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2 Quinn s Principles and Practice of Nurse Education Fifth Edition Francis M. Quinn, formerly University of Greenwich, London, UK and Suzanne J. Hughes, Cardiff University, Cardiff, UK Australia Brazil Japan Korea Mexico Singapore Spain United Kingdom United States

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4 Quinn s Principles and Practice of Nurse Education, Fifth Edition Francis M. Quinn and Suzanne J. Hughes Publishing Director: Linden Harris Publisher: Lucy Mills Production Controller: Richard Gogarty 2007, Cengage Learning EMEA ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced, transmitted, stored or used in any form or by any means graphic, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, information networks, or information storage and retrieval systems, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, or applicable copyright law of another jurisdiction, without the prior written permission of the publisher. While the publisher has taken all reasonable care in the preparation of this book, the publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions from the book or the consequences thereof. Products and services that are referred to in this book may be either trademarks and/or registered trademarks of their respective owners. The publishers and author/s make no claim to these trademarks. The publisher does not endorse, and accepts no responsibility or liability for, incorrect or defamatory content contained in hyperlinked material. For product information and technology assistance, contact emea.info@cengage.com. For permission to use material from this text or product, and for permission queries, emea.permissions@cengage.com. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. ISBN: Cengage Learning EMEA Cheriton House, North Way, Andover, Hampshire, SP10 5BE, United Kingdom Cengage Learning products are represented in Canada by Nelson Education Ltd. For your lifelong learning solutions, visit Purchase your next print book, e-book or e-chapter at

5 Introduction: 1 Nurse education in the university and the clinical setting The focus of this book is education within nursing, midwifery and specialist community public health nursing, and this introductory chapter identifies some key developments relevant to these professions. The aim of the introduction is to provide signposts for the reader, by indicating where some of the issues are further explored within the chapters of the book. Variety is one of the hallmarks of nurse education, consisting as it does of a variety of disciplines, engaging in a variety of activities, carried out by a variety of staff, in a variety of settings. The disciplines involved are nursing, midwifery and specialist community public health nursing, but within these main groups there are numerous subgroupings such as community midwives, intensive care nurses, liaison specialist community public health nurses, and so forth. The activities of nurse education range from the formal, academic type of teaching through to the impromptu teaching that occurs spontaneously in day-to-day work. The former includes a range of academic awards including diploma of higher education, bachelors degrees, postgraduate diplomas, masters degrees, and research degrees at masters and doctoral levels. This teaching is delivered by nursing personnel such as university lecturers, lecturer/practitioners, mentors, clinical and community practitioners, students themselves, and also by a range of non-nursing personnel including medical practitioners and members of the professions allied to medicine. The settings in which nurse education takes place include university departments of nursing, hospitals in both public and private sectors, clinics, GP surgeries, prisons, nursing homes, and patients /clients own homes. The instrumental ideology of nursing curricula Nurse education comes under the overall umbrella of post-compulsory education and training, i.e. education that takes place after completion of compulsory schooling at age 16. The principles of nurse education are based upon the theory and practice of adult learning, and as such differ significantly from the education of children in school. One of the main differences between curricula in nursing and the national curriculum for children is that nurse education curricula are instrumental; i.e. their purpose is the production of a nursing workforce that is equipped to deal with the demands of the role, and vocational relevance is therefore a key 1

6 Chapter 1 Introduction principle. This is not to say that nursing curricula omit the wider aspects of education such as the needs, aspirations and personal growth of the individual, but these considerations are secondary to the main purpose. Nurse education takes place within two major contexts, the National Health Service (NHS) and the university sector within the UK, and each of these is subject to continuing development and change. There are also important developments in professional nursing that have a major impact on the design and delivery of nurse education. The following sections will highlight some of these current developments, and reference will be made to the appropriate chapters of this book in which further discussion of some of these issues can be found. Developments in the nursing profession Perhaps the most significant development affecting the nursing profession is the Nursing Midwifery Council (NMC), which was set up by Parliament to protect the public by ensuring that high standards of care are provided by nurses and midwives. The Nursing Midwifery Council The NMC was established by the Nursing Midwifery Order 2001 and came into effect on 1 April The Nursing Midwifery Order 2001 provided legislative powers for the NMC to approve and monitor the standards of educational programmes that lead to entry on to the register and the educational institutions delivering these programmes. The main objective of the NMC in exercising its functions is to: Safeguard the health and well-being of persons using or needing the services of registrants. The principle function of the NMC is to: Establish from time to time standards of education, training, conduct and performance for nurses and midwives and to ensure the maintenance of these standards. There are now three parts to the NMC register for nurses, midwives and specialist community public health nurses, with only three recordable post-registration qualifications: specialist practice; teaching; nurse prescribing. However, a number of other important developments relating to the NMC are also included here. 2

7 Developments in the nursing profession Fitness for Practice (UKCC, 1999) In 1998, the UKCC established a commission to examine the future direction of pre-registration nursing and midwifery education, and its terms of reference were as follows: To prepare a way forward for pre-registration nursing and midwifery education that enables fitness for practice based on health care need (UKCC, 1999). The Fitness for Practice (FfP) curriculum is now fairly well established, and a number of key issues have now been addressed: The common foundation programme has been reduced to one year. Clinical skills and practice placements have been introduced in year one of the programme. Outcome competencies have been developed to identify standards for registration as a nurse. A portfolio of practice is now used to demonstrate students fitness for practice. The curriculum utilizes a range of teaching and learning methods. Health care providers and higher education institutions now work in tandem to enhance the student experience. The FfP document acknowledged that pre-registration programmes must meet certain requirements and provided a clear, ongoing set of outcomes for commissioning bodies, higher education institutes, NHS trusts, mentors and students. They all have a responsibility for ensuring that, at the point of initial registration, nurses and midwives are fit: Fit for Purpose (competency based) can function competently in clinical practice; Fit for Practice (professional legal and ethical outcomes) can fulfil the needs of registration; Fit for Award (meeting academic standards) have the breadth and depth of learning to be awarded a diploma or degree. The NMC (2006) post-registration education and practice (PREP) standards The NMC issued the new PREP standards in 2006, identifying two standards that affect a practitioner s registration. These are: the PREP (practice) standard; the PREP (continuing professional development) standard. The practice standard requires nurses, midwives and specialist community public health nurses to have completed a minimum of 450 hours of practice during the three years prior to renewal of registration. 3

8 Chapter 1 Introduction The continuing professional development (CPD) standard requires a commitment from registrants to undertake CPD and: undertake at least five days or 35 hours of learning relevant to practice during the three years prior to renewal of registration; maintain a personal professional profile of learning activity. Registrants must also comply with any request for auditing of the practitioner s personal professional profile by the NMC. PREP is discussed in Chapter 15 (p. 480). Standards for the Preparation of Teachers of Nurses, Midwives and Specialist Community Public Health Nurses (NMC, 2004a) In 2004 the NMC published its framework for the standards for the preparation of lecturers and practice educators of nurses, midwives and specialist community public health nurses and the standards for recording a teaching qualification. Although the standards were originally published by the UKCC, these new standards have been updated in light of the new rules derived from the Nursing Midwifery Order The NMC requires all educators in higher education institutions and practice settings to undertake additional preparation and education to a standard set by the NMC that leads to a recordable teaching qualification. The NMC (2004a) has advised that the study programme should be at post-graduate level and the practice element of the programme must be equivalent to 12 full-time weeks or 360 hours in duration. The programme should include: flexible modes of delivery; a modular structure; links to higher education institutions and education accreditation system; credit for prior learning; opportunities to observe, participate and be assessed in a range of teaching activities. Standards for the preparation of lecturers Lecturers undertake their main teaching role in a higher education institution, and also contribute to teaching in practice settings. Lecturers have effective NMC registration, a minimum of 3 years full-time experience (or part-time equivalent) in relevant professional practice in the last 10 years. Their additional professional knowledge must be no less than first degree level; their teaching qualification must be at postgraduate level and contain the equivalent of 12 weeks of full-time teaching practice. The NMC (2004a) identifies the core components that must be achieved within the programme. These include: communication and working relationships; facilitation of learning; assessment; 4

9 Developments in the nursing profession evaluation; creating a learning environment; context of education; professional development; and curriculum development. Standards for the preparation of practice educators Practice educators are experienced practitioners who make a significant contribution to education of students and practitioners, and lead practice developments within their setting. Practice educators must have effective NMC registration, and at least 3 years full-time experience (or part-time equivalent) within the last 10 years. The NMC (2004a) identifies the core components that must be achieved within the programme. These include: communication and working relationships; facilitation of learning; creating a learning environment; improving practice/multi-professional working; disseminating research findings; and development and/or review of courses. Standards for the preparation of mentors The NMC (2004a) identifies the core components that must be achieved within the programme. These include: communication and working relationships; facilitation of learning; assessment; role modelling; creating a learning environment; improving practice; disseminating research findings; and development and/or review of courses. The core components are very similar to the ones listed for practice educators above. Mentors must have effective NMC registration, and at least 12 months full-time experience. Standards of Proficiency for Pre-registration Nursing Education (NMC, 2004b) The NMC (2004b) states that: Applicants for entry to the nurses part of the register must achieve the standards of proficiency in the practice of adult nursing, mental health nursing, learning disabilities nursing or children s nursing. 5

10 Chapter 1 Introduction The standards of proficiency cover a range of practice issues under the four domains of: 1. Professional and ethical practice. 2. Care delivery. 3. Care management. 4. Personal and professional development. A summary of some of the standards is set out in Table 1.1. Table 1.1 Summary of the standards for pre-registration nursing eduction Manage and practise in accordance with the NMC code of professional conduct and an ethical and legal framework. Practise in a fair and anti-discriminatory way and promote the health and well-being of patients. Engage in, develop and disengage from therapeutic relationships through appropriate use of communication and interpersonal skills. Assess the physical, psychological, social and spiritual needs of patients. Plan nursing care in partnership with patients, carers and their family. Engage in safe nursing practice that is based on the best available evidence. Demonstrate sound clinical judgement across a range of professional and care-delivery contexts. Create and maintain a safe environment of care through quality assurance and risk-management strategies. Demonstrate a commitment to continuing professional development. Enhance the professional development and safe practice of others through peer support, leadership, supervision and teaching. Adapted from NMC (2004b) Standards of Proficiency for Pre-registration Midwifery Programmes of Education (NMC, 2004c) There are 15 standards relating to pre-registration midwifery education, which include standards for the lead midwife for education; admission to and continued participation in pre-registration midwifery programmes; structure and nature of pre-registration midwifery programmes and standards of education to achieve the NMC standards of proficiency. The standards of proficiency cover a range of practice issues under the four domains of: 1. Effective midwifery practice. 2. Professional and ethical practice. 3. Developing the individual midwife and others. 4. Achieving quality care through evaluation and research. A summary of some of the standards is set out in Table

11 Developments in the nursing profession To provide sound family planning information and advice. To diagnose pregnancies and monitor normal pregnancies. To care for and assist the mother during labour and to monitor the condition of the foetus in utero. To conduct spontaneous deliveries where required including an episiotomy and, in urgent cases, a breech delivery. To care for and monitor the progress of the mother in the post-natal period. Supervision and care of at least 40 women in labour. The student should personally carry out at least 40 deliveries. Supervision and care of 40 women at risk in pregnancy, or labour or the post-natal period. Observation and care of the new-born requiring special care including those born pre-term, post-term, underweight or ill. Care of women with pathological conditions in the fields of gynaecology and obstetrics. Table 1.2 Summary of the standards of proficiency for pre-registration midwifery programmes of education Adapted from NMC (2004c) Standards of Proficiency for Specialist Community Public Health Nurses (NMC, 2004d) The NMC (2004d) set standards of proficiency required for registration as a specialist community public health nurse. Although these standards were developed from previous competencies used for health visiting and community health care nursing, the framework has now been extended to include standards for public health. The NMC (2004d) stated that: Specialist community public health nursing programmes are developed from the premise that students are being prepared to enter a practice-based profession at a level beyond initial registration as a nurse or midwife. The programmes are practice based and recognize that: Evidence should inform practice through the integration of relevant knowledge. Students are actively involved in the delivery of community public health, under supervision. The code applies to all practice interventions. Skills and knowledge are transferable. Research underpins practice. Lifelong learning and continuing professional development are important. 7

12 Chapter 1 Introduction The standards of proficiency cover a range of practice issues under the four domains of: 1. Search for health needs. 2. Stimulation of awareness of health needs. 3. Influence on policies affecting health. 4. Facilitation of health enhancing activities. A summary of some of the standards is set out in Table 1.3. Table 1.3 Summary of the standards of proficiency for specialist community public health nurses Analyse, interpret and communicate data and information on the health and well-being and related needs of a defined population. Identify individuals, families and groups who are at risk and in need of further support. Develop, sustain and evaluate collaborative work. Communicate with individuals, groups and communities about promoting their health and wellbeing. Work with others to protect the public s health and well-being from specific risks. Identify and evaluate service provision and support networks for individuals, families and groups in the local area. Interpret and apply health and safety legislation and approved codes of practice with regard for the environment, well-being and protection of those who work with the wider community. Contribute to policy documents and influence policies affecting health. Prevent, identify and minimize risk of interpersonal abuse or violence, safeguarding children and other vulnerable people. Manage teams, individuals and resources ethically and effectively. Adapted from NMC (2004d) Developments in the NHS sector The NHS has made significant steps in providing faster, more convenient access to care through increases in capacity and changes in ways of working (DoH, 2005). Whilst it has always been very patient centred and delivered excellent care, the NHS Improvement Plan (DoH, 2004a) set out ways in which the NHS needed to change in order to become patient led. It stated that the NHS needs a change of culture to become truly patient led so that it is as concerned with health promotion as it is with sickness and injury. The NHS and local government have taken the lead together in promoting health by helping individuals make informed, healthy lifestyle choices and giving them the practical support and motivation to achieve this in a way that reflects the reality of their lives (DoH, 2005). This commitment is emphasized in the White Paper Choosing Health (DoH, 2004b) and means that patients will increasingly receive advice on improving their health as part of routine care. White Papers are further discussed in Chapter 11. 8

13 Developments in the NHS sector Skills for Health Skills for Health was established in 2002 and licensed by the Department for Education and Skills as the UK Sector Skills Council for Health in As part of the NHS, it covers the whole health sector and is funded through the four UK health departments: Scotland, Wales, England and Northern Ireland. The aim of skills for health is: To help the whole sector develop solutions that deliver a skilled and flexible UK workforce in order to improve health and healthcare. In order to do this, Skills for Health will: develop and manage national workforce competencies; profile the UK workforce; identify and articulate sector workforce needs; improve workforce skills; influence education and training supply; and work with key partners, stakeholders and customers across the sector. Modernising nursing careers: setting the direction (DoH, 2006) In , the four UK chief nursing officers established an agenda for updating nursing careers, which forms part of a working programme focusing on all the main health care professionals. The document, Modernising Nursing Careers: Setting the Direction (DoH, 2006), highlights that nursing and health care is changing and that, as a dynamic profession, nursing is responsive and adapting to meet the needs of patients and the public. The four elements of a nurse s role link to the core and specific dimensions of the NHS knowledge and skills framework. These four elements are: practice; education, training and development; quality and service development; and leadership, management and supervision. The DoH (2006) identifies four key priority areas that must be addressed in order to create modern nursing careers that are fit for purpose. These are: developing a competent and flexible nursing workforce; updating career pathways and career choices; preparing nurses to lead in a changed health-care system; and modernizing the image of nursing and nursing careers. 9

14 Chapter 1 Introduction Working Together, Learning Together (DoH, 2001) A vision of lifelong learning in the NHS was emphasized in the framework Working Together, Learning Together and published by the Department of Health in Aimed at education providers and NHS employers, it addresses health professionals learning from pre-registration education through to maintaining professional competence following registration. There is further discussion of lifelong learning in Chapter 13. Knowledge and skills framework (KSF) Agenda for Change (DoH, 2003a) sets out the new pay-and-reform package that ensures that people who work in the NHS are paid on the basis of equal pay for work that is of equal value. It applies to all NHS staff with the exception of doctors and dentists and the most senior of managers. The NHS KSF is based on the development review process and is designed to: identify the knowledge and skills that individuals need to apply in their post; help guide the development of individuals; provide a fair and objective framework on which to base review and development for all staff; and provide the basis of pay progression in the service. The DoH (2004c) explains that The NHS KSF provides a way of recognising the skills and knowledge that a person needs to apply to be effective in a particular NHS post. It will apply across the range of NHS posts to ensure better links between education and development and career and pay progression. The NHS KSF will be used for national roll-out. The knowledge and skills framework is discussed further in Chapter 15 (p. 486). Developments in higher education The Future of Higher Education (DoH, 2003b) The Future of Higher Education was published by the Department of Health in 2003 and sets out Government plans for radical reform and investment in universities and higher education colleges. This is further discussed in Chapter 13 (p. 436). The Higher Education Academy The Higher Education Academy (HEA) was formed in 2004 from a merger of the Institute for Learning and Teaching in Higher Education (ILTHE), the Learning and Teaching Support Network (LTSN), and 10

15 Developments in higher education the TQEF National Co-ordination Team (NCT). Its mission is to help institutions, discipline groups and all staff to provide the best possible learning experience for their students. One of the aims of the HEA is to lead, support and inform the professional development and recognition of staff in higher education. The UK professional standards framework for teaching and supporting learning in higher education (HEA, 2006) was launched in 2006, having been proposed in the White Paper The Future of Higher Education (DfES, 2003). The HEA is discussed in Chapters 4 (p. 160) and 14 (p. 465). Five Year Strategy for Children and Learners (DfES, 2004) In 2004, the Department for Education and Skills (DfES) published its five-year strategy for children and learners. The document is in sections according to educational levels, i.e. primary education, secondary education, further education and higher education, and Chapter 8 focuses on higher education. According to the DfES (2004), the goal of higher education is to ensure: access to a world class higher education system for all those with the potential to benefit. The DfES document explores many aspects of higher education including: issues and challenges associated with higher education; offers to individuals and employers; high-quality teaching; widening participation; a fair funding system; maintaining and developing research excellence; better partnerships between universities and employers; expansion of foundation degrees; student voice and choice as a driver for reform; university funding to match new patterns of study; collaboration to promote diversity, excellence and student choice; and improving leadership and management capacity. The DfES (2004) reforms mean that: Higher education in Britain is a success; with low drop-out rates, the completion rate from first degree courses is the fourth highest in the world. In research, British universities punch well above their weight on the normal measures of output and impact, with only the US ahead of us (DfES, 2004). 11

16 Chapter 1 Introduction The Higher Education Academy framework of professional standards for teaching in higher education will support teachers in meeting the needs of lifelong learners. University teaching should be seen as just as valuable as university research; the DfES is creating centres for excellence in teaching and learning, which will reward institutions with a strength in teaching. The long-term aims of the DfES reforms are that: Young people from all backgrounds aspire equally to go to university, and those with the potential to benefit have the opportunity to do so. Participation is increased towards 50 per cent of those aged by Research position will be enhanced through further investment, and universities will be involved in national and international collaborations addressing the biggest global challenges. More employers will be working with universities to innovate and apply new technology. Higher education will deliver graduates with the skills and knowledge that the economy needs from a variety of courses, including wellrecognized employer-led higher vocational qualifications. Students will make well-informed choices about universities and courses and will receive excellent teaching wherever they go. Higher education will be financially strong, benefiting from varied funding streams involving the state, voluntary and private sectors. Higher education will continue to challenge, stimulate independent thinking and be a positive force for social change at global, national and local level. Research assessment exercise The research assessment exercise (RAE) is a mechanism for allocating research funding to institutions based upon the quality of their research and is conducted by the four UK Higher Education Funding Councils every four to five years. The process involves peer review of an institution s research-active staff. In order to be considered research active, a member of academic staff must have had a minimum of four books, book chapters, or papers published in refereed journals within the four years preceding a given RAE. The RAE is discussed in Chapter 14 (p. 468). Summary Nurse education comes under the overall umbrella of post-compulsory education and training. The Nursing Midwifery Council was established by the Nursing Midwifery Order 2001 to protect the public by ensuring that high standards of care are provided by nurses and midwives. 12

17 References There are now three parts to the NMC register for nurses, midwives and specialist community public health nurses, with only three recordable post-registration qualifications: specialist practice; teaching and nurse prescribing. The NMC issued new PREP standards in 2006, identifying two standards that affect a practitioner s registration. The NMC requires all educators in higher education institutions and practice settings to undertake additional preparation and education to a standard set by the NMC and leading to a recordable teaching qualification. In 2004, the NMC set standards of proficiency required for registration as a nurse, midwife and specialist community public health nurse. The NHS has made significant steps in providing faster, more convenient access to care through increases in capacity and changes in ways of working. In 2001, the Department of Health promoted lifelong learning in the NHS, which was emphasized in the framework Working Together, Learning Together. Government plans for radical reform and investment in universities and higher education colleges were identified in The Future of Higher Education, published by the Department of Health in The Higher Education Academy was formed in 2004 and replaced the Institute for Learning and Teaching in Higher Education. DfES (2003) The Future of Higher Education. HMSO, London. DfES (2004) Five Year Strategy for Children and Learners. The Stationery Office, London. DoH (2001) Working Together, Learning Together: A Framework for Lifelong Learning for the NHS. The Stationery Office, London. DoH (2003a) Agenda for Change: A Modernised NHS Pay System. Department of Health, DoH (2003b) The Future of Higher Education. The Stationery Office, London. DoH (2004a) The NHS Improvement Plan: Putting People at the Heart of Public Service. Department of Health, London. DoH (2004b) Choosing Health: Making Healthy Choices Easier. Department of Health, London. DoH (2004c) The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process. The Stationery Office, London. DoH (2005) Creating a Patient-led NHS: Delivering the NHS Improvement Plan. Department of Health, London. DoH (2006) Modernising Nursing Careers: Setting the Direction. The Stationery Office, London. HEA (2006) The UK Professional Standards Framework for Teaching and Supporting Learning in Higher Education. Higher Education Academy, York. References 13

18 Chapter 1 Introduction NMC (2004a) Standards for the Preparation of Teachers of Nurses, Midwives and Specialist Community Public Health Nurses. Nursing Midwifery Council, London. NMC (2004b) Standards of Proficiency for Pre-registration Nursing Education. Nursing Midwifery Council, London. NMC (2004c) Standards of Proficiency for Pre-registration Midwifery Programmes of Education. Nursing Midwifery Council, London. NMC (2004d) Standards of Proficiency for Specialist Community Public Health Nurses. Nursing Midwifery Council, London. NMC (2006) The PREP Handbook. Nursing Midwifery Council, London. Nursing Midwifery Order The Stationery Office, Norwich, www. hmso.gov.uk. UKCC (1999) Fitness for Practice: the UKCC Commission for Nursing and Midwifery Education. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London. 14