Assessing Graduate Capability For Nursing Practice by Diane COLLINS,
Deanne GASKILL, and
Gail HART
Queensland University of Technology
Introduction
Graduate nurses are often expected by employers and other staff members to make an immediate and effective transition to a rapidly changing and diverse workplace. Although difficulties of adjustment from being a student to an accountable Registered Nurse may be acknowledged, relatively few transition programs are offered by employing agencies in which formal, organised support from experienced preceptors is provided. University Schools of Nursing thus face a challenge to optimise each new graduate's transition, regardless of employment destination.
Schools of Nursing in Australia aim to prepare students for their role as a health care professional, by using the competencies stipulated by the Australian Nursing Council (ANC) as a framework for curriculum development. These competencies encourage a focus on process skills as well as content. For example, the ability to function as a reflective practitioner requires a commitment to life- long learning, an orientation to adaptation and well-developed clinical reasoning skills. It is thus evident that during university preparation, attention by academic staff needs to be applied to both the personal and professional development of students so that a self-conscious awareness of their individual approach to learning and confidence to address unpredictable, unfamiliar and challenging situations is fostered. In order to promote the capacity of students to deal with an uncertain work environment, rich and variable learning experiences, matched with opportunities for reflection, should be provided.
Students also need encouragement and support to make fine distinctions between similar situations. They need to question why an intervention is effective in one context but not in another. To be safe within the clinical setting, graduates must have the confidence to question and consult with others, in order to determine the most appropriate intervention.
Ideally, the learning experience as a student should mirror the experience of graduate practice in which nurses work collaboratively in teams. However, as most university education is competitive, and individual achievement is emphasised, creating a student centred learning experience and supporting opportunities for reflection and peer consultation is challenging.
Clinical practice offers a rich learning experience for students but requires skillful facilitation (Hart, 1997). To maximise the learning opportunities embedded in clinical practice, students need time to reflect on, and share, their experience with others.
Structured clinical practice is not the only experience that can be exploited to foster what Stephenson (1992) calls "capabilities". This term describes the ability to act effectively and appropriately in an uncertain clinical setting. Thus, in order to assist pre-registration students to prepare for their initial role as a first level practitioner who is able to assume accountability for his/her own actions, a core unit has been developed within the Bachelor of Nursing course, entitled Professional Practice Development (PPD). This unit specifically addresses the following graduate capabilities:
- clinical problem solving
- reflective practice
- effective communication
- ethical practice
- collaborative team work
Development of an authentic learning experience
This unit aims to forge links between the student's own clinical experience, theory that informs practice and the use of research.. A variety of learning experiences are provided. A brief description of these follows.
PPD is organised around small group discussion sessions that aim to foster skills in life-long learning. Students (third year pre-registration students and post-registration students -registered nurses up-grading to a Bachelor of Nursing) prepare for each session by undertaking a self-directed leaning package that addresses specific theoretical concepts relevant to a deeper understanding of nursing issues. Each tutorial outline provides learning objectives, readings and reflective activities that aim to stimulate a more critical approach to practice. It is essential that students feel comfortable discussing issues with their peers, so the establishment and maintenance of a safe learning environment is critical. Confidentiality is stressed. Students evaluate their own contribution to each session, using stated criteria and award them self a mark. They must also write a justification for that mark. The mark sheet and justification is then handed to the facilitator who also awards a mark, based on the same criteria, and provides succinct written feedback to the student. Thus continuous feedback is provided throughout semester which is appreciated by the students.
All students have the opportunity to verbally present a draft practice incident from their clinical experience, and draw on supportive comments and questions from their peers. In this way deeper exploration of relevant issues raised in the practice incident may be promoted through group discussion and peer feedback. Promotion of reflective practice is the major focus of this assessment item. Students then provide a written version of the same practice incident for formal assessment at the end of semester. Sample practice incidents are provided to assist students to make links with the criteria (Stories from Experience, 1998). It is expected that students draw on relevant material presented in the self-directed modules as well as make extensive use of research literature in order to validate their conclusions.
Finally, working in a negotiated pair, each student marks their peer's written practice incident. Written feedback is provided, based on stated criteria. This feedback can then be used by each peer to strengthen their respective practice incidents. The facilitator marks the written feedback assignment and awards a mark to the student providing the feedback. It may be useful in future units to provide students with sample peer feedback assignments as a reference point.
Assessing graduate capability
Both formal and informal evaluation of this unit indicates that students find it a very useful and enjoyable learning experience. Specifically, in relation to the unit's assessment items, 52% (n=37) out of a total of 71 respondents surveyed in May 1997, using a University Assessment Tool agreed that "The unit's assessment requirements are closely linked to the objectives and topics covered", whilst 25% (n=18) strongly agreed. (Table)
Table: The unit's assessment requirements are closely linked to the objectives and topics covered
NA SD D N A SA TOTAL No. 0 0 3 13 37 18 71 % 0 0 4 18 52 25 100 NA not answered SD strongly disagree D disagree N neutral A agree SA strongly agree Objectives relate directly to those graduate capabilities identified in the introduction. The three assessment items in turn reflect professionally focused objectives. Crooks (1988,10) notes that
If the assessments do not emphasize the material and goals which the teacher believes and has stated to be of primary importance, then the assessments have low validity, no matter how elegantly the tasks are presented or how carefully they are marked.
Promotion of quality in the design and marking of assessment items
The University Assessment Officer has been consulted regarding the quality of objectives and assessment items used. Such expert feedback has been extremely valuable for the ongoing development of the unit. The number of pieces of assessment and their weighting is also carefully considered to reflect the number of credit points and contact hours involved in the unit. Staff workloads must also be considered when assessment items are designed.
Staff involved in the unit meet at regular intervals to critically evaluate the design of assessment items and accompanying criteria for marking . Staff are encouraged to provide adequate written feedback to students, based on stated criteria so that improvement is promoted (Crooks, 1988).
In order to enhance inter-marker reliability, all team members mark an anonymous practice incident then meet to discuss marking outcomes. Any piece of written assessment that receives a fail grade is cross-marked by another academic, without reference to the original marking sheet.
Because of the often intensely personal nature of practice incidents, great care is taken to maintain the security and confidentiality of these assessment items. This respectful approach to the student's work appears to be appreciated, according to anecdotal evidence.
In conclusion, the primary aim of PPD is to develop and extend skills in reflective practice and peer consultation. These strategies are seen as valuable tools that underpin a more critical approach to practice and encourage engagement in life-long learning.
References
Australian Nursing Council Inc. (1994). National Competencies for the Registered and Enrolled Nurse in recommended Domains. Dickson: ANCI.
Crooks, Terry.(1988). Assessing student performance: HERDSA Green Guide No. 8, Kensington: University of New South Wales
Hart, G. (1997). Clinical Teaching Strategies to Encourage Reflective Practice, International Journal of PEPE, 1(1), 53-67
Stephenson, J. (1992) Capability and quality in higher education, in J. Stephenson and S. Weil (Eds.) Quality in Learning: A Capability approach in higher education. London: Kogan Page
Stories from Experiences: monograph of practice incidents. (1998). Queensland University of Technology Teaching and Learning Support Services.
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