Developing a national musculoskeletal core capabilities framework for first point of contact practitioners

Objective We aimed to support service transformation by developing a core capabilities framework for first contact practitioners working with people who have musculoskeletal (MSK) conditions. Methods We conducted a modified three-round Delphi study with a multi-professional panel of 41 experts nominated through 18 national professional and patient organisations. Qualitative data from an open-ended question in round one was analysed using a thematic approach and combined with existing literature to shape a draft framework. Participants rated their agreement with each of the proposed 142 outcomes within 14 capabilities on a 10-point Likert scale in round two. The final round combined round two results with a wider online survey. Results Rounds two and three of the Delphi survey were completed by 37 and 27 participants respectively. 90 practitioners responded to the wider online survey. The final framework contains 105 outcomes within 14 capabilities, separated into 4 domains (Person-centred approaches; Assessment, investigation and diagnosis; Condition management, intervention and prevention; Service and professional development). Median agreement for all 105 outcomes was ≥ 9 on the 10-point Likert scale in the final round. Conclusion The framework outlines the core capabilities required for practitioners working as the first point of contact for people with MSK conditions. It provides a standard structure and language across professions; greater consistency and portability of MSK core capabilities. Agreement on each of the 105 outcomes was universally high amongst the expert panel and the framework is now being disseminated by Health Education England, NHS England and Skills for Health

Mentor judgements and decision making in the assessment of student nurse competence in practice: a mixed-methods study

Aim To investigate how mentors form judgements and reach summative assessment decisions regarding student competence in practice. Background Competence assessment is a significant component of pre-registration nursing programmes in the UK. Concerns exist that assessments are subjective, lack consistency and that mentors fail to judge student performance as unsatisfactory. Design A two stage sequential embedded mixed methods design. Data collected 2012-2013. Methods This study involved a whole student cohort completing a UK undergraduate adult nursing programme (N=41). Stage 1: quantitative data on mentor conduct of assessment interviews and the final decision recorded (N=330 from 270 mentors) was extracted from student Practice Assessment Documents (PADs). Stage 2: mentor feedback in student PADs was used in Stimulated Recall interviews with a purposive sample of final placement mentors (N=17). These were thematically analysed. Findings were integrated to develop a theoretically driven model of mentor decision making. Results Course assessment strategies and documentation had limited effect in framing mentor judgements and decisions. Rather, mentors amassed impressions, moderated by expectations of an ‘idealised student’ by practice area and programme stage that influenced their management and outcome of the assessment process. These impressions were accumulated and combined into judgements that informed the final decision. This process can best be understood and conceptualised through the Brunswik's lens model of social judgement. Conclusion Mentor decisions were reasoned and there was a shared understanding of judgement criteria and their importance. This impression based nature of mentor decision making questions the reliability and validity of competency based assessments used in nursing pre-registration programmes

How clinical nursing instructors define and construct interpersonal boundaries with their students

The purpose of this study was to examine how nursing instructors define and construct interpersonal boundaries with the students they teach. While the last two decades have seen a transition in the philosophy of teaching and learning in nursing, boundary construction within the new direction has not yet been fully examined. The literature reflects a wide variety of opinions on what constitutes an interpersonal boundary in the context of a teaching practice. Data collection involved open-ended interviews with eight nursing instructors. The data were analyzed from the perspective of naturalistic inquiry and utilized a constant comparative technique. The study found that interpersonal boundaries were defined as limitations in the relational dynamics between the instructor and student. The construction of boundaries was a process that involved a series of boundary crossings between the delineation of professional and personal. The process of boundary crossing was enacted in the level of connection between the clinical participants and the amount and depth of self disclosure.Applied Science, Faculty ofNursing, School ofGraduat