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Nursing degrees must be built on communication


So I’m wandering around a department store with my daughter while her mum tries on linen when I find - and I blame bad signposting near hosiery for this - that we have wandered into what I can only imagine to be the menopausal chiffon section.

We made a bolt for freedom but the static nearly dragged us back and we were forced to take shelter in the waiting area with the other viscose survivors. As we entered, a large man with a tiny baby was being told that he had to move his trolley.

‘Why?’ the man said.

‘Health and safety,’ the lady said.

‘What health and safety?’ asked the sweating man, and the baby started crying.

And that was the point when the woman should have said something like: ‘It’s OK, we are told to keep these areas clear but you have more important things to worry about,’ and maybe smiled or perhaps gone with: ‘Trolley schmolley - I’m sorry, have a seat.’

Instead, she went with: ‘It’s health and safety, sir. If you don’t move your trolley, I will have to move it for you.’ There was no smiling.

From there, things escalated quickly. The man became upset. He said: ‘This is discrimination.’ We all watched, trying to guess the form of discrimination he was referring to. Perhaps he thought she was going to stop him from breastfeeding?

The woman muttered the security word.

The man mentioned customer services and complaints. His wife emerged, anxious for his views on what may have been cut-off trousers or ill-fitting shorts. He told her he didn’t care. The baby cried louder. It may have been the shorts. My daughter and I decided the chiffon jungle was a better place to be.

And this was all because of a wrong communication decision.

‘We all watched, trying to guess the form of discrimination he referred to. Perhaps he thought the staff would stop him from breastfeeding?’

You know and I know that nurses make choices about how to communicate dozens of times a day. Sometimes they do it consciously, sometimes as second nature.

Sometimes they do it badly but, even if they do, the good ones can look at how they could do it better afterwards. Couldn’t they?

Understanding how to communicate effectively and skilfully is an interesting kind of ‘knowing’. It’s interesting because of how we know how to communicate and then integrate this into the way we live and work.
And it’s interesting because it is constructed as a body of knowledge in a different way from, say, learning about history or maths or anatomy or drug reactions.

Nursing will be moving to an all-graduate entry profession over the next few years and that may or may not be a good thing.

The requirements of good nursing - the capacity to choose how to communicate, to manage with skill the emotions of others, to reflect and articulate the nuances of human interaction in a constructive and helpful way - must be at the heart of all nursing degrees.

The special requirements of nursing need to be in the design of what a degree is, every bit as much as the standards implicit in a degree will design the future nurse


Readers' comments (7)

  • Why avoid the issue or dress is up as something as off the mark as communication. The quality and depth of nursing education ought not be measured in who communicates best, unless oratry is a fundamental part of our role. You can't intellectualize the science out. It matters not that there is a degree as that degree doesn't say this person knows about the body, illnesses or drugs.

    The profession will rot without diploma students but really it was at least 1/4 dead thanks to well meaning but non-essential clucking from those in a position to influence the direction of nursing. whether we get a diploma a dgree or nothing for doing the training, it matters not because all preceptors rely onthe sparsely valuable moments in clinical practice to make up their knowledge base, not the hyperbolic guff espoused by todays out-dated, out-of context and out-of-the-loop educators of today.

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  • I have just completed a nursing degree (transferring from diploma in the 3rd year to get the vital bursary for as long as possible). Apart from my dissertation (which nearly killed me) and one other small assignment, I did exactly the same work as my diplomate colleages. My degree has given me the ability to sit at the computor for weeks on end completing a 10,000 word paper which no-one will read. The main benefit of this is to be able to critically appraise research, a vital elements of EBP. However, we had already done an assignment on critical appraisal prior to the dissertation. The future plan, as I see it, is to have a glut of nurse researchers and managers, when what is really needed is nurses at the coal face. I did it for me, to know that I could do it, and I'm proud that I did. In hindsight however, I would have been just as proud to gain the Diploma and not had the stress or debt. Diploma nurses to not take different posts to degree registrants on qualification. It may give them a leg-up at promotion but most students aren't thinking about that. They just want to survive the (very tough) course and get going. My feelings are that the diploma course, with full bursary, is what's needed to get the nurse started. Those that aspire to the higher levels of nursing can study when they have earned their 'stripes'.

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  • I observe that with the current entry requirements for a nursing degree I would not be accepted. I have been in nursing now for 27 years. I wonder how all this is meant to make me and all my contemporaries in a similar boat to feel. However, I'm not sure we should worry- seems to me I've heard this "degree-only" mantra before...

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  • I think Mark accurately identified communication as a key tool for all nurses. However, I would have liked to see more on why he felt the degree option may not be the right direction for nursing. Paul Matheson does not need to feel undervalued because he qualified with a diploma. Most clinical psychologist practicing presently do not have the professional doctorate which has now become the minimum requirement for the role.

    Let us look at a few issues. First, clinical skills. Does a degree give you extra clinical skills? There may not be enough evidence to support an answer in the affirmative. But we know that it is not what you have but how you use what you have. Clinical skills alone without critical thinking amounts to practice by rote. A degree teaches you a higher level of critical thinking than a diploma. The exercise of critical essay writing helps to put you in this frame of mind. But then again, that also depends on the student, and how much importance he or she attaches to this teaching. The move towards EBP requires a high level of critical thinking to use, and generate research. This is just a small part of the practice benefits. Let us now look at objective professional value. By this I mean, how we are percieved by other professions. Most if not all the health professions have moved to degree only. The ones that have not are seriously considering it. How can we lay strong claim to professionalism if we do not have our own unique body of knowledge? And how can we generate ths body of knowledge if we do not know how to? How can other professionals take us seriously if they think they have gone through a more rigorous training. How can we have the knowledge and confidence to sit and demand more salary if are not qualified to be paid as much as others? Why should the doctor respect your opinion if he thinks he has a degree and you do not. This may sound hash, but that is the situation on the ground. I respect the opnions of the healthcare assistants that I work with. In fact, I seek it sometimes. But I know that I am speaking strictly for my self in this regard. This does not apply to all everyone I know. We must not kill this initiative for the degree option, it will only bring good things, and those who really want to be qualified nurses will cherish the discipline of a degree programme.

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  • It doesn's seem like lack of communication skills was the problem here. It seems like the problem was lack of consideration or courtesy. I don't think these can be taught in a degree course, if they can be taught at all.
    Tip of the Day: Don't wait until you introduce degree only nursing to find out the effect it has. Go and have a look at some of the countries that have already introduced it. That way you can stop this disaster before it happens.

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  • This type of communication failure comes down to skills training rather than level of education. It is just as important for all 'front of house' staff and is often linked to standards of care maintained by managers and level of morale of staff. Staff need to have the confidence that, if they make a considered judgement which diverges from the 'rule', their managers will back them. Maybe the store had had the equivalent of a Healthcare Commission inspection and the staff didn't dare step out of line in case they failed to meet the set criteria!
    On the education front it is fascinating to see that the argument over level of education still rages. I started training in 1969 (yes, really!) when there were hardly any degree courses. I did a 'shortened' more intensive training completing SRN in just over 2 years. 'Regular' nurses told us it was too much theory & not enough practice & all we wanted to be was high level managers and not nurses 'at the coal face' (sounds familiar?) . Well, at our 10 year reunion, of those working (some were taking breaks for family) all were still in nursing and the majority were in clinical roles.
    The argument has continued through introduction of the diploma (remember Project 2000?) and still continues. Meanwhile the world has moved on. A much higher proportion of the population is educated to degree level - should nursing be left behind? For better or worse, senior roles require degree or masters level education and hundreds of nurses are struggling to reach this level through part time study just to keep their careers going.
    The changes I have seen and had to absorb through my career have required a high level of application, education and adaptability. I believe the critical thinking and level of analysis required at degree level are invaluable in maintaining a forward moving profession.
    The question is not should we be an all graduate profession but how should this be achieved? The 2 main issues seem to be
    a) getting the curriculum right with the right balance of theory and practice to produce practitioners 'fit for purpose'.
    b) getting the funding right. It is tragic that one of the main arguments for not going the degree route is that it does not attract a bursary so is too expensive for many.
    It is essential we resolve these dilemmas if we wish to continue to develop as a profession worthy of respect able to meet the challenges of the future.

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  • Gillian Duncan

    I am a third year mental health nursing student and have found the course tough. The communication and therapeutic relationship are the essentials of nursing, for without these functioning to a good standard, the patient care cannot be delivered, the treatment not accepted and it opens a can of worms.

    We have to learn various models of research illness and other stuff, that does not work for human nature, the models are set in stone (it might work for robots).

    It has to be noted that as humans we are bundle of cells, emotions that change on a daily basis due to our interaction with the environment/people/bio-psycho-social model. Im sure however we came to be created, it was not from a model.

    In conclusion, we are all different, and I agree that communication is the root of good nursing. All the othe stuff like research allows for advances, but where are the studies, if we cannot communicate with the patients to gain their informal consent.

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