Psychomotor skills laboratories as self-directed learning: a study of nursing students' perceptions

Simulation: an effective pedagogical approach for nursing?

Simulation features strongly within the undergraduate nursing curriculum for many Universities. It provides a variety of opportunities for students as they develop their clinical nursing skills. The nursing literature highlights the potential of this approach and the positive opportunities afforded to students in terms of developing competence and confidence. However, much of this literature focuses upon the more operational concerns of simulation. This paper reflects upon the evolution of simulation in nurse education. It considers the theoretical positioning and understanding of simulation as a teaching and learning approach for undergraduate nursing skills development. The work of Vygotsky (1978) and Lave and Wenger (1991) are highlighted in order to begin to explore the theoretical basis of simulation as an effective pedagogical approach for nurse education today, enabling students to learn to be nurses.

Nursing competence 10 years on: fit for practice and purpose yet?

AIMS AND OBJECTIVES

This paper examines how nurses are prepared to be clinically competent and safe at registration, so that they are fit for practice and purpose. It follows up two papers on competence published in 1997 and 1998 and investigates subsequent developments.

BACKGROUND

In 1979, major changes in nursing affected nurse education and preparation for competence. In the following two decades, it became clear that nurses lacked clinical skills. This paper examines subsequent changes and asks the question whether this crucial shortcoming has now been remedied. This paper considers the background and context of change in nursing and nurse education in the 1980s. It looks at the new ideology, to prepare the 'knowledgeable doer' and examines the consequences of the change on nursing competency from the 1990s to the present day.

METHODS

This is a position paper. Professional policy documents from the English National Board for Nursing, Midwifery and Health Visiting, United Kingdom Central Council for Nursing, Midwifery and Health Visiting and Nursing and Midwifery Council, government reports and legislation on nursing and relevant nursing literature are examined and critically analysed and conclusions drawn.

CONCLUSIONS

From 1923-1977, mandatory nursing syllabuses set by the General Nursing Council of England and Wales required the registered nurse to have acquired certain specific clinical skills. These were rigorously tested to an explicit standard set by the General Nursing Council before a nurse was awarded state registration. Twenty-five years later, the loss of this system for ensuring this competence and the implications of this loss, have been widely recognised. As a result, many nurse training institutions have introduced clinical skills laboratories, simulation of practice and the Objective Structured Clinical Examination. However, to the authors' surprise and contrary to their initial expectations, the Nursing and Midwifery Council has not made these systems uniform or mandatory and so still has no way of ensuring all nurse training is producing safe nurses in the United Kingdom. The authors conclude that the untested educational ideology that brought root and branch change to nurse training in 1983 and which failed to produce nurses 'fit for practice and purpose' may still prevail.

RELEVANCE TO CLINICAL PRACTICE

The present paper demonstrates that United Kingdom nurse training still has no uniform and mandatory system in place to ensure, as far as is possible, that all registered nurses are clinically competent and safe to practice.

The debate in favour of using simulation education in pre-registration adult nursing

The purpose of this paper is to have a fresh look at the literature on the advantages and disadvantages of simulation education as a teaching, learning and assessment methodology within pre-registration nurse education. It will highlight the reasons why simulation education has been re-introduced into nurse education within many Higher Education Institutions (HEI) in the United Kingdom (UK). This is in an attempt to enable the student nurse to develop competence in the clinical skills required for fitness for award, practice and purpose. This comes at a time when the Nursing and Midwifery Council (NMC) are conducting further research on simulation education and whether it can replace practice hours.

Nursing students' and tutors' perceptions of learning and teaching in a clinical skills centre

BACKGROUND

Clinical Skills Centres (CSCs) can ease pressure on clinical skills development and assessment in clinical areas; and provide added value through experiential learning and self-directed learning. Published accounts of innovation in CSCs tell part of this story but little is known about perceptions of students and tutors engaged in day-to-day learning and teaching in CSCs.

METHODS

This paper reports one strand of a mixed methods study in a busy multidisciplinary CSC: a questionnaire survey of nursing students' and tutors' perceptions of learning and teaching. Questionnaires focused on items representing commonly espoused views regarding the use and usefulness of CSCs.

RESULTS

Students and tutors enjoyed learning and teaching within the CSC, although senior students were slightly muted in their views. All groups valued the supported practice of clinical and communication skills. The CSC was seen as a learning environment that supports the linking of theory and practice. There was some ambivalence, particularly among tutors, about the relationship between performance in the CSC and in clinical areas.

DISCUSSION

The favoured pedagogic approach of expert demonstration by tutors followed by supported practice necessitates attention to tutors' training. The muted responses of senior students may signal a need to review the CSC learning experiences offered to them.

Essential clinical skills for beginning registered nurses

A research project investigating the identification of essential clinical skills for registered nurses in their first year of practice was undertaken in a number of Sydney metropolitan hospitals in Australia. Using an adaptation of the Williams & Brammer (1996) study, 206 beginning registered nurses were surveyed to determine the clinical skills they performed frequently in their daily routine, and those they considered essential. One hundred and thirty two questionnaires were returned and the responses were analysed for frequency of clinical skill performance and essential rating. The clinical skills rated as most frequently performed related to universal precautions for infection control, vital sign assessment, management of intravenous therapy, administration of all forms of medication and a wide range of patient hygiene related skills. Many clinical skills rated as essential by these nurses were not rated as performed frequently, which may indicate concern for the need to draw upon less frequently performed skills during emergency situations and thus they rate these skills as essential. This study clearly identified the clinical skills rated as performed frequently by beginning registered nurses and identified those clinical skills deemed essential to beginning nursing practice by novice nurses. A larger sample size would strengthen the reliability of these findings.

The clinical skills resource: a review of current practice

This review is based on the findings of the Southampton Clinical Skills Project, which was a needs assessment and feasibility study to consider the development of a multiprofessional Clinical Skills Resource at Southampton. The project spanned a period of 18 months and used a range of methods of data collection, including visits to 12 clinical skills facilities in the UK. Most existing clinical skills centres have developed in response to changing healthcare policy, curricular initiatives and increasing emphasis on the quality of assessments and competencies. There is also increasing recognition that clinicians are no longer able to teach effectively all skills to students in the traditional ways, and that clinical skills training and assessment, particularly for undergraduates, is an area of deficiency. The potential scope of clinical skills centres is broad and encompasses not only clinical and communication skills but medical informatics, computer assisted learning, multiprofessional learning and assessment. Skills centres can also promote self directed and lifelong learning methods. The planning of skills centres involves a variety of stakeholders and users, including undergraduates, postgraduates, acute and community Trusts, Postgraduate Deans and medical schools. A successful skills centre needs to be flexible in its design, integral to the curriculum and relevant to educational and training requirements. This requires planning, organization and resources. Different organizational models can be used, depending on local factors. The management of skills centres involves consideration of issues such as security, safety, supervision of learners and staff development, informed by a network of experts and everyday users. The development of skills centres should include ongoing educational evaluation of outcomes and educational research. The use of a clinical skills centre has potential benefits for staff and students, including the provision of a safe environment in which to learn and practise skills before using them in the real clinical setting. This can reduce anxiety in students and protect patients from novice practice. Clinical skills centres provide a setting for structured learning with feedback as well as assessment of competence. The limitations of a skills centre are that it can only provide simulated experiences which are an adjunct to, but can never replace real clinical experience.

Evaluating a skills centre: the acquisition of psychomotor skills in nursing--a review of the literature

In 1994, as a result of both programme evaluations which identified students' fears and apprehensions about their practical ability, and a review of the literature on skill acquisition, experiential skills teaching was resumed within the faculty. Having invested considerable finance into the reconstruction of a skills centre to teach skills, it is now imperative that its use be formally evaluated. Part of the evaluative process includes a review of the empirical literature on the acquisition of psychomotor skills in nursing. This paper summarizes this review.