Developing a spiritual care competency framework for pre-registration nurses and midwives.

This paper identifies competencies in spiritual care from an in-depth literature review and develops a theoretical framework for competencies in spiritual care. It forms part of a larger modified Delphi study which recruited international nursing/midwifery experts. Using Braun and Clark (2006) adapted six-phase content thematic analysis, 7 domains and 116 competency items were generated from an in-depth literature review in three areas; spirituality and spiritual care, spiritual care education, and spiritual care curricular contents.

Design and development of a spiritual care competency framework for pre-registration nurses and midwives: A modified Delphi study.

This is the second of two papers reporting the development of a spiritual care competency framework for pre-registration nurses and midwives as part of a PhD study using an embedded sequential mixed methods eclectic research design. The first paper outlines how 116 competency items were generated from an in-depth review of international literature, and offers a theoretical model to underpin development of the Framework. AIM: This paper reports how the Framework was developed. METHOD/RESULTS: Five focus groups were held with stakeholders in Malta (chaplains/spiritual leaders, undergraduate nursing/midwifery educators, qualified nurses/midwives, parents/carers, patients/clients) to ensure that aspects of spirituality/spiritual care important to them, but not identified in the literature review, were included in the Framework. The resulting 55 competencies in seven domains formed the Delphi Questionnaire which was validated using a two round modified Delphi method involving experts from Malta. The final seven domain 54 item Framework demonstrated good to strong internal consistency, stability and a good fit with a six factor model. CONCLUSION: The Framework's greatest immediate contribution is in its ability to inform undergraduate nursing/midwifery spiritual care curriculum design and delivery. Further development of the Framework could assist in student selection ensuring that the 'art' of nursing/midwifery has parity with the 'science'.

Developing and integrating nursing competence through authentic technology-enhanced clinical simulation education: Pedagogies for reconceptualising the theory-practice gap.

The aim of this review and discussion paper is to advance the debate on competence in nursing, simulation education, and literacy in simulation education pedagogy. Building on our previous patient-safety critical translational research work on drug dosage calculation-competence modelling, and safeMedicate® virtual learning and diagnostic assessment environment design, we introduce three new concepts. First, we re-conceptualise the cognitive and physical modalities of a theory-practice gap, created by the traditional organisation of health professional education practice. Second, that simulated clinical environments occupy the liminal spaces between the ordered, symbolic and abstract world of the classroom, and the situated, messy world of clinical healthcare practice. Third, technology-enhanced boundary objects (TEBOs) function as simulation pedagogy modalities that (a) support students' transition across the liminal space and boundaries between classroom and practice setting, and (b) support competence development and integration in nursing. We use a constructivist-based clinical simulation education model as a guiding pedagogical framework for applying TEBOs and an integrated nursing competence model. The e-version of the paper has embedded animation and illustrative video content to demonstrate these constructivist principles, using technology and computer animation to make complex education ideas accessible to experienced educators and clinicians, early-stage educators, and nursing and healthcare students.

Safety in numbers 2: Competency modelling and diagnostic error assessment in medication dosage calculation problem-solving.

Accurately defining and modelling competence in medication dosage calculation problem-solving (MDC-PS) is a fundamental pre-requisite to measuring competence, diagnosing errors and determining the necessary design and content of professional education programmes. In this paper we advance an MDC-PS competence model that illustrates the relationship between conceptual competence (dosage problem-understanding), calculation competence (dosage-computation) and technical measurement competence (dosage-measurement). To facilitate bridging of the theory-practice gap it is critical that such models are operationalised within a wider education framework that supports the learning, assessment and synthesis of cognitive competence (the knowing that and knowing why of MDC-PS) and functional competence (the know-how and skills associated with the professional practice of MDC-PS in clinical settings). Within the context of supporting the learning and diagnostic assessment of MDC-PS we explore PhD fieldwork that challenges the value of pedagogical approaches that focus solely on abstract information, that isolate the process of knowledge construction from its application in practice settings and contribute to the generation of conceptual errors. We consider misconceptions theory and the concept of mathematical 'dropped stitches' and offer an assessment model and program designed to diagnose flawed arithmetical operation and computation constructs.

Safety in numbers 5: Evaluation of computer-based authentic assessment and high fidelity simulated OSCE environments as a framework for articulating a point of registration medication dosage calculation benchmark.

This paper reports a key educational initiative undertaken by NHS Education for Scotland (NES), based upon recommendations from a 'Numeracy in Healthcare' consultation. We report here the design of a web-based technical measurement authentic assessment environment evolved from the safeMedicate suite of programs that provided a model for an environment within which a medication dosage calculation problem-solving (MDC-PS) benchmark could be articulated. A sample of 63 third-year pre-registration nursing students was recruited from four participating universities in the UK. A counterbalanced design was employed where the virtual authentic assessment environment was evaluated for internal consistency reliability and criterion-related validity against an objective structured clinical assessment (OSCE) undertaken in high-fidelity simulated clinical environments. Outcome measures indicated an extremely high internal consistency of the web-based environment. It was concluded that the combination of a web-based authentic assessment environment and further assessment of safe technical measurement interpretation and dexterity in a practice/practice simulation setting, populated with a benchmark and a criterion referenced rubric validated by the profession, is an innovative, viable, valid and reliable assessment method for the safe administration of medicines. As a result, the rubric for assessment of the appropriate range of calculation type and complexity informed the NMC's revised Essential Skills Clusters for Medicines Management (NMC, 2010a; NMC, 2010b). This inclusion provides a particularly strong example of both research directly influencing policy and of evidence-based regulation.

Safety in numbers 4: The relationship between exposure to authentic and didactic environments and nursing students' learning of medication dosage calculation problem solving knowledge and skills.

Advancing the art and science of education practice requires a robust evaluation of the relationship between students' exposure to learning and assessment environments and the development of their cognitive competence (knowing that and why) and functional competence (know-how and skills). Healthcare education translation research requires specific education technology assessments and evaluations that consist of quantitative analyses of empirical data and qualitative evaluations of the lived student experience of the education journey and schemata construction (Weeks et al., 2013a). This paper focuses on the outcomes of UK PhD and USA post-doctorate experimental research. We evaluated the relationship between exposure to traditional didactic methods of education, prototypes of an authentic medication dosage calculation problem-solving (MDC-PS) environment and nursing students' construction of conceptual and calculation competence in medication dosage calculation problem-solving skills. Empirical outcomes from both UK and USA programmes of research identified highly significant differences in the construction of conceptual and calculation competence in MDC-PS following exposure to the authentic learning environment to that following exposure to traditional didactic transmission methods of education (p < 0.001). This research highlighted that for many students exposure to authentic learning environments is an essential first step in the development of conceptual and calculation competence and relevant schemata construction (internal representations of the relationship between the features of authentic dosage problems and calculation functions); and how authentic environments more ably support all cognitive (learning) styles in mathematics than traditional didactic methods of education. Functional competence evaluations are addressed in Macdonald et al. (2013) and Weeks et al. (2013e).

Safety in numbers 1: Essential numerical and scientific principles underpinning medication dose calculation.

Registered nurses spend up to 40% of their professional clinical practice engaged in the art and science of medication dosage calculation problem-solving (MDC-PS). In advancing this patient safety critical discipline it is our position that as a profession we must first situate MDC-PS within the context of the wider features of the nursing numeracy, medicines management and clinical pharmacokinetic domains that inform its practice. This paper focuses on the essential relationship between numeracy, healthcare numeracy, medicines management, pharmacokinetics and MDC-PS. We present a taxonomy of generic numerical competencies for the pre-registration curriculum, with examples of essential medication dosage calculation requirements mapped to each skills domain. This is followed by a review of the symbols and measurement units that represent essential components of calculation competence in healthcare and medicines management practice. Finally we outline the fundamental pharmacokinetic knowledge that explains how the body deals with medication and we illustrate through clinical correlations why numeric and scientific knowledge and skills must be mastered to ensure safe dosage calculation and medicines management practice. The findings inform nurse education practice via advancing our understanding of a number of issues, including a unified taxonomy of generic numerical competencies mapped to the 42 revised UK Nursing and Midwifery Council (NMC) Essential Skills Clusters (NMC, 2010a; NMC, 2010b).

Safety in numbers 7: Veni, vidi, duci: a grounded theory evaluation of nursing students' medication dosage calculation problem-solving schemata construction.

This paper evaluates nursing students' transition through schemata construction and competence development in medication dosage calculation problem-solving (MDC-PS). We advance a grounded theory from interview data that reflects the experiences and perceptions of two groups of undergraduate pre-registration nursing students: eight students exposed to a prototype authentic MDC-PS environment and didactic transmission methods of education and 15 final year students exposed to the safeMedicate authentic MDC-PS environment. We advance a theory of how classroom-based 'chalk and talk' didactic transmission environments offered multiple barriers to accurate MDC-PS schemata construction among novice students. While conversely it was universally perceived by all students that authentic learning and assessment environments enabled MDC-PS schemata construction through facilitating: 'seeing' the authentic features of medication dosage problems; context-based and situational learning; learning within a scaffolded environment that supported construction of cognitive links between the concrete world of clinical MDC-PS and the abstract world of mathematics; and confidence-building in their cognitive and functional competence ability. Drawing on the principle of veni, vidi, duci (I came, I saw, I calculated), we combined the two sets of evaluations to offer a grounded theoretical basis for schemata construction and competence development within this critical domain of professional practice.

Safety in numbers: an introduction to the Nurse Education in Practice series.

This paper introduces this Nurse Education in Practice 'Safety in Numbers' series. We introduce the background and seven papers that explore the outcomes of a 20-year programme of healthcare education translation research and education action research that focuses on medication dosage calculation problem-solving (MDC-PS) education.

Safety in numbers 3: Authenticity, Building knowledge & skills and Competency development & assessment: the ABC of safe medication dosage calculation problem-solving pedagogy.

When designing learning and assessment environments it is essential to articulate the underpinning education philosophy, theory, model and learning style support mechanisms that inform their structure and content. We elaborate on original PhD research that articulates the design rationale of authentic medication dosage calculation problem-solving (MDC-PS) learning and diagnostic assessment environments. These environments embody the principles of authenticity, building knowledge and skills and competency assessment and are designed to support development of competence and bridging of the theory-practice gap. Authentic learning and diagnostic assessment environments capture the features and expert practices that are located in real world practice cultures and recreate them in authentic virtual clinical environments. We explore how this provides students with a safe virtual authentic environment to actively experience, practice and undertake MDC-PS learning and assessment activities. We argue that this is integral to the construction and diagnostic assessment of schemata validity (mental constructions and frameworks that are an individual's internal representation of their world), bridging of the theory-practice gap and cognitive and functional competence development. We illustrate these principles through the underpinning pedagogical design of two online virtual authentic learning and diagnostic assessment environments (safeMedicate and eDose™).

Safety in numbers 6: Tracking pre-registration nursing students' cognitive and functional competence development in medication dosage calculation problem-solving: the role of authentic learning and diagnostic assessment environments.

Tracking the progress of pre-registration nursing students' medication dosage calculation problem-solving (MDC-PS) competence development is critical both to ensure achievement of professional and regulatory requirements and to evaluate the validity and reliability of nursing education preparation programmes. This paper focuses on the outcomes of a three-year professional healthcare education evaluation study that tracked the progress of 210 nursing students following the foundation programme and child, adult, mental health and learning disability branch programmes of a UK undergraduate pre-registration nursing degree programme. Outcome measures indicated that despite many students displaying a range of arithmetical deficits on entry to the undergraduate programme, exposure to the safeMedicate environment and practice based learning environments facilitated all 210 participants demonstration of:

Numeracy for nursing, report of a pilot study to compare outcomes of two practical simulation tools--an online medication dosage assessment and practical assessment in the style of objective structured clinical examination.

UNLABELLED: This pilot study compares the results of medications calculations carried out by student nurses using an online assessment tool with the results of the same calculations carried out within simulated practice. The numeracy project, of which this is part, is funded by NHS Education for Scotland (NES). OBJECTIVE: To test the efficacy of a realistic computer-based assessment of pre-registration nurses' medication calculations skills by comparing outcomes from using an online assessment tool with a practical assessment tool in the style of an Objective Structured Clinical Examination OSCE. Both assessment methods used medicine calculations usually presenting authentically in the practice setting. DESIGN: A multi-stage quantitative study using a cross-over design. SAMPLE: Fifty early 3rd year students on the adult branch of a pre-registration nursing programme at a large school of nursing in England. RESULTS: Results showed that, for assessing accuracy of calculation, there was a high level of congruence between the two methods. CONCLUSIONS: Computerised assessment of medications calculations using this particular platform is likely to closely mirror assessment of medication calculations done in a practical setting. As such it could be a useful adjunct to current assessment methods.