Anne Pegram

Developing and examining an Objective Structured Clinical Examination

Objective Structured Clinical Examinations are commonly used within pre-registration and post-qualification nurse education to test clinical competence. Station development and refinement of the pass mark is essential to the examination process. In this paper the process of blue-printing and standardisation are described as one method of agreeing examination content and subsequent pass mark. Issues of validity and reliability are discussed in relation to these and to the process of examining. The development of good practice guidelines to ensure consistency between different markers of the same station and of a single marker examining different students on one station is described. Recommendations in relation to transparency are made to optimise student understanding of what they are being tested on and hence their performance in the examination.

Clinical skills education for graduate-entry nursing students: Enhancing learning using a multimodal approach

This paper discusses the development of a new clinical skills course at a school of nursing and midwifery in London. The course, part of a two year pre-registration programme for graduates in other disciplines, adopted an innovative multimodal approach. This comprised a range of teaching, learning and assessment strategies designed to maximise comprehensiveness, complementarity and flexibility. The background to the development is discussed and each component is described in detail. A brief summary of relevant feedback generated from anonymous student evaluations is included. This provides important insights into the perceived strengths and weakness of the module from a learner perspective. The paper concludes by identifying proposed future developments and recommending wider applications of the multimodal approach within nursing and healthcare education on an international level.

The development and evaluation of a computer-based resource to assist pre-registration nursing students with their preparation for objective structured clinical examinations (OSCEs)

This paper presents a narrative discussion of an innovative, computer-based resource developed, implemented and evaluated by a small project team at a school of nursing and midwifery in London. The interactive resource was designed to assist first and second year pre-registration nursing students with both their clinical skills revision and formative preparation for Objective Structured Clinical Examinations and involved a small range of clinical skills. These included: skin assessment; hand hygiene; reading a drug prescription chart, weighing a baby and assessment of an intravenous cannulae site. The processes involved in the development of the tool are described and, the key drivers informing its development are identified. Although a formal research approach was not adopted a summary of feedback obtained from anonymous student evaluations is included. This provides important insights into the perceived usefulness of the tool and is discussed in light of the challenges and practicalities associated with the content development and technical issues. The paper concludes by identifying proposed future developments and wider applications of this innovative clinical skills education initiative within nursing and healthcare education.

Care, compassion and communication.

Care, compassion and effective communication are essential elements of nursing, which must be demonstrated by all nurses and nursing students. These requirements form the basis of the first essential skills cluster, which stipulates key skills and behaviours that must be demonstrated to meet the standards for registration with the Nursing and Midwifery Council. This article discusses the core aspects of compassionate care and effective communication and, in doing so, uses examples to demonstrate their use within nursing.

An exploration of the working life and role of the ward manager within an acute care hospital organisation

The ward manager’s role is a complex one that involves meeting financial targets, responding to changes in organisational structures and ensuring the delivery of quality patient care. Whilst the ward manager’s role remains key to service delivery, there has been limited research on the current role from the perspective of ward managers. A survey of ward managers, exploring aspects of their working lives and potential enablers of the ward manager role, is described. The variety of activities within the role was a source of job satisfaction despite the challenge of ‘keeping on top of everything’. Potential role enablers included having protected time for the managerial aspects of the role. The study findings indicate the need to understand the role of the ward manager with particular reference to job satisfaction, and the underpinning support required to enable ward managers to execute the role effectively.

Hand decontamination in clinical practice: a review of the evidence

Hand decontamination is known to significantly reduce the spread of hospital-acquired infections but, despite a wealth of guidelines and education campaigns, evidence suggests that many healthcare workers are non-compliant with hand decontamination. The behaviours that prevent hand decontamination are complex. Studies look at attitudes towards dirt, disgust, self-protective hand washing and familiarity with patients. Self-protection behaviours manifest themselves in washing hands more often after certain tasks. Professional issues are also reported to have an impact on hand decontamination, mainly lack of time, heavy workloads, understaffing and frequency of admissions to the clinical area. Further research needs to be undertaken to include comparison between self-reported studies and observational studies, as it has been shown that healthcare workers may rationalise their behaviour and that self-reporting can be unreliable.

Nutrition and fluid management.

Management of fluid intake and nutrition is an essential component of nursing care and should be practised skilfully by all nurses and nursing students. This requirement forms the basis of the fourth essential skills cluster, nutrition and fluid management. The essential skills clusters stipulate key skills and behaviours to be demonstrated to meet the standards for registration with the Nursing and Midwifery Council. This article, the fourth in a series on the essential skills clusters, discusses the core aspects of nutrition and fluid management and emphasises their importance in recovery from illness and in maintaining optimal health.

Infection prevention and control.

All newly registered graduate nurses are required to have the appropriate knowledge and understanding to perform the skills required for patient care, specifically the competencies identified in the Nursing and Midwifery Councils essential skills clusters. This article focuses on the third essential skills cluster - infection prevention and control. It provides an overview and discussion of the key skills and behaviours that must be demonstrated to meet the standards set by the Nursing and Midwifery Council. In doing so, it considers the key principles of infection prevention and control, including local and national policies, standard infection control precautions, risk assessment, standard isolation measures and asepsis.

Implementing peer learning to prepare students for OSCEs

First-year nursing students undertaking a first-year clinical skills module were given an opportunity to take part in a voluntary peer learning scheme, where they would learn from more senior students. It was envisaged this would help the students prepare for the modules summative assessment-an objective structured clinical examination (OSCE), which students can find stressful. The first-year students found peer learning helped them improve clinical skills, reduced anxiety and increased their self-confidence, and they appreciated the non-threatening learning environment and constructive feedback. The more senior students felt it helped prepare them for their mentoring role after registration. Incorporating peer learning more widely into the curriculum would allow it to be evaluated in more depth.

Organisational aspects of care.

Organisational aspects of care, the second essential skills cluster, identifies the need for registered nurses to systematically assess, plan and provide holistic patient care in accordance with individual needs. Safeguarding, supporting and protecting adults and children in vulnerable situations; leading, co-ordinating and managing care; functioning as an effective and confident member of the multidisciplinary team; and managing risk while maintaining a safe environment for patients and colleagues, are vital aspects of this cluster. This article discusses the roles and responsibilities of the newly registered graduate nurse. Throughout their education, nursing students work towards attaining this knowledge and these skills in preparation for their future roles as nurses.