Post-graduate initiatives in pre-registration nursing education: a case study in curriculum development

NurrrEduation

Today (lY90) 10,46&469 ~LongmanGroupUKLtd 1990

02606917/90/0010-04641510.00

WORK Post-graduate initiatives in pre-registration nursing education: a case study in curriculum development David J Carpenter

The author traces the development of plans to provide special schemes of training for graduate recruits to a Project 2000 course. The plans are shown to be founded in earlier curriculum development associated with the 1982 syllabus for mental nursing. This paper was presented with those previously published on Project 2000 initiatives in the Network section of the journal (Volume 10 Number 5 October 1990 pp380-397).

INTRODUCTION It is desirable to encourage a wide range of recruits into pre-registration nursing training including those with graduate backgrounds who bring a wealth of experience and expertise to the profession. Special provisions for graduates are being developed in Portsmouth School of Nursing which is a Project 2000 demonstration district. The development of these provisions will be traced from earlier curriculum innovation which provided an ideal background for the new initiatives. The project will be discussed as a case study in curriculum development which undoubtedly demonstrates the benefits of relationships between the school of nursing and the polytechnic. The study begins with a description

David J Carpenter MA (Med Ethics/Law) BA (Phil) RMN RGN RNT Senior Tutor (Mental Health), Portsmouth District School of Nursing/Associate School of Health Studies, Portsmouth Polytechnic, Portsmouth (Requests for offprints to DC) Manuscript accepted July 1990 464

of the school’s response to the 1982 syllabus for mental nursing; this response proved to be the basis of much further curriculum development including schemes for graduates.

BACKGROUND The publication of the syllabus of training for Mental Nurses in 1982 afforded a major opportunity for curriculum planners. Psychiatric nursing skills were clearly listed and categorised and a comprehensive knowledge base identified. Although the syllabus was welcomed it offered little help in respect of pragmatic organisational difficulties which have challenged nurse teachers for many years, particularly those problems associated with ward allocation. ‘Peaks and troughs’ of numbers of students allocated to individual wards had been identified as a major problem for those endeavouring to care maintain consistent and continuous commensurate with an adequate establishment of staff; other wards and clinical services were deprived of students on the basis that they were

NURSE EDUCATION

not accorded training status. Almost all students bemoaned the fact that, all too often, they were just at the point of effectively using well developed nurse-patient relationships when the period of allocation ended. Opportunities to develop real client centredness were clearly being thwarted by allocation systems as evidenced by the many requests made by students to continue working with an individual client. Although well conceived ward allocation plans had been seen as essential to modular approaches to nursing education attempts to realistically link theory and practice were often far from successful. It was clear that established structures within psychiatric nursing curricula required radical revision and we decided to respond to this need. The finer details of these revisions are not relevant to this paper but many of them facilitated the post-graduate initiative and should therefore be examined from this perspective. Modular schemes of training were abandoned in favour of a spiral curriculum utilising nursing skills identified within the syllabus as recurrent themes. It was also established that theory and skill acquisition should predominate at the beginning of training allowing well founded practice development later. It seemed obvious that practice should be limited according to the skills and knowledge of the student at any point in time if the risks of trial and error learning were to be avoided. This end was achieved by planning a gradually reducing theory content; in the earlier stages of training students would spend all of their time classroom based or under direct supervision whilst their school contact would be reduced to only half a day each fortnight in the later stages. In utilising this simple organisation we ensured that students would maintain a constant contact with the school of nursing as opposed to experiencing alternating ‘relegations’ to school and wards with consequent lack of continuity. A further considerable advantage gained was that in-depth study could be maintained without interruption allowing a truly education driven approach to nurse training. Practical experience was planned on the basis of students gaining an increasing case load of clients whilst being clinically supervised by

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specially prepared first level nurses throughout training. Case loads were planned to increase in of clients, range of respect of number specialisms and level of responsibility for care. Accountability was clearly identified as the prerogative of the first level nurse ultimately responsible for each individual client. Following these revisions in curricular structure it became clear that the students would necessarily achieve supernumerary status whilst nevertheless making a meaningful contribution to the nursing care of clients. The overall result was an established curriculum structure which was sufficiently flexible to permit further development including modifications to take into account the interests and needs of graduate recruits.

DEVELOPMENT OF THE RMN/MA (MENTAL HEALTH STUDIES) COURSE Relationships between the school of nursing and Portsmouth Polytechnic had been established for some time before a group was convened to consider joint ventures at sub-degree, graduate and post-graduate levels. At that time Porject 2000 had not been published though some of the earlier papers were available. After careful consideration the Mental Health Team resolved to pursue the possibility of developing an integrated RMNlMasters degree course designed with the graduate recruit in mind. Our venture could easily be seen to be facilitated by the nature of the curriculum at that time and the knowledge bases offered within the 1982 syllabus. There had been an increasing number of graduates applying for psychiatric nursing training and we were anxious to make some special provision for them thus acknowledging previously obtained knowledge and experience. We were not experiencing any particular difficulties in maintaining full recruitment though we were aware of demographic trends and the consequent need to direct recruitment strategies towards groups other than the more typical 18-year-old school leavers. The obvious advantages to be gained by attracting more mature candidates also featured

466

NURSE EDUCATION

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highly in our deliberations. be some evidence psychology,

and social sciences

vocational’

element

influenced

subject

disappointed

appeared

to

validating

particularly

in

accredited

had perceived

a

There

that graduates,

choice

It seemed at

nursing

to these graduates.

could be

The challenge

to develop

a course which would permit development

of

previous

enabling

was

exten-

learning

professional

edu-

curriculum

were restruc-

of a masters

degree

in

Mental Health Studies. Given the substantial knowledge base of the 1982 syllabus (1) it was not difficult

to construct

sufficient

breadth

extension

of,

exclusively,

a masters degree

a

example,

psychology

though

or

social

not science

degree. The extension was founded upon both the novelty of the subject material and its special application

within

the study of mental

health

issues. Proposals

for the integrated

course were well

received by the group established joint school of nursing/polytechnic and a curriculum comparatively

was produced

of the masters degree

RMN course

integration

rather

and separation

for stand

of for

years plus

alone,

part-time

The length of the course demonstrated of the advanced

the minimum

fessional

training

‘additional’

work

academic

prescribed for

longer

period

graduates

entailed

standing of pro-

given

in studying

the for

a

Masters degree.

MA IN MENTAL HEALTH STUDIES - SUMMARY OF STRUCTURE Part 1 - leading to a post-graduate Mental Health Studies All students

paradoxically,

both

and it became

clear

for other students, including qualified psychiatric nurses, who perhaps trained under less ambitious syllabuses. In developing a new curriculum for pre-registration training a much welcomed for all opportunity qualified professionals in the mental health services also ensued. course was well received by both

in

take:

ductory course on: Community tal Illness policy;

b)

Care, Men-

and the development

of social

for most of the year, two major courses on: Social Policy, Mental munity;

Illness and the Com-

Management

and

Planning

in

Mental Health Care;

c)

for

the

final

concluding Mental policy.

that the degree would be part of the RMN course be the case. The separability of the degree from the pre-registration professional training meant that it could be offered as a ‘stand alone’ course

certificate

4 for the first part of the year a short intro-

albeit taught in more depth than normally would

The complete

and 2 academic

recruits but was nevertheless

the degree

syllabuses were based on the prescribed areas of study within the RMN syllabus. It was this that ensured,

period

length

recognition

to promote initiatives

to allow for the integration as, effectively,

students

The

as 133 weeks

of potential

and validated

quickly. The current

was readily modified

feature

RMNIMA dissertation students.

procedures.

was established

course of

and depth to permit a logical for

validation

the course

than

as the syllabuses

of

inter-

separate

which had

sion

tured

their own particular

had been

that psychiatric

Parts of the existing

as an

of career

following graduation.

whilst simultaneously cation and training.

course, each retained

-

though,

a dearth

least possible

and

of the CNAA)

yet many

studies

opportunities attractive

institution

ests and concerns. Conjoint validation was not available at that time, there were, therefore, two

to their

to discover

bodies (ENB and Polytechnic

part

course

Illness

Part 2 - leading

and

of

the

year,

a short

on: Community the

future

to a post-graduate

Care,

of social

diploma

in

Mental Health Studies All student take:

4 for the first two terms: Advances in the Psychology Health and Disorder;

b)

of

Mental

Contemporary Issues in Mental Preparation for Research;

Health

for the final term:

NURSE EDUCATION

c) All students also choose one of the following options: Ethics, Law and Mental

Illness

to MA in Mental

Health

Studies All

students

write 2 000 words.

10 000-l

dissertation

a

of

integrated

RMNIMA

end

a

but

approaches obvious.

new

The RMNIMA Course had been established for only 1 year when Portsmouth School of Nursing, commenced

Portsmouth

as a Project

In theory

had achieved

to

areas

this

develop

similar

of nursing

became

with distinctions

and qualification.

between

regist-

It was contended

that

nursing had been disadvantaged in comparison with other professions by making no provision

NEW DEVELOPMENTS

district.

Course need

in other

that concerned

with

was that widening

The RMN/MA Course had helped in resolving an anomalous situation in nursing education; ration

in conjunction

perception

of obvious attraction to those with far more than the basic educational entry qualifications. The

Power and Expertise.

Par1 Three - leading

Our

entry gates clearly allowed for moving both ‘gate posts’, thus justifying increased access to courses

Psychopharmacology Professional

standards.

467

‘TODAY

Polytechnic,

2000

should

identification

of qualification

This anomaly

could be readily

identified

by contemplating

the circumstances

a person whose registration

demonstration

the RMN/MA

for the separate and registration.

have

nothing

to show

for

of

has lapsed, left with

the examination

passed

been discontinued since it led to registration on part 3 of the professional register not part 13; in

following a considerable period of study. It might well be argued that this situation casts

fact,

some doubt in respect of the justice

this

measure

would since

established

clearly the

example

have

been

RMN/MA

a foolish

Course

was an

of many of the desirable

nuation

of

registration

either

of discontithrough

failure to pay fees or failure to maintain

the

skill and

principles adumbrated within Project 2000. Special dispensation to continue the course for a

knowledge. The MA qualification might be seen as a forerunner to the DipHE qualification

further

in the light of

associated

2000 was gained. The modification a pressing matter but, equally, it was

addressed

Project became

year to allow modification

agreed that it should address the development post-graduate

been specified

within a recent

Regulations had largely

statutory

Project

instru-

Although

the school

of nursing

technic had been more curriculum development

gramme could be undertaken months whilst a full branch

on Masters

in a minimum of 6 should follow. It

that responsibility

for

ascertaining suitability of degrees has been given to the national boards and clear advice is still awaited. Motivation

to develop post-graduate

in so far

pathways

degree

and the Poly-

than fully occupied by for Project 2000, work

initiatives

had not ceased.

The MA in Mental Health Studies and a similar degree in Mental Handicap Studies had been successful

and

stirred

futher professionally courses. The Centre

interest

in developing

orientated post-graduate for Post-Graduate Pro-

fessional Studies was established

within the Poly-

within all branches was somewhat enhanced by continued emphasis upon ‘widening entry

technic with post-graduate

gates’. Some,

from a range of backgrounds including social services and the Police. These

in recognition this

emphasis

perhaps

inappropriately,

of potential

perhaps

political motives saw

as an attempt

to lower

as it

anomaly.

RESPONDING TO NEW DEVELOPMENTS

ment stating that, in the case of graduates in suitable subjects, the common foundation pro-

should be noted, however,

2000

of

pathways within all four branches

not just the mental health branch. appertaining to such developments

with

the aformentioned

entry

the aim of developing further opportunities for professionals

tunities included

health, oppor-

both taught Masters degrees

as

468

NURSE EDUCATION TODAY

GENERAL

COURSE

STRUCTURE

SPECIALIST Year One

Year One : Professional

and Ysnagement

PATHWAYS

STRUCTURE

:

Studies

Professional

and blonagement

Studies

OptIon One - ONE J+rXXn:

Option One (from General Options)

Age And Ayeirty Post-Graduate

Certilicstc

Cmnllaunify

IIeullh Sludior

Cri7ne. Police And Socwfy Year

lb0

: Proiessional

and Management

Option Two (from General Options) Research

Posl-Graduate

Studies Year

Two

:

Training

Prolessional

Post-Graduate Three

and Management

Studies

Option Two (from Gcner@ Options)

Diuloma

Research Year

Certificate

Training

:

Post-Graduate Diploma Thesis

I

Year

Thee I

: Thesis (within ares ol specialism)

1 MSc in PROFESSIONAL AND POLICY STUDIES

General

Options

MSC in PROFESSIONAL STUDIES

f Education Policy And The Shale 2 i’ohy. Inequality And Urban Chanye 3 Age And Agoing

:

(specialism’)

4 Commw~ity Health Studies 5 C?imc. Police And Sociely

Figure

well

as

the

research.

The

included

facilitation

and

supervision

centre’s

planning

team,

members

from

three

ments of the polytechnic school

of health

of

which

schools/depart-

as well as the associate

studies

(school

of nursing),

developed an MSc in Professional and Policy Studies. The interesting feature of the new degree

was

its

modular

structure

allowing

students to ‘package’ courses according to personal and professional interest. The range of packages permitted

and routes through the following

various

potential

pathways

outcomes:

1. MSc Professional and Policy Studies Studies (Community 2. MSc Professional Health) 3. MSc Professional Studies (Age and Ageing) 4. MSc Professional Studies (Crime, Police and Society)

The structure of the degree is summarised in the Figure. The degree was validated as a ‘scheme’ rather

than a specific

further

development

Mental

Health

Studies

auspices of the centre

course,

thus permitting

and extension.

The

MA

was brought

under

the

and, in part, linked with

the MSc though its unique identity was retained. The MSc was developed as a part-time degree aimed at experienced and qualified professional practioners; however, develop

its afforded further

unique

modular

structure,

excellent opportunities to pre-registration nursing

*If students select specialist pathways within the modular degree they will be able to gain a degree reflecting the specialism, for example, MSc in Professional Studies (Age and Ageing). The range of

potential specialisms can be readily increased by adding further course modules to the overall MSc Structure.

NURSE EDUCATION

schemes with integrated Masters degree studies for graduates by creating new modules and new pathways. It was apparent that some of the existing pathways could equally be attractive and relevant to students pursuing the adult branch and that the branch could be readily designed to take into account the content of the MSc. The potential for new course development, however, remains. Plans are now well-advanced for graduate pathways leading to all four branches of nursing following a specially designed 6-month common foundation programme which will have flexible content though it will be nursing orientated and have the facility to respond to varying needs to the students according to the subject matter of their previous degree courses. Whilst undertaking the CFP all students will pursue concurrent but integrated Masters degree studies centred around professional, policy and managerial issues. Following the CFP students will be able to pursue the branch of choice whilst continuing with Masters degree studies designed in conjuction with the particular branches. Potential qualifications on completion of the course will include: RN mental Health + MA in Mental Health Studies RN Mental Handicap + MSc in Mental Handicap Studies RN Adult + MSc in Professional and Policy Studies*

4. RN Child + MSc in Professional Studies* These plans will be subjected near future.

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469

and Policy

to validation

in the

CONCLUSION It is hoped that the special provisions being developed for graduates to undertake professional training will be successfully validated. The integrated RMN/MA Course has proved to be successful and we look forward to similar success across all branches of nursing. Finally, it should be noted that the school of nursing is indebted to colleagues within the Polytechnic who have shown considerable creativity in responding to the academic needs of members of the nursing profession and those in training. This case study reflects the benefits of partnership.

References General Nursing Council for England and Wales. Training Syllabus, Register of Nurses, Mental Nursing. London: GNC, 1982. United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Project 2000 Portsmouth Polytechnic. MA in Mental Health Studies. Extracted form course documentation Nurses, Midwives and Health Visitors (Training) Amendment Rules 1989 Portsmouth Polytechnic. MSc in Professional and Policy Studies. Extracted from course documentation.