Matrix showing the variations of pre - registration nursing programmes between Singapore and the four UK countries

The Singapore data is based on a Prof essor Sir Ron Cooke International Scholar ship Scheme, which may have changed since observation in July to Nov ember 2012 . Data for the four UK countries is based on the author’s current experience but the information is in the public domain. Hence, the information must be consume d in the appreciation of these limitation

Embracing a culture in conducting research requires more than nurses' enthusiasm

Aims This study explored the perceptions of clinical nurses about their research knowledge and experiences to highlight any gaps in nurse education in supporting research activities in healthcare organisations. Background Nurses' research activities have been encouraged by moving hospital-based nurse education into higher education institutions whereby there is a stronger emphasis on teaching and developing nursing research at both undergraduate and post graduate levels. They were further encouraged by the introduction of advanced nurse practitioner roles, in the hope to increase opportunities for research participation. Whilst nurses' research activities have been explored in many countries, nurses in Singapore where there is a strong emphasis on evidence-based practice have not been investigated. Methods A mixed-methods exploratory descriptive design, using a questionnaire based on open and closed questions was employed to obtain the views of clinical nurses about their capacity and organisational support in conducting research. The questionnaires were distributed to convenient samples who attended one of the 4 research seminars held on separate occasions between July and August 2011 in Singapore. Results A total of 146 nurses were recruited. Whilst nurses demonstrated strong enthusiasm in conducting research, this characteristic feature was not adequate for them to embrace a research culture in organisations. Active participation as co-investigators was not possible in healthcare organisations where skewed distribution of resources towards medical and nurse researchers was perceived. Conclusions The results suggest a need for a significant shift in focus on educational training from imparting research contents to providing opportunities to experience the research process. Organisational support in terms of protected time and financial support ought to be in place for nursing research experience. The findings also demonstrated that in places where organisational support was available, awareness of research opportunities such as educational and organisational support needed to be strengthened. This in turn would enable more nurses particularly those who provide direct patient care to conduct research within the context of the competing nursing practice demands

Evaluating students' perspective of the value of work placements and simulation-based learning as assets for vocational higher education

Abstract The challenges confronting students in higher education in today’s competitive environments have highlighted the importance for graduating students to feel competent and prepared for practice. In vocational disciplines such as nursing and engineering, the significance of student work placement experience together with other elements of ‘real-world’ practice built into the courses are especially crucial in terms of achieving readiness of the new graduates for employment. This paper is based on the authors’ experiences in two separate scholarship funded international projects beyond the context of the United Kingdom in nursing and engineering. The aim of the paper is to explain the significance of the nature and quality of student work placements and simulation-based learning as on-course practical activities in the two disciplines, demonstrating how the innovative implementation of active learning methods affect student motivation. Using student focus group discussion, the first author collected data in Singapore in the period between July 2012 and October 2013; and the second author collected data in Australia, North America and Continental Europe from September 2012 to January 2013. Work placements, albeit in different parts of the world and in very different disciplines; health and engineering, are regarded as important by students as a vital platform for linking theory to practice. While work placement environments are important for developing students’ confidence and organisational skills and hence motivation to learn, effective learning occurred best when they were complemented by appropriate on course pedagogies, and placements were supervised by individuals with good disciplinary knowledge and at the same time, proficient pedagogic skills to guide student

Critical discourse analysis : an alternative but vital route to understanding how nurses' caring behaviour is translated in text-based interprofessional online learning in higher education

Paper presented at ProPEL international conference 2014, 24-27 June, Stirling, Scotland. ABSTRACT Aim: to demonstrate Fairclough’s critical discourse analysis as an alternative but vital route to the understanding of translation of nursing caring behaviour in asynchronous text-based interprofessional online learning within higher education. Background: Positive asynchronous text-based online learning experience indicating nursing caring behaviours were reported in only a small number of studies about homogeneous nursing groups. In addition, these positive findings seemed to be eroded by nurses’ dominance in interprofessional learning situations. The dominance which might be a result of professional boundaries is a critical barrier to interprofessional education, where little is yet understood about the phenomenon. Design: A study which employed Fairclough’s critical discourse analysis was used to seek understanding of the translation of nursing caring behaviour in text-based interprofessional online learning within higher education. Data Source: The main findings based on Fairclough’s critical discourse analysis of a text-based discussion is used to demonstrate the usefulness of the methodology. The asynchronous online discussions for analysis was produced by 9 students who were undertaking an interprofessional online learning module at master’s level in a University in North England Findings: By using Fairclough’s critical discourse analysis, understanding of the semiotic categories corresponding to genres, discourses and styles is gained. However, it is through appreciating on how these 3 categories relate to social practices and social events has helped in making explicit the dialectical relations between semiosis and its other elements. In doing so, how nurses’ caring behaviours in interprofessional learning were translated in an asynchronous text-based learning environment can be explained. Conclusions: Fairclough’s critical discourse analysis was useful in explaining how nursing caring attributes could result in the interprofessional learning space being used as an alternate platform for nurses and allied healthcare professionals to co-construct the power-relations. It is critical to appreciate that the analysis was based on the researcher’s emic position. Owing to the fact that tacit knowledge of the research in the power-relations which entangled in the social order and practices in healthcare is required in the analysis, the strength of an emic position could become a limitation. This is particularly perceived amongst researchers who hold a strong view for an etic perspective in discourse analytic work. In this regard, research exploring issues of interprofessional education should consider triangulating the critical discourse methodology with other qualitative theoretical frameworks

Nursing care behaviour in interprofessional learning explained by critical discourse analysis

Aim: to demonstrate Fairclough’s critical discourse analysis as a way to understand nurse caring behaviour in asynchronous text-based interprofessional online learning within higher education. Background: asynchronous text-based learning experience of homogeneous nursing groups indicated nurse caring behaviour in a small number of studies. However, positive findings were not found in studies about interprofessional learning undertaken by nurses. Instead, nurses’ dominance which might be a result of professional boundaries was frequently reported as a barrier to interprofessional education, yet little is understood about the phenomenon. Design: a study which employed Fairclough’s critical discourse analysis was used to understand the translation of nurse caring behaviour in text-based online interprofessional learning within higher education. Data Source: the asynchronous online discussions produced by thirteen students undertaking an online interprofessional learning module at master’s level in a University in the North of England were the discourse data for analysis. Findings: By using Fairclough’s critical discourse analysis, understanding of the semiotic categories corresponding to genres, discourses and styles yielded information on nurses’ discourse in online learning. Through appreciating the subliminal way in which these three categories relate to social practices and social events, the dialectical relations between semiosis of the online text and its other elements were made explicit. In doing so, the way nurse caring behaviour in interprofessional learning were translated in an asynchronous text-based learning environment was explained. Conclusions: Fairclough’s critical discourse analysis was useful in explaining how nurse caring attributes when displayed online could result in the interprofessional learning space being used as a platform for nurses and allied healthcare professionals to co-construct power-relations. The analysis required researchers’ tacit knowledge, based on an emic (insider) position in healthcare practice and education, which is closely linked to the power-relations that is entangled in the social order and practices in healthcare. This explains why researchers outside of critical discourse analytic work would hold a strong view for an etic (outsider) perspective in discourse analysis. In this regard, one should consider triangulating critical discourse methodology with other qualitative theoretical frameworks

A Foucauldian analysis on the professionalisation effort of nursing in Singapore

Aim: A discussion using Foucault’s genealogical analysis to explain the professionalisation effort of nursing in Singapore. Background: Nursing in Singapore is strongly influenced by Western civilisation, however, the discipline may not have adopted similar responses to the world’s nursing professionalisation agenda as led by the West. An explanation on the ways nursing is spoken of and practiced in Singapore provides insights to the effects on nursing development in the country. Design: The discussion uses Foucault’s genealogy of power to draw on the practices of clinical nursing and nursing education in Singapore in an attempt to uncover the unorthodox professionalisation effort. Data Sources: The discussion is an outcome of a critical reflective observation made by the authors between 1993 and 2014. It is supported by related literature, critical debates amongst Singapore healthcare professionals, nurse lecturers and the Singapore locals. Implications for Nursing: Time and effort vested in overcoming medico-political dominance, should be used in the pursuit of high quality nursing clinical knowledge and acumen. Specialised nursing knowledge and autonomous practice should adopt an explicit focus in its mission to achieve the common good which is in favour of the public interest. Conclusions: While the hierarchical nursing structure was the foundation for professionalising nursing, nursing subservience was the gateway for advancing nursing in Singapore. Without generalising the positive effects of the power-relations in Singapore, nursing practice which reflected the ‘subservience in females’ and demonstrated respect for authority within a hierarchical system had evidently led to good quality nursing practices which serve as a strong foundation for nursing to secure professional recognition

Caring attributes and preparedness to care: effects of a pre-enrolled nursing certificate programme in Singapore

Background: Caring is a highly complex and abstract concept, and nurturing a caring attribute among individuals for a nursing career is believed to be best introduced at the start of student journey in preparatory courses specifically designed for nursing. However, because of the need to professionalise nursing, pre-enrolled nursing programmes have been discontinued and replaced by generic healthcare programmes in many parts of the world. Aim: This study aims to evaluate the impact of pre-enrolled certificate nursing education on students’ caring attributes and their preparedness to care. Methodology: A mixed methods approach using unstructured questions and the Caring Behaviour Inventory was employed to determine student caring attributes and their preparedness to care. The participants were final year pre-enrolled nursing students in Singapore. Findings: Students demonstrated attributes of caring based on an average CBI score of 4.55 (SD 0.32). Expressions of professional nurse caring were explicit in students’ entire learning journey and these took various forms of approach embedded in both curricular and extracurricular activites. The study also found that nurturing caring attributes was associated with a high expectation of student social behaviour and closely linked to the increasingly good reputation of nursing as a profession in that region. Conclusions: This study indicates the high potential value of pre-enrolled nursing education for developing the caring attributes of individuals. A nursing-oriented programme title and its high status associated with nursing were critical elements for nurturing the caring attributes. The implications for developments in nurse education and research are discussed

A glimpse into nursing discursive behaviour in interprofessional online learning

Background: The importance of interprofessional learning to provide quality patient care has resulted in the increasing use of asynchronous computer mediated conferencing in healthcare programmes within universities. The asynchronicity based on typed-written discussions in a virtual learning environment which provided flexibility in learning was used to increase opportunities for nurses and other allied healthcare professionals to participate in interprofessional learning in higher education. However, successful online learning relies on discursive practices in the virtual learning environment, embedded within discursive exchanges in practice are power relations in nursing language use; which had a negative impact on interprofessional learning and working relationships amongst nurses, between nurses and other allied healthcare professionals. This paper presents an analysis of the discursive practices of registered nurses in interprofessional learning based on asynchronous computer mediated conferencing. It aimed to ascertain if power relations were implicit in nursing language. Methods: Fairclough’s critical discourse analysis was used to analyse eight hundred and ninety typewritten online messages created in a 100% text-based online learning module at Master’s level in a University in North England between September 2004 and September 2009. Although the messages were created by 9 registered nurses and 4 other allied healthcare professionals undertaking interprofessional learning to learn about the issues surrounding e-learning in healthcare settings, this paper is part of a larger study focused on the messages by the nurses. Results: Nurses’ messages tended to appear as the first few responses in the discussion threads and their language was formal and objectifying. The genres resembled those found either in written assignment within higher education or in nursing documentation within practice. The virtual learning environment was an alternative social space for clinical practice where dominance of nurses was created, maintained and reinforced. Conclusions: Existing literature highlighted the incidents of problematic issues of interprofessional learning. In contrast, this paper explains the way nurses, through discursive practices, construct themselves in relation to their nursing and allied healthcare colleagues. Nurses need to be aware of the power-relations embedded in their language use and future research could usefully focus on the discursive aspect of interprofessional learning

High fidelity full sized human patient simulation manikins: Effects on decision making skills of nursing students

Background: The continued use of high fidelity full sized human patient simulation manikins (HF-HPSMs) for developing decision making skills of nursing students has led to growing research focusing its value on student learning and decision making skills. Methods: In October 2012, a cross-sectional survey using the 24-item Nurse Decision-Making Instrument was used to explore the decision making process of 232 pre-registration nursing students (age 22.0 + 5.4; 83.2% female) in Singapore. Results: The independent samples t-tests demonstrated three significant predictive indicators. These indicators include: prior experience in high fidelity simulation based on pre-enrolled nursing course (t = 70.6, p = .001), actual hands-on practice (t = 69.66, p < .005) and active participation in debrief (t = 70.11, p < .005). A complete experience based on role-playing followed by active discussion in debrief was a significant contributor to the decision making process (t = 73.6667, p < .005). However, the regression model indicated active participation in debrief as a significant variable which explained its development (t = 12.633, p < .005). Conclusions: This study demonstrated the usefulness of active participation in simulation learning for an analytic- intuitive approach to decision making, however active participation in debrief was a more important influencing element than role-playing. In situations where resources are limited for students to experience hands-on role-playing, peer reviewing and feedback on others’ experiences could benefit students, just as much. However, further study is warranted to determine the development of HF-HPSMs as a pedagogic tool for enhancing the decision making process of nursing students

A quasi-experiment to evaluate the effects of a blended approach of simulation learning and podcasting on caring behaviours

Background: The need for quality nursing personnel in clinical practice expected nurse teachers to be able to impart instrumental and expressive aspects of caring behaviours to nursing students. Operating in a resource-limited higher educational context, nurse teachers are required to do so in a cost effective way. This study as part of a larger study evaluated the effects of a blended approach to learning of caring behaviours based on ‘modified’ medium-fidelity simulation scenarios and podcasting to repeat debriefs. Methods: This study employed a quasi-experimental, two group pre-test-post-test design. The study included 146 second year nursing students. Participants were divided into ‘intervention’ and ‘control’ groups and were asked to complete a caring behaviour inventory scale at various stages of the research study. Results: Students in the intervention group scored statistically higher, post receiving medium-fidelity simulation learning and higher post podcasting. The exposure to high fidelity simulation learning has resulted in the lower scoring in control group. Conclusions: This study highlights the value of a blended approach based on medium-fidelity simulation learning and podcasting. Successful learning of caring behaviours lies in the heart of a care-oriented teaching approach rather than the use of sophisticated technologies. This study has implications for a better practice in nursing education for developing student caring behaviours, it also has a wider implication for all vocational and non-nursing healthcare education