Major review of healthcare programmes
The Department of Health, in partnership with the Nursing and Midwifery Council, the Health Professions Council and the Strategic Health Authorities have contracted with the Quality Assurance Agency for Higher Education (QAA) to carry out reviews of all NHS-funded healthcare programmes in England during the period 2003-06.
QAA helps to provide public assurance that the quality and standards of higher education are being safeguarded and enhanced by conducting academic reviews of higher education provision.
Major review
Major review is a peer review process. It starts when higher education institutions in partnership with their commissioning Strategic Health Authorities evaluate their provision in a self-evaluation document. This document is submitted to QAA for use by a team of academic and practitioner reviewers who gather evidence to enable them to report their judgements on the academic and practitioner standards and the quality of learning opportunities. Review activities include meeting academic and clinical staff and students, scrutinising students' assessed work, visiting practice learning environments, reading relevant documents, and examining learning resources.
Full details of the process of major review can be found in the Handbook for major review of healthcare programmes, 2003.
Judgements
The range of judgements that reviewers may utilise when they have completed a major review are summarised below.
Academic and practitioner standards
Reviewers make one of the following judgements on standards:
- confidence, which may be expressed as
- limited confidence, or
- no confidence.
To reach this judgement, reviewers look at:
- learning outcomes
- the curriculum
- student assessment
- student achievement.
Confidence in academic and practitioner standards: a judgement that is made if reviewers are satisfied with current standards and with the prospect of those standards being maintained into the future. A judgement of limited confidence is made if standards are being achieved but the reviewers have doubts about the ability of the HEI and partner placement providers to maintain them into the future.
No confidence in academic and practitioner standards: a judgement that is made if arrangements are inadequate to enable standards to be achieved or demonstrated. If a failure to achieve standards has occurred in specific programme/s and/or mode/s and/or level/s only, and there is confidence in standards at other levels, the failing programme/s mode/s level/s will be identified separately.
Quality of learning opportunities
Reviewers make one of the following judgements for each of three elements of learning opportunities:
- commendable
- approved
- failing.
The three elements of quality of learning opportunities are:
- learning and teaching
- student progression
- learning resources and their effective utilisation.
Maintenance and enhancement of standards and quality
Reviewers also report the degree of confidence they have in the providers' ability to maintain and enhance quality and standards in the healthcare programmes under review.
Commendable - the provision contributes substantially to the achievement of the intended outcomes, with most elements demonstrating good practice.
Approved - the provision enables the intended outcomes to be achieved, but improvement is needed to overcome weaknesses. The summary report will normally include a statement containing the phrase 'approved, but...', which will set out the areas where improvement is needed.
Failing - the provision makes a less than adequate contribution to the achievement of the intended outcomes; significant improvement is required urgently if the provision is to become at least adequate.
Summary of the main review outcomes
Subject provision and overall aims
Programmes in health visiting, midwifery and nursing at Anglia Ruskin University in partnership with Essex Strategic Health Authority and North East London Strategic Health Authority were reviewed in the academic year 2005-06. Judgements were made about the academic and practitioner standards achieved and the quality of the learning opportunities provided.
The review covered the following programmes:
Health visiting
Pre-registration
- BSc (Hons) Community Specialist Practice (Public Health Nursing - Health Visiting) **
- Postgraduate Diploma Community Specialist Practice (Public Health Nursing - Health Visiting) **
Midwifery
Pre-registration
- BSc (Hons) Pre-registration Midwifery (86 week) **
- BSc (Hons) Pre-registration Midwifery (156 week) **
- Diploma of credit Return to Professional Practice (Midwifery) **
- DipHE Extended Flexible delivery (four years + 10 weeks, part-time) **
Post-registration
- Diploma of credit Examination of the Newborn
- Diploma of credit Special and Intensive Care of the Newborn - Long Programme
Nursing
Pre-registration
- BSc (Hons)/DipHE Nursing (Adult*, Child*, Learning Disabilities, Mental Health) - 2000 curriculum **
- BSc (Hons)/DipHE Nursing (Adult*, Child*, Learning Disabilities, Mental Health) - 2005 curriculum **
- DipHE Registered Nurse (Adult *, Child *, Learning Disabilities, Mental Health) **
- Diploma of credit Return to Professional Practice (Nursing)
Post-registration
- MA Learning and Teaching (NMC component) **
- MA Mental Health
- MSc Child and Adolescent Mental Health
- MSc Community Specialist Practice
- MSc Public Health
- BSc (Hons) Child and Adolescent Mental Health
- BSc (Hons) Cognitive Behavioural Therapy
- BSc (Hons) Health and Social Care
- BSc (Hons) Learning Disability Studies
- BSc (Hons) Palliative Care
- BSc (Hons) Community Specialist Practice (Community Children's Nursing, Community Learning Disability Nursing, Community Mental Health Nursing, Community Nursing in the Home-District Nursing, General Practice Nursing, School Nursing) **
- BSc (Hons) Specialist Mental Health Practice **
- BSc (Hons) Specialist Nursing Practice (Adult) **
- BSc (Hons) Specialist Practice (Accident and Emergency Care, Anaesthetics and Theatre Care, Burns and Plastic Surgery Care, Coronary Care, Critical Care, Elderly Care, Intensive Care, Medical Care, Oncology Care, Orthopaedic Care, Stroke Care, Surgical Care) **
- Postgraduate Diploma Community Specialist Practice (Community Mental Health Nursing, Community Nursing in the Home - District Nursing, General Practice Nursing, School Nursing)
- Diplomas of credit (Care of the Patient Having Chemotherapy, Cognitive Behaviour Therapy, Cosmetic Surgery, Day Care Surgery, Extended Independent and Supplementary Prescribing for Nurses, Health and Social Care of the Elderly, Holistic Care at the End of Life, Introduction to Gastrointestinal Nursing and Endoscopy, Mentorship in Public Services, Prevention and Management of Violence and Aggression, The Promotion of Continence and the Management of Incontinence, Therapeutic Interventions in Diabetic Management, Tissue Viability Care, Updating Clinical Practice in Infection Control)
* Programmes that have been monitored for the Nursing and Midwifery Council (NMC) through major review
** NMC approved programmes
Academic and practitioner standards
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in health visiting, midwifery and nursing at Anglia Ruskin University in partnership with Essex Strategic Health Authority and North East London Strategic Health Authority.
Strengths
- The currency of the health visiting programmes has been successfully enhanced by the contribution of service colleagues through monthly practice development meetings with Institute of Health and Social Care health visiting staff (paragraph 7).
- Health visiting students present a community profile to their mentors/community practice teachers and managers, providing evidence of currency and reference to NMC requirements (paragraph 7).
- The midwifery practice educators support both mentors and students in practice, significantly contributing to the rigour of the assessment process, in particular, inter-rater reliability. This role is highly valued by mentors and students (paragraph 22).
- In the new pre-registration nursing curricula (2005), students are now placed in branch-specific, inquiry-based learning groups, with each module having a trigger scenario which focuses on a different branch of nursing and is led by the relevant branch module leader (paragraph 30).
- To facilitate prospective clients/patients being at the centre of the student's learning experience, service users and carers are increasingly involved in the development of all the nursing curricula. This is particularly strong in the pre and post-registration mental health programmes, where expert patients enhance the curricula (paragraph 30).
- Post-registration programmes are strongly aligned with the needs of the stakeholders. This collaborative nature of short-course and award-based developments is enabled by the University's ability to fast-track modules through academic regulations and validations without compromising the quality of the modules or awards (paragraph 31).
- The practice educator facilitators provide effective support to practice mentors in their assessment role to enhance the rigour of the assessment process (paragraph 35).
Weaknesses
- Health visiting students on both programmes find that the handwritten feedback on assignments can sometimes be difficult to read (paragraph 10).
- New mentors and students in year one of the BSc (Hons) 156-week programme and on the first part of the BSc (Hons) 86-week programme, in midwifery practice placements visited by the reviewers, were uncertain about the process for negotiating the learning contracts based on the intended learning outcomes (paragraph 14).
- Some written feedback on student work in pre-registration nursing can be difficult to read (paragraph 34).
Quality of learning opportunities
Learning and teaching
The quality of learning and teaching is commendable.
Strengths
- A system of seconded practitioner appointments is in operation, which successfully introduces practitioners to classroom teaching while ensuring contemporary practice knowledge underpins learning and teaching (paragraph 40).
- Staff research directly influences learning and teaching, especially in mental health (paragraph 41).
- A jointly-funded interprofessional education project between the University and the Essex Strategic Health Authority forms part of a long-term strategy (paragraph 42).
- The review of the postgraduate Advanced Practitioner programme has resulted in a collaborative care module open to different groups of professionals, an approach which is welcomed by practice staff and current master's students (paragraph 42).
- Practice educator facilitators and practice educator midwives work effectively with the University and the placement providers to manage placement capacity and to support mentors in practice settings. As such, they are very 'visible' in the practice areas and are appreciated by students and employers alike (paragraph 43).
- There is strong support from the Essex Strategic Health Authority to help manage the placement of pre-registration nursing and midwifery students and to introduce a new placement strategy to maximise the placement availability (paragraph 46).
Good practice
- The strategic development, implementation and rigorous evaluation of inquiry-based learning are outstanding features of learning and teaching (paragraph 39).
- Student conferences have been successfully introduced, initially in pre-registration child and learning disabilities nursing (paragraph 41).
Weaknesses
- It was not possible to establish how the central database reflected what was on the local Trust-managed databases, as the University's system is not yet fully operational (paragraph 45).
- Some placement staff stated that they do not receive formal feedback on the quality of opportunities for learning and teaching following student placements (paragraph 46).
Student progression
The quality of student progression is commendable.
Strengths
- The flexible delivery option for the DipHE Registered Nursing pathway, of four years and 10 weeks, is very popular in areas with high populations of families with young children and strengthens the widening participation strategy (paragraph 49).
- External examiners, students, practitioners, and the NMC commented on the network of practice educators across the provision, which provides excellent support to students while they are in placement settings (paragraph 52).
- In all aspects, support for student progression on the campus and in placements is well organised, effective and appreciated by students (paragraph 53).
Weaknesses
- Although the current pre-registration nursing student handbooks are highly informative, they include a few outdated references (paragraph 51).
- Withdrawal rates for the BSc (Hons) Nursing are high at an average of 24 per cent for the last three cohorts (paragraph 54).
Learning resources and their effective utilisation
The quality of learning resources and their effective utilisation is commendable.
Good practice
- To ensure that all staff members utilise the resource effectively to facilitate learning, all tutors are required to undertake a module focused on on-line learning materials and the use of the University's virtual learning environment, to ensure that high-quality resources are developed (paragraph 60).
Maintenance and enhancement of standards and quality
Strengths
- Annual monitoring reports pay close attention to the enhancement of the provision (paragraph 61).
- The reviewers regarded the relationship between the Institute of Health and Social Care and the Strategic Health Authorities as highly collaborative and supportive to ensure the ongoing enhancement of the provision (paragraph 63).
Weaknesses
- External examiners often lack sufficient information to be able to comment, or just do not comment, on the organisation and delivery of the practice experience in their reports (paragraph 61).
- Many of the audit reports for placements seen by the reviewers did not include action plans (paragraph 63).
Introduction
1 This report presents the findings of a review of the academic and practitioner standards achieved, and the quality of the learning opportunities provided, in health visiting, midwifery and nursing programmes at Anglia Ruskin University (the University) in partnership with Essex Strategic Health Authority (ESHA) and North East London Strategic Health Authority (NELSHA). The review was completed during the academic year 2005-06. The partnership comprises the Institute of Health and Social Care (IHSC) at the University and the ESHA and NELSHA, and other health and social care providers from the statutory, voluntary and independent sectors. The ESHA and NELSHA serve a geographical area that incorporates parts of North East London, the Thames Gateway and large urban centres such as Chelmsford, as well as rural communities. The IHSC was established in 2005 following the re-organisation of the University, and is an amalgamation of the pre-existing Schools of Health Care Practice and Community Health and Social Studies and the Health Business Centre. The Institute operates from two campuses, Chelmsford and Cambridge, with some provision in Basildon, Southend, Harlow and Colchester. At the time of the review, there were approximately 1,626 pre-registration and midwifery students and 419 full-time equivalent students on the post-registration pathways, a total registration of 5,000 students.
A Subject provision and overall aims
2 Health visiting, midwifery and nursing are currently offered in the following programmes:
Health visiting
Pre-registration
- BSc (Hons) Community Specialist Practice (Public Health Nursing - Health Visiting) **
- Postgraduate Diploma Community Specialist Practice (Public Health Nursing - Health Visiting) **
Midwifery
Pre-registration
- BSc (Hons) Pre-registration Midwifery (86 week) **
- BSc (Hons) Pre-registration Midwifery (156 week) **
- Diploma of credit Return to Professional Practice (Midwifery) **
- DipHE Extended Flexible delivery (four years + 10 weeks, part-time) **
Post-registration
- Diploma of credit Examination of the Newborn
- Diploma of credit Special and Intensive Care of the Newborn - Long Programme
Nursing
Pre-registration
- BSc (Hons)/DipHE Nursing (Adult*, Child*, Learning Disabilities, Mental Health) - 2000 curriculum **
- BSc (Hons)/DipHE Nursing (Adult*, Child*, Learning Disabilities, Mental Health) - 2005 curriculum **
- DipHE Registered Nurse (Adult *, Child *, Learning Disabilities, Mental Health) **
- Diploma of credit Return to Professional Practice (Nursing)
Post-registration
- MA Learning and Teaching (NMC component) **
- MA Mental Health
- MSc Child and Adolescent Mental Health
- MSc Community Specialist Practice
- MSc Public Health
- BSc (Hons) Child and Adolescent Mental Health
- BSc (Hons) Cognitive Behavioural Therapy
- BSc (Hons) Health and Social Care
- BSc (Hons) Learning Disability Studies
- BSc (Hons) Palliative Care
- BSc (Hons) Community Specialist Practice (Community Children's Nursing, Community Learning Disability Nursing, Community Mental Health Nursing, Community Nursing in the Home-District Nursing, General Practice Nursing, School Nursing) **
- BSc (Hons) Specialist Mental Health Practice **
- BSc (Hons) Specialist Nursing Practice (Adult) **
- BSc (Hons) Specialist Practice (Accident and Emergency Care, Anaesthetics and Theatre Care, Burns and Plastic Surgery Care, Coronary Care, Critical Care, Elderly Care, Intensive Care, Medical Care, Oncology Care, Orthopaedic Care, Stroke Care, Surgical Care) **
- Postgraduate Diploma Community Specialist Practice (Community Mental Health Nursing, Community Nursing in the Home - District Nursing, General Practice Nursing, School Nursing)
- Diplomas of credit (Care of the Patient Having Chemotherapy, Cognitive Behaviour Therapy, Cosmetic Surgery, Day Care Surgery, Extended Independent and Supplementary Prescribing for Nurses, Health and Social Care of the Elderly, Holistic Care at the End of Life, Introduction to Gastrointestinal Nursing and Endoscopy, Mentorship in Public Services, Prevention and Management of Violence and Aggression, The Promotion of Continence and the Management of Incontinence, Therapeutic Interventions in Diabetic Management, Tissue Viability Care, Updating Clinical Practice in Infection Control)
* Programmes that have been monitored for the Nursing and Midwifery Council (NMC) through major review
** NMC-approved programmes
3 The IHSC states that its overarching aim is to provide high-quality and professionally-approved education and training that is intended to directly benefit patients, clients, users and carers and is responsive to local needs and national initiatives by:
- developing students' knowledge, values, conceptual understanding and skills, appropriate to a range of careers in health and social care
- sustaining an environment of professional and academic support to facilitate student achievement and possible further study
- ensuring that government initiatives in health and social care are reflected in our curricula and research
- working in close collaboration with stakeholders to prepare students for employment or post-qualifying healthcare professional practice that meets the local and national needs
- developing curricula that aim to ensure that the patient/client experience is at the centre of the student learning experience
- equipping students to be fit for purpose, practice and academic award
- providing a portfolio of pre-registration and continuing professional development (CPD) health and social care pathways offering a variety of flexible entry opportunities, modes of study and exit points responsive to current and future practice
- promoting collaborative links between the National Health Service (NHS), other service providers and stakeholders and higher education that foster development and mutual benefit
- developing research and evidence-based practice in the cognate field of health and social care
- building upon our strength and commitment to research and interprofessional work
- supporting these aims by rigorous quality management that ensures and enhances academic and practice standards and quality.
B Academic and practitioner standards
B1 Health visiting
Intended learning outcomes
4 The intended learning outcomes (ILOs) for the BSc (Hons) and Postgraduate Diploma in Community Specialist Practice (Public Health) reflect the programmes' aims and meet the standards of the NMC and integrate the Nurse Prescribing (UKCC 2001). They are clearly outlined in programme specifications and indicate a balance between theory and practice as required by the NMC. The programme is mapped for the third part of the NMC register, Standards of Proficiency for Specialist Community Public Health Nurses. The reviewers confirm that the ILOs are aligned with the Subject benchmark statement for health visiting and The framework for higher education qualifications in England, Wales and Northern Ireland (FHEQ), published by QAA. In addition, the ILOs are mapped against relevant national service frameworks, Every Child Matters and Valuing People. The ILOs demonstrate the integration of theory and practice and the required knowledge and skills for fitness to practice, which include the evaluation of health interventions, undertaking health screening and building health alliances with other agencies.
5 The ILOs are clearly communicated to students in handbooks, module guides and the practice portfolio, and are shared and understood by the practice staff, students' mentors, subject staff and external examiners. A dedicated website has been developed to enable easier access to information relating to the programme. Students and mentors/community practice teachers (CPTs) can use this facility while in the practice setting. The ILOs are appropriately related to levels of learning and differentiated for diploma, honours and postgraduate awards, and meet the descriptors as outlined in the FHEQ. Students evaluate the appropriateness of the ILOs as part of the module evaluation process, the results of which are communicated back to the service through the pathway leaders and subject staff meetings, which include service representatives.
Curricula
6 The proficiencies identified within the NMC requirements for pre-registration health visiting programmes (2002) have been effectively incorporated into the curriculum. The existing programme is being reviewed to implement the new NMC requirements in September 2007. Health visiting students share a mandatory 60 credits with other students on the community specialist framework. It is envisaged that there will be more shared learning with other students on community programmes. The programme is equally divided between theory and practice in accordance with NMC requirements. The programme team has designed the curricula so that it is aligned with NMC QA Fact Sheet 4, which integrates nurse prescribing within the curricula. Students are offered ample information on the modules with which to make an informed choice on their preferred route.
7 The IHSC provides preparatory 'taster' modules for students to enable them to prepare for the programmes. The currency of the health visiting programmes has been successfully enhanced by the contribution of service colleagues through monthly practice development meetings with IHSC health visiting staff. Topics discussed include the changing emphasis within the government's wider public health agenda. The BSc (Hons) programme has been evaluated and expanded to include modules on the Introduction to Primary Health Care and the Practice Nurse Apprenticeship Scheme. This type of undergraduate independent learning has been very useful to employers and has supported professional development. Health visiting students present a community profile to their mentors/community practice teachers and managers, providing evidence of currency and reference to NMC requirements.
8 Practice is supported by CPTs who are appropriately prepared and supported by the programme leader and subject staff. The four principles of health visiting practice, the search for health needs, the simulation of the awareness of health needs, the facilitation of health-enhancing activities and the need to influence health policies affecting health, are clearly embedded in the curricula. Students are not able to move onto supervised practice before they have achieved all the core and integrated theory and practice learning outcomes, thereby assuring academic and intellectual progression. The integration of the theoretical aspects of the curricula with the practice setting is facilitated by the incorporation of student-driven, action-learning sets on study days throughout the programme. Mentor/CPT-led workshops in practice, including opportunities for interprofessional learning, have been well received by students. The practice modules have well-structured and comprehensive portfolio guidelines. The use of 'Patchwork Text' staged assessment within the Perspectives in Research in Professional Practice, module, whereby students are presented with a critical incident scenario and bring their findings together, has also been well received by students. Students on both programmes are confident that the curriculum is contemporary and includes references to research undertaken by members of the subject staff, which also supports curriculum development.
Assessment
9 The IHSC's processes for assessment are sound and fairly conducted and are congruent with the Code of practice; for the assurance of academic quality and standards in higher education (Code of practice), Section 6: Assessment of students, published by QAA. There are clear guidelines for theoretical and clinical assessment described within student handbooks, module guides and clinical assessment documentation. Further communication is provided for practitioners through mentor and CPT study days and regular meetings. External examiners comment positively on the academic rigour of the assessment process and confirm that any issues are dealt with in a fair and sensitive way. External examiners testify to the effectiveness of assessment methods in assessing achievement of the ILOs and the reviewers concur with this view. An appropriate range of assessment methods is utilised, including case studies, in-depth essays, critical-incident analysis, teaching packages, portfolios and the innovative use of 'Patchwork Text' staged assessment. Assessments scrutinised by the reviewers demonstrate that they are used to measure students' developments in the skills of reflection and critical analysis as well as conceptual, critical and independent thinking.
10 Students on both programmes considered the assessment workload to be challenging at times but they recognised that this was due to the short duration of the programmes and are of the view that overall assessment workloads are appropriate. Clear marking and assessment criteria are readily available to staff and students and these are consistently utilised. Assessment arrangements specify appropriate processes to ensure the security, integrity and consistency of the marking and moderation of assignments. Students receive comprehensive developmental feedback on their assignments that are clearly linked to the assessment criteria and to ILOs. Health visiting students on both programmes find that the handwritten feedback on assignments can sometimes be difficult to read.
11 During practice, placement mentors/CPTs assess practice using detailed grading criteria. Module leaders visit students on placement once a practice as part of a tripartite formative assessment interview, with the final assessment in practice conducted by the practice mentor. Internal moderation of practice is rigorous. The practice mentors/CPTs and the programme leader participate in the internal moderation of practice portfolios to ensure parity and consistency across the health visiting programme. Mentors/CPTs from other community specialist programmes also participate in this process. The portfolios are double-marked by the mentor and programme leader and a summative mark agreed. The rigour of the assessment of practice is supported by external examiners' scrutiny of practice portfolios.
Student achievement
12 The Postgraduate Diploma and BSc (Hons) Community Specialist Practitioner (CSP) Health Visiting programmes continue to provide the local NHS employers with competent, confident and well-prepared practitioners. The majority of students who complete the programmes are successfully employed in local Primary Care Trusts (PCTs). External examiners' reports and the reviewers' scrutiny of the students' work confirm that the students are achieving the professional and academic levels required by the NMC and their achievements are comparable with those of other institutions. For the BSc (Hons) programme, 44 per cent of the students over the last three years have been employed locally with 6 per cent going on to further study (Table 2a).
13 Completion and achievement data show that, for the BSc (Hons) programme, 7 per cent achieved First, 55 per cent Upper Second, 40 per cent Lower Second and 2 per cent Third Class Honours degrees. All 11 postgraduate students achieved a Pass at the first attempt. Health visiting students are achieving the ILOs and meet the NMC Standards of Proficiency (Table 1a).
Table 1a: Completion and achievement statistics for all award-bearing programmes in health visiting
| Discipline | Programme | Cohort | Degree classification | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2i | 2ii | 3 | P | F | |||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | |||
| Health visiting | ||||||||||||||
| Pre-registration Pathways |
BSc (Hons) Community |
Sep-02 | 1 | 7 | 9 | 64 | 4 | 29 | ||||||
| Sep-03 | 8 | 44 | 9 | 50 | 1 | 6 | ||||||||
| Sep-04 | 9 | 60 | 6 | 40 | ||||||||||
| PgDip Community Specialist Practice (Public Health Nursing - Health Visiting) |
Sep-02 | 3 | 100 | |||||||||||
| Sep-03 | 4 | 100 | ||||||||||||
| Sep-04 | 5 | 100 | ||||||||||||
Table 2a: Employment statistics for all pre-registration programmes and exception reporting only for post-registration/ post-qualification programmes
| Discipline | Programme | Cohort | Further Study |
Local Employers |
Employers elsewhere |
Unemployed | Other | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | |||
| Health visiting | Health Visiting students are already employed at Local Trusts | |||||||||||
| Pre-registration Pathway |
BSc (Hons) Community Specialist Practice (Public Nursing - Health Visiting) |
Sep-02 | 1 | 6 | 7 | 44 | 8 | 50 | ||||
| Sep-03 | 1 | 5 | 14 | 70 | 5 | 25 | ||||||
| Sep-04 | 2 | 12 | 15 | 88 | ||||||||
| PgDip Community Specialist Practice (Public Health Nursing - Health Visiting) |
Sep-02 | 3 | 100 | |||||||||
| Sep-03 | 4 | 100 | ||||||||||
| Sep-04 | 5 | 100 | ||||||||||
Summary of academic and practitioner standards for health visiting
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Health Visiting at Anglia Ruskin University, in partnership with ESHA and NELSHA.
Strengths
- The currency of the health visiting programmes has been successfully enhanced by the contribution of service colleagues through monthly practice development meetings with Institute of Health and Social Care health visiting staff (paragraph 7).
- Health visiting students present a community profile to their mentors/community practice teachers and managers, providing evidence of currency and reference to NMC requirements (paragraph 7).
Weakness
- Health visiting students on both programmes find that the handwritten feedback on assignments can sometimes be difficult to read (paragraph 10).
B2 Midwifery
Intended learning outcomes
14 The aims and ILOs for the midwifery programmes, BSc (Hons) Midwifery 156-week and 86-week, are appropriately mapped against relevant NMC competencies and requirements for fitness to practise and the Subject benchmark statement for midwifery. They are clearly stated in the programme specifications. Handbooks and module guides provide dissemination of the ILOs to students. A mentor handbook provides guidance for staff in practice, although new mentors and students in year one of the BSc (Hons) 156-week programme and on the first part of the BSc (Hons) 86-week programme, in midwifery practice placements visited by the reviewers, were uncertain about the process for negotiating the learning contracts based on the ILOs. The ILOs for interprofessional education (IPE) are less evident for current students, but will be formalised into the IPE modules for the September 2006 intake and shared initially with nursing and eventually with other disciplines of the health and social care community.
15 The ILOs for the pre-registration programmes have clearly been developed with the interests of the stakeholders and partners in mind through a number of forums involving input from clinical staff. Reference is made to recent government and NMC drivers. The programmes are designed to enable students to become competent and reflective practitioners of midwifery, basing their practice on evidence and the concept of holistic care. The ILOs are appropriately related to levels of learning in the pre and post-registration programmes, differentiated for diploma, honours degrees and meet the descriptors for each level as outlined in the FHEQ. External examiners confirm that the ILOs are set at the appropriate levels for both the pre-registration programmes. Post-registration midwifery provision has been reviewed recently in response to stakeholder and student evaluations. The changes, including modifications of ILOs, have largely been configured into free-standing diplomas of credit and different forms of learning, including open, distance and web-based modes.
Curricula
16 There are two modular programmes offered at pre-registration level: the 86-week Short Programme, designed for those nurses registered on appropriate parts of the Professional Register, and the 156-week Long Programme. Competence and safe practice are the prerequisites upon which the curricula are designed and are evidenced through the theory practice modules and the portfolio of clinical practice. The curricula support the students' attainment of the appropriate ILOs, are clearly linked to the Subject benchmark statement for pre-registration midwifery and meet the NMC and European Union (EU) requirements. Students on the Short Programme have found the EU requirement regarding the number of births challenging at times, but attainable. Progression in the curricula is demonstrated through the acquisition and achievement of proficiencies as identified in the portfolio of learning. Students follow the patient's journey in practice and have opportunities for interprofessional learning with physiotherapists and nurse specialists in diabetes and ultrasonography. Open and distance-learning modules are accessible and incorporate internet-based discussions with experts from other disciplines, for example, neonatal physiotherapy. Student midwives have opportunities in practice to work alongside a variety of professionals to develop understanding of the differing roles.
17 The compulsory modules in both programmes include the appropriate content in relation to intellectual skills and knowledge regarding holistic woman-centred care, genetics, physiology, public health, family planning and reproduction. Transferable skills, ethics and independent learning are embedded in the curricula. Through the Research Awareness in Midwifery module, students are able to demonstrate their awareness of evidence-based research and practice, which can be developed further in the undergraduate project at level 3. Students stated that they found the curricula provided them with the appropriate scientific knowledge base and skills to be able to apply in practice. The practice placements are designed to ensure that student midwives are able to assess, plan, implement and evaluate care and there is sufficient emphasis in both elements of the curricula to ensure that students are able to integrate theory and practice.
18 The midwifery programme team is vigilant in ensuring the currency of the curricula and in responding to changing healthcare needs. Regular reviews by students, stakeholders and subject staff ensure that pathways reflect contemporary practice and continue to meet NMC guidance, including curricula to facilitate conversion to the new 15/30-credit structure. As a consequence, the review and re-approval of the pre-registration curriculum has been delayed until April 2007. A further example of midwifery responding to changes in the practice environment is the development of more extensive skills in peri-operative care due to the increased Caesarean rate in some Trusts. The programme team has developed a more comprehensive package through the skills-based curriculum and Praxis sessions, which are designed to encourage the linking of theory and practice. In response to student and stakeholder evaluation, the pre-registration programme has undergone minor modifications, including the appointment of practice educators (PEs) to all five clinical sites, with particular emphasis on this provision in level 1. Students appreciate the support of PEs, particularly in identifying theory and practice links.
Assessment
19 Policies and procedures relating to the assessment process are contained within the Senate Code of Practice on the assessment of students, which are congruent with the Code of practice, Section 6: Assessment of students, published by QAA. The assessment process is effectively facilitated; modules are assessed and moderated at assessment panels, with awards considered at the IHSC award boards. Mitigation is considered at the adjudication panel and student review meetings that are subcommittees of the Award Board. There are rigorous monitoring procedures in place to ensure that potentially failing students are identified. External examiners comment positively on the rigour of the assessment process and confirm that any issues are dealt with in a fair and sensitive way. There is clear evidence that external examiners' comments are responded to both in individual assessments and as part of the annual programme monitoring process.
20 There are clear guidelines for theoretical and clinical assessment described within student handbooks, module guides and clinical assessment documentation. New students, as well as some mentors, claim that the practice portfolio can be difficult to understand initially. However, further communication and support during this time is provided through pathway and team meetings, pre-placement preparation, mentor preparation and update sessions, and by practice educator midwives (PEMs).
21 Assessments are clearly mapped against ILOs and module and programme aims. The range of assessment methods used secures reliable testing of clinical skills and subject knowledge. Methods include seminars, written portfolios, assignments, formal examinations and student workbooks. Marking guidelines are adhered to and external examiners support the view that the standard of marking and moderating is equitable and robust. Students receive written feedback on their assessments, which is mostly comprehensive and provides students with clear guidelines for further development. Students confirm that the return of their coursework is timely and usually within the agreed timescale.
22 For pre-registration midwifery, practice-based assessment occurs throughout the duration of the pathway and achievement is assessed through the practice portfolio. Practice mentors undergo annual updating and a register of mentors is updated on a biannual basis. The PEMs support both mentors and students in practice, significantly contributing to the rigour of the assessment process, in particular, inter-rater reliability. This role is highly valued by mentors and students. Practice-based portfolios and presentations, through attendance or by video, are scrutinised by external examiners. However, although external examiners are offered the opportunity to visit practice areas, this is currently rarely undertaken.
Student achievement
23 Student achievement, based on the statistics provided in Table 1b and external examiners' reports, indicates that they are achieving results comparable with those in other midwifery programmes. Over the last three cohorts of the 86-week programme, 9 per cent of the students achieved First, 30 per cent Upper Second, 43 per cent Lower Second and 16 per cent Third class honours awards; 2 per cent of the students failed. Over the same period, for the BSc (Hons) programme, 9 per cent achieved First, 42 per cent Upper Second, 35 per cent Lower Second and 11 per cent Third class honours awards; 3 per cent of the students failed. For the two post-registration programmes, all the students successfully achieved the awards. Students on all midwifery programmes are achieving the ILOs and meet the NMC Standards of Proficiency.
24 External examiners commented that students demonstrate reflection on their practice and the links between theory and practice. Through inquiry-based learning (IBL), one external examiner noted that students are encouraged to produce written work which is clearly evidenced-based, with better students demonstrating more critical analysis, reflection and independent learning. Similarly, with dissertations and level 3 work, better students show more critical awareness, with weaker students demonstrating a tendency towards description and less awareness of how knowledge relates directly to the role of midwife. From their scrutiny of samples of student work, the reviewers agree with these comments and note that, from the longitudinal samples, all students were able to demonstrate appropriate levels of skills and knowledge which increased as they progressed through the programme. Once again, better students showed more ability to provide knowledge of evidence-based practice in both theoretical work and practice portfolios.
25 Mentors and employers were confident that the programme prepared them for practice and employment and that the students were fit for practice, purpose and award. On the 86-week and the 156-week programmes respectively, 47 per cent and 30 per cent of the students are employed locally (Table 2b).
Table 1b: Completion and achievement statistics for all award-bearing programmes in midwifery
| Discipline | Programme | Cohort | Degree classification | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2i | 2ii | 3 | P | F | |||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | |||
| Midwifery | ||||||||||||||
| Pre-registration Pathways |
BSc (Hons) Midwifery (Pre-Registration) 86 Weeks |
Jan-02 | 2 | 13 | 4 | 27 | 5 | 33 | 3 | 20 | 1 | 7 | ||
| Sep-02 | 1 | 6 | 4 | 25 | 8 | 50 | 3 | 19 | ||||||
| Sep-03 | 1 | 8 | 5 | 39 | 6 | 46 | 1 | 8 | ||||||
| BSc (Hons) Midwifery (Pre-Registration) 156 Weeks |
Sep-00 | 2 | 10 | 17 | 85 | 1 | 5 | |||||||
| Sep-01 | 3 | 13 | 3 | 13 | 14 | 61 | 3 | 13 | ||||||
| Sep-02 | 1 | 4 | 8 | 35 | 9 | 39 | 4 | 17 | 1 | 4 | ||||
| Post-registration Pathways |
Diploma Credit Examination Of The Newborn |
Mar-03 | 16 | 100 | ||||||||||
| Mar-04 | 13 | 100 | ||||||||||||
| Mar-05 | 17 | 100 | ||||||||||||
| Diploma Credit Special and Intensive Care Of The Newborn |
Apr-04 | 1 | 100 | |||||||||||
| Sep-04 | 2 | 100 | ||||||||||||
| Jan-05 | 1 | 100 | ||||||||||||
Table 2b: Employment statistics for all pre-registration programmes and exception reporting only for post-registration/post-qualification programmes
| Discipline | Programme | Cohort | Further Study |
Local Employers |
Employers elsewhere |
Unemployed | Other | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | |||
| Midwifery | ||||||||||||
| Pre-registration Pathways |
BSc (Hons) Midwifery (Pre-registration) 86 Weeks |
Jan-02 | 11 | 65 | 1 | 6 | 5 | 29 | ||||
| Sep-02 | 3 | 14 | 8 | 36 | 2 | 9 | 9 | 42 | ||||
| Sep-03 | 2 | 11 | 8 | 45 | 8 | 44 | ||||||
| BSc (Hons) Midwifery (Pre-registration) 156 Weeks |
Sep-00 | 6 | 26 | 17 | 74 | |||||||
| Sep-01 | 5 | 17 | 24 | 83 | ||||||||
| Sep-02 | 14 | 47 | 16 | 53 | ||||||||
| Post-registration Pathways |
Diploma Credit Examination Of The Newborn |
Mar-03 | 1 | 6 | 16 | 94 | ||||||
| Mar-04 | 14 | 100 | ||||||||||
| Mar-05 | 1 | 6 | 17 | 94 | ||||||||
| Diploma Credit Special and Intensive Care Of The Newborn |
Apr-04 | 1 | 50 | 1 | 50 | |||||||
| Sep-04 | 3 | 100 | ||||||||||
| Jan-05 | 1 | 100 | ||||||||||
Summary of academic and practitioner standards for midwifery
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programme in Midwifery at Anglia Ruskin University in partnership with ESHA and NELSHA.
Strength
- The midwifery practice educators support both mentors and students in practice, significantly contributing to the rigour of the assessment process, in particular, inter-rater reliability. This role is highly valued by mentors and students (paragraph 22).
Weakness
- New mentors and students in year one of the BSc (Hons) 156-week programme and on the first part of the BSc (Hons) 86-week programme, in midwifery practice placements visited by the reviewers, were uncertain about the process for negotiating the learning contracts based on the intended learning outcomes (paragraph 14).
B3 Nursing
Intended learning outcomes
26 The aims and ILOs of the nursing curricula in both the 2000 and 2005 programmes are set out clearly in the programme handbooks and programme specifications. They have been developed in accordance with the University's programme development and approval process, which ensures appropriate standardisation, scrutiny, consistency and integrity of the ILOs in all programmes and awards. The ILOs have been designed in collaboration with partners and key stakeholders to meet the needs of the local and national drivers, including the National Service Frameworks (NSFs) and, in the most recent of the pre-registration nursing 2005 curriculum, the Essence of Care document. The ILOs are aligned with the Subject benchmark statement and the FHEQ. In the 2005 approval process, the ILOs were designed to be more specific to individual branch programmes.
27 Pre-registration programme ILOs enable the students to be fit for practice, purpose and award and for professional standing. Overall, outcomes for the various nursing programmes are appropriate and designed to enable students to achieve competencies and the knowledge necessary to become effective, safe practitioners. The ILOs refer to the integration of theory and practice and are directly relevant to practice placements areas. ILOs are appropriately related to levels of learning in the various programmes. They are differentiated for diploma, honours and postgraduate degrees and meet the descriptors for each of these levels as outlined in FHEQ. Students evaluate the ILOs as part of the module evaluation process. There are clear mentor handbooks for both pre-registration and post-registration programmes, and all students reported that they are well informed about the ILOs necessary for them to achieve in both theoretical and practical elements of the programmes.
Curricula
28 The development of curricula has been a joint venture between practitioners, academic staff, and students. Modifications to the curricula are informed by the review of evaluations, changes in policy, future demands of the education contract, innovative projects, successful modules and pathways, consumer demand, change within the discipline and professional body requirements. Programmes are offered at diploma, degree and master's levels and thereby provide opportunities for lifelong learning. They are congruent with the Subject benchmark statement for nursing and the FHEQ. The prerequisites for professional registration are demonstrated on a mapping grid included as a requirement of the approval process, which also shows appropriate academic and intellectual progression. All pre-registration modules are organised to integrate and support practice, provide clear learning outcomes and progressively build up professional skills. Challenges in the practice environment prompted the development of a Project Placement Plan devised in partnership with SHA colleagues, which has been piloted in one Trust for adult branch students. It has been positively evaluated by students and has been adopted on all sites for both adult and child branch students.
29 The programme team in nursing has demonstrated an awareness of developments in nursing theory and practice in the production of the new pre-registration curricula. Enhancements in the 2005 programmes include the continuation of an IBL curriculum and the inclusion of ILOs for IPE with the core principles of valuing people, understanding and enhancing the service-user experience and collaborating in practice. There is increased emphasis on pharmacology, biosciences and pathophysiology. The IHSC with its service providers have developed a number of innovative modules which make programmes increasingly interprofessional in structure, for example, the Postgraduate Certificate in Primary Care, the child and adolescent mental health pathway, the advanced scrub practitioners, the cosmetic surgery pathway and stand-alone modules such as continence, hypertensive disorders, tissue viability and issues in suicide and risk management. Evidence of curricular content being responsive to recent developments in interprofessional learning is the incorporation of the underpinning values for IPE. Opportunities for IPE in practice are maximised by the students being able to attend associate placements and following the patient's journey. A further development in IPE is the anticipated MSc Advanced Practice in Health and Social Care, which incorporates a compulsory module entitled Collaborative Practice for Integrated Care.
30 As a consequence of student evaluations identifying a bias towards adult nursing in the Common Foundation programme, modifications have been made to the level 1 curricula. In the new pre-registration nursing curricula (2005), students are now placed in branch-specific, IBL groups, with each module having a trigger scenario which focuses on a different branch of nursing and is led by the relevant branch module leader. To facilitate prospective clients/patients being at the centre of the student's learning experience, service users and carers are increasingly involved in the development of all the nursing curricula. This is particularly strong in the pre and post-registration mental health programmes, where expert patients enhance the curricula. Former service users also lecture on the post-registration MA programme. A learning disabilities placement successfully runs a user-led programme entitled Learning from Me.
31 Post-registration programmes and modules are designed to build on existing skills. Responding to local health service needs is enhanced by the close relationship with local Trusts and other agencies leading to the development of a wide range of post-qualifying pathways and innovative modules that constitute a response to new policies and changes in practice. These are increasingly available for workers from other professions and some are available for service users and carers. The post-registration nursing and postgraduate provision includes a Specialist Practice and Community Specialist Practice Framework in specific settings, designed in partnership with service providers aligned to national drivers which incorporate the Knowledge and Skills Framework and the NSFs, including diabetes, critical care and palliative care. Post-registration programmes are strongly aligned with the needs of the stakeholders. This collaborative nature of short-course and award-based developments is enabled by the University's ability to fast-track minor modifications to modules through its approval process without compromising the quality of the modules or awards.
Assessment
32 The IHSC's processes for assessment and examination are sound, fairly conducted and congruent with the Code of practice, Section 6: Assessment of students. Assessments for nursing adhere to the requirements of the University's Senate Code of Practice on the Assessment of Students. There are clear guidelines for theoretical and clinical assessment described within student handbooks, module guides and clinical assessment documentation. Further information regarding assessment criteria is communicated through pathway and team meetings, pre-placement preparation, mentor preparation sessions, and by practice education facilitators (PEFs). Assessment arrangements are clear and specify appropriate processes to ensure the security, integrity and consistency of the marking and moderation of assignments. There is clear evidence that external examiners' comments are responded to, both in relation to individual assessments and as part of the annual programme monitoring process.
33 External examiners, the NMC and the reviewers confirm that students' assessed work demonstrates the appropriateness of assessment to the ILOs, the curricular content, academic level and current healthcare provision. It is also evident that assessment loading is commensurate with the demands of each module of learning. A variety of assessment methods is used that support the development of professional knowledge as well as skills in reflection and critical analysis. These include essays, presentations, debate, use of a skills record, dissertations and practice-based assessment.
34 Clear marking and assessment criteria, readily available to staff and students, are used consistently. Students receive written feedback on assignments, which is detailed, helpful and relates to the marking criteria. Some written feedback on student work in pre-registration nursing can be difficult to read. However, the IHSC is aiming to ensure that all feedback comments are word processed in the future. Students confirm that the return of their assessed work is timely and normally within the agreed time frame.
35 Practice assessment guidelines are clearly specified in the practice documentation. These documents are reviewed in partnership with practitioner colleagues to ensure that they are fit for purpose. For assessment in practice, the named practice mentor assesses the student on a Pass/Fail basis. The completed assessment is read and signed off by the student's IBL facilitator. There are clear processes for dealing with assessment issues in practice and it was evident during visits to placements that practice staff were fully aware of these. Given the Pass/Fail basis of practice assessment, outstanding performance in practice can only be identified when mentors write clear additional comments to indicate this. The PEFs provide effective support to practice mentors in their assessment role to enhance the rigour of the assessment process. External examiners have the opportunity to review practice assessment documents and meet with students before the assessment panel. External examiners may visit practice areas, although, at present, very few engage in this activity.
Student achievement
36 The data for nursing programmes refer to the 2000 curricula. The new pre-registration BSc (Hons) and DipHE Nursing programmes, which commenced in September 2005, have their first cohorts entering the third trimester; therefore statistics are not available. As shown in Table 1c, for the DipHE programme, on average, 98 per cent of the students successfully achieved the award over the last three cohorts. Over the same period, for the BSc (Hons) programme, 6 per cent of the students achieved First class honours, 36 per cent Upper Second, 39 per cent Lower Second and 17 per cent Third class awards; 4 per cent of the students failed. For the post-registration undergraduate programmes, there were 12 per cent First class honours awards, 50 per cent Upper Seconds, 33 per cent Lower Seconds and 4 per cent Thirds; 2 per cent of the students failed. Of the postgraduate students, 96 per cent successfully achieved their awards. All nursing students achieved the ILOs and meet the NMC Standards of Proficiency.
37 External examiners' reports confirm that students are achieving the professional and academic levels required of their various programmes. Scrutiny of the students' work by the reviewers and external examiners confirms that the quality of the work is comparable with that of other institutions. Some students have difficulty with scientific and theoretical modules, although there are few students who perform poorly overall in pre-registration nursing. Employers confirmed that pre-registration nursing students are fit for practice, purpose and award, and that the majority achieve employment within the Essex area.
38 In their meetings with the reviewers, including practice visits, employers confirmed that nursing students are well prepared for work in the healthcare sector and that they are confident and competent practitioners who are adaptable, work well in teams and able to face the challenges put before them. The majority of students gain employment in the Essex region and former students informed the reviewers that they felt their experiences in the IHSC had provided them with sufficient theoretical and practical skills and knowledge to be safe and competent practitioners (Table 2c).
Table 1c: Completion and achievement statistics for all award bearing programmes in nursing
| Discipline | Programme | Cohort | Degree classification | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2i | 2ii | 3 | P | F | |||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | |||
| Nursing | ||||||||||||||
| Pre-registration Pathways |
BSc (Hons) Nursing | Sep-00 | 2 | 8 | 6 | 23 | 11 | 42 | 7 | 27 | ||||
| Oct-01 | 1 | 3 | 15 | 42 | 12 | 33 | 6 | 17 | 2 | 6 | ||||
| Oct-02 | 2 | 7 | 12 | 41 | 11 | 38 | 2 | 7 | 2 | 7 | ||||
| DipHE Registered Nurse | Oct-01 | 5 | 2 | 194 | 98 | |||||||||
| Apr-02 | 2 | 1 | 146 | 99 | ||||||||||
| Sep-02 | 5 | 3 | 187 | 97 | ||||||||||
| Post-registration Pathways |
Postgraduate Pathways (MA, MSc, PG Dip) |
1 | 4 | 23 | 96 | |||||||||
| Undergraduate Pathways (BSc) | 30 | 12 | 126 | 50 | 83 | 33 | 9 | 3 | 6 | 2 | ||||
Table 2c: Employment statistics for all pre-registration programmes and exception reporting only for post-registration/ post-qualification programmes
| Discipline | Programme | Cohort | Further Study |
Local Employers |
Employers elsewhere |
Unemployed | Other | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | |||
| Nursing | ||||||||||||
| Pre-registration Pathways |
BSc (Hons) Nursing | Sep-00 | 33 | 100 | ||||||||
| Oct-01 | 1 | 2 | 21 | 40 | 11 | 21 | 1 | 2 | 19 | 36 | ||
| Oct-02 | 2 | 4 | 17 | 35 | 2 | 4 | 28 | 57 | ||||
| DipHE Registered Nurse | Oct-01 | 12 | 4 | 154 | 56 | 18 | 6 | 92 | 33 | |||
| Apr-02 | 101 | 51 | 6 | 3 | 89 | 45 | ||||||
| Sep-02 | 97 | 36 | 11 | 4 | 159 | 60 | ||||||
| Post-registration Pathways |
Postgraduate Pathways (MA, MSc, PG Dip) |
1 | 2 | 6 | 11 | 1 | 2 | 48 | 86 | |||
| Undergraduate Pathways (BSc) | 24 | 6 | 115 | 29 | 15 | 4 | 238 | 61 | ||||
Summary of academic and practitioner standards for nursing
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Nursing at Anglia Ruskin University in partnership with ESHA and NELSHA.
Strengths
- In the new pre-registration nursing curricula (2005), students are now placed in branch-specific, inquiry-based learning groups, with each module having a trigger scenario which focuses on a different branch of nursing and is led by the relevant branch module leader (paragraph 30).
- To facilitate prospective clients/patients being at the centre of the student's learning experience, service users and carers are increasingly involved in the development of all the nursing curricula. This is particularly strong in the pre-and post-registration mental health programmes, where expert patients enhance the curricula (paragraph 30).
- Post-registration programmes are strongly aligned with the needs of the stakeholders. This collaborative nature of short-course and award-based developments is enabled by the University's ability to fast-track modules through academic regulations and validations without compromising the quality of the modules or awards (paragraph 31).
- The practice educator facilitators provide effective support to practice mentors in their assessment role to enhance the rigour of the assessment process (paragraph 35).
Weakness
- Some written feedback on student work in pre-registration nursing can be difficult to read (paragraph 34).
C Quality of learning opportunities
Learning and teaching
39 The IHSC's learning and teaching strategy, developed within the context of the University's teaching and learning strategy, promotes a wide variety of teaching and learning approaches with a strong emphasis on IBL. This forms a key element of the curriculum design in the 2000 pre-registration nursing curricula and has been developed in the revised 2005 curricula. IBL is central to pre-registration nursing and midwifery pathways and the Mentorship in Public Services pathway. IBL approaches are varied and include lead lectures, tutorials, reflective practice and skills-centre learning sessions. IBL continues to be used as a result of positive evaluations. One of the most common and striking comments made about IBL is that it prepares students for lifelong learning with the acquisition of transferable skills. Therefore, the IBL methodology has been retained in the 2005 curriculum as it was shown to enable students to be questioning, confident practitioners. Students positively evaluate IBL, saying that it helps to provide them with many transferable skills, although some students question the management of students not participating fully in IBL. Enhanced staff training and the setting of ground rules are in operation to ensure equity of student input and overall student effort. Students generally realise the benefit of IBL as they progress through programmes; however, some report finding it initially challenging and unstructured. Most students articulated how the IBL approach placed the patient at the centre of learning and encouraged exploration of the role of other health professionals from the patient's perspective. Employers spoke positively of the enhanced skills of nurses completing IBL-based programmes; this included analytical thinking and problem-solving skills. This perception was also voiced by one mental health service user who stated that he had noticed a positive difference in the nurses on the IBL curricula. One of the aims of the provision is to 'develop research and evidence-based practice in the cognate field of health and social care'. The Institute acknowledges that research needs to be developed further to support the provision. Published research by staff in the IHSC has been used to evaluate the IBL strategy, including an investigation into the experiences of tutors in co-teaching interprofessional collaboration to multidisciplinary groups of undergraduates and into the learning experiences of mental health nursing students. The strategic development, implementation and rigorous evaluation of IBL are outstanding features of learning and teaching.
40 Teaching sessions from specialist practitioners are evident in the community specialist practitioner programmes, resulting in pertinent and contemporary issues being addressed. A system of seconded practitioner appointments is in operation, which successfully introduces practitioners to classroom teaching while ensuring contemporary practice knowledge underpins learning and teaching. External examiners comment favourably on the quality and variety of practice/campus-based learning and teaching methods. Academic teaching is informed by lecturers' subject knowledge and clinical experience and is enhanced by staff development. A staff development strategy is in place and is informed by the outcomes of peer review of teaching. Outcomes of peer review have shaped developments such as on-line discussion groups. All new staff undertake an induction programme and are expected to undertake a recognised teaching qualification. This applies equally to the seconded practitioners who are supported by the Institute through postgraduate education programmes, even when on short-term contracts.
41 Staff research directly influences learning and teaching, especially in mental health nursing. For example, in mental health there is research in promoting mental health well-being in the workplace, users researching health and social care, the experiences of nurses with depression and service-user involvement in postgraduate mental health education. Other examples of nursing research include the awareness of complementary therapies, the disclosure of dyslexia in clinical practice and clinical leadership. Student conferences have been successfully introduced, initially in pre-registration child and learning disabilities nursing, and are now extending to pre-registration children's nursing and mental health nursing. These are evaluated well by students because they promote networking and the exchange of ideas and practices. The reviewers agree with the NMC report (2004-05), which identified the conference as highly effective for student learning.
42 A jointly-funded IPE project between the University and the ESHA forms part of a long-term strategy. Currently, IPE is included in the pre-registration nursing modules and there are some practice-based IPE outcomes. The 'core and associate' model of pre-registration nursing and midwifery placements facilitates IPE. A similar model exists for health visiting and community specialist practitioner students. However, at times, structured IPE in practice settings appeared to be informal and reliant upon the student's own initiative. The 2005 curriculum threads IPE throughout programmes, strengthening IPE teaching and learning across curricula. This approach includes sharing modules with students from other disciplines. There is evidence of structured IPE in the specialist practitioner programmes, with planned ILOs in theory and in practice documentation. The review of the postgraduate Advanced Practitioner programme has resulted in a collaborative care module open to different groups of professionals, an approach which is welcomed by practice staff and current master's students.
43 Community specialist practitioner students are well supported in practice by enthusiastic and well-prepared mentors. Pre and post-registration nursing and midwifery students are supported in practice by appropriately qualified mentors, link teachers and PEFs and, in midwifery, practice educator midwives (PEMs) are employed. PEFs and PEMs work effectively with the University and the placement providers to manage placement capacity and to support mentors in practice settings. As such, they are very 'visible' in the practice areas and are appreciated by students and employers alike. This role is key to supporting learning in practice across all pre-registration programmes. The SHA is engaged in a five-year strategy, which commits funding for these roles. The numbers of facilitators are based on student numbers.
44 A review of the link lecturer role is being undertaken in response to feedback from staff in practice placements. However, difficulties exist with some placement areas feeling that they do not have adequate link lecturer cover at present. Some link lecturers have to cover wide geographical areas and others are covering staff vacancies, which places extra pressure on the system. Some students and staff reported that they do not see link lecturers in practice and were unaware of the review of the link lecturer role.
45 Mentors felt well prepared for their role, with updates now being delivered on clinical sites to improve attendance. There was some uncertainty across some education staff and some mentors as to the NMC standard for mentor updating. In one clinical area, a small number of students on the pre-registration adult nursing programme were being mentored by practitioners who have not been updated and staff who have not yet been on a formal mentor programme. This situation has arisen due to the recent rapid rise in pre-registration nursing student numbers and is being managed through a system of team mentoring. However, the ongoing pressures to prepare and update sufficient mentors and to maintain the mentor register, particularly in specialist areas, are recognised by the Institute of Health and Social Care. A rigorous and flexible mentor preparation and updating programme is in place at this particular Trust (Broomfield Hospital) to address such deficits and ensure that NMC requirements are met. Students on all placements visited stated that they were well supported and work regularly with mentors. A centralised mentor database is being set up at the University which is managed by the recently-established Placement Development and Support Department (PDS) which has a remit to support, develop and monitor learning in practice and wider placement opportunities. It was not possible to establish how the central database reflected what was on the local Trust-managed databases, as the University's system is not yet fully operational. The demand for placements has increased with the rapid growth in student numbers and this is reflected in the increased number of placement officers and activity around placement planning. The system, at present, is based in local Trusts and is regularly updated by the PEF/PEM network, as each Trust/PCT continues to take responsibility for compiling and maintaining its own live register of mentors. At present, the mentor databases do not automatically 'trigger' mentor update alerts. There is a reliance on Trust and PCT systems to incorporate this into staff development and appraisal processes, but at this stage of development there is no audit to ascertain that appraisal systems routinely identify mentor updates.
46 There is strong support from the ESHA to help manage the placement of pre-registration nursing and midwifery students and to introduce a new placement strategy to maximise the placement availability. This work is supported by an ESHA-dedicated post to work in the PDS and ensure strategic direction regarding the number and increasingly diverse nature of placements. Visits to independent sector placement providers demonstrated good working relationships and effective mentoring for pre-registration and post-registration nursing students. A placement learning strategy is being drafted by the PDS to reflect the growth in student numbers, the changing placement circuit and the changes arising from implementation of the 2005 pre-registration nursing curriculum. A system for students to evaluate learning in practice is in place. However, some placement staff stated that they do not receive formal feedback on the quality of opportunities for learning and teaching following student placements. More usually, the link lecturer provides feedback to placement staff. Practice staff supporting students on pre and post-registration nursing, midwifery and community specialist practitioner programmes reported feeling unaware of the formal feedback system and that often only the more negative issues were fed back. An audit of practice learning environments is in place. However, it was not always evident from the audit documentation what action plans were in progress following audit. This is being addressed by the introduction of new audit documentation.
The quality of learning and teaching is commendable.
Strengths
- A system of seconded practitioner appointments is in operation, which successfully introduces practitioners to classroom teaching while ensuring contemporary practice knowledge underpins learning and teaching (paragraph 40).
- Staff research directly influences learning and teaching, especially in mental health (paragraph 41).
- A jointly-funded interprofessional education project between the University and the Essex Strategic Health Authority forms part of a long-term strategy (paragraph 42).
- The review of the postgraduate Advanced Practitioner programme has resulted in a collaborative care module open to different groups of professionals, an approach which is welcomed by practice staff and current master's students (paragraph 42).
- Practice educator facilitators and practice educator midwives work effectively with the University and the placement providers to manage placement capacity and to support mentors in practice settings. As such, they are very 'visible' in the practice areas and are appreciated by students and employers alike (paragraph 43).
- There is strong support from the Essex Strategic Health Authority to help manage the placement of pre-registration nursing and midwifery students and to introduce a new placement strategy to maximise the placement availability (paragraph 46).
Good practice
- The strategic development, implementation and rigorous evaluation of inquiry-based learning are outstanding features of learning and teaching (paragraph 39).
- Student conferences have been successfully introduced, initially in pre-registration child and learning disabilities nursing (paragraph 41).
Weaknesses
- It was not possible to establish how the central database reflected what was on the local Trust-managed databases, as the University's system is not yet fully operational (paragraph 45).
- Some placement staff stated that they do not receive formal feedback on the quality of opportunities for learning and teaching following student placements (paragraph 46).
Student progression
47 There is a comprehensive range of recruitment strategies and materials to assist potential students making programme choices. A range of activities enables the recruitment of students to the pre-qualifying pathways in nursing and midwifery. Attracting local recruits is undertaken by collaborative work within the NHS Trusts, in schools and Further Education (FE) Colleges. Despite the increased input into schools and FE colleges and continued success of the summer school programme, the number of students entering nurse education has decreased, particularly in the under-21 age group. Open days offer large numbers of potential students and guests the opportunity to visit the campus and meet with course team members and current students. Students find these days helpful and informative.
48 Applications for pre-registration nursing and midwifery pathways are managed within the University Admissions Office. Standard protocols and procedures are in place reflecting the guidelines set out by the Schwartz Report (2005). Students value the effective communications between the applicant and the Admissions Office. All pre-registration nursing, midwifery, and health visiting students undergo Occupational Health and Criminal Records Bureau checks. Applicants are provided with detailed information about the pathway structure and requirements on initial enquiry, and prior to interview. Students state that the pre-course information and the prospectus are informative and useful. The midwifery programmes have seen a large increase in commissions on the 156-week pre-registration programme, while the 86-week pre-registration programme continues to have contract numbers, the programme is being temporarily discontinued from September 2006. Key stakeholders are involved in the selection interviews. New selection protocols have been introduced and refined to strengthen the partnership between the University and its NHS partners. These have been well received by university staff, NHS managers and students. Successful pre-registration nursing candidates are informed within 10 working days and are sent a joining pack six weeks prior to course commencement.
49 The majority of students recruited are local Essex residents and from the outer fringes of London. Both applications and enrolments for all nursing, midwifery and health visiting programmes remain buoyant. There has been a substantial rise in recruiting numbers of students (65 per cent) in response to government initiatives, and a local increase by the ESHA in the commissioned numbers for pre-registration students in recent years. However, this year the numbers have reached a plateau. Students are recruited from traditional and non-traditional backgrounds and, for pre-registration nursing programmes, through secondments from local Trusts. Students may be recruited through an Access course, and the IHSC recognises previous academic study or experience through the accreditation of prior experiential learning. There are opportunities for some students to be seconded by employers for post-registration programmes. There is evidence of commitment to the widening participation agenda, for example, an extended flexible delivery DipHE Registered Nurse pathway and a bridging pathway for students with NVQ3 to access year two of nurse training. The flexible delivery option for the DipHE Registered Nursing pathway, of four years and 10 weeks, is very popular in areas with high populations of families with young children and strengthens the widening participation strategy. Midwifery students with young families stated that they would prefer a part-time option. Recruitment to the CSP pathways is normally within NHS contract constraints. Recruitment to all programmes reflects national patterns, with a high percentage of females.
50 All students undertake a comprehensive induction programme that includes an introduction to the information technology (IT) services. Support is available for students if they require it for updating their IT skills, helping them with difficulties they experience. Induction packs and orientation packs for midwives, nurses and health visitors are available on placements. Generally, these are of a particularly high standard. CSP students, their managers and CPTs/mentors are provided with information packs prior to the commencement of the pathway. In addition to the University's induction events, the School offers programme induction and, before students work in practice placements, the Trusts arrange induction, which includes health and safety information. Students are encouraged to visit the setting before joining the placement.
51 The two SHAs and Trusts work effectively with the IHSC to ensure that academic and practice staff are enabled to provide the necessary support to students. Students are assigned a member of the academic staff as a personal tutor who offers general advice and guidance on pastoral, personal or professional matters. The majority of students value highly the clearly-articulated personal tutor support. External examiners commented on the excellent personal tutor support provided. However, pre-registration students on the adult branch expressed confusion over the nomenclature of roles. University tutors are enthusiastic and helpful. They are accessible and respond timely to enquiries. Health visiting students particularly commented on the excellent support they receive from the Programme Leader and the administrative staff at the University. Student handbooks provide extensive information, including programme structures and specifications, module ILOs and content, assessment requirements, competencies and student support arrangements. Although the current pre-registration nursing student handbooks are highly informative, they include a few outdated references. For example, there are occasional references to UKCC and ENB documentation, which have been superseded by NMC documents.
52 Students receive appropriate preparation prior to commencement of the practice-based component of their programme. Data pertaining to placement allocation can be accessed from the IHSC's intranet, and mentors are fully informed of student allocation. Students have access to PEMs, PEFs, mentors, associate mentors, link lecturers, and CPTs in practice. External examiners, students, practitioners and the NMC commented on the network of practice educators across the provision, which provides excellent support to students while they are in placement settings. Students were most appreciative of this support and identify how valuable PEMs are in assisting them to link theory to practice. PEMs ensure there is equity and parity across clinical sites in relation to clinical skills acquisition and support. Students on pre-registration nursing and midwifery programmes voiced concerns regarding the inaccessibility and lack of support received from some of the link lecturers on placements. However, the IHSC has assured students that measures are in place to address these issues. Students on the Community Specialist Programmes, including health visiting, commented on the exceptional attributes of their CPTs. Students who are experiencing difficulties in practice can access additional support and advice from practice and university staff. There are clear protocols understood by staff and students both on campus and on placements. Students informed the reviewers that there is an effective network for peer support. External examiners have commented that all queries and issues in relation to student progression are fully explored, and appropriate and supportive strategies are in place for addressing student issues.
53 The number of students in the IHSC being diagnosed with learning needs and/or dyslexia has increased. The NMC and students have commented that student support services in the University and the IHSC are of an exceptionally good standard. Services include advice on financial issues, academic writing, compiling a CV and counselling services. The Learning Support Team includes student advisors, administrators, a dyslexia adviser, dyslexia tutors and learning support assistants. The University is committed to valuing diversity and promoting equality. The overarching 'Valuing Diversity and Promoting Equality Policy' is included in staff and student handbooks for all the programmes. In all aspects, support for student progression on the campus and in placements is well organised, effective and appreciated by students.
54 University staff meet with the SHAs and Trusts to produce an IHSC strategy and action plan to improve recruitment and retention rates in nursing, midwifery and health visiting. Completion rates across the provision are variable. In some cohorts, attrition rates are high but have decreased more recently, while in others they are quite low. For example, withdrawal rates for the BSc (Hons) Nursing are high at an average of 24 per cent for the last three cohorts (Table 3). However, the withdrawal rate for the DipHE Registered Nurse programme has decreased from 21 per cent in the 2001 cohort to 15 per cent in the 2002 cohort. Discontinuation rates are low in relation to withdrawal rates for all programmes. The attrition rates for post-registration nursing, pre-registration midwifery and health visiting are impressively low. The completion rate for health visiting is almost 100 per cent. The flexible nature of the postgraduate pathways complicates the statistics, although the attrition rates are fairly low. Students cite personal or financial difficulties, rather than academic ones, as reasons for withdrawal, and some students return to continue their studies at a later stage. Students and future employers have the opportunity to attend a 'Job Fair' prior to completing their programme. They are well attended and positively evaluated by students.
Table 3: Recruitment and attrition statistics for pre-registration and NMC recordable qualfications
| Discipline | Programme name | Cohort | Recruited | Withdrawal | Transfer in | Transfer out | Discontinuation | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Number | No. | % | No. | % | No. | % | No. | % | |||
| Pre-registration Pathways | |||||||||||
| Health visiting | BSc (Hons) Community Specialist Practice (Public Health Nursing - Health Visiting) |
Sep-02 | 15 | 1 | 7 | ||||||
| Sep-03 | 19 | ||||||||||
| Sep-04 | 17 | 1 | 6 | ||||||||
| PG Dip Community Specialist Practice (Public Health Nursing - Health Visiting) |
Sep-02 | 3 | |||||||||
| Sep-03 | 4 | 1 | 25 | ||||||||
| Sep-04 | 5 | ||||||||||
| Midwifery | BSc (Hons) Midwifery (Pre-registration) 86 Weeks |
Jan-02 | 17 | 1 | 6 | 1 | 6 | 1 | 6 | ||
| Sep-02 | 19 | 2 | 10 | 1 | 5 | ||||||
| Sep-03 | 16 | 1 | 6 | ||||||||
| Midwifery (Pre-registration) 156 Weeks |
Sep-00 | 23 | 3 | 13 | 1 | 4 | |||||
| Sep-01 | 29 | 3 | 10 | 1 | 3 | ||||||
| Sep-02 | 30 | 2 | 7 | 2 | 7 | 1 | 3 | ||||
| Nursing | BSc (Hons) Nursing | Sep-00 | 33 | 7 | 21 | ||||||
| Oct-01 | 52 | 15 | 29 | 12 | 23 | 1 | 2 | 2 | 4 | ||
| Oct-02 | 47 | 11 | 23 | 7 | 15 | 2 | 4 | ||||
| DipHE Registered Nurse | Oct-01 | 268 | 57 | 21 | 28 | 10 | 3 | 1 | 6 | 2 | |
| Apr-02 | 197 | 39 | 20 | 21 | 11 | 2 | 1 | 3 | 2 | ||
| Sep-02 | 269 | 40 | 15 | 21 | 8 | 1 | 1 | 4 | 2 | ||
| Post-registration Pathways | |||||||||||
| Midwifery | 55 | 1 | 2 | ||||||||
| Nursing | 1429 | 85 | 6 | 1 | 0.1 | 10 | 0.7 | ||||
| Postgraduate Pathways NB. Postgraduate Health Visiting is listed under Pre-registration Pathways above | |||||||||||
| Nursing | 97 | 16 | 17 | 2 | 2 | ||||||
The quality of student progression is commendable.
Strengths
- The flexible delivery option for the DipHE Registered Nursing pathway, of four years and 10 weeks, is very popular in areas with high populations of families with young children and strengthens the widening participation strategy (paragraph 49).
- External examiners, students, practitioners and the NMC commented on the network of practice educators across the provision, which provides excellent support to students while they are in placement settings (paragraph 52).
- In all aspects, support for student progression on the campus and in placements is well organised, effective and appreciated by students (paragraph 53).
Weaknesses
- Although the current pre-registration nursing student handbooks are highly informative, they include a few outdated references (paragraph 51).
- Withdrawal rates for the BSc (Hons) Nursing are high at an average of 24 per cent for the last three cohorts (paragraph 54).
Learning resources and their effective utilisation
55 The IHSC has a comprehensive and effective learning resources strategy delivered in close cooperation with central services and placement providers to support the overall aims of the provision. There is a range of feedback mechanisms in place to ensure that students' needs are met. Overall, students expressed a high level of satisfaction with most aspects of resources provision and their management. Where issues have been identified, the appropriate action has been taken to enhance facilities, for example, the new-build project, which is expected to be completed by 2007, will address the accommodation and modern classroom agendas. Students have complained that the teaching accommodation, room allocation, and catering facilities are overcrowded and inadequate. This will be resolved when the new accommodation is available in 2007.
56 There has been a significant rise in student numbers, which has led to challenges within the clinical areas and for accommodation on campus. The IHSC acknowledges that there is great pressure on the adult branch students' mentors. The Placement Development and Support Unit is utilising a computerised placement management system to assist in the allocation of placements. This information is used in collaboration with the PEFs and the academic teams to ensure that students continue to receive quality experiences