Nursing

Please help us keep this up to date.  Contact us with improvements and amendments. 

Authors

Dr Anne Fothergill, Principle Lecturer, School of Care Sciences, University of Glamorgan afotherg@glam.ac.uk

Dr Janet Barker, Senior Health Lecturer, School of Nursing, University of Nottingham janet.barker@nottingham.ac.uk

With contributions from Susanne Forrest (School of Community Health, Napier University) and Hugh O'Donnell (School of Nursing and Midwifery, Queens University Belfast)

1. Undergraduate teaching

Nurse education is a relatively new arrival in Higher Education Institutions (HEIs). Whilst a few pre-registration undergraduate nursing programmes have been available since the 1960s, and some nurses have accessed undergraduate programmes following registration, nurse education has had little to do with HEIs until recent years. Traditionally, the majority of pre-registration nurse education was based on an apprenticeship model. Student nurses were employees of the health services, and learnt their required skills 'on the job' with minimal time allocated to theoretical input. Schools of Nursing were attached to specific hospitals with the educational programmes adhering to the syllabus of training produced by nursing's governing body.

This was to change in the late 1980s. Driven by concerns about the ability of the educational system to produce nurses able to meet the challenges and demands of the modern health care system, a new form of education - Project 2000 - was launched. The intention was to create self-directed, autonomous practitioners (UKCC, 1986) and place all nurse education within HEIs. The programme was originally envisaged as a Diploma in Higher Education, however a number of Advanced Diplomas (with 60 credits at level 3) and Degree courses are now in place. A move to an all-graduate preparation has been discussed at length; however this has not been universally accepted (UKCC 1999). England continues to offer predominately Diploma programmes, whilst Northern Ireland, Wales and Scotland are moving towards all-graduate preparation

Pre-registration

Student nurses generally undergo a three year education programme. All branches of nursing (mental health, adult, learning disabilities and child ) share a common foundation programme - initially of eighteen months, reduced to one year in 2000 - with a branch specific programme (again initially of eighteen months and now two years). Students spend 50% their time in the classroom and 50% in clinical practice.

In the foundation year all students, irrespective of their chosen branch of nursing, share 'common' theoretical input. A larger proportion of their clinical experience is in their own branch area, however, with short 'insight' visits and/or theoretical/portfolio work in relation to other areas of nursing. In this way nurses following pathways other than mental health will acquire some insight into mental health issues. However a frequent criticism of the course is that this 'common foundation' is 'adult branch' orientated, emphasising skills and knowledge more pertinent to the physical care of individuals, with little emphasis placed on mental health needs.

Theoretical content is focused around:

  • Professional, legal and ethical issues
  • Theory and practice of nursing
  • Context of health and social care
  • Organisational structures
  • Communication
  • Social and life sciences

Frameworks for social care and care systems

  • Practice competencies relate to four domains
  • Profession and ethical practice
  • Care delivery
  • Care management
  • Personal and professional development

How these aspects are organised varies between the UK countries and across the HEIs, although the Nursing and Midwifery Council (NMC) must validate all courses.

All successful students are eligible to register for practice with the NMC as well as receiving a HEI award i.e. Diploma in Higher Education or Bachelor of Nursing.

A variation on the normal type of qualification is available at the University of Teeside where a BSc (Hons) Social Work / Mental Health Nursing programme is on offer. This three year programme equips graduates with a dual qualification and the ability to develop collaborative working between Social Services and Health within new, integrated mental heath care structures.

Welsh Context

The Welsh Assembly Government standardises nine core elements of the nursing curriculum across Wales - accreditation of prior learning; access/entry, assessment strategy; assessment of clinical practice, student portfolio, mentor preparation, education clinical audit tool, research elements in the curriculum and evaluation mechanisms. HEIs develop their curriculum content in relation to these elements. It is the intention of the National Assembly for Wales to have all-graduate education from 2004.

Scottish Context

NHS Education for Scotland (NES) exists to advance the knowledge and develop the skills of all NHS staff. The Nursing, Midwifery & Allied Health Professions Directorate of NES (NMAHP) act as agents in Scotland for the UK regulator (the Nursing and Midwifery Council) to quality assure the statutory provision of pre- and post-registration education provision. The Directorate conducts the approval and annual auditing of nursing courses. It is the intention of the Scottish Executive to have an 80% graduate outcome from pre-registartion nurisng courses by 2005.

Northern Irish Context

The Department of Health and Social Services for Public Safety (DHSS&PS), Northern Ireland, currently commissions pre/post registration nursing programmes for the region. The Northern Ireland Practice and Education Council for Nursing and
Midwifery (NIPEC), is responsible for the approval and quality assurance evaluation of these programmes. Diploma and Degree pathways are currently available for new entrants into nursing. It is likely that these pathways will be continue to be provided by HEIs in the immediate future.

2. Postgraduate/post qualifying teaching

All qualified nurses are expected to continue their 'life-long learning', accessing educational programmes appropriate to their area of practice and increased specialisation. Most HEIs have developed and offer Continuing Professional Development (CPD) frameworks, enabling nurses to access modules or programmes at either undergraduate or postgraduate level; however these may not have content specifically related to mental health, or such modules may be optional.

In the 1970s only a handful of nurses (a minority of whom were mental health nurses) held degrees. Early post-registration education generally focused on in-house training or the acquiring of certificates validated by the various nursing National Boards (England, Wales, Scotland and Northern Ireland) - now combined under the auspices of the NMC. The movement of pre-registration education into HEIs required a reconsideration of post-registration education. Qualified nurse were provided with opportunities to develop the knowledge and skills required to meet the demands of current practice. This resulted in an increase in the number of undergraduate programmes specific to nursing and health care issues.

The last 10 years have seen the number of modules/programmes specific to mental health grow exponentially, these being as diverse as the care groups represented within the mental health setting. For example a mental health nurse can access modules which specifically address Child and Adolescence care, Psychosocial Interventions; Substance misuse, Acute settings, or Care of Older People with dementia, to name but a few.

The type of education programme accessed very much depends on the career path chosen by the individual nurse. If the intention is to remain in clinical practice and develop advance standing in a particular clinical area then Masters programmes and taught Doctorates emphasising practice development and clinically orientated research are likely to be the chosen options. Alternatively career progression in relation to management, education or research will lead individuals to access Masters and Doctoral programmes providing the necessary insights in these areas.

3. Key issues in mental health teaching

The development of mental health nurse education is driven by the government's modernisation agenda which recognises the need to develop effective collaborative approaches and engage service users/carers in meaningful ways. If mental health nurses are to develop the knowledge, skills and attitudes necessary to facilitate partnership working, service users and carers must be involved at all levels of the learning process, including direct delivery and curriculum development. The difficulty lies, as Peter Campbell notes in an article on the RCN Learning Zone, in ensuring that this does not degenerate into tokenism

The pre-registration nurse education review, Fitness for Practice  (UKCC 1999) highlighted a. number of areas to be addressed by nurse education to ensure that nurses are 'fit to practice' in relation to current health needs, and these continue to be the central tenets of nurse education.

  • Development of competency based programmes, ensuring a balance between knowledge and skills acquisition
  • Use of problem/enquiry-based learning in facilitation practice focused learning
  • Portfolio development to enhance the integration of theory and practice, critical reflection, and skills development
  • Evidence-based practice and the enhancement of nurse research activity
  • Inter-professional learning. The integration of health and social care delivery makes this essential within the mental health setting as multi-agency working becomes the order of the day. However shared lectures are not seen as the appropriate model; rather facilitated group work encouraging the development of interdisciplinary understanding is proposed as the way forward.

Learning and teaching methods include:

  • Experiential learning methods such as role play, scenarios, simulated cases
  • Problem based learning
  • Debate/discussions (classroom and electronically via blackboard)
  • Lead lecturers (including some delivered by service users)
  • Critical reflection/portfolios
  • Distance/e learning.

4. `Cutting edge' areas of practice/development/research

  • Service user and carer involvement in practice development, education and research (see Repper et al., 2001)
  • Social inclusion (see Repper and Perkins, 2003)
  • Therapeutic relationships (see Stickley and Freshwater, 2002)
  • Clinical supervision (see Butterworth et al., 1998)
  • Inter-professional learning (see Billingsley & Lang, 2002)
  • Nurse prescribing (see Gournay & Gray, 2003)
  • The Tidal Model (Phil Barker) http://www.tidal-model.com/         see participation in mental health research

5. Key Journals and websites

Key journals

6. Regulatory bodies


References

Billingsley R. & Lang L. (2002) The case for interprofessional learning in health and social care, MCC: Building Knowledge for Integrated Care. 10(4):31-4

Butterworth T., White E., Carson J., Jeacock J. & Clements, A.(1998) Developing and evaluating clinical supervision in the United Kingdom. EDTNA/ERCA Journal. 24(1):2-8,

Gournay, K. & Gray, R. (2003) Mental health prescribing: the research challenge, NT Research 8(3), 173 -84.

Repper, J & Perkins, R (2003) Social inclusion and recovery: a model for mental health practice. London: Bailliere Tindall

Repper J., Felton A., Hanson B., Stickley T. & Shaw T. (2001) One small step towards equality, Mental Health Today. December, 24-7

Stickley, T. & Freshwater, D. (2002) The art of loving and the therapeutic relationship, Nursing Inquiry, 9(4), 250-6

U.K.C.C. (1986) Project 2000: A New Preparation for Practice. London: U.K.C.C.

U.K.C.C. (1999) Fitness for practice. The U.K.C.C. Commission for Nursing and Midwifery Education. (Chaired by Sir Leonard Peach). London: U.K.C.

 

 

TAGS ON THIS PAGE

Nursing subject area
HOME NEWS and EVENTSABOUT USNETWORKSRESOURCESCOUNTRIES & REGIONSSUBJECT AREASTHEMESGATEWAY