A three-phase evaluation study to explore nursing students

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A three-phase evaluation study to explore nursing
students assessment skills.

• Deborah Coleman

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Content overview

• Flowchart of study
• How I developed research topic
• Aim of study
• Workbook development- intervention
• Systematic literature review
• Objective -1 literature review- chapter 2
• Objective 23 literature review- chapter 3
• Study results

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(No Transcript)
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Research topic

• Ageing population
• This has led to assessment of need becoming a
  central feature of government policy and
  practice.
• Patient assessment has become an increasingly
  multi-disciplinary activity in order to meet the
  complex needs of older individuals and ensure
  that care planning is person centred,
  co-ordinated and effective.
• Increasing complexity of clinical settings-
  limits opportunities to practice assessment
  skills.

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Aim

• To explore second year nursing students
  assessment skills with older people.

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Needed to consider

• How do students learn?
• How can we measure clinical competence?
• How can I measure if the workbook (intervention)
  will make a difference?
• How will I know if the workbook was of use?

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Workbook development

• The purpose of the workbook is to provide a guide
  for nursing students learning the skill of
  patient assessment with older people.
• The Older Persons Assessment Workbook (OPAW) was
  developed during doctoral studies and is based on
  self-directed learning, constructive and
  reflection educational theories .

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Initial literature searches

• Nursing competence and self-efficacy are
  important factors associated with high-quality
  patient care.
• There are a limited number of instruments
  available which attempt to measure these
  constructs in nursing students and there is
  limited knowledge of the psychometric quality of
  these instruments.
• Showed a lack of evidence to support
  effectiveness of teaching and learning methods
  used

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Systematic literature review (1)

• Title
• Teaching and Learning strategies to support
  holistic older person assessment by nursing,
  medical and social work students A systematic
  review.
• A systematic literature review undertaken to
  identify the available evidence for the
  effectiveness of educational strategies used to
  support nursing, medical and social work
  students learning in relation to assessing the
  needs of older people.

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Systematic literature review (2)

• Search Methods
• A search of electronic databases included
  Medline, CINAHL, ERIC, British Education index,
  Proquest Education, the Australian Education
  Index, International Bibliography of Social
  Sciences (IBSS), Social Science Citation Index,
  Sociological Abstracts and Social Policy Online.
• Reference lists of relevant articles and reviews
  were also searched.

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Systematic literature review (3)

• PICOS Review questions/key words.
• Population nursing students, medical students or
  social work students
• Intervention teach, learn, experience, workbook,
  portfolio, lecture, simulation, demonstrate,
  observe, perform, reflect, train, educate,
  support or mentor.
• Comparison None
• Outcome holistic, or person centred, or patient
  centred or client centred, individual or
  psychosocial, comprehensive history taking or
  patient assessment with older people.

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Systematic literature review (4)

• Inclusion/exclusion criteria
• Studies RCTs or cluster randomised controlled
  trials, quasi-experimental design studies, before
  and after controlled and uncontrolled studies and
  interrupted time series (ITS) studies.
• Any study which involved the health or social
  needs assessment of an adult (at least 65 years
  of age), which was carried out by a medical,
  nursing or social work student will be included.

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Systematic literature review (5)

• Inclusion/exclusion criteria
• There are no restrictions related to health
  status to allow for the wide variety of
  assessment skills which may be required on
  occasions.
• Patients may be assessed in a variety of
  environments including hospital, General
  Practitioner surgery, residential or nursing home
  or in the patient / clients own home.
• Studies which involved children as patients will
  be excluded as their needs, and thus the
  assessment of those needs, differ from those of
  the adult patient.

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Objective 1

• To test the reliability and validity of two
  psychosocial measures
• Self-efficacy in clinical performance scale
  SECP which measures assessment of self-beliefs
  
• Nursing competence questionnaire-NCQ which
  measures self-reported clinical competence
  behaviours.

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Literature review-objective 1(1)

• Aim
• The aim of this literature review is to identify
  literature relating to the development and
  testing of instruments used to measure the
  clinical competence or performance of nursing
  students.
• Search Methods
• A search of electronic databases included
  Medline and CINAHL
• Reference lists of relevant articles and reviews
  were also searched.

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Literature review-objective 1(2)

• Key words
• The literature was retrieved using the
  following search terms nursing student or
  student nurse in authors keywords and assess
  or measur or evaluat in AB and competenc or
  performance in TI.
• The search range included papers published in
  English between 2000- 2014. This timeframe was
  selected to reflect the adoption of the concept
  of competence in nurse education within the UK.

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Literature review-objective 1(3)

• Inclusion criteria
• Peer- reviewed papers were included where the
  focus of the paper was the development and
  testing of instruments to measure nursing student
  competence or performance
• The work related to pre-registration adult
  nursing students
• Published between 2000-2014.

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Literature review-objective 1(4)

• Exclusion criteria
• The paper related to specific competence, such as
  cultural, informatics, spiritual, emotional, or
  to specific skills, such as, catheterisation,
  communication
• The sample was not adult general nursing
  students, such as midwifery or mental health
  field, or post-registration students.

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Literature review-objective 1(5)

• Identification
• Screening
• Eligibility
• Included

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Objective 2

• To determine if there is a relationship
  between changes in the NCQ scale and
  self-efficacy items and nursing students use of
  the older persons assessment educational
  workbook.

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Objective 3

• To explore nursing students use and opinions
  of an older persons assessment educational
  workbook.

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Literature review- objective 23(1)

• Aim
• The aim of this review is to identify literature
  relating to the effectiveness of teaching and
  learning strategies used to support the clinical
  skills development of pre-registration nursing
  students.
• Search Methods
• A search of electronic databases included
  Medline, ERIC and CINAHL
• Reference lists of relevant articles and reviews
  were also searched.

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Literature review- objective 23(2)

• Key words
• Population nursing student or student nurse
• Intervention teach or learn or educat or
  train or simul or OSCE or portfolio or
  reflect or workbook or standardised patient or
  observ or PBL or EBL or case based learning
• Comparison None
• Outcome self-efficacy or competenc or self
  assess or perform or skill or proficienc.

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Literature review- objective 23(3)

• Inclusion criteria
• Research based papers or reviews were included
  where the focus of the paper was evaluation of
  the effectiveness of teaching and learning
  strategies used to support the clinical education
  of pre-registration nursing students
• Published between 2000-2014.

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Literature review- objective 23(4)

• Exclusion criteria
• The paper related to pre-registration nursing
  students and or nurse educators issues and
  perceptions of teaching and learning strategies
• The paper described the development or
  implementation of a teaching and learning
  strategy/method

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Literature review- objective 23(5)

• Exclusion criteria
• The paper described the strategies used to teach
  specific skills, such as, numeracy
  catheterisation, recording of vital signs,
  recognising the deteriorating patient, pain
  assessment.
• The sample did not include adult general nursing
  students, such as midwifery or mental health
  field, post-registration students, or focused
  solely on other healthcare professionals.

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Literature review- objective 23(6)

• Identification
• Screening
• Eligibility
• Included

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Study results

• Objective 1- The NCQ scale showed evidence of
  acceptable reliability and construct validity
  when measuring nursing competence in a sample of
  second year nursing students. There are concerns
  about the psychometric properties of the SECP
  scale when used with the same group.
• Objectives 23- The participants evaluated the
  workbook as useful for assisting with a patient
  assessment. The least liked aspect of the
  workbook was the reflection points.

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Conclusions/implications

• This exploratory work has provided
  information needed for a future RCT evaluation of
  a complex intervention (educational OPAW).
  Following a power calculation the sample size
  needed is n 26. Question refinement in a small
  number of workbook questions may encourage a more
  in-depth participant response. The workbook could
  provide nursing students with a structured
  approach to patient assessment, integrating
  academic and practice skills and utilising
  learning opportunities from practice placements.
  Nursing students would benefit from structured
  opportunities to develop patient assessment
  skills and to integrate reflection into practice.

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Future research (1)

• Objective 1-
• Further testing of the NCQ is indicated to
  provide support for its use with pre-registration
  nursing students- should include nursing students
  from other years of study and pre-registration
  fields.
• Testing of NCQ, alongside a more objective
  measure of competence, such as an OSCE or
  simulation, as part of a multiple mode of
  assessment, to test if there is a relationship
  between competence and self-reported competence.

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Future research (2)

• Watson and colleagues (2002) reported that the
  NCQ appeared to be sensitive to changes in
  self-assessment of clinical competence, providing
  direction for future work by administering the
  NCQ at different times in the programme to the
  same groups, to further test the sensitivity of
  the scale.

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Future research (3)

• Further research is indicated to explore the
  psychometric properties of the SECP with other
  larger samples.
• Further research is indicated in development of a
  scale specifically designed to measure nursing
  students competence in undertaking a patient
  assessment.

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Future research (4)

• Objectives 23
• Future research is indicated for data
  collection over a longer period, with larger
  samples from different years and fields of
  nursing, to measure if there are changes in
  competence over time in patient assessment skills
  as self-assessed by the participants.
• Inclusion of mentors and Practice Education
  Facilitators perceptions of the use of the
  workbook by nursing students would be beneficial
• Findings from the workbook evaluation
  questionnaire showed that the students found it
  useful in practice, lending support for further
  research into its effectiveness.

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Challenges of the study

• Time restriction due to academic requirements
• Ethical process
• Literature searches
• P/T study plus full time job no life at times!
• Steep learning curve
• Lack of confidence in ability
• Small sample

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Survival!

• Do not underestimate how long it takes
• Wide reading/focus
• Follow the guidelines
• Break down into manageable pieces
• Seek help- academic staff, librarians, SGC
• Peer/ family support
• Work life balance
• GOOD LUCK!