Cathrine Derham

Student nurses spend a significant amount of time learning within clinical environments. Little is known about the extent to which the verbal feedback they receive represents high quality feedback, which enables sustainable feedback practices. The results of this research study indicate that verbal feedback was highly valued by students, but challenges were encountered in obtaining high quality feedback. This impacted upon their ability to engage with and make sense of feedback in order to enhance future practice. More attention needs to be paid to preparing students for practice and the development of feedback literacy skills, as this impacts upon opportunities to engage with and utilise feedback. We also reflect upon the added benefit of using a student-staff partnership approach for collecting and interpreting data for this investigation.

With an increasing emphasis on the importance of real-world learning in higher education, coupled with demand for placement experience, simulation has become an increasingly popular pedagogy. However, literature is scant on how students feedforward their learning from the simulation debrief into placement. A mixed-method study of 108 student nurses explored how feedback from the debriefing contributed to students’ learning from immersive simulation and whether students used this learning in the placement that followed. In this case, authenticity, realism and interaction were achieved through the use of actors, high fidelity mannequins, clinicians, medical equipment and replicated clinical environments. Results indicated barriers to feedforward at the two stages of the simulation feedback process and the transition of learning into practice. Recommendations identify measures to strengthen the formative feedback phases between the university and practice settings and further enhance the potential of simulation pedagogy.

This paper explored verbal feedback and the concept of high quality feedback within the practice setting (Johnson et al., 2016).  The results of a research study indicate the extent to which students experience high quality feedback: feedback which promotes self-regulation by encouraging engagement and the processing of advice to inform development. Students recognised the importance of verbal feedback received from multiple sources and identified challenges in obtaining this.  Insights gained have implications for the introduction of the NMC Standards for Student Supervision and Assessment (2018), in order to ensure difficulties students encountered are not perpetuated through this new approach.

Simulations and games are being used across a variety of subject areas as a means to provide insight into real world situations within a classroom setting; they offer many of the benefits of real world learning but without some of the associated risks and costs. Lean, Moizer, Derham, Strachan and Bhuiyan aim to evaluate the role of simulations and games in real world learning. The nature of simulations and games is discussed with reference to a variety of examples in Higher Education. Their role in real world learning is evaluated with reference to the benefits and challenges of their use for teaching and learning in Higher Education. Three case studies from diverse subject contexts are reported to illustrate the use of simulations and games and some of the associated issues.

As one component of the feedback process , annotations on student work should focus upon providing explanations and guidance, which encourage students to use the comments to develop their abilities to act as self-regulated learners; thus promoting what Carless (2015) refers to as the new paradigm of feedback practices. This is contrary to the old paradigm in which annotations merely serve to transfer information, characterised by evaluative statements and corrective advice. It is argued that it is not only the content of the message, but also the language used, which has an impact upon the sustainability of this form of feedback practice. The current study reports on an analysis of annotations in the form of 1760 in-text comments added by markers to 52 summative essays. Findings indicated that the majority of comments were directed at the level of task performance rather than relating to the process (i.e. giving students advice about their future work and regulation of their actions). Additionally, there were positive correlations found between grades and words expressing a positive emotional tone, as well as negative correlations between grades and words which had connotations of sadness, risk and were phrased as questions. It appears that all annotations encourage the old paradigm as they focus upon the delivery of information, which minimises the potential upon student learning. It is argued that markers’ practices could be modified to incorporate appropriate language and direction which could have a more positive impact upon students learning, maximising the benefit of in-text comments.

An under developed aspect of this pedagogic approach is understanding  how students use the insights and knowledge gained during the experience and formative feedback process,  to feedforward into their own professional practice. The transfer and recontextualisation of knowledge and learning from one setting to another is vital in order to achieve learning gain. Learning gain is recognised as the development in knowledge, skills, work-readiness and personal development made by students (HEFCE 2017). In order to maximise the impact of immersive simulation and formative feedback it is important to recognise the challenges associated with the transfer of learning from one setting to another and workplace recontextualisation.

Using a mixed method approach we  investigated students’ perception of their learning; how the debrief was used to give formative feedback; and strategies students used to transferred their learning into clinical practice.

Findings from an evaluation questionnaire highlighted the success of the event overall. Issues were raised within focus groups concerning the formative feedback process, which took place immediately after the simulation activity as a form of interactive dialogue between students and the facilitator. Challenges associated with how learning and feedback could be successfully transferred into the workplace were identified and strategies to address the barriers which impact upon workplace and learner recontextualisation were identified. It is important that these are understood and addressed in order to ensure the subsequent development of the learner and to optimise the learning gain associate with this pedagogic approach.

An under developed aspect of the use of simulation is understanding of how students use formative feedback, or ‘the debrief’, to feedforward into their own professional practice. 120 third year student nurses undertook an immersive simulated experience prior to their final placement before registration. Using a mixed method approach we explored students’ perception of their learning, how the debrief was used and ways in which students could more effectively transfer the learning gained during simulation into real like practice.

Results highlighted the requirement for two different and interdependent feedback strategies, These were important for students as they enabled them to capitalise on their immediate learning during the simulation, as well as being able to take their learning into future practice. The first feedback, ‘the debrief’, was categorised by students as specific, immediate and personalised. The reactive nature of the feedback was enhanced using all players in the simulation; staff, actors and the students themselves. The second phase of the feedback required students to re-contextualise their experience and feedback to the workplace and write an relevant action plan to guide their practice. Data indicated that the potential to build upon the simulation debrief was diluted by a number of factors: students’ difficulty in deconstructing meaningful feedback; their concealment of areas for improvement from their practice supervisors; and their lack of awareness of the importance of feedforward to their long-term development.

Simulation has become a pedagogy integral to the professional preparation of students for real world settings. A literature review demonstrates its impact in the developed world where countries such as the UK, Australia and the USA invest time and resource in the development of sophisticated simulation suites for their students. A mixed method study analysed the sustainability of this model for pre-registration nursing preparation for practice. In particular, the study findings focus on the ability of students to transfer their learning from simulation to real life practice.

Findings highlighted the success of a two- stage feedback approach to students’ learning. The first allowed immediate interactive dialogue with students’ about  their simulation experience.  The second, crucially often missed as part of students’ development, examined how feedback could be successfully transferred into a professional developmental discussion with clinical staff in a different setting away from the original simulation. Difficulties bridging the recognised theory – practice gap in nursing (Evans et al 2010) were identified. Findings align with the move to sustainable feedback skills in higher education as part of students’ development both in the academic and practice settings.

An invited speaker asked to share experiences of being involved in the development of a nursing curriculum,  which had lead to an overall improvement in the student experience and satisfaction.

Whilst it is important to consider innovative practices and ideas, it is the context in which the curriculum is based  which is vital in ensuring success. The interdependence between the organisational culture, leadership and the environment needs to considered when developing a curriculum. This includes sharing  educational values and being supported by strong visionary leadership which enables critical reflection, motivates  and rewards people for developing a  different educational experience for students.  The environment most likely to foster innovation is one that encourages collaborative approaches across disciplines , with students acting as co-producers, service users and practice colleagues. Determination and resilience are vital in order to keep programmes contemporary.

The aim of any assessment strategy is to enable development. Effective feedback should serve to summarise activities and achievements, in addition to highlighting issues related to future practice (Maton 2012, Jenkins 2010).  This is the  purpose of the ongoing achievement record (NMC 2008) and thus there is an expectation that comments made by mentors,  should both state attainment and feed forward to  identify what needs to be developed and how this might be achieved. Although there is evidence that students are critical of mentors who provide feedback that is not developmental (Clynes and Rafferty 2008, Duffy 2004), very little is known about the nature or quality of written feedback and the effectiveness of the on-going achievement record as a tool to enable development.

This work  examines the quality of mentor feedback documented in the on-going achievement record. A quantitative analysis of feedback was completed using 22 students’ practice assessment documents from across the fields of nursing practice. Mentors’ feedback was classified using a scoring system with criteria ranging from ‘personal opinion’ to ’informative developmental guidance’. Findings from the analysis of data indicate that the majority of mentor feedback is descriptive, with reference made to students’ personal characteristics or simply stating what has been achieved. There is little evidence of developmental feedback, even in the case of the failing student.

The findings from the study raise significant concerns about the nature and quality of written feedback and the use of the on-going achievement record.  It is argued that the ongoing achievement record is not being utilised effectively as results indicate that mentor feedback does not enable progression and on-going learning. 

Patients with heart failure  benefit from self-management educational programmes. Most research reports tend to adopt a quantitative approach and report on outcome measures such as quality of life and symptom management.  The objective of this review was to synthesise the evidence related to the experiences of people who participated in the self-management patient education programmes and the impact upon their subsequent health maintenance. Eight studies were included in the review. Forty-seven findings were extracted and grouped into seven categories. These were synthesised into two  findings: the motivation to attend self-care programmes and adopt health behaviours; the experience of greater confidence and control over heart failure through participation in group programmes with supportive healthcare professionals. Self-management programmes were useful in building confidence to manage the condition  Patient self-management was enhanced when programmes were provided by supportive staff, augmenting patients' understanding and motivation to change their eating habits, take regular exercise and manage and monitor their symptoms.  

In-text comments, in the form of annotations on students’ work, are a form of feedback information that should guide students to take action. It is both the focus of in-text comments, and the ways in which they are linguistically communicated, that has the potential to impact upon how they are perceived by students. This study reports on an analysis of 2101 in-text comments added by markers to 60 summative essays from two disciplines. The majority of comments, regardless of the grade awarded, were found to be directed at the task performance, rather than relating to the level of process or self-regulation. Work awarded higher grades received fewer annotations; these essays were found to include more feedback comments expressing a positive tone, with limited opportunities for informing further development. Work awarded lower grades mainly received corrective comments, as well as comments characterised by interrogative language and words expressing risk. It is argued that the linguistic style may influence engagement with in-text comments, impacting upon students’ affective and emotional states, and their level of cognitive engagement with the feedback information. Recommendations for markers’ practices are identified to facilitate the opportunities for engagement and action that in-text comments might afford.

There is a fundamental link between patient recovery and family wellbeing. Increasing numbers of patients are benefiting from treatment in intensive care, who return home to be cared for by their families and other care givers. Recognising the caregivers’ needs is essential in order to safeguard the family unit, provide holistic care and ensure effective patient rehabilitation. Caregivers provide a crucial role in this, but face many challenges.

There is little research related to the family experience after intensive care, but evidence suggests they go through a wide range of both positive and negative events and emotions. A literature review was completed to investigate original research into the caregiver experience at home. The findings identified a  new syndrome, Post Intensive Care Syndrome – Family which suggests caregivers experience psychological problems after a patient is discharged from hospital. The caregiver experience at home is more complex than suggested by PICS-F and that the syndrome should be widened. The impact upon caregivers can be both positive and negative affecting psychological and physical wellbeing, family dynamics, friendships, and lifestyles.

Post ICU caregivers are a largely unrecognised group and receive limited, if any support after hospital discharge. Therefore family members need open-ended support beyond the hospital stay and there is potential to redefine the interpretation of critical care without walls. ICU teams need to move beyond ‘silo thinking’ to embrace a more multidisciplinary approach to care after discharge.

The policy document, Comprehensive Critical Care, suggested that patients with critical care needs should expect the same standard of care wherever they are nursed, be that in a traditional critical care setting or in a general ward area. It is recognized that in order for this to occur, the developmental needs of ward nurses need to be met to enable them to care for patients with level 1 and level 2 needs. A second document, The Nursing Contribution to the Provision of Comprehensive Critical Care for Adults: A strategic Programme of Action, proposed a programme of action and outlined five priority areas to be considered to ensure the success of comprehensive critical care. Education, training and workforce development was one of the areas outlined, and thus, in response, the role of the practice development facilitator was created as a means of developing the critical care knowledge, skills and practice in ward areas. It became apparent that education and training alone were insufficient to ensure that the aims of comprehensive critical care were realized. The way in which the nurses approached and organized their work and the availability of resources had a great impact on the ability of staff to care for these patients. It is argued that achieving comprehensive critical care is complex and that a multi-dimensional approach to the implementation of policy is essential in order to realize its aims.

This paper offers a perspective on ‘care’ as a component in the identity of successful university teachers. Three key lines of flight within this assemblage (care, pedagogic health, and salutogenesis) are examined here. In combination, they may offer a response to hegemonic neoliberal discourses that typically divert academics from enacting their professional values. A ‘triple point’ is hypothesised, at which the three lines would be found to co-exist, without border or barriers.