Practice Skills in the Pre-registration Nursing curriculum: bridging the theory-practice gap
Authors: Nickless, L. and Joy, R.
Conference: Nurse Education Tomorrow: Networking for Education in Health Care
Dates: 4-6 September 2007
Abstract:If the purpose of curriculum is to provide a plan for educational delivery then the need for an innovative healthcare curriculum is now required more than ever. The client experience lies at the heart of all healthcare educational programmes and the primary objective of these is to deliver a workforce that has the capacity and capability to meet the ever changing needs of these clients and the environments they are found in. Recent initiatives (DoH 2006, NMC 2004, QAA 2001) have resulted in significant changes to the way services are delivered to clients, creating further challenges to the way we prepare our healthcare workforce. The Nursing and Midwifery Council in the United Kingdom (UK) has committed pre-registration nursing programmes to deliver standards of educational curricula that result in nurses who are fit for practice, fit for purpose and fit for award (NMC 2004). In other words, a newly qualified nursing workforce that is expected to ‘hit the floor running’. This requires a curriculum that results in nurses who are autonomous, responsive, critically aware and reflective, with the capability to provide care holistically.
Health care programmes require approval through revalidation every five years. Two years ago Bournemouth University witnessed a re-evaluation of the pre-registration nursing curriculum and in light of recent professional guidelines (NMC 2004) grading of practice, both in the placement environment and the practice skills centre, has been incorporated. The impact of these changes has raised the profile of practice skills within this environment thorough the intercalation into a theoretical unit based upon individual health needs.
However, whilst the values of practice skills environments are recognised within Bournemouth University, their contribution to nursing curricula continues to be scrutinised elsewhere. (NMC 2004, Scholes et al 2004, Moore 2005). Having originally emerged within many nurse education programmes in response to growing concerns regarding the clinical ability of newly qualified nurses (DoH 1999, UKCC 1999), they are viewed by many as safe, risk-free learning environments in which to practice skills prior to the ‘hands-on’ patient care (DoH 2001, Pfeil 2001, Murrell and Pegram 2003). The philosophy within Bournemouth Universities’ skills centre no longer focuses upon skills proficiency alone. We acknowledge that practice skills environments will not be able to replace the experiential learning and consolidation of skills that occurs in practice. The expectation is not therefore one of proficiency in a skill alone at the end of the programme, rather the development of safe ongoing practice through the development of qualities such as self-appraisal and self-awareness. It is suggested that by encouraging the development of qualities such as critical thinking, reflection early on in the programme, student nurses may adopt them throughout the wider curricula and promote a more holistic approach to patient care through the development of lifelong learning (Hoyles et al 2000, Price 2005, NMC 2004). The challenge when designing programmes is finding innovative approaches to teaching and learning which facilitate the development of these qualities.
Early links between theory and practice are essential to the development of nurse education (Hoyles et al 2000). There is a considered opinion that students do not learn practical skills in isolation. They are required to think cognitively and to rationalise their actions, thereby reflecting on their nursing practice after they know ‘how to do it’ (Hallett et al 1996, Banning 2005). Therefore the main thrust of Bournemouth Universities’ skills philosophy is to encourage the students to ‘learn through doing’ (Biggs 2003).
The skills environment at Bournemouth University provides the student with the overall impression of the skill to be acquired. Simulation and role play are used extensively within the practice rooms. This is important because success of such an approach to teaching is dependent on there being a positive transfer between initial exposure to the skill and performance in the caring context (Quinn 2000, Turner 2005).
Simulated practice scenarios are an invaluable teaching strategy and allow the opportunity for students to reflect upon their practice (Bradley and Postlethwaite 2003) - the Bournemouth University recorded assessment strategy takes this one step further by ensuring the student nurse reflects upon their own practice whilst underpinning those skills with evidence in an atmosphere conducive to learning. Preparation for the assessment includes the students’ critically reviewing recorded examples of nursing practice, either individually or as a group. This not only allows for the students to explore and reflect on their own actions (self-appraisal) but also those of others (peer-appraisal); a rare learning opportunity, especially outside of the clinical setting (Johnson et al 1999). This gives permission for students to be more open, to share different views and experiences and in some situations observe correct but different approaches to clinical situations. Through exploration of these activities, guided by a dedicated skills tutor, immediate feedback is obtained. The major benefit of immediate feedback is alluded to by Glover (2000) who proposes that it heightens the student nurses awareness of the impact of their actions and those of others.
Nurse education remains politically and socially driven with patient outcomes equating with practice quality. To achieve this, Bournemouth University has taken steps within the current pre-registration nursing curriculum to grade practice both in the clinical setting and in the practice skills environments. Integrating the theory and practice elements of the students learning experience is now visible. The practice skills sessions are recognised as part of a validated unit which sees the assessment weighting as 60/ 40% in favour of the recorded assessment. This is a significant and innovative step forward and one that places nursing practice firmly on the same side of the ‘bridge’ as nursing theory.
If the nursing practitioner of the future is to be critically aware, reflective and motivated, the mode in which pre-registration nurse education is delivered needs to echo that which is experienced in clinical practice. We feel that by making practice skills more explicit within the curriculum we are part way to addressing the much debated theory-practice gap. References
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