Investigating the processes and influences involved in the transformational journeys of Registered Nurse Degree Apprentices: A realist informed qualitative study.

AIM: This study aimed to investigate students' learning journeys across the duration of a new registered nurse degree apprenticeship programme and to develop an understanding of the contextual factors, mechanisms and outcomes involved. BACKGROUND: Registered nurses are the largest group of healthcare workers globally, but shortages exist. To encourage existing UK healthcare employees into nursing, national investment was made into Registered Nurse Degree Apprenticeships. In 2018 a UK health service organisation and a university collaboration led to development of a nursing degree apprenticeship programme. Research into these novel undergraduate programmes in nursing is lacking, with scarce evidence or understanding of processes and experiences involved in such programmes. DESIGN AND METHODS: An exploratory qualitative design informed by realistic evaluation was employed. Three sequential semi-structured interviews were conducted with an entire cohort (n=8) across the 18-month programme (24 interviews). Focused interviews were also undertaken with practice assessors (n=8) involved in the apprentices' journey. Initial thematic analysis was followed by application of Realist Evaluation principles and a temporal lens to move beyond qualitative description. RESULTS: Analysis identified four interrelated temporal themes, each comprising contextual factors, mechanisms and outcomes acting to inhibit or facilitate transition across the apprenticeship journey: (1) Starting out (Latent Ambition, enhanced motivation and expectations): programme availability and conditions enabled enactment of ambitions to become qualified nurses, preconceived assumptions regarding roles influenced expectations. (2) Initial stages (Identity dissonance, transition to academia, becoming a student nurse) related to changing identity and re-conceptualisation of their role to student nurse, alongside transitioning into higher education. (3) Travelling through (Being an apprentice, social capital, self-efficacy and confidence) facilitated confident integration into placements, although over confidence could be risky. Academic struggles prompted some episodes of emotional dissonance. (4) Moving beyond to become registered nurses (Confidence, empowerment and loyalty in the transition to becoming a nurse) saw apprentices transform, with revised understandings of nursing, increased empowerment and self-efficacy. All expressed gratitude and loyalty for the apprenticeship opportunity, with all securing jobs in their employing organisation. CONCLUSION: This study is one of the first of its kind, providing detailed insight into processes experienced by students over the duration of a novel apprenticeship programme. Analysis identified several factors that facilitated and inhibited progress in participants' 'learning journeys', mapping context, mechanism, outcome configurations which came into play at various stages. These were influential in successful completion of the programme by all apprentices, resulting in the development of competent Registered Nurses.

'Hello, my name is ': an exploratory case study of inter-professional student experiences in practice.

BACKGROUND: The 'Hello my name is …' campaign emphasises the importance of compassionate care and focuses on health professionals introducing themselves to patients. Research has found that using names is key to providing individuals with a sense of belonging and can be vital in ensuring patient safety. OBJECTIVE: To investigate the student experience of having 'Hello my name is …' printed on student uniforms and implement this campaign in practice. DESIGN: A case study was used to capture the experiences of 40 multiprofessional healthcare students in practice. Participants were asked to complete a reflective diary during their first week in practice and attend a focus group with 4-8 other students. SETTING: A higher education institution in the north east of England with students from adult, child and learning disability nursing, occupational therapy, physiotherapy and midwifery programmes, in a variety of clinical placements throughout the region. FINDINGS: The implementation of the campaign and logo branding on the uniforms of students resulted in an increase in the number of times students were addressed by their name in practice. Participants reported that the study helped them to quickly develop a sense of belonging when on placement, and aided them in delivering compassionate care. Occasions when patient safety was improved were also reported. CONCLUSION: The use of names is a key feature in human relationships and the delivery of compassionate care, and the authors advocate use of the 'Hello my name is …' campaign for all health professionals.

The influence of culture, structure, and human agency on interprofessional learning in a neurosurgical practice learning setting: a case study.

The World Health Organization supports the notion that interprofessional learning (IPL) improves healthcare outcomes and contributes to safe, effective, and high-quality care. Consequently, IPL is an integral component within most UK undergraduate healthcare programs. Although much is written about IPL, research to date has mainly focused on the classroom or simulation lab as a setting for IPL. Less is known about how the practice learning environment influences the experiences and outcomes for those involved. A case study research design, situated within a critical realist framework, was undertaken which aimed to better understand how IPL was facilitated for undergraduate healthcare students within a neurosurgical practice learning setting. Interviews, non-participatory observations, and secondary documentary data were used as the methods of data collection to inform the case. Thematic analysis was undertaken, and the findings clustered into overarching themes of culture, structure, and human agency, facilitating a more in-depth exploration of the complex interplay between the factors influencing IPL in the study setting. IPL was supported within the setting which operated as an 'interprofessional community of practice,' facilitating student engagement and investing in its staff for the benefit of the patients who had complex neurological needs. A practice-based IPL Multi-Dimensional Assessment Tool was also created to enable colleagues in practice learning environments worldwide to better understand their capability and capacity for the facilitation of practice-based IPL.

Performing neurological observations.

Trauma to the brain from injury or illness can cause sustained, raised intracranial pressure. In such patients, neurological observations are a fundamental aspect of nursing care and the ability to make and record such observations accurately is an essential nursing skill. Neurological observations are a collection of information on the function and integrity of a patient's central nervous system-the brain and and spinal cord. This article will discuss the tools used in their observation, including the Glasgow Coma Scale tool, pupillary response, and limb power observations, and provide a 'how-to' guide on neurological observations.

Facilitating classroom based interprofessional learning: a grounded theory study of university educators' perceptions of their role adequacy as facilitators.

The provision of inter professional learning (IPL) within undergraduate programmes is now well established within many Higher Education Institutions (HEIs). IPL aims to better equip nurses and other health professionals with effective collaborative working skills and knowledge to improve the quality of patient care. Although there is still ambiguity in relation to the optimum timing and method for delivering IPL, effective facilitation is seen as essential. This paper reports on a grounded theory study of university educators' perceptions of the knowledge and skills needed for their role adequacy as IPL facilitators. Data was collected using semi structured interviews with nine participants who were theoretically sampled from a range of professional backgrounds, with varied experiences of education and involvement in facilitating IPL. Constant comparative analysis was used to generate four data categories: creating and sustaining an IPL group culture through transformational IPL leadership (core category), readiness for IPL facilitation, drawing on past interprofessional learning and working experiences and role modelling an interprofessional approach. The grounded theory generated from this study, although propositional, suggests that role adequacy for IPL facilitation is dependent on facilitator engagement in a process of 'transformational interprofessional learning leadership' to create and sustain a group culture.

Learning to work collaboratively: nurses' views of their pre-registration interprofessional education and its impact on practice.

One of the challenges of contemporary health care is the need for health and social care professionals to work differently to meet the complex needs of patients/clients. However it cannot be assumed that these professionals have been prepared with the skills and confidence to collaborate effectively, outside of traditional professional boundaries. Interprofessional education (IPE) is well established as an effective learning and teaching approach to prepare practitioners for collaborative practice at the point of qualification (DOH 2001; Hale 2003; Morison et al., 2003; Department of Health 2006; Hammick et al., 2007). The phenomenological study reported in this paper sought to follow up a group of newly qualified adult nurses at six months post-qualification. These nurses had undertaken a pre-registration curriculum in which classroom-based interprofessional learning was well embedded and formally assessed within their three year programme. Data from eight in depth interviews were analysed and five key themes were emerged: common understanding of IPE; teaching and learning; understanding of professional roles; stereotypes; influence of the practice environment. The outcome of the study suggested IPE should be as practice focused as possible to improve its relevance to nursing practice. This study contributed to the development of an innovative curriculum which provides the opportunity for nurses to integrate IPE theory within their collaborative working practice.

Assessing the impact of a study skills programme on the academic development of nursing diploma students at Northumbria University, UK.

BACKGROUND: The Government's nursing recruitment campaign has widened access for those wishing to enter the profession, resulting in some students entering university with clinical experience but little experience of academic writing or using libraries. For these students, the library and study advice staff have an important role to play in helping them acquire appropriate information literacy and study skills. OBJECTIVE: To evaluate the impact of workshops supplementing online instruction in study skills on students' study and writing skills, and level of information literacy. METHODS: A small group of pre-registration nursing students identified as needing support with information literacy and study skills participated in focus groups to identify areas of concern, and were offered four remedial workshops. A follow-up focus group explored whether the students' needs had been addressed. Further evaluation of the workshops' impact was completed by diagnostic testing within the University's information literacy programme, Skills Plus. OUTCOMES: The results showed that all students who attended at least one workshop improved their academic grade in their next assignment. Qualitative data indicated that the students' confidence level and information literacy, including referencing skills, had improved. CONCLUSION: Evaluating the impact of this intervention has provided the evidence to demonstrate the value of this additional support.

In search of evidence: a small scale study exploring how student nurses accessed information for a health needs assignment.

To help students develop the knowledge and skills necessary to provide evidence-based practice in nursing, a health needs analysis assignment is incorporated within a pre-registration nursing programme. As student nurses have reported difficulties in accessing and utilising some of the information needed for this assigned task, the aim of the study was to explore their experiences of undertaking this assignment. Using a qualitative methodology data was collected from focus groups and categorised under three main themes: the challenge of evidence gathering; the nature of the support students needed and understanding the importance of evidence for practice. This paper illustrates that although accessing and utilising material was demanding and required more guidance, the biggest challenge lay in making judgements about it and there was a clear indication of the need for further support in developing their critical and evaluative skills. The quality of debate within the focus groups also led the research team to question whether educationalists are making the most of capitalising on the rich learning gained from students sharing their experiences of undertaking assignments.