The Integrated Vocational Route (IVR): an employer-driven learning programme in health & social care practice at the FE/HE interface

In 2006, the Open University Awarding Body, Faculty of Health & Social Care and the Vocational Qualifications Assessment Centre began exploratory discussions with health and social care (HSC) employers regarding the creation of a flexible programme of vocational and academic development which would seek to bridge the FE-HE divide, embed learning in the workplace rather than the classroom and facilitate progression in this field of practice. The product of these discussions was the ‘Integrated Vocational Route’ (IVR). The IVR is designed to meet the needs of support staff directly involved in the provision of health and/or social care who have higher career aspirations and employers seeking to develop those non-professional care workers in their organisation whom they believe have the greatest potential to progress to more senior roles. The original programme integrates a Level 3 HSC (Adults) National Vocational Qualification (NVQ) within the OU K101 ‘An Introduction to Health and Social Care’ module (offering 60 credits at NQF Level 4). Successful completion of the IVR will therefore provide both a ‘Certificate of Health and Social Care’ (60 credits at NQF Level 4) and a full NVQ Level 3 HSC Adults award. HSC employer consultation and briefings in twelve UK towns and cities helped shape the IVR model and four organisations (Newcastle City Council, Northumberland, Tyne & Wear NHS Trust, Salisbury Foundation NHS Trust and Social Work Information & Interpretation Services [SWIIS] Foster Care Scotland) have been particularly influential in determining IVR design and models of delivery. One such model enables both the IVR tutor and assessor roles to be undertaken by staff within a partner organisation and tutorials to be held in the workplace. Most of the IVR learning and support materials are available online and a bespoke, user-friendly electronic portfolio has been created for the integrated NVQ. By simultaneously developing and assessing academic skills, knowledge and competence related to care practice, the IVR offers better preparation for progression to qualifying routes such as nursing and social work and scope for credit transfer. A second IVR integrating a full Level 3 HSC Children and Young People (CYP) NVQ within the K101 module was offered for the first time in 2009. The IVR is currently being re-developed to accommodate the new vocational Diploma qualifications which replace Level 3 NVQs from 2011

The theory of human relatedness as a potential underlying causative mechanism in nursing student placement experiences: a UK-based critical realist study

Context: This study, underpinned by Critical Realism, re-analysed interview data acquired to examine the views and experiences of four stakeholder groups involved in the delivery of employer-sponsored pre-registration nursing programmes offered by a UK university in which all students already held an appointment as a non-registrant carer and who completed their placements within a block or integrated practicum framework. The re-analysis focused on the extent to which this interview data aligned with the key propositions of the Theory of Human Relatedness and therefore whether this theory, congruent with assertions based on the results of an earlier realist synthesis, might provide a causative explanation of factors affecting nursing student placement experiences. Methods: Semi-structured, digitally recorded and professionally transcribed interviews, each lasting approximately 30 minutes, were held with a purposive sample of 37, predominantly female, respondents in 4 stakeholder groups involved in employer-sponsored pre-registration nursing programmes. These stakeholder groups were students, employers, mentors, and practice tutors and were associated with programme provision within twelve healthcare organisations in northern England. Results: Although more modest in some areas, data provides support for every key proposition identified within the Theory of Human Relatedness; suggesting this theory may closely reflect the criteria that stakeholders implicitly employ to evaluate placement models. More respondents in all groups described the block practicum model in ways that suggest it is best able to promote a sense of connectedness, belonging and synchrony for learners. In contrast, an integrated placement design was portrayed in terms that implied it may increase the risk of disconnectedness but might also be more likely to promote reciprocity. Insufficient data was available to identify the perceived effect of either practicum design in respect of enmeshment, parallelism, and mutuality. Conclusion: The results of this research suggest that a block placement may foster more positive relatedness experiences for students and other stakeholders within nursing programmes. Moreover, the extent to which a practicum framework is perceived to promote connectedness, belonging, reciprocity and mutuality, to minimise disconnectedness and enmeshment and to reduce the need for parallelism may underpin stakeholder appraisal of the two practicum frameworks. Little research regarding the effect of placement duration and intensity on student learning within pre-registration healthcare programmes or the application of the Theory of Human Relatedness to practicum experiences, however, has been undertaken to date and such investigation is complicated by inconsistent terminology to describe practicum designs. It is argued that further academic enquiry within both fields should be a priority for healthcare educators; not least because it may provide further insights into curriculum designs capable of reducing student attrition. (DIPF/Orig.

Cultural differences in General and Psychiatric Nurses: A critical analysis using Social Identity Theory

This paper explores cultural identity within General (Adult) and Psychiatric (Mental Health) nursing as reflected in healthcare literature; illustrating how significant cultural differences associated with the history of the disciplines, representation of their fields of practice, professional knowledge, power, status, gender and employment rights affect interdisciplinary communication and working relationships. Applying Social Identity Theory (SIT), it argues that psychiatric nursing is a low status group compared to general nursing and highlights actions, congruent with SIT, which can be regarded as attempts to enhance the status of this discipline; so far with very limited success

An examination of Positivist and Critical Realist Philosophical Approaches to Nursing Research

This paper emphasises the importance for researchers to explicitly locate their work within a philosophical framework. It examines the ontological, epistemological and methodological similarities and differences of Positivism and Critical Realism; highlighting the strengths and weaknesses of these philosophical approaches in relation to nursing research. Whilst acknowledging several limitations and risks associated with undertaking research from a critical realist perspective it concludes that this perspective still appears to provide a more appropriate foundation for systematic enquiry within the discipline of nursing than is achieved by adopting a positivist approach to such investigation

Purpose, Quality and Value in Critical Realist Research within Nurse Education

Background: There have been a wide range of practice fields in nursing research including education; however, the quality of research in these disciplines has often failed to provide a sufficiently robust foundation. Purpose: This paper explores the purpose of educational research, how quality can be assured in such research and how the value of a research study in nurse education can be determined; focusing predominantly on arguments associated with the use of qualitative, and to a lesser extent, mixed methods research. Methods: A Critical Realist review drawing upon relevant literature from the fields of nursing, education and healthcare was undertaken to examine issues of purpose, quality and value in such research. Results: A wide range of criteria were identified to evaluate the purpose, quality and value of Critical Realist research using qualitative and mixed methods research within nurse education. Conclusion: The holistic, theoretically-eclectic, pragmatic and solution-focused nature of nursing as a discipline means that Critical Realist research in nursing, and more specifically, nurse education should explicitly reflect these principles

“Yes, the type of student supervision matters, but what about the placement structure?” – A Critical Realist review of block and integrated practice learning models within pre-registration nursing programmes

This paper highlights the importance of effective clinical experiences for pre-registration nursing students and the wealth of published work associated with practice learning, particularly regarding approaches to student supervision during a practicum. It draws attention to frequent calls within nursing literature for longer placements; many of which fail to either identify the perceived benefits of such change or state whether a longer practicum should involve increased practice learning hours or redistribute existing hours over an extended period; key omissions given the resource-intensive nature of providing these educational opportunities. It also highlights a paucity of research regarding the effect of placement duration and intensity on clinical learning and that practicum design is commonly shaped by custom, practice, operational and financial considerations rather than a sound educational rationale. A Critical Realist review of studies associated with two fundamental placement structures, the block, and integrated models, is offered to consider their strengths and limitations. Moreover, work that evaluates initiatives offering students paid employment in caring roles undertaken alongside a pre-registration programme and therefore displaying similarities to the integrated practice learning model are examined. The review concludes that, as yet, there is insufficient empirical evidence to recommend the targeted application of either a block or integrated placement model within any specific part of a pre-registration nursing programme, calls for greater consistency in the language of placement structure and outlines the author’s own current work contributing to the extremely limited body of knowledge available regarding this aspect of curriculum design within nurse education

In-depth interviewing as a research method in healthcare practice and education: value, limitations and considerations

This paper explores the value and limitations of in-depth qualitative interviews as a research method within healthcare practice and education. It challenges the common view that interviewing is a simple and unproblematic approach to data collection and highlights a range of structural, contextual, operational, intrapersonal, interpersonal and ethical factors which those intending to undertake such research should take into consideration when planning interviews. It also emphasises the fundamental need for those involved in interviewing to develop critical reflexivity

Practicum structures and nursing student retention/achievement rates in a United Kingdom university: a quantitative analysis

This study sought to examine whether the consistent application of a specific placement design to student practice learning experiences within two pre-registration nursing degree programmes offered by a university in the United Kingdom (UK) affected retention and achievement levels. The quantitative analysis involved a sample of 460 employer-sponsored undergraduates, all of whom worked as non-registrant carers, within two cohorts of a part-time adult (physical) or mental health nursing degree programme, both of four years duration, offered by a large academic institution with a presence in all four UK nations. Cross-tabulation and multinomial logistic regression analyses found no statistically significant relationship between exclusive student exposure to either block or integrated practicum experiences in respect of programme withdrawal rates or the degree classification achieved by such learners. Unlike pre-registration nurse education programmes offered within some other countries, for example Australia and Canada, most of those provided in the UK have traditionally been based solely on a block design. Nevertheless, recent changes in the programme options available to learners seeking to acquire registered nurse status, combined with growing demand for healthcare placements, have led some UK universities to now consider alternative practicum models and so optimize the use of available placement capacity. Internationally, no previous work investigating the potential impact of the two practicum designs on student retention and academic achievement appears to have been undertaken in respect of pre-registration programmes, either in nursing or any other health or social care discipline. The absence of any statistically significant effect of a practicum design upon the identified performance measures may therefore be both helpful and reassuring to academic institutions either using, or planning to implement, both models. Whilst the results are institutionally and geographically specific and derived exclusively from only two nursing programmes, they still make an important contribution to a seriously under-researched field. It is hoped that the work will stimulate further investigation regarding the impact of undergraduate experience within different placement models both within and beyond nursing education. The literature review associated with this study also identified widespread inconsistent use of terminology to describe the two practicum models; a situation which may be adversely affecting efforts to consolidate the body of knowledge related to the effect of different placement designs. Résumé Cette étude visait à examiner si l’application cohérente d’une conception de stage particulière pour les expériences d’apprentissage pratique par le corps étudiant dans le cadre de deux programmes de grade en sciences infirmières menant au droit de pratique, offerts par une université du Royaume-Uni, avait un effet sur les niveaux de rétention et de réussite. L’analyse quantitative a porté sur un échantillon de 460 membres du corps étudiant de premier cycle, parrainés par un employeur, qui travaillaient tous comme soignants non-inscrits, au sein de deux cohortes d’un programme de grade en sciences infirmières à temps partiel pour soins aux adultes (physique) ou en santé mentale, tous deux d’une durée de quatre ans, offerts par une grande institution universitaire présente dans les quatre pays du Royaume-Uni. Les tableaux croisés et les analyses de régression logistique multinomiale n’ont trouvé aucune relation statistiquement significative entre l’exposition exclusive du corps étudiant à des expériences de stage en blocs ou intégrées en ce qui concerne les taux d’abandon du programme ou le classement obtenu par ces stagiaires qui ont réussi. Contrairement aux programmes de formation en sciences infirmières menant à la pratique offerts dans certains autres pays, par exemple l’Australie et le Canada, la plupart de ceux dispensés au Royaume-Uni ont traditionnellement été basés uniquement sur une conception en blocs. Néanmoins, des changements récents dans les options de programme pour stagiaires cherchant à acquérir le statut d’infirmière ou infirmier, combinés à la demande croissante de stages en soins de santé, ont conduit certaines universités britanniques à envisager désormais d’autres modèles de stage et ainsi optimiser l’utilisation de la capacité de places disponibles. À l’échelle internationale, aucune étude antérieure portant sur l’impact potentiel des deux conceptions de stage sur la rétention du corps étudiant et la réussite scolaire ne semble avoir été entreprise en ce qui concerne les programmes menant à la pratique, que ce soit en sciences infirmières ou dans toute autre discipline de la santé ou des services sociaux. L’absence de tout effet statistiquement significatif d’une conception de stage sur les mesures de rendement identifiées peut donc être à la fois utile et rassurante pour les établissements universitaires qui utilisent ou prévoient mettre en œuvre les deux modèles. Alors que les résultats sont institutionnellement et géographiquement spécifiques et proviennent exclusivement de seulement deux programmes de sciences infirmières, ils apportent tout de même une contribution importante à un domaine sérieusement sous-étudié. Nous espérons que l cette étude stimulera une recherche plus approfondie concernant l’impact de l’expérience de premier cycle dans différents modèles de stage à la fois au sein de la formation en sciences infirmières et au-delà. L’analyse documentaire associée à cette étude a également identifié une utilisation incohérente généralisée de la terminologie pour décrire les deux modèles de stage; une situation qui peut nuire aux efforts visant à consolider l’ensemble des connaissances liées à l’effet de différentes conceptions de stage

A Critical Realist Review of Pre-Registration Nursing Student Stress

This Critical Realist review recognises the transitional challenge faced by all undergraduates on their path to becoming qualified practitioners but draws attention to the particularly high levels of student stress associated with the experience of learners who enrol on pre-registration nursing programmes. It also examines international evidence of factors which contribute to such stress. Professional opinion, reports, qualitative, quantitative and mixed methods research is thematically presented to indicate the wide range of educational, social, environmental, intrapersonal and interpersonal variables that contribute to pre-registration nursing student stress. Congruent with the principles of Critical Realism, the paper also identifies several emerging fields associated with student nurse stressors that are worthy of further investigation due to an apparent paucity of published work. Finally, the authors briefly highlight their own research activity currently underway to extend the body of knowledge in these areas and in so doing seek to help address student retention issues within nursing

Groundwater Flow and Thermal Modeling to Support a Preferred Conceptual Model for the Large Hydraulic Gradient North of Yucca Mountain

This task will create a two-dimensional, saturated zone, vertical cross-section model of groundwater flow and thermal transport through the large hydraulic gradient (LHG). This model is referenced herein as the thermal model. The scope of this study is limited to presenting a postulated hydrogeologic configuration of the LHG. The conceptualization will include the use of postulated hydrogeologic structures and material properties. The thermal model will be spatially limited to the area immediately upgradient and downgradient of the LHG and will not reproduce the many hydrogeologic features of the existing regional and site-scale models. The thermal model will be orientated north to south, approximately along a saturated zone streamline. The results of the thermal modeling will be compared to temperature data reported for site wells by the U.S. Geological Survey (USGS) and in peer-reviewed journals. Most, if not all, of this reported data is non- qualified. This task will not qualify the reported data and the reported data will be used only as a basis of comparison for the model simulations