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
The Health Visiting, Midwifery, Nursing and Operating Department Practice programmes at the University of Luton in partnership with Bedfordshire and Hertfordshire Strategic Health Authority and Thames Valley Strategic Health Authority were reviewed in the academic year 2004-05. Judgements were made about the academic and practitioner standards achieved and the quality of the learning opportunities provided.
The review covered the following programmes:
Pre-registration health visiting **
- BA (Hons) Health Visiting
Pre-registration midwifery **
- BSc (Hons) Midwifery/Registered Midwife (3 years)
- BSc (Hons) Midwifery/Registered Midwife (18 months)
Pre-registration nursing **
- Diploma in Higher Education (DipHE) Nursing/Registered Nurse (Adult)
- DipHE Nursing/Registered Nurse (Child)
- DipHE Nursing/Registered Nurse (Mental Health) *
- DipHE Nursing/Registered Nurse (Learning Disability) *
- BSc (Hons) Nursing/Registered Nurse (Adult)
- BSc (Hons) Nursing/Registered Nurse (Child)
- BSc (Hons) Nursing/Registered Nurse (Mental Health) *
- DipHE Enrolled Nursing/Registered Nurse (Adult or Child or Mental Health * or Learning Disability *)
Operating department practice ***
- DipHE Operating Department Practice
Post-registration healthcare **
- DipHE Health Care
- BA (Hons) Health Care
- BA (Hons) Health Care (Acute and Critical)
- BA (Hons) Health Care (Palliative)
- BA (Hons) Health Care (Care Management)
- BA (Hons) Health Care (Women's Health)
- BA (Hons) Health Care (Mental Health or Learning Disabilities)
- BA (Hons) Health Care (Specialist Community Practice)
- Nursing in the Home (District Nursing)
- Community Mental Health
- Community Learning Disabilities
- School Nursing
- General Practice Nursing
Stand alone modules **
- Return to Practice - Adult, Child, Mental Health, Learning Disability and Midwifery *
- Mentorship and Supervision in Professional Practice (MSPP)
Postgraduate programmes
- MSc in Professional Practice
- Research and Evaluation
- Clinical Leadership
- Palliative Care
- Acute and Critical Care
- Public Health
- Advanced Practitioner
- Mental Health and Learning Disability
- Midwifery.
* These programmes underwent Nursing and Midwifery Council (NMC) annual monitoring as part of the major review of healthcare programmes.
** NMC approved programmes.
*** Health Professions Council approved programme.
Academic and practitioner standards
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Health Visiting, Midwifery, Nursing and Operating Department Practice at the University of Luton in partnership with Bedfordshire and Hertfordshire Strategic Health Authority and Thames Valley Strategic Health Authority.
Strengths
- Various assessment modes are used in health visiting which are highly relevant to one of the main aims of the programme, namely, to use the work-base opportunities for learning and to capitalise on the working environment (paragraph 11).
- Intended learning outcomes for midwifery are conscientiously reviewed and amended according to the needs of the health service (paragraph 18).
- Curriculum content and care philosophies in midwifery practice are based upon a clearly-focused, woman-centred framework (paragraph 22).
- The recently-introduced infant-feeding practice assessment tool in midwifery supports the integration of UNICEF baby-friendly standards within the curriculum (paragraph 27).
- The relationship between theory and practice in pre-registration nursing is thoughtfully planned throughout the programme and in each of the modules (paragraph 37).
- Students on the post-qualifying and postgraduate nursing programmes have 100 per cent completion rates, with the data showing that there were no failures (paragraph 47).
- The reviewers agreed with student comments that the inclusion of the use of questioning technique in the anatomy and physiology examination for operating department practice is a useful way of testing and contributing to students' learning of this skill (paragraph 53).
Good practice
- The Bedford PCT Health Living Initiative, which is held at the Sikh Temple once a month, is an excellent example of innovative practice and multi-agency working initiated by the Queen's Park District Nursing and Health Visiting teams (paragraph 9).
- The student assessment and examination handbook for pre-registration nursing is a highly informative and well-produced document which provides an accurate and comprehensive guide for staff, students and external examiners (paragraph 39).
- Some student work in operating department practice is of publishable standard and four students have had their work published in the professional monthly journal (paragraph 56).
Weaknesses
- The overall curriculum for the current health visiting cohort does not have sufficient health visiting emphasis (paragraph 8).
- Feedback to health visiting students is generally constructive and helpful, but could be better presented if all markers used the feedback pro forma (paragraph 12).
- Although there is some engagement of healthcare users, the strategy for public/user involvement in midwifery could be developed further (paragraph 21).
- There is a standard assessment feedback form available in the Faculty, but not all markers make use of this to provide written comments to midwifery students (paragraph 27).
- The issues associated with the award of high grades for practice in the three-year undergraduate midwifery programme are recognised by the programme team as a significant issue to be addressed (paragraph 28).
- Problems of inter-assessor reliability in midwifery practice have been recognised by the programme team (paragraph 28).
- Although some staff research strengths were identified in the self-evaluation document, it was not always clear, except in the case of reflective practice in the postgraduate programme, how these informed the pre-registration nursing curriculum development (paragraph 35).
- The quality of the written feedback for pre-registration nursing assignments is sometimes varied; at best it is detailed and clearly identifies strengths and weaknesses, but not all staff make use of the Faculty's pro forma (paragraph 42).
- Postgraduate nursing students reported that they are given conflicting advice on the word length for some assignments by staff of the Business School and Faculty of Health and Social Sciences (paragraph 42).
- Markers for the postgraduate programmes do not make use of the Faculty's feedback pro forma (paragraph 42).
- Although some practitioners were involved in their development, not all mentors are sufficiently familiar with the intended learning outcomes for operating department practice (paragraph 50).
- A more strategic view of operating department practice is required to ensure that students spend the correct number of hours within appropriate practice areas and are thereby able to achieve all the required intended learning outcomes within the timeframe of the module (paragraph 52).
- Some intended learning outcomes identified in the practice assessment document in operating department practice are more difficult to achieve because of the nature of the placement (paragraph 53).
- Not all operating department practice mentors have a full understanding of the practice assessment document to enable them to use the document to assess students appropriately and use the assessment to support student learning (paragraph 53).
- Written feedback, although in most cases thorough and helpful to operating department practice students' learning, was not produced on the Faculty's assessment feedback sheet. In 2004, the external examiner suggested that this pro forma should be used (paragraph 54).
Quality of learning opportunities
Learning and teaching
The quality of learning and teaching in nursing, midwifery and operating department practice is commendable.
Strength
- The University's education centres are in close proximity to the hospitals and assist students on all programmes to access practice placements, where they spend a significant proportion of their learning experiences (paragraph 57).
Good practice
- In midwifery and operating department practice, and especially in nursing programmes, the learning and teaching strategy, although challenging, has a clear focus and philosophy, is well planned and is effective in meeting students' needs (paragraph 57).
The quality of learning and teaching in health visiting is approved.
Weaknesses
- The strategic leadership of the health visiting programme, especially for learning and teaching, remains unclear (paragraph 59).
- The relationship between the theoretical and practical aspects of student learning and the balance between the input of university and practice staff are, as yet, imprecise (paragraph 59).
Student progression
The quality of student progression is commendable.
Strength
- Attrition rates are generally low. Progression data are carefully compiled and monitored with regular reports collated and sent to the Strategic Health Authorities (paragraph 64).
Good practice
- The Student Attainment Review Board is highly effective in identifying students at risk, noting students requiring continual monitoring and, where necessary, overseeing the withdrawal of students (paragraph 63).
Weakness
- Current health visiting students did not receive pre-programme reading lists, despite asking for them (paragraph 60).
Learning resources and their effective utilisation
The quality of learning resources and their effective utilisation is commendable.
Strength
- The learning resources strategy, reinforced by the close working of the University and the Trusts, is effective in supporting the challenging learning model and in facilitating students' achievement of their intended learning outcomes (paragraph 65).
Good practice
- One particular benefit of the virtual learning environment is the valuable learning experience provided by the formative drug assessment exercise for pre-registration nursing programmes (paragraph 68).
Weakness
- The use of the virtual learning environment by teaching staff is patchy, with much depending on the enthusiasm and ability of individual staff to use the system, therefore, students from all programmes have not yet been able to make full use of this learning resource (paragraph 68).
Maintenance and enhancement of standards and quality
Strengths
- The reviewers regarded the shared approach to annual monitoring as an appropriate way to enhance staff participation in quality assurance process (paragraph 69).
- A clear sense of partnership is evident in the annual contract review process, involving the HEI, Strategic Health Authorities and placement providers, in ensuring and enhancing the quality of commissioned programmes (paragraph 71).
Weakness
- Not all practice areas receive timely feedback on student evaluations (paragraph 70).
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, Nursing and Operating Department Practice (ODP) programmes at the University of Luton (the University) in partnership with Bedfordshire and Hertfordshire Strategic Health Authority (SHA) and Thames Valley SHA. The Thames Valley SHA commissions student numbers for pre and post-registration nursing and midwifery programmes. Students are predominantly placed within Buckinghamshire Hospitals National Health Service (NHS) Trust, Buckinghamshire Mental Health Trust and the three primary care trusts (PCTs), Vale of Aylesbury, Wycombe and Chiltern, and South Buckinghamshire. Bedfordshire and Hertfordshire SHA commissions student numbers for pre and post-registration nursing, midwifery, health visiting and ODP programmes. Students are predominantly placed within the Bedford Hospital NHS Trust, Luton and Dunstable Hospital NHS Trust, East and North Hertfordshire Hospitals Trust, West Hertfordshire Hospitals Trust and the three PCTs, Bedfordshire Heartlands PCT, Luton PCT, Bedford PCT and the Bedford and Luton Partnership Trust. All the programmes are delivered by the Faculty of Health and Social Sciences and the Trusts. The Faculty comprises 87 academic staff, 1,127 full-time and 944 part-time students. Support is provided by 22 full-time equivalent administrative staff.
A Subject provision and overall aims
2 Disciplines are currently offered in the following programmes:
Pre-registration health visiting **
- BA (Hons) Health Visiting
Pre-registration midwifery **
- BSc (Hons) Midwifery/Registered Midwife (three years)
- BSc (Hons) Midwifery/Registered Midwife (18 months)
Pre-registration nursing **
- Diploma in Higher Education (DipHE) Nursing/Registered Nurse (Adult)
- DipHE Nursing/Registered Nurse (Child)
- DipHE Nursing/Registered Nurse (Mental Health) *
- DipHE Nursing/Registered Nurse (Learning Disability) *
- BSc (Hons) Nursing/Registered Nurse (Adult)
- BSc (Hons) Nursing/Registered Nurse (Child)
- BSc (Hons) Nursing/Registered Nurse (Mental Health) *
- DipHE Enrolled Nursing/Registered Nurse (Adult or Child or Mental Health * or Learning Disability *)
Operating department practice ***
- DipHE Operating Department Practice
Post-registration healthcare **
- DipHE Health Care
- BA (Hons) Health Care
- BA (Hons) Health Care (Acute and Critical)
- BA (Hons) Health Care (Palliative)
- BA (Hons) Health Care (Care Management)
- BA (Hons) Health Care (Women's Health)
- BA (Hons) Health Care (Mental Health or Learning Disabilities)
- BA (Hons) Health Care (Specialist Community Practice)
- Nursing in the Home (District Nursing)
- Community Mental Health
- Community Learning Disabilities
- School Nursing
- General Practice Nursing
Stand alone modules **
- Return to Practice - Adult, Child, Mental Health, Learning Disability and Midwifery *
- Mentorship and Supervision in Professional Practice (MSPP)
Postgraduate programmes
- MSc in Professional Practice
- Research and Evaluation
- Clinical Leadership
- Palliative Care
- Acute and Critical Care
- Public Health
- Advanced Practitioner
- Mental Health and Learning Disability
- Midwifery.
* These programmes underwent Nursing and Midwifery Council (NMC) annual monitoring as part of the major review of healthcare programmes.
**NMC approved programmes
***Health Professions Council (HPC) approved programme
3 The aims of the provision reflect the beliefs, values and attributes of the purchasers and providers of higher education in healthcare, as well as the professional and statutory bodies, and are to:
- be committed to the provision of high-quality, vocationally-relevant programmes that have a strong regional presence
- deliver robust academic and practice-based curricula to meet the statutory requirements of the NMC and HPC, leading to registration or recordable qualifications
- provide opportunities through widening participation and a range of entry gates to enable a cross-section of the regional population to successfully complete professional programmes of study
- prepare students for employment, career enhancement and development as well as help to maintain their professional role and function in healthcare settings
- work in partnership with a range of stakeholders to provide programmes to meet the changing healthcare and workforce needs
- create an environment for stimulating and lively student-centred learning that encourages a commitment to lifelong learning
- maintain an appropriate range of contemporary practice experiences where students can integrate their knowledge and understanding into care practice
- provide opportunities to develop the students' knowledge and skills and their application of an evidence base through from initial registration to postgraduate study.
B Academic and practitioner standards
B1 Health visiting
Intended learning outcomes
4 The ILOs are formulated through the Standards for Education and Practice (UKCC 1994). The specialist community practice programme, of which health visiting is part, was revalidated in 2001 and revised in 2002. The ILOs were prepared with reference to the NMC's 'Requirements for Pre-registration Health Visiting Programmes'. Reference was also made to the FHEQ and relevant Subject benchmark statement published by QAA. Among the key ILOs identified for students to demonstrate are the ability to be innovative in practice, to act as change agents and to use work-based opportunities for learning. The ILOs will comply with the 'Standards of proficiency for specialist community public health nurses' at the forthcoming validation. There has been widespread consultation in preparation of the ILOs for this new programme which is due to commence in September 2005. This has involved practitioners and key stakeholders.
5 The ILOs are embedded in a composite of common core and specialist modules, and include the ability to appraise and synthesise the evidence underpinning practice and the evaluation of practice in relation to changing national health policies. The ILOs described in the module handbooks, including the Nurse Prescribing module, meet the theoretical and practice elements required by the NMC. The student handbooks for the common modules are well constructed and give clear guidelines on outcomes and how they relate to assessment.
Curricula
6 Health visiting is a modular 'top up' programme developed within the framework of the specialist community practice programme and is designed to enable health professionals to further increase their professional knowledge and skills. Recently, the curriculum has undergone several revisions. It was revalidated in 2001, revised in 2002 and, at the time of the review, was being prepared for revalidation. The curriculum was also revised in 2004 in response to students' concerns about overlap in two modules and the NMC's concerns about the exclusion of the public health module.
7 The programme has an equal proportion of theory and practice to meet professional requirements. The health visiting provision was part of the NMC Annual Programme Monitoring Process for 2003-04. Following this process, during which areas for improvement were identified, an action plan was agreed and scheduled for review in January 2005. The areas for improvement included appropriate staffing for the programme, ensuring that different pathways on the Specialist Community Practitioner programme had sufficient discipline-specific academic content, reducing the reliance on placement providers to maintain pathway-specific input and the strategic planning, direction and management of the programme. Outcomes of the review in January were positive. At the beginning of May, the University received written confirmation from the NMC that the health visiting provision meets the NMC regulatory requirements.
8 For the current cohort, the theory on the Specialist Practice modules has been shared for much of the timetable, particularly in the first semester of the academic year. Although it is acknowledged that other modules and reflective sessions include health visiting-specific education, the overall curriculum for the current health visiting cohort does not have sufficient health visiting emphasis.
9 The curriculum is organised so that students gain all of their practice experience in one placement with the benefit of intensive mentorship support. They may spend between one and two weeks sampling another type of placement to extend their practice experience. Students have the opportunity to participate in a wide variety of practice experiences within the healthcare provision, including working with individuals, group work and public health initiatives. The Bedford PCT Health Living Initiative, which is held at the Sikh Temple once a month, is an excellent example of innovative practice and multi-agency working initiated by the Queen's Park District Nursing and Health Visiting teams.
Assessment
10 The assessment strategy adheres to the general regulations of the University's modular credit scheme, which regulates such matters as progression, submission, pass grades and examination boards. It is aligned with the Code of practice, published by QAA. Assessments are designed to enable students to demonstrate the knowledge and skills necessary to meet ILOs. Students are supplied with specific guidelines at the beginning of each module, when requirements of the assessment are discussed and students are encouraged to seek tutorial support, in terms of assignment development with the module leader, well in advance of the submission date. Module guidelines for assessment are clear and comprehensive. Practice mentors, responsible for supporting and assessing students in practice, are invited to attend a series of study days each academic year. The Specialist Community Practice team facilitates study days with an agenda which enables discussion and dissemination of information on the assessment of the ILOs. Mentors are expected to attend these study days and are pleased to attend as they find them useful and supportive.
11 Various assessment modes are used in health visiting which are highly relevant to one of the main aims of the programme, namely, to use the work-based opportunities for learning and to capitalise on the working environment. The modes include action plans, portfolios of evidence, essays to demonstrate the application of pertinent theories to practice and seminar presentations. The assessment of the project (45 credits), which is a common module for all students on the specialist practitioner programme, offers students a choice of either carrying out an in-depth literature review, a management project or a research proposal. Students are required to evidence practice progression by the assessment of their portfolio. The assessment of the work-based learning nature of the practice portfolio enables students to evaluate their own learning needs in consultation with their mentor. The students match these activities against the module learning outcomes and are advised to check that the portfolio meets the criteria for assessment with the practice mentor. Assessment of the portfolio is graded using a criterion-referenced system.
12 The reviewers agree with the comments of the external examiner that the marking process is clear, fair and well managed. For example, mentors first mark the practice portfolio and discuss the process with the students. University staff second-mark the portfolio, with moderation taking place during mentor workshops at the University. The external examiner reviews the portfolios prior to assessment boards. Students' comments on the assessment process indicate that they have a clear understanding of what is required of them and that assessments contribute to their learning, in particular assessing their ability to relate theory and practice. Feedback to health visiting students is generally constructive and helpful, but could be better presented if all markers used the feedback pro forma.
Student achievement
13 The external examiner reported that the standard of student work was comparable to that in similar institutions and that students were achieving the ILOs. From their scrutiny of student work, the reviewers agree with these comments and that the students are fit for practice. Student work demonstrated an ability to relate theory to practice in the workplace, to use evidence and to critically evaluate current practice.
14 On average over the last three years, 4 per cent of the students achieved a First class award, 76 per cent an Upper Second class and 20 per cent a Lower Second class. All students were employed within their seconding NHS Primary Care Trust and expressed satisfaction that the programme had advanced their specialist skills and knowledge and enabled them to practise with confidence.
Table 1a: Completion and achievement statistics for all award-bearing programmes
| Programme | Cohort | Diploma programmes |
Diploma programmes |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pass | Fail | 1 | 2i | 2ii | 3 | P | F | ||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| BSc (Hons) Specialist Community Practice - Public Health Nursing (Health Visiting) | Sept 01 | 0 | 0 | 7 | 70 | 3 | 30 | 0 | 0 | 0 | 0 | 0 | 0 | ||||
| Sept 02 | 1 | 12 | 7 | 88 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||
| Sept 03 | 0 | 0 | 7 | 70 | 3 | 30 | 0 | 0 | 0 | 0 | 0 | 0 | |||||
Table 2a: Employment statistics for all pre-registration programmes and exception reporting only for post-registration/post-qualification programmes
| Programme (Award bearing only) | Further study | Local employers | Employers elsewhere | Unemployed | Other* | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | |
| BSc (Hons) Specialist Community Practice - Public Health Nursing (Health Visiting) | ||||||||||
| 2001 | 0 | 0 | 10 | 100 | 0 | 0 | 0 | 0 | 0 | 0 |
| 2002 | 0 | 0 | 8 | 100 | 0 | 0 | 0 | 0 | 0 | 0 |
| 2003 | 0 | 0 | 10 | 100 | 0 | 0 | 0 | 0 | 0 | 0 |
* Not known
Overall, the reviewers have confidence in the academic and practitioner standards achieved in Health Visiting at the University of Luton in partnership with Bedfordshire and Hertfordshire Strategic Health Authority and Thames Valley Strategic Health Authority.
Strength
- Various assessment modes are used in health visiting which are highly relevant to one of the main aims of the programme, namely, to use the work-based opportunities for learning and to capitalise on the working environment (paragraph 11).
Good practice
- The Bedford PCT Healthy Living Initiative, which is held at the Sikh Temple once a month, is an excellent example of innovative practice and multi-agency working initiated by the Queen's Park District Nursing and Health Visiting teams (paragraph 9).
Weaknesses
- The overall curriculum for the current health visiting cohort does not have sufficient health visiting emphasis (paragraph 8).
- Feedback to health visiting students is generally constructive and helpful, but could be better presented if all markers used the feedback pro forma (paragraph 12).
B2 Midwifery
Intended learning outcomes
15 The ILOs relate closely to the aims of the provision and meet the professional and regulatory requirements. They demonstrate an alignment with the relevant Subject benchmark statement, published by QAA. The provision meets regulatory and professional requirements regarding ILOs. A revised set of ILOs is being developed and will include the mapping of the requirements of the National Service Frameworks and the NMC Standards of Proficiency.
16 There is some reference to interprofessional learning in the ILOs but this occurs particularly within clinical practice. There are plans to strengthen shared learning. The ILOs will include strategies for involving women who use the service; these are being developed and are now in draft form.
17 The ILOs are communicated to staff, students and external examiners through the semester and programme handbook. All clinical areas have a practice placement portfolio which also identifies the relevant ILOs for practice. Practice educators are aware of the ILOs and, with students, regard these as helpful guides for providing learning support and guides to learning respectively.
18 ILOs for midwifery are conscientiously reviewed and amended according to the needs of the health service. For example, the higher education institution (HEI) involved the Trusts and other health services in developing the learning outcomes by encouraging feedback from the placement areas. When newly-qualified midwives and their mentors suggested that there was a need for more managerial skills in their programme, this was fed back to the teaching team and the ILOs were amended to include a module on Management and Leadership of Midwifery Care.
Curricula
19 There are two undergraduate pre-registration midwifery programmes, the pre-registration shortened programme, for nurses on the appropriate part of the Professional Register, and the three-year long programme, enabling students to gain an honours degree and to register as a midwife. A range of opportunities for midwives is also available at undergraduate and postgraduate level. Relevant scholarship and practice development enable the curricula to retain their currency. The pre-registration programmes are designed to meet the regulatory requirements of the NMC and European Union Midwives Directive (80/155/EEC Article 4). The curriculum has been mapped against external reference points such as the Subject benchmark statement for midwifery, published by the QAA, and NMC Standards of Proficiency. The modular programmes are designed to ensure an equal proportion of theory and practice.
20 There is a strong partnership approach in the development and monitoring of the curriculum which is demonstrated by the involvement of practitioners, link lecturers and practice educators in programme boards, assessment boards and the practice experience group. Students have a designated supervisor of midwives who provides support and discusses issues pertinent to midwifery supervision and clinical governance. The Faculty's Lead Midwife for Education is actively involved in discussing issues relevant to midwifery education at all levels, for example, at the supervisor of midwives and head of midwifery meetings. Evaluations of students' experiences of practice and programme delivery feed into the overall strategic development of midwifery education and curriculum development.
21 Some references to user involvement and their perspectives informed the curriculum through labour ward forums and peer groups in SureStart areas. Some units (Luton and Dunstable Hospital NHS Trust) have a debriefing form to receive feedback from women about care received. References to student midwives involvement are fed back to midwifery lecturers. In the first year of the three-year programme, students undertake a longitudinal study where they have a defined case load of four women. The women's experiences of the care they receive informs the curriculum through reflective discussions during study days. Although there is some engagement of healthcare users, the strategy for public/user involvement in midwifery could be developed further.
22 Curricula design and structure support the attainment of the stated learning outcomes and promote the integration of theory and practice. The content and design are relevant and informed by contemporary practice, for example the integration of UNICEF baby-friendly standards within the programmes. Curriculum content and care philosophies in midwifery practice are based upon a clearly-focused, woman-centred framework. Practice placements are well structured and integrated into the theoretical elements of the curricula to meet students' learning needs. Students value the early introduction to clinical practice and the weekly study days which provide the opportunity to debrief and share experiences from different practice settings, giving a broader view of midwifery practices and enabling relevant application of theory to the practice. Non-midwifery placements provide clear guidelines about the placement experience to be achieved and specific workbooks are provided for medical, theatre, gynaecology and neonatal placements to enhance the learning experience.
23 The pre-registration curricula have an appropriate design and content to meet the ILOs. Students report being well prepared to work as qualified midwives and practice staff stated that the curricula enable students to become appropriately employable and fit for practice for part two of the professional register.
Assessment
24 The assessment strategies are designed to measure achievement of the ILOs and are aligned with the Code of practice, published by QAA. A range of assessments in theory and practice enables students to demonstrate achievement of learning outcomes relating to professional and regulatory requirements. These include essays, microteaching, oral examinations, short and long examinations, case studies, seminar presentations, family study and the research proposal.
25 Assessment information is provided in the programme handbook for all pre and post-registration midwifery/women's health programmes, with specific guidelines for assessments detailed in module guides. Assessment guidelines are clearly understood by students. Students commented that they receive good support from academic and practice staff in preparation for assessments and receive timely feedback. Assessment for each module includes theory and practice elements, using a criterion-based, 16-point scale; the overall score for the module is an aggregate score of each element. Assessments clearly identify differing academic levels of achievement.
26 The balance and timing of assessments is manageable in the long programme. Although students commented on the heavy assessment load in semester two of the short programme, they said that they were able to cope with this. Students are encouraged through the self-assessment process to gain more insight into themselves and reflect on theoretical and practice experiences to enhance their learning and development of midwifery knowledge and skills. Assessment of theoretical elements of the modules is robust and secure. Samples of theoretical assignments scrutinised by the reviewers demonstrate clear marking guidelines and evidence of second-marking and moderation, which is also noted in external examiners' comments.
27 There is a clear strategy for assessing practice in midwifery through the use of the practice assessment document (PAD), which contains a practice log relating to NMC midwifery standards of proficiency (competencies) and module practice learning outcomes. The recently-introduced infant-feeding practice assessment tool supports the integration of UNICEF baby-friendly standards within the curriculum. The PAD provides a comprehensive record of the student's progress through the semester and related modules. The practice log is assessed by mentors to inform their marking of the practice criterion-referenced grid/grading profiles. Mentors have access to a comprehensive mentor handbook and are prepared for their role at mentor preparation days and updates. Overall feedback to students provides information about strengths and areas for improvement. There is a standard assessment feedback form available in the Faculty, but not all markers make use of this to provide written comments to midwifery students.
28 Student work scrutinised by the reviewers confirmed the external examiner's comments that high grades were awarded for practice to students who were struggling theoretically and that this could have the effect of skewing the final grades. There were instances when a good performance in practice assessment may lead to a degree classification that may not accurately reflect achievement with regard to the academic ability of the candidate. The issues associated with the award of high grades for practice in the three-year undergraduate midwifery programme are recognised by the programme team as a significant issue to be addressed. The programme team and mentors are currently engaged in a review of the assessment of practice. Problems of inter-assessor reliability in midwifery practice have been recognised by the programme team.
Student achievement
29 Students' assessed work demonstrates that ILOs and midwifery professional requirements have been met. From their scrutiny of samples of student work, the reviewers agree with the external examiners that students demonstrated an ability to relate theory and practice, use current evidence and a woman-centred approach to care. Standards achieved by learners meet the minimum expectations for the award as measured against relevant subject benchmarks and the FEHQ.
30 On average over the last three years, 78 per cent of the students on the three-year programme have achieved First class awards and 12 per cent Upper Second class. For the 18-month programme, 13.6 per cent achieved First class awards, 56.6 per cent Upper Second class and 17.3 per cent Lower Second class.
31 Students report that they believe themselves to be fit for purpose and practice and are well regarded by colleagues. Statistics indicate successful progression to and in careers in midwifery. Post-registration students identified satisfaction with the provision of funded CPD programmes. Most midwives choose to seek employment in the Trust where they have undertaken their training. Students regard themselves as being well prepared for careers as competent healthcare practitioners and being equipped for self-critical lifelong learning. Facilitation of access to supervisors of midwives is incorporated into the course and helps prepare them for employment.
32 The University, placement providers and the SHAs work effectively together to promote student achievement and prevent and reduce attrition. Agenda items of meetings between the partners regularly include discussions of student achievement and a range of strategies are being employed to ensure that students complete their programmes.
Table 1b: Completion and achievement statistics for all award-bearing programmes in midwifery
| Programme | Cohort | Diploma programmes |
Diploma programmes |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pass | Fail | 1 | 2i | 2ii | 3 | P | F | ||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| BSc (Hons) Midwifery (3 year) | Sept 99 | 14 | 67 | 4 | 19 | 0 | 0 | 0 | 0 | 0 | 0 | 3 | 14 | ||||
| Sept 00 | 15 | 88 | 1 | 16 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 6 | |||||
| Sept 01 | 13 | 81 | 1 | 6 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 13 | |||||
| BSc (Hons) Midwifery (18 month) | April 02 | 1 | 17 | 4 | 66 | 1 | 17 | 0 | 0 | 0 | 0 | 0 | 0 | ||||
| Sept 02 | 1 | 11 | 4 | 44 | 2 | 22 | 0 | 0 | 0 | 0 | 2 | 22 | |||||
| March 02 | 1 | 14 | 4 | 58 | 1 | 14 | 0 | 0 | 0 | 0 | 1 | 14 | |||||
Table 2b: Employment statistics for all pre-registration programmes and exception reporting only for post-registration/post-qualification programmes
| Programme (Award bearing only) | Further study | Local employers | Employers elsewhere | Unemployed | Other* | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | |
| BSc (Hons) Midwifery (3 year) | ||||||||||
| Sept 1999 | 0 | 0 | 13 | 72 | 4 | 22 | 0 | 0 | 1 | 6 |
| Sept 2000 | 0 | 0 | 16 | 100 | 0 | 0 | 0 | 0 | 0 | 0 |
| Sept 2001 | 0 | 0 | 11 | 78 | 3 | 22 | 0 | 0 | 0 | 0 |
| BSc (Hons) Midwifery (18 month) | ||||||||||
| April 2002 | 0 | 0 | 5 | 83 | 0 | 0 | 0 | 0 | 1 | 17 |
| Sept 2002 | 0 | 0 | 6 | 86 | 0 | 0 | 0 | 0 | 1 | 14 |
| March 2003 | 0 | 0 | 5 | 83 | 0 | 0 | 0 | 0 | 1 | 17 |
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 the University of Luton in partnership with Bedfordshire and Hertfordshire Strategic Health Authority and Thames Valley Strategic Health Authority.
Strengths
- Intended learning outcomes for midwifery are conscientiously reviewed and amended according to the needs of the health service (paragraph 18).
- Curriculum content and care philosophies in midwifery practice are based upon a clearly-focused, woman-centred framework (paragraph 22).
- The recently-introduced infant-feeding practice assessment tool in midwifery supports the integration of UNICEF baby-friendly standards within the curriculum (paragraph 27).
Weaknesses
- Although there is some engagement of healthcare users, the strategy for public/user involvement in midwifery could be developed further (paragraph 21).
- There is a standard assessment feedback form available in the Faculty, but not all markers make use of this to provide written comments to midwifery students (paragraph 27).
- The issues associated with the award of high grades for practice in the three-year undergraduate midwifery programme are recognised by the programme team as a significant issue to be addressed (paragraph 28).
- Problems of inter-assessor reliability in midwifery practice have been recognised by the programme team (paragraph 28).
B3 Nursing
Intended learning outcomes
33 The intended learning outcomes (ILOs) for pre-registration, post-registration and postgraduate programmes are appropriate to ensure fitness for purpose, practice and award. The BSc (Hons) and DipHE pre-registration programmes meet the requirements of the NMC, while reflecting changing contemporary practice in each of the four different branches of healthcare provision. For the DipHE and BSc in Nursing, the ILOs reflect regulatory practice domains relating to professional and ethical practice, care delivery, care management and personal and professional development. The ILOs within all nursing programmes appropriately reflect The framework for higher education qualifications in England, Wales and Northern Ireland (FHEQ), published by QAA.
34 The ILOs are communicated to students, mentors and external examiners through programme and semester handbooks, and they are also available on the virtual learning environment (VLE) which is used and appreciated by students. Within practice, welcome packs containing the ILOs are given to students up to six weeks prior to a placement. The mapping exercise of ILOs against opportunities in placements is included in the packs. Mentors are regularly updated and any changes in ILOs are discussed. Students and practice staff reported that they understood the learning outcomes and their association with the requirements of the NMC. A handbook on module structures provides teaching staff with helpful guidance on the construction of ILOs.
Curricula
35 The pre-registration curricula have been developed with reference to the main aim of the programme, namely to produce newly-qualified nurses who are able to provide effective care in a reflective and knowledgeable manner that takes account of the demanding and dynamic nature of modern healthcare. The curricula have been mapped against the Subject benchmark statement, published by QAA and have been linked to meet NMC statutory requirements. Programme development involved a range of stakeholders. The programme specifications and definitive document include external reference points and reports that identify current national debates in healthcare policy. Although some staff research strengths were identified in the self-evaluation document (SED), it was not always clear, except in the case of reflective practice in the postgraduate programme, how these informed the pre-registration nursing curriculum development.
36 The diploma and degree curricula are carefully designed to ensure progression through the arrangement of modules at different levels, which enables students to build on knowledge, practice and skills. A common foundation programme (CFP) in level 1 enables students to achieve entry into one of the four branches. The branch programmes enable students to extend their knowledge and skills from the CFP and to specialise in the study of pertinent theoretical knowledge and apply their learning in specific practice settings. Coherence in the curricula is ensured through the application of semester themes based on the user perspective and the nurse's role within each module. Each module then has an assigned proportion of theory and practice hours.
37 The programme is based on the University's modular scheme, but with some variations because of the need to provide a practice component to meet the statutory requirement for student experience hours. The relationship between theory and practice in pre-registration nursing is thoughtfully planned throughout the programme and in each of the modules. The curricula comply with the professional body requirement of students experiencing 50 per cent theory learning and 50 per cent in a clinical setting. As a formative experience, students are required to undertake a five-week elective experience in one of the semesters during the branch programme. Subsequent statutory practice placements are arranged to enable students to enter the relevant part of the NMC professional register. Overall, the knowledge, skills and practice in the curricula are sufficiently well designed to enable the students to achieve the ILOs in both theory and practice.
38 The master's programmes are designed to focus on the developing practitioners to work effectively in advanced roles as required by the NHS Modernisation Agenda. The key theme in the MSc in Professional Practice is the development of reflective practitioners who can become informed clinicians and effective leaders with the ability to critique evidence. The curriculum and the emphasis on work-based learning are sufficiently well organised to ensure that students are able to develop their own learning profile and meet the needs of their employing organisation's agenda.
Assessment
39 The student assessment and examination handbook for pre-registration nursing is a highly-informative and well-produced document which provides an accurate and comprehensive guide for staff, students and external examiners. The handbook identifies assessment methods, assessment and progression regulations, appeals procedures, information on submission of assignments, NMC outcomes and standards of proficiency, essay and assessment of practice and grading profiles. The assessment strategy is closely aligned 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. Assessments for pre-registration programmes are clearly designed to measure the ILOs for both theoretical and practical modules in all the branches. Practice is assessed against NMC competency statements. The teaching staff have taken care to design assessments that measure students' abilities to relate theory and practice. There is a strong focus on using evidence and ensuring that assessments relate to the learning methods of the enquiry-based learning strategy. Students informed the reviewers that they had a clear understanding of the assessment process.
40 A variety of assessment methods is used for theory assignments, including essays, unseen written examinations, seminar presentations, research reviews and bibliography constructions, case studies and projects. Assessment of practice uses a 16-point, criteria-referenced grading system to enable the student to identify the standards achieved. Students' capabilities to safely carry out a range of core and specialist nursing skills are also recorded, using the Practical Skills Acquisition Manual. The mandatory practice portfolio is used to facilitate a dialogue between student, lecturer and practitioner to record learning experiences and to demonstrate the achievement of NMC outcomes by the end of level 1 for entry to the branch programme. At the end of the programme, the portfolio is used to record the achievement of the NMC standards of proficiency for entry to the register. The overall responsibility for assessment of practice lies with a named practice assessor/mentor. Overall, this assessment process is well-organised, with close links between the University and the practice placements, ensuring that assessment matters are quickly addressed and students are well supported. The Practice Educator in most practices, or the Clinical Placement Facilitator in others, support the assessment process by bringing students at risk to the attention of teaching staff, for example the link lecturer. Recently, mentor updates have been used to support mentors whose feedback to the University identified that they were found to be struggling with using the grading profile.
41 Students receive oral and written feedback on their assignments to provide support for their development and learning. The quality of the written feedback for pre-registration nursing assignments is sometimes varied; at best it is detailed and clearly identifies strengths and weaknesses, but not all staff make use of the Faculty's pro forma. Pre-registration student work is thoroughly marked with markers making use of the agreed marking criteria. External examiners have commented, and the reviewers agree, that marking is fair and consistent and that assessments are appropriate for the ILOs for both theoretical and practical work.
42 Assessments for the postgraduate programmes are mainly and carefully designed to evaluate students' achievements of research and evaluation capabilities of healthcare. The assessments are clearly set out in the student handbook and include technical reports, reflective practice reports, experimental critiques and a research dissertation. However, postgraduate nursing students reported that they are given conflicting advice on the word length for some assignments by staff of the Business School and the Faculty of Health and Social Sciences. The marking of postgraduate student work is thoroughly moderated and written feedback is detailed and comprehensive, although markers for the postgraduate programmes do not make use of the Faculty's feedback pro forma.
Student achievement
43 From a scrutiny of student work from across nursing programmes and from visits to a range of practice environments, the reviewers concluded that, overall, students are achieving the ILOs on the programmes. The reviewers agree with the views expressed by external examiners that, in nursing programmes, student performance in terms of knowledge, understanding and skills is comparable to that in other institutions. Overall, the standards achieved by students meet the minimum expectations for award and the award classifications are consistent with national standards and the FHEQ. Postgraduate students demonstrated research skills and the ability to use evidence and apply this to healthcare, often in their own workplace.
44 In pre-registration programmes, students demonstrate that they are able to fully integrate theory and practice, progressively meet the requirements to gain entry to the professional register and enhance their nursing practice once qualified. External examiners' reports confirm that students are meeting the minimum standard and expectations for the level of each of the awards.
45 Within pre-registration programmes, students are able to obtain initial entry to the register. The provision of shortened courses, enrolled nurse conversion courses and Return to Practice offer qualified nurses opportunities to regain registration or to obtain post-qualifying registration, for example, learning disability students being sponsored to obtain qualification in the child branch over a 14-month period.
46 Within post-registration programmes, students claimed to have changed individually since attending their chosen programme and that they were able to change practice. They felt that they were allowed, with supervision, to introduce change in their workplaces. As a consequence of their participation in the MSc in Clinical Leadership, at least two of the staff have been appointed nurse consultants.
47 On average, over the last three years, 95 per cent of the nursing students on the pre-registration diploma programme and 86 per cent of the students on the conversion programme achieved their awards. Of the last two cohorts for the BSc (Hons) Nursing, students achieved 14.5 per cent First class awards, 61.5 per cent Upper Second class, 17 per cent Lower Second class with 7 per cent Failing. Completion rates for post-registration and postgraduate programmes reflect the open-ended nature of the programmes where students study part-time over five years. The level of achievement based upon degree classifications and exit awards is good, with the majority of qualifying students attaining an Upper Second class degree or higher. Students on the post-qualifying and postgraduate nursing progammes have 100 per cent completion rates, with the data showing that there were no failures.
48 The rate of progression into employment for the pre-registration nursing programmes is high, with qualifying students securing employment, 57 to 62 per cent locally. The progression statistics did not reveal details of students undertaking further study following qualification in the DipHE. Within the BSc (Hons), all qualifying students managed to secure employment, with between 48 and 59 per cent locating within the local Trusts.
Table 1c: Completion and achievement statistics for all award-bearing programmes in nursing
| Programme | Cohort | Diploma programmes |
Diploma programmes |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pass | Fail | 1 | 2i | 2ii | 3 | P | F | ||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| Diploma of Higher Education - Nursing | Sept 00 | 100 | 95 | 5 | 5 | ||||||||||||
| Feb 01 | 123 | 96 | 5 | 4 | |||||||||||||
| Sept 01 | 121 | 94 | 7 | 6 | |||||||||||||
| BSc (Hons) Nursing | Sept 00 | 2 | 8 | 14 | 59 | 7 | 29 | 0 | 0 | 0 | 0 | 1 | 4 | ||||
| Sept 01 | 4 | 21 | 12 | 64 | 1 | 5 | 0 | 0 | 0 | 0 | 2 | 10 | |||||
| Diploma of Higher Education - Enrolled Nurse Conversion | Sept 01 | 41 | 91 | 4 | 9 | ||||||||||||
| Sept 02 | 25 | 80 | 6 | 20 | |||||||||||||
| Sept 03 | 21 | 87 | 3 | 13 | |||||||||||||
| BA Healthcare | 2001 | 3 | 7 | 0 | 0 | 3 | 7 | 13 | 30 | 8 | 18 | 1 | 2 | 16 | 36 | 0 | 0 |
| 2002 | 7 | 17 | 0 | 0 | 1 | 2 | 10 | 24 | 10 | 24 | 0 | 0 | 13 | 33 | 0 | 0 | |
| 2003 | 6 | 10 | 0 | 0 | 0 | 0 | 14 | 23 | 13 | 21 | 4 | 7 | 24 | 39 | 0 | 0 | |
| BA Professional Practice | 2001 | 2 | 8 | 0 | 0 | 1 | 3 | 14 | 48 | 5 | 17 | 0 | 0 | 7 | 24 | 0 | 0 |
| 2002 | 0 | 0 | 0 | 0 | 2 | 4 | 14 | 31 | 4 | 9 | 0 | 0 | 24 | 54 | 0 | 0 | |
| 2003 | 1 | 2 | 0 | 0 | 1 | 2 | 18 | 30 | 3 | 5 | 0 | 0 | 37 | 61 | 0 | 0 | |
| BA Women's Health | 2001 | 1 | 33 | 2 | 67 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||
| 2002 | 0 | 0 | 1 | 50 | 0 | 0 | 0 | 0 | 1 | 50 | 0 | 0 | |||||
| 2003 | 1 | 25 | 2 | 50 | 0 | 0 | 0 | 0 | 1 | 25 | 0 | 0 | |||||
| BA Work based Development | 2001 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||
| 2002 | 0 | 0 | 3 | 100 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||
| 2003 | 0 | 0 | 1 | 100 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||
| Programme | Cohort | Master's with Distinction | Master's | Postgraduate Diploma with Distinction | Postgraduate Diploma | Postgraduate Certificate | Fail | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| Postgraduate | 2001 | 0 | 0 | 5 | 72 | 0 | 0 | 1 | 14 | 1 | 1 | 0 | 0 |
| 2002 | 0 | 0 | 6 | 67 | 0 | 0 | 2 | 22 | 1 | 11 | 0 | 0 | |
| 2003 | 3 | 9 | 17 | 48 | 2 | 6 | 5 | 14 | 8 | 23 | 0 | 0 | |
Table 2c: Employment statistics for all pre-registration programmes and exception reporting only for post-registration/post-qualification programmes
| Programme (Award bearing only) | Further study | Local employers | Employers elsewhere | Unemployed | Other* | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | |
| Diploma of Higher Education - Nursing | ||||||||||
| Sept 2000 | 0 | 0 | 57 | 57 | 12 | 12 | 0 | 0 | 31 | 31 |
| Feb 2001 | 0 | 0 | 77 | 62 | 23 | 19 | 1 | 1 | 22 | 18 |
| Sept 2001 | 0 | 0 | 75 | 61 | 23 | 18 | 1 | 1 | 22 | 20 |
| BSc (Hons) Nursing | ||||||||||
| Sept 2000 | 0 | 0 | 11 | 48 | 7 | 30 | 0 | 0 | 5 | 22 |
| Sept 2001 | 0 | 0 | 10 | 59 | 6 | 35 | 0 | 0 | 1 | 6 |
* Not known
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 the University of Luton in partnership with Bedfordshire and Hertfordshire Strategic Health Authority and Thames Valley Strategic Health Authority.
Strengths
- The relationship between theory and practice in pre-registration nursing is thoughtfully planned throughout the programme and in each of the modules (paragraph 37).
- Students on the post-qualifying and postgraduate nursing programmes have 100 per cent completion rates, with the data showing that there were no failures (paragraph 47).
Good practice
- The student assessment and examination handbook for pre-registration nursing is a highly-informative and well-produced document which provides an accurate and comprehensive guide for staff, students and external examiners (paragraph 39).
Weaknesses
- Although some staff research strengths were identified in the self-evaluation document, it was not always clear, except in the case of reflective practice in the postgraduate programme, how these informed the pre-registration nursing curriculum development (paragraph 35).
- The quality of the written feedback for pre-registration nursing assignments is sometimes varied; at best it is detailed and clearly identifies strengths and weaknesses, but not all staff make use of the Faculty's pro forma (paragraph 42).
- Postgraduate nursing students reported that they are given conflicting advice on the word length for some assignments by staff of the Business School and Faculty of Health and Social Sciences (paragraph 42).
- Markers for the postgraduate programmes do not make use of the Faculty's feedback pro forma (paragraph 42).
B4 Operating department practice
Intended learning outcomes
49 The ILOs are derived from the Association of Operating Department Practitioners' (AODP) Curriculum Framework which consists of three aspects relating to outcomes, themes and core knowledge areas. The external examiner's report confirms that the learning objectives of the programme and its elements are clearly defined and that the standards set are appropriate for a qualification at this level. The mapping of modules is consistent with the FHEQ and regard is also paid to the Subject benchmark statement for healthcare, published by QAA. The validation documents clearly map the professional body framework with the programmes ILOs. The programme will be reviewed after two years and include a review of the ILOs in light of the professional body's review of learning outcomes.
50 Students are made aware of the ILOs within the first week and are regularly reminded throughout the year. Details are available in the student handbook, in module information and on the University's VLE. Students regard the ILOs as useful guides for their learning. Although some practitioners were involved in their development, not all mentors are sufficiently familiar with the ILOs for ODP.
Curricula
51 The ODP programme was validated in June 2002 with approval for five years. The Academic Standards Committee commended the ODP team on the good relationship that had been developed in the clinical areas to produce the programme. The programme was validated jointly with the University and the AODP and it reflects the professional body's requirements. The forthcoming review of the programme will be used to take account of the new Subject benchmark statement (published by QAA in November 2005). Successful completion of the programme leads to registration with the AODP and the HPC. The programme was recently amended to enable postgraduate nurses to study anaesthetics modules to meet the needs of the Trusts. Students stated that sharing the modules with nurses was beneficial to their own learning.
52 The curriculum aims to ensure that theory and practice are related, with six of the eight modules having equal proportions of theory and practice. The other two modules are wholly theory. Progression is assured by the structure and sequencing of modules, with level 1 introducing students to a wide range of knowledge and skills required of a developing practitioner. At level 2, the curriculum enables students to build upon their skills and knowledge and move from novice to competent practitioner. Transferable skills, such as communication, information technology and problem-solving, are embedded in the curriculum. Professional issues are explored and research methods addressed. The curriculum provides knowledge and skills to enable students to become multiskilled practitioners in all areas of ODP. To deliver effective patient care, the curriculum aims to enable students to evaluate practice and supervise others in the maintenance of a safe working environment. The practice hours, for example, include scrubbing which students informed the reviewers is rigorously applied. Overall, the theoretical elements of the curriculum are well designed and have the appropriate content to enable students to achieve the ILOs. However, a more strategic view of ODP practice is required to ensure that students spend the correct number of hours within appropriate practice areas and are thereby able to achieve all the required ILOs within the timeframe of the module.
Assessment
53 The programme assessment strategy follows the Faculty's guidelines and is aligned with the Code of practice, published by QAA. Practice and theory each contribute equally to the overall grade for any module that has a practice element. The PAD is completed for each placement. Intermediate and summative practice assessments and theoretical assignments are assessed against a 16-point grid using a range of descriptors. Currently, the PAD does not have space for an initial interview. Some ILOs identified in the PAD in ODP are more difficult to achieve because of the nature of the placement. The range of assessment methods is mapped with the ILOs. They are carefully designed to measure the achievement of various ILOs and include multiple-choice tests, skills logs, reflective essays, audits of current theatre practice and accounts of critical incidents. These methods are explained to students in the programme handbook with guidelines for presenting written work for assessment. The reviewers agreed with student comments that the inclusion of the use of questioning technique in the anatomy and physiology examination is a useful way of testing and contributing to students' learning of this skill. Students said that they had a clear understanding of how and why they were assessed in these ways. However, not all ODP mentors have a full understanding of the PAD to enable them to use the document to assess students appropriately and use the assessment to support student learning.
54 Effective processes are in place for the moderation of student work and for the involvement of the external examiner. In most cases, work that had been second-marked was confirmed as consistent with the original marking. The external examiner commented that marks were appropriate and consistent for both theory and practice assignments. From their scrutiny of student work, the reviewers noted that written feedback, although in most cases thorough and helpful to ODP students' learning, was not produced on the Faculty's assessment feedback sheet. In 2004, the external examiner suggested that this pro forma should be used.
Student achievement
55 The DipHE ODP programme started in September 2002 with a small cohort of seven students. Five students successfully completed the programme in September 2004. The external examiner reported that students met the standards for an award at this level and that students are fit for practice. All students are employed in local Trusts.
56 From their scrutiny of samples of student work, the reviewers can confirm that students are demonstrating the skills and knowledge required to become a multiskilled practitioner in all aspects of ODP. Students show an enquiring approach to current practice and an ability to apply evidence to practice. Some student work in ODP is of publishable standard and four students have had their work published in the professional monthly journal.
Table 1d: Completion and achievement statistics for all award-bearing programmes in operating department practice
| Programme | Cohort | Diploma programmes |
Diploma programmes |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pass | Fail | 1 | 2i | 2ii | 3 | P | F | ||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| Diploma of Higher Education - Operating Department Practice | Sept 02 | 5 | 100 | 0 | 0 | ||||||||||||
Table 2d: Employment statistics for all pre-registration programmes and exception reporting only for post-registration/post-qualification programmes
| Programme (Award bearing only) | Further study | Local employers | Employers elsewhere | Unemployed | Other* | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | |
| Diploma of Higher Education - Operating Department Practice | ||||||||||
| Sept 2002 | 0 | 0 | 5 | 100 | 0 | 0 | 0 | 0 | 0 | 0 |
Overall, the reviewers have confidence in the academic and practitioner standards achieved in Operating Department Practice at the University of Luton in partnership with Bedfordshire and Hertfordshire Strategic Health Authority and Thames Valley Strategic Health Authority.
Strength
- The reviewers agreed with student comments that the inclusion of the use of questioning technique in the anatomy and physiology examination is a useful way of testing and contributing to students' learning of this skill (paragraph 53).
Good practice
- Some student work in operating department practice is of publishable standard and four students have had their work published in the professional monthly journal (paragraph 56).
Weaknesses
- Although some practitioners were involved in their development, not all mentors are sufficiently familiar with the intended learning outcomes for operating department practice (paragraph 50).
- A more strategic view of operating department practice is required to ensure that students spend the correct number of hours within appropriate practice areas and are thereby able to achieve all the required intended learning outcomes within the timeframe of the module (paragraph 52).
- Some intended learning outcomes identified in the practice assessment document in operating department practice are more difficult to achieve because of the nature of the placement (paragraph 53).
- Not all operating department practice mentors have a full understanding of the practice assessment document to enable them to use the document to assess students appropriately and use the assessment to support student learning (paragraph 53).
- Written feedback, although in most cases thorough and helpful to operating department practice students' learning, was not produced on the Faculty's assessment feedback sheet. In 2004, the external examiner suggested that this pro forma should be used (paragraph 54).
C Quality of learning opportunities
Learning and teaching
57 The University's teaching and learning strategy supports developments at the local level. In the case of healthcare, this is demonstrated through programme strategies. The key drivers of the learning and teaching strategy include enquiry-based learning in pre-registration nursing and work-based learning in post-registration programmes. Enquiry-based learning is used more explicitly in pre-registration nursing. The strategy is clearly explained in the student handbooks and involves delivering the curriculum around key current professional issues or situations drawn from real practice. The strategy seeks to make learning more meaningful, to place the patient/client at the centre of practice and to encourage students to work together to solve problems. Work-based learning provides students with the opportunity to undertake a problem-solving approach in relation to learning needs specifically related to their own areas of work. The University's education centres are in close proximity to the hospitals and assist students on all programmes to access practice placements, where they spend a significant proportion of their learning experiences. This strategy presents challenges, including the need for staff to travel to the four centres, to coordinate the taught elements and ensure that there is parity of opportunity for students. In midwifery and ODP, and especially in nursing programmes, the learning and teaching strategy, although challenging, has a clear focus and philosophy, is well planned and is effective in meeting students' needs.
58 There is a range of learning and teaching methods in the strategy including action learning sets, lectures, tutorials, clinical and theatre work. Reflective learning is encouraged in all programmes, and the use of personal development plans and reflective records enables students to identify learning needs. Learning accounts enable students to plan their learning. Practice logs play a key role in identifying learning needs and their achievement. In midwifery, weekly study days provide students with opportunities to debrief and to share experiences from different practice settings. Opportunities for interprofessional learning are available primarily though practice placements, when students work with multiprofessional teams. Practice experience groups, one in each county, have been established, with a remit to identify areas of good practice in placements and to disseminate these through, for example, the compilation of folders produced by the groups.
59 In the health visiting programme, students expressed some concerns about their learning experiences in the early stages of the programme, including insufficient specialist teaching, lack of clarity over programme leadership, insufficient theoretical teaching to support practical work and an over-reliance on the input of practice placement staff. Some of these issues were also raised in the NMC Report in 2004. Since then, a new fractional appointment (0.4) has been made which has, in the view of the students, transformed their learning experiences. In particular, they now receive improved support for their portfolio. The University has also responded to the NMC and the conditions have been met. However, the strategic leadership of the health visiting programme, especially for learning and teaching, remains unclear. The relationship between the theoretical and practical aspects of student learning and the balance between the input of university and practice staff are, as yet, imprecise. Although health visiting students also access education provision in practice, it is not wholly clear how much is contributed by the faculty staff. There has been a significant improvement in the delivery of the curriculum since the appointment of a specialist health visiting lecturer. The progamme will be revalidated shortly after the major review, when the issues discussed by the reviewers with teaching staff will be addressed. The reviewers did not have the opportunity to see the proposals.
The quality of learning and teaching is commendable, with the exception of Health Visiting.
Strength
- The University's education centres are in close proximity to the hospitals and assist students on all programmes to access practice placements, where they spend a significant proportion of their learning experiences (paragraph 57).
Good practice
- In midwifery and operating department practice, and especially in nursing programmes, the learning and teaching strategy, although challenging, has a clear focus and philosophy, is well planned and is effective in meeting students' needs (paragraph 57).
The quality of learning and teaching in Health Visiting is approved.
Weaknesses
- The strategic leadership of the health visiting programme, especially for learning and teaching, remains unclear (paragraph 59).
- The relationship between the theoretical and practical aspects of student learning and the balance between the input of university and practice staff are, as yet, imprecise (paragraph 59).
Student progression
60 Recruitment to all programmes is guided by a number of strategies that the University and its Trust partners have developed. The SHAs have contract review meetings which discuss methods of supporting the partnership arrangements and identifying cohort numbers dependent on the needs of the service providers and any planned service expansion. This process is managed effectively to ensure that recruitment targets are achieved. Helpful information on programmes is provided through a series of 'fliers' provided to applicants and students accepted on the programmes. However, current health visiting students did not receive pre-programme reading lists, despite asking for them.
61 The University is an active participant in delivering the SHA's Knowledge and Learning Resources Strategy for the Thames Valley SHA. The widened entry gate means that students enter with a range of entry qualifications and need various types of support. The recruitment process continues all year and is not restricted by the semester breaks. Interview timetables are planned a year in advance to allow staff the opportunity to plan their calendars. The process is a joint initiative between the Trusts and the University. The University is strengthening its links with further education colleges and is offering career advice on careers in the health professions. The University has developed a strategy for students within schools and higher education to enquire about the opportunities for healthcare options; one aim of this is to identify what life is really like for student nurses. An example of partnership working to improve recruitment includes a joint initiative with local schools and further education colleges in providing opportunities for students to explore healthcare career options. 'Aimhigher' is a strategy to widen participation into the healthcare professions and has been developed to offer potential students first-hand experience from practising nurses and healthcare professionals, and also includes opportunities to practise practical skills.
62 Students spoke positively about the induction process for both University and practice placements and the support they receive throughout their programmes. All students have a personal tutor and a module leader who is responsible for supporting student learning. Students are provided with advice regarding any change of branches after the common foundation programme. Postgraduate students receive specialist support from supervisors when studying for their dissertations. The practice educator plays a key role in supporting students, although teaching staff expressed some concern over future funding for this role. The practice educators are accessible to identify issues early and to support mentors. Regular mentor updates have been used to review how students are supported and their progress monitored.
63 The University has developed an 'at risk' register to identify potentially failing students, which includes not only students having difficulties with academic skills but also with personal and financial problems. The Student Attainment Review Board (SARB) had its first meeting in November 2004 with the prime role of monitoring student engagement and to identify actions taken for students at risk. The SARB is highly effective in identifying students at risk, noting students requiring continual monitoring and, where necessary, overseeing the withdrawal of students. There were 420 students first identified to be within the 'at risk' category, 240 of these students are now considered to be no longer perceived to be within this category, 148 have been identified for continual monitoring and 31 students have effectively withdrawn. In the BSc (Hons) and DipHE Nursing (Adult Branch), for example, the external examiner was impressed with how potentially failing students are supported and by the thoroughness of how student cases are handled and documented by clinical staff. Overall, the reviewers agree with the examiner's statement that there are robust systems for supporting students who are at risk. Placement visits by the reviewers confirm that practice staff are aware of this process and of steps required to provide support for students. Visits to practice confirm that there are good communications and relationships between practice and the University. Fitness for practice guidelines clearly identify the University's expectations in relation to behaviour, attitudes and attendance. A Professional Suitability Board, involving relevant partners, has been implemented to consider appropriate courses of action for students who are not professionally suitable to progress to registration.
64 Retaining students is regarded as pivotal to the success of the University and the Trusts to meet the contractual agreements. Attrition rates are generally low. Progression data are carefully compiled and monitored with regular reports collated and sent to the SHAs. Students are encouraged to complete exit interviews and any unusual trends are investigated by the appropriate SHA. Over the last three years, for all pre-registration nursing programmes, the average withdrawal rate is 9 per cent, with only 1 per cent of the students Failing. For the midwifery three-year programme, the withdrawal rate is 13 per cent and the Failure rate 5 per cent, and only one student withdrew from the equivalent 18-month programme. For the specialist community practice programme in health visiting, all students completed the programme. Of the seven students recruited to the ODP programme in 2002, two students withdrew and of the 18 recruited in 2003 four withdrew and six Failed, producing an attrition rate of 29 per cent. So far, of the 36 students on the 2004 cohort, there have been no withdrawals.
The quality of student progression is commendable.
Strength
- Attrition rates are generally low. Progression data are carefully compiled and monitored with regular reports collated and sent to the Strategic Health Authorities (paragraph 64).
Good practice
- The Student Attainment Review Board is highly effective in identifying students at risk, noting students requiring continual monitoring and, where necessary, overseeing the withdrawal of students (paragraph 63).
Weakness
- Current health visiting students did not receive pre-programme reading lists, despite asking for (paragraph 60).
Table 3: Recruitment and attrition statistics for pre-registration and NMC recordable qualifications
| Award title | Recruited number | Withdrawal | Transfer in | Transfer out | Discontinuation | ||||
|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | ||
| Diploma of Higher Education - Nursing | |||||||||
Sept 2003 |
168 | 17 | 10 | 14 | 8 | 16 | 10 | 5 | 3 |
| Feb 2004 | 134 | 17 | 12 | 4 | 3 | 9 | 7 | 2 | 2 |
| Sept 2004 | 255 | 18 | 7 | 1 | 1 | 0 | 0 | 0 | 0 |
BSc (Hons) Nursing |
|||||||||
| Sept 2002 | 22 | 4 | 18 | 1 | 4 | 1 | 4 | 0 | 0 |
| Sept 2003 | 23 | 1 | 4 | 0 | 0 | 0 | 0 | 0 | 0 |
| Sept 2004 | 60 | 3 | 5 | 0 | 0 | 1 | 2 | 0 | 0 |
| BSc (Hons) Midwifery (3 year) | |||||||||
| Sept 2002 | 31 | 6 | 19 | 4 | 13 | 4 | 13 | 3 | 10 |
| Sept 2003 | 45 | 8 | 18 | 3 | 7 | 7 | 15 | 2 | 4 |
| Sept 2004 | 59 | 1 | 2 | 0 | 0 | 0 | 0 | 0 | 0 |
| BSc (Hons) Midwifery (18 month) | |||||||||
| Sept 2003 | 16 | 0 | 0 | 0 | 0 | 2 | 12 | 0 | 0 |
| March 2004 | 15 | 1 | 7 | 1 | 7 | 1 | 7 | 0 | 0 |
| Sept 2004 | 11 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| BSc (Hons) Specialist Community Practice - Public Health Nursing (Health Visiting) | |||||||||
| 2002 | 5 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 2003 | 9 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 2004 | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Diploma of Higher Education - Operating Department Practice | &nb | ||||||||