Mentor judgements and decision-making in the assessment of student nurse competence in practice: A mixed-methods study.

AIM: To investigate how mentors form judgements and reach summative assessment decisions regarding student competence in practice. BACKGROUND: Competence assessment is a significant component of pre-registration nursing programmes in the United Kingdom. Concerns exist that assessments are subjective, lack consistency and that mentors fail to judge student performance as unsatisfactory. DESIGN: A two-stage sequential embedded mixed-methods design. Data collected 2012-2013. METHODS: This study involved a whole student cohort completing a UK undergraduate adult nursing programme (N = 41). Stage 1: quantitative data on mentor conduct of assessment interviews and the final decision recorded (N = 330 from 270 mentors) were extracted from student Practice Assessment Documents (PADs). Stage 2: mentor feedback in student PADs was used in Stimulated Recall interviews with a purposive sample of final placement mentors (N = 17). These were thematically analysed. Findings were integrated to develop a theoretically driven model of mentor decision-making. RESULTS: Course assessment strategies and documentation had limited effect in framing mentor judgements and decisions. Rather, mentors amassed impressions, moderated by expectations of an "idealized student" by practice area and programme stage that influenced their management and outcome of the assessment process. These impressions were accumulated and combined into judgements that informed the final decision. This process can best be understood and conceptualized through the Brunswik's lens model of social judgement. CONCLUSION: Mentor decisions were reasoned and there was a shared understanding of judgement criteria and their importance. This impression-based nature of mentor decision-making questions the reliability and validity of competency-based assessments used in nursing pre-registration programmes.

Parents' experience of children with acquired brain injury undergoing neurorehabilitation: a systematic review.

BACKGROUND: This systematic review aims to synthesise the qualitative evidence exploring parents' experiences of children with acquired brain injury (ABI) undergoing neurorehabilitation during the first year post-injury. METHODS: A systematic review of qualitative research was conducted using thematic synthesis with Thomas and Harden's approach. The population, exposure and outcome model was used for the search strategy. The electronic databases Ovid Embase, Ovid MEDLINE, CINAHL, Scopus and PsycINFO were searched from 2009 to 2023. The review included qualitative and mixed-method studies published in English only. Grey literature was excluded. There were no geographical restrictions. Reporting within the review followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guideline. The studies' quality was appraised using the Critical Appraisal Skills Programme tool. RESULTS: Three studies met the inclusion criteria and were included in the synthesis, representing the experiences of 30 parents. The quality assessment showed that the three included studies met most quality indicators. Following thematic synthesis, four analytical themes were identified: school unpreparedness, parents as advocates and navigators, parents as monitors, and parents recognising the impact of ABI on their child. The reviewers proposed a group of recommendations for services reviewing their parental support. CONCLUSION: This review highlights some challenges parents of children diagnosed with ABI experience during their child's neurorehabilitation journey. This review has suggested potential improvements that could be made in paediatric neurorehabilitation services when reviewing their parental support and care pathways. These will ultimately influence parents' and children's experience of paediatric neurorehabilitation services.

Discontinuation of long-term growth hormone treatment in adults with growth hormone deficiency: a survey of UK practice.

Objective: We conducted a survey of UK endocrine clinicians between June 2022 and August 2022 to understand current practices regarding GH treatment discontinuation in adults with growth hormone deficiency. Design and methods: Using Survey Monkey®, a web-based multiple-choice questionnaire was disseminated to the UK Society for Endocrinology membership. It consisted of 15 questions on demographics, number of patients receiving GH and current practice on GH treatment discontinuation. Results: In total, 102 endocrine clinicians completed the survey. Of these, 65 respondents (33 endocrinologists and 32 specialist nurses) indicated active involvement in managing patients with growth hormone deficiency. In total, 27.7% of clinicians were routinely offering a trial of GH discontinuation to adults receiving long-term GH therapy. Only 6% had a clinical guideline to direct such practice. In total, 29.2% stated that GH discontinuation should be routinely offered as an option to patients on long-term treatment, whilst 60% were not clearly in favour or against this approach but stated that it should probably be considered, and 9.2% were against. During the GH withdrawal period, most clinicians monitor signs and symptoms (75.4%), measure IGF-1 (84.6%), and complete a quality-of-life assessment (89.2%). Conclusion: The practice of offering a trial of GH discontinuation in growth hormone deficiency adults on long-term GH therapy is highly variable, reflecting the lack of high-quality evidence. Around a quarter of clinicians offer GH withdrawal for a number of reasons, but only a few have a local clinical guidance. A further 60% of clinicians stated they would probably consider such an approach. Methodologically sound studies underpinning the development of safe and cost-effective guidance are needed. Significance statement: In this UK survey of endocrine clinicians managing adults with growth hormone deficiency on long-term GH therapy, we explored for the first-time current practice and views on offering GH treatment discontinuation. In total, 27.7% of clinicians were routinely offering this option for a variety of reasons. Only 6% have local clinical guideline available to direct their practice on this. The majority of clinicians (60%), were not clearly in favour or against this approach but indicated it should probably be considered. In the absence of robust evidence on consequences of GH withdrawal, clinicians proposed monitoring of various clinical, biochemical and quality-of-life parameters during the period of discontinuation. Methodologically sound studies that will underpin the development of a safe, cost-effective guidance are needed.

Parents' experience of children with acquired brain injury undergoing neuro-rehabilitation: thematic synthesis protocol.

INTRODUCTION: Children with moderate to severe acquired brain injury frequently require a period of demanding medical and rehabilitative care to optimise their long-term capabilities and quality of life. Usually, the initial acute care is provided in tertiary centres and can last up to 12 months following the original injury. Parents of children with acquired brain injury share that experience with their child and face many different challenges encountered as their child's long-term needs become apparent. Parents are essential partners in care, hence there is a need to better understand their experiences to support them as they face those challenges and adapt to the needs of their child. We aim to synthesise the qualitative evidence exploring parents' experiences of children undergoing neuro-rehabilitative care. METHODS AND ANALYSIS: The Enhancing Transparency in Reporting the Synthesis of Qualitative Research guideline was used in the design of this protocol. The Population, Exposure and Outcome model was used to define inclusion and exclusion criteria and refine search terms. The databases Ovid Embase, Ovid MEDLINE, CINAHL, Scopus and PsychINFO will be searched from 2009 to 2022. Two independent reviewers will review studies, assess quality using the Critical Appraisal Skills Programme and scrutinise and extract the data. Disagreements will be resolved after discussion with the third reviewer. Thematic synthesis using Thomas and Harden's approach will be undertaken to provide the evidence to develop a model for parental support during the first year of their child's neuro-rehabilitation. ETHICS AND DISSEMINATION: Ethical committee approval will not be required as no new data will be collected. The findings will be disseminated through presentations at professional conferences, publications in peer-reviewed journals and shared with the public through relevant charities and local family support groups and networks. PROSPERO REGISTRATION NUMBER: CRD42022333182.

Enhancing healthcare students' clinical placement experiences.

Over the past few years, efforts to address a shortage of nurses in the UK has led to an increase in nursing student numbers. However, in one large UK healthcare trust, this increase in student numbers led to a need to improve the quality of the trust's clinical placements. To address this issue, the authors undertook a quality improvement project, in which focus groups were used to enable 53 nursing, allied health professional, midwifery and nursing associate students to have in-depth discussions about their clinical placement experiences in the trust. Three main themes emerged from the data: being part of a team; support; and being unprepared. Following the project, the trust introduced student-led clinical learning environments to provide an innovative practice-based experience for students.

The experiences of diploma registered nurses returning to undergraduate study in Qatar: A descriptive qualitative study.

BACKGROUND: Qatar aspires to provide world-class healthcare comparable with Western countries. Compelling evidence demonstrating the positive effects of bachelor of nursing (BN) educated nurses on patient outcomes is creating a global demand for these graduates, particularly in contexts such as Qatar where historically RN-to-BN programs were unavailable. OBJECTIVE: The aim of this study was to examine the return to education experiences of diploma educated registered nurses (RNs) undertaking a bachelor program. METHODS: This descriptive qualitative study included 19 diploma educated registered nurses enrolled in a BN program in a Qatar campus of a Canadian university. Focus groups and thematic analysis were used. RESULTS: Three major themes described RNs' experiences of returning to education: the right time, balancing act and rewards. The convergence of timing, BN program availability and employer sponsorship were significant levers. Returning to education was challenging and required balancing competing demands of work, home, and study. The exposure to enquiry-based learning required rapid development of study skills to enable learning. Previous education was often seen as incongruent with requirements for academic success. A notable omission from accounts was reference to professional identity. Undertaking the program brought returns such as increased self-esteem, enhanced knowledge and potential for career progression. Organizational culture and commitment appeared to impact on students' experience. CONCLUSIONS: Completing a BN program was reward for the challenges engendered by returning to education. Effective partnerships and structural support between academic and service providers are required to ensure the benefits of BN attainment become embedded and impact on professional identity.

Registered nurses' attitudes towards the role of the healthcare assistant.

AIM: To elicit the views of registered nurses (RNs), working in the surgical directorate of an acute NHS trust, concerning the responsibilities of RNs to healthcare assistants (HCAs), specifically in relation to delegation, development and accountability. METHOD: A survey using a 24-item questionnaire and a six-point Likert scale design was administered to a convenience sample of 219 RNs working within the surgical directorate. A total of 148 completed questionnaires were returned, giving a 68% response rate. RESULTS: The results suggested that the majority of RNs were aware of their responsibilities regarding accountability for delegated tasks, believe that HCAs should be regulated and, once prepared adequately, held individually accountable for their actions. CONCLUSION: RNs should undertake appropriate skill development in pre-registration programmes and be provided with preceptorship to ensure they are equipped adequately to supervise and delegate work to HCAs.

A process-environment model for mentoring undergraduate research students.

Undergraduate nursing student engagement in research remains much contested. The debate centers on whether undergraduate education is preparation for application of research findings to practice versus early exposure and engagement to discovery of new knowledge focused research as is done in graduate education. We take the position that involvement in research is beneficial but mentorship is required if the endeavor is to be meaningful. In the absence of a model to guide effective mentorship for undergraduate co-researchers we synthesized the available undergraduate mentorship literature and relevant pedagogy to develop a mentorship model for use by nurse educators who undertake research with nursing students. This was applied and refined through active engagement in, and reflection on, the execution of a research project exploring peoples' experiences of mental illness. Synthesis of the evidence and reflections led to the development of a process-environment mentorship model. This model provides an evidence- and experientially-based framework for mentoring undergraduate student co-researchers.

Towards identifying nurse educator competencies required for simulation-based learning: A systemised rapid review and synthesis.

OBJECTIVES: This paper presents the results of a systemised rapid review and synthesis of the literature undertaken to identify competencies required by nurse educators to facilitate simulation-based learning (SBL). DESIGN: An international collaboration undertook a protocol-based search, retrieval and critical review. DATA SOURCES: Web of Science, PubMed, CINAHL Plus, PsycInfo, ERIC, the Cochrane Library and Science Direct. The search was limited to articles published in English, 2002-2012. REVIEW METHODS: The search terms used: nurse*, learn*, facilitator, simula*, lecturer, competence, skill*, qualificat*, educator, health care, "patient simulation", "nursing education" and "faculty". The search yielded 2156 "hits", following a review of the abstracts, 72 full-text articles were extracted. These were screened against predetermined inclusion/exclusion criteria and nine articles were retained. Following critical appraisal, the articles were analyzed using an inductive approach to extract statements for categorization and synthesis as competency statements. RESULTS: This review confirmed that there was a modest amount of empirical evidence on which to base a competency framework. Those papers that provided descriptions of educator preparation identified simulation-based workshops, or experiential training, as the most common approaches for enhancing skills. SBL was not associated with any one theoretical perspective. Delivery of SBL appeared to demand competencies associated with planning and designing simulations, facilitating learning in "safe" environments, expert nursing knowledge based on credible clinical realism, reference to evidence-based knowledge and demonstration of professional values and identity. CONCLUSIONS: This review derived a preliminary competency framework. This needs further development as a model for educators delivering SBL as part of nursing curricula.