Key influences on the professional socialisation and practice of students undertaking different preregistration nurse education programmes in the United Kingdom

Pergamon ht. .I. Nun Stud., Vol. 33, No. 5,pp. 50&51X, 1996

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Key influences on the professional socialisa tion and prac tice of students under taking different pre- registration nurse education programmes in the United Kingdom

JOANNE M. FITZPATRICK, B.Sc., R.G.N. ALISON E. WHILE, B.Sc., M.Sc.,Ph.D., R.G.N., R.H.V., Cert.Ed. JULIA D. ROBERTS, B.A., M.A., Cert.Ed., R.G.N., R.N.T. Department of Nursing Studies, King’s College London, University of London, Cornwall House, Waterloo Road, London SE1 8 WA, U.K.

Abstract-A principal aim of pre-registration nurse education programmes is the process of effective socialisation of students into the professional role. Key influences on the professional socialisation and practice of students undertaking such programmes were explored using a semi-structured interview approach (N= 99). This work formed part of a major comparative study of outcomes of pre-registration nurse education programmes in the United Kingdom. Analysis revealed differences between the programmes regarding positive influences of the respective courses; therapeutic influences of the practice environment; modelling performance on exemplars of high quality practice; and the identification of teachers within the educational setting and nurses in practice as key persons. This study has confirmed that the positive influence of the education programmes and the practice environment as well as high quality role models from both education and practice establishments are critical to the professional socialisation of student nurses. Copyright 0 1996 Elsevier Science Ltd.

506

U.K. PRE-REGISTRATION NURSE EDUCATION PROGRAMMES 507

Background to the study

The aim of the research as a whole was to compare the outcomes of pre-registration programmes of nurse preparation in the United Kingdom. A multi-method design was employed which encompassed four elements: an information-seeking exercise, a care-plan- ning exercise, non-participant observation of performance in the practice setting and a semi-structured interview. Thus simulated and actual-situated behaviour were examined. This work was commissioned by the English National Board for Nursing, Health Visiting and Midwifery.

The semi-structured interview was designed expressly to complement data collected in other elements of the study. Thus the interview focused upon gathering data which might provide insight into the influences which informed participants’ perception of practice. It is the semi-structured interview which is the focus of this paper, of particular interest is the data collected in response to two key questions: events considered significant to the participants’ nursing practice and key persons who had influenced their development as nurses. The findings are considered within the professional socialisation framework and the mechanisms through which students of nursing are initiated into the professional role.

Pre-registration nurse education in the United Kingdom

At the time of this study, three types of pre-registration programme of nurse preparation were in existence: the registered general nurse (RGN) programmes, diploma RN programmes and integrated degree programmes. The RGN programmes, in common with the first teacher training schemes (Maguire, 1994) were based upon an apprentice-type model and were designed to include periods of clinical experience with associated blocks of theory in a health service education setting (UKCC, 1986). Underpinning the clinical experience was a substantial service contribution with student nurses providing up to 75% of all bedside nursing care (DHSS, 1972) and being integral to service delivery (UKCC, 1986). In contrast, the diploma level RN programmes, which have now replaced the RGN programmes, are sited in institutions with established higher education links and have a service contribution of only 20% (UKCC, 1986). Thus the diploma RN students have full student status, and with the exception of a rostered service period, are supernumerary throughout their clinical placements. In common with the diploma level RN programmes, the integrated degree programmes, the first of which was established in 1957, are education-led and students have supernumerary status during clinical allocations. The integrated degree courses are based within institutions of higher education.

Professional socialisation of student nurses

Students may therefore select different routes to gain professional registration. It is argued, however, that socialisation into the profession occurs for all students of nursing regardless of programme of preparation. Equally significant is the ongoing nature of this process, as highlighted, for example, in an interview (N= 30) and questionnaire (N= 143) study conducted by Olsson and Gullberg (1988) in Sweden. Interestingly, Olsson and Gullberg reported that nurses’ perceptions of the professional role were more favourable one year after registration in comparison to their perceptions at the end of the education

508 J. M. FITZPATRICK et al.

programme. They concluded that increased appreciation of the professional role occurs in the post-registration period.

The socialisation process as defined by Merton (1957): “the process by which people selectively acquire the values and attitudes, the interests, skills and knowledge-in short the culture--current in groups to which they are, or seek to become, a member” (p. 278) highlights the acquisition of knowledge and skills critical to role enactment. In addition, Merton (1957) has emphasised the understanding of attitudes, beliefs and values appropriate to the profession as central to the process of adopting a particular occupational role. Lacey (1977), however, has challenged Merton’s definition with the contention that it represents: “a filling of empty vessels notion of socialisation” (p. 14). Instead Lacey, whilst acknowl- edging that the development of self is inherent within development of the individual as a professional, has proposed that an individual’s past experiences also impinge upon the socialisation process. Developing this further, it is asserted that the individual’s personal qualities, values and motivations are also intrinsic to the socialisation process (Du Toit, 1995). Thus the development of a personally and professionally acceptable role occurs (Cohen, 1981). In the light of this, investigation of the professional development process for students undertaking the different programmes was considered an important element of the present study.

Understanding the nurse role is critical to effective socialisation during the education programme, culminating in a professional who possesses a sound knowledge base, clinical proficiency, and with attitudes favourable to client and consumer participation (Meleis, 1975). The role of the nurse has been explored in an earlier paper (Fitzpatrick et al., 1992) and the literature revealed that nursing embodies a combination of psychomotor, cognitive and affective skills necessary for the delivery of high quality patient care which reflect the competences set out in the Statutory Instrument No. 1456 (1989). These skills are inculcated during the course of nurse education programmes through a process of role-clarification. The latter has been defined by Meleis (1975) as: “mastery of the knowledge or the specific information and cues needed to perform a role” (p. 267) and is achieved through a variety of mechanisms, including intentional role instruction; interaction with professional reference groups; role modelling; and role rehearsal. Other factors which have been highlighted as significant to successful role development include the setting in which learning takes place, having the opportunity to enact the professional role as a student, and exposure to, as well as the quality of, professional role models (Olsson and Gullberg, 1987; Smith, 1988; Orton et al., 1993).

The impact of the practice environment upon the professional socialisation and practice of student nurses is well established (Fretwell, 1980, 1982; Ogier, 1981, 1982; Melia, 1987) and a multitude of contributory factors have been identified including: effective interpersonal and communication skills, team leadership skills, sensitivity to learners’ needs, accessibility and approachability of trained staff, the philosophy and management styles of the ward sister, and the power of role models. An effective mentorship system has also emerged as an indicator of a therapeutic ward learning environment in Orton et d’s (1993) recent research. This finding echoes the assertion that quality supervision in the practice setting is imperative for the consolidation of knowledge and clinical skills and the continued development of a professional practitioner (UKCC, 1990; Butterworth and Faugier, 1992). Defined as; “an individual who has an understanding of the context of the students’ learning experience and is selected by the student for the purpose of providing guidance and support” (ENB, 1994a, p. 6), the mentor is designated to inform the professional development


process. This definition was reflected in the views of teachers (N= 33) participating in Orton et al.‘s (1993) research, they regarded the mentor as the key person for shaping student experience, providing support and identifying learning objectives (p. 27). The diploma RN programme participants (N=220) in turn highlighted several key attributes of a good mentor which included: being supportive, enthusiastic, positive about their role as mentor, knowledgeable about the course, interested in teaching and having time for students. It is thus concluded that mentors in the practice setting are potentially significant persons in the professional socialisation and practice of student nurses.

A significant mechanism in the professional socialisation of nursing students is role modelling, that is, assistance and instruction regarding how a role is to be fulfilled (Bandura, 1963; Olsson and Gullberg, 1987; Windsor, 1987). Additionally, it has been asserted that individuals perceive their identity in relation to those with whom they associate, those who have related roles, and those who affect or are affected by an individual’s identity and performance (Simms and Lindberg, 1978). Role modelling, it has been argued occurs mainly through observational learning which is characterised by the processes of attention, retention and motor reproduction (Bandura, 1977). The need for role models at all stages of professional life has been affirmed (Dotan et al., 1986) and for students of nursing modelling may centre upon significant persons drawn from both education and practice establishments.

Students’ professional role is determined to a large extent by the availability of role models within the practice setting (Melia, 1987; Howie, 1988; Davies, 1993) and the powerful influence of practice-based role models on the professional socialisation of nursing students has been well researched (Marson, 1982; Ogier, 1981; Orton, 1981; Smith, 1987). Role models within the clinical situation have been recognised for their compassionate, caring and empathetic approach to care delivery, as well as their approachability, flexibility, professional competence and power (Stephenson, 1984; Dotan et al., 1986; Davies, 1993). In Windsor’s (1987) interview study, students (N= 9) reported how they drew upon the practice of other nurses to inform their professional role acquisition and participated in nursing activities to “learn how to act like a nurse” (p. 151). Further, Melia (1987) highlighted the significant impact of trained and untrained nurses as well as other student nurses upon the occupational socialisation of student nurses as well as other student nurses upon the occupational socialisation of student nurses undertaking an RGN programme in Scotland. Interestingly, none of the student sample in Campbell et al’s (1994) research identified nurses within the clinical setting as role models. It was suggested, however, that this may have been because the students were allocated to a clinical instructor during their time in the practice setting. Further, it is possible that work-related role models may become increasingly more significant than those from the eduction setting on commencement of employment as highlighted in a small questionnaire (N=25) study by Green (1988). These findings accord with the theory that opportunity to enact the professional role as a student, which is facilitated by a therapeutic learning environment, and exposure to high quality professional role models enhance successful role development. However, as well as the selection of high quality role models, it is suggested that discernment of less effective behaviour (i.e. identification of anti-models) is also critical to the development of a professional practitioner. The paucity of empirical research in this area, however, is noteworthy. A small-scale study by Parathian and Taylor (1993) investigated the effects of different role models in teaching final year student nurses (N= 18) how to communicate bad news to patients. Using a standard written scenario, students were rated role-playing the activity of


communicating bad news to patients. Subsequently the student sample observed a videotape depicting a model performing the same scenario. Participants were separated into three groups, students in group A were exposed to a videotape depicting a poor model, group R observed an expert model, and group C viewed both poor and expert models consecutively. Following this students were rated role-playing the original activity for the second time. Parathian and Taylor (1993) reported improved student performance which they concluded was owing to the fact that the negative model was emphasised by teachers as an example of behaviour to be avoided. Parathian and Taylor’s study serves to highlight that skills in observing and judging behaviour and the ability to discern between effective and ineffective performance are imperative to sound professional practice.

As well as identifying the key role of the practice environment in shaping the professional development of student nurses, the literature has also highlighted the influence of the educational establishment (e.g. institutional ethos) and teaching staff (Simpson, 1979; Dotan and Ichilov, 1980; Jarvis, 1983; Wilson and Startup, 1991). For example, in an interview and questionnaire study to explore the professional socialisation of baccalaureate student nurses (N= 131) Campbell et al. (1994) found that clinical instructors (equivalent to the clinical teacher in the U.K.) and peers were highlighted as significant persons influencing learning in the practice environment. Clinical instructors identified as positive role models were valued for their impact upon students’ professional knowledge and skills acquisition and the development of attitudes, beliefs and opinions favourable to the nurse role. Further, organisational skills and the ability to develop effective professional relationships with patients, students, and other nurses were highlighted. Other research has revealed the desirability of sound professional knowledge and clinical proficiency, skilled communication, approachability and empathy as attributes of the effective clinical teacher (Mogan and Knox, 1987; Nehring, 1990; Wilson, 1992).

It has been argued that individuals also perceive their identity in relation to those who have related roles and a variety of research has explored the influence of peers on the professional socialisation process (Oleson and Whittaker, 1968; Jacka and Lewin, 1987; Iwasiw and Goldenberg, 1993). For example, Jacka and Lewin (1987) investigated student nurse learning in the clinical setting and found that RGN programme students gained much from their peers. This probably reflected their close working relationship which was reported by the majority of students from two of the three participating hospitals. Exploring the effects of peer teaching on student nurse learning, Iwasiw and Goldenberg (1993) found that while cognitive improvement scores were significantly higher for the experimental group (PC 0.0.5), no statistically significant differences emerged between the experimental and control groups for psychomotor test scores. Nonetheless, peer teaching has been advocated as a strategy for student nurse learning in the clinical setting and it is one which is likely to be increasingly pertinent in the current health care arena, for example, owing to increasing numbers of support workers and a reduced registered nurse: student ratio. The peer role has been described as having three dimensions (Campbell et al., 1994) namely: (a) the facilitation of learning by sharing experiences, knowledge and clinical expertise; (b) the provision of emotional support; and (c) assistance with psychomotor skills. Further, Campbell et al. (1994) found that students tended to adopt one another as role models in the latter part of their education programme and they distinguished between peers who were becoming good nurses and those who were considered to be less effective in their care delivery.

As outlined, the importance of both education programmes and the practice environment,


as well as exposure to high quality role models have been highlighted as having a significant influence upon the professional socialisation and practice of student nurses (Orton, 1981; Fretwell, 1982; Olsson and Gullberg, 1987). However, previous studies have tended to focus upon the views of students representing a single nurse education programme (Melia, 1987; Wilson and Startup, 1991; Campbell et al., 1994). With this in mind a study to explore and compare the perceptions of influential practice events and key persons in the professional socialisation of student nurses from different pre-registration programmes was considered necessary.

The study

Method

The target population for this research were students completing their programmes of nurse preparation for Part 1 (RGN) and Part 12 (Adult Nursing) of the Register. Par- ticipation was voluntary and informed consent was sought from all participants. The final sample (N= 99) included students representing the RGN programme (N= 34) the diploma RN programme (N=34) and the integrated degree programme (IV= 31) and each programme was represented by three institutions. A semi-structured interview schedule was designed to explore the following areas: events considered significant to the participants’ nursing practice; events considered to demonstrate high and low quality nursing care; issues considered important to their practice; the participants’ views of their strengths regarding practice; and conversely practice areas in which they felt less confident; and finally key persons who have influenced the participants’ development as nurses. The interview schedule was piloted on final year diploma students (N= 7) and nursing degree students (N= 5) drawn from a location not involved in the main study.

Data analysis

For the main phase of the study a random selection of the audiotaped interviews were transcribed verbatim and the remaining interviews were analysed directly from audiotape. To further enhance data familiarisation and accuracy of interpretation all interviews were listened to on more than one occasion. Content analysis was employed and the data were coded thematically for both manifest and latent content. A random selection of twenty interviews were used to inform the development of the coding frames, a process which was facilitated by the concurrent development of detailed coding instructions. To maximise coder consistency an independent researcher coded a random 10% of the data set, any disagreements were discussed and the interview data were scrutinised until an agreement was reached and recoded as required. The specific questions which are explored in this paper were multiple-response questions, that is, participants had the opportunity to give more than one response and this should be borne in mind when considering the findings. The data generated were at the nominal level of measurement and are presented descriptively.

Findings

Events which participants considered signljicant to their nursing practice. The majority of participants representing the three programmes of preparation identified events which they


considered significant to their practice and responses are set out in Table 1. For both the integrated degree programme (58%, N= 18) and the RGN programme (49%, N= 16) the most frequent response was the significance of therapeutic influences of the practice environment. This category encompassed the identification of high quality nursing practice and positive role models and exemplars included:

“Well, I think having a good mentor in the first place. Having someone that you can-if you’re coming across things for the first time, you can go along with them, do something with them and they can explain exactly what they’re doing and why they’re doing it, so that-you know, next time, I’ll know exactly what it’s all about” (R63lintegrated degree programme participant).

“There’s some staff nurses, when I’ve been on other, who I don’t know, you look up to them and quite respect them and things that they have taught you have really stuck in my mind and I try to sort of, not mould myself, but sort of take that element of what I thought was good about their care” (Rl9/diploma RN programme participant).

“I suppose when I first started the most significant thing that I found was watching, observing other people and mainly senior staff or senior students definitely, I always looked up to them and the staff nurses. But I suppose also observing the negative aspects of other nurses and then trying not to do what they had done” (Rl3/RGN programme participant).

The majority of participants from the diploma RN programme (53%, N= 18) focused upon the positive influences of aspects of their course. This was the second most frequent response for participants from the integrated degree programme (55%, N= 17). No participants from the RGN programme highlighted this category.

Comments typical of this category were:

Table 1, Programme of preparation by events considered significant to participants’ nursing practice

Integrated Events considered significant to degree participants’ nursing practice programme

Therapeutic influence of the practice 18 environment (e.g. role modelling, organ- isation of nursing care)

Positive influence of aspects of course (e.g 17 course philosophy, particular course units)

Drawing upon specific practice allo- 5 cations/clinical experiences (e.g. com- munity allocation, experience in oncology setting)

Non-therapeutic influence of the practice 6 environment (e.g. lack of support, inef- ,fecfive nursing practice)

Personal domain (e.g. personal experience 1 ofhospitalisation, the death of a significant other)

Negative influence of aspects ofcourse (e.g. 0 limited duration of clinical experience, lack of management theory)

Other (e.g. NHS changes) or unclear 1

Column total 48

Sample size 31

Diploma RN RGN programme programme Row total

9 16 43

18

8

8 7 21

1 6 8

5

0

49

34

2

6 7

46 143

33 98

35

22

7

Note that participants were allowed two answers so that column totals exceed the sample size.


“I think the main thing is the way we’re taught to think-like in a number of ways-we’re taught to work things out from the first principles-so rather than just learning conditions, diseases off- pat you sort of think about what’s causing them and then work out what the symptoms might be and what treatment might be. So that you don’t necessarily have to know every disease and condition. So like we did alot ofphysiology and biochemistry and that sort of thing” (RgO/integrated degree programme participant).

“A lot of the theory that we did in the beginning--I know we spent IO months in college, but I think tht a lot of that theory that we did I brought through, and then when we went to the wards and worked more in with the practice, we brought in the theory, so the way of looking at things was different, and bringing in research” (R20/diploma RN programme participant).

Table 2 sets out participants’ rationale for events which they considered significant to their practice. Integrated degree programme participants highlighted the acquisition and application of new knowledge and skills to enhance role performance (55%, N= 17) and modelling performance on exemplary practice (52%, N= 16). These categories were also most frequently identified by participants from the RGN programme. Comments typical of modelling performance on exemplary practice were:

“Basically from how my peers perform in terms of like, the role models that you have on the wards, in terms of mentors and things. I mean, that’s one of the most significant ways for influencing how you work. If you’ve seen sort of like a lot of bad practice and things-you want to think ‘oh, 1 never want to be her-1 never want to perform in such a way’. And also like really good practice as well and good role models and how they go about prioritising care and how they deliver the care, and sort of like-what that-you know, what they perceive as being their priorities that’s been quite significant to me at the end of four years” (R74/integrated degree programme participant).

“She was just a very good role model, and I think-urn-because I identified-I identified a good role model on that ward, I tend now when I’m-to look for-nurses on a ward and think-that’s what I’d aspire to be like-that’s what I want-although now, I look more at more senior nurses and think-you know, that’s what I want to be like when I’m a senior Staff Nurse or a Sister, or

Table 2. Programme of preparation by rationale for events which participants considered significant to their nursing practice

Rationale for events which participants considered significant to their practice

Integrated degree

programme Diploma RN programme

RGN programme Row total

Acquisition and application of new knowledge and skills to enhance role performance

Modelling clinical performance on exemplars of good practice

Increased awareness of the biopsy- chosocial domains of the nurse’s role

Professional growth and awareness

Nature of the learning/practice environment

Confidence-building experiences

Personal development

Other (e.g. informed career pathway) or unclear

Column total

Sample size

17 18 10 45

16 6 12

7 12 8

5 5 6 16

1 6 3 10

48 54 47 149

31 34 33 98

34

27

Note that participants were allowed two answers so that column totals exceed that sample size.


whatever, but-1 always--I kind of-look-identify with people that-urn-you know, that I want to be like” (R49/diploma RN programme participant).

The most frequent response from participants of the diploma RN programme, similar to the integrated degree programme, was the acquisition and application of new knowledge and skills to enhance role performance (53%, N= 18). Typical examples from this category were reference to the theoretical aspects of participants’ course content, for example, interpersonal/communication skills, psychosocial aspects of health and illness and nursing issues such as health care ethics.

SigniJicant persons considered to have influenced participants’ development/practice as nurses. The majority of participants from the three programmes of preparation identified nurses in practice within the institutional setting as key persons in their development as nurses (Table 3). Further, more than two-fifths of participants from the integrated degree programme identified teachers from the educational setting as key persons in their development (45%, N= 13). The majority of participants from the programmes of preparation highlighted the positive impact of significant persons on their development as nurses and only one participant identified an anti-model of practice. Further, the most frequently cited rationale (Table 4) for identifying significant persons were as models of high quality nursing practice, for example:

“...She was a fantastic leader, she really had good leadership qualities and I’d like to be like her. She involved herself, she didn’t get caught up in the paperwork she still had time for the patients, students and time to run the ward and she kept the morale really good and she was just very knowledgeable in her field” (R33/RGN programme participant)

and the provision of support/supervision/teaching which was reflected by comments such as:

“I think just because they always come round, they’re very supportive and they are there, obviously they are not part of the ward staff, so they come along and if you’re not sure of something they’ll go through it with you and do it with you” (R63/integrated degree programme participant).

“She took time to teach me lots kept me under her wing.. she always made me feel that I knew more than perhaps I did by letting me try things out, taking me through it or showing me making me feel part of the team” (R23/diploma RN programme participant).

“She encourages learning even though we are fairly short staffed on the ward, we have two teaching days a month where we can learn whatever we want, we can go to theatres, we can stay at home

Table 3. Programme of preparation by significant persons considered to have influenced participants’ development as nurses

Significant persons identified by participants

Integrated degree

programme Diploma RN RGN programme programme Row total

Nurses in practice (institutional setting) Teachers from the educational setting Mentor in practice environment Nurses in practice (non-institutional setting)

16 18 8 52 13 3 2 18 4 6 8 18 0 4 0 4

Unqualified nursing staff 0 1 2 3 Other 3 3 3 9 Column total 36 35 23 104 Sample size 29 32 30 91


U.K. PRE-REGISTRATION NURSE EDUCATION PROGRAMMES

Table 4. Programme of preparation by rationale for identifying significant persons

515

Rationale for identifying significant persons

Integrated degree


Models of high quality nursing practice Provision of support/supervision/teaching Facilitative in the development of clinical skills Facilitative in the development of personal skills Models of low quality nursing practice Other Column total Sample size

16 19 14 49 15 12 13 40

I 1 2 4

0

3 36 29

0

0 3

35 32

2

0 2

33 30

1 8

104 91

Note that participants were allowed two answers so that column totals exceed the sample size

and study a particular subject. So within your work time you can go to the library, you can go to theatres, you can go and watch whatever investigations you want and she will organise it for you” (R3IRGN programme participant).

The majority of participants from the integrated degree programme (63%, N= 12) identified a high level of knowledge and/or skill as factors potentially contributing to the significant person’s approach (Table 5). For the majority of participants from the diploma RN programme and RGN programme positive personal attributes/philosophy underpinning practice was the most frequently cited response.

Table 5. Programme of preparation by perceptions of factors contributing to significant persons’ approach

Factors considered to contribute to significant persons’ approach

Integrated degree


Positive personal attributes/philosophy underpinning practice High level of knowledge and/or skill Professional education profile Other Column total Sample size

11

12 2

26 19

20 14 45

9 8 29 1 2 5 1 3 4

31 21 83 27 22 90


Discussion

The interview data explored in this paper have highlighted key events and persons considered significant to the participants’ professional socialisation and practice. As noted, socialisation into the profession occurs for all students regardless of programme of preparation. It was not surprising therefore that similarities emerged in the responses of participants from the three programmes, for example, participants from all programmes identified nurses in practice as key persons in their professional development. Equally, there were differences within the interview data which are noteworthy.

Exploring events which participants considered significant to their professional devel-


opment, the integrated degree programme and diploma RN programme participants identified the positive influence of their courses. In contrast, this response was not highlighted by the RGN programme participants. This may in part be due to the effects of recent innovations within nurse education, in particular the reallocation of resources away from the RGN programmes to the replacement diploma RN courses (Jowett et al., 1994).

Consistent with previous research (Smith, 1987; Orton et al., 1993) the therapeutic influence of the practice environment upon the development of participants’ nursing practice was considered positively, this encompassed the influence of both positive and anti-models of nursing practice. In particular, the therapeutic influence of the practice environment was highlighted by the RGN programme and the integrated degree programme participants. This may in part reflect the more extensive clinical placements experienced by these groups in comparison with the diploma RN programme participants (Statutory Instrument No. 1675, 1969; Statutory Instrument No. 873, 1983; Statutory Instrument No. 1456, 1989) as well as the predominant service focus of the RGN programmes (DHSS, 1972; UKCC, 1986). Opportunities for the acquisition and application of new knowledge and skills for the development of nursing practice were highly valued by most participants with modelling of performance on exemplars of good practice being raised by over half the integrated degree programme group and more than a third of the RGN programme group.

The study findings concur with previous research which highlighted the importance of clinical placements and models of high-quality nursing practice in facilitating the development of professional skills (Melia, 1987; Smith, 1987, 1988; Davies, 1993). In this study nurses in practice within the institution setting were identified by the majority of participants as key persons in their development as nurses. In contrast to the other groups, more than two-fifths of the integrated degree programme participants particularly valued teachers from the education setting. This may reflect the success of allocated clinical teachers and course lecturers in facilitating professional knowledge and skill acquisition in the clinical setting, coupled with the limited cohort size of these programmes. In contrast, large cohorts of students on diploma RN programmes militate against student-centred approaches (Schu- macher, 1973; Jowett et al., 1994; Miller et al., 1994).

Similar to other findings (Mogan and Knox, 1987; Wilson and Startup, 1991; Wilson, 1992; Campbell et al., 1994) the majority of all participants identified significant persons as models of high quality nursing practice, who possessed a sound personal philosophy and provided effective support in the clinical setting.

Conclusion

The aim of pre-registration nurse education is to equip students with a sound knowledge base and clinical proficiency with attitudes and values favourable to the professional nurse role (ENB, 1994b). This study has confirmed previous findings that the positive influence of the educational programmes and the practice environment as well as high quality role models from both education and practice establishments are critical to this process. Of particular note were the positive views held by the integrated degree programme and diploma RN programme participants regarding their courses. Further, the key role of nurses in practice within the institutional setting and teachers from the educational setting in the professional socialisation process was highlighted. These data lend support to the strengthening of education-practice links and specifically the continued development of a clinical liaison role for educationalists. Indeed it has been suggested that it is through such


initiatives that the development of a professional practitioner is facilitated and enhanced (UKCC, 1990; Butterworth and Faugier, 1992).

Ackno&edgemenfs-This work was commissioned by the English National Board for Nursing, Midwifery and Health Visiting. Responsibility for the views expressed, issues of interpretation, questions of inclusion and omission, remain as always with the research team and do not necessarily reflect the views of the English National Board for Nursing, Midwifery and Health Visiting.

References

Bandura. A. (1963). The role of imitation in personality development. J. Nuts. Educ. B(4), 207-215. Bandura, A. (1977). Social Learning Theory. Prentice-Hall, Englewood Cliffs, NJ. Butterworth, T. and Faugier, J. (eds) (1992). Clinicul Supervision and Mentorship in Nursing. Chapman and Hall,

London. Campbell, I. E., Larrivee, L., Field, P. A., Day, R. A. and Reutter, L. (1994). Learning to nurse in the clinical

setting. J. Adv. Nurs. 20, 112551131. Cohen, H. (1981). The Nurse’s Questfor Professional Identity. Addison-Wesley, Menlo Park, CA. Davies, E. (1993). Clinical role modelling: uncovering hidden knowledge. J. Adv. Nurs. 18, 627-636. Department of Health and Social Security. (1972). Report of the Committee on Nursing. Cmnd 5115. Chairman:

Professor Asa Briggs. HMSO, London. Dotan, M. and Ichilov, D. (1980). Formation of professional images among Israeli student nurses. Znt. J. Nurs.

Stud. 11,247-259. Dotan, M., Krulik, T.. Bergman, R., Eckerling, S. and Shatzman, H. (1986). Role models in nursing. Nurs. Times

82(3), 55-57. Du Toit, D. (1995). A sociological analysis of the extent and influence of professional socialisation on the

development of a nursing identity among nursing students at two universities in Brisbane, Australia. J. Adv. Nurs. 21, 164-171.

English National Board for Nursing, Midwifery and Health Visiting (1994a). News 14. English National Board for Nursing, Midwifery and Health Visiting (1994b). Creating Li$elong Learners

Partnerships,for Care. Guidelines for Pre-Registration Nursing Programmes of Education. ENB, London. Fitzpatrick, J. M., While, A. E. and Roberts, J. D. (1992). The role of the nurse in high quality patient care: a

review of the literature. J. Adv. Nuts. 17, 121t31219. Fretwell. J. E. (1980). An inquiry into the ward learning environment. Nurs. Times 76(16), 69-73. Fretwell, J. E. (1982). Wurd Teaching and Learning: Sister and the Learning Environment. RCN, London. Green, G. J. (1988). Relationships between role models and role perceptions of new graduates. Nurs. Res. 37(4),

2455249. Howie, J. (1988). The effective clinical teacher. Austral. J. Adv. Nuts. 5(2), 23-26. Iwasiw, C. L. and Goldenberg, D. (1993). Peer teaching among nursing students in the clinical area: effects on

student learning. J. Adv. Nurs. 18, 659-668. Jacka, K. and Lewin, D. (1987). The clinical learning of student nurses. Report No. 6. Nursing Research Unit,

King’s College, University of London. Jarvis, P. (1983). Professional Education. Croom Helm, London Jowett, S.. Walton, I. and Payne, S. (1994). Challenges and Change in Nurse Education: a Study qfthe Implemen-

fation of’ Project 2000. NFER, Slough, Berkshire. Lacey, C. (1977). The Socialisation of Teachers. Methuen, London. Maguire, M. (1994). The job of educating teachers. Unpublished PhD Thesis, University of London. Marson. S. (1982). Ward sister: teacher or facilitator: an investigation into behavioural characteristics of effective

ward sisters. J. Adv. Nurs. 7, 347-357. Meleis, A. (I 975). Role insufficiency and role supplementation: a conceptual framework. Nurs. Res. 24(4), 264

271. Melia, K. M. (1987). Learning and Working: the Occupational Socialisation of Nurses. Tavistock, London. Merton, R. K. (1957). Social Theory and Social Structure. The Free Press, Illinois. Miller, C.. Jones, M. and Tomlinson, A. (1994). The Current Teaching Provision for Individual Learning Styles qf

Students on Pre-registration Diploma Programmes in Adult Nursing. Research Highlights No.9. ENB, London, Mogan, J. and Knox, J. E. (1987). Characteristics of ‘best’ and ‘worst’ clinical teachers as perceived by university

nursing faculty and students. J. Adv. Nurs. 12, 331-337. Nehring. V. (1990). Nursing clinical teacher inventory: a replication study of the characteristics of ‘best’ and

‘worst’ clinical teachers as perceived by nursing faculty and students. J. Adv. Nurs. 15, 934940. Ogier, M. E. (1981). The influence of ward sisters upon nurse learners. Nurs. Times Occasional Paper 77(14), 41..

43.


Ogier, M. (1982). An Ideal Sister: a Study of the Leadership Style and Verbal Interactions of Ward Sisters and Nurse Learners in General Hospital. RCN, London.

Oleson, V. and Whittaker, E. (1968). The Silent Dialogue a Study of the Social Psychology of Professional Socialisation. Jossey Bass, San Francisco.

Olsson, H. M. and Gullberg, M. T. (1987). Nursing education and professional role acquisition: theoretical perspectives. Nurse Educ. Today 7, 171-176.

Olsson, H. M. and Gullberg, M. T. (1988). Nursing education and importance of professional status in the nurse role: expectations and knowledge of the nurse role. ht. J. Nuts. Stud. 25(4), 287-293.

Orton, H. D. (1981). Ward Learning Climate: a Study ofthe Role of the Ward Sister in Relation to Student Nurse Learning on the Ward. RCN, London.

Orton, H. D., Prowse, J. and Millen, C. (1993). Charting the Way to Excellence: Indicators of Ward Learning Climate. Sheffield Hallam University, Sheffield.

Parathian, A. R. and Taylor, F. (1993). Can we insulate trainee nurses from exposure to bad practice: a study of role play in communicating bad news to patients. J. Adv. Nuts. 18(5), 801-807.

Schumacher, E. F. (1973). Small is Beautiful: a Study ofEconomics as tfPeople Mattered. Blond Briggs, London. Simms, L. and Lindberg, J. (1978). The Nurse-Person: Developing Perspectivesfor Contemporary Nursing. Harper

and Row, New York. Simpson, J. (1979). Student to Nurse: a Longitudinal Study of Socialisation. Cambridge University Press.

Cambridge. Smith, P. A. (1987). The relationship between quality of nursing care and the ward as a learning environment:

developing a methodology. J. Adv. Nurs. 12(4), 413420. Smith, P. A. (1988). Quality of nursing and the ward as a learning environment for student nurses: a multimethod

approach. Unpublished PhD Thesis, University of London. Statutory Instrument No. 1675. (1969). The Nurse Rules, Approval Instrument. HMSO, London. Statutory Instrument No.873. (1983). The Nurses, Midwhes and Health Visitors Rules Approval Order. HMSO,

London. Statutory Instrument No. 1456. (1989). The Nurses, Midwives and Health Visitors (Registered Fever Nurses

Amendment Rules and Training Amendment Rules) Approval Order. HMSO, London Stephenson, P. M. (1984). Aspects of the nurse tutor-student nurse relationship. J. Adv. Nurs. 9, 282-290. United Kingdom Central Council (1986). Project 2000: A New Preparation for Practice. UKCC, London. United Kingdom Central Council (1990). The Executive Summary of the Report of the Post-Registration Education

and Practice Project. UKCC, London. Wilson, A. (1992). Qualities of a good teacher. Nurs. Times 88(19), 59. Wilson, A. and Startup, R. (1991). Nurse socialisation: issues and problems. J. Adv. Nurs. 16, 1478-1486. Windsor, A. (1987). Nursing students’ perceptions of clinical experience. J. Nurs. Educ. 26(4), 150-154.

(Received 3 July 1995; accepted,for publication 14 November 1995)

Key influences on the professional socialisation and practice of students undertaking different preregistration nurse education programmes in the United Kingdom

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