Background. A programme of postgraduate study was developed in partnership between a health board and a university in New Zealand, having identified critical thinking and practice change as key determinants of good care delivery. Aim. To explore the impact after 12 months of a postgraduate programme for registered nurses on patient assessment and clinical reasoning, and the status of implementation plans for improved patient care. Design. Outcome evaluation using a survey and focus groups. Setting. On location at a hospital in a small city in New Zealand that provides healthcare services for 102,000 people across rural and urban areas. Participants. Registered nurses who had completed the programme ( ) and seven clinical mentors. Methods. A survey, focus groups, and follow-up data about quality improvement projects were used to explore how the programme was experienced and its impact. Results. The survey revealed perceptions of improved knowledge and skills but a lack of confidence in communicating with medical staff. Of 28 quality improvement projects planned, all but three had been implemented and were still in use. Two themes were generated from focus group data: “new ways of thinking” and “doing things differently.” Conclusions. This academic/clinical partnership positively influenced nurses’ knowledge and skills, encouraged critical thinking and self-efficacy, and resulted in the sustained implementation of nurse-initiated projects intended to improve patient care. 1. Introduction As the context of nursing practice continues to increase in uncertainty, instability, and complexity, registered nurses are exposed regularly to situations that take them to the edge and at times beyond their current knowledge and skill base, putting on full stretch their resources to adapt and learn [1]. Therefore, appropriate support in this environment goes beyond that based on “thinned out” understandings of the clinical context and their work. Decisions about nurses’ professional development needs that are made in isolation of an appreciation of the realities of practice can lead to excessive emphasis on performance, blame-seeking, insufficient attention to the complexity of practice, and a default to generic, technical education to fix problems [2]. Therefore, transformative learning in which registered nurses grow as critical thinkers and knowledge workers while also continuing to develop essential technical knowledge and skills is both a challenge and an essential goal for nursing education and for advancing nursing knowledge [3, 4]. 2. Tame and Wicked Problems
References
[1]
T. Britt Pipe, “Preparing the emerging nursing and health care workforce: a case study,” Nursing Administration Quarterly, vol. 38, no. 2, pp. 120–127, 2014.
[2]
S. Nairn, “Social structure and nursing research,” Nursing Philosophy, vol. 10, no. 3, pp. 191–202, 2009.
[3]
M. McAllister, “STAR: a transformative learning framework for nurse educators,” Journal of Transformative Education, vol. 9, no. 1, pp. 42–58, 2011.
[4]
G. Rolfe, “Rethinking reflective education: what would Dewey have done?” Nurse Education Today, vol. 34, no. 8, pp. 1179–1183, 2014.
[5]
H. W. J. Rittel and M. M. Webber, “Dilemmas in a general theory of planning,” Policy Sciences, vol. 4, no. 2, pp. 155–169, 1973.
[6]
J. Edmonstone, “On the nature of problems in action learning,” Action Learning: Research and Practice, vol. 11, no. 1, pp. 25–41, 2014.
[7]
K. Manley, “'The way things are done around here'-Developing a culture of effectiveness: a pre-requisite to individual and team effectiveness in critical care,” Australian Critical Care, vol. 21, no. 2, pp. 83–85, 2008.
[8]
A. Bandura, “Toward a psychology of human agency,” Perspectives on Psychological Science, vol. 1, no. 2, pp. 164–180, 2006.
[9]
S. Hardy, C. Jackson, J. Webster, and K. Manley, “Educating advanced level practice within complex health care workplace environments through transformational practice development,” Nurse Education Today, vol. 33, no. 10, pp. 1099–1103, 2013.
[10]
K. Manley, “Transformational culture: a culture of effectiveness,” in Practice Development in Nursing, pp. 51–82, Blackwell, 2008.
[11]
B. Mccormack, J. Dewing, L. Breslin et al., “Practice development: realising active learning for sustainable change,” Contemporary Nurse A, vol. 32, no. 1-2, pp. 92–104, 2009.
[12]
L. M. Aitken, J. Currey, A. P. Marshall, and D. Elliott, “Discrimination of educational outcomes between differing levels of critical care programmes by selected stakeholders in Australia: a mixed-method approach,” Intensive and Critical Care Nursing, vol. 24, no. 2, pp. 68–77, 2008.
[13]
L. Currie and L. Watterson, “Investigating the role and impact of expert nurses.,” The British Journal of Nursing, vol. 18, no. 13, pp. 816–824, 2009.
[14]
J. Wilson-Barnett, “Continuing challenges for nursing in higher education,” Journal of Advanced Nursing, vol. 3, no. 3, pp. 219–220, 2006.
[15]
L. H. Aiken, S. P. Clarke, R. B. Cheung, D. M. Sloane, and J. H. Silber, “Educational levels of hospital nurses and surgical patient mortality,” Journal of the American Medical Association, vol. 290, no. 12, pp. 1617–1623, 2003.
[16]
J. Considine, L. Ung, and S. Thomas, “Clinical decisions using the National triage scale: how important is postgraduate education,” Accident and Emergency Nursing, vol. 9, no. 2, pp. 101–108, 2001.
[17]
C. L. Covell, “Outcomes achieved from organizational investment in nursing continuing professional development,” The Journal of Nursing Administration, vol. 39, no. 10, pp. 438–443, 2009.
[18]
C. Bennison, “Emergency nurses' preceptions of the impact of post graduate education on their practice in New Zealand,” in Nursing, p. 158, University of Otago, Dunedin, New Zealand, 2008.
[19]
C. E. Cragg and M. Andrusyszyn, “Outcomes of Master's education in nursing,” International Journal of Nursing Education Scholarship, vol. 1, no. 1, article 18, 2004.
[20]
L. Clark, “Degrees of confidence,” Nursing Older People, vol. 21, no. 2, pp. 23–25, 2009.
[21]
B. Landmark, A. Wahl, and A. B？hler, “Competence development in palliative care in Norway: a description and evaluation of a postgraduate education program in palliative care in Drammen, Norway.,” Palliative & Supportive Care, vol. 2, no. 2, pp. 157–162, 2004.
[22]
S. Walker, “Extolling the benefits of postgraduate education,” Kai Tiaki Nursing New Zealand, vol. 15, no. 10, pp. 16–18, 2009.
[23]
S. L. Tame, “The effect of continuing professional education on perioperative nurses' relationships with medical staff: findings from a qualitative study,” Journal of Advanced Nursing, vol. 69, no. 4, pp. 817–827, 2013.
[24]
D. Barnhill, A. McKillop, and C. Aspinall, “The impact of postgraduate education on registered nurses working in acute care,” Nursing Praxis in New Zealand, vol. 28, no. 2, pp. 27–36, 2012.
[25]
D. Pelletier, J. Donoghue, and C. Duffield, “Australian nurses' perception of the impact of their postgraduate studies on their patient care activities,” Nurse Education Today, vol. 23, no. 6, pp. 434–442, 2003.
[26]
S. Wildman, A. Weale, C. Rodney, and J. Pritchard, “The impact of higher education for post-registration nurses on their subsequent clinical practice: an exploration of students' views,” Journal of Advanced Nursing, vol. 29, no. 1, pp. 246–253, 1999.
[27]
E. Williamson and M. Horsburgh, Evaluation of the Graduate Clinical Nursing Courses at the University of Auckland, University of Auckland, 2000.
[28]
M. C. Cooley, “Nurses' motivations for studying third level post-registration nursing programmes and the effects of studying on their personal and work lives,” Nurse Education Today, vol. 28, no. 5, pp. 588–594, 2008.
[29]
J. Drennan, “Professional and academic destination of masters in nursing graduates: a national survey,” Nurse Education Today, vol. 28, no. 6, pp. 751–759, 2008.
[30]
M. McAllister, “Challenges facing nursing education in Australia: two solutions,” Journal of Nursing Education and Practice, vol. 2, no. 1, pp. 20–27, 2012.
[31]
S. Barradell, “The identification of threshold concepts: a review of theoretical complexities and methodological challenges,” Higher Education, vol. 65, no. 2, pp. 265–276, 2013.
[32]
J. Meyer and R. Land, “Threshold concepts and troublesome knowledge: linkages to ways of thinking and practising within the disciplines,” ETL Project Occasional Report 4, Edinburgh, UK, 2003.
[33]
B. McCormack and J. Wright, “A realist synthesis of evidence relating to practice development: findings from the literature analysis,” Practice Development in Health Care, vol. 6, no. 1, pp. 25–55, 2007.
[34]
B. McCormack, “Advancing the practice development outcomes agenda within multiple contexts,” International Practice Development Journal, vol. 1, no. 4, 2011.
[35]
J. Mezirow, Learning as Transformation, Jossey-Bass, San Francisco, Calif, USA, 2000.
[36]
J. Dewing, “Moments of movement: active Learning and practice development,” Nurse Education in Practice, vol. 10, no. 1, pp. 22–26, 2010.
[37]
B. McCormack, J. Dewing, and T. McCance, “Developing person-centred care: addressing contextual challenges through practice development,” The Online Journal of Issues in Nursing, vol. 16, no. 2, article 3, 2011.
[38]
B. McCormack, K. Manley, and A. Titchen, Practice Development in Nursing and Healthcare, Wiley-Blackwell, Oxford, UK, 2nd edition, 2013.
[39]
J. Rycroft-Malone, “The PARIHS framework: a framework for guiding the implementation of evidence-based practice,” Journal of Nursing Care Quality, vol. 19, no. 4, pp. 297–304, 2004.
[40]
C. Pope, S. Ziebland, and N. Mays, “Analysing qualitative data,” British Medical Journal, vol. 320, no. 7227, pp. 114–116, 2000.
[41]
N. Mays and C. Pope, “Rigour and qualitative research,” British Medical Journal, vol. 311, no. 6997, pp. 109–112, 1995.
[42]
D. F. Bell, E. Pestka, and D. Forsyth, “Outcome evaluation: does continuing education make a difference?” The Journal of Continuing Education in Nursing, vol. 38, no. 4, pp. 185–190, 2007.
[43]
K. Caldwell, “Postgraduate education for nurses: the Middlesex model,” Nurse Education Today, vol. 21, no. 3, pp. 218–224, 2001.
[44]
S. Pullon and B. Fry, “Interprofessional postgraduate education in primary health care: is it making a difference?” Journal of Interprofessional Care, vol. 19, no. 6, pp. 569–578, 2005.
[45]
D. Spence, “Advancing nursing practice through postgraduate education (part one),” Nursing Praxis in New Zealand, vol. 20, no. 2, pp. 46–55, 2004.
[46]
C. Schmalenberg and M. Kramer, “Nurse-physician relationships in hospitals: 20,000 nurses tell their story,” Critical Care Nurse, vol. 29, no. 1, pp. 74–83, 2009.
[47]
K. Walsh, C. Moss, and M. Fitzgerald, “Solution focused approaches and their relevance to practice development,” Practice Development in Health Care, vol. 5, no. 3, pp. 145–155, 2006.
[48]
M. McAllister, L. Venturato, A. Johnston, J. Rowe, M. Tower, and W. Moyle, “Solution focused teaching: a transformative approach to teaching nursing,” International Journal of Nursing Education Scholarship, vol. 3, article 5, no. 1, 2006.
[49]
C. R. May, F. Mair, T. Finch et al., “Development of a theory of implementation and integration: Normalization Process Theory,” Implementation Science, vol. 4, no. 1, article 29, 2009.
[50]
G. Rolfe, D. Freshwater, and M. Jasper, Critical Reflection for Nursing and the Helping Professions, Palgrave, New York, NY, USA, 2001.
[51]
N. Thompson and J. Pascal, “Developing critically reflective practice,” Reflective Practice: International and Multidisciplinary Perspectives, vol. 13, no. 2, pp. 311–325, 2012.
