Factors influencing nurses' engagement with CPD activities: a systematic review.

BACKGROUND: Continuing professional development (CPD) is necessary for nurse registration and development. Understanding the factors influencing engagement may enhance CPD uptake. REVIEW QUESTION: What factors influence hospital-based nurses' engagement with CPD activities in the UK? DESIGN: This was a systematic review incorporating narrative synthesis. Database searches for published and grey literature from January 1995 to November 2018 were conducted via EBSCO Discovery Service, the British Nursing Index and the British Library. REVIEW METHODS: An approved systematic review protocol was followed with studies then assessed against strict inclusion and exclusion criteria. Included studies were critically appraised, data extracted and a narrative synthesis conducted. FINDINGS: Five studies were reviewed. Four themes emerged: nurses' individual resources, their professional motivation, organisational commitment to learning and development, and managerial support. CONCLUSION: Factors influencing nurses' engagement with activities are multifaceted and inter-woven. A question-based checklist to facilitate discussions between nurses and educators, managers or appraisers is presented.

A longitudinal, mixed methods investigation of newly qualified nurses' workplace stressors and stress experiences during transition.

AIM: To investigate transition in newly qualified nurses through an exploration of their stressors and stress experiences during their first 12 months postqualifying. BACKGROUND: Globally, thousands of new nurses qualify annually. They are crucial for the profession and healthcare service delivery. Work-related stress has multiple serious consequences, yet there is a lack of robust, empirical evidence that directly analyses newly qualified nurses and the stress they feel and experience in the workplace. Understanding what causes newly qualified nurses' stress is vital to retaining and nurturing this vital component of the workforce. DESIGN: Longitudinal, explanatory sequential mixed methods, cohort study. METHODS: At the point of qualification (n = 288), 6 months postqualifying (n = 107) and 12 months postqualifying (n = 86), newly qualified nurses completed the Nursing Stress Scale, with 14 completing a one-to-one interview at 12 months postqualifying. Data were collected from 2010 - 2012. Inferential statistics, "thematic analysis" and "side-by-side comparisons in a discussion" were used for analysis. RESULTS: Workload was consistently the highest reported stressor with inadequate staffing and managing multiple role demands given as explanations. Incivility within the workplace was a noted stressor. Conversely, being part of "a good team" provided a civil, supportive, facilitative work environment. Entering nurse education with previous healthcare experience had a mediating effect on the reported frequency of stressors. CONCLUSIONS: Newly qualified nurses encounter multiple work-related stressors over their first 12 months postqualifying, which are intrinsically entwined with their transition. Employing organizations need to be more proactive in managing their workload and addressing workplace incivility.

The effect of fluency in English on the continuing professional development of nurses educated overseas.

BACKGROUND: In the United Kingdom, many nurses who were educated overseas and are not native English speakers are undertaking continuing professional development study within their host country. This study investigated the effect of fluency in English on the teaching and learning of registered nurses undertaking continuing professional development within a health and social care faculty in a U.K. university. METHODS: A qualitative, interpretive method was used. Data were obtained through thematic analysis of semi-structured individual interviews with educators, nurses educated in the United Kingdom, and nurses educated overseas who were not native English speakers and were undertaking continuing professional development. RESULTS: Participants included six educators, six registered nurses who were educated in the United Kingdom, and six registered nurses who were educated overseas and were not native English speakers. Educators resorted to generalizations in describing nurses' teaching and learning characteristics. Classroom dynamics that impeded nurses' learning were reported. Critical thinking, academic success, and integration within the classroom were affected by the ability to research, question, and discuss new or complex continuing professional development topics in English. CONCLUSION: Fluency in academic nursing English is necessary for successful continuing professional development. Educators should use and develop strategies to encourage integration in the classroom between nurses who were educated in the United Kingdom and those who were educated overseas and are not native English speakers to support critical thinking and engagement by all participants.

Dealing with death: first encounters for first-year nursing students.

End-of-life care, particularly for older people, is often sub-optimal in England, and the Government has introduced several initiatives to improve this care. The authors believe the twin frameworks of emotional labour and ethics of non-abandonment underpin the provision of high-quality care. This article discusses a research project that investigated first-year nursing students' encounters with patient deaths. The research found that, to the student, every death in clinical practice is a learning experience and potentially a source of emotional distress; some students reported experiencing flashbacks afterwards and were developing avoidance behaviours. Students sometimes felt unsupported by mentors and also felt that sometimes dying patients and families were inadequately cared for. The theme of abandonment was evident in the students' stories. The authors conclude that there is still room for improvement in end-of-life care. Good role modelling and pastoral care by mentors is vital to student development. Link lecturers and mentors need to be alert to student distress.

Point-of-care testing and recognizing and preventing errors.

Jenny, the practice nurse of a busy GP surgery, was asked to carry out a commercially available test to exclude a diagnosis of infectious mononucleosis. The test was negative. The patient was prescribed amoxycillin and later developed a severe rash. However, the blood tests from the local pathology laboratory showed that the patient did have infectious mononucleosis. The GP discovered from colleagues that over the last few weeks other patients as the surgery had been recorded as having negative tests but positive laboratory results had later followed.

Protecting the interests of the child bone marrow donor.

At a time when designer babies have been created to act as cord blood donors to sick siblings, ethical debate has focused predominantly on the extent to which it is acceptable to create one human being to assist another. However, children are frequently used this way, by their families and doctors who extract their bone marrow, to try to save the life of another, usually a sibling. With any life-threatening illness, there is the possibility that the urgency of the sick sibling's need means that the short-term welfare of the donor child receives less attention than it should by parents and doctors. This article suggests ways to protect the interests of such children and empower them within the decision-making process and concludes that the drive to save life must be tempered by recognition of the intrinsic worth of donor children and their rights not to be exploited.

Service user involvement in nurse education: a report on using online discussions with a service user to augment his digital story.

Service user involvement is a key element within current pre- and post-registration nurse education in the U.K. but achieving this is challenging. Most service user involvement is through classroom visits. Digital stories, film and audio are alternatives but lack the interactivity and development of reflection that can be achieved through face-to-face contact. This report reviews the background to service user involvement in healthcare professional education then provides a reflective account of a novel initiative whereby a spinal-injured patient was involved in creating a digital story around some of his in-hospital experiences and then engaged in online discussions with post-registration nursing (degree) and practice educator (masters) students. These discussions provided a richer experience for the students enabling them to reflect more deeply on how nursing care is delivered and perceived by service users. The report concludes that digital stories can be used with repeated groups to inspire discussion and reflection. Augmenting such digital stories with online discussions with the service user whose story is told helps practitioners develop greater empathy, insight and understanding which are beneficial for improving service delivery and nursing care.

An integrated approach to resource allocation.

Resource allocation decisions are often made on the basis of clinical and cost effectiveness at the expense of ethical inquiry into what is acceptable. This paper proposes that a more compassionate model of resource allocation would be achieved through integrating ethical awareness with clinical, financial and legal input. Where a publicly-funded healthcare system is involved, it is suggested that having an agency that focuses solely on cost-effectiveness leaving medical, legal and ethical considerations to others would help depoliticise rationing decisions and command greater public acceptance.

Reflective practice in nursing ethics education: international collaboration.

BACKGROUND: The Internet provides the opportunity for international comparative study and collaboration when learning about ethics in clinical nursing practice. AIM: This paper aims to discuss Internet links developed between US and UK postregistration nursing students who were reflecting on clinical practice in order to explore how political and organizational structures of the health care system affect ethical decision-making. DISCUSSION: An analysis is presented of the stages in developing an exchange course for students from these countries, which involved various combinations of classroom-based teaching, on-line discussions and international visits by students and teachers during its evolution. The strengths and weaknesses of the different methods are considered, and future developments identified. CONCLUSION: The Internet collaboration resulted in postregistration nursing students using reflection on practice in the study of ethics in clinical practice and an understanding of how systems structures and procedures affect ethical decision making. Internet-assisted teaching offers opportunities for collaboration, and student participants demonstrate sophisticated critical thinking in ethical decision-making. Issues of access barriers and motivation remain challenges to wider use.