Deborah Coleman

Content overviewFlowchart of studyHow I developed research topicAim of studyWorkbook development- interventionSystematic literature reviewObjective -1 literature review- chapter 2Objective 2+3 –literature review- chapter 3Study results

Phase 1-To test the reliability and validity of two psychosocial measures (Self-efficacy in clinical

performance scale –SECP which measures assessment self-beliefs and Nursing competence questionnaire-

NCQ which measures self-reported competence behaviours)

Phase 3-To explore nursing students’ use and opinions of an older person’s assessment educational workbook

Phase 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 person’s assessment educational workbook

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

Exploratory factor analysis-sample 2nd year nursing

students

Confirmatory factor analysis-sample 2nd

year nursing students

Using same subsample as phase 2 of 2nd year students who have

completed workbook

Small subsample of 2nd year students complete NCQ and SECP post workbook completion

Researcher undertakes content analysis of

completed workbook and students complete

questionnaire about satisfaction and utility of

workbook

Analysis- exploratory and confirmatory factor analysis, cronbach alpha for reliability

Inferential statistics using Wicoxon sign-rank

test to compare NCQ scale and 4 single self-efficacy items pre and

post intervention

Research topic Ageing populationThis 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.

Aim:

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

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?

Workbook developmentThe 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 .

Initial literature searchesNursing 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

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.

Systematic literature review (2) Search MethodsA 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.

Systematic literature review (3) PICOS Review questions/key words.Population: nursing students, medical students

or social work studentsIntervention: teach, learn, experience,

workbook, portfolio, lecture, simulation, demonstrate, observe, perform, reflect, train, educate, support or mentor.

Comparison: NoneOutcome: holistic, or person centred, or patient

centred or client centred, individual or psychosocial, comprehensive history taking or patient assessment with older people.

Systematic literature review (4) Inclusion/exclusion criteriaStudies: 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.

Systematic literature review (5) Inclusion/exclusion criteriaThere 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 / client’s 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.

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.

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 CINAHLReference lists of relevant articles and reviews

were also searched.

Literature review-objective 1(2) Key words: The literature was retrieved using the following

search terms: nursing student* or student nurse* in author’s 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.

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.

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.

Literature review-objective 1(5)Identification

Screening

Eligibility

Included

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.

Objective 3:

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

Literature review- objective 2+3(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 CINAHLReference lists of relevant articles and reviews

were also searched.

Literature review- objective 2+3(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: NoneOutcome: self-efficacy or competenc* or self

assess* or perform* or skill* or proficienc*.

Literature review- objective 2+3(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.

Literature review- objective 2+3(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

Literature review- objective 2+3(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.

Literature review- objective 2+3(6)Identification

Screening

Eligibility

Included

Study resultsObjective 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 2+3- The participants evaluated the workbook as useful for assisting with a patient assessment. The least liked aspect of the workbook was the reflection points.

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.

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.

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.

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.

Future research (4)Objectives 2+3 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.

Challenges of the study Time restriction due to academic requirementsEthical processLiterature searchesP/T study plus full time job = no life at times!Steep learning curveLack of confidence in abilitySmall sample

Survival! Do not underestimate how long it takesWide reading/focusFollow the guidelinesBreak down into manageable piecesSeek help- academic staff, librarians, SGCPeer/ family supportWork life balance GOOD LUCK!