ReviewWidening participation in nurse education: An integrative literature review☆,☆☆
Introduction
Widening participation (WP) into Higher Education is an international concern (Bowes et al., 2013, Shah et al., 2016). It is essentially concerned with increasing the numbers of people from underrepresented groups attending Higher Education. Whilst particular target groups differ internationally some commonalities exist, for example, mature or second chance learner, students with disabilities, students from black or ethnic minority groups and from lower socioeconomic backgrounds (Thomas and Quinn, 2003). In England, the commitment to WP is demonstrated in the national strategy ‘Access and student success in higher education’ (Department for Business Innovation and Skills, 2014, p. 3), which asserts: ‘…anyone with the potential to succeed in Higher Education should have the equal opportunity to do so’. Nomenclature differs between countries, for example (National Centre for student equity in higher education, 2017) in the United Kingdom, the phrase widening participation is used, whereas in Australia the preferred term is equity; at the heart of both of these is a commitment to increase opportunities and outcomes for groups which traditionally have limited access to Higher Education and the associated benefits. However it has to be remembered that Widening Participation (and equivalent concepts) is not just concerned with access to Higher education, but also success in higher education and beyond, including completion, attainment and progression to employment and/or post graduate study (Higher Education Funding Council for England, 2013).
Reasons for the drive to increase the diversity of the student population are multi-faceted, with benefits to individuals, the HE community and society (Department for Business Innovation and Skills, 2014). Graduates have greater job security, increased financial well-being and better physical and mental health. Greater diversity within higher education also enriches learning, promoting values such as equality and tolerance and diversifying the social and cultural environment (Shaw et al., 2007). While for society WP promotes social mobility and societal economic and cultural growth (Department for Business Innovation and Skills, 2014). Social Mobility relates to the ability of individuals to move their social status, education is key mechanism of social mobility as it changes individuals and groups social status through greater financial stability.
Before we explore WP in nursing, we need to define what we mean by ‘nursing’. Within the nursing workforce there are unregistered but trained nursing assistants and associates, however for the context of this paper the word ‘nurse’ and ‘nursing’ refers to individuals who have a registered nursing qualification with the Nursing and Midwifery Council, the UK nursing regulatory body. The nursing profession constitutes the largest professional group within the NHS, and as such it is a key group to consider with regards to WP in healthcare services.
As the majority of educational programmes for nursing professions are located within higher education, these courses contribute to the educational sector's responsibility for WP. However there is also responsibility of the professions to diversify the workforce to meet the needs of the communities they work with. For example, the indigenous population in Australia experiences stark health inequalities (Stewart et al., 2016); health care professionals working in these communities have not been effective in addressing health inequalities for a number of reasons one being cultural differences. This has resulted in the Australian Nursing and Midwifery Accreditation Council asserting that nurse education programmes have to include education on indigenous health and culture (Australian Nursing and Midwifery Accreditation Council, 2012). This has promoted targeted recruitment and training of indigenous health workers to work within their local community (Kumar et al., 2015). Within Europe, the UK National Health Service (NHS) is the largest employer yet the diversity of the current workforce is not representative of the general population (Health Education England, 2014). Widening Participation is not only important for patient care; it is also a fundamental mechanism to address workforce issues within the profession. There are concerns regarding nursing numbers (Department of Health, 2010). There is an international nurse shortage, due to both an ageing workforce as well as a reduction in the numbers of young people entering the profession (Marangozov et al., 2016), and the global mobility of nurses.
During the 21st century nursing sustained a strong record for recruiting and training a diverse population of students (Royal College of Nursing, 2008), but completion rates have been lower than in other subjects (Woodfield, 2014) and for specific groups: for example males and students born outside of the United Kingdom (Mulholland et al., 2008), highlighting that there is still more work needed to truly widen participation into nursing. A literature review undertaken on WP on health care programmes (Kaehne et al., 2014), found that the evidence base about WP is limited, and studies tend to be small and often single site. There have been no published reviews which have specifically explored WP in nurse educational programmes. Where there has been targeted work this has be within the field of gender — increasing the numbers of males accessing nursing (Mauritius, Hollup, 2014 and Australia, Weaver et al., 2013). Other research has been undertaken specifically about students with disabilities, focusing on supporting disabled students already enrolled on nursing programme rather than WP per se (in the United Kingdom, Salkeld, 2016, Morris and Turnball, 2006, Australia, Azzopardi et al., 2013, Canada, Ashcroft and Lutfiyya, 2013, Japan, Ikematsu et al., 2014, Ireland, Evans, 2014, Howlin et al., 2014a, Howlin et al., 2014b). Health Education England who are responsible for ensuring the healthcare workforce have the right skills have developed their own WP strategy (Health Education England, 2014) cementing the professional commitment to WP. One of their priorities is to increase the understanding of what works and does not work in relation to WP and healthcare education. This paper highlights and contributes to this agenda. The research question that framed the review was: To what degree is widening participation embedded in nurse education? The aim is to provide an integrative review of published papers on WP in undergraduate, pre-registration nursing students in the United Kingdom.
Section snippets
Review Methods
An integrative review methodology was chosen as it enables the inclusion of empirical papers as well as data gained from theoretical and conceptual papers (Tavares de Souza et al., 2010) thus enabling a comprehensive examination of WP in nursing in the United Kingdom.
Findings
This section shall firstly present some reflections on the study characteristics of the papers included in the review before continuing to explore each of the four themes identified (knowledge and identification of WP, pedagogy and WP, attrition and retention, and career prospects).
Discussion
We now return to the question that framed the review ‘to what degree is widening participation embedded in nurse education?’ It is evident that WP is a key issue for nursing, firstly to ensure that it recruits a diverse workforce that is representative and able to meet the healthcare needs of a diverse population. Secondly it is a key recruitment strategy for the profession, due to an international shortage of nurses and an ageing workforce. Despite this, WP is not really integrated into nurse
Conclusion
Widening participation is a key issue for the nursing profession to address. Historically nursing has been successful in recruiting from a diverse base, but the policy context is changing and a strategic vision is required for the profession to ensure that it continues to attract, recruit and educate those from diverse backgrounds. It is of paramount importance that both nursing education providers and clinical nurses begin to have a more strategic understanding of and focus on WP across the
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Cited by (0)
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We wish to acknowledge Jan Hutt Academic Support Librarian (Bournemouth University) for her support in conducting the initial search.
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This work was part of a larger study funded by Bournemouth and Edge Hill Universities.