Russell Gurbutt

The Nursing Associate is a new role within UK healthcare that entails a two year vocational undergraduate diploma education pathway integrated with extensive front line clinical practice. The curriculum mirrors aspects of existing preregistration nursing programmes of which common features are regulation and development of professional attributes. Curriculum content includes teaching about such values with the intention of developing the students’ knowledge and translating this until it becomes embodied in their practice .
A mixed methods survey study was designed to evaluate the extent to which this curriculum aim was being achieved to inform subsequent related teaching and learning interventions. The aim was to describe students’ perceptions of developing as an honest, caring, compassionate, conscientious and competent nursing associate. Enquiry also included exploring students’ perceptions of how this development is likely to impact on patient care as well as enablers and barriers to achieving fitness for practise in these 5 domains. Ethical approval was granted by the University of Bolton Faculty Research Ethics chairperson. Students from the first cohort of this new programme were invited to participate and complete the survey (n=68 with 57 participants). They were working in 4 different National Health Service Trusts. The survey had 4 dimensions – a self-rating scale of 5 professional domains and a free text counterpart in which respondents could explain why they had chosen that rating. A final section of the survey invited any further free text comment about factors enabling or posing a barrier to developing professional attributes.
Thematic analysis of qualitative comments was undertaken to generate findings. These showed that students expressed these attributes as a sense of being (already embodied) and also development (becoming) in so far as they had learnt more about what each attribute was and could recognise steps they had taken to move towards embodying the attribute. Some respondents also identified praxis – where real world practice fell short of their expectations, and a positive aspect was that they reported being courageous enough to challenge such mismatches.
Overall the findings suggest that the pedagogic design linking propositional knowledge to students'clinical work promoted reflection on real world practice experience was moving students towards developing professional attributes. It also highlighted differences in the degree of reflective insights students demonstrated about their own values, thus directing attention towards how this could be promoted as an essential skill within the curriculum. These findings provide the basis for informing tripartite (university student and service) working relationships, especially around challenging areas of concern to students and also how to draw role models from current practice into shared classroom teaching. Additionally it identified some factors that could be used to inform students decision making to overcome barriers to developing these professional attributes.

This paper reports on the co-production of a healthcare leadership model that was generated through in-class qualitative inductive analysis and subsequently critiqued in relation to real world value for local healthcare practice. Healthcare leadership is informed by various theoretical models and associated competencies (e.g. The UK Healthcare leadership Model NHS 2016 ) and when teaching post graduate students there is a need to go beyond merely adopting an 'off the shelf model' and to critically examine what leadership is and how it can be understood in relation to local healthcare culture and practices. Previous work on creative education (Gurbutt & Gurbutt in Brewer and Hogarth 2015) and collaborative practice for public health (Gurbutt 2016) informed a desire to enhance the students' experience of creative collaboration.
The aim was to develop students' critical thinking about real world value of leadership models through a co-production activity to enhance engagement and the student learning experience. The participants were a post graduate cohort of NHS employees in Greater Manchester UK studying a leadership module at the University of Bolton, UK.
A qualitative inductive analysis methodology was used to produce a descriptive leadership model. The methods included a series of steps initially to generate data using a 'post-it' note exercise exploring local leadership and leading in healthcare. Students sorted the data and developed categories and then through discussion refined them. These were developed into themes that were subsequently represented visually on a sketch-board. This process enhanced students' experiential learning about experience aspects of research methodology that linked to a future research module in their programme. A further step involved discussion about the themes and their possible relationships and facilitation of several iterations of an agreed class diagrammatic model comprising four themes (Support, traits, process, direction) around a core focus (patients). Following this the model was verbally critiqued in relation to informing competency identification in relation to real world healthcare leadership practice as well as reflexivity in terms of participants' awareness of their interpretive standpoint.
Learning occurred through the process and about it. Students provided written feedback on their own learning (on the process and the model) as well as how to relate the model to practice. Students reported liking being able to share perspectives and practice putting new ideas forward as well as considering what would operationalise its four main themes. An academic colleague provided in class peer review feedback on tutor facilitation of the co-production activity to inform how to develop this activity further. An employer partner who funded students to undertake leadership modules also provided feedback in terms of partnership collaboration and adding value to the workforce. Overall the aims were met and value was added to co-production through reflective co-learning in this case about developing healthcare leaders.

Innovation and leadership education requires students to develop their creative approaches to thinking, especially in healthcare settings that are resource constrained, outcome focused and subject to continual change. Public healthcare settings are often complex, resource limited busy environments subject to workforce shortages that are challenging for front line healthcare leaders, especially when it comes to leading others through change. A leadership and innovation module undertaken by advanced practitioners included a segment on motivating others. A novel approach was designed to help students to move from surface learning through a lecture approach and towards gaining deeper learning through immersion in research activity to generate a model of motivation relevant to a healthcare setting.
The intervention was a day long activity in which 30 students were invited to participate in research study to develop a model of motivation. This had three key steps: generating a description of motivation, inductively generating a model of motivation and finally representing that as a conceptual model and critically discussing it. The tutor role was as facilitator and the students co-produced a model. An individual semi-structured qualitative questionnaire about motivation was completed before the session and also an evaluation questionnaire on completion. Ethical approval was granted by the University of Bolton Faculty research ethics chair.
The activity added value to the students' learning in several ways: research design, reflexivity and real world application. It introduced students to research enquiry, including identifying potential questions, devising a methodology and generating an answer to the question. This illustrated a process that they would encounter if they progressed to undertake an empirical dissertation. Students gained deeper insights into their standpoint and how they shaped data interpretation as well as triangulation to confirm meaning attributed to stages during data analysis. Deeper learning was developed through a critical discussion of the concepts, their interrelationships and application of the class generated model to the real world of healthcare practice. In this way students developed critical thinking skills about approaches to motivating others. Subsequent learning introduced existing motivation models and a focus for critical discussion of their merits in relation to the class generated version. Student evaluation demonstrated a range of benefits gained through the experience including peer learning, transferable skills and developing critical thinking.
Learning about innovation demands tutor modelling of innovative practice - in this case facilitating healthcare students to learn through a collaborative research process, so that value is added to classroom sessions and students can take forward both subject knowledge and critical thinking development as well as a learning approach that could be used by themselves to develop this within their own teams.

This paper reports on the development and evaluation of an online scenario based compassion intervention for nursing students. Reports suggest that nursing education programmes should include simulation based learning, and be developed using service users to help teach nursing students about compassionate care, and what it actually feels like to be the patient. In addition, many of the problems arise in hospital environments that are under immense pressure, both financially and to perform well with limited resources. The complex and resource constrained practice environment shapes how people act This underlines an additional need to include educational programs that can prepare nursing students for the reality of practice. In an attempt to address this, previous studies have used both simulation and online teaching environments to teach nursing students about empathy and compassion. Although results showed improvements in the delivery of empathy, confidence and understanding of compassion, very few, if any, have explored the effectiveness of online scenarios as a teaching intervention for nursing student’s compassion. To address this gap, eight nurse – patient scenarios, based on real life clinical experiences, were recorded and developed further with additional theoretical information in Articulate software package. A sample of nurse educators and nursing students participated in a short pilot study aimed at evaluating the experience and understanding of compassion from those using the intervention. The findings from the study are presented and the implication for nurse education discussed.

Compassion in nursing is an important moral virtue that forms the basis of ethical guidelines for practice (Dietze & Orb, 2000; Armstrong, 2000). However, identified compassion failures (UK) (Francis, 2013) have led to a renewed interest in championing it across nurse education programs. Debate exists as to whether compassion is an innate quality or something that can actually be taught (Bray et al, 2014; Johnson, 2013). Some argue that it can be taught combined with reflective practice, and should be even though evidence exists of it being overlooked in preregistration education (Benbow, 2016; Bramley & Matiti, 2014; Sinclair et al., 2010).
This paper reports on the design considerations for a self-evaluation online tool (built using Articulate) incorporating a compassionate strengths scale and patient case scenarios to assist nursing students in developing their strengths of compassion. The compassion strengths scale is employed as a tool for learners to self-evaluate areas where their compassion is strong and areas where development can occur. In this way it focus on what learners have rather than a deficit approach to build on the strong qualities and grow in areas where it is less so. A reference group of students also inform the content development and evaluate the functionality of the tool. The design is research informed (primary research) and pedagogically designed around a reflective model and collaboratively developed with academic, student and patient group contributions.
The purpose of the tool is to be used as an online curriculum intervention blended with classroom teaching content. Compassion is relevant all nursing practice and the tool is designed to include discipline specific case examples. It facilitates accessible education at a time place and pace according to learner requirements working in practice alongside their learning. The tool supports student’s development of lifelong learning and reflective self-evaluation of their compassion strengths. Overall the design is a unique approach employing content creation software to champion compassion education in nursing practice that could also be a basis for developing an Interprofessional learning approach with a wider stakeholder group