Competency versus proficiency: trying to develop an understanding of these terms in the context of practice learning.

The language of nurse education in the UK has shifted from 'competency' to 'proficiency' since 2018. The shift in language has been poorly articulated leaving individual higher education institutions, practice supervisors and assessors to interpret what these terms mean in relation to assessing student nurses. There appeared to be some confusion regarding the interpretation of the term proficiency among those who engaged in an exchange on the topic via Twitter. Students may focus on the procedure-based checklists within the standards. The relationship between proficiency and implementing a person-centred approach to care remains unclear.

Peer learning and collaborative placement models in health care: a systematic review and qualitative synthesis of the literature.

AIMS: To summarise the international empirical literature to provide a comprehensive overview of peer learning and collaborative practice placement models in health care and to synthesise their benefits and challenges. BACKGROUND: Practical placements for students are in high demand due to the need for an increased nursing, midwifery and health professional workforce, thus collaborative placement models are an attractive solution to potentially increase placement capacity and enhance the student learning experience. DESIGN: A systematic search of the literature and qualitative data synthesis using the PRISMA checklist and ENTREQ guidelines. REVIEW METHODS: MEDLINE and CINAHL searched in March 2020. Quality appraisal of studies conducted. Collaborative models and empirical findings summarised. Reported benefits, challenges and implementation recommendations synthesised. Two tables developed for data representation. RESULTS: 172 studies were identified by the search strategy. Of these, 47 articles were included for appraisal and synthesis. 30 articles employed qualitative, seven quantitative and ten mixed-methods approaches. Research took place in eight countries. The majority of studies employed focus groups, interviews as well as questionnaire design. The total participant sample was 3462 consisting of students and educators. CONCLUSIONS: This review confirmed that any peer learning is beneficial in supporting students' confidence and team working skills. It is especially helpful when pairing first year with third-year students. The latter can demonstrate their clinical skills and prepare for working in practice. Simultaneously, expert-led learning is important for role modelling and for the recognition of acquired skills. Evidence on the optimal placement experience is inconclusive; however, it can be concluded that any form of collaborative placement model requires careful planning and continuous preparation for staff and students. RELEVANCE TO CLINICAL PRACTICE: Decision makers should consider implementing at least some form of peer learning to assist students with peer support, and ideally work towards a collaborative learning environment.

The impact of COVID-19 on practice learning in nurse education.

The COVID-19 pandemic has impacted healthcare education and delivery, including both theory and practice learning. Academic staff responded rapidly to move teaching online during the first lockdown, with many returning to practice to deliver care or upskill practice staff to work in critical care. Many pre-registration students responded by becoming paid NHS employees, contributing to care delivery while remaining on their programme of study. Practice learning partners, despite the challenges of the pandemic, continued to support students to achieve their registration status. This occurred within the context of the Emergency and Recovery Standards, published by the Nursing and Midwifery Council between March 2020 and September 2021. This paper sets out the response of students, practice learning partners and higher education institutions involved in pre-registration nursing and midwifery programmes.

Promoting community engagement in a pre-registration nursing programme: a qualitative study of student experiences.

AIMS: To offer child health student nurses a broader learning experience in practice with an autonomous choice of a volunteer placement area. To reflect the changing nature of health care and the move of care closer to home in the placement experience. To evaluate participants' experiences. DESIGN: This study used descriptive and interpretative methods of qualitative data collection. This successive cross-sectional data collection ran from 2017 to 2020. All data were thematically analysed using Braun and Clarke's model. METHODS: Data collection strategies included two focus groups (n=14) and written reflections (n=19). RESULTS: Students identified their increased confidence, development as a professional, wider learning and community engagement. They also appreciated the relief from formal assessment of practice and the chance to focus on the experience. CONCLUSION: Students positively evaluated this experience, reporting a wider understanding of health and wellbeing in the community. Consideration needs to be given to risk assessments in the areas students undertake the placements and the embedding of the experience into the overall curriculum.

Practice educators' attitudes and perspectives of interprofessional collaboration and interprofessional practice learning for students: A mixed-methods case study.

Interprofessional collaboration (IPC) is important for the delivery of effective integrated health and social care systems. Interprofessional practice learning (IPPL) enables students to learn to work together within a relevant context and prepare for future IPC. While there is some evidence that negative attitudes impact on IPC and interprofessional education, there is a dearth of research on health and social work professionals' attitudes and perspectives of IPC and IPPL opportunities for students. A mixed-methods case study was used to investigate practice educators' attitudes and perspectives of IPC and IPPL for their students. Results showed that attitudes were positive and that mainly meso- and macro-level factors, as opposed to the micro level, impacted on the implementation of IPC and IPPL for students' learning in practice settings. IPC was perceived to be best enabled by effective communication, established teams, IPPL for staff, and shared processes and policies. Close working proximity to other professionals encouraged informal communication and positive interprofessional relationships. Motivation and resources were perceived as enablers of IPPL, but there were often missed opportunities for IPPL. These findings suggest that further work is required to identify systems for improving IPC and to enhance IPPL opportunities for students learning within practice settings.

Critical exploration of the new NMC standards of proficiency for registered nurses.

Following its consultation with key stakeholder groups the Nursing and Midwifery Council (NMC) has launched Future nurse: standards of proficiency for registered nurses ( NMC, 2018a ). These compulsory new standards will be available for use in curricula by approved education institutions (AEIs) from the end of January 2019. In this article, the authors provide their personal perspectives on the potential impact of the new standards, particularly focusing on those relating to supporting and assessing students from within the practice environment. The new roles of practice supervisor, practice assessor and academic assessor are explored, making comparisons to the current mentorship role. There is a clear need for effective partnerships between AEIs and healthcare organisations as they lead on the implementation of the standards. They must think creatively about practice placements and provide opportunities for interprofessional supervision, so that students can learn about the roles of other disciplines and how to collaborate in a multidisciplinary team.

Developing and piloting a new role to enhance the clinical learning environment.

Environments that support pre- and post-registration students' and staff learning are vital to ensure the delivery of high quality patient care by knowledgeable and competent healthcare practitioners. A project was undertaken at Chesterfield Royal Hospital NHS Foundation Trust to modernise and enhance preceptorship against a background of national and local drivers. This article describes the development, piloting and evaluation of a new role designed to support and enhance practice learning environments for newly qualified nurses, preceptors, pre-registration nursing students and mentors. The article identifies the factors that affect clinical learning environments and discusses some practical solutions to the challenges associated with learning in practice. Finally, the article offers some recommendations and implications for practice in relation to the pilot outcomes.

A case study exploring the experience of graduate entry nursing students when learning in practice.

AIM: To explore how Graduate Entry Nursing students present and position themselves in practice in response to anti-intellectualist stereotypes and assessment structures. BACKGROUND: A complex background turbulence exists in nurse education which incorporates both pro- and anti-intellectualist positions. This represents a potentially challenging learning environment for students who are recruited onto pre-registration programmes designed to attract graduates into the nursing profession on the basis of the specific attributes they bring known as 'graduateness'. DESIGN: A longitudinal qualitative case study conducted over 2 years. METHODS: Data were collected from eight Graduate Entry Nursing students at 6 monthly points between 2009-2011 via diaries, clinical assessment documentation and interviews. Forty interviews took place over 2 years. Additionally, three focus groups involving 12 practice assessors were conducted at the end of the study period. Data were analysed through a social constructivist lens and compared with a set of suppositions informed by existing empirical and theoretical debates. FINDINGS: Demonstrated the interplay of performance strategies adopted by Graduate Entry Nursing students to challenge or pre-empt actual or perceived negative stereotypes held by established practitioners to gain acceptance, reduce threat and be judged as appropriately competent. CONCLUSION: Students interpreted and responded to, perceived stereotypes of nursing practice they encountered in ways which facilitated the most advantageous outcome for themselves as individuals. The data present the creative and self-affirming strategies which students adopted in response to the expectations generated by these stereotypes. They also depict how such strategies commonly involved suppression of the attributes associated with 'graduateness'.

Enhancing undergraduate community placements: a critical review of current literature.

In the face of the UK-wide policy shift to increased home care, inspiring and enabling the next generation of community nurses is more urgent than ever. The quality of the pre-registration practice learning experience is highly influential on career choices at the point of qualification. Given that 50% of learning by pre-registration students takes place in practice, mentors have a crucial role to play in preparing the next generation of nurses to work in the community. This article discusses the findings of a systematic and critical literature review of pre-registration placements that was funded by the Queen's Nursing Institute Scotland. The review found that students' experiences of learning in community settings are variable, and perceptions of students and mentors are misaligned in terms of what a quality placement should look like. Although there is no clear definition of what constitutes a community placement and there is some underuse of learning environments in areas such as general practice nursing, there are also a number of examples of new and imaginative placements. While these innovations provide 'whole experience' placements, they are currently lacking robust evaluation, despite their potential usefulness on a larger scale. Mentors have the opportunity to provide students with a range of learning opportunities that increase preparedness for working in the community, allowing final year students in particular greater influence over their learning experience. Students undertaking community practice learning, where they have a managed level of autonomy, are more likely to feel confident to take on community nursing roles.

Mentors' perceptions and experiences of supporting student nurses in practice.

This paper reports on a funded project that explored the perceptions and experiences of mentors regarding student nurse support in practice. The study employed a mixed-method approach, using questionnaires and focus groups with mentors from one acute Trust and one community Trust. The findings highlighted the multifaceted nature of student learning in practice, with mentors reporting that clinical skills, adjustment to the placement and integrating into the team were the aspects students needed most support with. Mentors were aware of their roles and responsibilities in supporting students and recognized the importance of their own personal attributes. The participants reported a number of challenges, particularly time, competing demands and paperwork, and suggested that a team approach and support groups could help to overcome these. The support for students provided by peers and health-care assistants was recognized, as was the need to ensure that students are prepared to take responsibility for their learning.

Health promotion: reconfiguring nurses' practice to reduce social inequalities.

Inequalities in people's health due to economic or social circumstances remain a persistent challenge in the UK, with people from disadvantaged communities disproportionately likely to die earlier and experience more health issues than the general population. Health promotion has a vital role in reversing health inequalities and requires a focus on structural and political-level determinants of health, rather than individuals' lifestyle choices. However, while health promotion is a significant aspect of nurse education curricula, individual nurses may experience role confusion regarding the application of health promotion in their practice. Therefore, a shift is required in nurse education and training on health promotion, as well as its practical implementation. This article suggests some approaches that could be taken to reconfigure the role of nurses in health promotion.

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.

Nurse independent prescribing: exploring the opportunities and challenges.

The Nursing and Midwifery Council states that nurses should be able to demonstrate competence in prescribing practice at the point of registration to be 'prescribing ready'. The aim is to increase the number of nurse independent prescribers and improve access to pharmacological treatments for patients. However, while this policy presents opportunities for nurses to develop their prescribing knowledge and skills, there are also challenges involved in integrating prescribing theory into nurse education and ensuring there are enough suitable mentors available in practice. This article details how the policy of prescribing readiness is being addressed in preregistration nurse education and explores the supervision of nurse prescribing in clinical practice. The author also discusses how best to support the professional development of nurse independent prescribers beyond their initial training.

Adopting a 'community of practice' between palliative and dementia care nurses.

Dementia usually occurs as a result of brain disease and, while it is usually chronic or progressive in nature, it has not traditionally been conceptualised as a terminal or life-limiting syndrome. However, the median survival time for people with dementia is between 3.5 years and 4.5 years from symptom onset to death, although this varies depending at which stage the dementia is diagnosed and its cause. As such, it has long been recognised that people with dementia and their family carers have palliative care needs equal to those of patients with cancer. However, a palliative approach to dementia care requires both the dementia and palliative care workforces to fully understand the needs of people with dementia and their families towards the end of life. This article describes the development of a 'community of practice' where healthcare professionals from dementia and palliative care services shared their practice and learned from each other in a safe and supportive environment.

A novel research competency framework for clinical research nurses and midwives.

BACKGROUND: Clinical research nurses and midwives (CRN/Ms) are highly specialised registered nurses. They combine their clinical nursing expertise with research knowledge and skills to aid in the delivery of rigorous, high-quality clinical research to improve health outcomes, the research participant's experience and treatment pathways ( Beer et al 2022 ). However, there is evidence that the transition into a CRN/M role is challenging for registered nurses. AIM: To discuss the development of a competency framework for CRN/Ms. DISCUSSION: The authors identified a gap in their organisation for standards that would support the development of CRN/Ms new to the role. The standards needed to be clear and accessible to use while encompassing the breadth of scope of CRN/Ms' practice. The authors used a systematic and inclusive process drawing on Benner's ( 1984 ) theory of competence development to develop a suitable framework. Stakeholders engaged in its development included research participants, inclusion agents and CRN/Ms. CONCLUSION: The project identified 15 elements that are core to the CRN/M role and the knowledge, skills and behaviours associated with it. IMPLICATIONS FOR PRACTICE: A large NHS trust has implemented the framework. It is also being shown to national and regional networks. Evaluation is under way.

An exploratory study of the clinical technology undergraduate program in South Africa: Preparedness of students for clinical practice.

BACKGROUND: This study sought to understand whether the theoretical components of the curriculum prepared students for clinical practice training in the Bachelor of Health Sciences (BHSc) in Clinical Technology program at the Durban University of Technology. MATERIALS AND METHODS: Two samples were recruited, namely, academics and students using non-probability sampling methods. The first sample comprised 13 students, and the second sample included four academics, involved in teaching and supervising the placement of students at healthcare institutions. At least one student from each of the 13 units where clinical practice training was undertaken was invited to participate. Data was gathered using in-depth, semi-structured interviews on an adapted version of Gibbs' cycle of reflection. RESULTS: Three broad themes emerged, namely, curriculum structure, factors that enabled graduate attribute development in the clinical environment, and the transition to online teaching. CONCLUSION: While it appears that the curriculum had in many ways prepared students for clinical practice, the study highlights key issues that may guide curriculum developers when seeking to improve preparedness of students for clinical practice. Furthermore, it underscores the need for continuous review of current curricula so that these are responsive to student and societal needs.

How to undertake structured clinical reflection.

RATIONALE AND KEY POINTS: While clinical reflection has been an essential aspect of nursing practice for many years, some nurses may still find it challenging to constructively engage with this process and may not recognise the benefits and learning that can result from it. This article provides practical guidance for nurses on how to undertake reflection, to support them to reflect regularly as part of their practice. • Reflection is a process of engaging with and learning from one's thoughts, emotions and actions in a supportive and critical manner.• Reflection can assist nurses to learn from practice, support team working and promote self-care.• Nurses can reflect alone or with others, and there are various structured models of reflection that they can use to support them. REFLECTIVE ACTIVITY: 'How to' articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How you think you could use this article to improve your practice in undertaking structured clinical reflection.• How you could use this resource to educate your colleagues about the process of reflection.

The lived experiences of racial bias for Black, Asian and Minority Ethnic students in practice: A hermeneutic phenomenological study.

AIM: This study explored the lived experiences of racial bias for Black, Asian and Minority Ethnic students undertaking an undergraduate or post-graduate degree in nursing, midwifery and allied health courses in the United Kingdom. BACKGROUND: Previous research indicates that students from Black, Asian and Minority Ethnic groups have fewer opportunities to succeed at university and this has brought about a race awarding gap in their degree attainment. The reasons for this awarding gap are complex and multi-factorial and it is crucial that the lived experiences of racial bias are explored from the student perspective. DESIGN: A hermeneutic phenomenological approach was adopted to elicit individual and collective experiences in the practice environment, a mandatory component of the student's degree. METHODS: A focus group and individual semi-structured interviews were conducted to collect data from sixteen participants and analysed using thematic analysis RESULTS: Three encompassing themes were identified which included a sense of not belonging, trauma impact on mental health and understanding covert and overt racism. Participants reported incidences of racism and appeared to be traumatised by their experiences within practice and the university. They also reported poor mental health and well-being as shared experiences and a lack of confidence in the university and practice to mitigate racial issues. CONCLUSIONS: Meaningful action must be taken by universities and practice partners to advance racial inequality initiatives by having robust anti-racism action plans and processes. These should be co-created with students and staff to reduce the race awarding gap.

Emerging social workers during COVID-19: Exploring perceived readiness and training needs.

Summary methods and approach: Social workers support clients' psychosocial and resource needs across care settings. Social workers are typically not, however, trained to engage in emergency response practices such as the ones that may be necessary to support needs brought on by the COVID-19 pandemic. This article reports findings from a cross-sectional survey of social work students and recent graduates entering the field of social work during COVID-19, exploring their preparation, perceived readiness, and training needs. Findings: The study sample (N = 94) included 70 students and 24 recent graduates. The sample was 52% White, 22% Hispanic, and 21% Black/African American. Respondents reported training needs in the areas of trauma-informed care (70%), behavioral health (57%), culturally competent practice (49%), telehealth (48%), loss and grief (44%), and emergency management (43%). No significant differences emerged in self-efficacy ratings of students and recent graduates; both groups reported low self-efficacy in their ability to apply advanced practice skills. After controlling for demographics, receiving training specific to the COVID-19 pandemic (ß = .271, p < .05), perceived readiness (ß = .779, p < .001), and satisfaction with training/preparation (ß = .4450, p < .001) significantly contribute to levels of perceived self-efficacy among SW students and recent graduates. Applications: Social work curricular developments, and continuing education, are needed to prepare and support emerging social workers for practice in the context of COVID-19 and its long-term implications. This includes enhancing social workers' readiness to engage in telehealth, trauma-informed practice, emergency management, policy interpretation, self-care, and grief support.

Indigenising systematic reviews with a collaborative model of 'training the trainers'.

BACKGROUND: Developing a workforce with the skills to produce and make judicious use of evidence for policy and practice decisions requires trainers who can tailor evidence and training to policy and practice priorities. AIM: To describe how a collaborative learning model adapted a systematic review course to suit Indian nurse educators and research scholars in the conduct and use of systematic reviews. DISCUSSION: A collaborative learning team of academics and research scholars brought together expertise in nursing education in India, and evidence synthesis in India and the UK. Participants found the course was highly beneficial, enhanced independent and critical thinking, and instilled them with the confidence and skills to deliver such courses to Indian researchers, nurses and other healthcare professionals. CONCLUSION: Contextualising materials and methods to participants' experiences made learning more relatable. The use of adult learning approaches enabled participants to apply the same approaches when leading training in their own institutions and underpinned long-term sustainable working relationships between facilitators and learners, leading to new studies and new resources to support evidence-informed decision-making. IMPLICATIONS FOR PRACTICE: An educational intervention on 'indigenising systematic reviews' with online collaborative learning can produce improvements in the knowledge and skills of participants. Advantages of this educational approach include its flexibility, active involvement of participants and sustainable partnership building. The principles and methods used could be replicated in any setting to train trainers.