Lynn Sayer

Current educational challenges for specialist community public health nurses following a health-visiting pathway and the consequences of these challenges for public health:

The UK Standing Conference on Specialist Community Public Health Nurse Education represents the interests of those most intimately involved with specialist community public health nurse (health visitor) (SCPHN (HV)) education in higher education institutions across the UK. This paper summarizes issues currently affecting the education of SCPHN (HV)s and the delivery of health visiting and public health nursing services across the UK. Difficulties in recruitment, numbers of practice teachers and tensions created by the gap between expected and actual practice roles for health visitors are discussed. This discussion takes place in the context of the Programme of Action on Health Visiting, which was launched in 2009 by the Department of Health in England. Recommendations for action by HEIs are made in response to the difficulties identified in particular. Although this paper applies to all the UK SCPHN education programmes the majority of these are in England, which has resulted in a focus being placed on challenges in England.

The efficacy of alarm therapy versus desmopressin therapy in the treatment of primary mono-symptomatic nocturnal enuresis: a systematic review.

AIM To investigate the efficacy of alarm therapy versus desmopressin therapy in treating primary mono-symptomatic nocturnal enuresis (PMNE). BACKGROUND PMNE is a common childhood disorder, which if left untreated can have a significant impact on a childs self-esteem and behaviour. Alarm therapy and desmopressin therapy are the two main treatments currently available in UK-based nurse-led enuresis clinics. METHODS A systematic review of the literature was undertaken to assess the efficacy of PMNE treatments. Following application of inclusion/exclusion criteria eight randomised controlled/clinical trials were identified involving children aged 5-17 years with PMNE receiving either alarm therapy or desmopressin therapy. FINDINGS Seven studies found no statistical difference in nocturnal continence improvement between the two interventions at the point when treatment was stopped. Four studies had a significantly larger relapse rate of nocturnal enuresis with desmopressin compared with alarm therapy when the treatment was withdrawn. Two papers reported that those participating in the alarm therapy intervention of the trials had a higher attrition rate than the desmopressin intervention. The overall findings from the eight studies showed that long term alarm therapy was more effective in treating nocturnal enuresis than desmopressin therapy. The review found that families and children receiving the alarm therapy intervention require more support from health care professionals to comply with treatment than those receiving the desmopressin therapy. However, if nurse-led clinics can support families to persist with the alarm therapy intervention, they are more likely to experience longer term improvement in continence.

Strategies used by experienced versus novice practice teachers to enact their role with community nurse students

This study offers an original analysis of how community nurse practice teachers learn to enact their role. A constructivist grounded theory approach was applied to a study of thirty community nurse practice teachers. Practice teachers were interviewed using a lightly structured interview approach following ethical approval. The study found that practice teachers considered relationships and nurturance to be of central importance. This led to emphasis being placed on providing experience for students and formative assessment. A number of key differences between the way novice and experienced practice teachers saw themselves functioning were discovered. These differences were theorised to explain the finding that novice practice teachers were much more likely to identify students as experiencing major difficulties than experienced practice teachers. It was discovered that practice teachers learn to enact their role within a socio-cultural context drawing upon a transformation approach to learning. This approach becomes firmly established over a period of approximately three years and is at odds with the current emphasis on competency based transmission models of learning.

Communities of practice, a phenomenon to explain student development in community nursing.

AIM To explore practice teachers understanding of the process of professional education experienced by community nursing students. BACKGROUND This paper analyses the concepts of situated learning and communities of practice as an underpinning theoretical framework to understand the professional education of community nurses in practice settings. The paper also highlights the strengths and limitations of the community of practice theory as applied to professional education. METHODS A qualitative grounded theory study was undertaken involving interviews with 30 community nurse practice teachers. FINDINGS Emerging from the data were the central components of Lave and Wengers theory of communities of practice. The practice teachers appeared to use these components including legitimate peripheral participation, sponsorship and journeying to good effect in facilitating the development of community nurse students. The paper extends Lave and Wengers community of practice phenomenon and identifies how communities are (re)produced over time. The development of professional practitioners over a lengthy period of time within supportive communities of practice where one person with expertise in professional education sponsors the student and takes responsibility for their journey was perceived by practice teachers to be an important and appropriate approach. An approach that was found by practice teachers to transform the students professional identity, enabling them to undertake a complex multifaceted role using a holistic, problem solving and participative style with clients and communities. It is also an approach that was hypothesised to allow the profession itself to (re)produce in a way that supports continuity but also promotes changes in practice.

An innovative strategy to increase a professional workforce: the fast track initiative for health visitors in England

Objectives Fast tracking is one strategy that organizations use to ameliorate workforce shortfalls by attracting new recruits, and accelerating their skills development and experience. In response to the Government’s target of rapidly expanding the number of health visitors in England’s National Health Service, the fast track initiative was launched to recruit newly qualified (fast track) as well as experienced (standard entry) nurses and midwives onto health visiting programmes. This paper evaluates the fast track initiative, from the perspective of fast track and standard entry students, practice teachers and health visitor managers. Methods A mixed methods design was used comprising a questionnaire survey (n = 71 students), semi-structured interviews (n = 37 students), telephone interviews (n = 13 managers) and six focus groups (n = 24 practice teachers). Data were collected between April 2012 and July 2013. Descriptive statistics, t-tests and the Pearson Chi-square test were used to analyse the quantitative data. The qualitative data were analysed thematically. Results Motivations for health visiting as a career choice were similar for fast track and standard entry students, with career progression and interest in health promotion being key motivators. There was consensus that personal qualities and characteristics were more important than experience or qualifications. However, fast track students were significantly less confident about their public health competencies in leadership and management (p < 0.05) and communication (p < 0.02). Practice teachers and managers also reported that fast track students required more intensive supervision particularly at the beginning of the programme. Programme completion including pass rates and academic achievement showed no significant difference by route of entry (p > 0.5). Conclusion Fast tracking offers a useful recruitment strategy in order to expand the health visitor workforce, but longitudinal research is needed to confirm benefits such as retention and career trajectories.

Joined-up teaching

In the UK, interprofessional working is becoming a cornerstone of social care practice. This article outlines how the authors, both academics in a university’s health and social care department, are developing the teaching of interprofessional skills as an integral component of effective child protection education. This has become particularly pertinent in light of the recent legislative and policy shifts highlighted within the Laming Report (2003) and Every Child Matters (DfES, 2003). The proposed interprofessional children’s teams will provide new challenges to all professions who hold child protection responsibilities. For students who exhibit high levels of anxiety about working in this area of practice, we have implemented an innovative and responsive educational programme to facilitate the development of knowledge and skills of interprofessional working within the field of child protection. By providing skills training in a professional setting, we aim to enable students to gain interprofessional knowledge through experience with practice.