DESARROLLO MEDIOAMBIENTAL

basic things in school today'

Should procedures be practised in the ward as taught in school? Sisters were more emphatic than trainees in th e ir responses to this question. 12 gave an unqualified 'yes' stressing that i t was important. A further 4 gave a qualified 'yes' response e.g.

'Yes, I think they have improved the procedures but i t is d iffic u lt to stick rig id ly to the book'

The remaining 5 were not asked this question due to shortage of time. What cannot be taught on the wards

Four sisters f e lt i t would be d iffic u lt to teach theory on the ward due to lack of time or th e ir own feelings of inadequacy in this area.

' I wouldn't like to go deeply into th eo ry,It is a while since I did any'

One sister f e lt that some 'things' do get le f t out

'Talking to bereaved relative s,fo r instance,you have to learn i t by experience.There are no set rules'

The remainder f e lt most things could be taught on the ward given s u ffi­ cient time and s ta ff with expertise.

The next few questions were designed to e lic it which routines were used to introduce new trainees to the ward, and the measures taken to assess the trainees' pre-knowledge and s k ills .

Previous knowledge and experience

Of the twelve sisters* who were asked this question,all attempted some form of assessment of previous experience,usually at the f ir s t interview. This took the form of asking a trainee what wards had been worked on and what procedures had been done. The impression given was that this preliminary interview is a superficial one; in some instances assumptions are made about a trainee's previous experience and standard of expertise -

e.g. ' I f they have been on a surgical ward we know pretty well what they should know'.

Induction routines

The induction routine followed a standard pattern. New trainees were interviewed by sis ter, usually on the f ir s t day, who explained ward routines and her expectations of the trainee. A conducted tour of the w ard,either with sister or another member of .the trained s ta ff,

followed the interviews. I t was frequent practice fo r the trainee" to be put to work with one particular member of the permanent s ta ff until 's ettle d ' in , the settling in period varying from one or two days to a week. There were variations to this routine, two sisters preferring to interview trainees a fte r the settling period; that is , a fte r the f ir s t week. The g eria tric day hospital sister approach was less formal, trainees joining s ta ff over a cup of coffee on the f ir s t morning. There is an apparent discrepancy between trainee^ and si sterns accounts of induction procedures, that is ,12% of trainees reported being set straight into work without a formal introduction during th eir last ward experience. This could in part be accounted fo r by absence of the sister on holiday, sick leave or leave of absence.

*NB In some interviews questions had to be omitted due to shortage of time.

Questioning by sisters

Most sisters (61%) reported asking trainees questions i.e .

When working with trainee 6

During reports 2

During drug rounds 2

At end of period on ward 2

During slack periods 1

Questions asked related to topics such as:- Nursing care

Patients' names and diagnoses Drugs:actions and side effects Diagnostic tests

What to do in emergencies

One charge nurse disliked;formal questioning, encouraging

trainees to formulate th eir own questions,then find out the answers fo r themselves from a f il e of reading materials kept in the office. The materials were o ff-p rin ts of articles from nursing journals, typed hand-outs and diagrams. Two sisters gave trainees essays to write and one had compiled a set of multi-choice questions.

Sisters reported doing more teaching to students who were actively interested and those who were approaching examinations.

Time for teaching

Five out of the eighteen sisters answering this question(27%) reported having l i t t l e time for teaching; these were sisters from

'acute' wards i.e . medical, surgical, orthopaedic and accident and emergency unit.

A further four (22%) f e lt that plenty of time could be found for teaching i f trained s ta ff were interested; two of these sisters were

on acute waras ana two on geriatric waras. inree sisters 1 10.07°;

took a much broader view of teaching and learning, emphasising that i t was going on a ll the time; by example, 'by doing' and during a c ti­ v itie s lik e report sessions. The question ' I f you had more time what would you do that you don't do now?' brought a variety of responses

Go over things in more detail 4

More case discussions with trainees 3

Carry out more nursing care with

individuals 3

Prepare visual aids 2

Give trainees.projects to do 1

Ask more questions 1

Personal study 1

Not asked 5

Value of doctors*rounds/ward reports

There was general agreement that the value of doctors'rounds depended on the doctor. Some doctors were excellent teachers, knew what the nurses wanted, others went too deeply. Surgical ward rounds were frequently stated to be too hurried to be of value. Ward reports were considered invaluable for teaching purposes.*

Best ways of teaching on the ward

Eight sisters f e lt they had nothing to add to what they had already said, when asked this question.

Those who did respond answered in the following way:-

Demonstration and practice 3

Teaching by example 3

Involving trainees 2

Support from trained s ta ff l

Total patient care 1

Make them seek knowledge 1

Lectures 1

Nothing to add 8

Training for the teaching role

Training and teaching methods is a topic often included in fir s t line management courses and six sisters had experienced such training. Ten had attended an 'a rt of examining' course.

One sister had attended a short seminar on teaching techniques, two had no training at a ll. For the remainder the interview had to be

concluded before this question was reached.

Six of the sisters (28.5%) were assessors for the General Nursing Council's ward based practical examinations.

Development courses

Of the sisters responding to this question seven (one third of the sample) f e lt a need fo r more 'c lin ic a l updating' courses* reading nursing journals was not considered su ffic ien t. One sister only expressed a wish for a course to develop her teaching role. Satisfaction with present system of training

Of the eleven sisters answering this question two only expressed satisfaction, the remainder feeling the.re was a need for improvement. Some specific criticism s were:-

' I don't think they get su fficien t support in the school. We have more failures now'

'The theory should be more related to practice' 'The discipline has gone now'

'The students are apathetic,they need spoon feeding today1 'There are too many distractions. Many of them are married nowadays'

Suggestions for improvements included:-

'More tutors on the ward/more clin ical teaching' 'Modular system and study days'

'More trained s ta ff to support trainees'

The last question asked the sisters how long they had been a sister. The responses varied from eighteen months to sixteen years, four years being the mode.

SUMMARY OF FINDINGS - interviews With sisters The main findings were as follow s:-

1. Ward allocations - periods of less than four weeks were consid­