Michelle Roxburgh

Why students leave in the UK: an integrative review of the international research literature

AIMS AND OBJECTIVES The purpose of this integrative review of the literature was to find and review international research studies that explored student attrition to determine what is known about the topic and to identify gaps in the research with a view to addressing the situation in the UK. BACKGROUND Attrition from nursing programmes is a serious problem in the UK. It is recognised as a complex phenomenon, not attributable to a single cause. Regardless of actual attrition rates and trends, departments of nursing are challenged to perform in a business-like manner. Consequently, every student lost to a programme of study equates to a financial penalty for the department and to the future workforce and community. DESIGN   Integrative review of the literature. METHOD Using electronic databases and specific search terms, 18 articles were identified and reviewed. Findings from the identified international research literature were analysed using qualitative content analysis. RESULTS Four broad themes that accounted for factors of relevance to attrition were identified: Social, Prediction, Programme and Personal. CONCLUSIONS Retention studies are fraught with methodological problems. These include incomplete or inaccurate data and low response rates. Attrition early in programmes may be attributed to a failure to understand the roles of nurses in contemporary societies. This has led to dissatisfaction with programmes and academic failure, as students may underestimate the intellectual demands of their programmes. Attrition later in the programme may be attributed to a combination of personal factors that culminate in a personal crisis. RELEVANCE TO CLINICAL PRACTICE The research literature suggests that stereotyping of nurses is a major factor in attrition. Both professions need to find ways of communicating contemporary roles to wider society.

Flying Start NHS™: easing the transition from student to registered health professional

AIMS AND OBJECTIVES To evaluate the impact and effectiveness of Flying Start NHS™ on the confidence, competence and career development of newly qualified practitioners. BACKGROUND The first year of practice as a registered nurse, midwife, or allied health professional is recognised as challenging. This paper presents the findings of a two-year evaluation of Flying Start NHS™, a web-based programme developed by NHS Education Scotland to support newly qualified health professionals during the transition from student to qualified practitioner. DESIGN Descriptive design with one to one and focus group interviews, plus a survey. METHODS The evaluation employed a multi-method approach including telephone interviews with Flying Start NHS™ leads/coordinators (n=21) and mentors (n=22) and focus groups with newly qualified practitioners (n=95). An online survey was completed by 547 newly qualified practitioners. RESULTS A majority of newly qualified practitioners reported that Flying Start NHS™ had been useful in terms of clinical skills development and confidence. Those who were able to take protected time were more likely to complete the learning units and report that the support they received was good. Both newly qualified practitioners and mentors reported a lack of time. Newly qualified practitioners who took up posts in the community expressed greater satisfaction with the support received. CONCLUSIONS NHS Boards should ensure that there is an ethos of support at all levels, as well as an understanding of the purpose of Flying Start NHS™ and what newly qualified practitioners require to do to complete it. The expectation that newly qualified practitioners will enrol on Flying Start NHS™ should be accompanied by an expectation that they will complete the programme in their first year, coupled with support to enable them to do so. RELEVANCE TO CLINICAL PRACTICE Undertaking Flying Start NHS™ in the first year of employment increases clinical skills development and confidence. Mentors require training and time to enable them to provide support.

Early findings from an evaluation of a post-registration staff development programme: The Flying Start NHS initiative in Scotland, UK

The first year post-qualifying as a nurse or midwife is often seen as a key transitional period. Flying Start NHS is the national development programme for all newly qualified nurses, midwives and allied health professionals in NHS Scotland. It is designed to support the transition from student to newly qualified health professional through supporting learning in everyday practice. It is a web-based or CD-ROM programme which seeks to increase the confidence and competence of newly qualified nurses and midwives during their first year of employment following registration. The aims of this study were to establish levels of self-report competency, self-efficacy, job demands and career intentions in newly qualified nurses undertaking Flying Start NHS programme in Scotland. The aims were met by conducting a cross-sectional survey of Flying Start NHS students. Newly qualified nurse participants (n=97) comprised a convenience sample of newly qualified nurses who were registered as undertaking the Flying Start NHS on-line programme during Autumn-Winter 2007. Most newly qualified nurses intend to remain in the NHS although a small but important number may leave.

Self-neglect consultation rates and comorbidities in primary care.

The aims of this study were, through secondary data analysis, to establish consultation rates for self-neglect by 100 000 of the Scottish population and by deprivation and to identify the main comorbidities associated with self-neglect. Data from a national dataset recording consultations in general practices where a self-neglect diagnoses was made were analysed. Rates of self-neglect in patients who consulted a Practice Nurse or General Medical Practitioners vary over time. Self-neglect is more common in the 75 years and over group but is found across the age spectrum. It is more common in males and is linked to higher levels of deprivation. Self-neglect is recorded as a diagnosis relatively infrequently in general practice. A wide range of comorbid conditions are found coexisting with self-neglect. Nurse interventions generally focus on comorbidities and not self-neglect. Self-neglect does present in primary care. Nurses need to be aware of its varied presentations. Practice Nurse interventions suggest we need to develop self-management interventions rather than respond to associated comorbid conditions.The aims of this study were, through secondary data analysis, to establish consultation rates for self-neglect by 100 000 of the Scottish population and by deprivation and to identify the main comorbidities associated with self-neglect. Data from a national dataset recording consultations in general practices where a self-neglect diagnoses was made were analysed. Rates of self-neglect in patients who consulted a Practice Nurse or General Medical Practitioners vary over time. Self-neglect is more common in the 75 years and over group but is found across the age spectrum. It is more common in males and is linked to higher levels of deprivation. Self-neglect is recorded as a diagnosis relatively infrequently in general practice. A wide range of comorbid conditions are found coexisting with self-neglect. Nurse interventions generally focus on comorbidities and not self-neglect. Self-neglect does present in primary care. Nurses need to be aware of its varied presentations. Practice Nurse interventions suggest we need to develop self-management interventions rather than respond to associated comorbid conditions.

Exploring the compassion deficit debate

Several recent high profile failures in the UK health care system have promoted strong debate on compassion and care in nursing. A number of papers articulating a range of positions within this debate have been published in this journal over the past two and a half years. These articulate a diverse range of theoretical perspectives and have been drawn together here in an attempt to bring some coherence to the debate and provide an overview of the key arguments and positions taken by those involved. In doing this we invite the reader to consider their own position in relation to the issues raised and to consider the impact of this for their own practice. Finally the paper offers some sense of how individual practitioners might use their understanding of the debates to ensure delivery of good nursing care.

A cover up? Potential risks of wearing theatre clothing outside theatre

A report from the Hospital Infection Society Working Group (2002) examined ritualistic practices in theatre and evidence was sought to establish which practices could be supported with clear scientific evidence. The report stated that there is little or no research to show that wearing theatre attire outside the theatre and returning without changing into clean theatre attire increases wound infection rates. It is difficult to implement infection control practices on a scientific basis as there is often a lack of evidence to support the practice. Moreover, many practices are grounded in ‘this is the way things are done around here’ (Ward 2000).

Rwanda: A thousand hills a thousand dreams a thousand challenges for nurses and midwives and the Millennium Development Goals.

This editorial discusses the roles and challenges of nurses and midwives in Rwanda and their attempts to reach the Millennium Development Goals (MDGs). It describes the consensus that the Rwandan Government came to on the establishment of regional schools in order to promote effective education and practice. While it commends the great improvements over the years in the numbers of qualified nurses and midwives it states that the number still remains too low to support the countrys growing population.

The quality of on-line communication in a national learning programme for newly qualified nurses, midwives and allied health professionals

Asynchronous communication has become the dominant mode of on-line instruction and has been incorporated into Flying Start NHS, an on-line programme for newly qualified NMAHPs in the transition phase from student to registered practitioner. On-line programmes have a number of objectives including the delivery of educational materials and the development of on-line communities. This study sought to provide a direct and objective understanding of the quality of the on-line community within Flying Start NHS and give an indication of areas of strength and weakness. The study used mixed methods including a Gricean analysis of on-line communication focusing on quantity, quality, relevance, and manner, and a thematic analysis of communication content. There was little evidence that students engaged in the type of interactive communication essential for creating on-line learning communities. The majority of postings related to progression through Flying Start. The small number of communications which did begin to engage with the learning materials were limited with little evidence of the development of critical debate. Analysis of the qualitative data indicates that the period of transition continues to be stressful with Flying Start NHS being undertaken concurrently with local CPD being seen as duplication of effort.

Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit

Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test and implement the CPOT. The process measures related to (i) the nursing staff’s reliability to assess and document pain scores at least every four hours and (ii) to treat behavioural signs of pain or CPOT scores ≥ 3 with a rescue bolus of opioid analgesia. The findings from this project confirm that the observed trends in both process measures had reduced over time. Four hourly assessments of pain had increased to 89% and the treatment of CPOT scores ≥3 had increased to 100%.

Fool's gold or real gold?

The term evidence-based practice is not new. For over twenty years the debate has been ongoing about how to make it happen. To practice within an evidence base, practitioners must determine if the evidence available is relevant for the particular patient (DiCenso et al 1998). This article aims to contextualise, clarify and explore the meaning of evidence-based practice for perioperative practitioners and, through introducing two models, identify and categorise sources of evidence to base practice on.