Joan Curzio

Failing a student nurse: A new horizon of moral courage

The factors preventing registered nurses from failing students in practice are multifaceted and have attracted much debate over recent years. However, writers rarely focus on what is needed to fail an incompetent pre-registration nursing student in their final placement. This hermeneutic study explored the mentor experience of failing a pre-registration nursing student in their final placement. A total of 19 mentors were recruited from 7 different healthcare organisations in both inner city and rural locations in the southeast of England. Participants took part in individual reflective interviews about their experience of failing a pre-registration nursing student in their final placement. These experiences were interpreted through a hermeneutic discovery of meaning. The new horizon of understanding which developed as a result of this research is framed within the context of moral stress, moral integrity and moral residue with the overall synthesis being that these mentors’ stories presented a new horizon of moral courage.

Peer bullying in a pre-registration student nursing population

Peer bullying is a major problem in schools and workplaces including the National Health Service. Although there are a few published studies exploring the incidence of peer bullying among university students, none is specific to pre-registration nursing students. Nursing programmes are delivered across two campuses of the university however students registered at individual campuses do not mix which makes the experiences of each campus individual. The aim of this study was to explore the incidence and manifestation of peer bullying amongst pre-registration nursing students in the university setting. The study describes the reported incidence of the three types of peer bullying behaviour: physical, verbal and non-verbal bullying. Participants in their final year of adult nurse education were asked to explore their perceptions of peer bullying, the frequency of witnessed or experienced behaviour and the location of where this behaviour occurred on the university campuses via a quantitative questionnaire. In total 190 students were surveyed with 156 (82%) responding. Participants reported peer bullying is experienced by student nurses on university premises and that academic members of staff are sometimes present when this behaviour is demonstrated. Reported levels of bullying decreased during their 2nd and 3rd years of the course compared to the foundation year. This decrease may have been in response to the universitys strong anti-bullying stance.

Avoiding the pitfalls of Action Learning

Agenda for Change and the Modernisation Agenda are promoting rapid change within the health service and education has an important role in supporting staff developing themselves and their service. An innovative educational approach that has potential to facilitate these developments is Action Learning. Action learning was originally developed by Revans (1983) as the most effective way of developing managers. Small groups of ‘comrades in adversity’ were seen to learn more from each other’s failures and victories rather than from expert instruction. The overriding proposition is that learning had to be equal to the rate of change in organisations. This form of group learning lends itself to today’s health service admirably. Over the past 10 years and most noticeably in the last five years Action Learning has been included on programmes to produce nurse leaders (RCN, 2002), and there are anecdotal reports of action learning being used to further masters research (University of Westminister, 2001). Unfortunately, the majority of the literature on action learning remains descriptive and anecdotal (Neubauer, 1992; Pedler and Boutall, 1992; Graham, 1995). Although Heidari and Galvin (2003) attempt to examine the effect of participating in Action Learning sets on the education of student nurses, their interpretation of what is an Action Learning Set differs from that used by many of those cited above. There is a need to distinguish between what is Action Learning and what is essentially an Action Learning approach, e.g., reflective practice. We risk losing sight of some of the key principals of Action Learning theory by adapting it too freely, thus rendering it

Evaluation of how a curriculum change in nurse education was managed through the application of a business change management model: A qualitative case study

BACKGROUND Curriculum changes are a regular feature of nurse education, yet little is known about how such changes are managed. Research in this arena is yet to emerge. OBJECTIVE Evaluation of how a curriculum change in nurse education was managed through the application of a business change management model. METHOD A qualitative case study: the single case was the new curriculum, the Primary Care Pathway. PARTICIPANTS AND SETTING One executive, three senior managers, two academics and nineteen students participated in this study in one faculty of health and social care in a higher education institution. RESULTS The findings suggest that leadership was pivotal to the inception of the programme and guiding teams managed the change and did not take on a leadership role. The vision for the change and efforts to communicate it did not reach the frontline. Whilst empowerment was high amongst stakeholders and students, academics felt dis-empowered. Short-term wins were not significant in keeping up the momentum of change. The credibility of the change was under challenge and the concept of the new programme was not yet embedded in academia. CONCLUSION Differences between the strategic and operational part of the organisation surfaced with many challenges occurring at the implementation stage. The business change model used was valuable, but was found to not be applicable during curriculum changes in nurse education. A new change model emerged, and a tool was developed alongside to aid future curriculum changes.

Contemporary nursing wisdom in the UK and ethical knowing: difficulties in conceptualising the ethics of nursing

This papers philosophical ideas are developed from a General Nursing Council for England and Wales Trust-funded study to explore nursing knowledge and wisdom and ways in which these can be translated into clinical practice and fostered in junior nurses. Participants using Carpers (1978) ways of knowing as a framework experienced difficulty conceptualizing a link between the empirics and ethics of nursing. The philosophical problem is how to understand praxis as a moral entity with intrinsic value when so much of value seems to be technical and extrinsic depending on desired ends. Using the Aristotelian terms poesis and praxis can articulate the concerns that the participants as well as Carper (1978) and Dreyfus (in Flyvbjerg, 1991) among others share that certain actions or ways of knowing important for nursing are being devalued and deformed by the importance placed on quantitative data and measurable outcomes. The sense of praxis is a moralized one and most of what nurses do is plausibly on any account of normative ethics a morally good thing; the articulation of the idea of praxis can go some way in showing how it is a part of the discipline of nursing. Nursings acts as poesis can be a part of how practitioners come to have praxis as phronesis or practical wisdom. So to be a wise nurse, one needs be a wise person.

Expert Nurses' Perceptions of the Relevance of Carper's Patterns of Knowing to Junior Nurses.

This study explored with expert nurses in the UK how nursing wisdom can be developed in new and junior nurses. Carpers patterns of knowing and Benners novice-to-expert continuum formed the theoretical framework. Employing a constructionist research methodology with participant engagement in co-construction of findings, data were collected via 2 separate cycles comprising 4 consecutive sessions followed by a nationally advertised miniconference. Empirical, ethical, personal, and esthetic knowing was considered evident in junior nurses. Junior nurses in the UK seem to lack a previously unrecognized domain of organizational knowing without which they cannot overcome hegemonic barriers to the successful development of nursing praxis.