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Developing and Supporting Educational Roles for Community Specialist Practice

Posted on: Tuesday, 11 October 2005, 03:00 CDT

By Byers, Pauline

INTERPROFESSIONAL PRACTICE EDUCATION

DEVELOPING AND SUPPORTING EDUCATIONAL ROLES FOR COMMUNITY SPECIALIST PRACTICE

Date: 22 June 2005

Venue: Assembly Rooms, Derby

This one-day conference was designed to facilitate the development of interprofessional practice education aimed at meeting the NHS modernisation agenda across specialist community and community specialist public health nursing. Delegates were given the opportunity to hear from relevant speakers and be updated on current issues affecting practice education.

The issues discussed at the conference were: specialist community public health competencies; interprofessional learning; NMC Standards; and public involvement.

Delegates included: community educators (from all four countries); university lecturers; Workforce Confederation leads and members; managers of learning; practice educators; service managers and practitioners.

Heather Livesey, acting head of nursing and midwifery St Martin's College, Lancaster and Carlisle, chaired the event.

The programme began with an overview of key developments in public health presented by Yinglen Butt, professional officer public health, Department of Health.

The focus of the presentation 'Public health in practice' discussed setting public health practice in the context of key drivers, with a specific overview of Choosing Health.1 Some of the key drivers outlined include:

Every Child Matters: Change for Children? the National Service Framework for Children, Young People and Maternity Services,'' Liberating the public health talents of community practitioners and health visitors? Wanless reports,5 Tackling Health Inequalities: A Programme for Action^ Skills for Health, National Occupational Standards for Public Health? Promoting Health benchmark (Draft in consultation),8 Creating a Patient-led NHS.9

Ying Butt argued that while the population's health has dramatically improved, there continues to be marked inequalities. The need to tackle inequalities is a significant message in the key drivers. The general principles highlight the need to ensure that promoting health remains a fundamental part of nursing and should be included in practice education.

Public health policy clearly recognises the significant contribution that nurses (health visitors, school nurses, practice nurses, district nurses and midwives) have made and can continue to make in relation to influencing good health outcomes for the population. This is reinforced, in the priority areas for action, where nurses are identified as key participants in health improvement.

Community practitioners are well placed to use every contact as an opportunity to promote health. However, training will need to equip them with the appropriate skills and competencies to engage with a more informed population. Health improvement and promoting health is high on the policy agenda. We need to grasp hold of the opportunity that presents and creatively engage to ensure the nursing contribution can be fully realised. It is therefore important that we are developing a generation of practitioners who are able to effectively meet the new public health challenges.

Liz Plastow, professional officer, specialist community public health nursing at the NMC, outlined the nature of the Specialist Community Public Health Nursing programme.

Ms Plastow pointed out that this is an educational preparation that equips nurses with the broad public health skills and competencies to meet the Standards for Specialist Community Public Health Nursing. The programme will replace existing health visiting, school nursing, occupational health nursing and family health nursing programmes. However until all universities move over to the new programme, the existing specialist practitioner qualification will remain valid and nurses undertaking these programmes will be automatically registered on the specialist community public health nursing part of the register.

The programme is 52 weeks in length and is more flexible than the specialist practice qualification. Students will share keynote, lectures and may then apply broad public health skills to their own specific area of specialism, bringing this back to the wider group. The aim is to ensure all specialist community public health nurses have a broader appreciation of public health nursing and understanding of each other's roles. Students would be expected to have the opportunity to experience much broader public health placements including health promotion, community regeneration, health protection, environmental health, housing, environment agency and emergency planning.

The specialist community public health nursing part of the register is similar to the 'nursing' part in that all nurses are registered on this part of the register but not all do the same role eg, orthopaedics, gynaecology, A&E, ITU.

The specialist community public health nursing register is a register for all nurses working in specialist public health nursing and although all will meet the broad standards for registration, not all will use the same skills and competencies, depending on the area in which they work. For further information, contact Liz Plastow at the NMC. Email: liz.plastow@nmc-uk.org

Jacky Martin, learning in practice manager, Primary Care Trusts Learning in Practice, Nottingham Unit (LiPNU) spoke on 'Modernising mentoring: Developing a collaborative team approach to practice teacher roles for specialist community and specialist public health nurses'.

Jacky Martin identified that within the Trent Health Community there needed to be an increase in placement capacity for specialist community nurses (health visitors, district nurses, school nurses and practice nurses) in order to meet future student commissioning numbers. 50k was allocated to each health community within Trent through a non-competitive bidding process. The Trent Health Community 18-month project bid builds on the sterling work already in place across the PCTs where lead specialist nurses already manage the local recruitment, development and support processes as part of existing clinical lead roles.

The steering group, with representation from the University of Derby and senior manager representation from the four Nottingham PCTs has a clear remit of increasing practice placements through identifying and agreeing an exit strategy including on-going funding streams. The project team will investigate and pilot different and more effective methods of mentoring and practice teaching with ideas generated from existing practice teachers through a series of workshops.

This team will also consider recruitment, retention and other issues, which affect capacity for practice education. It is also within the project aims to establish an on-going forum for practice education where issues and ideas can continue to be generated, and also identify and use any potential for interprofessional learning.

Delegates attended a series of workshop events including 'Interprofessional learning' facilitated by Lisa Hughes, director, Creating an Interprofessional Workforce Programme. Alison Higley, practice educator, Amber Valley PCT and Mary Malone, senior lecturer, King's College London encouraged delegates to engage further with the Specialist Community Public Health Nursing Competencies, their implications for practice teaching and to explore new ways of ensuring that specialist public health nurses meet the new public health competencies.

Glenys Hook, senior lecturer in specialist community public health nursing, University of the West of England, facilitated a workshop, 'Developing and designing learning contracts: the assessment of portfolios'. Glenys Hook argued that the assessment of professional practice has occupied educationalists for many years and still poses many questions" in parallel with the debate around enhancement of student learning. Both processes demand on-going assessment and justification11,12 which allows both 'surface' and 'deeper' approaches to learning.13 There is evidence14 that students favour the use of portfolios and that the process of preparing them yields positive feelings.

Learning contracts ('a written agreement between teacher and student which makes explicit what a learner will do to achieve specified learning outcomes')15 form the basis of such assessment and promote learning that is independent, led by discovery and both individualised and professionally grounded. In essence all participants will know what to do.

As Rolfe16 suggested, learning contracts with identified outcomes and competencies can bridge the gap between practice and theory and demonstrate the transference of knowledge. The elements of a learning contract include initial discussion to access prior learning, experiences, identification and agreement of learning needs, competencies and knowledge, assessment methods, map and record activities and roles and responsibilities. All include knowledge, skills, attitudes and values.

Chan and Wai-Tong17 found that the use of contract learning increases student autonomy, sharing between students and assessors and that learning is more meaningful. They do though raise the issue of possible difficulty in forming learning contracts for those not experienced in doing so, whether student or assessor.

Issues to consider include:

* Partnership between the student and the assessor. Self- directed learning requires careful planning, implementatio\n and facilitation with a shift from, initially, a teacher-directed to a student-directed focus. Reece and Walker18 suggest that a good teacher will get a 'feel' for the student's emotional needs, social background and cognitive development. In conjunction with professional and facultative skills, they use this information to assist students to overcome anxiety and help sustain interest and enthusiasm. The skills of the assessor are both catalytic and cathartic with the assessor a role model moving from a transmitter to facilitative style.

* Achievement of learning outcomes and competencies. Action plans developed from learning contracts provide a basis for recording progress and judging the 'readiness' for competencies to be 'signed off. There are a plethora of tools available (including Benner,19 Steinaker and Bell20) which can be used to help the marking process. But still the debate around a 'pass/fail' to 'percentage of overall classification' continues.

Many assessors now contribute on a formal basis to the marking process. The requirements for validity, reliability and consistency can be problematic and call for a rigorous tripartite approach. Compensation cannot be permitted within these programmes and therefore the most solid of partnerships can be threatened when non achievement occurs.

A frequently asked question is around evidence and the amount required. With the use of learning contracts this issue becomes diminished in light of the application and relevance of the information.

Portfolios and learning contracts are set to be used more widely in assessing practice and certainly within the process of migration onto the Specialist Community Public Health Nursing part of the NMC register. The future is also likely to see the development of electronic portfolios where archiving of records and continuous discussion between the student, assessor and academic. Hence, the achievement of the overall aim of specialist practice programmes, 'the development of skills and ability to practice safely and effectively without supervision'.3

References

1 Choosing health: making healthy choices easier. London: Department of Health, 2004.

2 Every child matters: Change for children. London: Department for Education and Skills/Department of Health, 2004.

3 National Service Framework for Children, Young People and Maternity Services. London: Department for Education and Skills/ Department of Health, 2004.

4 Liberating the public health talents of community practitioners and health visitors. London: CPHVA/Department of Health, 2003.

5 Department of Health (2002/2004). Wanless reports.

6 Tackling health inequalities: A programme for action. London: Department of Health, 2003.

7 Skills for Health. National Occupational Standards for Public Health, 2004. www.skillsforhealth.org.uk

8 Promoting Health benchmark (Draft in consultation). London: Department of Health, 2005.

9 Department of Health. Creating a patient-led NHS. London: Department of Health, 2005.

10 Brown N. What are the criteria that mentors use to make judgements on the clinical performance of student mental health nurses. An exploratory study of the formal written communication at the end of clinical nursing practice modules. Journal of Psychiatric and Mental Health Nursing 2000; 7,407-416.

11 Biggs JB. Assumptions underlying new approaches to educational assessment: implications for Hong Kong. Curriculum Forum 1995; 4,2: 1-22.

12 Biggs JB. Teaching for Quality Learning at University. Society for Research into Higher Education. Bucks: Open University Press, 1999.

13 Marton F, Booth S. Learning and awareness. New Jersey: Lawrence Erlbaum Associates, 1997.

14 Tiwari A, Tang C. From process to outcome: the effect of portfolio assessment on student learning. Nurse Education 2003; 23,4: 269-277.

15 Richardson S. Implementing contract learning in a senior nurse practicum. journal of Advanced Nursing 1987; 12,201-206.

16 Rolfe G. Closing the theory-practice gap. Oxford: Butterworth Heinemann, 1996.

17 Chan S, Wai-Tong C. Implementing contract learning in a clinical context: report on a study. Journal of Advanced Nursing 2000; 31, 2: 298-305.

18 Reece I, Walker S. Teaching, training and learning: A practical guide. (4th ed). Sunderland: Business Education Publishers, 2000.

19 Benner P. From novice to expert: Excellence and power in clinical practice. CA US: Addison-Wesley, 1984.

20 Steinaker NW, Bell MR. The experiential taxonomy: a new approach to teaching and learning. London: Academic Press Inc, 1979.

21 UKCC. Fitness for practice. London: UKCC, 1999.

PAULINE BYERS, CPHVA professional officer education and senior lecturer, University of Derby, offers a brief overview of a national CPHVA conference

Copyright TG Scott & Son Ltd. Sep 2005

Source: Community Practitioner

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