Accredited work-based learning (AWBL) for new nursing roles: nurses' experiences of two pilot schemes

The influence of workplace culture on nurses' learning experiences: a systematic review of qualitative evidence

BACKGROUND

A healthy workplace culture enables nurses to experience valuable learning in the workplace. Learning in the workplace enables the provision of evidence-based and continuously improving safe patient care, which is central to achieving good patient outcomes. Therefore, nurses need to learn within a workplace that supports the implementation of evidence-based, professional practice and enables the best patient outcomes; the influence of workplace culture may play a role in this.

OBJECTIVES

The purpose of this review was to critically appraise and synthesize the best available qualitative evidence to understand both the nurses' learning experiences within the workplace and the factors within the workplace culture that influence those learning experiences.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Registered and enrolled nurses regulated by a nursing and midwifery board and/or recognized health practitioner regulation agency (or their international equivalent).

PHENOMENA OF INTEREST

This review considered studies that described two phenomena of interest: the nurses' learning experience, either within an acute healthcare workplace or a workplace-related learning environment and the influence of workplace culture on the nurses' learning experience (within the workplace or workplace-related learning environment).

CONTEXT

This review considered studies that included nurses working in an acute healthcare organization within a Western culture.

TYPES OF STUDIES

This review considered studies that focused on qualitative evidence and included the following research designs: phenomenological, grounded theory and critical theory.

SEARCH STRATEGY

Published and unpublished studies in English from 1980 to 2013 were identified using a three-step search strategy, searching various databases, and included hand searching of the reference lists within articles selected for appraisal.

METHODOLOGICAL QUALITY

For studies meeting the inclusion criteria, methodological quality was assessed using a standardized checklist from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).

DATA EXTRACTION

Qualitative data were extracted from articles included in the review using the standardized data extraction tool from the JBI-QARI.

DATA SYNTHESIS

Qualitative research findings were pooled using the Joanna Briggs Institute Qualitative Appraisal and Review Instrument (JBI-QARI). This involved the aggregation and synthesis of findings to generate a set of categories, which were then subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings that could be used as a basis for evidence-based practice.

RESULTS

Fourteen articles were identified following appraisal and a total of 105 findings (85 unequivocal and 20 credible) were extracted from included studies and grouped into eight categories based on similarity of meaning. Subsequently, categories were grouped into two synthesized findings. The two synthesized findings were as follows: ORGANIZATIONAL INFLUENCES: Enabling nurses to demonstrate accountability for their own learning, along with clear organizational systems that provide resources, time, adequate staffing and support, demonstrates encouragement for and the value of nurses' learning and education.

RELATIONAL DYNAMICS

Nurses value their peers, expert nurses, preceptors, mentors and educators facilitating and encouraging their learning and professional development.

CONCLUSION

An optimal workplace culture is central for nurses to experience valuable and relevant learning in the workplace. To emphasize the importance of nurses' learning in the workplace, working and learning is understood as an integrated experience. Consequently, a dual system that enables nurses to demonstrate accountability for their own learning, along with clear organizational and educational systems, is required to demonstrate the value in nurses' learning and education.

A novel Interactive Health Communication Application (IHCA) for parents of children with long-term conditions: Development, implementation and feasibility assessment

BACKGROUND

Few evidence-based, on-line resources exist to support home-based care of childhood long-term conditions.

METHODS

In a feasibility study, children with stages 3, 4, or 5 chronic kidney disease, parents and professionals collaboratively developed a novel Online Parent Information and Support (OPIS) application. Parents were randomized to an intervention arm with access to OPIS or a control arm without access. OPIS usage was assessed using Google Analytics. Parents in the intervention arm completed the Suitability Assessment of Materials (SAM) and User Interface Satisfaction (USE) questionnaires and participated in qualitative interviews.

RESULTS

Twenty parents accessed OPIS with a mean of 23.3 (SD 20.8, range 2-64) visits per user. Responses from the SAM and USE questionnaires were positive, most respondents rating OPIS highly and finding it easy to use. Qualitative suggestions include refinement of OPIS components, enabling personalization of OPIS functionalities and proactive endorsements of OPIS by professionals.

CONCLUSIONS

Implementation of OPIS into standard practice is feasible in the centre where it was developed. Suggested developments will augment reported strengths to inform ongoing testing in the wider UK network of units. Our design and methods are transferrable to developing and evaluating web-applications to support home-based clinical care-giving for other long-term conditions.

Emerging communities of child-healthcare practice in the management of long-term conditions such as chronic kidney disease: qualitative study of parents' accounts

BACKGROUND

Parents of children and young people with long-term conditions who need to deliver clinical care to their child at home with remote support from hospital-based professionals, often search the internet for care-giving information. However, there is little evidence that the information available online was developed and evaluated with parents or that it acknowledges the communities of practice that exist as parents and healthcare professionals share responsibility for condition management.

METHODS

The data reported here are part of a wider study that developed and tested a condition-specific, online parent information and support application with children and young people with chronic-kidney disease, parents and professionals. Semi-structured interviews were conducted with 19 fathers and 24 mothers who had recently tested the novel application. Data were analysed using Framework Analysis and the Communities of Practice concept.

RESULTS

Evolving communities of child-healthcare practice were identified comprising three components and several sub components: (1) Experiencing (parents making sense of clinical tasks) through Normalising care, Normalising illness, Acceptance & action, Gaining strength from the affected child and Building relationships to formalise a routine; (2) Doing (Parents executing tasks according to their individual skills) illustrated by Developing coping strategies, Importance of parents' efficacy of care and Fear of the child's health failing; and (3) Belonging/Becoming (Parents defining task and group members' worth and creating a personal identity within the community) consisting of Information sharing, Negotiation with health professionals and Achieving expertise in care. Parents also recalled factors affecting the development of their respective communities of healthcare practice; these included Service transition, Poor parent social life, Psycho-social affects, Family chronic illness, Difficulty in learning new procedures, Shielding and avoidance, and Language and cultural barriers. Health care professionals will benefit from using the communities of child-healthcare practice model when they support parents of children with chronic kidney disease.

CONCLUSIONS

Understanding some of the factors that may influence the development of communities of child-healthcare practice will help professionals to tailor information and support for parents learning to manage their child's healthcare. Our results are potentially transferrable to professionals managing the care of children and young people with other long-term conditions.

Understanding the essential elements of work-based learning and its relevance to everyday clinical practice

AIM

To critically review the work-based learning literature and explore the implications of the findings for the development of work-based learning programmes.

BACKGROUND

With NHS budgets under increasing pressure, and challenges to the impact of classroom-based learning on patient outcomes, work-based learning is likely to come under increased scrutiny as a potential solution. Evidence from higher education institutions suggests that work-based learning can improve practice, but in many cases it is perceived as little more than on-the-job training to perform tasks.

EVALUATION

The CINAHL database was searched using the keywords work-based learning, work-place learning and practice-based learning. Those articles that had a focus on post-registration nursing were selected and critically reviewed.

KEY ISSUES

Using the review of the literature, three key issues were explored. Work-based learning has the potential to change practice. Learning how to learn and critical reflection are key features. For effective work-based learning nurses need to take control of their own learning, receive support to critically reflect on their practice and be empowered to make changes to that practice.

CONCLUSIONS

A critical review of the literature has identified essential considerations for the implementation of work-based learning. A change in culture from classroom to work-based learning requires careful planning and consideration of learning cultures.

IMPLICATIONS FOR NURSING MANAGEMENT

To enable effective work-based learning, nurse managers need to develop a learning culture in their workplace. They should ensure that skilled facilitation is provided to support staff with critical reflection and effecting changes in practice. CONTRIBUTION TO NEW KNOWLEDGE: This paper has identified three key issues that need to be considered in the development of work-based learning programmes.

Secondment as a means of practice development for Community Learning Disability Nurses working with children

Many Community Learning Disability Nurses (CLDNs) in Scotland who work with children will have had some child health input during their registered nurse education programme, but often not specific to the needs of children who might be referred to them now as result of population changes, community care policy and improved methods of diagnosis (PHIS, 2004). Community nurses have relatively poor skills in detecting and managing mental health problems and identify training as a means of addressing this (Fox et al., 2003). To address the practice development needs identified by CLDNs through their Personal Development Plans (PDPs), secondments were provided to a Child and Adolescent Mental Health Service (CAMHS) for children and young people with learning disabilities for 2 days a week for six months. This was taken up by five CLDNs over a period of 3 years. The goals they set in their secondments were evaluated using Goal Attainment Scaling (GAS). This paper aims to discuss the use of GAS within secondments, as a means of identifying learning needs and developing practice in the area of CAMH nursing. The background to the paper, work based learning, health needs of children with LD and GAS are highlighted. Recommendations for future development are made.

Work-based learning: a leadership development example from an action research study of shared governance implementation

AIM

An empowering action research study was undertaken to evaluate and strengthen the implementation of shared governance. One aim was to identify factors that acted as aids or barriers to effective decision-making by clinical leaders. As a work-based learning approach, action research was expected to lead to integration of learning into practice by researcher and participants alike.

BACKGROUND

Shared governance replaces traditional hierarchies and requires and develops clinical leaders. Strategies are needed to maximize learning from introduction of such initiatives at the individual, group and organizational level.

METHODS

Participant-observations and interviews were undertaken with shared governance council members from one model in north-west England.

RESULTS

Leadership skills and knowledge and shared governance practices were significantly enhanced. Preparation for council roles was considered inadequate. Increased structured time for reflection and action planning was indicated.

CONCLUSIONS

Implementation of shared governance has succeeded in developing leadership capacity. Evaluation findings have led to improvements in the overall shared governance model. Action research has been found to have great utility at optimizing work-based learning. Nurse Managers need to develop their coaching and facilitating skills and recognize there is no "quick fix" for developing clinical leaders. Implications include the need to support learners in identifying and implementing changes arising from work-based learning activities, the significant resource implications and the need to optimize the organizational climate if work-based learning approaches to leadership and management development are to succeed.

Taking a degree after qualifying as a registered general nurse: constraints and effects

In recent years, there has been a growing emphasis on nurses obtaining degrees with many arguing for an all graduate profession. Traditionally trained nurses may feel increased pressure to obtain degrees to compete with their diploma and degree trained successors. This paper presents findings from the sixth questionnaire in a Department of Health-funded, longitudinal study into the careers of traditionally trained nurses who qualified in 1990/91. It discusses the experiences of a cohort of 620 nurses eight years after qualification, in terms of the proportion who had taken/were taking a degree, the support offered by employers and the perceived effects of a nursing/healthcare degree on their work. The findings showed that almost half did not plan to take a degree and that a main constraint was the difficulty of combining paid work with studying, especially for women with childcare responsibilities. However, for the minority who had taken/were taking a degree, the perceived effects included increased self-confidence, with the majority reporting enhancement of clinical skills and better career prospects. The findings point to a need for employers to address issues of flexible working, study leave and funding in order that nurses are given every opportunity for career development.