G. Pead-Ferenczi, S. King, J. Booth

Central Adelaide Local Health Network (AUSTRALIA)
Sequential learning is based upon a constructivist educational design originally developed by Ryden (1984) which see’s education activities following a logically flow and building on previous learning and experiences to attain new levels of understanding. This educational methodology also compliments the Dreyfus Model of Skills Acquisition and the application of this model to nursing by Patricia Benner (1982). This model posits that with the acquisition and development of skill, individuals pass through five stages or levels of proficiency being, novice, advanced beginner, competent, proficient and expert. This adaption by Benner has not been without academic debate, however, none the less, forms a solid foundation to build the skill development of the current nursing workforce. Despite this framework, practical operationalization of sequential learning pathways to support the transition of learners through novice to expert in the workplace is often problematic in implementation and poorly articulated. This issue has been identified as particularly relevant to the area of clinical education for surgical nursing staff in a healthcare environment that experiences rapid change in technologies, clinical practice, policy and legislation as well as healthcare consumer acuity and expectations.

In order to overcome and operationalise a solid and robust approach to skills acquisition, the authors present a practical methodology for development, measurement and provision of a sequential learning approach for post-graduate surgical nursing staff in a major public hospital in Australia. The clinical educators of the surgical directorate of the Royal Adelaide Hospital have developed and operationalised a functional framework for skill acquisition and enhancement for its current nursing workforce using the framework developed by Dreyfus and Benner, coupled with: opportunities for development, clinical exposure, access to clinical educators and mentors, and providing and supporting a culture of learning. Further adaption of the novice to expert framework was undertaken by the authors and the level of ‘competent’ was deliberately excluded. The rationale for this is that each individual nurse regulated by a Board and legislation is competent within their own Scope of Practice. The degree of this ‘competence’, measured by skill acquisition is then reflected by undertaking self-reflection at the time of a Professional Review and Development process with their direct line manager.

The methodology of implementation consisted of a multiphasic approach including:
1. Key stakeholder engagement to formulate core and specialised skill and knowledge sets
2. Mapping of skill sets to peak and professional bodies
3. Skill sets subjected to risk assessment to determine priority in trajectory of attainment
4. Sequence mapping skill sets to the development of a local orientation program
5. Self evaluation of skill sets to comply with Peformance Review and Development Process
6. Developing of individualised learning plans complimenting Continuing Professional Development registration standards