NURSE EDUCATION TODAY (1985) 5. 122-123 0 Longman Group Ltd 1985

COMMENT

A look to the future or back to the past?

S M Hall

Are colleges of nursing the way forward? Should we be making these the basis of

our profession and changing our attitudes towards the value of our practical expertise?

The author is convinced that the present trend in training should be reversed, by being more rather than less ward based. She outlines a new scheme of training in

which the student might spend the first year in a college or school of nursing and

the second and third years in a hospital.

Recently, a friend of mine visited me from

Australia. As she is a nursing sister in a busy

general hospital, it was not long before we

were exchanging our views on nursing. I was

surprised to learn that she is very much against

the training of nurses in colleges. She had

apparently already had experience of nurses

trained in this way and felt they were not

generally oriented to or interested in carrying

out the practical tasks required by the sick.

There is of course the strong possibility she was

biased in her view, having trained in the

traditional way, and one could also say that

perhaps her ward conditions may not have

been entirely suited to the college-trained

nurse. Whatever the reason, I do believe we

need to think clearly and carefully before we

rush into a form of training which may remove

the trainees from where they most desire to be _ in the wards caring for the sick.

ADVANTAGES OF TEACHING NURSING IN WARD AREAS

Nursing is essentially an amalgam of practical

skills. This is obviously only half the picture

S M Hall SRN DN(Lond) RNT, Nurse Tutor, Rotherham Scfiool of Nursing

122

because alongside those practical skills, we

must acquire knowledge and understanding of

the patient’s disorders and needs. The patient’s

major concern is that he or she gets a caring

individual, who is able to carry out skilled

nursing care coupled with theoretical know-

ledge and understanding. In my experience, for

many patients it is the small things that count:

the face-cloth rinsed out after the bed bath and

not crushed, sticky with soap, into the toilet

bag; the thoughtfulness of the nurse who brings

to the patient on ‘nil orally’ something to rinse

the mouth or clean the teeth, the nurse who

cleans the old man’s spectacles before putting

them in position, the nurse who recognises the

signs of pain in the restlessness and facial

expression, and the nurse who is able to com-

municate, by the touch of a hand, sympathy

and understanding for a patient in need.

I have recently completed an introductory

course in which most of the basic nursing

procedures were taught in the ward and not in

the training school. In spite of all the dif-

ficulties - and there were some both in the

ward and in the training school - in general

these young trainees showed greater confidence

by the end of the course. As a tutor, I do

spend time most weeks working in busy ward

areas and I recognise the very real need of the

trainees for expert tuition and guidance in

carrying out nursing care. Patient care is most-

ly given by the least trained. Trained nurses on

the wards are often under a lot of pressure and

are not always able to provide the supervision

and guidance required by trainees. Why do we

train? It is surely so that we can eventually

become experts in nursing care. Therefore,

should not the major part of the nursing care

given to patients be given by trained nurses

and not, as it is at present, by those with

minimal experience?

From the many years I have spent in nurs-

ing, I am convinced that training must become

more ward based, not get further away. Where

else can the practical skills be learnt other than

at the bedside? Nowhere. Who should teach

these skills? No one but the trained nurse, who

should be an expert in those skills. If practical

procedures and skills were properly taught and

supervised by trained nurses in the ward area,

we would not perhaps impose such strain on

our young trainees as they try to steer a middle

course through that which is taught in school

and what is practised on the ward. On entry

into nursing, most young recruits are eager to

get onto the wards to learn and practise their

clinical skills, yet the more experienced he or

she becomes, the further away from the bedside

he or she moves. This tendency to undervalue

our practical nursing skills would suggest that

anyone with a little common sense and pract-

ical brnt could carry out skilled nursing care.

Teaching in ward areas has other ad-

vantages, as probably many trained nurses will

recognise. Often students and pupils do not

correlate theory and practice very well and will

carry out practical procedures with little cog-

nition of the relevance to body function and

disorder. In the wards is where all the common

disorders and conditionst,are to be found and

where. it is hoped, the required nursing care is

being carried out. How many of us have

remembered a patient we have nursed and

used that information in examinations? I am

not suggesting. we dispense with textbooks, but

we could gain a great deal more information

from the living examples. Communication and

management skills also can only really be de-

vrloped in the clinical area; at first following

the examples

experience is

accept varied

NURSE EDTCATIOX I‘ODA’I 123

set by trained nurses until, as

gradually gained, the ability to

amounts of responsibility for pa-

tient care is acquired.

SUGGESTION FOR A NEW SCHEME OF TRAINING

Would it not be possible to design a scheme of

training whereby the new recruit spends per-

haps the first year in a college or nurse training

school, being taught the basic sciences? During

this year they could be treated to full student

status. A period could be spent with a social

worker, health visitor and a district nurse to

gain full experience of life and thr community

with all its attendant problems.

The student could perhaps produce a piece

of work on health education during this time.

In the second year and into thr third year,

the student could be assigned to a hospital, and

acquire practical skills and knowledge of illness

and disease in selected departments and ward

areas used. Throughout the whole of this time,

each student could be allocated to a trained

nurse in each area. Patient-centred tutorials

could be encouraged and all nursing practice

supervised until proficiency is achieved. Cont-

inuing assessment of the student carrying out

these skills could be employed. Practical assess-

ments of nursing performance and patient case

studies could be submitted for examination

purposes. In the last six months of the third

year, the student could be paid OJI a salary

scale; it is during this time that management

and teaching skills could be developed and

perhaps a piece of research undertaken as part

of the final examination. The emphasis at this

stage of the course to be placed on preparing

the student for the staff nurse role.

While I realise my ideas are far from perfect

and have not been fully explored. and would

certainly require a rethink of thr ratio of

trained to untrained staff in the clinical area,

there must be many others in this country with

good ideas worth developing rather than keep

on trying to emulate those whose idea of health

care and services are not necessarilv relevant to

our own.