Masters in nursing degrees: an evaluation of management and leadership outcomes using a retrospective pre-test design

How to design and deliver a small group teaching session

RATIONALE AND KEY POINTS

Small group teaching sessions are commonly used in healthcare to deliver education, provide practice updates and support continuing professional development. Such sessions can provide opportunities for participants to acquire new knowledge, foster peer relationships, consolidate learning and develop skills. This article provides a step-by-step guide for nurses and other healthcare professionals on designing and delivering a small group teaching session. • A small group teaching session requires considered, detailed and methodical preparation. • When designing a small group teaching session, it is important to determine its aims, learning outcomes, group characteristics, location and timeframe. • A well-planned small teaching session includes learning activities that are constructively aligned to the aims and intended learning outcomes. • Assessing participant learning and addressing gaps in their understanding is essential during the delivery of small group teaching. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article could improve your practice when designing and delivering a small group teaching session. • How you could use this information to educate your colleagues on small group teaching methods.

Exploring the contribution and impact of master's education for leadership development in adult general nursing: A scoping review

AIM

The aim of this scoping review was to explore the evidence relating to master's education for leadership development in adult/general nurses who are not in advanced practice or leadership roles and its impact on practice.

BACKGROUND

The importance of effective, clinical leadership in nursing and health care, has been highlighted following failings reported by Public Inquiries both nationally and internationally. While initiatives have been implemented to address these, the provision of safe, quality care remains problematic. Complex care requires highly skilled professionals to challenge and lead improvements in practice. Master's education results in graduates with the skills and confidence to make these changes and to become the clinical leaders of the future.

METHODS

An a priori scoping review protocol was developed by the review team. This was used to undertake searches across CINAHL Ultimate; Medline (Ovid), Scopus and ProQuest Complete databases, chosen due to their relevance to the subject area. Articles were limited to those in the English Language, peer reviewed and published since 2009. Citation chaining via the reference lists of frequently identified articles were also searched. A further search for relevant grey material using the same relevant keywords and phrases was performed using the limited, Trip Database and Google Scholar.

RESULTS

Eight articles were selected for data extraction, and these were published between 2011 and 2019. The articles were predominantly from the UK and Europe, with a focus either on master's education or on aspects of leadership in nursing and healthcare. Themes identified: a) The need for clinical leadership; b) master's education for clinical leadership skills; and c) master's education for professional and organisational outcomes.

CONCLUSIONS

The scoping review identified that there is a need for strong clinical leadership in the practice setting. Evidence shows that effective nursing leadership can improve patient outcomes as well as enhancing workplace culture and staff retention. The review has shown that the skills required for clinical leadership are those produced by master's education. Studies of the impact of master's education are often self reported and tend to focus on nurses in advanced practice roles. More research is required into master's education for adult/general nurses not in advanced roles and in examining the link between master's education and improved patient, professional and organisational outcomes.

Contextualisation of Early and Enhanced Clinical Exposure Model through Development of Curricula for Advanced Practice Nursing and Midwifery

Background

An Advanced Practice Nurse is a generalist or specialized nurse who has acquired thorough graduate education a minimum of a master's degree. The need for Advanced Practice Nurses is increasingly recognized globally. This paper describes the process, which was undertaken by School of Nursing Sciences, University of Zambia in reviewing and developing advanced practice nursing and midwifery curricula which will be implemented using the Early and Enhanced Clinical Exposure model (EECE).

Materials and Methods

The curricula development/review process utilized a modified Taba's Model which followed a step-by-step approach including: 1) desk review, 2) diagnosis of needs (needs assessment), 3) stakeholder consultations, 4) content development, 5) validations and approval from which several lessons were learnt and recommendations made. Findings and recommendations from different stages were used as a basis for reviewing and developing advanced practice nursing and midwifery curricula.

Results

Desk review needs assessment and stakeholder consultations identified both strengths and weaknesses in the existing curricula. Major strengths were duration and core courses which met the minimum requirement for postgraduate nursing and midwifery training. Major weaknesses/gaps included some content that was too basic for the master's level and the delayed exposure to practicum sites which limited the development of advanced practice skills. Others were inadequate competence for advanced practice, inadequate research methodology course, lack of content to foster development of personal soft skills and predominant use of traditional teaching methods. Stakeholders recommended implementing advanced, clinical and hands-on Masters of Nursing and Midwifery programmes which resulted in the review of four existing and development of five demand-driven curricula.

Conclusion

The reviewed and developed curricula were strengthened to close the identified gaps. Both the reviewed and developed curricula have been implemented using the Early and Enhanced Clinical Exposure Model with a view to producing Advanced Practice Nurses and Midwives who are competent to meet diverse health care needs and contribute to improving patient outcomes.

Postgraduate nurse education and the implications for nurse and patient outcomes: A systematic review

OBJECTIVES

To synthesise the current evidence of the implications of postgraduate nursing qualifications on patient and nurse outcomes.

DESIGN

A systematic review.

DATA SOURCES

Primary research findings.

REVIEW METHODS

A systematic search following PRISMA guidelines and the Joanna Briggs Institute's framework was conducted. A structured and comprehensive search of three electronic databases CINAHL, MEDLINE, PsychINFO, search engine Google Scholar, and a manual-search of reference lists was undertaken. The search was limited to articles in English between 2000 and 2019. The combined search yielded 3710 records. Search records were exported to EndNote X8 and duplicates were removed. Inclusion eligibility was assessed by title, abstract and full text. All team members were involved in selecting the studies and assessing methodical quality. Discrepancies were resolved through rigorous discussion between the reviewers. Twenty studies (quantitative and qualitative) were finally selected as suitable for inclusion in the review. A qualitative descriptive synthesis was undertaken to summarise and report the findings.

RESULTS

This systematic review has shown that the empirical evidence to date does not support nurses' perceptions of the implications of postgraduate education. The findings from this review fell into three major themes: perceived implications of postgraduate study, clinical outcomes and patient satisfaction. Nurses perceived that postgraduate qualifications had improved their knowledge and skills and thus clinical practice, patient outcomes and health services. This perception has not been borne out by measurable outcomes as yet. The literature also suggests that postgraduate education should improve career opportunities and progression for nurses. This is not supported by the nurses' perceptions in the research available to date. It should be noted that these findings predominantly came from qualitative data. A few studies did report descriptive statistical analysis: demographics, knowledge levels, qualifications etc. None conducted any inferential statistical analysis.

CONCLUSION

Although the literature suggests that postgraduate nursing qualifications improve outcomes for patients, the level of evidence is weak. Exploration methods are suggested to move beyond examining nurses' perceptions, to empirical measures of the value of postgraduate education on nurse and patient outcomes.

Perceived importance and performance of clinical leadership in practice: A cross-sectional study of nurses and midwives of all grades

AIM

To explore the differences in perceived importance and actual performance of clinical leadership for all grades of nurses and midwives engaged in clinical practice.

BACKGROUND

Clinical leadership is central to the provision of person-centred care. However, little is known about how nurses and midwives perceive this in practice.

METHODS

Data were collected on a sample of nurses and midwives in the Republic of Ireland, using a cross-sectional study design (n = 324). The clinical leadership needs analysis instrument was used to measure perceived importance and performance of clinical leadership in practice. Grades of nurses/midwives included; staff, manager, advanced practitioner and senior manager.

RESULTS

Senior managers were more likely to report significantly higher scores than staff grades for perceived importance of Technology & Care Initiatives (p < .01) and Financial & Service Management (p = .02). Performance of Staff & Care Delivery was significantly higher for senior managers than staff grades [F(5,309) = 6.06 p < .01].

CONCLUSION

There was a mismatch between the perceived importance and actual performance of clinical leadership in practice between different grades of staff.

IMPLICATIONS FOR NURSING MANAGEMENT

Leadership training for all grades and mentoring of staff grades can promote the building of confidence and empower staff in leading clinical practice.

Exploring taught masters education for healthcare practitioners: a systematic review of literature

BACKGROUND

Masters-level education is a key pathway of professional development for healthcare practitioners. Whilst there is evidence that Masters-level education leads to career enhancement, it is unclear how the programme pedagogy contributes to this. The objective was to: (1) examine the programme pedagogies and context that supports learning, and (2) synthesise the outputs, outcomes and impact of Masters-level healthcare programmes.

METHODS

A systematic review was conducted according to the Cochrane Collaboration handbook and is reported in line with PRISMA. Using pre-defined key terms and eligibility criteria, two reviewers independently searched Medline, ERIC, Web of Science, ProQuest, and CINAHL Plus databases from inception to 14th November 2016, reference lists of retrieved articles and selected websites. Data were extracted independently. The Mixed Methods Appraisal Tool was used to assess methodological quality. A Weight of Evidence Framework enabled evaluation of the overall quality of evidence. Data were synthesised using thematic qualitative analysis.

RESULTS

Thirty-five studies were included. All studies were retrospective, evaluated programmes in nursing (n = 19), physiotherapy (n = 6), general and family medicine (n = 4), public health (n = 3), dentistry (n = 1), interdisciplinary (n = 1), and occupational therapy (n = 1). Most studies were rated low in methodological quality, with an overall low to moderate weight of evidence for programmes' outcomes and impact. Pedagogies that promote social participation and knowledge co-construction, reflection, learner-centred approach, relevance and authenticity influenced outcomes and impact.

CONCLUSION(S)

Notwithstanding the low to moderate weight of evidence, the review identified multiple positive outcomes of Master-level education for healthcare practitioners. Whilst the pedagogies that contributed to such positive outcomes were examined in some studies, there is a need to further explore links between programme pedagogy, outputs, outcomes and impact. A cultural approach to evaluation may capture how M-level education drives changes.

Impact of a compassionate care leadership programme

Compassionate care delivery enhances patient satisfaction and quality of life and reduces nurse burnout. This study measured the perceptions of nursing and midwifery leaders regarding the impact of the ‘Leaders for Compassionate Care Programme’ on their personal development, learning experience, service and care delivery, programme quality, and satisfaction with the programme. Seventy-nine leaders were surveyed using the Leaders for Compassionate Care Outcomes Evaluation Questionnaire and the Leaders for Compassionate Care Evaluation Questionnaire. Participants' perceived ability to support peer learning, manage conflict, and build trust with patients increased significantly following the programme (P≤0.001). Over 80% of participants reported that they were able to apply to practice what they had learnt from the programme and reported an increase in their motivation to lead in compassionate care delivery. Various strategies are needed to improve compassionate care leadership and further research is needed to explore the long-term impact of the programme.

Impact of a critical care postgraduate certificate course on nurses' self-reported competence and confidence: A quasi-experimental study

BACKGROUND

Postgraduate education is said to support the development of nurses' professional competence and confidence, essential to the delivery of safe and effective care. However, there is a shortness of empirical evidence to demonstrate an increase to nurses' self-reported confidence and competence on completion of critical care postgraduate certificate-level education.

OBJECTIVES

To explore the impact of a critical care postgraduate certificate course on nurses' self-reported competence and confidence. To explore the psychometric properties and performance of the Critical Care Competence and Confidence Questionnaire.

DESIGN

A quasi-experimental pre/post-test design.

PARTICIPANTS

A total population sample of nurses completing a critical care postgraduate certificate course at an Australian University.

METHODS

The Critical Care Competence and Confidence Questionnaire was developed for this study to measure nurses' self-reported competence and confidence at baseline and follow up. Descriptive and inferential statistics were used to explore sample characteristics and changes between baseline and follow-up. Reliability of the questionnaire was explored using Cronbach's Alpha and item-total correlations.

RESULTS

There was a statistically significant increase in competence and confidence between baseline and follow-up across all questionnaire domains. Satisfactory reliability estimates were found for the questionnaire.

CONCLUSIONS

Completion of a critical care postgraduate certificate course significantly increased nurses' perceived competence and confidence. The Critical Care Competence and Confidence Questionnaire was found to be psychometrically sound for measuring nurses' self-reported competence and confidence.

Quality and relevance of master degree education for the professional development of nurses and midwives

BACKGROUND

Advanced education in nursing is essential to provide safe, high quality and efficient health services in line with population needs. However, there is an almost complete lack of studies on how nurses view the usefulness of post-graduate education for their current employment and for professional advancement.

OBJECTIVES

To evaluate how nurse graduates view the quality, relevance and applicability of the knowledge and skills acquired during the Master of Science in Nursing (MSN) degree.

DESIGN

Multicentre cross-sectional study.

METHODS

A multicenter cross-sectional study was carried out through an online questionnaire mailed (July 2014-June 2015) to 560 nurses who obtained the MSN degree from 23 Italian universities in the academic year 2010-2011.

DISCUSSION

A total of 426 nurses completed the survey (response rate 76.1%), 80% of whom believed they had acquired knowledge and skills useful in their professional life after graduation. A multiple logistic regression model highlighted the characteristics of nurse graduates who judged the master's course relevant for their present role. In brief, they are expert nurses (OR=3.41, 95% CI=1.54-7.54) who achieved professional growth after the course (OR=5.25, 95% CI=2.67-10.33) and who judged the course very good or excellent (OR=2.16, 95% CI=1.04-4.52). Only 8% of the respondents achieved a full professional growth after the course.

CONCLUSION

In Italy, MSN courses are able to provide a high level of skills and competencies. However, given the low rate of professional growth after the course, specific policies should increase the employment rates of new master's graduate nurses.

Leadership research in healthcare: A realist review

Being largely considered a human right, healthcare needs leaders who are able to make choices and to set directions. Following the recommendations expressed by Gilmartin and D'Aunno's review and roadmap compiled in 2008, today, it is important to acknowledge researchers' contributions to outline this landscape. The realist review of 77 publications answered questions such as “what works, for whom, and in which circumstances” highlighting: the effectiveness and acceptance of transformational and collaborative approaches; professionalism, expertise, and good task delegation within operational teams; distributed leadership, relationships, and social responsibility at a systemic level. The relevancy and need of leadership development programs, framed within a wider strategy, emerged. Nonetheless, gaps still exist and require further investigation: particular needs in public vs. private contexts; professionals' and women's differentiating characters; generational gaps; associations between leadership and recruitment HR practices research; how (and if) leaders (should) influence the organizational culture and values; and developing countries specific challenges. Also, a greater proportion of relevant findings should be drawn by empirical and more rigorous studies. Finally, a major attention could be paid to interactions happening at the team, organizational, and systemic level among different leaders and among leaders, followers and external actors.

The Courage to Care-An innovative arts-based event to engage students and the local community to reflect on Australian nurses' roles in the First World War and after

There is a large body of work that documents the history of the nursing profession and the experiences of nurses during significant historical eras such as the First World War. Yet learning about nursing history is commonly a tiny, or absent, component in the undergraduate nursing curriculum. This paper discusses an innovative project that had multiple aims. A primary aim was to engage nursing students and educators in a project that valued nursing history by integrating it into an event to celebrate International Nurses Day. As the paper will explain, other aims were in organising the event so that it capitalised on particular creative arts strengths within the faculty, offering cross-disciplinary connections, engagement and appreciation. A Readers' Theatre event, involving academics and students in nursing, creative arts and education, was conceived, developed and performed for the community. The theme was the experiences of First World War nurses and how they encapsulated values important to nursing today - the 6 Cs - which guide high standards of nursing. The 6 Cs are care, compassion, competence, communication, courage and commitment. We called the Readers' Theatre "The Courage to Care", and this involved a 4month process of script development, event planning and a performance. This process and outcomes were evaluated, prompting a reflection on the strengths and challenges of working in this creative way to engage a wide group of stakeholders to advance the profession of nursing.

Leading Through Lifelong Learning

School nurses, as leaders, are able to exhibit leadership skills through embracing, advocating for, and demonstrating a commitment to lifelong learning. With the continual changes in healthcare and technology, ongoing education is essential to maintain a high standard of expertise and practice. School nurses have many opportunities for continuing education. This article will briefly explore various levels of continuing education, as well as relating ongoing learning to leadership principles.

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on

BACKGROUND

Nursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time.

METHODS

In the nascence of the expansion of the role of nurses in Australian general practice (2003-2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009-2010 and comparative analysis of the datasets undertaken to explore workforce changes over time.

RESULTS

Two hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses' role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses' role in general practice was slightly decreased over time.

CONCLUSIONS

This study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse role development. Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce.