Facilitating international students' learning during placements: the experiences of practice assessors and practice supervisors

BACKGROUND

There are increasing numbers of international students applying for preregistration nursing courses in the UK. Encouraging overseas students to study nursing in the UK has potential benefits for the profession, but practice assessors and practice supervisors may face challenges when supporting international students during placements.

AIM

To explore the experiences of practice assessors and practice supervisors in facilitating international preregistration nursing students' learning during placements.

METHOD

A qualitative interpretive research method was used. Data from ten semi-structured interviews undertaken in one hospital in an acute NHS trust were analysed using reflexive thematic analysis and interpretive approaches.

FINDINGS

Three overarching themes emerged: communication, support and collaboration. Participants identified barriers related to language and culture and expressed a desire for additional information about students' background before the start of placements. Solutions included drawing from the expertise of colleagues with similar backgrounds to those of students, using buddying and creating peer support groups.

CONCLUSION

Effective collaboration between universities and practice placement providers is needed to develop interventions that can support practice assessors and practice supervisors to enhance international students' learning experiences.

Participation and co-production for learning and development of identities: wherever I go, I meet myself

BACKGROUND

Contemporary society is characterised by constant change with an ever-increasing feature of interconnection, having clear implications for healthcare professional learning and role identity. It is proposed that active participation and coproduction for learning can provide options to understand contemporary challenges and opportunities in the development of personal and professional identity.

AIMS

This research aimed to explore the value of learning and development of identity through participation in co-produced practical workshop activity involving service users and students across a Year 1 (level 4) undergraduate BSc(Hons) Physiotherapy module. Co-production was also reflected within the research project design and operationalisation.

MATERIALS & METHODS

Following delivery of the workshops, data were collected and analysed from a series of individual semi-structured interviews (n = 11) and a focus group.

RESULTS

Six emergent themes were identified. A central theme of identity and self-worth was deconstructed within five interdependent sub-themes; real and safe, person-centred, backstage learning, good to talk and staging of curriculum.

CONCLUSION

A process of open dialogue within co-produced workshop design and delivery would appear to enhance learning and a contextual appreciation of a broader 'whole' for all participants. Future research is aimed at building on this project, to explore co-produced learning opportunities across levels and settings that provide further insight into personal and professional identity development.

Evaluation of service user-led workshops in children's palliative care education

Children's nurses report feeling unprepared when caring for children with life-limiting conditions and their families, while the value of including service users in the provision of nursing education is increasingly recognised. This small-scale service evaluation examined the effect on learning of service user-led workshops as part of a module for final-year children's nursing students and post-registration children's nurses. The workshops focused on the experience of children's palliative care and child bereavement from the parents' perspective. Findings from evaluation data indicated high levels of satisfaction with the workshops and identified three themes: safe space, shift in perspective and enhancing practice. A model of service user facilitated learning describes how these themes can enable learning about children's palliative care. This evaluation suggests that the involvement of service users as partners in healthcare education can be transformative, enabling children's nursing students to examine their own perspectives and consider ways to enhance their future practice.

Supporting nursing degree apprentices: advice for higher education institutions and employers

A nursing degree apprenticeship offers an alternative route into nursing from the traditional preregistration nurse education programme by enabling apprentice employees to work and study at the same time. This route could address some of the issues associated with attrition from preregistration nurse education programmes, such as financial challenges. However, nursing degree apprentices may experience other challenges, for example suboptimal work-life-study balance and inadequate support from employers and higher education institutions (HEIs), resulting in dissatisfaction with or non-completion of their apprenticeship programme. This article examines some of the literature on apprenticeships and suggests ways in which employers, HEIs and nursing degree apprentices can work together to improve the apprenticeship experience.

Emotional intelligence in preregistration nurse education

Emotional intelligence (EI) is considered essential to nursing practice, but it is unclear how best to support nursing students to develop EI skills. This article details a literature review that was undertaken to explore EI in preregistration nurse education and to identify effective methods for developing nursing students' EI skills. A total of 12 articles were included in the review, from which data were extracted, compared and categorised. Three main areas were identified regarding EI in preregistration nurse education: EI constructs, EI components and EI teaching methods. The review found that a range of EI constructs and components may be included in nurse education curricula, meaning that there is often inconsistency in the approaches used. Classroom teaching methods were primarily used, alongside online methods and experiential methods such as simulation-based learning. The findings of the review suggest there is a need for greater consistency in the EI constructs and components used in preregistration nurse education, as well as further research to determine which EI teaching methods are most effective.

Protecting the mental health of the future workforce: exploring the prevalence of cognitive distortions among nursing students

BACKGROUND

Evidence suggests that stress and anxiety are commonly experienced by nursing students. Cognitive distortions, or negative thinking styles, are linked to stress and anxiety and have been shown to have a detrimental effect on mental health. Therefore, identification of cognitive distortions among nursing students may serve to prevent the development of mental health issues among this population.

AIM

To explore the prevalence of cognitive distortions among a sample of nursing students, identify which types were more common and determine how these types varied by sociodemographic characteristics.

METHOD

A cross-sectional online questionnaire survey was conducted with undergraduate nursing students at a university in Palestine. All students enrolled during the 2020-21 academic year ( n =305) were invited to participate, of whom 176 responded.

RESULTS

Of the 176 students who responded, 9 (5%) had severe levels of cognitive distortion, 58 (33%) had moderate levels, 83 (47%) had mild levels and 26 (15%) had healthy levels. Of the nine types cognitive distortions described in the questionnaire, respondents engaged most in emotional reasoning, followed by perfectionist thinking and 'What if?'

QUESTIONS

The cognitive distortions that respondents were least likely to engage in were polarised thinking and overgeneralising. Single, first-year and younger respondents had a significantly higher level of cognitive distortions.

CONCLUSION

The results emphasise the importance of identifying and managing cognitive distortions in nursing students, not only in the mental health clinics at the university where the study took place, but also in preventive well-being services. Universities should prioritise nursing students' mental health.

Community nurse lecturers' experiences of pre-registration nurse education: a phenomenological study

The aim of this study was to explore the lived experiences of community nurse lecturers in pre-registration nurse education and to gain insight into the nature of community nursing and its profile within pre-registration nursing. A qualitative phenomenological approach explored pre-registration, adult field nurse lecturers' experiences of being community nurses and subsequently their experiences of being community nurse lecturers. Three participants audio recorded answers prompted by three questions that allowed for storytelling and prompted memory recall. The results were analysed, and the themes identified were: community nursing is vastly different to hospital nursing, with a notable heightened sense of accountability, lone working and a recognition of experience needed to be a community nurse. When reflecting on their role as lecturers, research participants recalled responses that informed the second theme: the pre-registration adult nursing curriculum was acute care focused and this was also the expectation of students. Results identified tensions between community nursing and critical care nursing, and a loss of identity to which each of them embraced in different ways.

A district nurse's reflection on pre-registration nursing education: a troubling position

This article explores the author's observations as a qualified district nurse and senior lecturer in pre-registration nurse education. Perceived 'troubling' reflections suggest pre-registration nurse education appears very hospital focussed. Additionally, the role of the district nurse has become synonymous with the term 'community nurse', hiding the historical specialism it represents. Media representations of the term 'frontline' was particularly noted in relation to COVID-19, suggesting a heroism of nursing that only happened in hospital. More discussion will take place around how nursing is viewed within education by students, such as what we do to patients (catheterisation, blood sugars etc) rather than how we can work with them. All these areas appear to strengthen lingering historical myths around district nursing and student perceptions of this specialist profession.

Exploring how reflective practice training affects nurse interns' critical thinking disposition and communication skills

BACKGROUND

It is useful for nurses to be able to engage in reflective practice. Reflective practice is an essential aspect of experiential learning.

AIM

To explore how reflective practice training during an internship programme in Saudi Arabia affected nurse interns' critical thinking disposition and interpersonal communication competency.

METHOD

A convenience sample of 93 senior nursing students undertaking the internship programme at a nursing college in a university in Saudi Arabia answered a questionnaire before and after taking part in reflective practice training sessions. The questionnaire used three tools: the Reflective Practice Questionnaire; the Critical Thinking Disposition Scale; and the Interpersonal Communication Competency Scale.

RESULTS

After the training, the overall mean scores for reflective practice, critical thinking disposition and interpersonal communication competency were significantly higher than before the training. Reflective practice had a positive correlation with critical thinking disposition and interpersonal communication competency. It also had predictive capability for the variance in critical thinking disposition and interpersonal communication competency (R 2 =0.798 and R 2 =0.553, respectively, P <0.001).

CONCLUSION

Reflective practice training provided to nurse interns in Saudi Arabia improved their reflective practice, critical thinking and interpersonal communication. Reflective practice training would be a useful addition to pre-graduate nurse education and to preceptorship or orientation programmes for newly recruited nurses.

Supporting the well-being of nursing students and student midwives during the COVID-19 pandemic

Throughout the coronavirus disease 2019 (COVID-19) pandemic the Queen's University Belfast Connections (QUB Connections) project has provided online well-being support to nursing students and student midwives. The project, which was co-designed and led by students and academic staff, provided an online well-being service for students who took on front-line roles during the early part of the pandemic and for those who had to pause their studies. Insights gained from responses to an evaluation of the support sessions suggested that some students felt stigmatised, frightened, lost, isolated and abandoned during this period, but that QUB Connections gave them a sense of 'being held' and 'attended to' in a time of uncertainty. The evaluation findings are a reminder of the need to continue to help nursing and midwifery students and newly qualified staff develop self-care and support mechanisms. QUB Connections is now embedded in the university's school of nursing and midwifery pre-registration programmes to support students and those new to nursing and midwifery practice.

Exploring nursing students' knowledge of Alzheimer's disease

BACKGROUND

As the number of people with a diagnosis of dementia continues to increase, it is essential that nurses have the skills required to provide high-quality care. However, there may be gaps in dementia teaching in undergraduate nurse education programmes in the UK.

AIM

To assess knowledge of Alzheimer's disease among one cohort of third-year nursing students to improve the education content of the dementia module at Oxford Brookes University, England.

METHOD

A total of 35 participants completed the Alzheimer's Disease Knowledge Scale, a validated tool that measures knowledge about risk factors, assessment and diagnosis, symptoms, course (disease progression), life impact, caregiving, and treatment and management. Data were analysed using quantitative methods.

RESULTS

Participating students appeared to have greater knowledge about dementia in relation to treatment and management, life impact, caregiving, and assessment and diagnosis, and less knowledge about risk factors, course and symptoms. This may be because the focus of teaching is on caregiving and medical treatment.

CONCLUSION

This study identified strengths and gaps in nursing students' knowledge of Alzheimer's disease. The results have informed recommendations for ways to improve the education content of the dementia module for future cohorts and to enhance dementia education in nursing, health and social care undergraduate programmes in general.

Disaster nursing and disaster preparedness: an investigation of nursing students' knowledge, competence and attitudes

BACKGROUND

Any country is at risk of disasters associated with natural, biological, technological and societal hazards. Such disasters pose ever greater challenges for healthcare systems. Nurses and nursing students have a crucial role in responding dynamically to disasters in their communities.

AIM

To investigate nursing students' knowledge of and self-perceived competence in disaster nursing and attitudes towards disaster preparedness.

METHOD

A descriptive cross-sectional study design was used to investigate knowledge, competence and attitudes in a convenience sample of 300 nursing students in their third and fourth years at a nursing college in Saudi Arabia. Students were asked to complete an online questionnaire on disaster nursing and disaster preparedness. A 96% response rate was obtained.

RESULTS

Most participating students had a favourable attitude towards disaster preparedness. They also perceived themselves as having a relatively high degree of competence in disaster nursing. However, most participants had inadequate knowledge of disaster nursing and may not have been fully aware of their role in disaster relief operations.

CONCLUSION

Enhancing nursing students' awareness of the importance of disaster preparedness and competence in disaster nursing can potentially save lives. Disaster nursing and disaster preparedness should be part of undergraduate nurse education curricula and nurse educators should develop innovative educational interventions on these topics.

Co-producing transgender awareness training for healthcare students and professionals

Nurses and doctors must be culturally competent to care for transgender patients. However, there is little time dedicated to lesbian, gay, bisexual, transgender and queer plus (LGBTQ+) health in undergraduate and postgraduate nursing and medicine education and healthcare professionals often lack the competence and skills to treat transgender patients sensitively. At Queen's University Belfast, a transgender awareness training session was developed to enhance the cultural competence of nursing and medicine students and academic staff. The training was co-produced with students and transgender people and delivered by a transgender person. Training on transgender health should be designed in collaboration with transgender people and should be a core component of undergraduate and postgraduate healthcare curricula.

Exploring support strategies for improving nursing student retention

Nursing student attrition is a significant concern in many countries, including the UK. Higher education institutions (HEIs) are seeking creative ways of improving retention and it is crucial to understand which support strategies encourage students to persist with their studies. This article describes a systematic review of the literature exploring nursing students' experiences and perceptions of support strategies used by HEIs to reduce attrition and improve retention. Having a sense of belonging, a connection with the university, self-confidence, self-efficacy and motivation appeared to make students more likely to stay on their course. Several support strategies appeared to enhance retention, including an automated text messaging system, an Academic, Personal and Professional Learning (APPL) support mechanism, a pastoral care support adviser service and an extracurricular student support group. Developing a holistic and multifaceted approach to retention involves working collaboratively with students to enhance the understanding of their needs.

Providing interprofessional education for pre and post-registration nurses

During an episode of care, a patient may be attended by a variety of healthcare professionals. In addition, healthcare service provision can be complex, and patients may feel that elements of their care have been missed or delayed due to inadequate collaboration and communication between the staff involved. Interprofessional education (IPE) involves students from two or more professions learning about each other's roles and skills. Increasing calls for integrated and joined-up healthcare services mean that staff will be increasingly required to collaborate with colleagues, with the aim of providing joined-up care. This article explains the background to IPE, how it can be implemented in practice and the barriers that nurses should consider to ensure effective implementation.

Nursing students' experiences of, and socialisation in, dementia care in the acute hospital setting

BACKGROUND

An ageing population with a range of co-morbidities means the number of hospital admissions of older people with dementia is increasing. People with dementia can find acute hospital settings unsettling and they need to be cared for by a workforce skilled and knowledgeable in dementia care.

AIM

To explore nursing students' experiences of, and socialisation in, dementia care in the acute hospital setting in England through a secondary qualitative analysis of data from a phenomenological study of nursing students' cultural beliefs around, and understanding of, dementia.

METHOD

Data from ten focus groups with 81 undergraduate nursing students at two universities in the south of England were subjected to content analysis. This was a secondary qualitative analysis of data retrieved from an earlier study.

FINDINGS

Two categories emerged: 'exposure to dementia care' and 'socialisation in dementia care'. Participants often felt unprepared to care for patients with dementia and their experiences were negatively affected by staff's views of patients with dementia, who were often considered challenging to manage. Participants also encountered specialist dementia nurses who enabled them to learn more about person-centred dementia care.

CONCLUSION

Optimal dementia care knowledge and skills can contribute to enhanced patient outcomes and positive attitudes towards older people's care. To reduce deficits in dementia care education, nurses need regular continuing professional development in dementia care, higher education institutions need to commit to developing dementia care in their curricula, and students need to be socialised in dementia care earlier during undergraduate nurse education.

Evidencing diversity: development of a structured tool for investigating teaching of pressure injury on people with darker skin tones

BACKGROUND

Dismantling structural racism challenges nurses to consider the extent to which issues of inclusion, diversity and race are operationalised in day-to-day professional practice. This includes nurse education. To be truly effective, any examination of teaching content in nurse education needs to be investigated through document analysis plus observation in the classroom. However, tools to ensure consistency between these methods of collecting data are limited.

AIM

To design a structured tool for collecting data by analysing teaching materials and observing teaching on pressure injuries and people with darker skin tones.

DISCUSSION

This novel approach of using a single tool provides a unique opportunity to explore teaching materials and what is actually taught in the classroom. The data collected can assist with comparative analysis, enabling an in-depth view of curriculum content.

CONCLUSION

The nuanced and subtle data gathered using the complementarity of analysis between teaching materials and teaching observations in the exemplar tool presented created a unique data set for examination.

IMPLICATIONS FOR PRACTICE

This tool has broad applications for nurse researchers, particularly for examining topics that are often perceived to be sensitive, such as race and skin tone. It can be used for in-depth scrutiny of classroom teaching, to develop and influence curriculum content and team discussions, and in larger studies exploring nurse education content.

Exploring the effects of a high-fidelity environment on nursing students' confidence and performance of CPR

BACKGROUND

Simulation is often used in healthcare education because it enables students to practise clinical skills in a safe environment where mistakes can occur without the risk of patient harm. Simulation can involve varying levels of fidelity (realism), ranging from low fidelity (for example, using role play) to high fidelity (for example, using sophisticated technology such as augmented or virtual reality).

AIM

To investigate if a high-fidelity simulation environment improves confidence and the performance of cardiopulmonary resuscitation (CPR) in first-year undergraduate adult nursing students.

METHOD

This small pilot study involved a sample of 15 participants who were randomised into an intervention group (n=7) and a control group (n=8). The control group received teaching and were tested on the skill of CPR using a manikin in a medium-fidelity simulation scenario in a modified classroom environment, while the intervention group received the same teaching, testing and simulation scenario but in a high-fidelity 'immersion suite'. Quantitative data were collected using a pre-intervention and post-intervention self-report confidence questionnaire and from performance data generated by the Laerdal Medical 'Little Anne' manikin QCPR software.

RESULTS

Overall, there were no statistically significant improvements in performance metrics for the intervention group compared with the control group. Both groups reported overall improvements in confidence regarding their knowledge and skills in managing a critically ill patient, but these results were not deemed to be statistically significant.

CONCLUSION

The results of this study indicate that the use of simulation increases nursing students' confidence in undertaking CPR, but that a high-fidelity simulation environment does not necessarily improve their performance of CPR.

Learning and leadership in advanced dementia care

This article, part of a series in Nursing Older People exploring the nursing care of people living with advanced dementia, considers learning and leadership. It outlines learning opportunities about advanced dementia and what developments are needed. The need for strong leadership at all levels and settings is explored along with the challenges of educating those who care for the person with advanced dementia. It also outlines educational opportunities and programmes before illustrating how one nurse leads advanced dementia care in practice.

Designing an adolescent safeguarding curriculum framework for preregistration nurse education programmes

Adolescence is a crucial period of transition during which young people are exposed to a range of safeguarding risks in the wider social context. However, it has been identified that the need to safeguard adolescents is less well recognised than the need to safeguard children. Furthermore, there is evidence that child development education provided as part of preregistration nurse education programmes tends to neglect adolescent development. Therefore, there is a need to adopt a life-course approach - which focuses on all stages of child development, including adolescence - and to review child development education to support future nurses in their role in safeguarding young people in practice. This article proposes a curriculum framework for adolescent safeguarding education, outlining a structure to support nurse educators when designing or reviewing preregistration nurse education programmes.

Using legitimation criteria to establish rigour in sequential mixed-methods research

BACKGROUND

Despite the extensive use of mixed methods across health sciences, there has been a limited discussion about the methodological rigour and quality in mixed methods research (MMR). Although the empirical and methodological literature about mixed methods is increasing, there are few practical examples of the implementation of rigour criteria.

AIM

To discuss and illustrate the application of 'legitimation criteria' to the design and conduct of a sequential exploratory MMR study of nurse educators' challenges when teaching undergraduate students.

DISCUSSION

The legitimation criteria can establish philosophical and methodological validity and rigour in MMR. MMR is complex and daunting, so maintaining rigour is crucial in ensuring the conclusions drawn are plausible and researchers, practitioners and policymakers use them to guide research and practice.

CONCLUSION

The legitimation criteria are specific to MMR and are useful in improving the conduct and execution of studies. They enable researchers to maintain quality throughout their studies, from the development of a research question to the generation of conclusions.

IMPLICATIONS FOR PRACTICE

This illustration of the legitimation criteria for the design and conduct of MMR will guide researchers in establishing rigour and lessen the threats to their studies' validity.

Implementing the National Early Warning Score 2 into pre-registration nurse education

Recognising signs of deteriorating health in patients and responding to them appropriately are crucial nursing competencies. In acute care, failure to detect and act promptly on deterioration can lead to the patient's death. To achieve clinical competence, nursing students require training in the use of techniques for monitoring physiological observations as well as protocols that enable them to respond to deterioration. The use of early warning scores has been advocated to standardise the methods and frequency of patient monitoring in acute care settings. In 2012, the Royal College of Physicians developed the National Early Warning Score (NEWS), which was updated in 2017 and known as NEWS2. This early warning score is used in acute hospitals in England, Scotland, Wales and Northern Ireland. This article explores the benefits and challenges of using NEWS2 as an educational tool in pre-registration nursing programmes to support nursing students in recognising and responding to deteriorating health.

Primary school children's participation in selecting children's nursing students

Despite the importance of seeking children's views in healthcare being widely recognised, there are few reports of child service user involvement in selecting children's nursing students. At Oxford Brookes University, the children's nursing team has had three years' experience of partnership with a local primary school where children have engaged in the selection of children's nursing students. At the end of the first year of the initiative an evaluation was undertaken to elicit the children's views about their experience of participating in an interview day. A modified nominal group technique was used to elicit feedback. The children reported positive experiences of writing and asking interview questions, and of engaging in skills lab activities, although they found aspects of the experience challenging. The findings were similar to those in the literature on this topic. Feedback from the evaluation was incorporated into children's involvement in the subsequent two years of this initiative. Partnerships between universities and schools can have many mutually beneficial outcomes, but good preparation, support and ongoing evaluation are needed to ensure children's best interests are safeguarded. Recommendations for future research are also proposed.

Promoting recruitment by rebranding the image of nursing

Understanding the factors that can influence people to pursue a career in nursing is essential for healthcare service managers, human resource professionals and nurse educators, particularly given the global shortage of nurses. There is evidence that the public perception of nursing can be negatively influenced by the media and nursing recruitment advertisements, and that this can discourage some people from choosing nursing as a career. At the Dalhousie University in Canada, evidence regarding the career choices of prospective nurses was used to inform a rebranding strategy for the School of Nursing's recruitment materials. The aim of the rebranding strategy was to present the School of Nursing as a diverse institution that provided a range of career opportunities for its nursing students. This article describes the background and implementation of the rebranding project. It also details how the university's evidence-based rebranding strategy was designed to positively influence people to choose nursing as a career.

Exploring the characteristics of effective communicators in healthcare

Nurses require effective communication and interpersonal skills to provide optimal care, and to ensure that patients and their families and carers have a positive experience of receiving care. The new Nursing and Midwifery Council standards of proficiency for registered nurses, and for nurse education and training, published in May 2018, recognise that future nurses will be practising in increasingly complex roles and environments. This article identifies the essential communication skills that will be required by nurses in the future, summarising the characteristics of a modern nurse communicator. It also suggests various approaches that nurses can use to develop their communication skills.

Student-led simulation: preparing students for leadership

It is vital to prepare nurses to become informed leaders with the required knowledge and skills to support effective patient care and outcomes. This article describes an innovative teaching method that enables students to create simulation scenarios based on their clinical experiences, to lead simulations and to take part in self-reflection and peer review activities. The article shows how the method can help prepare nursing students to become future leaders by allowing them to practise 'real-life', real-time leadership skills, and apply theory to practice in the safety of a simulated scenario.

Nursing students' experiences of delivering dementia friends sessions to peers

BACKGROUND

Nursing students and registered nurses often feel underprepared for their roles in dementia care. Extracurricular activities offer nursing students additional opportunities for professional development. A student-academic partnership initiative was developed in which nursing students delivered dementia friends sessions to their peers before formal taught content.

AIM

To explore dementia champion nursing students' experiences, identify factors that affect collaborative working and make recommendations for future student-academic partnership projects.

METHOD

In individual and dual interviews, three students were asked about their experiences of participating in the initiative. Interviews were recorded, transcribed and analysed using a thematic analysis framework.

FINDINGS

Four themes were identified: commitment to working with people who have dementia, difficulties in taking on extracurricular responsibilities, personal development, and relationships and collaboration.

CONCLUSION

Students were motivated by the need to provide high-quality dementia care. They identified benefits of collaborative working including development of time management, team working, leadership, communication and presentation skills. Future projects should take into account student workloads and offer rewards that are congruent with nursing students' values.

Results of cross-faculty 'capstone' assessments involving nursing and performing arts students

This article describes how 'capstone' assessments were created to provide two different student groups, nursing and performing arts students, with a lived experience of learning together about their own fields of practice. Capstone assessments combine 'live' human simulation with self-reflection and peer review. A capstone assessment is the integration of a body of relatively fragmented knowledge and learning to form a unified whole and can be used as a transitional assessment and a bridging experience to connect knowledge between modules or courses. The capstone assessments involved two faculties and four modules, three nursing and one performing arts. Case studies were designed to represent real-life situations that students were likely to encounter during their careers, either playing a patient as an actor or performing a caring role as a nurse. Assessments for the capstone simulation were formative, and involved the students engaging in self-reflection and peer review. Videos were available to enhance the self-reflection and peer-review process. Evaluation was undertaken through verbal feedback during debrief, written feedback, video footage and nursing student and acting student peer review. The experience of capstone assessments for two diverse student groups provided valuable learning from their own and from a different group outside their subject area.

Nurse education in the British armed forces

Defence nurses form the largest registered specialty in the UK defence medical services. Once qualified, defence nurses maintain and develop their nursing and clinical skills in appropriate healthcare settings, and can be deployed in operational environments such as Afghanistan. Workforce planning and staffing establishment levels are defined to meet the needs of British armed forces, allies and, potentially, local populations. Since the workforce is geographically dispersed, deployed or undertaking non-clinical duties, there are constraints on nurses' attempts to maintain basic skills and access continuing professional development. This article explores the concept and the developing role of defence nurse lecturers in improving educational support for defence nurses.