Nursing Education: Planning and Delivering the Curriculum

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Jennifer Boore & Pat Deeny

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    Copyright

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    Dedication

    This book is dedicated to the late Gordon Rae, Emeritus Professor of Psychology and Jenny's husband, whose encouragement and advice on education and statistics helped to make this book possible.

    List of Figures, Tables and Boxes

    Figures
    • Figure 2.1 Educational Philosophies and Models Of Learning 17
    • Figure 2.2 Maslow's Hierarchy of Needs in Nursing Education 18
    • Figure 2.3 Domains of the Curriculum in Professional Subjects (Barnett and Coate, 2005) 19
    • Figure 2.4 Outline of NMC Standards 22
    • Figure 2.5 Proposed Curriculum Framework Pre-Registration Nursing Education 25
    • Figure 3.1 Example of Curriculum Development Structures 31
    • Figure 3.2 Managing Partnership Working 32
    • Figure 3.3 Role Characteristics Between Students and Mentors in the Peer Support Scheme 38
    • Figure 3.4 A Whole Systems Approach to Service User and Carer Involvement 42
    • Figure 5.1 The Dimensions of PBL 82
    • Figure 5.2 Taxonomies of Learning (based on and cited by Atherton, 2011) 87
    • Figure 5.3 Constructive Alignment: Learning Outcomes, Teaching and Assessment (Biggs and Tang, 2007) 90
    • Figure 5.4 The Sold Taxonomy – A Hierarchy of Learning (Biggs and Tang, 2007) 91
    • Figure 6.1 Spiral Curriculum: Communication, Teaching and Learning 112
    • Figure 7.1 Dimensions of Learning (adapted from Ausubel et al., 1978) 123
    • Figure 7.2 Kolb's Experiential Learning Model (Knowles et al., 2011) 125
    • Figure 7.3 The Balance Between Experience and Reflection 126
    • Figure 8.1 Learning Styles and Reflection within Kolb's Experiential Learning Model 130
    • Figure 8.2 Effective Thinking and Problem-Solving cycle 135
    • Figure 8.3 Aspects of Creative Thinking (based on Osborn's Seven-Step Model (Standing, 2010)) 136
    • Figure 8.4 The Lobster Pot Model of Decision-Making (Adair, 2007: 29) 139
    • Figure 9.1 Managing Anxiety through Preparation (derived from Exley and Dennick, 2004a) 147
    • Figure 9.2 Ground Rules for Small Group Teaching (Exley and Dennick, 2004b) 153
    • Figure 9.3 Summary of the Key Features of Effective Problems (Barrett and Moore, 2011) 156
    • Figure 10.1 The PCN Framework (McCormack and McCance, 2010: 34) 161
    • Figure 10.2 Example of ‘Hub And Spoke’ Practice Learning 171
    • Figure 10.3 Themes from Students Undertaking Community Final Placement (Anderson and Kiger, 2008: 446) 173
    • Figure 10.4 An Example of a Learning Contract (Gopee 2008: 27) 174
    • Figure 10.5 An Example of An Action Plan (Gopee 2008: 165) 174
    • Figure 11.1 Technology in Nursing Education 177
    • Figure 11.2 Continuum of Reality in Using Simulations (Jeffries, 2007) 182
    • Figure 11.3 The Nursing Education Simulation Framework 183
    • Figure 11.4 Lectures, Powerpoint Presentations and Handouts in Promoting Learning 193
    • Figure 12.1 Six Principles of Assessment for Learning 200
    • Figure 12.2 Preparation for Self-Assessment 212
    • Figure 15.1 The Personal Tutor 262
    • Figure 15.2 Student Support Services 266
    • Figure 17.1 Achievement of Quality in Nursing Programmes 293
    • Figure 17.2 Academic Infrastructure 295
    • Figure 17.3 Integrating Approaches of Clinical Governance (Scally and Donaldson, 1998) 297
    • Figure 17.4 Quality of Individual Lecturer 300
    • Figure 17.5 Quality of Mentor Input to Education 300
    Tables
    • Table 2.1 Outline of Nursing Subject Benchmarks 24
    • Table 3.1 Costs and Benefits for External Organisations Participating in Curriculum Planning Team 29
    • Table 3.2 Organisations in Disaster Response 45
    • Table 4.1 Higher Education Qualifications in Nursing in the UK (adapted from QAA, 2008b) 54
    • Table 4.2 Honours Degree Classification 56
    • Table 5.1 NMC Domains and Framework Themes 71
    • Table 5.2 Course Outcomes within the Theme of Leadership and Management Showing Graduate Qualities 74
    • Table 5.3 Example of Course Outcomes for Pre-Registration Nursing Programme 75
    • Table 5.4 Comparison Between a Problem-Based and a Case-Based Curriculum (Uys and Gwele, 2005) 84
    • Table 5.5 Selected ILO Verbs Applicable to Bloom's Taxonomy: Revised Cognitive Domain 91
    • Table 5.6 Possible Practice Learning Experiences in a Pre-Registration Community Nursing Programme 93
    • Table 5.7 Sequencing of Learning 93
    • Table 6.1 Expected Requirements for Pre-Registration Nursing Education in the UK (linked to themes in Figure 2.5). Most of this content is taken from Standards for Pre-Registration Nursing Education, NMC, 2010a) 97
    • Table 6.2 Outline of Topics within Theme on Reflective and Proficient Practice 99
    • Table 6.3 Topics within Theme on Theoretical and Professional Issues 103
    • Table 6.4 Possible Nursing Grand Theories within the Curriculum 104
    • Table 6.5 Topics within Theme on Communication, Teaching and Learning 105
    • Table 6.6 Outline of Topics within Theme on Health and its Determinants (from Carr et al., 2007) 107
    • Table 6.7 Outline of Topics within Theme on Leadership and Management 108
    • Table 6.8 Topics within Theme on Research and Evidence-Based Practice 110
    • Table 6.9 Module on Caring for those with Chronic Illness 113
    • Table 6.10 PBL Module on Caring for those with Chronic Illness 114
    • Table 7.1 Gagne's Distinctive Types of Learning (adapted from Knowles et al., 2011) 118
    • Table 7.2 Factors Encouraging Surface or Deep Learning 119
    • Table 7.3 Summary of Dreyfus Model of Skill Acquisition (Eraut, 2000: 126) 122
    • Table 7.4 Functions of the Learning Environment (Knowles, 2011) 128
    • Table 8.1 Learning Styles and Reflection at Stages in the Experiential Cycle (Sharples, 2009) 132
    • Table 8.2 A Structure for Student Reflection 133
    • Table 8.3 Development of Critical Thinking (Burnard, 2002) 136
    • Table 8.4 Modes of Thinking (Adair, 2007) 137
    • Table 8.5 Decision-Making and Problem-Solving Process (Marquis and Huston, 2012: 7; Adair, 2007: 25) 139
    • Table 8.6 De Bono's (1986) Six Thinking Hats (from De Bono, 2000) 140
    • Table 9.1 Stimuli and Activities within Lectures (from Exley and Dennick, 2004a; Fry et al., 1999; Bligh, 1998) 145
    • Table 9.2 Value of Discussion Techniques (from Bligh, 1998) 146
    • Table 9.3 Aims of Small Group Teaching (Exley and Dennick, 2004b) 148
    • Table 9.4 Approaches to Small Group Teaching (adapted from Quinn and Hughes, 2007; Exley and Dennick, 2004b) 149
    • Table 9.5 Team Role Characteristics (Belbin, 2010) 151
    • Table 10.1 Outline of Types of Skills Applicable Across All Fields of Practice 160
    • Table 10.2 Frameworks for Psychomotor Skills Development (cited in Exley and Dennick, 2004b) 165
    • Table 11.1 Communication Skills and their Application (Dickson et al., 1997) 186
    • Table 11.2 Feedback Characteristics (Dickson et al., 1997) 187
    • Table 11.3 Simulation Components Used by Effective Studies (Cant and Cooper, 2010: 12) 192
    • Table 11.4 Principles for Elearning Development Based on Empirical Research (Clark and Mayer, 2008) 194
    • Table 12.1 Assessment Supporting Learning 201
    • Table 12.2 Assessment Through Examination 206
    • Table 12.3 Assessment Through Coursework 207
    • Table 12.4 Types of Essay Questions (Habeshaw et al., 1998) 208
    • Table 12.5 Assessment Schedule for Dissertation 210
    • Table 12.6 Examples of Assessment in Small Group Teaching and Learning (Exley and Dennick, 2004b) 211
    • Table 12.7 Assessment Criteria for Group Working 213
    • Table 12.8 Proposed Guide for Marking Essays 215
    • Table 12.9 Example of Analytical Marking Scheme 216
    • Table 12.10 Sources of Examination Error 217
    • Table 13.1 Roles in Assessment of Clinical Competence 226
    • Table 13.2 Checklist for Assessing Wound Dressing 229
    • Table 13.3 Possible Marking Grid for Practice Learning Portfolio 235
    • Table 13.4 Student Responses to a Failed Assessment 241
    • Table 14.1 Expected Requirements for Entry to Nursing Education (Most of this content taken from Standards for Pre-Registration Nursing Education (NMC, 2010a: 54–9)) 244
    • Table 14.2 Examples of Educational Entry Qualifications for Nursing (University of Ulster, 2011b) 246
    • Table 14.3 Reasonable Adjustments for Students with Disabilities 249
    • Table 14.4 Perceived Gender Appropriateness and Popularity of Nurse Specialisms (Muldoon and Reilly, 2003: 95) 254
    • Table 14.5 Why They Leave and Why They Stay (papers cited by Cameron et al., 2010, 2011; Pryjmackuk et al., 2009; Mulholland et al., 2008) 257
    • Table 14.6 Example of BSc Students Between 18 and 24 at University of Greenwich 2005–6 (Shepherd, 2008) 258
    • Table 14.7 Reasons Why Students Nearly Left Nursing and Why They Did Not (Bowden, 2008) 259
    • Table 15.1 Benefits of RCN Membership 271
    • Table 16.1 Outline of Developmental Framework to Support Teaching and Assessment in Practice 275
    • Table 16.2 Outline of Preparation of Mentors, Practice Teachers and Teachers 276
    • Table 16.3 Approaches to Lecturer's Teaching in Clinical Context 281
    • Table 16.4 Activities Dependent on Senior Administrative and Support Staff 286
    • Table 16.5 The Clinical Learning Environment (Stuart, 2007) 290
    • Table 17.1 Government Standards for Health and Social Care 298
    • Table 17.2 Outline of Content within Educational Audits for Practice Placement 309
    • Table 17.3 Key Risks for NMC Monitoring (NMC, 2011c) 311
    Boxes
    • Box 2.1 Agreeing Concepts, Values and Beliefs about Nursing 10
    • Box 2.2 Example of Statement of Concepts, Values and Beliefs 11
    • Box 2.3 The Defining Characteristics of Nursing Are … 15
    • Box 3.1 Consensus Conference 32
    • Box 3.2 Healthy Cities Principles and Values 47
    • Box 3.3 Topics for Consideration 48
    • Box 4.1 The Code of Practice 53
    • Box 4.2 Summary of the England, Wales and Northern Ireland (EWNI) Generic Credit Level Descriptors 55
    • Box 4.3 The Honours Degree (Universities UK, 2007: 56) 57
    • Box 4.4 Credit Points and Credit Hours 59
    • Box 4.5 The Diploma Supplement (UK HE Europe Unit, 2006: 19–20) 60
    • Box 4.6 Usual Modular Load for One Academic Semester 67
    • Box 5.1 Example of Aims for Pre-Registration Nursing Programme 74
    • Box 5.2 Key Elements of Problem-Based Learning (Boud and Feletti, 1997) 79
    • Box 5.3 Examples of Hybrid Approaches in PBL in Nursing 83
    • Box 5.4 Examples of Questions for EBL (Price, 2003) 83
    • Box 5.5 Transformational Outcomes-Based Education (adapted from Uys and Gwele, 2005: 196–7) 86
    • Box 6.1 Genetics Nursing Competencies (Kirk et al., 2011) 101
    • Box 6.2 Capabilities for Interprofessional Practice (CUILU 2010, cited in Barr et al., 2011) 109
    • Box 8.1 The Ideal Critical Thinker (Facione, cited by Billings and Halstead, 2009: 238) 134
    • Box 8.2 Critical Thinking 134
    • Box 9.1 Effective Lectures (Fry et al., 2009) 143
    • Box 9.2 Disadvantages of Lectures (adapted from Quinn and Hughes, 2007) 144
    • Box 10.1 Student Nurses Comment on Arts in Teaching Nursing (Grindle, 2000: 291) 164
    • Box 10.2 System for Teaching Psychomotor Skills 166
    • Box 11.1 Example of Tools in a VLE (University of Ulster, 2011a) 179
    • Box 11.2 Approaches to Sensitisation in CST (Dickson et al., 1997) 186
    • Box 11.3 Simulation of a Mental Health Nursing Visit 190
    • Box 11.4 Simulation in Disaster Relief Nursing 191
    • Box 11.5 Using PowerPoint 193
    • Box 12.1 Giving Students Feedback 219
    • Box 12.2 Indications of Plagiarism 222
    • Box 13.1 Items of Communication Assessed with Healthcare Students (Davies and Lunn, 2009) 227
    • Box 13.2 Positive Aspects of Using Video-Recording (Brimble, 2008) 230
    • Box 13.3 Increasing Reliability in OSCEs (Stuart, 2007) 232
    • Box 13.4 Increasing Validity in OSCEs (Stuart, 2007) 232
    • Box 13.5 Elements of a Case Study 236
    • Box 13.6 Elements of Reflection (Bulpitt and Deane, 2009) 237
    • Box 13.7 Summary of Four Categories of Reflection (Kember et al., 2008) 238
    • Box 13.8 Difficulties in Failing Students 239
    • Box 13.9 Indicators of Possible Failure (Duffy and Hardicre, 2007a) 240
    • Box 14.1 Eight Interview Stations for Selection of Medical Students 251
    • Box 14.2 Professional Groups Studied and Motivation for Entering Healthcare Professions 253
    • Box 15.1 Characteristics of Structured Personal Tutoring (Watts, 2011) 264
    • Box 15.2 Strategies for Handling Exam Stress (University of Ulster, 2011c) 266
    • Box 16.1 Principles of Roles in Teaching and Learning 274
    • Box 16.2 Responsibilities of Mentors 277
    • Box 16.3 Responsibilities of Teachers 279
    • Box 16.4 Maintaining Clinical Relevance (NMC, 2008a: 40–41) 282
    • Box 16.5 CAIPE Competencies for Interprofessional Teaching (Freeth et al., cited by Anderson et al., 2009: 83) 284
    • Box 16.6 Responsibilities for Practice Learning (NMC, 2010a; 76–78; NMC, 2008a) 288
    • Box 17.1 Principles of Standards Assurance and Quality Management (University of Ulster, 2010a) 293
    • Box 17.2 Outline of Areas of Responsibility of Course Committee (derived from University of Ulster, 2011d) 302
    • Box 17.3 Detailed Module Review by Head of School 304
    • Box 17.4 Typical Responsibilities of External Examiners 305
    • Box 17.5 Criteria for Appointment as External Examiner (QAA, 2011c) 306
    • Box 17.6 Joint Approval Process (NMC/Mott MacDonald, 2011) 310
    • Box 17.7 Grounds for Consideration under Fitness for Professional Practice (University of Ulster, 2011e: 75) 313
    • Box 17.8 Possible Actions by Fitness for Professional Practice Panel (University of Ulster, 2010e: 77) 313

    About the Authors

    The authors have worked together for many years in nursing education at the University of Ulster, and have developed considerable expertise in curriculum development and nursing education in general. Their involvement in curriculum innovations have included the first examples of a community nursing programme integrating the four branches of nursing, an international online masters degree in disaster relief nursing, and a professional Doctorate in Nursing. They have contributed to the nationally and internationally recognised research profile of the School.

    Pat Deeny is a Senior Lecturer and Course Director for Specialist Nursing Practice programmes. As external examiner and nursing education consultant, he has provided support to curriculum teams in universities in Ireland, United Kingdom, Finland, United States and South Korea on critical care nursing, pre-hospital care, disaster relief nursing and emergency preparedness. He and his wife Kate live on a farm in the North Sperrins in Northern Ireland with their three daughters Aoife, Bronagh and Dearbhla.

    In 1984 Jennifer Boore became the first Professor of Nursing in the island of Ireland when appointed as Head of Department at the University of Ulster. She now lives in Portstewart, Northern Ireland and holds the title of Emeritus Professor of Nursing. During her career she has seen nursing education move from the apprenticeship system through Project 2000 diploma programmes to degree qualifications for entry to the profession. She has substantial experience of teaching and examining pre and post-registration nursing education programmes and research degrees. She is a Fellow of the Royal College of Nursing in the UK, holds an OBE and is still actively involved in review of papers for publication in both nursing and higher education journals and in pre-doctoral education in South Africa.

    Acknowledgements

    The authors wish to acknowledge the valuable help of the large number of people who have contributed in various ways:

    Numerous colleagues in the University of Ulster, including nursing academics, technical and senior administrative staff, particularly those responsible for academic affairs, quality management and student services and the students’ union.

    Nursing academic colleagues elsewhere in the UK, in Finland, Australia and the USA.

    Staff at the numerous organisations consulted particularly the NMC, and QAA.

    The staff at SAGE Publications who have been a delight to work with (and who have been so kind during Jenny's recent and sudden bereavement).

    List of Abbreviations

    AEIApproved Education Institutions (term used by NMC)
    APLAccreditation of Prior Learning: ‘a process for accessing and, as appropriate, recognising prior experiential learning or prior certificated learning for academic purposes’.
    CATSCredit Accumulation and Transfer
    CBLCase Based Learning
    CPDContinuing Professional Development
    CQCCare Quality Commission
    CSTCommunication Skills Teaching
    ECTSEuropean Credit Transfer and Accumulation System
    EHEAEuropean Higher Education Area
    FHEQFramework for Higher Education Qualifications for England, Wales and Northern Ireland
    FQ-EHEAFramework for Qualifications of the European Higher Education Area
    GCSEGeneral Certificate of Secondary Education, normally taken at age 16
    HEHigher Education; third level or university level education
    HEFCEHigher Education Funding Council for England
    HEIHigher Education Institution (NMC refers to AEIs or Approved Education Institutions)
    ICNInternational Council of Nurses
    IELTSInternational English Language Testing System. Consists of 4 sections: listening, reading, writing and speaking.
    IPEInterprofessional Education
    NGONon-Governmental Organisation
    NHSTrust Organisation which provides health care within UK National Health Service
    NICATSNorthern Ireland Credit Accumulation and Transfer System
    NIPECNorthern Ireland Practice and Education Council for Nursing and Midwifery
    NLNNational League for Nursing, USA
    NMCNursing and Midwifery Council; the Statutory Body for Nursing in the UK
    NSLNursing Skills Laboratory
    OBEOutcomes-Based Education
    OSCEObjective structured clinical examination
    PBL/EBL/TBLProblem-Based Learning/Enquiry-Based Learning/Task-Based Learning
    PCNPerson-Centred Care
    QAAQuality Assurance Agency for Higher Education
    RCNRoyal College of Nursing; the major professional organisation and one of the trade unions for Nurses in the UK
    REF (RAE)Research Excellence Framework (replacing the Research Assessment Exercise) a regular audit of research quality in the UK
    SCQFScottish Credit and Qualifications Framework
    UCASUniversity and College Admission System
  • Glossary

    • Academic Staff The term used in the UK for faculty.
    • Honours Degrees In most UK universities Bachelor's degrees are awarded as 1st, upper 2nd, lower 2nd, or 3rd class honours degrees or unclassified degrees.

      An honours degree requires a higher standard of academic achievement.

    • Lecturer A specific grade of academic staff, but also used generically to refer to all university teachers.
    • Link Lecturer Term used by most HEIs to refer to a lecturer with responsibility for working with students and mentors in clinical practice.
    • Mentor/Preceptor and Sign-off Mentor The term mentor is usually applied in the context of a long-term relationship in which a more senior colleague provides counselling and facilitates career development. In the UK, they are responsible for supporting and assessing pre-registration nursing students.

      A preceptor has been described as someone who provides transitional role support and learning experiences within a collegial relationship for a specific time while continuing to perform some or all of the other responsibilities of their position. http://www.hspcanada.net/glossary.asp. In the UK they provide support for newly qualified nurses.

      A sign-off mentor is a mentor who has undertaken additional preparation in order to undertake the responsibility of confirming that a nursing student has achieved a level of competence to permit registration on the NMC Register of Nurses.

    • Module A unit of learning within a programme, sometimes known as a course.
    • NHS Trust Organisation which provides health care within UK National Health Service.
    • Nursing Statutory Body An organisation set up by law which is responsible for maintaining the register of nurses within that country and for setting the standards to permit registration.
    • Personal Tutor Lecturer with responsibility for monitoring progress and supporting students throughout their programme. Sometimes known as studies adviser.
    • Professor In the UK, Professor is the title used only for those of the most senior academic rank.
    • Programme The complete curriculum experience leading to a formal qualification. Sometimes known as a course (but see Module above).
    • School The term used in this book to mean the grouping of staff responsible for offering the programme. It may be a school or department within a university or multi-professional college, or a hospital-based school or college of nursing.
    • Service This refers to the range of statutory, private and voluntary organisations which provide health care.

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    Author Index

    This index is in word-by-word order. Page references in italics indicate figures, those in bold indicate tables, and those in bold italic indicate boxes.


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