Journal of Advanced Nursing, 1977, 2, 503-519

Integrating theory and practice in modular schemes for hasic nurse education Janet Harrison S.R.N. B.A. Dip.Soc.Admin. Research Officer

Margaret E. Saunders S.R.N. R.N.T. B.A. Research Officer

Alan Sims B.A. M.Phil. Acting Director The General Nursing Council for England and Wales Research Unit, 32 Creat Portland Street, London WiN 5AD. Accepted for publication 26 November

HARRISON JANET, SAUNDERS MARGARET & SIMS ALAN {1977) Journal of Advanced Nursing 2, 503-519

Integrating theory and practice in tnodvilar schemes of basic nurse education The report describes factors influencing integration of theory and practice in modular schemes of nurse education. It examines the possibility of identifying learners who are more able to see relationships between classroom teaching and a practical experience, the types of experience where integration is more easily achieved, and the ability of hospitals to create and maintain an integrated system whilst still meeting patient demands. Evidence suggested that some students were more able to identify and follow basic principles when working in the practical situation and that tutors were able to identify these students early in their training (after two practical experiences). As might be expected, both students and teachers reacted more favourably to 'special' wards when asked how far integration could be and had been achieved. Interviews with ward staff and studies of ward staffing levels and structures again showed how the need to move trained staff, to create stable numbers on wards, militated against the formation of a stable relationship between a learner and a given trained member of staff. Some suggestions for improving integration are made and the need to prepare detailed plans before introducing a modular scheme is stressed.

INTRODUCTION The Nurse Tutor Working Party Report (Department of Health and Social Security 1970), on which modular systems were based, had as one of its main aims 503

504

/• Harrison, M. Saunders and A. Sims

the improved integration of theory and practice: 'An integral part of the system of training is that concurrent teaching should accompany the periods of clinical experience.' Bendall (1971) has shown that with juxtaposition of theoretical instruction and practical experience, students demonstrated improved performance on tests of knowledge. Whether theory preceded or followed practice seemed to make no difference. She wrote 'In terms of organization, these results argue for concurrence of theory and practice and for the so-called modular system. . . where a student spends a period in and receiving theory concerned with a clinical area.' Improved integration ofthe two types of learning experience has long been a goal of both teachers and students in and outside of nursing. In industrial and commercial settings the geographical separation of 'school' and 'work', and attempts to cater in the 'school' for learners coming from a variety of practical settings, have been shown to produce problems in integrating theory and practice and maintaining continuity of learning (Venables 1967, Weir 1971). The problems are linked in many ways to the general issue of objectives, i.e. the need for at least a common core of values and information to be shared by both the teacher and the practical supervisor (and made known to the learner). For example. Beard et al. (1974) reported on the problems faced by medical students when left in a practical situation for a period o f clinical observation'. Basically the question asked by these students was 'But what is it that we are supposed to observe?' This question of prior preparation of students is a central one. Whatever happens to nursing education in the future, it is almost certain that the person most responsible for learning will be the learner herself. Perhaps the most that teachers and ward staff can do is to provide the learner with information on what she is supposed to be learning and then provide an environment in which this learning can take place. There are many factors which might help the learner to integrate theory and practice. In this report we shall consider three such factors. 1 Some individuals are better able to grasp the relationship between theory and practice, perhaps as a function of the level of their general education, perhaps because they dare to ask questions, or perhaps because they generally find it easier to use libraries, take notes or recognize the educational significance of some event in the ward. One could hypothesize that if streaming is to be ofany value, then the value lies in accelerated students being better able to integrate their course. 2 Some areas of nursing which have a fairly specific body of knowledge and procedures are likely to be more easily integrated because of an agreed but unwritten 'syllabus' shared by teacher and practitioner. 3 If there is to be a core of information and values shared by the school and the ward then changes in the membership ofthe two 'teams' could affect their ability to pass these on to the learner. Similarly, one ofthe advantages ofthe apprenticeship type of education lies in the ability ofthe learners to work with, and perhaps model themselves on, a particular 'skilled' individual. The ability of hospitals to provide this stable environment could be a limitation on improving nursing education.

Modular schemes for basic nurse education QUESTIONNAIRE

RESPONSES

Altogether 323 students in the three general hospitals (A, B and C) and 36 in the psychiatric hospital (D) completed a questionnaire (appended) after approximately two years of their training. Five of the questions were directly related to integration and one asked for suggested improvements to the scheme. The questions were open-ended and responses were categorized by the authors. Differences between hospitals and streams were calculated using the chi square statistic and the matrices were collapsed where expected cell frequencies fell below 5. Rather than present the tables we shall simply quote the most frequent categories and the level of any statistically significant difference. The modules which the students found best integrated were paediatrics, obstetrics, a module which combined these two, and trauma (this last experience was, however, only really mentioned by students in hospital A, 107 'mentions' out of a total of 109). There were other differences. Students in hospitals B and C were more likely to mention medicine, surgery and geriatrics as being wellintegrated (P < o-ooi). When hospitals were combined and students divided into fast and normal streams, again a difference appeared. Fast stream students were more likely to mention these three experiences as being well-integrated (P < o*oi). This would tend to support the hospitals' streaming decisions, i.e. that accelerated students should be better equipped to interpret and apply general principles. The feasibility and desirability of streaming in modular schemes has already been discussed (Harrison, Saunders & Sims 1977). The main perceived reasons for integration were that the experience was special with a specific body of knowledge and activities, that there was continuity with close relations between the school and the ward, that there was encouragement, support and teaching from ward staff and that the conditions and procedures were in line with topics taught in the school. There was a difference between hospitals, with hospital A more likely to mention that the experience was special, whilst B and C were more likely to mention support from ward staff (P < o-ooi). Whilst there was this large and significant difference, it cannot be interpreted simply. It could mean that ward staff in hospitals B and C more overtly encouraged students, or quite the reverse, that students in hospital A had a high level of encouragement which did not stand out in terms of differences between experiences. There was no difference between streams. As might be expected, the least well-integrated experiences were the general ones (medicine, surgery and geriatrics). These were more likely to be mentioned by students in hospital A whilst those in B and C mentioned community, trauma and psychiatry (P < o-ooi). There was no difference between streams. The most frequently mentioned reasons for non-integration were lack of relevance of lectures, complex topics or 'split' modules, inappropriate wards and poor staffing levels on the wards. Again there were differences between hospitals. Students in hospital A were more likely to mention inappropriate wards whilst B and C reported topics which were complex or split (P < 0-02). These findings

505

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J. Harrison, M. Saunders and A. Sims

were consistent with the structure of the courses. A complaint which ran through many of our contacts with hospital A students was 'allocation to wards' whicli they saw as inappropriate to the proposed content of the module. Similarly in hospitals B and C there was more splitting of sets with a necessary reduction in the amount of specific preparation. Clearly there is no one correct solution to this problem. There was no difference between streams. The main suggestions for improved integration were the need for more interest in and teaching for students in the wards, more clinical teachers/tutors visiting the wards and more up-to-date teaching methods. There was no difference between hospitals, but fast stream students were more likely to request more up-todate teaching methods (P < 0-05). The general suggestions for improving the schemes differed considerably between hospitals {P < o-ooi) and illustrated fundamental differences in the way the schemes had been set up and structured. Students in hospital A wanted to see more choice in the allocation decision and changes in the nature of modules immediately prior to the State Final examination. In hospitals B and C students requested a reduction in the length ofthe introductory course (hospital A had never had this 12-week introduction), more basic nursing, more tutors and, in one hospital, more advanced information about their educational programme. Limited numbers of students prevented any detailed analysis of student responses in hospital D (psychiatric) and the different types of experience prevented us from grouping their responses with those of the other hospitals. In the main, the experiences seen as best integrated were those involving the nursing of acutely ill, disturbed or recently admitted patients. The most commonly mentioned reason for integration centred on the patients' manifestations of prescribed symptoms and the existence of clearly identified methods of treatment and care (including the influence ofthe Mental Health Act of 1959). The next most common group of responses related to the freedom to put ideas into practice and the degree to which ward staff worked as a team. Sitnilarly, the experiences seen as least integrated were those which involved what were seen as physical or custodial care (psychogeriatrics, long-stay and physical illness). The main reason for the perceived lack of integration was the degree of routine and the similarity between these three types of nursing (the physical illness modtile was undertaken within the hospital). These reasons were linked to statements about staffing difficulties which were seen as routinizing care. The suggested improvements centred on improved staffing and more opportunity for students 'to practice theory'. As in the general hospitals, there was a plea for more clinical teaching. Clearly these comments and the general comtnents on the scheme are as much related to psychiatric nursing in general as they are to integrating specific experiences. It is quite probable that the person entering the profession sees mental illness as acute, disturbed and amenable to treatment. The integration problems are probably less to do with the training scheme than with coming to terms with a hospital population, predominantly chronic in nature, and nursing regimes which, perhaps by necessity, are largely custodial. Running through these comments

Modular schemes for basic nurse education

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were problems related to 'becoming a nurse' (problems so well described by Towell 1975), illustrated by one studetit who remarked 'More attention could be paid to seeing that the nurse understands him/herself. . . Are tutors afraid to talk about such things and nurses afraid of group discussions about their attitudes? . . . sometimes I feel unable to cope with situations because of my own prejudices and the prejudices of others . . .'.

Interviews with students, teachers and ward staff Some of the problems involved in arranging modules of integrated theory and practice lie in the nature of nursing. For instance, certain common skills (e.g. dealing with anxious patients or relatives) develop over a period of time and hence cannot be neatly fitted into a specific module. Also the content and educational aims of, say, a medical module might differ considerably according to whether it comes early or later in the students' training. The problem of modular content particularly manifested itself in the early modules. Teaching staff tended to stress the general rather than the specific, placing emphasis on common procedures and conditions which were, in addition to being common, illustrative of general principles. They tried to dissuade students from becoming engrossed in specific or rare conditions. However, for the students the possibility of having just one period in their training in a particular clinical area meant that they were inclined to want information about rare as well as common conditions and procedures. So, for example, where gynaecological or plastic surgery wards were used for general surgical experience, students expected lectures and clinical teaching specific to those topics. Teaching staff, however, felt that at this stage (the first or second module) they should be teaching general surgical principles. Conversely, when students were allocated to geriatric wards for a medical module, they found the lectures covering a far wider range of conditions and procedures than did their clinical experience. In all these situations students felt that their allocation was something of a compromise. When we take into account the fact that students may have only one allocation to a medical or surgical module before they take final examinations, it is possible, and indeed was reported, that students may not in the course of their training have nursed patients with such common conditions as myocardial infarction or diabetes mellitus, or patients requiring general abdominal surgery, or, indeed, general surgery of any kind. Yet they will, undoubtedly, have received theoretical teaching about such conditions and situations. This possible difference between students and teachers was mirrored in the perception of ward staff. Influencing their thinking was the concept of'the junior nurse' and the type of tasks and levels of responsibility suited to the first year student. It was not surprising then that many sisters should complain that students wanted to know far too much about aetiology, for example, or only wanted 'to be in on the drama'. Certainly the task of agreeing a set of aims or objectives for these early modules has provided problems. One step towards reducing these

5o8

J. Harrison, M. Saunders and A. Sims

problems is the practice in the hospitals of referring (formally in some cases) to these experiences as 'the basic nursing care modules'. The teaching staff's task of relating theory to practice becomes more difficult if during a module the student set has to be split up into groups and sent to a wide variety of chnical experiences. With specialties such as ENT*, ophthalmics and radiotherapy this may be inevitable. However, some hospitals may be short of general medical and surgical wards, perhaps because of consultants' specialties, so that sets are divided, say, between medical, surgical and geriatric wards. This may not simply be to meet the service needs of the hospital, but could also be seen as educationally preferable to allocating very large numbers of learners to a small number of wards where they may be underemployed and tend to become bored. However one views this, the problem remains tlaat of having to teach two or more very different bodies of theoretical knowledge. The obvious difficulties include shortage of staff, classroom space, practical rooms and equipment. At one hospital one module covered orthopaedics, neurosurgery, radiotherapy, gynaecology and trauma. Clearly such a combination must make for considerable difficulties for teaching staff in relating theory to practice, adding stress and frustration to their already demanding job. Successful integration of theory and practice also depended upon the students' ability to attend study sessions (whether day, morning, afternoon or part of an afternoon) during the clinical part of the module. Tutors often used these sessions to relate the theory directly to at least some of the students' experience. Students greatly appreciated these sessions, but they sometimes experienced difficulty in leaving the wards to attend them, either because of pressure of work in the wards, or because of lack of enthusiasm on the part of the nurse in charge for the student to attend tutorials. Where ward staff involved themselves in teaching the students, topics covered were usually directly related to patients in the wards. However, in the view of many sisters, this teaching was not as effective as it might have been because they and other senior ward staff had an inadequate knowledge of the content of the introduction to the module and what the students had covered on previous modules. SOME STAFFING

CONSIDERATIONS

A fundamental assumption underlying the idea of integration is that whilst teachers and service staff by necessity have different priorities, they can come together and agree the main educational aims and ways of attaining them. We should not underestimate the ward sister's (head nurse's) ability to influence the student's education. She can not only modify the student's behaviour in the ward, but influence her whole attitude to the value of the educational process. For example, Venables (1967), examining craft and technician apprentices, reported that the best predictors of apprentice progress in the college were the attitudes to * Ear, nose and throat.

Modular schemes for basic nurse education

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the course held by the apprentices' shop floor supervisors. Furthermore should agreement be reached, then integration is still dependent to a great extent on there being limited staff changes in the school and the ward (although written objectives are frequently cited as a means to reducing the negative effect on staff changes) and the existence of a core of trained staff to see that the objectives are met. Examination of ward staffing levels and patterns illustrated how variable was the potential for such ward involvement. Table i illustrates the different average staffing levels (over a io-month period) in three comparable wards receiving similar numbers of students. The picture was even less promising at 8.00 hours. TABLE I Average number of staff on duty at lj.oo hours for three wards Number

of Ward

beds

I

32

2

22

3

17

Sisterl charge nurse 0-45 0-50 0-55

Staff nurse 1-51 1-24

o-i6

State enrolled nurse I-I4 1-20 o-8o

Student nurse 2-30 2-07 2-07

Pupil nurse

Nursing auxiliary

0-54 0-99 0-00

0-40 0-37 1-37

Total 6-34 6-37 4-96

Figure i illustrates the changes of staff (day duty) in two wards over a io-month period. Ward A appeared to have a core of trained staff at sister, staff nurse and SEN level. Ward B, however, had five different sisters, sixteen staff nurses and thirteen SBNs. Ward B is by no means atypical. Structures like this, whilst possiblyunavoidable if a service is to be provided, cannot help to build up a 'stable relationship' between an individual student and a member of the trained staff, nor foster the concept of 'the ward team'. Pomeranz (1973) reported the wide range of potential contact that different students could have with a sister (potential contact being defined as the number of shared shifts). The hospitals involved in the modular scheme revealed a similar range suggesting that the amount of trained supervision received by students still contains elements of a lottery. In hospitals B, C and D the amount of possible contact with a given sister or charge nurse was on average 4i'5, 37*6 and 56*9 respectively (these figures are the time which students spent on the same shift as a sister or charge nurse expressed as a percentage of the students' time on the ward). Again the maximum time each student spent with a given staff nurse was calculated and the percentages were 42-8, 33-1 and 23-7 and, for a given enrolled nurse, 34'8, 50-3 and 22*7. Standard deviations ranged from ii'22 to 25*19 illustrating the wide range amongst students. In these three hospitals then, some students were having little opportunity to benefit from that aspect of the apprenticeship system which involves working with a specific trained member of staff. By and large, however, students in all three hospitals spent most of their time on duty with at least one registered nurse, as is illustrated at Table 2. We also looked to see if the seniority of students influenced these figures, i.e. did 'junior' students have more possible contact with trained staff than did their more senior

510

J. Harrison, M. Saunders and A. Sims Nos.

Sister

1

Staff nurse

6

Number of times on duty 20 30 40 T

10

50

Enrolled nurse 5 Student nurse 5 Auxiliary

Sister

Staff nurse

16

Enrolled nurse 13

Student nurse 12 Auxiliary FIGURE I Number of different staff on duty on two wards, by grade and frequency (based on 8o randomlyselected 24-hour periods over 10 months) TABLE 2

Students' percentage time on duty with trained staff

Only I registered nurse Only I enrolled nurse No trained nurse At least I registered nurse More than i trained nurse

B

Hospitals C

19-3 4-75

16-9 22-2

D

1-2

2-1

37-6 1075 10-9

94-1

757 58-8

78-3 4075

7475

counterparts. There was 110 significant difference. This perhaps reflects the tendency for 'special' wards to have a greater ratio of trained staff and for these experiences to come later in the students' training.

Possible ways of solving or alleviating the problem If we accept the reality that only very rarely can students all go to identical or

Modular schemes for basic nurse education even comparable clinical areas, we need to consider how theory and practice can be integrated despite problems of allocation. During the course of the three years research, the following suggestions (some more easily implemented than others) have been made to us by students, teachers and service staff. The suggestions need not be seen as only relevant to modular schemes. 1 Ensure that care is taken over allocation so that some students do not get too many, what might be termed 'fringe' or 'special' experiences. 2 If there is a study day or afternoon it should be safeguarded, i.e. ensure that, except for times of genuine staffing emergencies on the wards, students are able to attend. 3 Teach, as far as possible, basic skills and principles, giving the students guidelines as to how and where to find information on detail and specialties. 4 Increase the amount of teaching in the wards from ward staff, clinical instructors and tutors. 5 Ensure that the aims of a particular experience are stated and agreed. Improve communication, between school and ward staff in particular, so that ward staff know what students have been taught, the gaps in their knowledge and experience, and the aims of the module. 6 Assuming 5 above, encourage ward staff to organize the students' work and learning situations so that they can achieve the aims of the module and 'fill in' the gaps in their experience. 7 Encourage students, tutors and ward staff to identify what: a must be covered b ideally should be covered c would be 'nice to know' in each clinical area so that, where teaching time is limited, priorities can be established and time given to agreed essentials. 8 Do not undertake a change in the pattern of training without examining teaching and clinical resources and make sure that the aims and structure of the programme are made known to all parties. CONCLUSION To summarize, it was felt that an experience was integrated when the content of introductory and consolidation weeks was closely related to the type of patient met in the ward, and when there was regular contact with teaching staff over the period of the practical experience. It appeared least integrated when the type of patients and their conditions did not seem to match up with those covered in the two weeks in school. Clearly then, good allocation lies at the heart of the success of these schemes. However, given that service constraints and small numbers of wards sometimes make for problems in allocation, there are other ways in which integration might be improved. These include use of study days or afternoons, making sure students see beyond specific tasks or conditions to general principles, increased ward teaching, gaining agreement between teaching and ward staff as

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to the aims of a tnodule, helping students to identify for themselves activities which will enable them to meet these aims.

References BEARD R., HEALEY F.G. & HOLLOWAY P.J. (1974) Changing Objectives in Higher Education. Society for Research in Higher Education Limited, London. BENDALL E. (1971) The learning process in student nurses, 2. Occasional papers. Nursing Times 67, 173-175DEPARTMENT OF PIEALTH AND SOCUL SECURITY (1970) Report of the Nurse Tutor Working Party. H.M.S.O., London. HARRISON J., SAUNDERS M.E. & SIMS A. (1977) Some structural considerations in modular education for basic nursing students. JoMrna/ of Advanced Nursing 2, 383-391. POMERANZ R. (1973) The Lady Apprentices. Occasional papers on social administration no. 51. G. Bell & Sons, London. TOWELL D . (1975) Understanding Psychiatric Nursing. Royal College of Nursing, London. VENABLES E. (1967) The Young Worker at College: A Study ofthe Local Tech. Faber & Faber, London. WEIR A . D . (1971) A Day Off Work? Attitudes of Craft Apprentices to Further Education. The Scottish Council for Research in Education, Edinburgh.

Modular schemes for basic nurse education -1

513

-

QUESTIONNAIRE TO STUDENTS TOWARDS COMPLETION OF TRAINING

Column Numbers (1)

a

HOSPITAL.

(2) (3) (4) (5)

nnnn

NAME

(6) (7)

SET HOW LONG HAVE YOU BEEN ON THIS COURSE?.

_Yrs..

Mths. (Please tick)

Which stream are you in?

Fast/Accelerated Normal Length Which of the following modules have you completed (including the one you are on at the moment)?

DD (8)

D (9)

n (10)

Medical Surgical Geriatric Paediatric/Obstetric Paediatric Obstetric Community Psychiatric Trauma

nan nnn nnn nnn MULTIPUNCH

Other (please name)

Bearing in mind the above list, in which module(s) do you think theory and practice were most closely related? What reasons can you give for this?

nnn (14)

n (15) (16) (17) In which modules were theory and practice least well related? What reasons can you give for this?

nnn (18)

n Can you suggest any ways in which the integration of theory and practice could be improved?

(19)

n

- 2 In earlier interviews in modular hospitals students were asked to suggest some of the Column Numbers strengths and weaknesses of their training scheme. We have listed the strengths below and would like to know whether these were features of your course. Please tick the appropriate column. You will find that "varies" is only appropriate for some course features.

YES

NO

VARIES

The course has a sound theoretical content

(20)

Theory and practice relate/are concurrent

(21)

Theory is spaced out evenly over the course

(22)

Tutors are good at getting information across to us

(23)

There are weekly study afternoons

(24)

Introductory weeks include orientation visits to wards

(25)

The overall plan of allocation is known in advance

(26)

There is an element of choice in allocation

(27)

There is a wide range of nursing experiences

(28)

There is an element of choice in the streaming decision

(29)

We have regular contact with members of our own set

(30)

Personal interest is shown by school staff

(31) (32) (33) (34)

There are good library facilities Educational needs are put before service needs There are tests at the end of each module There is an opportunity for us to evaluate our course The modular scheme encourages students to teach other students Please list any other strengths which were features of your course

(35) (36) (37

(38)

What do you think are the three most important strengths of the modular training scheme, whether they were features of your course or not? 1 2. 3

(39) (40) (41)

D

- 3 Column Numbers The weaknesses which have been mentioned by students in previous interviews are listed below. Again we would iike to know if these were features of your course or not. Please tick the appropriate column. YES

42 43 44 45 46 47 48 49

NO

(42) (43)

Varies

The introductory course was badly organised The introductory course was too long Modules are too short Modules were in the wrong order Allocation is too rigid Obstetrics and Paediatrics are too much to cover in one module Theatre/I.C. and Casualty are too much to cover in one module Some wards did not relate to the lectures given in the introductory and consolidation weeks

(44) (45) (46) (47) (48) (49) (50)

50 51 52 53 54 55 56 57 58 59 60 61

There are insufficient tutors There are insufficient clinical instructors There is a lack of continuity of tutors Some lectures are duplicated There are insufficient tutorials There are insufficient tutorials before finals There are insufficient lectures in school in 3rd year It is difficult to get library books when students are studying same topic It was a "do it yourself" course

(51)

Students work fewer week-ends than other staff Too many students from the same set are on the same ward There is insufficient practical experience

(58)

(52) (53) (54) (55) (56) (57)

(59) (60) (61)

62 63 64 65 66 67 68 69 70

There is insufficient ward teaching from school staff There is insufficient ward teaching from ward staff Some ward sisters feel lectures replace ward teaching There is insufficient ward teaching from medical staff There is insufficient time for study on the wards Cleaning jobs are put before study on the wards Communications between school and ward break down Other staff label students as "modular" There is ill-feeling between other staff and modular students

(62) (63) (64) (65) (66) (67) (68) (69) (70)

Please list any other weaknesses which were features of your course:

(71) (72)

What do you think are the three greatest weaknesses of the modular training scheme, whether they were features of your course or not?

D (73) (74) (75)

"DC (80)

This scheme of training was the first to involve streaming students. Please tick the appropriate columns to indicate how strongly you agree or disagree with the following statements which students have made. Strongly Agree Agree

Column Numbers

UnStrongly Disagree decided Disagree (1)

Streaming is a good idea The streaming decision is carried out too early Streaming itself is carried out too early Students do not have enough say in the streaming decision Streaming helps you to go at your own pace Students should be allowed to change streams at least once Streaming divides up friendships There is no ill feeling between fast and slow streams When the fast stream leaves the set the other students suffer academically Streaming is necessary in nurse traininq

(2) (3) (4)

(5) (6) (7) (8) (9)

(10)

Another aspect of the scheme is fixed allocation which is to help produce a planned training programme. Please tick Have you ever been moved from one ward to another during a module to help out? (11) Yes

No

If 'yes', about how many times have you been moved during your training so far? 0-

5

6-10

(12)

11 - 15 16-20 Over 20 If 'yes', were such moves on the whole within the same unit (to a ward of similar kind)? (13) Yes

No

— 5— Please tick Column Numbers Have you taken State Finals yet?

(14) Yes

D

No

How well prepared do/did you feel for taking written finals? Well

(15)

Moderately Not yet prepared Not at all

Have you been in charge of a ward fora shift yet? On night duty only

(16)

On day duty only

D

On both days & nights Not at all

How well prepared do you feel for being left in charge of a ward? Night Well Moderately Not yet prepared

Day

(17)

D

Not at all

Have you ever felt like leaving? No

(18)

Yes, but not seriously Yes, seriously

If 'yes', why?

If 'yes', what made you decide to stay? .

(19) (20) (21)

DDD (22) (23) (24)

nan

- 6 Column Numbers What do you see yourself doing over the next 2 years? (25) (26)

What are your long term career intentions? (27) (28) (29)

DDD If you plan to stay in nursing and have not already mentioned details, what kind of nursing do you have in mind? (30) (31)

If you had the chance to choose a career again would your choice be nursing?

Please tick Yes

(32)

No

D

Not sure

If 'no' or 'not sure' can you say very briefly why you wouldn't choose nursing again? (33) (34) (35)

DDD How much have you enjoyed your training so far? Very much Moderately Not very much Not at all

(36)

D

-7

-

In your opinion how well is the modular scheme running in your hospital?

Please tick Column Numbers Very well Fairly well

(37)

Not sure

D

Not very well Badly

If you were free to reorganise your course how would you do it?

(38) (39) (40)

Dan

In the space below please add any comments about your training which you feel are not covered by this questionnaire and enlarge upon anything which has been covered.

(80)

Integrating theory and practice in modular schemes for basic nurse education.

Journal of Advanced Nursing, 1977, 2, 503-519 Integrating theory and practice in modular schemes for hasic nurse education Janet Harrison S.R.N. B.A...
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