Preface

Identifying a New Philosophy
Welcome to a book designed specifically for nursing students. The focus of this book is to assist developing nurses into gaining the essential knowledge and practical understanding necessary to excel as a newly qualified nurse. The initial knowledge and skill base required on qualification by a modern nurse can appear unachievable; when commencing your chosen course the University structure will be divided into many subsets or faculties, each one will consider themselves pinnacle to your development and show little regard for the workload and deadlines you will encounter from the combination of them all.

I, Cliff Evans, have written and taught both pre and post-registration nursing courses as an Adult branch Lecturer specialising in both emergency care and acute cardiology, Emma Tippins has been employed predominately as a Senior Sister and practice educator within emergency care, this includes facilitating both advanced life support and advanced trauma courses, more recently Emma has developed the role of the Modern Matron within emergency care. Our combined theoretical and practice experience has enabled us to construct this book with an underpinning philosophy centring on assisting student nurses to be fit for practice or fit for purpose by the end of their duration of initial academic study and clinical placements.

When placed within clinical practice, many students can be bewildered by what may appear as total disparity between what is being taught within the classroom and what is being delivered within clinical practice. This theory / practice divide is not a new phenomenon and has had serious implications for students over many years. The Nursing and Midwifery Council (2005a), Duffy (2003), and many providers of healthcare (Healthcare Trusts), have recognised this and as a direct result have had to introduce post-registration educational programmes for newly qualified nurses enabling them to develop the skills and knowledge to be fit for purpose. This can have a very negative affect on the newly qualified nurse who understandably may feel aggrieved after spending three years in full time education and amassed considerable debt to be told they are unfit to practice safely.

Why inconsistencies between the Nursing and Midwifery Council’s requirements, pre-registration courses and the skills and knowledge necessary to deliver quality care? Although it may initially appear that someone, or an organisation must be held accountable for this inconsistency it may not be the case. Over recent years the role, knowledgebase, and clinical skills required by nurses has proliferated at an incredible rate. It is almost unbelievable to imagine that in 1969, the year in which I was born, it was common practice for only doctors to record blood pressures. Today nurses have taken on many tasks traditionally, or historically, undertaken by other disciplines such as medical physicians and made them their own by developing researched and evidenced based initiatives surrounding these acts. Traditionally doctors learnt on the see one, do one, teach one basis. Within the nursing profession you will find almost a paradoxical approach with a study day, competency document and a period of supervised practice mandatory for many ‘advanced or ‘extended’ tasks. Although this may appear unfair this culture of education and underpinning rationales has had a dramatic affect on care delivery and the confidence and respect that nurses receive. To fully understand the development of nursing as a profession it is necessary to look back into the not so distant past and visualise how nursing education has developed and how it will continue to do so. On completion of this book I hope you will realise that nursing education was, and remains mainly experiential, and that to become a dynamic and proactive practitioner your education will continue until you retire, this is termed life long learning and is at the centre of good clinical practice.

The team of contributors within this book all currently practice or deliver educational programmes. It is envisaged that this inspiring mix of educators and healthcare providers have combined to produce a book that amalgamates the best of both worlds by actually applying theory to clinical practice and, through the use of scenarios, demonstrate not only the physical skills associated with nursing, but also the considerable knowledge base a modern nurse requires.

Using the Book
This book is split into three distinct parts:
Part one is an introduction to nursing which includes a reflective account of the many changes one nurse has experienced over her 40-year career.

Part two provides a ‘systems’ based approach to understanding modern healthcare. The rationale being that by understanding the basic functioning of a physiological system of the body a nurse can easily anticipate and recognise the associated clinical signs and symptoms when a particular system begins to fail. This foundation of anatomical and physiological knowledge is seen as essential to practicing nurses. The clinical application of this knowledge, in association with a structured assessment process, can result in both increasingly effective care and reduced morbidity and mortality rates (Evans & Tippins 2007). This section has been designed with particular components to assist the student with fundamental elements of their educational programme. These learning activities consist of individual exercises with common themes designed to facilitate this process. Activities include:

• Applying theory to practice
• Developing and delivering expert care
• Anatomy & Physiology in Action
• Questioning Clinical Practice

The importance of a research and evidence base to rationalise modern healthcare will be highlighted with the purpose of familiarizing students at an early stage of their training to both a questioning approach to the care they deliver and introducing students to ‘best practice’ initiatives geared at improving and standardising patient outcomes. These include Government driven initiatives such as the national service frameworks that currently underpin many areas of healthcare delivery structuring local healthcare delivery strategies, through to internationally agreed guidelines delivered via the World Health Organisation.

Part three details the separate but intrinsically linked branches of nursing, all nurses need to gain insight into all specialities as they will encounter varying patients throughout their careers with a multitude of needs and in order to provide a quality of care individuals must be seen as a whole (holism).

Part three is also designed to assist student nurses in gaining some of the associated skills required by nurses that are not always part of a University’s curriculum (although this may be changing in the near future). These skills focus on a detailed understanding surrounding medications and their administration and the ability of future nurses to provide effective first aid both within and outside the hospital setting.

There are also online resources designed to develop the facilitator student relationship, this is achieved by the provision of PowerPoint presentation for each chapter which can be utilised by lecturers within the academic setting or by the students for quick reference. A selection of other materials is also available to ease the learning process.

All Chapters commence with identified learning outcomes; the student can then identify their own abilities and areas for development by completing the end of chapter quiz, answers to which can be found at the back of the book. Each chapter shares common themes these include in-depth patient scenarios detailing how complex patient management can be, activity boxes highlighting best practice initiatives, and the integration of anatomy and physiology, and theory into clinical practice. The activity boxes are also designed to encourage students to question their practice, rationales, and the evidence base of care delivery. This enquiry based approach treats students as adults and encourages individuals to seek further understanding for themselves, this does require discipline and it is envisaged that by completing the exercises within this book at their own pace, the individual student will gain the essential professional skills associated with life long learning and remain fit for practice.