Materials matter: Understanding the importance of sociomaterial assemblages for OSCE candidate performance.

INTRODUCTION: The OSCE is a sociomaterial assemblage-a meshing together of human and material components producing multiple effects. Materials matter because they shape candidate performance, with potentially calamitous career consequences if materials influence performance unjustly. Although the OSCE literature refers to materials, few papers study the sociomateriality of OSCEs. Therefore, we explored OSCE stakeholders' talk about sociomaterial assemblages to better understand their importance for candidate performance. METHODS: We conducted 15 focus groups with OSCE candidates (n = 42), examiners (n = 20) and simulated patients (n = 17) after an Australian postgraduate nursing OSCE. Sociomateriality informed our team-based framework analysis of data. RESULTS: Participants identified a multiplicity of OSCE materials (objects, technologies and spaces) thought to matter for candidate performance. Candidates' unfamiliarity with materials and missing or malfunctioning materials were reported to yield numerous negative impacts (eg cognitive overload, negative affect, time-wasting), thereby adversely affecting candidate performance. Both examiners and candidates made micro-adjustments to sociomaterial assemblages during the OSCE in order to make it work (eg candidates saying what they would do rather than doing it). Sometimes, such tinkering extended so far that sociomaterial assemblages were ruptured (eg examiners ignoring rubrics to help pass candidates), potentially influencing OSCE standardisation. DISCUSSION: Our novel empirical study extends previous conceptual work by illustrating wide-ranging sociomaterial assemblages influencing OSCE candidate performance. Further research is now needed employing sociomaterial approaches to further elucidate sociomaterial entanglements in diverse OSCEs. We encourage OSCE stakeholders to become more attuned to the productive nature of materials within all stages of OSCE design and implementation.

A review of key national reports to describe the development of paramedic education in England (1966-2014).

INTRODUCTION: In the year 1966, important advances in mobile coronary care and trauma care in the UK and USA influenced globally the development of modern prehospital emergency services and paramedic education. In that year, to meet the evolving role of prehospital care in the UK, the 'Millar Report' specified a new syllabus for ambulance personnel in England. As the 50th anniversary of this report approaches, this paper reviews key national UK reports to describe the development of paramedic education in England over this period. METHODS: A hand search of documents available and a Google search identified documents in the public domain. MEDLINE and CINAHL Plus were searched for peer-reviewed publications. Thematic analysis was used to identify descriptive themes. RESULTS: Of the 83 reports and 431 articles screened, 33 documents met our inclusion criteria. We identified four historical periods in English paramedic education: development of paramedic education (1966-1996); paramedic role changes influencing education (1997-2004); paramedic education level changes and the emergency care practitioner (2005-2008); and paramedic education for the future (2010-2014). Our discussion of four descriptive themes: government authority and policy, influence of health professions, quality assurance and development of the paramedic profession includes comparisons with paramedic education in the USA and Australia. CONCLUSIONS: Political reform agendas and initiatives and advances in clinical medicine largely shaped paramedic roles and education in England. The degree to which the paramedic profession initiated education development is difficult to determine from the literature. Overall, a nationally coherent standard for paramedic education in England needed five decades to develop and mature.

Using contribution analysis to evaluate health professions and health sciences programs.

Introduction/background: Course evaluation in health education is a common practice yet few comprehensive evaluations of health education exist that measure the impact and outcomes these programs have on developing health graduate capabilities. Aim/objectives: To explore how curricula contribute to health graduate capabilities and what factors contribute to the development of these capabilities. Methods: Using contribution analysis evaluation, a six-step iterative process, key stakeholders in the six selected courses were engaged in an iterative theory-driven evaluation. The researchers collectively developed a postulated theory-of-change. Then evidence from existing relevant documents were extracted using documentary analysis. Collated findings were presented to academic staff, industry representatives and graduates, where additional data was sought through focus group discussions - one for each discipline. The focus group data were used to validate the theory-of-change. Data analysis was conducted iteratively, refining the theory of change from one course to the next. Results: The complexity in teaching and learning, contributed by human, organizational and curriculum factors was highlighted. Advances in knowledge, skills, attitudes and graduate capabilities are non-linear and integrated into curriculum. Work integrated learning significantly contributes to knowledge consolidation and forming professional identities for health professional courses. Workplace culture and educators' passion impact on the quality of teaching and learning yet are rarely considered as evidence of impact. Discussion: Capturing the episodic and contextual learning moments is important to describe success and for reflection for improvement. Evidence of impact of elements of courses on future graduate capabilities was limited with the focus of evaluation data on satisfaction. Conclusion: Contribution analysis has been a useful evaluation method to explore the complexity of the factors in learning and teaching that influence graduate capabilities in health-related courses.

The defining characteristics of newly graduated nurses - A Delphi study.

Despite processes designed to ensure that graduates of accredited nursing programs possess the necessary skills and knowledge to enter the workforce, a gap remains between graduate capabilities and industry expectations of work-readiness. This study aims to identify the defining characteristics of work-ready graduate nurses from the perspective of a purposive sample of new graduates, employers and academics utilising a three-round Delphi design and to compare the findings. In Round One participants provided free-text descriptors of graduate attributes, core knowledge and skills. In Rounds Two and Three participants prioritised categorised results from Round One and added free-text responses. Data from these rounds were not aggregated. In Round One, 14 academics, 20 clinicians and 12 graduates provided responses. In Round Two we received 10, 12 and 5 responses respectively and in Round Three 9, 8 and 4 responses respectively. The final round identified 19 characteristics and attributes, 10 knowledge areas and 11 skills for work-ready graduate nurses. This study identified that graduates should be safe practitioners, with professional behaviours, an understanding of anatomy and physiology, pathophysiology of disease, and medication safety, with good patient assessment and communication skills. Time management and prioritisation skills that graduates expect of themselves, develop with consolidation of practice.

Establishing quality standards for graduate entry master of nursing curricula in Australia and New Zealand: A Delphi study.

AIM: To describe the common elements of Graduate Entry Master of Nursing curricula and identify a set of standards and quality indicators for benchmarking purposes within and across jurisdictions. BACKGROUND: Internationally, there has been an increase in universities offering Graduate Entry Masters programs in Nursing. Such programs specify a bachelor degree as an entry requirement and then offer an intensive program of study that prepares graduates for registration as a nurse. To date, no formal standards exist to guide evaluation of these curricula. DESIGN: A two phased sequential mixed-methods design comprising thematic content analysis of curricula and a Delphi study. The setting was the Australian and New Zealand tertiary education sectors. Participants were nurse academics who were recruited to participate in the Delphi study. Quota sampling was used to identify educators from the education providers meeting organisational inclusion criteria (program coordinator and one lecturer working as a subject coordinator of the program) and nominated by their Head of Department. METHODS: Phase One of the study involved a thematic analysis of the curricula of nine Graduate Entry Master of Nursing programs to identify common elements of curricula and domains of quality. In Phase Two these themes were used in a series of Delphi rounds to identify a set of agreed quality domains, statements and indicators. RESULTS: Participants (n = 16) responded over three Delphi rounds. A total of nine domains of quality were determined, a set of 26 quality statements were identified based on the acceptance threshold of > 75% level of agreement and 27 quality indicators were established. CONCLUSIONS: Our research provides an agreed set of indicators for evaluating the quality of Graduate Entry Master of Nursing programs. This work will also make it possible to measure the immediate and longer-term impacts of Graduate Entry Master of Nursing programs for the nursing workforce. Future work must focus on testing feasibility and optimising utility while refining indicators across jurisdictions.

Graduate entry students' early perceptions of their future nursing careers.

Graduate entry nursing programs designed for individuals with prior degrees in other disciplines are becoming increasingly popular internationally. They provide entry into nursing for people with unique skill-sets. Yet, little is known about why these individuals choose career change into nursing and what they expect from their new careers. This component of a larger study sought to explore graduate entry nursing students' short and longer term career intentions on commencement of their courses. A cross-sectional survey was used. Descriptive frequencies were used to analyse demographic data, while summative content analysis was used with the open-ended questions. Participants were drawn from eight cohorts of commencing students from enrolled in one graduate entry masters program in Australia between 2009 and 2015. Content analysis identified three main categories: professional role, work location, and work context. Longer term responses were categorised under four categories: professional role, work location, work context and personal and professional goals. Many students had clear directions about their future nursing careers. On graduation, many envisioned working in advanced roles or in clinical specialty areas, primarily in hospital settings. However, in the longer term, there was diversity among with many envisaging work outside traditional hospital settings, and some in other health disciplines.

Graduate entry nurses' initial perspectives on nursing: Content analysis of open-ended survey questions.

BACKGROUND: Graduate entry nursing courses offer individuals with prior degrees the opportunity to gain nursing qualifications and facilitate career change. While it is known that accelerated graduate entry courses are increasingly popular, the perceptions of nursing held by such individuals and the influence this has on those seeking to enter the profession are less clearly understood. OBJECTIVE: To explore graduate entry nursing students' perceptions of nursing on entering their pre-registration course. DESIGN: A descriptive design utilising cross-section survey with two open-ended questions: What do you believe the role of the nurse is? What things have influenced that view? were asked. Demographic data were analysed using descriptive frequencies, while the two open-ended questions were analysed using summative content analysis. SETTING: One university-based postgraduate graduate entry nursing course in Australia PARTICIPANTS: Eight cohorts (n=286) commencing students with prior degrees other than nursing. RESULTS: The course attracts students from diverse backgrounds. Exposure to nursing and nurses, either as a consumer of health care or other health care role, plays a primary role in influencing career change. However, similar to those found with school leavers, there remains much misinformation about nurses' roles for students in these courses. Most identify the role of caring in nursing. For some, media representations are the only information sources. DISCUSSION: Graduate entry courses offer opportunities to attract new nurses and contribute to addressing workforce shortages. However, there is still a lack of knowledge of nursing roles among students on entry. More work is required by the profession to ensure nursing is accurately and positively represented to the community.

Is graduate entry education a solution to increasing numbers of men in nursing?

Males have traditionally constituted a very small proportion of the nursing workforce in many countries, including Australia. Together with a need to address the gender imbalance, nursing workforce shortages require strategies for recruiting new nurses, including males. This study examined characteristics of males entering one accelerated graduate entry masters pre-registration nursing program in Victoria, Australia. A quantitative survey gathered a variety of demographic data and factors relating to participants' decisions to undertake nursing. Data were analysed using descriptive statistics including frequencies and distributions. Forty-three male nursing students from four cohorts of the Master of Nursing Practice (MNP) course from 2009 to 2011 completed the survey. The proportion of males (30%) was considerably greater than traditional nursing courses and the profession generally. Participants demonstrated wide distributions in age ranges, professional backgrounds and previous years in the workforce. Graduate entry appears attractive to males of varying ages, personal and professional backgrounds. More research is needed to examine this phenomenon on a larger scale.

An Historical Examination of the Development of Emergency Medical Services Education in the US through Key Reports (1966-2014).

INTRODUCTION: The Emergency Medical Services (EMS) approach to emergency prehospital care in the United States (US) has global influence. As the 50-year anniversary of modern US EMS approaches, there is value in examining US EMS education development over this period. This report describes US EMS education milestones and identifies themes that provide context to readers outside the US. METHOD: As US EMS education is described mainly in publications of federal US EMS agencies and associations, a Google search and hand searching of documents identified publications in the public domain. MEDLINE and CINAHL Plus were searched for peer reviewed publications. Documents were reviewed using both a chronological and thematic approach. RESULTS: Seventy-eight documents and 685 articles were screened, the full texts of 175 were reviewed, and 41 were selected for full review. Four historical periods in US EMS education became apparent: EMS education development (1966-1980); EMS education consolidation and review (1981-1989); EMS education reflection and change (1990-1999); and EMS education for the future (2000-2014). Four major themes emerged: legislative authority, physician direction, quality, and development of the profession. CONCLUSION: Documents produced through broad interprofessional consultations, with support from federal and US EMS authorities, reflect the catalysts for US EMS education development. The current model of US EMS education provides a structure to enhance educational quality into the future. Implementation evaluation of this model would be a valuable addition to the US EMS literature. The themes emerging from this review assist the understanding of the characteristics of US EMS education.