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1355-1841/$ -doi:10.1016/j.

Journal of Neonatal Nursing (2011) 17, 11e16

www.elsevier.com/jneo

Neonatal Surgical Nursing: Widening the scopeof neonatal nurse education

Julia Petty

School of Community and Health Sciences, City University, London, UK

Available online 8 October 2010

KEYWORDSNeonatal nursing care;Care of the surgicalneonate;Learning needs andcompetencies;Curriculumdevelopment;Neonatal surgicalmodule;Delivery;Evaluation

ess: j.d.petty@city.ac.

see front matter ª 201jnn.2010.09.010

Abstract The article discusses the process of curriculum development, deliveryand evaluation of a post-registration neonatal surgical care module for neonatalnurses. The module was set up in response to the Neonatal Taskforce recommenda-tions published in 2009 and the first intake of 28 attendees has now completed. Theissues discussed in this paper aim to inform and add to knowledge in the field ofneonatal education in relation to broadening the scope of content within neonatalContinuous Professional Development (CPD) curricula. This has, to date, beenmainly medical focused and dedicating CPD modules to neonatal surgical practicespecifically is a recent positive development in this speciality.ª 2010 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.

Introduction

The speciality of neonatal care requires compe-tency in a vast array of clinical skills in order todeliver best practice to the sick neonate andfamily. Educating nurses in these essential skillsand underpinning knowledge is essential and iscurrently one area of discussion at both local andnational level. The NHS Neonatal Taskforce set upin February 2008 prompted by the publication ofCaring for Vulnerable Babies: The Re-organisationof Neonatal Services in England. (National AuditOffice, 2007) identified a number of issues thatrequired attention and further discussion in the

uk.

0 Neonatal Nurses Association

field of neonatal care and education; namelyFamily Centred care, Surgery, Transfers, Work-force, Data and Governance.

Standard 6 of the Taskforce Toolkit focuses onneonatal surgery stating that “Babies receivingneonatal surgery can expect the same level ofcare, support, resource and specialist input asa baby receiving care in a medical neonatal unit”(NHS Neonatal Taskforce, 2009). With this in mind,it is imperative that nurses receive adequate andrelevant education in neonatal surgical care aswell as the medical input that nurses alreadyreceive on existing programmes of CPD. The NHSTaskforce acknowledges that nurses providing carefor neonates must have expertise in both neonataland surgical care.

. Published by Elsevier Ltd. All rights reserved.

12 J. Petty

In addition, Standard 5 on “Professionalcompetence, education and training” states thataccredited modules should be provided coveringIntensive Care, High Dependency, Special Care,Neonatal Surgery and Neonatal Transfer. Withinthe author’s place of work, modules relating to thefirst three areas already exist and run regularly anda short course in neonatal transport has been inplace for a number of years. However, until 2010,there was no programme dedicated to the care ofthe surgical neonate.

These factors led to development of a curric-ulum for a dedicated module in Neonatal SurgicalNursing Care. The module is aimed at nurses whowish to undertake a ‘stand alone’ module in thisarea but also those who wish to integrate themodule into the BSc Nursing Studies (NeonatalRoute) pathway as an optional module to broadenchoice and scope of Neonatal CPD offered.

Developing a module of this nature hoped toaddress these recommendations and current gapsin CPD provision with subsequent integration intothe commissioning process for neonatal education.The RCS (2007) agree that commissioning stan-dards for neonatal surgical care need to bedeveloped based on present best practice whichthe module can address.

Curriculum development

So where does the design of this module fit in withmodels of curriculum development within highereducation? There are a range of approaches to thedesign of programmes and modules and the processis not always undertaken in a linear manner. Themodel emerging from the literature in this area thatbest suits the module in question is a competencybased curriculum design as proposed by McKimm(2007). The approach comprised a Needs and taskAnalysis (what do students need to know and do)with specific knowledge and skills ascertainedleading to objectives and competencies being setfor performance that were realistic, measurable,achievable and specific. In addition, teaching,learning and assessment strategies were definedwithin this model.

Other writers such as Toohey (2002) and Smith(1996, 2000) also describe similar models for designand delivery that are focused around competenciesbased on the specific subject area, in this caseneonatal surgery; i.e. programmes that are designedaround the content and competencies that studentsneed to learn. Within Toohey’s (2002) 5-point clas-sification of curriculum design; traditional or disci-pline based, performance or systems based,

cognitive, experiential and socially critical, thecurrent module fits in with the second of these;namely performance based (Neonatal SurgicalNursing Care). Smith (1996, 2000) similarly classifiesa curriculum in 4 ways: as a body of knowledge, anattempt to achieve certain ends in students(product), as a process and as a praxis. Again, theneonatal surgical module fits with the second ofthese; the aim to achieve competent and knowl-edgeable surgical neonatal nurses.However, one canargue that all named elements of curriculum designcan in some way inform the development of sucha module; as well as being performance/compe-tency based, certainly the subject is also disciplinebased in relation to a specific area of nursing andtheremust be a certain cognitive element in relationto the expected level of thought processes (i.e.critical thinking and reflection at degree level).Moreover, much knowledge also comes from expe-rience and so it is vital that the curriculum is devel-oped within the wider ‘social’ context.

Therefore, many elements from various modelscan be applied to the development of this neonatalsurgical module. However, in order to clarify theprocess and summarise important elements for itsdevelopment, this is detailed in the followingoutline of 8 stages.

Relating Fig. 1 to the module in question yieldsthe following answers:

1. Need and demand: Needed in relation to theNeonatal Taskforce recommendations (NHSNeonatal Taskforce, 2009). Demand is clearacross many units spanning at least 5 networkswithin the Pan London area

2. Student characteristics: Neonatal nurses frombothmedical and surgical unitswhohave studiedbasic level neonatal care and have at least 6months experience following neonatal training

3. Programme structure: Modular4. What will the ‘students be expected to do e

meet the learning outcomes for the module asspecific to neonatal nursing surgical care

5. Philosophy and content e outlined later in thepaper

6. Goals, objective and outcomes e again, out-lined later in the paper and in Table 1

7. Learning, teaching and assessment approacheseoutlined later

8. Evaluation and review e outlined later

Educational aims

The module aimed to prepare nurses working withneonates within the neonatal unit, hospital or

Figure. 1 Curriculum development process.

Education in Neonatal Surgical care 13

community setting, to safely care for neonateswho require, or have undergone, surgery. It soughtto provide learning opportunities encouraging theattending students to acquire, explore, share,apply and develop knowledge and skills that willpromote their understanding of the principles thatunderpin neonatal surgical care practices. As theteaching was provided, in the main, by clinicalexperts in the field of neonatal surgery, it washoped that they were given a sound knowledgebase for the neonatal surgical care they deliver. Inaddition, the module aimed to be relevant andvaluable to nurses not only working directly ina neonatal surgical unit but also to those workingwithin the medical remit that experience surgicalconditions requiring referral. In addition, thiscould also apply to nurses working on Paediatricgeneral wards and/or the community who care forneonates once discharged home following surgery.

The learning outcomes for the module can beseen in Table 1.

Content and delivery

Following a Needs Analysis and collaboration withkey clinical figures in the neonatal surgical areawithin the authors’ workplace, the content of themodule was devised and comprised a number ofessential areas. Firstly, it was essential to includein the first instance, general principles of pre-operative assessment and care in order to preparethe neonate undergoing surgery. These generalprinciples needed also to extend to post-operativeassessment and care, again as relevant to theneonate specifically.

As part of this, there was an inclusion of theneonate’s response to surgery and the relatedanatomy and physiology that underpins thisresponse. Specific conditions were covered toinclude those acute unexpected conditionsrequiring emergency care and surgery (e.g. intes-tinal obstruction, Necrotising Enterocolitis) as wellas congenital surgical conditions acquired in utero

Table 1 Learning outcomes.

Neonatal surgical care modulesKnowledge and understandingTo demonstrate competence and a sound knowledge of pre- and post-operative care principles specific to theneonates’ needs

Apply knowledge and understanding of specific neonatal surgical conditions and related pathophysiology tooptimise care for the neonate and family

SkillsCritically evaluate the physiological and psychological response of the neonate to surgery to positively influencecare and outcome for neonate and family

Demonstrate an ability to apply and analyse current evidence based guidelines and literature to the care of thesurgical neonate in order to give best practice

Assess competently and give appropriate care in relation to the pre and post op needs of neonates presenting witha range of conditions, be they requiring acute, emergency care or that involving elective, planned surgery

Demonstrate competent practice in a range of specific skills areas as relevant to the surgical neonate both pre- andpost-operatively

Demonstrate the ability to apply core biological and surgical nursing knowledge to minimise risk and optimise carewithin the acute hospital environment and the community/home setting

Apply the principles of assessment and best practice in surgical pre and post op care within both the surgical andmedical neonatal and/or Paediatric fields

Values and AttitudesUtilise professional experience to demonstrate a proactive response to the dynamic needs of the surgical neonateDemonstrate an awareness of the pertinent ethico-legal issues surrounding the surgical care of neonate and familysuch as maintaining patient confidentiality, the need for informed consent, outcome issues following surgery andthe psycho-social needs of the family

14 J. Petty

presenting either antenatally or at delivery.Content also comprised the continuing care of thesurgical neonate in the hospital and communitysetting in relation to long term implications for careand outcome. Finally, the issue of family support,being such an important area to address for anyfield of neonatal care, was included in relation tothe necessary interventions for family care duringdiagnosis, preparation and essential care duringand after surgery. Also important was the need toinclude ethical issues as pertinent to the surgicalneonate and family in line with the decision-makinginvolved in the diagnosis, care and general psycho-emotional situations that often arise.

Additionally, it was valuable to performa preliminary literature review to gauge the extentof academic work and research based knowledge inthe field e key papers were identified (de la Hunt,2006; Dickson and Smith, 2006; Donahue, 2007;Goyal et al., 2006; Hall et al., 2009; Hancock,2000; Hansen and Puder, 2009; Harres, 2007;Hedrick, 2010; Howard, 2006; Hutson et al., 2008;Irving, 2006; Johnson, 2005; Lin and Stoll, 2006;Lund and Berrios, 2007; Owen et al., 2009; Peterset al., 2005; Pierro, 2003; Pierro et al., 2006;Stormer et al., 2007; Walker et al., 2009). Thereview assisted in adding to the knowledge andwork necessary to impart to neonatal nurses on the

module and so integrate into the content. Aselection of this review is listed here.

Delivery pattern

Teaching and learning methodsClassroom based teaching was in the form oflectures and group discussions relating to specificconditions and cases in clinical practice. Theteaching pattern in relation to available to theavailable breakdown of hours permitted forthe module delivery can be seen in Table 2.Clinical surgical staff delivered the majority of theteaching from both the nursing and medical side.Service teaching: students were required tonegotiate a placement on a neonatal surgical unitfor a given time period.

Assessment

In line with the module of curriculum design dis-cussed earlier, it was important that the assess-ment centred on the same focus; that ofperformance in the practice of safely and compe-tently caring for surgical neonates. Therefore, theassessment designed was a Practice Portfolio inNeonatal Surgical Nursing Care comprising a Log

Table 2 Module teaching pattern.

Teaching component Type Contact hours Self directedstudy hours

Total studentlearning hours

Delivery of proposedcontent

Classroom/lecture/18 h 30 total 120 150Seminar/2 hCase presentations/2 hReflection/8 h

Education in Neonatal Surgical care 15

book of skills acquired to serve as supportingevidence for achievement of the learningoutcomes outlined in Table 1. Linking up assess-ment criteria with the learning outcomes enablescontingent alignment, a term utilised in highereducation to ensure the assessment is assessingwhat it is supposed to. The Log book also includesreflection on practice allowing the student toincorporate relevant evidence into discussion andrelate this to practice in line with degree levelanalysis.

To summarise, this module is essentially a prac-tice based module whereby students work withina surgical placement for an agreed period toacquire essential neonatal surgical skills. There-fore, it was vital that the assessment was devel-oped with a practice based focus centring aroundthe acquisition of evidence in this speciality sup-ported by a practice based mentor who is some-body experienced in the field.

Evaluation

Evaluation is an essential component of moduledesign and should be considered when a pro-gramme is first developed. The process andmethods must be considered as early as possible sothat it is an ongoing process that informs devel-opment and improvement and provides ongoingfeedback. With this in mind, evaluation for themodule discussed in this paper did commenceearly in relation to ascertaining the need anddemand for the module.

In fact even before the module commenced, itwas clear that the level of interest in the content andprogramme delivery was significant enough towarrant sustained applications and continuation.Student evaluation was ascertained immediatelyafter the last classroom based teaching. To summa-rise, the module was found to be very useful, appli-cable to practice and positive for both thoseworkingwithin surgical units and also those within medicalneonatal units. The content was appropriate for thelevel of nurses who attended overall and the inputfrom clinical experts (namely; Surgeons,

Neonatologists, pain specialists, stoma carespecialist, transport sister, surgical nursing team,ethical speaker) was regarded as very valuable,informative with the teaching regarded as excellentoverall.

The future

It is clear by the development of this module inneonatal surgical care, that there is a real need tooffer education of this nature to neonatal nursesin all areas of the field. What needs to happennow is to offer the module to more neonatalnurses and make the module more available interms of wider provision. It is hoped that themodule will now form part of the commissioningprocess, that there is the emergence of morefunded places and that stakeholders commit tothis module as an essential component of CPD forneonatal nurses. With increased marketing andcollaboration with other centres, it is hoped thatthere may be some shared teaching with otherinstitutions nationally. Finally, the developmentof online and/or self directed learning tools tosupport the classroom based teaching is necessaryin line with the number of hours that arepermitted to teach the content face-to face inthe classroom. The self directed element doesneed to be addressed so that students haveguidance in their learning away from the formalteaching setting.

Conclusion

This paper has outlined the development ofa specific module in Neonatal Surgical Nursing Carein relation to the curriculum development thattook place to inform the delivery and content. Thisserves as one example of a specific area withinneonatal nurse education which broadens thescope of education opportunities available toneonatal nurses to aid in their CPD. For any furtherinformation on neonatal surgery and/or educationin this area, please contact Julia Petty; NeonatalLecturer j.d.petty@city.ac.uk

16 J. Petty

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