AN EXPLORATION OF THE SHIFTING IDENTITIES OF PRE-REGISTRATION NURSING STUDENTS ACROSS A BSc ADULT NURSING PROGRAMME

The adult student nurses of today are continually challenged to negotiate the meanings of their experiences as members of different communities of practice, both as students of a university and also in the myriad of clinical placements that are so integral to their achievement of fitness for registration by their professional body. This study aims to explore the shifting identities of pre-registration students across a BSc adult nursing programme and gain deeper understanding of their participation in both university and clinical practice. Adult nursing students are currently attempting to develop, achieve and learn how to be a nurse in a challenging, ever changing context still reflecting on several high profile scandals and reports of poor care and less than ideal nursing practice. These events have led the profession, public, politicians and media to question the values, skills and principles of those who are choosing to take up nursing and question if nurse education is producing the necessary empowered, confident caring staff and strong leadership essential to ensure the delivery of optimum clinical care. This thesis details a qualitative study exploring the experiences of student nurses and how the communities they find themselves in construct their identities and is an investigation of their perceptions and understanding of nurse identity and what they believe it means to ‘be a nurse’. Focus groups and interviews were completed with students in each of the three years of a BSc adult nursing course at a university in the north of England and a systematic thematic analysis of the data undertaken. The three main themes that were generated were: Becoming a nurse Engagement with old timers The University - Practice dissonance The findings indicate that participation in clinical practice and university produces a perception of intellectual power in the students that sustains them and helps to offset any negative experience in clinical practice and helps maintain a belief in their unique roles as positive change agents and ‘nurses of the future’. The recounting of their experience highlights significant problems with the apprenticeship model and challenges the Belief that apprenticeship type approaches are necessarily a guaranteed way to promote positive outcomes, quality and any reduction in the likelihood of further failures of care in the healthcare environment

Understanding SCPHN students’ experience of practice educator led peer support groups

Specialist Community Public Health Nursing (SCPHN) students are expected to develop significant skills and competencies in practice whilst also achieving academic success. This workload can be very stressful for students particularly as their placements with Practice Educators can isolate them from other students, reducing the valuable support that peers can provide. Practice Educator led peer support groups were established in an attempt to ameliorate student stress and improve wellbeing by providing peer support whilst simultaneously delivering opportunities for learning and promoting preparedness for qualification. A service evaluation was subsequently conducted using focus group methodology to explore students’ experience of the peer support groups. This was to ascertain their effectiveness in supporting learning within practice placements and improving student wellbeing. Data analysis identified three key themes: ‘Peer support and Emotional nourishment’ and ‘Filling the Theory-Practice gap’, with a further theme focusing on ‘Group Organisation and Planning’ including ‘what would better look like?’. Findings indicated that the Support Groups were a valued and important element of SCHPN training for the student cohort involved in this service evaluation, engendering an improved sense of wellbeing and an enhanced educational experience

Developing a Culture of Publication: a joint enterprise writing retreat

Purpose: Many students irrespective of level of study produce excellent course work which, if given support and encouragement could clearly be of a publishable standard. Academic staff are expected to produce quality publications meeting peer review standards although they may be relatively novice authors. All are engaged in some aspects of academic writing practices but not as frequently involved in co-production of publications emanating from student work. This activity is still at the margins of much of the student experience. Design/methodology: Mindful of these issues, we designed and offered a writing programme including a writing retreat. This brought together undergraduate and postgraduate students from a range of applied disciplines (health and art, design and architecture) and their supervisors with the aim of co-producing publications and participating in a community of scholarly practice. The project was delivered over nine months. It involved four days ‘compulsory’ attendance and included a preparatory workshop, a two day off campus writing retreat and a dissemination event. Student and supervisors applied to participate as a team. Kirkpatrick’s (2006) four-stage classic model: reaction, learning, changes in behaviour and real world results was used as a framework for the educational evaluation. Key findings organised thematically were: Supervisor-supervisee relationships; space and time; building confidence enabling successful writing and publication. Originality/Value: This paper will provide an overview of the design, content and approaches used for successful delivery of this innovative project. It will draw on examples that illustrate the different types of joint enterprise that emerged, illuminate experiences of co-production and co-authorship along with recommendations for future ventures

Jumping to the wrong conclusions? An investigation of the mechanisms of reasoning errors in delusions

Understanding how people with delusions arrive at false conclusions is central to the refinement of cognitive behavioural interventions. Making hasty decisions based on limited data ('jumping to conclusions', JTC) is one potential causal mechanism, but reasoning errors may also result from other processes. In this study, we investigated the correlates of reasoning errors under differing task conditions in 204 participants with schizophrenia spectrum psychosis who completed three probabilistic reasoning tasks. Psychotic symptoms, affect, and IQ were also evaluated. We found that hasty decision makers were more likely to draw false conclusions, but only 37% of their reasoning errors were consistent with the limited data they had gathered. The remainder directly contradicted all the presented evidence. Reasoning errors showed task-dependent associations with IQ affect, and psychotic symptoms. We conclude that limited data-gathering contributes to false conclusions but is not the only mechanism involved. Delusions may also be maintained by a tendency to disregard evidence. Low IQ and emotional biases may contribute to reasoning errors in more complex situations. Cognitive strategies to reduce reasoning errors should therefore extend beyond encouragement to gather more data, and incorporate interventions focused directly on these difficulties

Neuropsychological functioning and jumping to conclusions in delusions

Background: It has been consistently demonstrated that delusions are related to jumping to conclusions (JTC), a data-gathering bias and potential candidate endophenotype of psychosis. Recent research suggests that JTC may be a marker of treatment response. However, we know little about the factors contributing to the occurrence of this reasoning bias. This study investigated the relationship between JTC and hypothesised deficits in working memory, employing standard well-validated neuropsychological tests, in people with current delusions. Method: One hundred and twenty six people with schizophrenia spectrum psychosis and current delusions were assessed for current symptoms, and tested for JTC. We compared performance on tests of working memory in those with the reasoning bias and those without. Results: As expected, 30–40% of this sample of people with current delusions showed the JTC bias. There were no differences in premorbid IQ between those with and without the JTC reasoning bias. However, the performance of the JTC group was significantly worse on tests of working memory. Conclusions: The JTC data-gathering bias is associated with impairments in working memory. New non-pharmacological interventions for people with delusions, designed to improve data gathering, may benefit from incorporating strategies to overcome deficits in working memory

Spelling pronunciation and visual preview both facilitate learning to spell irregular word

Spelling pronunciations are hypothesized to be helpful in building up relatively stable phonologically underpinned orthographic representations, particularly for learning words with irregular phoneme-grapheme correspondences. In a four-week computer-based training, the efficacy of spelling pronunciations and previewing the spelling patterns on learning to spell loan words in Dutch, originating from French and English, was examined in skilled and less skilled spellers with varying ages. Reading skills were taken into account. Overall, compared to normal pronunciation, spelling pronunciation facilitated the learning of the correct spelling of irregular words, but it appeared to be no more effective than previewing. Differences between training conditions appeared to fade with older spellers. Less skilled young spellers seemed to profit more from visual examination of the word as compared to practice with spelling pronunciations. The findings appear to indicate that spelling pronunciation and allowing a preview can both be effective ways to learn correct spellings of orthographically unpredictable words, irrespective of age or spelling ability. Copyright © 2006 by The International Dyslexia Association®

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

The effectiveness of nurse-led surgical pre-assessment clinics

Pre-operative pre-assessment has this summer been the subject of National Institute for Clinical Excellence (NICE) guidance (see Box 1), However, in a review of pre-assessment clinics, Clinch (1997) states that, before 1990, there was little published formal research on preassessment, with most accounts being descriptive, anecdotal and aimed at sharing the experience of organising such services, Box 2 shows the traditional pathway for patients requiring elective surgery in the UK