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
Audiology, health visiting, midwifery, nursing, and speech and language therapy programmes at De Montfort University, with The People's College, Nottingham, (since renamed Castle College) for audiology, in partnership with the Leicestershire, Northamptonshire and Rutland Strategic Health Authority, the Trent Multi Professional Deanery, and the Hampshire and Isle of Wight 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:
Audiology
Pre-qualification
- BSc (Hons) Audiology ***
Health visiting
Pre-registration
- BSc (Hons) Community Health Nursing (Health Visiting) * **
- Return to Practice **
Midwifery
Pre-registration
- Diploma of Higher Education (DipHE) in Midwifery **
- BSc (Hons) Midwifery **
- BSc (Hons) Midwifery (shortened programme) **
- Return to Practice **
Post-registration
- BSc (Hons) Clinical Midwifery
- MA Midwifery/MSc Midwifery Practice
Nursing
Pre-registration (including second registration)
- Diploma of Higher Education (DipHE) in Nursing (Adult, Mental Health, Learning Disabilities, Children's Nursing) **
- BSc (Hons) Nursing (Adult, Mental Health, Children's Nursing) **
- Return to Practice (Adult, Mental Health, Learning Disabilities, Children's Nursing) **
Post-registration
- BSc (Hons) Community Health Nursing * ** (District Nursing, Mental Health, Learning Disabilities, General Practice Nursing, School Nursing)
- BSc (Hons) Specialist Nursing Practice ** incorporating Extended Independent and Supplementary Prescribing for Nurses, Midwives and Health Visitors *
- BSc (Hons) Specialist Health Practice incorporating Prescribing for Health Care Professionals
- MSc Advanced Nursing Practice
- MSc Advanced Nursing Practice: Nursing Practice
- MSc Advanced Nursing Practice: Specialist Nursing Practice (Adult, Mental Health, Learning Disabilities, Children's Nursing)**
Speech and language therapy
Pre-qualification
- BSc (Hons) Human Communication (Speech and Language Therapy) ***
* These programmes underwent Nursing and Midwifery Council (NMC) annual monitoring as part of the major review of healthcare programmes.
** These programmes are NMC approved.
*** These programmes are Health Professions Council (HPC) approved. Audiology is awaiting approval from the Registration Council for Clinical Physiologists.
Academic and practitioner standards
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in audiology, health visiting, midwifery, nursing, and speech and language therapy at De Montfort University with The People's College, Nottingham for audiology, in partnership with the Leicestershire, Northamptonshire and Rutland Strategic Health Authority, the Trent Multi Professional Deanery and the Hampshire and Isle of Wight SHA.
Strengths
- Audiology assessments are often thoughtfully designed to facilitate the application of theory to practice contexts, for example, by developing a patient information leaflet (paragraph 14).
- The involvement of peers in formative verification of the achievement of the audiology intended learning outcomes (ILOs) is an example of innovative practice (paragraph 14).
- A three-day, interprofessional education module, run in collaboration with Leicester University and the University of Northampton, is undertaken by most students on the BSc (Hons) Community Health Nursing (Health Visiting), providing excellent opportunities for work with students from a number of professions (paragraph 29).
- Assessment tasks for all midwifery programmes facilitate good linkage between practice experiences and enable the learning outcomes to be appropriately assessed (paragraph 50).
- The use of tripartite practice assessments in pre-registration midwifery and return to practice programmes to ensure practice competence significantly increases the level of understanding (paragraph 52).
- A strength of the BSc (Hons) Community Health Nursing programme is the interdisciplinary, post-registration modules which have ILOs directed at experiencing and learning about interdisciplinary care in practice (paragraph 60).
- A new, part-time speech and language therapy programme facilitates the widening access agenda (paragraph 85).
- Curricular content of the speech and language therapy programme is continuously updated through consultation with the curriculum development group, which consists of lecturing staff, service managers, Strategic Health Authority and Multi Professional Deanery representatives and service users, including carers and adult users, and also with other stakeholders, including people with learning disabilities (paragraph 87).
- The professional portfolio links explicitly to Health Professions Council competences for speech and language therapists and is in a format which supports transition to the workplace and future continuing professional development (paragraph 89).
- Students and practice staff comment positively on the use of early formative assessment on the clinical placements on the speech and language therapy programme, which allows time for additional University support to be provided to facilitate the achievement of the ILOs (paragraph 90).
Weaknesses
- Students and clinical placement staff confirm that interprofessional education is limited within the audiology curriculum (paragraph 10).
- There is currently little service-user input into curricular design and development in audiology (paragraph 10).
- The audiology curriculum has limited opportunity to provide clinical skills in the first two years of the programme, a situation confirmed by students and practice staff (paragraph 11).
- Any delay in the assessment of the National Audiology Clinical Practice Portfolio causes anxiety for the audiology students concerned, reduces equity in the student assessment experience and may add to the assessment load in year four (paragraph 17).
- The programme specification for the BSc (Hons) Community Health Nursing (Health Visiting), supplied to the reviewers, fails to identify the Nursing and Midwifery Council competences for Health Visiting 2002, against which the programme was mapped at revalidation in 2004, and includes previous United Kingdom Central Council for Nursing, Midwifery and Health Visiting requirements on programme prerequisites (paragraph 22).
- To date, the involvement of service users and carers in curricular design and delivery on the BSc (Hons) Community Health Nursing (Health Visiting) has been limited (paragraph 27).
- On the BSc (Hons) Community Health Nursing (Health Visiting) there is an overreliance on essay-style assignments and limited practice-teacher involvement in summative assessment that reduce students' opportunities to demonstrate their knowledge and skills in a full range of relevant ways (paragraph 36).
- Child branch students on the DipHE and BSc (Hons) Nursing and clinical staff report that preparation for the safe administration of medicines in practice could be improved in the University setting (paragraph 65).
- Students and associate and lead mentors commented that the pre-registration Continuous Assessment of Practice document in nursing is repetitive, in places difficult to understand and open to interpretation (paragraph 73).
- Nursing students indicated that the Continuous Assessment of Practice documents are not fully explained to them by university staff, and mentors stated that the documents are not discussed specifically during mentor-update sessions, resulting in a level of confusion for both mentors and students (paragraph 73).
- For examinations, over a period of two years, tight marking schedules prior to the examination board have made it difficult for speech and language therapy staff to meet the time deadlines and this has resulted in difficulties for external examiners in reviewing work thoroughly (paragraph 91).
Quality of learning opportunities
Learning and teaching
The quality of learning and teaching is commendable.
Strengths
- In speech and language therapy, a well-organised reciprocal arrangement enables practitioners to contribute to the delivery of modules and also allows lecturers time to maintain contemporary practice (paragraph 100).
- The University and its partners are working together to ensure the quality and consistency of practice placements, including the clinical learning environment reviews undertaken by Leicestershire, Northamptonshire and Rutland Strategic Health Authority, within the Acute Trusts (paragraph 105).
Good practice
- Evidence and research-based practice learning opportunities include students' involvement in local public health projects, using an innovative and collaborative approach linking theory to practice (paragraph 105).
Weaknesses
- Limited learning opportunities are provided by the virtual learning environment, which is at an early stage of development in some areas (paragraph 99).
- Peer observation of teaching has not yet been implemented within the School of Allied Health Sciences (paragraph 100).
- As yet, there is no consistent process for collecting feedback from placement experience and, while students gave some examples of changes that had occurred in response to their feedback on their campus and practice experiences, they also indicated that sometimes processes only worked very slowly (paragraph 101).
- Some DipHE students and mentors in the adult and mental health branches of nursing report that high student numbers in busy placement areas compromise their learning (paragraph 103).
Student progression
The quality of student progression is commendable.
Strength
- The reviewers agree with students that the quality of written feedback on assignments across the provision is high, with specific comment detailing areas of improvement, thereby significantly helping student progression (paragraph 112).
Learning resources and their effective utilisation
The quality of learning resources and their effective utilisation in Health Visiting, Midwifery, Nursing and Speech and Language Therapy is commendable.
Weakness
- Although nursing and midwifery mentors are required to attend an annual update, it is clear from the database that this is not always the case and not all mentors have received their update yet (paragraph 127).
The quality of learning resources and their effective utilisation in Audiology is approved.
Weaknesses
- In audiology, the number of placements that allow the full achievement of competences during year three is insufficient compared with the number of students commissioned for the programme (paragraph 122).
- At People's College restricted library opening hours and limited availability of audiology materials do not fully support learning (paragraph 124).
- Access to information technology for audiology students in years one and two is limited, partly due to the restricted opening hours of People's College (paragraph 125).
Maintenance and enhancement of standards and quality
Strength
- Strategic Health Authorities and employers meet regularly with the University to scrutinise all provision in an effective manner (paragraph 132).
Weakness
- For audiology and speech and language therapy, School management boards are poorly attended by staff and students, and a considerable amount of information is not available or delayed (paragraph 129).
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 audiology, health visiting, midwifery, nursing and speech and language therapy programmes at De Montfort University (the University), with The People's College, Nottingham (the College), since renamed Castle College for audiology, in partnership with the Leicestershire, Northamptonshire and Rutland Strategic Health Authority (LNRSHA), the Trent Multi Professional Deanery and the Hampshire and Isle of Wight Strategic Health Authority (HIWSHA). The review was completed during the academic year 2005-06.
2 The University traces its academic roots back over 100 years to the founding of Leicester College of Technology in 1887. The University was established in 1992 and is organised as six faculties, situated on three campuses in Leicester and Bedford. The University currently has approximately 23,000 students and 1,100 full-time academic staff. All the healthcare provision covered by this major review is based in the University's Faculty of Health and Life Sciences. The Faculty has 4,923 full-time equivalent (FTE) students, 258 FTE academic staff and 128 FTE administrative and technical staff. The Faculty comprises four schools: the School of Nursing and Midwifery, the School of Applied Social Sciences, the School of Allied Health Sciences and the Leicester School of Pharmacy. The programmes included in this review are in the School of Nursing and Midwifery and the School of Allied Health Sciences.
3 The health visiting and nursing provision is offered at the Charles Frears Campus. The School of Nursing and Midwifery has 1,354 FTE students and 81 FTE academic staff, and has a wide variety of clinical staff from a diverse range of specialist areas, who provide input as visiting lecturers. The audiology, midwifery and speech and language therapy provision is situated on the Leicester City Campus, based in the Hawthorn Building. Years one and two of the degree programme in audiology are based at the College, a collaborative partner of De Montfort University in conjunction with the Queen's Medical Centre, Nottingham. The School of Allied Health Sciences has 682 FTE students and 31 FTE academic staff, and there are four FTE academic staff who teach on the programme at the College.
4 The nursing, midwifery and health visiting programmes are commissioned by LNRSHA, audiology is commissioned by the Trent Multi Professional Deanery, while speech and language therapy is commissioned by both LNRSHA and by HIWSHA.
5 At the time of the review, the current local SHAs (Leicestershire, Northamptonshire and Rutland SHA and Trent Multi Professional Deanery) were in the process of merging to become the combined East Midlands SHA. The new SHA will cover 28 Primary Care Trusts, eight Acute Trusts, three Ambulance Trusts and five Mental Health/Learning Disability Trusts. They have a combined annual healthcare resource of £4 billion and cover a population of 4.3 million. Geographically, the two SHAs cover six counties, including rural and sparsely-populated areas as well as densely populated, multicultural cities.
A Subject provision and overall aims
6 Audiology, health visiting, midwifery, nursing and speech and language therapy are currently offered in the following programmes:
Audiology
Pre-qualification
- BSc (Hons) Audiology ***
Health visiting
Pre-registration
- BSc (Hons) Community Health Nursing (Health Visiting) * **
- Return to Practice **
Midwifery
Pre-registration
- Diploma of Higher Education (DipHE) in Midwifery **
- BSc (Hons) Midwifery **
- BSc (Hons) Midwifery (shortened programme) **
- Return to Practice **
Post-registration
- BSc (Hons) Clinical Midwifery
- MA Midwifery/MSc Midwifery Practice
Nursing
Pre-registration (including second registration)
- DipHE in Nursing (Adult, Mental Health, Learning Disabilities, Children's Nursing) **
- BSc (Hons) Nursing (Adult, Mental Health, Children's Nursing) **
- Return to Practice (Adult, Mental Health, Learning Disabilities, Children's Nursing) **
Post-registration
- BSc (Hons) Community Health Nursing* ** (District Nursing, Mental Health, Learning Disabilities, General Practice Nursing, School Nursing)
- BSc (Hons) Specialist Nursing Practice ** incorporating Extended Independent and Supplementary Prescribing for Nurses, Midwives and Health Visitors *
- BSc (Hons) Specialist Health Practice incorporating Prescribing for Health Care Professionals
- MSc Advanced Nursing Practice
- MSc Advanced Nursing Practice: Nursing Practice
- MSc Advanced Nursing Practice: Specialist Nursing Practice (Adult, Mental Health, Learning Disabilities, Children's Nursing)**
Speech and language therapy
Pre-qualification
- BSc (Hons) Human Communication (Speech and Language Therapy). ***
* These programmes underwent Nursing and Midwifery Council (NMC) annual monitoring as part of the major review of healthcare programmes.
** These programmes are NMC approved.
*** These programmes are Health Professions Council (HPC) approved. Audiology is awaiting approval from the Registration Council for Clinical Physiologists (RCCP).
7 The overall aims of the provision are:
- to produce students who meet professional body and regulatory body requirements and who therefore demonstrate fitness for practice, fitness for purpose and fitness for award
- to integrate theory and practice in teaching, learning and assessment, both professionally and academically, within an appropriate context of inter and multiprofessional learning
- to ensure that students develop the necessary knowledge, skills and attitudes to demonstrate the following competences:
a show respect for clients' and patients' individuality, dignity and privacy
b demonstrate an awareness of the nature of equality of opportunity, discrimination and social justice and undertake practice in an anti-discriminatory manner
c ensure their clients' and patients' right to be involved in decisions about their healthcare
d justify public trust and confidence
e maintain high standards of practice
f protect their clients and patients from the risk of harm
g cooperate, collaborate and communicate with colleagues as an active member of the caring team showing respect for the various contributions of the other members of the team
h contribute to the education of students, colleagues, clients and patients, and the wider public
i assess the needs and plan, implement and evaluate high-quality, evidence-based healthcare practice which effectively meets the needs of individuals and groups within their specific patient/client group
j demonstrate the ability, through reflection and critical self-awareness, to evaluate the broader aspects of the provision and delivery of healthcare
k draw upon a range of appropriate academic disciplines to inform and underpin their practice, and demonstrate knowledge and understanding of:
- the structure, function and dysfunction of the human body
- physical and psychological human growth and development
- psychology applied to health and social care
- sociology and social policy as it applies to health and social care
- public health principles
- health education
- legislation and professional and statutory codes of conduct that affect health and social care practice
- ethical principles and practice.
B Academic and practitioner standards
B1 Audiology
Intended learning outcomes
8 The external examiner commented that intended learning outcomes (ILOs) for the new four-year BSc (Hons) Audiology are appropriate, comparable with other audiology programmes and clearly communicated to students through module handbooks. The ILOs are also appropriately described in a programme specification. Students indicated that they are aware of the ILOs. Visits to placement sites confirmed that clinical placement supervisors are aware of the ILOs through the students' National Audiology Clinical Placement Portfolio (NACPP), although supervisors would like their own copy, and the on-line version is not yet being used due to network security concerns. The programme team is in the process of mapping the ILOs against the Subject benchmark statement for audiology, published by QAA.
9 The ILOs were developed to produce graduates eligible for voluntary registration with the RCCP and, in future, to register with the HPC. The degree reflects the accreditation documentation of the RCCP and is consistent with the requirements of The framework for higher education qualifications in England, Wales and Northern Ireland (FHEQ), published by QAA. While the ILOs do foster the development of independent study, there is little development of interprofessional learning.
Curricula
10 The programme is four years long and is delivered in modular format for the campus-based teaching which properly reflects the ILOs. However, the programme leader indicated that the curriculum is being extensively reviewed. The curriculum is predominantly delivered within the first two years in Nottingham through subcontract arrangements with the College. The College in turn has local arrangements for clinical staff from NHS Nottingham School of Audiology at Ropewalk House (Ropewalks), part of the Queen's Medical Centre NHS Trust, to deliver part of the curriculum. Regular meetings between the University and the College staff facilitate curricular development and delivery. The programme was in the process of accreditation by the RCCP during the period of the review. The audiology curriculum is monitored by a curriculum development group that consists of academic and NHS staff and reports to the Audiology Advisory Group; hence it is responsive to feedback from students and clinical placement supervisors. Students are effectively prepared for self-critical, lifelong learning and have strong transferable skills. The academic programme delivered in years one, two and four effectively underpins the acquisition of clinical skills and is consistent with the RCCP, HPC and the original Department of Health (DH) requirements. However, students and clinical placement staff confirm that interprofessional education (IPE) is limited within the audiology curriculum. Moreover, there is currently little service-user input into curricular design and development in audiology.
11 The original model defined by the DH was to concentrate the acquisition of clinical skills within a single, year-long placement, with the third year spent in practice. The audiology curriculum has limited opportunity to provide clinical skills in the first two years of the programme, a situation confirmed by students and practice staff. The NACPP requires students to become competent in managing adult patients with hearing disorders and to have the competence to assist in paediatric and balance testing. Therefore, the acquisition of skills in the curriculum depends very much on the nature of the third-year placement. Where clinical placement sites do not offer adult, paediatric and balance services, a situation confirmed by the placement visits, there is potential for students not to be able to acquire all required competences. Some placement supervisors expressed concern about this. In these instances, the onus appeared to be on the placement area to arrange additional opportunities at other clinical centres. However, if students are unable to obtain all the necessary competences, the programme team indicated that space is found in the curriculum in year four for additional training within a clinical skills facility, at the University and at Leicester Royal Infirmary, to ensure that students acquire all necessary competences. Of the 2005-06 cohort of year three students, all students had acquired all the compulsory clinical skills before the end of the programme. Moreover, in response to feedback, the programme team has arranged further blocks of clinical training in the fourth year, with a four-week block in the spring term, to ensure that students' clinical competences are re-evaluated and reinforced immediately before graduation.
12 Students complete a research project within the fourth year with the aid of a project module. However, the curriculum is not appropriately designed to support this project work fully from an early stage, as some students and practice staff report that the genesis, design and performance of this is heavily dependent on practice staff.
Assessment
13 Assessment procedures are clearly specified in the student handbooks and are closely aligned to the University Assessment Policy, which itself is properly informed by 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, and by the RCCP requirements. University-wide marking criteria are employed, which are explicit and comprehensive.
14 A full range of assessment methods is used, allowing students to demonstrate the broad range of ILOs. Individual assessments map clearly to module ILOs. Audiology assessments are often thoughtfully designed to facilitate the application of theory to practice contexts, for example, by developing a patient information leaflet. The involvement of peers in formative verification of the achievement of the audiology ILOs is an example of innovative practice.
15 The reviewers considered a sample of assessments from across the modules. Marking is fair and standards are appropriate, and detailed written feedback is given. Students value this feedback in supporting their learning. Anonymous marking is used for examinations but not phase tests or coursework, in line with current University policy. The external examiner's report expresses confidence in the standard of the assessments used. However, it is an issue of concern that the external examiner did not receive examination scripts in time to view them before the Subject Authority Board (SAB), due to the short period of time between the examination period and the SAB, although an opportunity was provided to the external examiner to report back to the Chair on the quality of the papers. The assessment load is achievable and return of work is timely. The samples considered by the reviewers provide evidence of the proper moderation of student work.
16 In practice-based settings, both formative and summative assessment is carried out by clinical supervisors. Summative assessment is graded as Pass or Fail. Clinical supervisors attend preparation sessions and are clear about their assessment role in assessing NACPP competences, which reflect RCCP requirements. The reviewers looked at a sample of the documentation concerned with the signing-off of these competences. One audiology student, for whom the NACPP is required to be signed at intervals, had some competences signed off on the same day, which militates against robust assessment of clinical skills.
17 In certain placement settings it is difficult for clinical supervisors to provide all the necessary practical experiences and subsequent assessment required for the NACPP to be signed off. University staff are aware of this and all students have the opportunity to achieve the full range of ILOs, either through local initiatives led by the placement providers in year three, or through additional experience in year four at clinics run by university staff who have honorary contracts with Leicester Royal Infirmary. However, any delay in the assessment of the NACPP causes anxiety for the audiology students concerned, reduces equity in the student assessment experience and may add to the assessment load in year four. Visits from university staff ensure moderation of practical work and this partnership is valued by students and clinical staff. The external examiner does not have any involvement in viewing practical work.
Student achievement
18 The first cohort of students will complete the programme at the end of the 2005-06 academic session, when they will finish year four. The University is one of the first two higher education institutions in the UK who will then provide BSc (Hons) Audiology graduates at that time, with other institutions following in later years.
19 The reviewers' consideration of a variety of students' written assignments and examination scripts at levels 1 to 3 shows achievement of the theoretical learning outcomes and fitness for purpose. Clinical staff find that students have acquired appropriate knowledge by the time they enter level 3. A review of students' clinical and practical assessment material shows them to be achieving clinical skills required for voluntary registration with the RCCP, with a strong element of reflective practice.
20 The external examiner reports comparability with other undergraduate audiology programmes, although undergraduate audiology programmes are new in all institutions. The implementation of the NACPP also ensures that clinical skills achieved are in line with those of audiology students across the country. The placement visits by the reviewers confirm that practice staff are suitably informed about their role in the students' training, although not all locations offer the full range of audiology services. The final year of the programme maintains and strengthens the learning outcomes, with the help of the new audiology skills laboratory.
21 The University has encouraging evidence that almost 50 per cent of the students in the first cohort have already been given offers of permanent employment to be taken up following successful completion of the programme. Future graduates are expected to find suitable employment as audiologists in the NHS.
Summary of academic and practitioner standards for audiology
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Audiology at De Montfort University, in partnership with the Leicestershire, Northamptonshire and Rutland SHA, the Hampshire and Isle of Wight SHA and the Trent Multi Professional Deanery.
Strengths
- Audiology assessments are often thoughtfully designed to facilitate the application of theory to practice contexts, for example, by developing a patient information leaflet (paragraph 14).
- The involvement of peers in formative verification of the achievement of the audiology intended learning outcomes is an example of innovative practice (paragraph 14).
Weaknesses
- Students and clinical placement staff confirm that interprofessional learning is limited within the audiology curriculum (paragraph 10).
- There is currently little service-user input into curricular design and development in audiology (paragraph 10).
- The audiology curriculum has limited opportunity to provide clinical skills in the first two years of the programme, a situation confirmed by students and practice staff (paragraph 11).
- Any delay in the assessment of the National Audiology Clinical Practice Portfolio causes anxiety for the audiology students concerned, reduces equity in the student assessment experience and may add to the assessment load in year four (paragraph 17).
B2 Health visiting
Intended learning outcomes
22 The ILOs for BSc (Hons) Community Health Nursing (Health Visiting) are clearly stated, enable students to meet the NMC (2002) health visitor competences, and are mapped against the Subject benchmark statement for health visiting, published by QAA. However, the programme specification for the BSc (Hons) Community Health Nursing (Health Visiting), supplied to the reviewers, fails to identify the NMC competences for Health Visiting 2002, against which the programme was mapped at revalidation in 2004, and includes previous UKCC requirements on programme prerequisites.
23 Previously-registered health visitors wishing to return to health visiting practice can undertake a Return to Practice (Health Visiting) module, although there are no students registered at the moment. ILOs for this module are generic in nature, with specific application taking place in practice. The programme specification provided by the University covers all return to practice students, including those in nursing.
24 The ILOs are communicated to students at the beginning of the programme, through student subject guides and module handbooks, and, in the case of return to practice, through workbooks. Tripartite visits in the practice setting allow the student, practice teacher and tutor to explore the learning outcomes together.
25 Practice teachers attend regular meetings in the University, allowing input to the review and development of the degree programme and its learning outcomes, and thus maintaining currency. Module amendments resulting from student evaluations are notified to students and communicated to practice teachers at an annual workshop at the University before the start of each cohort.
26 The ILOs for nurse prescribing from the nurses' formulary are appropriate and are contained within the Specialist Practice and Final Integrated Practice modules, which involves practice teachers, who are experienced prescribers, and who can offer advice about developments in practice.
Curricula
27 The BSc (Hons) Community Health Nursing (Health Visiting) was revalidated within the University and by the NMC in 2004, with full and part-time routes available. Validation of the programme followed consultation with key stakeholders and a collaborative development process involving practitioners. To date, the involvement of service users and carers in curricular design and delivery on the BSc (Hons) Community Health Nursing (Health Visiting) has been limited. The 45-week, full-time or 90-week, part-time programme enable students to meet the Standards for Community Specialist Practice and the NMC 2002 Health Visitor competences, including preparation as a prescriber from the nursing formulary. The curriculum allows students to be fit for purpose, practice and award on successful completion of the programme. Employers confirm that students are fit for practice on qualification.
28 The curriculum utilises an integrated approach, with theoretical and practice components running concurrently. An eight-week consolidation period is undertaken at the end of the programme. The centrality of the client in the curriculum is implicit within the programme outcomes.
29 The programme runs in conjunction with Community Specialist Practice Pathways in nursing; five of the eight modules undertaken are shared with the other pathways, providing good opportunities for interdisciplinary learning. A three-day IPE module, run in collaboration with Leicester University and the University of Northampton, is undertaken by most students on the BSc (Hons) Community Health Nursing (Health Visiting), providing excellent opportunities for work with students from a number of professions. There is some flexibility in the programme, as students are able to select an elective module from a menu of modules available within the Faculty. The option of including a module in child protection is clearly valued by practice teachers.
30 Placements offer a range of experience across the continuum of public health, allowing for integration of theory and practice. This experience varies from placement to placement, but is suitably matched to student needs. The public health focus of the programme has recently been updated and strengthened following feedback from the external examiner.
31 The Return to Practice curriculum suitably incorporates the ILOs in a flexible manner, with the specific detail often being determined in practice, and therefore students are fit for purpose, practice and award on successful completion. Students may take one or two semesters to complete, which is helpful to students in differing circumstances.
Assessment
32 The programmes have an appropriate assessment strategy which is communicated effectively to assessors and students. The assessment procedures followed are congruent with University and Faculty guidelines, are informed by the Code of practice, published by QAA, and are in line with NMC requirements. Assessment procedures and grading criteria are made clear to students through their subject guide, module assessment guidelines and the university undergraduate scheme handbook.
33 The external examiners express confidence in the standards and reliability of the assessments, and marking and moderation procedures for both theory and practice elements. The reviewers' consideration of a sample of student work supports these conclusions and indicates that students receive extensive written feedback on their work.
34 The assessments on the BSc (Hons) Community Health Nursing (Health Visiting) allow the ILOs to be properly tested in both campus and practice settings. Effective use is made of formative assessment prior to summative assessment, particularly in modules delivered early in the programme.
35 On the BSc (Hons) Community Health Nursing (Health Visiting) programme, concerns about the assessment in one module expressed by the external examiner have been explored by the programme team and have resulted in modification to the assessment in the specialist practice module, so that its public health focus is emphasised to fully address the ILOs.
36 On the BSc (Hons) Community Health Nursing (Health Visiting) there is an overreliance on essay-style assignments and limited practice-teacher involvement in summative assessment, which reduce students' opportunities to demonstrate their knowledge and skills in a full range of relevant ways. Other types of assessment include requiring students to deliver a lesson, and write both a plan and a reflective account of the success of their intervention for promotion of health in the community. This successfully facilitates integration of theory and practice.
37 Academic staff assess students, in conjunction with practice teachers, according to clear ILOs for practice assessment. Mentors provide detailed formative feedback to contribute effectively to this portfolio assessment and also provide a practice assessment report. This report is considered as part of the overall practice assessment and is graded by percentage by academic staff to ensure equity across the placements. Practice mentors are involved in the internal moderation of practice placement reports. Mentors are prepared for their role in assessing students through annual mentor updates. The assessment of nurse prescribing is achieved through competences being signed off by practice mentors. The mentors give formative feedback on students' planned lessons in the Promotion of Health in the Community, prior to module tutors' summative assessment.
38 The assessments on the Return to Practice programme properly assess the ILOs, and their application to diverse situations, and foster problem-solving abilities and independent learning. They have been developed in consultation with practitioners and are carefully designed to integrate theory and practice.
Student achievement
39 External examiners report that the achievements of graduates on the BSc Community Health Nursing (Health Visiting) programme meet the expectations for the award, and that the level of achievement is comparable with other similar programmes. The reviewers confirm that samples of student work and completed practice assessment documents show evidence of progressive and full achievement of the ILOs for the programme. The grades achieved by the students are supported by the external examiners and show that almost all students gain a Second class honours degree, with no First class honours (Table 1a), but all students completing the programme achieving an award.
40 Practice teachers facilitate a range of learning opportunities that support the achievement of individual learning needs and practice outcomes. In particular, public health initiatives within local Primary Care Trusts (PCTs) are helping students to achieve contemporary practice experience. Students, health visitors, practice teachers and PCT service managers report that the students are fit for practice, purpose and award. All students are seconded and employed by local PCTs.
41 While there are no students on the Return to Practice programme at the moment, Table 1a indicates that all former completing students were successful. External examiners for the whole Return to Practice programme, which includes nursing students, agree that the level of achievement is appropriate. A survey in January 2006 of all 52 Return to Practice students from the four cohorts between September 2003 and February 2005, including those doing health visiting, found that all the 39 who returned the questionnaire were in employment locally.
Table 1a: Completion and achievement statistics for all award-bearing programmes in health visiting
| Programme | Cohort (entry year) | Diploma programmes Pass |
Diploma programmes Fail |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2i | 2ii | 3 | P | F | ||||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| BSc (Hons) Community Health Nursing (Health Visiting) | Sep 2005 | 0 | 0 | 3 | 30 | 7 | 70 | 0 | 0 | 0 | 0 | 0 | 0 | ||||
| Sep 2004 | 0 | 0 | 3 | 25 | 7 | 58 | 2 | 17 | 0 | 0 | 0 | 0 | |||||
| Sep 2003 | 0 | 0 | 5 | 38 | 8 | 62 | 0 | 0 | 0 | 0 | 0 | 0 | |||||
| Return to Practice (Health Visiting) | Aug 2005 | 1 | 100 | 0 | 0 | ||||||||||||
| Aug 2004 | 1 | 100 | 0 | 0 | |||||||||||||
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 De Montfort University, in partnership with the Leicestershire, Northamptonshire and Rutland SHA, the Hampshire and Isle of Wight SHA, and the Trent Multi Professional Deanery.
Strength
- A three-day interprofessional education module, run in collaboration with Leicester University and the University of Northampton, is undertaken by most students on the BSc (Hons) Community Health Nursing (Health Visiting), providing excellent opportunities for work with students from a number of professions (paragraph 29).
Weaknesses
- The programme specification for the BSc (Hons) Community Health Nursing (Health Visiting), supplied to the reviewers, fails to identify the Nursing and Midwifery Council competences for Health Visiting 2002, against which the programme was mapped at revalidation in 2004, and includes previous United Kingdom Central Council for Nursing, Midwifery and Health Visiting requirements on programme prerequisites (paragraph 22).
- To date, involvement of service users and carers in curricular design and delivery on the BSc (Hons) Community Health Nursing (Health Visiting) has been limited (paragraph 27).
- On the BSc (Hons) Community Health Nursing (Health Visiting) there is an overreliance on essay-style assignments and limited practice-teacher involvement in summative assessment that reduce students' opportunities to demonstrate their knowledge and skills in a full range of relevant ways (paragraph 36).
B3 Midwifery
Intended learning outcomes
42 The individual programme specifications clearly outline the ILOs for the midwifery programmes. Programme learning outcomes reflect the FHEQ and the Subject benchmark statement for midwifery, published by QAA. The pre-registration midwifery learning outcomes appropriately address the knowledge and skills required of an honours graduate in midwifery and meet the standards of proficiency required for NMC registration, which incorporate the European Union Midwives' Directive 80/155/EEC Article 4, and this has been noted by the external examiners. The post-registration programmes have suitable ILOs for meeting the requirements for the continuing professional development (CPD) of registered midwives.
43 Development of the ILOs is undertaken in conjunction with a range of stakeholders, including clinical staff, students and members of the Maternity Services Liaison Committee. This collaboration, for both pre and post-registration programmes, is apparent from the membership and participation of various curriculum development groups and programme management committees. The diverse membership of this curriculum steering group helps ensure that the ILOs remain current and relevant to practice.
44 The ILOs are given in programme and module handbooks and clinical practice documentation. Interprofessional learning is an integral feature of the learning outcomes of clinical placements and is a particular feature of the Interprofessional Learning Midwifery Portfolio. Meetings with students and mentors, as well as visits to practice settings, confirm that the ILOs are understood and inform the students' clinical experience and assessment.
Curricula
45 The pre-registration programmes in midwifery offer a broad-based curricula that provides intellectual and clinical opportunities to ensure that, on completion, students are competent practitioners. For example, it is confirmed by mentors and employers that successful students are fit for purpose, practice and award. The curricula also develop the reflective and critical evaluative skills that are required in current midwifery practice. The reports of the external examiners also confirm that the design and content of the curricula are appropriate for the ILOs.
46 There is a clear intention of the midwifery curricula to promote the integration of practice and theory. All pre-registration midwifery curricula are appropriately structured so as to aid the development of key midwifery skills, including those associated with woman-centred midwifery practice. This was reinforced during a visit to a community-based facility, a birth centre, where the preferences of mothers were the main determinants of the centre's philosophy. Other taught elements of the curricula also focus on the centrality of the service user in the student's learning experience. The shortened pre-registration programme provides an intensive and relevant experience that, as with other such programmes, on occasions places heavy demands on the students.
47 There are structures in place that help ensure that providers and service users have input into planning the design of the pre-registration curricula. Development of the recently-approved MSc Midwifery Practice is an example of the desire to increase the post-registration and postgraduate provision so as to widen opportunities for CPD for registered midwives by offering a curriculum that meets the needs of modern professional practice. However, to date, recruitment to the programme has been disappointing.
48 Interprofessional learning opportunities are a feature of the clinical components of the student's programme. For example, visits to clinical areas have demonstrated that students are exposed to a wealth of shared learning and teaching opportunities. Students on the pre-registration midwifery programme also participate in a collaborative venture with Leicester University and the University of Northampton, whereby midwifery students share learning experiences with a variety of undergraduate and pre-registration students who are studying on other healthcare programmes. The aim of the experience is to facilitate greater understanding of the roles of other members of the multiprofessional team. Strand one of this programme has been delivered in 2005-06 and it is planned that strands two and three will be delivered in future years.
Assessment
49 The assessment strategy for midwifery complies with NMC requirements and incorporates the principles of the University Assessment Policy, and so fairly reflects the principles of the Code of practice. It provides a realistic balance between examinations and coursework and places equal weighting on theory and practice.
50 Across the provision, a wide range of suitable assessment methods is used, which appropriately assesses the ILOs. Assessment tasks for all midwifery programmes facilitate good linkage between practice experiences and enable the learning outcomes to be appropriately assessed. The master's programmes are assessed by a range of coursework, including essays, seminar papers, projects and clinical portfolios. Midwifery external examiners comment consistently on the high quality of assessment feedback.
51 The marking criteria used as a guide for students and staff is limited and provides insufficient information to support students in discriminating between the different academic levels. The University is currently reviewing the marking criteria and guidance for students which will be linked to amendments in the undergraduate regulations.
52 The assessment of clinical practice in the pre-registration midwifery programmes is appropriately based on the achievement of the NMC Standards of Proficiency for pre-registration midwifery education. Students who successfully complete the criteria have their practice assessment performance graded which contributes to the total grade for the module. The use of tripartite practice assessments in pre-registration midwifery and return to practice programmes to ensure practice competence significantly increases the level of understanding. This activity is organised around practice allocation weeks in the University, to enable staff to facilitate the practice meetings, to help students to identify their personal learning needs and to set appropriate action plans in collaboration with mentors.
53 The Continuous Assessment of Practice (CAP) document is perceived by students to be a good vehicle for providing them with a clear identification of practice achievement; it is viewed positively. Overall, students perceived that clinical assessments are handled well and that mentors meet the NMC standards in terms of student support. Mentors confirmed that they are regularly updated and that they have a clear understanding of the assessment process and the process to be followed for failing students. The CAP documents clearly articulate the ILOs to be achieved at each academic level.
54 External examiners report that they have the opportunity to review an appropriate sample of all assignments, including practice documentation which is available at the SAB meetings. The reviewers' consideration of a sample of student work showed that a comprehensive process of moderation is in place, with all scripts being double-marked. External examiners are also offered the opportunity to meet students and undertake practice visits.
55 Employers state that they have regular education forums at which they can influence curricula and particularly practice assessment documents. Feedback is particularly influential during curriculum development sessions and has resulted in refinements to the CAP documents. An example of stakeholder influence is the inclusion of the assessment of professional conduct and behaviour within all CAP documents. Mentors also stated that they have an opportunity to feed into curricular reviews both directly and through practice educator representatives on development teams. This is evidence of partnership working at all levels of the organisation.
Student achievement
56 For both pre and post-registration programmes, the external examiners indicate that students are achieving the ILOs and that graduates and diplomates reach the required academic and professional standards. The reviewers' consideration of a sample of student work, covering a variety of types and levels, confirms this view.
57 The external examiners report that the grade of award given to students properly reflects the level of achievement and that gradings are determined in a way that is comparable with other institutions. On the DipHE in Midwifery, all students in the last three cohorts who reached the final assessments achieved a Pass, while on the BSc Midwifery, achievement on the last two graduating cohorts has been very high, with most students gaining an Upper Second class award or better, albeit for relatively small numbers (Table 1b). On the BSc Midwifery (shortened), while the majority of this small group who finished the programme achieved an Upper Second class degree, a number have exited with a DipHE (Table 1b). The Return to Practice and the MA and MSc midwifery programmes have no failures among students reaching the end of the programmes.
58 Employers, commissioners and mentors report that graduates and diplomates from the midwifery programmes are suitably prepared for practice and employment and that their level of skill and knowledge is similar to students completing programmes at other institutions. For all pre-registration students, except one single case shown in Table 2b, the figures indicate that there was no unemployment among midwifery graduates and diplomates. While there is a bias towards midwifery students getting employment locally, a significant percentage obtain jobs in other areas (Table 2b). Employers work closely with the University in the development of programmes, and this means that post-registration midwifery students returning to their employers have gained additional skills very relevant to modern midwifery practice.
Table 1b: Completion and achievement statistics for all award-bearing programmes in midwifery
| Programme | Cohort | Diploma programmes Pass |
Diploma programmes Fail |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2i | 2ii | 3 | P | F | ||||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| Diploma of Higher Education Midwifery | Jan 2005 | 20 | 100 | 0 | 0 | ||||||||||||
| Jan 2004 | 15 | 100 | 0 | 0 | |||||||||||||
| Jan 2003 | 11 | 100 | 0 | 0 | |||||||||||||
| BSc (Hons) Midwifery* | Aug 2005 | 3 | 38 | 1 | 13 | 4 | 50 | 0 | 0 | 0 | 0 | 0 | 0 | ||||
| Aug 2004 | 6 | 50 | 5 | 42 | 1 | 8 | 0 | 0 | 0 | 0 | 0 | 0 | |||||
| Aug 2003 | 0 | 0 | 6 | 43 | 6 | 43 | 2 | 14 | 0 | 0 | 0 | 0 | |||||
| BSc (Hons) Midwifery (shortened) | Sep 2005 | 1 | 14 | 3 | 43 | 1 | 14 | 0 | 0 | 2** | 29 | 0 | 0 | ||||
| Sep 2003 | 3 | 33 | 1 | 11 | 3 | 33 | 0 | 0 | 2** | 22 | 0 | 0 | |||||
| Dec 2001 | 1 | 14 | 3 | 43 | 2 | 29 | 1 | 14 | 0 | 0 | 0 | 0 | |||||
| Return to Midwifery Practice (start date) | Mar 2004 | 2 | 100 | 0 | 0 | ||||||||||||
| Oct 2002 | 2 | 100 | 0 | 0 | |||||||||||||
| Sep 2001 | 3 | 100 | 0 | 0 | |||||||||||||
Postgraduate programmes |
Postgraduate programmes Fail |
||||||||||||||||
| MA Midwifery/MSc Midwifery Practice (start date) | Sep 2004 | 1 | 100 | 0 | 0 | ||||||||||||
| Oct 2003+ | n/a | n/a | n/a | n/a | |||||||||||||
| Sep 2002 | 1 | 100 | 0 | 0 | |||||||||||||
No student cohorts have yet completed the BSc (Hons) Clinical Midwifery
*two of August 2005 cohort to be reassessed.
** DipHE exit + one student continuing
Table 2b: Employment statistics for all pre-registration programmes and exception reporting only for post-registration/post-qualification programmes in midwifery
| Programme | Output year | Further study | Local employers | Employers elsewhere | Unemployed | Other | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | ||
| Diploma of Higher Education in Midwifery | Jan 2005 | 0 | 0 | 10 | 50 | 7 | 35 | 0 | 0 | 3 | 15 |
| Jan 2004 | 0 | 0 | 9 | 60 | 2 | 13 | 0 | 0 | 4 | 27 | |
| Jan 2003 | 0 | 0 | 6 | 55 | 1 | 9 | 0 | 0 | 4 | 36 | |
| BSc (Hons) Midwifery | Aug 2005 | 0 | 0 | 3 | 37 | 5 | 63 | 0 | 0 | 0 | 0 |
| Aug 2004 | 0 | 0 | 7 | 58 | 2 | 17 | 0 | 0 | 3 | 25 | |
| Aug 2003 | 0 | 0 | 8 | 57 | 4 | 29 | 0 | 0 | 2 | 14 | |
| BSc (Hons) Midwifery (shortened) | Sep 2005 | 0 | 0 | 3 | 43 | 4 | 57 | 0 | 0 | 0 | 0 |
| Sep 2003 | Not available | ||||||||||
| Dec 2001 | 0 | 0 | 6 | 86 | 0 | 0 | 1 | 14 | 0 | 0 | |
| Return to Midwifery practice (start dates) | Mar 2004 | 0 | 0 | 1 | 50 | 1 | 50 | 0 | 0 | 0 | 0 |
| Oct 2002 | 0 | 0 | 22 | 67 | 0 | 0 | 0 | 0 | 1* | 33 | |
| Sep 2001 | 0 | 0 | 2 | 67 | 1 | 33 | 0 | 0 | 0 | 0 | |
*Doing voluntary work
NB: Employment statistics are taken from student surveys undertaken immediately prior to completion of programme. Thus students included under the 'Other' category are indicative of students awaiting job offers or other factors (for example, awaiting return to home location prior to job application) that preclude them from being recorded as employed at the time of programme completion.
Summary of academic and practitioner standards for midwifery
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Midwifery at De Montfort University, in partnership with the Leicestershire, Northamptonshire and Rutland SHA, the Hampshire and Isle of Wight SHA and the Trent Multi Professional Deanery.
Strengths
- Assessment tasks for all midwifery programmes facilitate good linkage between practice experiences and enable the learning outcomes to be appropriately assessed (paragraph 50).
- The use of tripartite practice assessments in pre-registration midwifery and return to practice programmes to ensure practice competence significantly increases the level of understanding (paragraph 52).
B4 Nursing
Intended learning outcomes
59 The ILOs for the nursing programmes reflect the aims of the provision and are appropriately mapped against external academic and professional reference points, including the Subject benchmark statement for nursing, published by QAA, and the standards specified by the NMC. These mapping exercises have ensured that the outcomes are appropriate for academic level and meet NMC requirements. It is intended that recent pre-registration diploma curricular development will address the need more explicitly to align the pre-registration programme ILOs to the FHEQ.
60 The importance of user and carer consultation is recognised in the development of nursing programmes, and this is evidenced through the Faculty's development of a useful patient and public involvement strategy. Pre-registration and undergraduate programmes also include ILOs that reflect opportunities for students to work interprofessionally. For example, there are interprofessional strands that utilise case-studies and interdisciplinary workshops in the pre-registration curriculum, and it is planned to develop similar approaches in later years of the programme. This undergraduate curricular strand involves medical, nursing, midwifery, speech and language therapy, social work and pharmacy pre-registration students. Similarly, a strength of the BSc (Hons) Community Health Nursing programme is the interdisciplinary, post-registration modules which have the ILOs directed at experiencing and learning about interdisciplinary care in practice. These modules focus case-study work with community health nurses, doctors, social workers and selected patients. NHS commissioners also express their satisfaction, especially in recent years, with the Faculty's responsiveness to meeting changing service needs. An example given was that of the Minor Injury module.
61 The ILOs of programmes are generally well understood by students and clinical staff. They are clearly communicated through module handbooks and the continuous assessment of practice documentation. However, some mentors and students did say that the learning outcomes given in the pre-registration continuous assessment of practice documentation are repetitious. Practice mentors are also made aware of the students' ILOs through mentor updating sessions that are organised in partnership between service and academic staff.
62 The ILOs of the BSc (Hons) Community Health Nursing reflect the programme aims and ensure that students have the opportunity to achieve the requisite professional competences. This includes the NMC requirements pertaining to non-medical prescribing for District Nurses and Specialist Nursing Practice and Specialist Health Practice programmes. Similarly, the three related MSc programmes with similar outcomes help ensure that students develop competences related to the evidence-based practice agenda in nursing practice and are facilitated in the development of their research skills. The ILOs of the Return to Nursing and Specialist Nursing Practice programmes also meet the statutory requirements and are focused on preparing staff returning to practice with the appropriate competences.
Curricula
63 Nursing curricula are developed with the involvement of a range of stakeholders including students, service users, NHS Trust staff, health service practice managers and clinical practitioners. Employers and commissioners verify that students are fit for purpose, practice and award. Scrutiny of external examiner reports and NMC annual monitoring reports also confirm that the curricula allow successful students to achieve the NMC requirements.
64 The pre-registration curriculum has undergone revision and re-approval in March 2006 and the revisions will commence in September 2006. However, it is apparent that the present curriculum has been the subject of ongoing modifications in order to maintain its currency and relevance. For example, the design and content of the current pre-registration curriculum enable the standards of proficiency and safe practice to be progressively developed. It is also appropriately focused on safe professional practice.
65 The design and balance of clinical practice and theoretical work in the pre-registration programmes ensure that NMC standards are met. A rigorous system is in place to ensure that students complete the required programme hours required for registration, although students who need to make up missed academic sessions report disparity in how this is addressed by some module leaders. Hours completed in clinical practice are recorded by students, countersigned by their mentors and verified by the students' personal tutor. Curricular content also ensures that clinical experience for adult nursing specified by the European Directive 771/1453/EEC are met. Even though there is a session on numeracy and drug calculations, and the University offers remedial support to students who require additional help with the development of numeracy skills, child branch students on the DipHE and BSc (Hons) Nursing and clinical staff report that preparation for the safe administration of medicines in practice could be improved in the university setting.
66 The BSc (Hons) Community Health Nursing programme offers a number of pathways. While the programme meets the NMC requirements, one external examiner comments that the district nurse pathway is less innovative than some other programmes available. For example, there is a little input into public health, a key NHS driver. However, meetings with employers, students and mentors confirm that the programme is flexible and offers opportunities for full and part-time study and a variety of learning experiences. Student reports of a lack of academic leadership for the school nursing pathway have been addressed through interim arrangements and the appointment of a member of staff with school nurse practice experience. The Return to Practice programme also offers a flexible curriculum, with students being able to complete the programme over one or two semesters. Likewise, the Specialist Nursing Practice and Specialist Health Practice programmes give students the choice to select from a broad range of modules that may contribute to a named award or be taken as stand-alone modules.
67 Shared learning is a prominent feature of the BSc (Hons) Community Health Nursing programme, with much of the theoretical aspects of the programme being shared by students on the various pathways. A very positive aspect of the programme is student participation in an interprofessional learning initiative that is undertaken in conjunction with the University of Leicester and the University of Northampton. This enables students to develop appreciation of the roles of the multiprofessional team through case-study work and joint visits to patients being cared for in the community. Visits made to practice also confirm that students are given opportunities to engage in teamworking and multidisciplinary practice. The pre-registration curriculum also offers opportunities for shared and multidisciplinary learning both in the university and practice setting.
Assessment
68 The assessment strategy for the nursing provision has been developed in accordance with the University's Assessment Policy, which properly reflects the Code of practice, published by QAA, and the requirements of the NMC. However, the full extent of this strategy is not always apparent to students. For instance, students report that formative assessment concentrates on consideration of past examination papers and mock examinations.
69 Generally, both pre-registration and post-registration nursing programmes adopt a wide range of suitable assessment methods which allow the ILOs to be properly assessed and particularly foster problem-solving abilities and independent learning. However, while the BSc (Hons) Community Health Nursing programme handbook identifies a reasonable range of assessment methods, the reviewers' consideration of student work showed a preponderance of essays, which students also feel detracts from meeting clinical requirements.
70 The Specialist Nursing/Health Practice and Return to Practice programmes have integrated theory and practice assessments that have been developed in conjunction with practitioners, demonstrating evidence of partnership working. Communication between the community module team and mentors has been enhanced by the development of a summary sheet so that appropriate support can be provided to students. The use within specialist nursing practice programmes of a poster presentation to feedback outcomes of theory assessments to clinical practice is very effective in enhancing learning and allowing dissemination to practice.
71 The assessment processes for marking and moderation are rigorous and transparent, with clear assessment criteria and links between module learning outcomes and content articulated in module handbooks. Extensive double-marking of assignments is in place, with an appropriate sample being reviewed by external examiners. The quality of assessment feedback is high and is structured to assist students in identifying the rationale for the mark awarded and clear guidance for retrieval of academic failure. However, pre-registration students report that assessment turnaround times can be much greater than the recommended three-week period. University procedures now allow students to be given unratified results which should improve this situation.
72 While external examiners are generally fully involved in the assessment process, the NMC Annual Monitoring Report of 2004-05 indicated that external examiners do not consider practice assessments, and recommended that they are encouraged to report on this area. The academic staff provide external examiners with an opportunity to review practice documentation at examination boards, as well as opportunities for them to access practice and meet students. This is only possible if external examiners arrive early enough to avail themselves of these opportunities.
73 Generally, placement staff understand their role in assessing students and are offered useful updating sessions through a formal teaching session or a newsletter, although some had not yet fully taken up these opportunities. Students and associate and lead mentors commented that the pre-registration CAP document in nursing is repetitive, in places difficult to understand and open to interpretation. Students also stated that mentorship is variable and inconsistent during some practice placements, resulting in feelings of stress as the ILOs in their CAP documents were frequently signed off very late during the placement. Assessments of practice used in the nursing programmes are all based on Pass/Fail criteria and are not graded. Nursing students indicated that the CAP documents are not fully explained to them by university staff, and mentors stated that the documents are not discussed specifically during mentor-update sessions, resulting in a level of confusion for both mentors and students.
Student achievement
74 Across the full range of nursing programmes, external examiners indicate that students are achieving the ILOs and with outcomes consistent with other comparable qualifications. The reviewers' consideration of various types of student work also indicates an appropriate level of achievement, as well as showing that self-assessment and the development of clear reflective and critical capabilities are encouraged. External examiners also indicate that the grades awarded to students are appropriate.
75 At least 90 per cent of completing DipHE in Nursing students are successful in their programme and over 70 per cent obtain employment offers locally before completion. Others obtain employment further afield or anticipate employment upon completion. Those who fail to complete the whole programme but exit with non-registerable qualifications may obtain posts in the healthcare sector.
76 All BSc (Hons) Nursing students who complete the programme obtain classified honours degrees in nursing, the majority with Upper or Lower Second class honours degrees and a few achieving Firsts or Third class awards. About 70 per cent of students obtain posts locally to be taken up on completion, with the remainder increasingly finding employment elsewhere before completion (Table 2c).
77 Community Health Nursing graduates will have had experience of working in multidisciplinary settings and, as such, are properly prepared for employment alongside other professionals and consistent with the concept of interprofessional learning. All students who complete the BSc (Hons) Community Health Nursing programme obtain classified honours degrees. The majority of students obtain Upper or Lower Second class honours degrees and a few achieve Firsts or Third class awards. All students on this programme are seconded from their employers and resume employment upon completion.
78 All students who complete the Return to Practice programme have been successful in obtaining re-registration, either through the slow or fasttrack route and with placements to suit the needs of individual students. Employment statistics for this group are incomplete but, of the known completers, about 90 per cent resume work in public or private healthcare, all in the local geographical area.
79 The BSc (Hons) Specialist Nursing Practice with Specialist Practitioner Qualification programme allows a large number of seconded nurses to achieve credit from particular modules relevant to their CPD. About 10 per cent of the student cohort go on to obtain the 120 level 3 credits necessary for the degree, with about half of these gaining classified honours degrees and half obtaining Pass degrees. All students to date have been successful in the degree programme. All candidates are seconded from employing organisations and, as such, are employed following completion of their programme (Tables 1c and 2c).
80 The BSc (Hons) Specialist Health Practice programme has recruited relative small numbers of allied health professionals, other than nurses, who mainly register on individual modules for the purpose of CPD, although a minority obtain classified honours or Pass degrees. The majority of candidates who undertake the programme are already employed within the service provider organisations, demonstrating positive multidisciplinary development in local healthcare provision.
81 The three related MSc programmes recruit post-registration nurses who have up to six years to complete the taught programme and dissertation. Those who do not complete the degree leave with postgraduate institutional credits. The majority of candidates are already employed within service provider organisations.
82 Mentors in practice have a strong ethos of aiming to produce graduates fit for practice and are willing to fail those who do not achieve this standard. Practitioners who supervise students have confidence in university nursing graduates who are seen to be fit for purpose and practice, with many being employed locally. Furthermore, the current widening participation agenda has promoted recruitment from the local population who are then likely to be employed locally. Employers and commissioners work closely with the University to maintain the quality and employability of graduates from all the nursing programmes.
Table 1c: Completion and achievement statistics for all award-bearing programmes in nursing
| Programme | Cohort | Diploma programmes Pass |
Diploma programmes Fail |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2i | 2ii | 3 | P | F | ||||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| Diploma of Higher Education Nursing | Jan 2005* | 118 | 98 | 3 | 2 | ||||||||||||
| Jan 2005 | 131 | 99 | 1 | 1 | |||||||||||||
| Aug 2004 | 122 | 97 | 4 | 3 | |||||||||||||
| BSc (Hons) Nursing | Aug 2005* | 4 | 21 | 12 | 63 | 2 | 11 | 1 | 5 | 0 | 0 | 0 | 0 | ||||
| Aug 2004 | 3 | 12 | 8 | 31 | 15 | 57 | 0 | 0 | 0 | 0 | 0 | 0 | |||||
| Aug 2003 | 1 | 4 | 10 | 34 | 15 | 52 | 3 | 10 | 0 | 0 | 0 | 0 | |||||
| Return to Nursing Practice (cohort start date) | Sep 2005** | 10 | 100 | 0 | 0 | ||||||||||||
| Feb 2005** | 13 | 100 | 0 | 0 | |||||||||||||
| Sep 2004 | 9 | 100 | 0 | 0 | |||||||||||||
| BSc (Hons) Community Health Nursing (cohort start date) | Sep 2004 | 2 | 10 | 8 | 40 | 8 | 40 | 2 | 10 | 0 | 0 | 0 | 0 | ||||
| Sep 2003 | 2 | 10 | 7 | 35 | 9 | 45 | 2 | 10 | 0 | 0 | 0 | 0 | |||||
| Sep 2002 | 0 | 0 | 8 | 62 | 5 | 38 | 0 | 0 | 0 | 0 | 0 | 0 | |||||
| BSc (Hons) Specialist Nursing Practice | 2005-06 (to date) |
1 | 5 | 8 | 36 | 2 | 9 | 0 | 0 | 11 | 50 | 0 | 0 | ||||
| 2004-05 | 2 | 2 | 18 | 17 | 37 | 35 | 2 | 2 | 46 | 44 | 0 | 0 | |||||
| 2003-04 | 1 | 1 | 13 | 19 | 14 | 20 | 2 | 3 | 39 | 57 | 0 | 0 | |||||
| BSc (Hons) Specialist Health Practice*** | 2005-06 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 100 | 0 | 0 | ||||
| 2004-05 | 0 | 0 | 1 | 13 | 1 | 13 | 0 | 0 | 6 | 74 | 0 | 0 | |||||
| 2003-04 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||
Table 1c: Completion and achievement statistics for all award-bearing programmes in nursing
| Programme | Cohort | Postgraduate programmes Pass |
Postgraduate programmes Fail |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2i | 2ii | 3 | P | F | ||||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| MSc Advanced Nursing Practice (start date) | Sep 2004 | 1 | 100 | 0 | 0 | ||||||||||||
| Mar 2004 | 5 | 100 | 0 | 0 | |||||||||||||
NOTES
* Some students are to be re-assessed
** Some students not yet finished the programme
*** The first commencement date on the BSc (Hons) Specialist Nursing Practice programme was September 2003
Table 2c: Employment statistics for all pre-registration programmes and exception reporting only for post-registration/post-qualification programmes in nursing
| Programme | Output year | Further study | Local employers | Employers elsewhere | Unemployed | Other* | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | ||
| Diploma of Higher Education in Nursing | Aug 2005 | 0 | 0 | 103 | 87 | 8 | 7 | 0 | 0 | 7 | 6 |
| Jan 2005 | 0 | 0 | 97 | 74 | 14 | 11 | 0 | 0 | 20 | 15 | |
| Aug 2004 | 0 | 0 | 92 | 75 | 17 | 14 | 0 | 0 | 13 | 11 | |
| BSc (Hons) Nursing | Aug 2005 | 0 | 0 | 16 | 84 | 3 | 16 | 0 | 0 | 0 | 0 |
| Aug 2004 | 0 | 0 | 21 | 81 | 3 | 11 | 0 | 0 | 2 | 8 | |
| Aug 2003 | 0 | 0 | 20 | 69 | 5 | 17 | 0 | 0 | 4 | 14 | |
* 'Other' includes students awaiting job offers
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 De Montfort University, in partnership with the Leicestershire, Northamptonshire and Rutland SHA, the Hampshire and Isle of Wight SHA, and the Trent Multi Professional Deanery.
Strength
- A strength of the BSc (Hons) Community Health Nursing programme is the interdisciplinary, post-registration modules which have intended learning outcomes directed at experiencing and learning about interdisciplinary care in practice (paragraph 60).
Weaknesses
- Child branch students on the DipHE and BSc (Hons) Nursing and clinical staff report that preparation for the safe administration of medicines in practice could be improved in the University setting (paragraph 65).
- Students and associate and lead mentors commented that the pre-registration Continuous Assessment of Practice document in nursing is repetitive, in places difficult to understand and open to interpretation (paragraph 73).
- Nursing students indicated that the Continuous Assessment of Practice documents are not fully explained to them by university staff, and mentors stated that the documents are not discussed specifically during mentor-update sessions, resulting in a level of confusion for both mentors and students (paragraph 73).
B5 Speech and language therapy
Intended learning outcomes
83 The development of ILOs for the three-and-a-half-year BSc (Hon