A review of curriculum evaluation in United Kingdom nursing education

Revitalizing Medical Education Delivery through Teacher-Led Curriculum Critiques: A Narrative Review

A teacher in a medical college is like a compass who has the responsibility and the power to guide budding medical students in their educational journey to become effective and efficient members of the healthcare team. The purpose of the current review is to justify the significance of curriculum evaluation, explore the role of teacher in the capacity of curriculum evaluator, enlist various methods and tools to perform curriculum evaluation, and identify the challenges and suggest potential solutions to overcome them. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and a total of 16 articles were selected based upon their suitability with the current review objectives and analyzed. Keywords used in the search include curriculum evaluation in the title alone only (viz. curriculum [ti] AND medical [ti]; curriculum evaluation [ti] AND methods [ti]; curriculum evaluation [ti] AND approaches [ti]; curriculum evaluation [ti]). A number of strategies can be employed to perform the evaluation of the medical curriculum, ranging from obtaining feedback from medical students at the end of each professional phase to assessing content, teaching methods, assessment, and attainment of learning outcomes. The process of evaluation of medical curriculum by teachers is a complex and challenging one and needs careful planning and execution of different aspects. These identified challenges clearly provide evidence that teachers have to be given the necessary training, resources, and institutional support to enable them to conduct effective medical curriculum evaluation. In conclusion, teachers in their capacity as curriculum evaluators remain the most important stakeholder in ensuring continuous improvement in the quality of education delivered to students. Owing to their in-depth awareness of classroom dynamics, the learning process, and the awareness about unique needs of students, their involvement in curriculum evaluation can ensure alignment between the delivered curriculum and the needs of the society.

Suitable, fit, competent and safe to practice nursing? Assessing nursing students' personal qualities in clinical placement-An integrative review

AIMS AND OBJECTIVES

This study aims to explore, describe, and synthesize the personal requirements student nurses are assessed in their clinical placement to be suitable, fit, competent, and safe for the nursing profession.

BACKGROUND

There are different terms and concepts used when describing what nursing students are assessed by regarding personal requirements needed to be eligible to enter the nursing profession. This is regulated and enforced mainly by different standards and guidelines.

DESIGN

An integrative review using Whittmore and Knafl's (2005) methodology.

METHODS

Searches were systematically conducted in CINAHL, Education Source, ERIC, Academic Source Elite, MEDLINE and EMBASE, NORART, SveMed+, and Bibliotek.dk. The PRISMA checklist for systematic reviews was used.

RESULTS

Eighteen studies were included in the review. The results present various factors student nurses are assessed by in clinical placements, which were categorized into three themes: attitude and personal characteristics, behavior, and basic knowledge. Assessing students is a complex and subjective endeavor, and decisions are based on a holistic assessment of several different aspects of the student's performance and behavior CONCLUSIONS: The personal requirements to be deemed suited for det nursing profession are complex and composed of several different components. Assessments are often based more on assessors' subjective standards and intuition than on the provided guidelines and standards. There is no universal understanding of which characteristics or qualities are considered necessary for a student to be deemed suited for the nursing profession.

RELEVANCE TO CLINICAL PRACTICE

This study points at challenges with the assessment of nursing students today as there are no clear standards or understanding of the requirements needed.

Systematic review of program evaluation in baccalaureate nursing programs

Program evaluation is a common practice in nursing education programs; however, evidence indicates that many schools only focus on program evaluation around the scheduled accreditation period, thus reducing the potential value of the evaluation. This systematic review explores the current program evaluation practices of prelicensure baccalaureate nursing programs. ERIC, CINAHL, and Scopus databases were searched to locate original research articles published in English. Twenty articles met the inclusion criteria. The purposes of the evaluated studies varied from needing to meet external accountability requirements to proposing conceptual frameworks and evaluation tools. However, most studies focused on summative evaluation assessing program products and on providing evidence of program evaluation based on descriptive data. Notably, few studies employed a rigorous method to evaluate and interpret program evaluation findings. Most studies solicited information from multiple stakeholder groups, with students being the most represented. Despite the wide range of data collection tools used in the reviewed studies, reporting of validity and reliability was limited. Student grade point average, graduation rate, NCLEX passing rate, and satisfaction with the learning experience were the most common variables. Further studies are needed to assess the effectiveness of current educational program evaluation practices in nursing education.

Current access and recruitment practices in nursing education institutions in KwaZulu-Natal: A case study of student nurses with disabilities

Background

While institutions of higher education may have increased access and accommodation for students with disabilities, institutions primarily providing nurse training in South Africa do not mirror the same practice.

Objectives

Notwithstanding the integration of disability policies enacted in South Africa in 2010, a majority of people with disabilities are still excluded from the activities of society equally applicable to nursing education. This article describes the current access and recruitment practices for student nurses with disabilities (SNWDs) in nursing education institutions in KwaZulu-Natal to provide baseline data, which is largely absent in nursing institutions.

Method

A concurrent mixed-method design using a multiple embedded case study approach was employed. This article presented phase 1 of the study, a quantitative survey of all private nursing education institutions (n = 27), complemented by individual, in-depth interviews with SNWDs (n = 10). Quantitative data were analysed using SPSS version 24, with a response rate of 78% (n = 21), whereas qualitative data were analysed using content analysis.

Results

The findings revealed that the majority of private NEIs lack policy guidelines for recruiting SNWDs; however, other means of guidance is sought, for example, using the technical assistance. While NEIs were willing to recruit SNWDs, access to clinical sites, lectures, support systems and reasonable accommodation was challenging.

Conclusion

Private NEIs are providing an inclusive education to all students including those with disabilities; however, they still have a long way to go in meeting the needs of SNWDs with regards to support and accommodation.

Evaluation of how a real time pre-registration health care curricula was managed through the application of a newly designed Change Management Model: A qualitative case study

BACKGROUND

Curricula change in nurse education is of international importance. The pace of such change has been continuous and has triggered criticisms of inadequate preparation of practitioners. There are no change formulae for managing curricula change and despite a raft of change methods, globally change success remains low. A lack of a unified voice, undue focus on cognition, and arguably no existing models for academia and a literature gap contribute to change challenge. A new Change Management Model designed from research with emotion as its underpinning philosophy is evaluated.

OBJECTIVE

Evaluation of a newly designed Change Management Model through a real time pre-registration health care curricula change.

DESIGN

A qualitative case study was adopted. The single case study was the new pre-registration health care curricula.

SETTING

This study took place in a Faculty of Health and Social care in one HEI in the UK.

PARTICIPANTS

Four senior academics and fifteen academics across professions and specialisms involved in the curricula change took part in the study.

RESULTS

The findings suggested that leadership operated differently throughout the organisation. Distributive and collective leadership created a critical mass of people to help deliver the new curricula but academics felt excluded at the strategic level. Emotion at the strategic level inhibited innovation but boosted engagement, emotional relationships and creativity at the operational level. Face to face communication was favoured for its emotional connection. A top down approach created an emotional disconnect and impacted inclusiveness, engagement, empowerment, vision and readiness for change.

CONCLUSION

Testing the new model widely not only in organisations, practice and team changes but personal change in improving health and wellbeing could be beneficial. The continuing gap in knowledge on the link between emotion and curricula change, practice and organisational change and therapeutic value of the model also warrants further research.

Evaluation of how a curriculum change in nurse education was managed through the application of a business change management model: A qualitative case study

BACKGROUND

Curriculum changes are a regular feature of nurse education, yet little is known about how such changes are managed. Research in this arena is yet to emerge.

OBJECTIVE

Evaluation of how a curriculum change in nurse education was managed through the application of a business change management model.

METHOD

A qualitative case study: the single case was the new curriculum, the Primary Care Pathway.

PARTICIPANTS AND SETTING

One executive, three senior managers, two academics and nineteen students participated in this study in one faculty of health and social care in a higher education institution.

RESULTS

The findings suggest that leadership was pivotal to the inception of the programme and guiding teams managed the change and did not take on a leadership role. The vision for the change and efforts to communicate it did not reach the frontline. Whilst empowerment was high amongst stakeholders and students, academics felt dis-empowered. Short-term wins were not significant in keeping up the momentum of change. The credibility of the change was under challenge and the concept of the new programme was not yet embedded in academia.

CONCLUSION

Differences between the strategic and operational part of the organisation surfaced with many challenges occurring at the implementation stage. The business change model used was valuable, but was found to not be applicable during curriculum changes in nurse education. A new change model emerged, and a tool was developed alongside to aid future curriculum changes.

Undergraduate student nurses' perceptions of two practice learning models: a focus group study

BACKGROUND

Phase 1 of this study examined student, mentor and clinical manager's perceptions of a 'Hub and Spoke' practice learning model in year 1 of an undergraduate nursing programme. Findings from Phase 1 suggested that the model had significant educational merit in orientating students to clinical learning and emphasising the primacy of the mentor relationship in developing and supporting students. Following the students through year 2 of their programme, wherein they experienced a 'rotational' practice learning model, which provided an opportunity to explore student perceptions of both models.

AIMS

To explore undergraduate nurses' perceptions of two experienced practice learning models: hub and spoke model, and the classical rotational model. In a previous study the hub and spoke model appeared to develop 1st year students' sense of belongingness, continuity and quality of practice learning, there for it was important to understand what students reported about these issues when recounting their 2nd year experience in the clinical setting that was organised according to a classical rotational model.

DESIGN

Qualitative approach utilising focus groups.

PARTICIPANTS

10 under-graduate student nurses at the end of 2nd year.

METHODS

Focus group interviews.

RESULTS

Students responded in ways that indicate they believed the experiences of year 1 had raised their faith in their ability to cope with the practice learning and educational demands of nursing. They saw themselves as being better prepared for year 2 as a result of their exposure to hubs and spokes. The study has identified traits of resilience, continued belongingness and self-confidence in orientation to learning in clinical practice in hub and spoke experienced students.

CONCLUSIONS

The student nurses found the hub and spoke model valid in 1st year, whilst stating that for 2nd year the rotational model can be valid. This supports earlier findings that student nurses require a structured and supportive 1st year learning environment to enable development of resilience for subsequent years.

The evolution of midwifery education at the master's level: a study of Swedish midwifery education programmes after the implementation of the Bologna process

In Europe, midwifery education has undergone a number of reforms in the past few decades. In several countries, it has shifted from vocational training to academic education. The higher education reform, known as the "Bologna process" aimed to create convergence in higher education among a number of European countries and enhance opportunities for mobility, employment and collaborative research. It also indicated a transparent and easily compared system of academic degrees, generating a new educational system in three cycles. This study explores the implementation of the process in Sweden when the midwifery education was transferred from diploma to postgraduate or master's level. The aim of this study was to analyse how the implementation of the Bologna process in the Swedish higher education system has impacted midwifery education programmes in the country. Descriptive statistics and content analysis were employed to analyse 32 questionnaire responses from teachers and the 2009-2010 curricula and syllabi of 11 postgraduate midwifery education programmes at Swedish universities and university colleges. The results revealed variations among the universities at the major subject into the three disciplines; midwifery, nursing and caring with different conceptualisations, even when the content was identical in the curricula to that of the midwifery professional knowledge base. Implementation of the new reform not only has accelerated the academisation process, but also puts higher demand on the students and requires higher competencies among teachers to involve more evidence-based knowledge, seminars, independent studies and a postgraduate degree project in the major subject. Thus the students earn not only a diploma in midwifery, but also a master's degree in the major subject, which affords the opportunity for an academic career. But still there is a tension between professional and academic education.

Preparing nursing students to be community health practitioners

There is currently a greater emphasis on community-based health care and, with that, a shift in focus for pre-registration nursing education within policy documents and standards (Nursing and Midwifery Council (NMC), 2010). This paper reports a mixed methods study that examined the implementation of an initiative that enabled third year adult field student nurses the opportunity to spend the final year of their education within the community setting. Using a questionnaire and focus groups, the views of students at the end of the 12-month period were captured. The diverse approach to the placement provision enabled undergraduate nurses to be fit for purpose and ensured that practice at the point of registration would meet the challenges of working in the community setting. Students developed confidence through the diverse placement provision, opportunities for lone working and the support provided by mentors. This model of placement provision is worthy of consideration by service leads and curriculum planners, particularly in view of the present focus of the NMC's (2010) standards for pre-registration nursing programmes.

Impact of the Bologna process in Bachelor nursing programmes: The Swedish case

The higher education reform in Europe known as the "Bologna Process" implies further harmonisation and integration of nursing programmes into the higher education system. This study explores this process in Sweden, where the development of nursing education into an undergraduate programme started in 1977. The aim of this study was to analyse characteristics of the major subject and its relationship to other subject areas, such as medical sciences and social sciences, in Bachelor level nursing programmes in Sweden following initial implementation of the Bologna process. A constructivist approach and descriptive content analysis were employed to analyse the 2008 nursing curricula and syllabi of 27 undergraduate programmes at 26 Swedish universities and university colleges. The results revealed variation in terms and concepts used for the major subject as well as its scientific foundation, demarcation between the major subject and other subjects included in the study programmes and its relationship to the profession. These variations are linked to the variety of research orientations under debate in the Scandinavian countries: Nursing Science and Caring Science; representing different knowledge domains, focus, challenges and visions for the discipline. Potential implications of basing curricula on a major subject other than Nursing Science in a Bachelor level nursing programme are highlighted.

Forensic learning disability nursing skills and competencies: a study of forensic and non-forensic nurses

This paper reports on an investigation into the skills and competencies of forensic learning disability nurses in the United Kingdom. The two sample populations were forensic learning disability nurses from the high, medium, and low secure psychiatric services and non-forensic learning disability nurses from generic services. An information gathering schedule was used to collect the data; of 1200 schedules, 643 were returned for a response rate of 53.5%. The data identified the "top ten" problems that forensic learning disability nurses may encounter, the skills and competencies necessary to overcome them, and the areas that need to be developed in the future. The results indicated that the forensic learning disability nurses tended to focus on the physical aspects to the role whilst the non-forensic learning disability nurses tended to perceive the forensic role in relational terms. This has implications for practice, policy, and procedures.

Professionalisation of gerontological nursing--the development of an international online gerontological master degree programme

Due to demographic changes and the growing demand for a nursing workforce in the gerontological field adequate nursing curricula are required. This paper describes the development of the international online gerontological master degree programme GEROM. Health and nursing science institutions from six European countries are collaborating in this EU-project. The project milestones as well as the study programme architecture are introduced. Furthermore, the evaluation concept is illustrated. Collaboration across the partners is affected by some problems; varying accreditation procedures and cultural differences inhibit the implementation of a joint degree. Institutional commitment and communication between the partners are essential for a successful process.

Fitness for practice in nursing and midwifery education in Scotland, United Kingdom

AIM

The aim of this paper is to report findings from a major study that evaluated the Fitness for Practice nursing and midwifery curriculum in Scotland, UK.

BACKGROUND

The competence of student nurses and midwives at the point of registration has been the focus of debate and research. However, no major study, on such a large scale, had specifically evaluated pre-registration programmes to determine whether they enabled students to achieve 'fitness to practice'.

DESIGN

The study had a broad evaluation design conducted in three phases using a mixed methodology.

METHOD

Phase 1 involved questionnaires, Objective Structured Clinical Examination's (OSCE) and curriculum evaluation. Phase 2 involved semi-structured interviews (some telephone) and focus groups across main stakeholders: students (n = 78), mentors (n = 78), practice-education facilitators (n = 24), academics (n = 59), senior clinical (n = 46) and education managers (n = 16), service users and carers (n = 10).

RESULTS

The findings suggest that the Fitness for Practice curriculum model in Scotland has on the whole been successful. The key finding is the predominant opinion of stakeholders that newly qualified nurses and midwives are perceived as being fit for practice at the point of registration. A perceived lack of confidence is, as with all transitions to new roles, an understandable outcome.

CONCLUSIONS

Previous concern that student nurses and midwives are not 'fit for practice' has focused on the perceived lack of clinical skills at the point of registration, not on competence to practice in general. This study demonstrates that this is an important distinction and recognises that registration is only the beginning of a life long learning experience.

RELEVANCE TO CLINICAL PRACTICE

Students need to be supported to develop their confidence following registration as well as additional skills in their chosen field of practice. Appropriate mentorship and a period of preceptorship should be in place to accommodate this.

Mental health content of Australian pre-registration nursing curricula: summary report and critical commentary

BACKGROUND

Concerns have been expressed about inadequate mental health content in generic pre-registration nursing curricula in Australia. These have led to claims new graduates are inadequately prepared to care for patients with mental health issues. The Mental Health Nurse Education Taskforce set up for the purpose of the project by the Australian Health Ministers' Advisory Council, carried out a national exploration of mental health content in pre-registration nursing curricula in order to develop a framework for including mental health in future pre-registration courses. This paper summarises the Taskforce's report, and presents a critical commentary on several aspects, of the Taskforce's report.

METHODS

The project comprised a literature review, a national survey, national consultations, and advice from an Expert Reference Group.

RESULTS

The report sets out a framework, which included the core values underpinning learning and teaching, learning outcomes, learning and teaching principles, and benchmarks for inclusion of mental health content in curricula. It recommended that a national approach needed to be taken to accreditation of curricula. This, together with greater collaboration between universities and clinical agencies, and the adoption of innovative strategies to secure clinical places, will help ensure a consistent adoption of the framework in each state and territory.

The impact of clinical simulation on learner self-efficacy in pre-registration nursing education

Clinical simulation is becoming increasingly popular in pre-registration nursing education. Incorporating teaching and learning strategies that enhance learner self-efficacy will theoretically improve clinical competence (Bandura, 1986, 1997). This paper presents the findings of a study that aimed to explore the impact of clinical simulation on self-efficacy beliefs amongst pre-registration nurses. A preliminary study (Pike, 2008) used a pre- and post-test design to measure learner self-efficacy before and after a clinical simulation session. Qualitative responses to questions on the post-test questionnaire provided themes to explore in a focus group interview with a convenience sample of nine participants. Thematic content analysis of the interview highlighted two principal findings. Firstly, students described low levels of self-efficacy with regards to communication skills, an area identified as a priority within pre-registration nursing education (NMC, 2007a). Second, students highlighted the need for learning experiences within clinical simulation to be more authentic, to improve the theory to practice gap. It is argued by incorporating strategies within clinical simulation that enhance learner self-efficacy, overall clinical competence will be improved. Suggestions for how pedagogical approaches may be developed within clinical simulation are discussed, whilst acknowledging the limitations of the small scale nature of the study.