those with greater levels of teamwork involving non-GP staff for the control group but not the intervention group. Patients who had a TCA self-assessed their quality of care (measured by PACIC scores) to be higher than those who did not. CONCLUSIONS: Findings were consistent with the purpose of TCAs--to provide multidisciplinary care for patients with longer-term complex conditions. Significant barriers to TCA use remain, especially in rural areas and for men, and these may be more challenging to overcome in larger practices.

The development of a ranking tool for refereed journals in which nursing and midwifery researchers publish their work.

Publication in quality journals has long been a yardstick for measuring academic performance, although there is a divergence of opinions as to how to define and measure "journal quality". For some time the primary tools for assessing journal quality have been the ISI Journal Citation Reports and the Journal Impact Factors (JIFs), although it has been argued that these are less appropriate for practical disciplines such as nursing midwifery. In order to accurately reflect the nature of nursing and midwifery as a discipline, given the inherent flaws of using just one indicator of journal quality to assess performance overall, this project was designed to develop a tool which combined both objective and subjective methods to produce a ranking system which is specifically relevant to the disciplines of nursing and midwifery. This project succeeded in developing the Journal Evaluation Tool (JET), through extensive consultations with experts in the fields of nursing and midwifery. This tool may overcome some problems associated with the sole use of the journal impact factor, and may be utilised as an alternative measure of journal quality. The new tool was tested using a sample of 52 responding journals; and has now been disseminated to nursing and midwifery bodies in Australia and New Zealand, along with instructions for its use and recommendations for future research.

Developing scholarship in nursing - steps within a strategy.

This paper seeks to share with the reader some of the mechanisms currently being used to generate scholarship in academic nursing, both at the institutional and individual levels. It then goes on to explore other ways in which educational managers might encourage scholarly activity. Finally, it presents the crystallization of ideas generated during discussions conducted with lecturers focusing on their selection of a workable path towards a future of scholarship, for them as an academic. It is intended as food for thought for managers of educational programmes and individual nurse academics as they scan the horizons of the future in an attempt to make the 'best' decisions for the profession of nursing and individuals within it.