There may have been even more rapid developments in the knowledge base that student nurses need than any other area of their development. Although all have to meet certain minimum requirements to be validated, in keeping with both NMC competencies and QAA Benchmark Statements, university departments vary considerably in their specific curriculum content, and in the emphasis placed on different subjects. Whilst a detailed analysis of subjects and their integration, or otherwise was beyond the scope of this project, we asked respondents to identify what they thought to be essential knowledge for practice. Here a case study ‘A’ midwife gives her view:
The knowledge I would expect them to have, I, I mean, I focus a lot myself on the physiological knowledge, so, an understanding of how a uterus works and understanding the changes the woman’s body experiences during pregnancy and post-natally. I would also expect them to have an understanding of certain emergency procedures that you can anticipate within pregnancy and labour. (Midwife Case study A)
Building on the ‘textbook knowledge’, she continued:
Yeah, in an ideal world the real knowledge of birth is normal, this is for Midwifery. If you think, you know, it's different from nursing in that respect. A real confidence if that’s the case and a knowledge about the physiological process and skills just to, basically a Midwife is someone who is ‘with woman’, that’s just to be with her, to be a normal human being and giving care. (Midwife Case study A)
Another midwife made it clear that women’s needs during pregnancy were becoming more complex and that midwifery had to rise to this challenge:
I think on the other-hand as well from a strategic point of view if you look at all the documents that are coming from the Scottish Executive, each one of them, you have to put a picture of a pregnant woman with a learning disability for instance and how we have to be able to care for her and provide her with all the appropriate needs when she is pregnant as well as when she is not pregnant so I think there is more and more pressure on trained staff and on girls in training to have quite a broad handle on child protection, …learning disability, mental health. (Midwifery manager Case study E)
It is acknowledged that an increased focus on mental health and illness has already been addressed by midwives in Scotland, to the extent that there is now a Perinatal Mental Health Curricular Framework (NES 2006). This offers a set of learning outcomes for curriculum developers which focus on mental health and illness competencies in five dimensions of practice: underpinning knowledge, prevention, detection, management and professional, ethical and legal practice.
A Charge nurse (Case study A) was reluctant to specify knowledge, but had clear expectations of the level:
I wouldn’t expect them to be completely prepared for what is coming in front of them. I often say to students, particularly final year students, you know, the university academic and the clinical preparation that they receive during their training does not adequately prepare them for what is going to happen once they receive their registration. Once they receive their registration that is when their education really begins because then they have the accountability, they have the responsibility, you know, it is just that the university training is a preparation for what is to come forward.
Although many students felt that their knowledge level was very good, there remained some concern that theory and practice do not always come together:
A lot of the theory doesn’t even relate to the stuff you do on placement, you know like, maybe in the first year, you know, you’ve your core skills and that, your blood pressures and that, but like in relation to third year...most of, the majority of the stuff doesn’t relate to what you learn on placements, so placemen’s like a separate entity. You know, you are learning everything you need to know as much when you’re on placement, and you’re learning aspects of nursing while your doing theory but you’re not really learning what you need know when you’re on placement, you learn it when you’re on placement, kinda thing…..that’s what I find. (Student nurse Case study H).
Despite this, most acknowledged that the theory and the practice do fall into place by the end of the programme. The students in particular, noted that there was also knowledge required of physiology and other subjects such as evidence based practice:
Anatomy, physiology and everything that you do in first year gives you a real good grounding for the kind of human disease and understanding. I think the way that they focus on how the healthy body works and then they go into all those diseases, I think that really helps you to understand what should be like, results and things out on the ward. (Student nurse Case study J)
…knowing the rationale and know why you do a procedure in such a way, the best evidence to know why you do it in such a way. (Student nurse Case study K)
It is interesting to note that even in the previous evaluation of pre-registration programmes for nursing and midwifery in Scotland (May et al 1997), students were already beginning to use research knowledge and saw the value of evidence based practice. Although there were other examples of different subjects the students main responses focused on the skills and related knowledge discussed above.