The impact of a simulated intervention on attitudes of undergraduate nursing and medical students towards end of life care provision

Background: The concerns of undergraduate nursing and medical students’ regarding end of life care are well documented. Many report feelings of emotional distress, anxiety and a lack of preparation to provide care to patients at end of life and their families. Evidence suggests that increased exposure to patients who are dying and their families can improve attitudes toward end of life care. In the absence of such clinical exposure, simulation provides experiential learning with outcomes comparable to that of clinical practice. The aim of this study was therefore to assess the impact of a simulated intervention on the attitudes of undergraduate nursing and medical students towards end of life care.
Methods: A pilot quasi-experimental, pretest-posttest design. Attitudes towards end of life care were measured using the Frommelt Attitudes Towards Care of the Dying Part B Scale which was administered pre and post a simulated clinical scenario. 19 undergraduate nursing and medical students were recruited from one large Higher Education Institution in the United Kingdom.
Results: The results of this pilot study confirm that a simulated end of life care intervention has a positive impact on the attitudes of undergraduate nursing and medical students towards end of life care (p < 0.001).
Conclusions: Active, experiential learning in the form of simulation teaching helps improve attitudes of undergraduate nursing and medical students towards end of life. In the absence of clinical exposure, simulation is a viable alternative to help prepare students for their professional role regarding end of life care.

Addressing the theory practice gap in nurse education: evaluating teaching through audit against NMC standards and final management placement

Introduction
This paper outlines an innovative approach to auditing and evaluating the content of a management and leadership module for undergraduate nursing students after their final management clinical placement. Normally evaluations of teaching in a module take place at the end of a teaching module and therefore do not properly reflect the value of the teaching in relation to practical clinical experience.
Aim
This audit and evaluation sought to explore both the practical value of the teaching and learning, and also the degree to which it the teaching reflected against the NMC Standards of Education and Learning (2010 domain 3).
Methods
Having piloted the evaluative tool with an earlier cohort of nursing students, this evaluation explored both a quantitative assessment employing a Personal Response System (n =172), together with a qualitative dimension (n=116), thus delivering paper-based comments and reflections from students on the value and practicality of the module teaching theory to their final clinical management experience. The quantitative audit data were analysed for frequencies and cross tabulation and the qualitative audit data were thematically analysed.
Results
Results suggest a significant proportion of the students, appreciated the quality of the standard of teaching, but more importantly, ‘valued or highly valued’ the teaching and learning in relation to how it helped to significantly inform their management placement experience. A smaller proportion of the students underlined limitations and areas in which further improvement can be made in teaching and learning to the module.
Conclusion
Significantly positive evaluation by the students of the practical value of teaching and learning, to the theoretical management module. This has proved a useful auditing approach in assessing the theoretical teaching to student’s Level 3 clinical experience, and facilitated significant recommendations as far as developing the teaching and learning to better reflect the practice needs of nursing students

A literature review to Examine the Validity and Reliability of group poster presentations as an assessment method of a module in an undergraduate nursing degree programme

The introduction of a poster presentation as a formative assessment method over a multiple choice examination after the first phase of a three phase “health and well-being” module in an undergraduate nursing degree programme was greeted with a storm of criticism from fellow lecturers stating that poster presentations are not valid or reliable and totally irrelevant to the assessment of learning in the module. This paper seeks to investigate these criticisms by investigating the literature regarding producing nurses fit for practice, nurse curriculum development and wider nurse education, the purpose of assessment, validity and reliability to critically evaluate the poster presentation as a legitimate assessment method for these aims.

Implementing change in practice: Part 2- the change process

Pain management in premature and sick babies has long been recognisedas a vital component of neonatal care; however practices pertaining to painassessment and administration of analgesia remain variable in Neonatal Units(NNU). Sucrose has been identified as an effective agent in reducing pain during minorpainful procedures in premature babies but the uptake has been modest.This article (part 2) follows on from an earlier article on evidence to support theimplementation of sucrose administration as a measure for pain relief for minorprocedures (part 1) and will centre on practice-based change in the NNU and reflecton the strategies used as well as the effectiveness of the proposed change. A theoreticalchange model will be used as a framework to help unpack the influencesinherent within the change process.

Nursing Home Care- Nursing Students as Carers discussing and addressing the negatives; a Northern Ireland Perspective

Abstract
The quality of nursing home care for some remains a significant cause of concern. This paper explores and discusses some of the significant critiques and limitations to nursing home care within the UK, particularly and including end of life care. The paper also explores some of the international literature by way of comparison.
Aim
To identify some of the characteristics contributing to the quality of holistic care within nursing homes
Methods
Two short narratives drawn from the experiences of nursing home care within Northern Ireland. The narrators (and co-authors to the paper) are first year student nurses who are also employed (part-time) as carers within nursing homes
Results
The paper identifies evidence of good nursing and care, together with evident quality in end of life care within nursing homes. The paper addresses the context of nursing home care and explores significant characteristics that reflect in the delivery of holistic care to nursing home residents, including the important role of a `culture’ of care, ongoing and specialist training( particularly and including within end of life care) and the important impact in the quality of nursing home leadership.
The paper concludes with some short recommendations to better develop practice within nursing homes

Nursing and medical students as agents of change in health care: impact of schools core values and culture-a discussion paper

Within the UK the quality of care delivered in some hospitals, nursing homes and caring facilities has been the subject of significant enquiry, challenge and concern in recent years. There was need for a change in the culture of patient and client care. Traditionally a change in culture is seen as moving from an organisational head through to the organisation and in this case through to front-line care. This hasn’t necessarily achieved the desired effect and impact in terms of quality of care within the UK. Historically, certainly nurses have acted more as recipients of change, rather than agents of change
This paper suggests that schools of nursing and medicine with robust core values and a more consistently enacted culture of care, are better able and more likely to transfer this to nursing and medical students within their professional socialisation. In addition, and rather than the newly qualified nurse or doctor being absorbed into existing cultures of care delivery (which are not necessarily always reflecting high qualities of care), schools of nursing and medicine could better facilitate the development of more `agency’ within students and better equipping the students on qualification and stepping into practice, with a role and function as potential agents of change. Effective leadership within schools of nursing and medicine can both translate to quality and consistency, and enactment of organisational core values and working culture. The working culture of schools is intrinsic to developing students as agents of change

A 'before and after' study of nursing students' self-assessed competence in identifying the needs of older patients in hospital using an educational workbook.

Background: A core component of nurse education is clinical practice in order to support the development of clinical skills and competence. Assessment and measurement of the clinical competence of nursing students is important to gauge their professional development and educational needs.

Aim: To evaluate the impact of an Older Persons’ Assessment Educational Workbook (OPAEW) and explore second year nursing students’ competence and their opinions and use of the workbook.

Methods: A ‘before and after’ pre-experimental design was undertaken with n=6 second year nursing students. Outcome measures were the Nursing Competencies Questionnaire and the Self-efficacy in Clinical Performance Scale. Content analysis of workbooks and a survey (n=5) of opinions regarding the workbook was undertaken.

Findings: Pre and post test results for the study (n=5) were tested to determine if there was a relationship between changes in the NCQ and SECP repeated measures and use of an OPAEW. Testing identified evidence of a statistically significant difference for both SECP measures (SECP28 p=0.043; SECP7 p=0.042), with no clear statistical evidence of a difference for the NCQ (p=0.08). A weak negative association (NCQ ρ=-0.600 p=0.285; SECP28 ρ=-0.300 p=0.624; SECP7 ρ=-0.205 p=0.741), was found indicating that those participants who scored the lowest scores at the start of the study, benefited most from the workbook.

Content analysis of the OPAEW (n=5) found that 3 of the 5 participants completed all components of the workbook, with a mean of 1051 words used (SD 281.8). Through the survey (n=5) students reported the workbook as a useful guide when undertaking a patient assessment.

Conclusions: The OPAEW showed potential as an intervention to support the development of nursing students’ competence in older person assessment skills.

A 'before and after' study of nursing students' self-assessed competence in identifying the needs of older patients in hospital using an educational workbook.

Background: A core component of nurse education is clinical practice in order to support the development of clinical skills and competence. Assessment and measurement of the clinical competence of nursing students is important to gauge their professional development and educational needs.

Aim: To evaluate the impact of an Older Persons’ Assessment Educational Workbook (OPAEW) and explore second year nursing students’ competence and their opinions and use of the workbook.

Methods: A ‘before and after’ pre-experimental design was undertaken with n=6 second year nursing students. Outcome measures were the Nursing Competencies Questionnaire and the Self-efficacy in Clinical Performance Scale. Content analysis of workbooks and a survey (n=5) of opinions regarding the workbook was undertaken.

Findings: Pre and post test results for the study (n=5) were tested to determine if there was a relationship between changes in the NCQ and SECP repeated measures and use of an OPAEW. Testing identified evidence of a statistically significant difference for both SECP measures (SECP28 p=0.043; SECP7 p=0.042), with no clear statistical evidence of a difference for the NCQ (p=0.08). A weak negative association (NCQ ρ=-0.600 p=0.285; SECP28 ρ=-0.300 p=0.624; SECP7 ρ=-0.205 p=0.741), was found indicating that those participants who scored the lowest scores at the start of the study, benefited most from the workbook.

Content analysis of the OPAEW (n=5) found that 3 of the 5 participants completed all components of the workbook, with a mean of 1051 words used (SD 281.8). Through the survey (n=5) students reported the workbook as a useful guide when undertaking a patient assessment.

Conclusions: The OPAEW showed potential as an intervention to support the development of nursing students’ competence in older person assessment skills.

Paradigms in health care and its relationship to the nursing theories: an analytical test

DANTAS, Rodrigo Assis Neves; NÓBREGA, Walkíria Gomes da; MORAIS FILHO, Luiz Alves; MACÊDO, Eurides Araújo Bezerra de ; FONSECA , Patrícia de Cássia Bezerra; ENDERS, Bertha Cruz; MENEZES, Rejane Maria Paiva de; TORRES , Gilson de Vasconcelos. Paradigms in health care and its relationship to the nursing theories: an analytical test . Revista de Enfermagem UFPE on line. v.4,n.2, p.16-24.abr/jun. 2010. Disponível em < http://www.ufpe.br/revistaenfermagem/index.php/revista>.

The Metaethics of Nursing Codes of Ethics and Conduct

Nursing codes of ethics and conduct are features of professional practice across the world, and in the UK, the regulator has recently consulted on and published a new code. Initially part of a professionalising agenda, nursing codes have recently come to represent a managerialist and disciplinary agenda and nursing can no longer be regarded as a self-regulating profession.This paper argues that codes of ethics and codes of conduct are significantly different in form and function similar to the difference between ethics and law in everyday life. Some codes successfully integrate these two functions within the same document, while others, principally the UK Code, conflate them resulting in an ambiguous document unable to fulfil its functions effectively. The paper analyses the differences between ethical- codes and conduct-codes by discussing titles, authorship, level, scope for disagreement, consequences of transgression, language and finally and possibly most importantly agent-centeredness. It is argued that conduct codes cannot require nurses to be compassionate because compassion involves an emotional response. The concept of kindness provides a plausible alternative for conduct-codes as it is possible to understand it solely in terms of acts. But if kindness is required in conduct-codes, investigation and possible censure follows from its absence. Using examples it is argued that there are at last five possible accounts of the absence of kindness. As well as being potentially problematic for disciplinary panels, difficulty in understanding the features of blameworthy absence of kindness may challenge UK nurses who, following a recently introduced revalidation procedure, are required to reflect on their practice in relation to The Code. It is concluded that closer attention to metaethical concerns by code writers will better support the functions of their issuing organisations.

Debriefing in simulation conducted in small and large groups : nursing students’ experiences

The debriefing phase in human patient simulation is considered to be crucial for learning. To ensure good learning conditions, the use of small groups is recommended, which poses a major challenge when the student count is high. The use of large groups may provide an alternative for typical lecture-style education and contribute to a more frequently and repeated training which is considered to be important for achieving simulation competency. The purpose of the present study was to describe nursing students’ experiences obtained during the debriefing conducted in small and large groups with the use of a qualitative descriptive approach. The informants had participated in a human patient simulation situation either in large or small groups. Data was collected through the use of five focus-group interviews and analysed by content analysis. The findings showed that independent of group-size the informants experienced the learning strategies to be unfamiliar and intrusive, and in the large groups to such an extent that learning was hampered. Debriefing was perceived as offering excellent opportunities for transferable learning, and activity, predictability and preparedness were deemed essential. Small groups provided the best learning conditions in that safety and security were ensured, but were perceived as providing limited challenges to accommodate professional requirements as a nurse. Simulation competency as a prerequisite for learning was shown not to be developed isolated in conjunction with simulation, but depends on a systematic effort to build a learning community in the programme in general. The faculty needs to support the students to be conscious and accustomed to learning as a heightened experience of learning out of their comfort zone.

Paradigms in health care and its relationship to the nursing theories: an analytical test

DANTAS, Rodrigo Assis Neves; NÓBREGA, Walkíria Gomes da; MORAIS FILHO, Luiz Alves; MACÊDO, Eurides Araújo Bezerra de ; FONSECA , Patrícia de Cássia Bezerra; ENDERS, Bertha Cruz; MENEZES, Rejane Maria Paiva de; TORRES , Gilson de Vasconcelos. Paradigms in health care and its relationship to the nursing theories: an analytical test . Revista de Enfermagem UFPE on line. v.4,n.2, p.16-24.abr/jun. 2010. Disponível em < http://www.ufpe.br/revistaenfermagem/index.php/revista>.

Intensive care survivors’ experiences of ward-based care: Meleis’ theory of nursing transitions and role development among critical care outreach services.

Aims and objectives. To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Background. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Design and methods. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.’s mid-range theory on experiencing transitions. Results. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. Conclusion. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Relevance to clinical practice. Meleis et al.’s work has resonance in terms of explicating intensive care patients’ experiences of psychosocial distress throughout the transition to general ward–based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed.