Nursing education--is it time to go back to the future?

This article attempts to project the future of nursing education by learning the lessons of the past. Since 1989, a constant discourse has evolved: pre-registration nurses are emerging from nursing education programmes without essential clinical skills. It is argued that, if the profession is to heed the lessons from the past, a focus on this constant discourse is inevitable. This is because, in the UK, nursing practice-based learning has long been valued and considered to be of equal importance to institution-based learning. The article thus draws on lessons that can be learnt from the evolution of models of nursing education over the past two decades. Having identified and outlined three models of nursing education, the article predicts the demise of pre-registration nursing and the development of practice-based assistant practitioner programmes and practice-based postgraduate nursing programmes owned and managed by primary care trusts and NHS foundation trusts.

Diversity in nursing education: do we really want it?

This paper explores the concept of diversity at the level of the system and organisation, in essence, at the level of Faculty, School or Department of Nursing. As a major educational concept, it has a strong ethical and policy component. The idea of diversity can also provoke debate. Issues that are debated include: Why is diversity important? How can it be measured? Is it increasing or decreasing? What policies can enhance or restrict it?

The impact of commissioning processes on the delivery of continuing professional education for cancer and palliative care.

Educational commissioning was introduced into nursing and non-medical education in the mid 1990s. However, little research has been undertaken to explore its effect on continuing professional education despite early concerns that it could have a negative impact, especially in relation to more specialist provision such as that required by nurses delivering cancer and palliative care. The in-depth, qualitative study reported in this paper examined the commissioning process and how it was perceived by key stakeholders in one Workforce Development Confederation and the two universities which provided the education for practitioners throughout a local Cancer Network. The study identified failure to address educational needs accurately because too little attention was given to training needs analysis at the level of National Health Service Trusts. Commissioning was dominated by the need to demonstrate value for money at the expense of educational innovation and there was scope for improving communication between stakeholders. In addition scope existed for better collaboration between the two provider universities. Although all respondents voiced the similar criticisms, lecturers, service managers and Trust education leads were more able to suggest solutions to problems than education managers because of their awareness of service needs and the requirements of individual practitioners. The findings of this study cannot be generalised beyond the Cancer Network in which it took place. However, they clearly indicate possible weaknesses in the commissioning process which should be explored in greater depth, in relation to continuing professional education for specialist and non-specialist areas of practice.

Delivering practice-based interprofessional education to community mental health teams: Understanding some key lessons.

This paper describes a project that offered an interprofessional education (IPE) experience to two community mental health teams (CMHTs) based in separate inner city locations. Team members were offered three weekly workshops that aimed to enhance their understanding of interprofessional collaboration and improve their collective work as a team. A multi-method research design was employed to evaluate the impact of the workshops. Data were collected at four points in time: before, directly after, three months and 12 months following the workshops. It was found that participants enjoyed their IPE experience and reported that it was helpful in enhancing their understanding of collaboration. In addition, one team reported that the workshops had contributed to improving their communication with one another. However, two key factors constrained the overall impact of this IPE experience: a limited involvement of medical staff, which undermined the 'value' of the workshops; and a lack of senior managerial support, which impeded efforts to transfer team-based learning into practice. These findings are discussed in relation to the IPE, sociology and change management literature in order to help understand some key lessons associated with delivering practice-based IPE.

Dangerous and severe personality disorder: an ethical concept?

Most clinicians and mental health practitioners are reluctant to work with people with dangerous and severe personality disorders because they believe there is nothing that mental health services can offer. Dangerous and severe personality disorder also signals a diagnosis which is problematic morally. Moral philosophy has not found an adequate way of dealing with personality disorders. This paper explores the question: What makes a person morally responsible for his actions and what is a legitimate mitigating factor? How do psychiatric nurses working with this client group understand the awful things some clients do? What concepts do they need, if they are to know how to explain and how to react? It is suggested that dangerous and severe personality disorder is best regarded as a moral category, framed in terms of goodness, badness, obligation and other ethical concepts. It seems plausible that in important ways the dangerous and severe personality disordered client does not understand morality or understands it differently. The peculiar position of the dangerous and severe personality disordered individual in our system of moral responsibility stems from his apparent inability to see the importance of the interests of others. It might be more helpful to regard personality disordered clients as we do children: partially but not fully reasonable for their actions. We might regard the dangerous and severe personality disordered client responsible for those actions which he most clearly understands, such as causing others physical pain, but not for those with which he is only superficially engaged, such as causing emotional pain. The paper concludes by suggesting that the dangerous and severe personality disordered individual does not fit easily into any conventional moral category, be it criminal, patient, animal or child, and thus an assessment of his moral accountability must take into consideration his special circumstances.

Developing interprofessional education in the pre-registration curricula: mission impossible?

Interprofessional education has long been cited in health and social care policy as a remedy to improve many of the problems faced by the National Health Service (NHS) around co-ordination and collaboration of staff. More recently, this form of education has been acknowledged as having a key role in delivering the government's modernisation agenda to produce a more 'flexible' workforce. Given the large number of logistical problems connected to developing interprofessional education before registration, this type of activity more often occurs after registration. It is interesting, therefore, to note that pre-registration interprofessional education has recently been hailed by NHS policy as a primary method for enhancing collaboration. However, these policy documents have both contributed to the conceptual confusion in this area and also overlooked the range of factors (educational, organisational and cultural) connected with implementing and sustaining this type of education in the pre-registration sector. In posing the question, 'pre-registration interprofessional education: mission impossible?' this paper examines the cultural, organisational and educational factors that affect the development of this activity. It also considers attempts to build an evidence-base for interprofessional education. This paper finally outlines how the implementation of interprofessional practice-based placements can be an achievable goal for the pre-registration curricula.