What should we assess in practice?

Aim: This article reports on a PhD study and follow up work undertaken to review and develop a tool for assessment of practice. Background: The assessment of practice in nursing and midwifery education and, other health professions has been the source of concern, criticism and research for a number of years with the conclusion that it might not be possible to develop an assessment tool that could encompass all aspects of professional practice. Methods: A qualitative evaluation study was undertaken using the naturalistic method of inquiry. A combination of tools was used in order to collect the data and enable progressive focusing and cross checking of the findings. These included documentary analysis, a questionnaire and focus group and individual interviews. The data was collected from documents analysis, focus group interviews, individual interviews and questionnaires. Results: The results showed that the assessment tool in use at the time did not encompass all criteria assessors used and six areas were identified as those to include in any future tool. Conclusion: The six areas identified by subjects as those to include in any assessment tool were further developed with specific statements so that they could be used within a tool. Implications for nursing management and education: Within the changing nature of health care there is a need to review whether the tool used for assessing pre-registration education of nursing and midwifery students practice is ‘fit for purpose’

Gravity Amplitudes from a Gaussian Matrix Model

We reformulate MHV scattering amplitudes in 4D gauge theory and supergravity as correlation functions of bilinear operators in a supersymmetric gaussian matrix model. The model retains the symmetries of an S(4) of radius L and the matrix variables are represented as linear operators acting on a finite-dimensional Hilbert space. Bilinear fields of the model generate a current algebra. In the large N double scaling limit where l_pl ~ L / sqrt(N) is held fixed, there is an emergent flat 4D space-time with a built in short distance cutoff.Comment: v3: 55 pages, 4 figures, clarifications adde

Foodservice in hospital: development of a theoretical model for patient experience and satisfaction using one hospital in the UK National Health Service as a case study

Hospital foodservice does not operate in isolation but requires the cooperation and integration of several disciplines to provide the ultimate patient experience. The objective of this research was to explore the antecedents to patient satisfaction and experience, including the service element. Accordingly, focus groups were conducted with doctors (n = 4), nurses (n = 5), ward hostesses (n = 3) and patients together with their visitors (n = 10), while open-ended interviews were conducted with the foodservice manager, facilities manager, chief dietitian, orthopaedic ward dietitian and chief pharmacist. Themes centred on ‘patients’, ‘foodservice’ and ‘mealtimes’, and results show that food qualities, particularly temperature and texture, are important factors impinging on patient satisfaction, and the trolley system of delivery is an acceptable style of service. Service predisposition demonstrates little relevance to patient satisfaction towards overall meal enjoyment. A theoretical model has been developed that identifies hospital foodservice in a cyclic relationship with the community primary healthcare team

Establishing a method to support academic and professional competence throughout an undergraduate radiography programme

Purpose: Radiography degree programmes are coming under increasing pressurefrom the community to ensure that graduates have not only the necessary academic developmentbut also the practice-based skills. This study aims to establish a method of monitoringstudents’ progress towards, and ability to meet, academic and professional competencesthroughout a radiography programme.Methods: Questionnaires were designed for students and academic staff to determine thestages and standards of progress of competence development, and to inform the review processof the current assessment tools throughout the programme. A literature search identifiedthe appropriate pedagogy as a basis for devising the method. Another questionnaire was distributedto overseas radiography institutions to gain insights into other assessment practicesto validate the framework.Results and discussion: It was established that years of study rather than semester periodswere appropriate to allow students to meet the standards. Discrepancies were noted in theexpectations between academic staff (higher expectations) and students (more realistic) interms of the pace of development expected. As students progress at different rates, and donot experience the same clinical exposure, their ability to meet expectations may differand so both sets of expectations were combined as a range of criteria. A multi-dimensionalassessment approach should be adequate to gauge students’ progress but time and resourceeffectiveness has not yet been addressed. The portfolio was identified as the pedagogy capableof integrating all the competence assessment tools, linked by reflective writing, to gatherindividual outcomes into a whole, and form a holistic framework.Outcome: The portfolio framework will initially run as a voluntary activity and standards ofprogress corresponding to the students’ stages will be delivered to participants in advance.Participants will be required to select materials and reflect on these, as evidence of development.Faculty members will provide support and feedback to students and oversee the wholeprocess

Prescription for nursing informatics in pre-registration nurse education.

Nurses need to be able to use information and communications technology not only to support their own practice, but also to help their patients make best use of it. This article argues that nurses are not currently adequately prepared to work with information and technology through their pre-registration education. Reflecting the lack of nursing informatics expertise, it is recommended that all pre-registration nursing programmes should have access to a nursing informatics specialist. A prescription to meet the informatics needs of the newly qualified nurse is proposed. This places the areas that need to be included in pre-registration education into broad groups that both articulate the competencies that nurses need to develop, and indicate why they are needed, rather than providing context-free checklists of skills. This is presented as a binary scatter chart with two axes, skill to knowledge and technology to information

Reflections on a 'virtual' practice development unit: changing practice through identity development

Aims. This paper draws together the personal thoughts and critical reflections of key people involved in the establishment of a ‘virtual’ practice development unit of clinical nurse specialists in the south of England. Background. This practice development unit is ‘virtual’ in that it is not constrained by physical or specialty boundaries. It became the first group of Trust-wide clinical nurse specialists to be accredited in the UK as a practice development unit in 2004. Design and methods. The local university was asked to facilitate the accreditation process via 11 two-hour audio-recorded learning sessions. Critical reflections from practice development unit members, leaders and university staff were written 12 months after successful accreditation, and the framework of their content analysed. Findings and discussion. Practice development was seen as a way for the clinical nurse specialists to realize their potential for improving patient care by transforming care practice in a collaborative, interprofessional and evolutionary manner. The practice development unit provided a means for these nurses to analyse their role and function within the Trust. Roberts’ identity development model for nursing serves as a useful theoretical underpinning for the reflections contained in this paper. Conclusions. These narratives provide another example of nurses making the effort to shape and contribute to patient care through organizational redesign. This group of nurses began to realize that the structure of the practice development unit process provided them with the means to analyse their role and function within the organization and, as they reflected on this structure, their behaviour began to change. Relevance to clinical practice. Evidence from these reflections supports the view that practice development unit participants have secured a positive and professional identity and are, therefore, better able to improve the patient experience

Plugging a hole and lightening the burden: A process evaluation of a practice education team

Aim: To investigate the perceptions of clinical and senior managers about the role of Practice Educators employed in one acute hospital in the UK. Background: Producing nurses who are fit for practice, purpose and academic award is a key issue for nurse education partnership providers in the UK. Various new models for practice learning support structures and new roles within health care institutions have been established. To sustain funding and policy support for these models, there is a need for evaluation research. Design: A process evaluation methodology was employed to determine the current value of a practice education team and to provide information to guide future direction. Methods: Data were collected through semi-structured telephone interviews using a previously designed schedule. All senior nurse managers (N=5) and a purposive sample of clinical managers (n=13) who had personal experience of and perceptions about the role of practice educators provided the data. Interview notes were transcribed, coded and a thematic framework devised to present the results. Results: A number of key themes emerged including: qualities needed for being a successful practice educator; visibility and presence of practice educators; providing a link with the university; ‘plugging a hole’ in supporting learning needs; providing relief to practitioners in dealing with ‘the burden of students’; alleviating the ‘plight of students’; and effects on student attrition. Conclusions: Findings provided evidence for the continued funding of the practice educator role with improvements to be made in dealing with stakeholder expectations and outcomes. Relevance to clinical practice: In the UK, there still remain concerns about the fitness for practice of newly registered nurses, prompting a recent national consultation by the professional regulating body. Despite fiscal pressures, recommendations for further strengthening of all systems that will support the quality of practice learning may continue to sustain practice learning support roles

Flexible working and work-life balance: Midwives’ experiences and views

This article presents midwives’ views and experiences of flexible working and work–life balance. Both flexible working and work–life balance are important contemporary agendas within midwifery and can have both positive and negative consequences for midwives. Full-time midwives and those without caring commitments feel disadvantaged by flexible working and work–life balance policies as they have to fit when they work around part-time midwives and are increasingly expected to cover extra work. They feel their work–life balance is marginalized and this is fuelling discontent and resentment among midwives and leading to divisions between full- and part-time staff that reinforce flexibility stigma. Although flexible working and work–life balance are important for recruiting and retaining midwives they are part of the ongoing tensions and challenges for midwives and the midwifery profession

Autonomy and caring: towards a Marxist understanding of nursing work

The aim of this paper is to re‐examine nursing work from a Marxist perspective by means of a critique of two key concepts within nursing: autonomy and caring. Although Marx wrote over 150 years ago, many see continuing relevance to his theories. His concepts of capital, ideology and class antagonism are employed in this paper. Nursing's historical insertion into the developing hospital system is seen in terms of a loss of autonomy covered over by the development of cults of loyalty toward those institutions, while the concept of emotional labour is used to re‐examine nursing's high valuing of “caring” and to understand it as potentially exploitative of nurses. Raising awareness of this alternative way of understanding nursing work can become a first step toward change