An exploration of the challenges facing critical care education

Finch, Jeremy (2018) An exploration of the challenges facing critical care education. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

This thesis is the result of a two-year participatory action research study that led to a radical change in the way critical care nurse education is delivered in Greater Manchester. It was motivated by concerns that poor academic performance by degree and master’s students was reflective of a teaching ‘ecology’ (Kemmis et al., 2014) focused on sharing tacit specialist technical knowledge, rather than developing higher order thinking skills. The use of teaching strategies that support the development of these skills is important not only to academic improvement but also to clinical practice, where critical care nurses routinely critically analyse a large volume of data during decision making (Lyte, 2008). Methodology: Action Research (using mixed methods) • Focus groups and questionnaires explored the views of all students (n=250), Practice based educators (n=11), lead nurses (n=10), managers (2), university link lecturers (n=2). • Classroom observations evaluated teaching methods and content over the two-year study, measuring how well they were aligned to programme learning outcomes (n=24). Results • Classroom observations identified lectures lacked pathophysiology, evidence-based theory and contained little consideration of patient-centred ‘nursing’ care. • In contrast, students prioritised learning pathophysiology, the evidence-base underpinning clinical decisions and preferred teaching methods that enabled them to work with peers to apply theory directly to the context of clinical practice. • PBEs and students discovered new ways of teaching and learning. • Critical care nurse education was separated from acute care nurse education. Impact The findings changed local education provision, leading to the introduction of a new local critical care programme which commenced in September 2016. Critical care nurse education was refocused away from a technical, medical model towards one that provides opportunities for students to spend time in the classroom thinking like nurses to develop evidence based patient centred humane care solutions. The findings highlighted the value of academia, identified the usefulness of formative assignments and informed the development of new and innovative assessment strategies. The interventions corresponded with significant improvements in student academic performance and clinical confidence, which had a positive impact on care delivery. The findings informed the development of the National Standards for Adult Critical Care Nurse Education, which were published in 2016 (CC3N, 2016). Conclusion Nurse education needs to evolve to meet the changing needs of students and practice. A tripartite approach involving academics, clinical practice and students working together, was highly effective in reshaping both local and national critical care nurse education.