Transition to a Health Visitor Role: A Constructivist Grounded Theory

There has been a scarcity of studies which explore transition to the health visitor (HV) role. This is in stark contrast to research into the transition from student nurse to a newly qualified nurse (NQN) role, which is known to be a difficult and challenging time, impacting upon overall retention in the nursing role. As a nurse lecturer, I have witnessed very similar difficulties and challenges as aspirant HVs undergo the transition to the HV role. However, this transition differs fundamentally to that of a student nurse to NQN, due to the prerequisite for a registered nurse/midwife status before entry into training for the HV role. The student HV is therefore moving from a role in which they are already established, often highly skilled and autonomous practitioners, into to a new professional role. Using a constructivist grounded theory approach, this longitudinal study has explored this transition to the HV role, providing in-depth understanding of the experiences of the participants. It incorporated focus group and interview methods over a series of data collection points, throughout the transition. The aim to develop a substantive theory of the transition to the HV role. The transition is multifaceted and is influenced by a range of factors including changes to role identity and community of practice, alongside individual resilience, and the support provided by the wider HV team. The three core categories of Role Identity, Way of Working and Living the Journey are encompassed within the developed conceptual model, which also provides a framework to support this complex transition process. The transition from qualified nurse/midwife to HV is a multidirectional process and is fraught with challenges. Hence, the greater understanding of the transition provided by this study, will help both inform and support future HV students, the wider HV team, practice assessors/supervisors, employers and education providers. Recommendations include wide dissemination of the findings and conceptual model to allow exploration of the complexities of the transition with student and aspirant HVs, practice colleagues, educators and other stakeholders. Thus, enhancing the support for those undergoing this transition. There should also be greater recognition and valuing of individuals and diversity in the workforce and a focus on building resilient tendencies and wellbeing. Future research should include further exploration of managing multiple role identities, heightened definition of the HV role and the impact of difficult areas of practice (e.g., safeguarding). Other methods of entry into the HV role, rather than from a pre-existing registered nurse or midwife status, are recommended as this could alleviate some of the specific challenges faced within this important transition. There should also be further research to test this substantive theory in other role transitions, where there is a move from one professional role to another.n/

Supporting newly qualified nurses in the UK: a systematic literature review

Aim: This is a systematic literature review of the existing published research related to the development of preceptorship to support newly qualified nurses in the United Kingdom (UK). Background: It has been known for some time that newly qualified nurses experience a period of unsettling transition at the point of registration. In the UK, preceptorship has been the professional body’s recommended solution to this for over 20 years. Data Sources: Searches were made of the CINAHL Plus and MEDLINE databases. Review Methods: A systematic review was carried out in August 2011. Twelve separate searches were conducted generating 167 articles, of which 24 were finally reviewed. Papers were critically reviewed and relevant data were extracted and synthesised using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis ( PRISMA). Results and Discussion: A results table is presented of the twenty-four sources generated by the systematic search. Three themes were identified from the empirical evidence base: ‘Managerial Support Framework’; ‘Recruitment and Retention’; and ‘Reflection and Critical Thinking in Action’;. Conclusion: There is strong evidence that the newly qualified nurse benefits from a period of supported and structured preceptorship, which translates to improved recruitment and retention for the employing organisations. Recommendations for Further Research and Practice: The existing literature provides an evidence base upon which to construct a preceptorship programme and a means by which to measure its efficacy and monitor its future development. Case study research projects should be considered for future preceptorship programmes in order to find the most effective methods of delivery.Research funded by Chesterfield Royal Hospital NHS Trus

Framing the Narrative: Female Fighters, External Audience Attitudes, and Transnational Support for Armed Rebellions

Female combatants play a central role in rebel efforts to cultivate and disseminate positive narratives regarding the movement and its political goals. Yet, the effectiveness of such strategies in shaping audience attitudes or generating tangible benefits for the group remains unclear. We propose and test a theory regarding the channels through which female fighters advance rebel goals. We argue that female fighters positively influence audience attitudes toward rebel groups by strengthening observers’ beliefs about their legitimacy and their decision to use armed tactics. We further contend that these effects directly help them secure support from transnational non-state actors and indirectly promote state support. We assess our arguments by combining a novel survey experiment in two countries with analyses of new cross-national data on female combatants and information about transnational support for rebels. The empirical results support our arguments and demonstrate the impact of gender framing on rebel efforts to secure support

Pre-nursing care experience and implications for its role in maintaining interest and motivation in nursing

In response to the Government’s mandate to give aspirant student nurses front line care experience before commencing a programme of nurse education, the East-Midlands participated in a national pilot programme to recruit aspirant nurses into HCA roles. Here, we discuss research evaluating our programme of pre-nursing care experience and explore the findings relating to how this programme maintained participant’s interest and motivation in nursing. We then discuss these findings within the context of current policy drivers within the NHS today.This research was funded by Health Education England working across the East Midlands

Pre-nursing care experience for maintaining interest and motivation in aspirant nurses

In response to the Government’s mandate to give aspirant student nurses front line care experience before commencing a programme of nurse education, the East-Midlands participated in a national pilot programme to recruit aspirant nurses into HCA roles. Here, we discuss research evaluating our programme of pre-nursing care experience and explore the findings relating to how this programme maintained participant’s interest and motivation in nursing. We then discuss these findings within the context of current policy drivers within the NHS today

Preceptorship programmes in the UK: A systematic literature review

This is a systematic literature review of the existing published research related to the development of preceptorship programmes in the UK. It has been known for some time that newly qualified nurses experience a period of unsettling transition at the point of registration. In the UK preceptorship has been the professional body’s recommended solution to this for over 20 years. Searches were made of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and AMED. A systematic review was carried out based on the following questions: What is the experience of the preceptee? What is the experience of the preceptor? What are the ways of measuring the outcome of the preceptorship process? What are potential ways of measuring the outcome of other transitional periods in industries outside of the nursing profession? What are the ways of assessing the learning environment and learner needs? Papers were critically reviewed and relevant data were extracted and synthesised. A results table is presented of the 39 sources generated by the systematic search. Eight themes were identified from the empirical evidence base: ‘Managerial Support Framework’; ‘Recognition and Status of Role’; ‘Protected Time for Preceptor and Preceptee’; ‘Education Preparation of Preceptors’; ‘Recruitment and Retention’; ‘Competence of Preceptees’; ‘Reflection and critical thinking in action’; and ‘Efficacy of Existing Measurement Tools’. There is strong evidence that the newly qualified nurse wants and benefits from a period of structured preceptorship. This translates to improved patient care and benefits recruitment and retention for the employing organisations. Recommendations for Practice: The existing literature provides an evidence base upon which to construct a preceptorship programme and a means by which to measure its efficacy and monitor its future development. Recommendations for Future Research: Case study research projects should be considered for future preceptorship programmes in order to find the most effective methods of delivery.Chesterfield Royal Hospital NHS Trus

Preceptorship Research Project Report: Chesterfield Royal Hospital NHS foundation trust

Nurse education in the UK has been solely university based since the mid-1990s but despite careful preparation and assessment of student nurses it has been considered necessary to provide a period of additional support for Newly Qualified Nurses (NQNs) to help them settle into their new role and responsibilities. Preceptorship is the process of supporting NQNs over this transition period from student to registered nurse and it is recognised that this can be a stressful and difficult time for NQNs. This project developed from work already undertaken by the clinical placement learning team at Chesterfield Royal Hospital NHS Foundation Trust and was led by the University of Derby in partnership with them and took a case study approach to evaluating how preceptees and their preceptors are supported in practice; what their expectations are and what factors in the clinical area support or inhibit transition to qualified nurse. A systematic review was conducted as part of this project (Whitehead et al 2012 and 2013). The evidence suggests that properly resourced and organised preceptorship is a positive and essential experience for NQNs and their employers. Negative experiences come from an absence of preceptorship; preceptorship being offered but not fully delivered; and feelings of poor self-confidence despite having sufficient competence. The implication of this is that organisations can improve their likelihood of producing reliable and competent registered nurses (RNs) by the introduction of properly resourced and organised preceptorship frameworks. Recommendations for practice and for further research are made. A modified version of Lincoln and Guba’s Naturalistic Inquiry (1985) was used. This provided an authoritative and reliable ontological framework upon which to base the project. A qualitative case study method was developed and consisted of a multistage approach to data collection including semi-structured interviews with key personnel; documentary analysis of preceptorship material and focus groups with key actors. Ten interviews and five focus groups were undertaken with a total of 40 focus group participants. The participants were purposively sampled from representative groups within the Trust. NVivo was used to support analysis and ethical approval was attained for the project. Findings are grouped under the headings of: preceptor training; preceptor support; experiences of preceptorship; what the nurse should be like at the end of a period of preceptorship and the use of the tool. In addition further themes emerged from the findings in relation to indicators for successful transition; formal recognition of preceptor role; confidence and resilience; culture of support including peer support and management structure to support preceptorship; selection and preparation of preceptors and clinical skills. It is evident that there are a range of factors which are seen to affect the success or otherwise of the preceptorship period and the transition to confident RN. The findings indicate that there are a range of factors which are reported to affect the successful transition from student to NQN with the period of preceptorship in this case. These are : the selection and preparation of preceptors; a need to formally recognise the preceptor role; specific time to engage with preceptorship ; a management structure to support preceptors and preceptorship; the individualisation of preceptorship needs and ways to ensure successful preparation of students and NQNs ; the acquisition of the right clinical skills for the job; the culture of support; peer support for preceptees and preceptors; the confidence and resilience of preceptees and technological support processes. Based on these factors recommendations are made for this case in practice and for further research generally.Chesterfield Royal Hospital NHS Trus