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A critical care specialist practitioner programme

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VOL: 96, ISSUE: 39, PAGE NO: 46

Dorothy J. Armstrong, BSc, RGN, MN, is course coordinator, Department of Nursing, Royal Infirmary of Edinburgh

At the time of writing Rebecca Strachan, PhD, MEd, DN, RSCN, RGN, RCNT, RNT, was practice research and development adviser, Department of Nursing, Royal Infirmary of Edinburgh, she is now a freelance writer;at the time of writing Margaret Sibbald, RGN, RM, was service manager, Cardiothoracic Unit, Royal Infirmary of Edinburgh, she is now retired

The need for high-quality, responsive education that prepares nurses for their changing roles has been well documented (Kitson et al, 1997). There has also been increasing political awareness that the availability of experienced, well prepared critical care nurses has been failing to meet the demand. With these facts in mind the Royal Infirmary of Edinburgh has introduced the first trust-led accredited specialist-practitioner programme in Scotland.

The need for high-quality, responsive education that prepares nurses for their changing roles has been well documented (Kitson et al, 1997). There has also been increasing political awareness that the availability of experienced, well prepared critical care nurses has been failing to meet the demand. With these facts in mind the Royal Infirmary of Edinburgh has introduced the first trust-led accredited specialist-practitioner programme in Scotland.

The Royal Infirmary, which is part of Lothian University Hospitals NHS Trust, is an acute regional specialist and general service provider that meets the health care needs of the population of Edinburgh and south-east Scotland.

The trust has an international reputation for teaching and research and for its proactive nurse-education initiatives, which contribute to a high standard of patient care across the general and specialist care settings.

The trust provides a broad range of specialist services, which include liver and renal transplantation, general intensive care, cardiology and cardiothoracic surgery.

Background to development of the critical care programme
The boundaries between the roles and responsibilities of doctors and nurses continue to change. This has been highlighted in the UKCC's Scope of Professional Practice (UKCC, 1995) which could be described as a liberating tool, enabling nurses to assume their legitimate role in practice.

Similarly, the demands placed on nurses in critical care requires the facilitation of robust programmes of education to meet the changing dimensions of partnerships in care, as medical and nursing staff work together ever more collaboratively.

The specialist courses available to nurses within the trust were provided by the University of Edinburgh's faculty of health through professional studies modules. However, these modules did not provide the opportunity to develop critical care knowledge and practice to the level required by the changing needs of the service. In addition, it was clear that nurses wishing to specialise in critical care also wanted to progress along an accredited educational route gaining a recognised academic award combined with clinical practice.

The Practice Research and Development Unit undertook a needs analysis to identify the demand for specific critical care education and to seek nurses' views about their expectations of courses in the future. In addition, it examined the views of service managers and the cost implications.

The planning stage
Having decided that a new critical care course was both viable and desirable, a team was formed to take the course to the stage of implementation.

Representative staff from each critical care area joined the practice research and development adviser and the lead service manager to plan the content of the course. The service manager had a specific remit, which proved invaluable in the anticipation of organisational, contractual and budgetary issues, which needed to be addressed proactively.

The course's rigorous curriculum-development phase required dedicated time and a high level of commitment from the planning team. Help and advice was available from National Board for Nursing Midwifery and Health Visiting (Scotland) and from the academic partner - the University of Edinburgh.

The course was designed and planned in the same way as any higher education course in the prevalidation phase. The appointment of an internal board of studies and an external examiner completed the initial stages of course preparation.

The first course was scheduled to begin in January 1998. Approval to offer the Specialist Practitioner Course in Critical Care Nursing, was granted by the Scottish National Board in October 1997. The course was also awarded a postgraduate certificate (SM level - 60 ScotCAT points) by Edinburgh University.

Philosophy
The course aims to equip nurses with the necessary knowledge and expertise to lead critical care nursing into the 21st century by:

- Providing a responsive programme shaped and supported by practitioners;

- Emphasising an integrated approach to clinical practice and education;

- Enhancing the patient-focused values of compassion and caring;

- Developing the clinical nursing leaders of the future;

- Focusing on evidence-informed practice and innovative nursing care.

Course implementation
Having appointed the nurse teacher responsible for the day-to-day running of the course, the planning phase was well under way. Timetables, lectures and tutorials had to be set.

The advantage of being a trust-led course was that the expertise of trust staff could be used. This meant there was a huge variety of lectures which were of a high standard. Speakers included nurse specialists, clinical managers, medical staff and the professions allied to medicine. As the classrooms were on site, invited lecturers found access easy and were keen to be involved at the outset.

Clinical placements
Students were allocated three six-week clinical placements. During the clinical placement students were assigned a clinical superviser who was responsible for negotiating their learning outcomes and offering general support.

Students were encouraged to assume ownership of their learning with facilitation offered by clinical staff and an academic superviser. A series of clinical supervision workshops was planned to provide the information and set the framework for this initiative. In addition, the nurse teacher visited the students on placement to offer clinical guidance and support.

Each of the critical care areas had a designated education coordinator who also assumed an active role in facilitating learning.

Progress of students
All 12 students brought quite diverse academic backgrounds to the course and were experienced critical care nurses in their chosen fields. Initial assignments highlighted the varying abilities of the students. However, as the students progressed through the programme, their ability to challenge and analyse the literature and apply evidence to clinical practice improved.

Because one of the aims of the programme was to create the leaders of the future, course content included core management skills, such as communication and team building, leadership, motivation and coaching and managing change.

Elective placement
During the second semester, students were given the opportunity of planning a three week-elective placement to a critical care environment outside their own clinical area. Part of the whole learning experience was preparing and planning for the trip and applying for funding. Students visited hospitals in the UK and abroad including north America, South Africa and Australia. On completing their travels, each student submitted a written report and a study day was organised to share highlights with colleagues.

Assessment
Because of the clinical nature of the course, equal weighting was applied to practice and academic work. All the students met their clinical outcomes and were successful in meeting the academic requirements of the programme.

Methods of assessment varied and included a patient-care study, examinations, essays and a dissertation. A number of students are now being encouraged to publish their work and others are using their dissertations as a ward learning resource.

Quality assurance
Considerable attention was paid to ensuring there was a robust internal system of quality assurance that would meet rigorous external criteria. We are continuing to improve the course. Having completed the first programme, the external examiner and the higher education establishment with whom we are working are satisfied with course standards.

Continuing professional development: the way forward
A descriptive study is currently being completed to evaluate the impact of the course on nursing practice. The study explores the perceived impact that completing a postgraduate course has on the experiences of the student and on their clinical colleagues.

We will observe with interest and enthusiasm the progress of the first and subsequent groups and continue to offer this innovative educational opportunity for the critical care nurses of the future.

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