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Developing a National Approach to Practice Assessment Documentation for the Pre-registration Nursing Programmes in Scotland
Developing a National Approach to Practice Assessment Documentation for the Pre-registration Nursing Programmes in Scotland
© NHS Education for Scotland 2011. You can copy or reproduce the information in this document for use within NHSScotland and for non-commercial educational purposes. Use of this document for commercial purposes is permitted only with the written permission of NES.
Designed in-house by the NES Corporate Communications team.
Contents
Foreword 03Introduction 04CorePracticeAssessmentDocumentation 06CoreComponentsofaNationalApproachtoPracticeAssessmentDocumentation 08ServiceUserandCarerInvolvementinPracticeAssessment 16GradingofPractice 17SupportingStudentswithDisabilitiesThroughAssessmentofProfessionalPractice 18References 20
Appendices:DeliveryGroupandShortLifeWorkingGroupInitiatives 21GroupMembership 22
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I am very pleased to provide the foreword to this national approach to practice assessment documentation for pre-registration nursing education in Scotland. Developing a consensus approach to the documents used to record practice learning and assessment is a major step forward for our students, mentors and university staff in reducing the range and complexity of documents used and fostering greater understanding and focus on the principles and values of the assessment process.
The guidance has been developed as part of the work of the ‘Delivery group for nursing and midwifery student recruitment and retention’ an investment by Scottish Government now led by NHS Education for Scotland (NES) which aims to improve student retention and provide a more positive assessment experience for pre-registration nursing students and their mentors.
The guidance was developed by a working group with representation from Scotland’s Universities and Colleges, and Practice Education Facilitators. It is informed by the findings from two commissioned literature reviews pertaining to key areas of practice assessment as well as analysis and peer review of existing assessment documents.
Included with this guidance will be core templates for practice assessment documents, as well as recommendations for programme providers in relation to issues such as service user involvement in student assessment and grading of practice.
ForewordRobust and informed practice based assessment is not only essential for the development of competent and confident practitioners but also for patient safety and quality of care delivery. Assessment of pre-registration nursing students involves a number of stakeholders including mentors, service users, other service staff and academic personnel within Scotland’s Universities and Colleges. It is hoped that this guidance will prove useful to all those involved. Whilst implementation of the recommendations should reflect the institutional context, we hope that all stakeholders will use this guidance to critically evaluate and develop their practice assessment processes.
The timing of this guidance coincides with implementation of the new NMC Standards for pre-registration nursing education (NMC 2010) and the development of new curricula in Scotland. It therefore provides a real opportunity for all stakeholders to adopt a collaborative and creative approach to curriculum development, particularly in relation to practice learning requirements. NES is committed to working alongside providers to support and enhance pre-registration education and I hope that this work will provide a further opportunity for stakeholders to shape the strategic direction and continue to work together to embed values based care at the heart of student assessment in all programmes across Scotland.
Dr Colette Ferguson,Associate Director of Nursing and Midwifery,NHS Education for Scotland
The guidance in this document relates to the implementation of core practice assessment documentation for the pre-registration nursing programmes in Scotland. The document focuses on the core elements of practice assessment and is intended to provide consistency in approach, support Programme Providers to make the best use of resources, and provide a more positive assessment experience for both students and mentors. The underlying principles and core components developed will inform the development of the ongoing achievement record (OAR) whilst continuing to support flexibility within individual institutions.
Backgroundandcontext
NHS Education for Scotland (NES) and the Scottish Government are committed to supporting the recruitment and retention of student nurses and midwives. In 2007 the Scottish Government Health Directorates (SGHD) published the Student Recruitment and Retention Report (SGHD, 2007a) which was followed by the establishment of a delivery group under joint Service / Universities chairmanship with wide stakeholder and partnership involvement. Five short life working groups formed to advance a number of initiatives to support the targeted outcomes of this report (Appendix 1). The practice learning short life working group, informed by three nationally funded
projects123, identified three broad programmes of work to be progressed under the headings of assessment, practice learning and mentor support.
Findings from the Evaluation of Fitness for Practice Pre-registration Nursing and Midwifery Curricula Project (Lauder et al, 2008) raised issues around student assessment of theory and practice, in particular the variability which exists across universities in relation to assessment processes and documentation. The diversity of assessment methods was reported as creating difficulties for supervising clinical staff and mentors. Some may be supporting and mentoring students from more than one university, each of which issues different assessment documents and defines different expected outcomes.
Whilst the notion of local flexibility in assessment has traditionally been viewed positively, in view of the evidence and discussions with stakeholders it would appear that the time is right to support and develop a national approach to student practice assessment documentation (NES, 2008a). By creating this kind of consistency, the practice learning experiences of high numbers of students may be enhanced; this consequently may have a positive impact on retention rates, and have a very positive impact on the workload of workplace mentors (NES, 2008a).
Additionally, work to develop a national approach
Introduction
to practice assessment in the mental health branch programmes was already being progressed by NES, on behalf of the SGHD, to support of the implementation of the National Framework for the Preregistration Mental Health Nursing Programmes in Scotland (NES & SGHD, 2008). This work was incorporated into the broader project, with the path finding work in mental health informing the overall project methodology.
Acollaborativeapproachtodevelopment
A national working group was established in May 2009 with representation from Scotland’s Universities and Colleges that deliver pre-registration nursing education, NHS Boards and NES.
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1 Lauder W et al (2008) Nursing and Midwifery in Scotland: Being Fit for Practice. The Report of the Evaluation of Fitness for Practice Pre-registration Nursing and Midwifery Curricula Project2 NHS Education for Scotland (2008) Nursing and Midwifery in Scotland: being fit for practice3 Carlise C et al (2008) Evaluation of the Practice Education Facilitator Project
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Over a series of planned events, the group worked collaboratively following a strengths based approach to review the current methods used by universities when documenting assessment of practice in pre-registration nursing programmes in Scotland. Using a strengths based approach allowed acknowledgement of current practices and systems within each university, a process which acknowledged and welcomed strengths of institutional diversity. In doing so, the group agreed that harmonisation was not inconsistent with academic freedom or distinctiveness. Furthermore, rationalisation and alignment of practice assessment documentation was considered achievable without compromising institutional autonomy. A shared space community was established to support work outside of the national working group meetings.
Following a thematic analysis of the identified strengths, agreement was reached on core components of the practice assessment process, with flexible elements identified where consensus could not be reached. This allowed for a set of principles to be developed that support a national common approach to practice assessment documentation.
During the course of this process, other issues associated with practice assessment emerged that the group felt warranted further exploration. As such, NES commissioned two literature reviews to explore issues in the use of grading of practice, and service user and carer involvement in practice assessment. A workshop was also conducted by NES’ Equality and Diversity Advisor with a focus on supporting students with disabilities in practice. Recommendations arising from these three additional pieces of work are summarised within this document for information.
Date Activity Purpose
May 2009 National working group meeting
• Introduce and discuss the context of the project• Consideration of the associated evidence base• Consideration of phase 2 Nursing and Midwifery Council
(NMC) review of pre-registration nursing education, and the implications for this project
• Agree parameters for the working group• Forward plan and agree next stages
September 2009
National working group meeting
• Review existing documentation and share examples of good practice, identifying emerging themes and issues
• Agree parameters for a national approach to practice assessment documentation
• Discuss findings of grading of practice literature review• Forward plan and agree next stages
February 2010
National working group meeting
• Thematic analysis of strengths based approach, and agreement on core and flexible elements of practice assessment documents
• Discuss findings of service user and carer involvement in practice assessment literature review
• Equality and diversity workshop – implications for practice assessment
• NMC Review of pre-registration nursing education consultation – implications for practice learning and practice assessment
• Consideration of framework document and draft documentation.
• Establish writing group to progress documents
April 2010 National working group meeting
• Review work to date from earlier meetings• Further develop core practice assessment documentation• Consider principles for core practice assessment
documentation• Consider recommendations from literature reviews and equality
and diversity workshop
Nationalworkinggroupactivitytimeframe
The development of core practice assessment documentation is designed to facilitate consistency in the approaches taken to practice assessment in the pre-registration nursing programmes in Scotland through providing common core documentation for use in all practice settings. Furthermore, this may assist universities and their service partners in making the best use of resources and provide a more positive assessment experience for both students and mentors.
The NMC introduced the concept of an ongoing achievement record (OAR) as a vehicle for ensuring that feedback and incremental assessment across different periods of practice learning is collated and shared between those involved in supporting and assessing pre-registration students (NMC, 2008; NMC, 2010). The OAR is an important tool in presenting an overall picture of student achievement of programme requirements at progression points and at the end of the programme (NMC, 2010). This evidence is of particular importance where there are developmental needs or areas of concern which need to be addressed promptly or over time (NMC, 2010). Effective use of the OAR is fundamental to maintaining continuity of practice assessment in pre-registration programmes (NMC, 2010).
The underlying principles of the core practice assessment documentation will inform the consistent development of the ongoing
achievement record as a system of record keeping that documents students’ progress, achievements, areas for development and any issues of concern. The principles continue to support flexibility within individual institutions where appropriate; where national consistency could not be achieved, recommendations have been made based on the best available evidence.
Underlyingprinciples
The working group adopted a strengths based approach to review current practice assessment documents in each university. Following thematic analysis of these strengths, the group reached consensus on the core components required of practice assessment documents. This allowed for a set of underlying principles that support a national common approach to practice assessment documentation to be developed:
• The ongoing achievement record (OAR) will be structured as a single document.
• The OAR will be structured to avoid unnecessary duplication of information that is readily available via other resources, instead it will signpost appropriately.
• Core components are intended to provide national consistency in relation to the content, language / terminology and presentation of practice assessment documents, providing a more positive assessment experience for mentors and students.
CorePracticeAssessmentDocumentation
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In addition to the core components identified, it was agreed that the OAR would also include an introductory section containing the following information:
• An outline of the overall document structure• Guidance for continuous assessment methods
used in the pre-registration programmes, including guidance for making reasonable adjustments in practice
• Methods of recording student’s achievement of competencies
• Cause for concern processes• Accident / incident reporting procedures,
and how this information is shared between placement providers and the university
• Brief programme outline, for example a diagrammatic representation of theory and practice
• Links to other relevant resources and contacts, for example, university website, mentor centre, practice education resources
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Core component PurposeRecord of signatories • Facilitates readability of signatures and provides a comparison for documented
signatures• Allows an at-a-glance summary of mentors and others contributing to the practice
assessment process during student learning experiencesPractice learning experience information
• Provides a concise and current summary of information relevant to the practice learning experience
Induction to practice learning environment
• Orientates student to their practice learning environment, ensuring appropriate areas of governance are addressed
• Welcomes and supports the student in practiceLearning development plan
• Supports mentor and student to jointly review ongoing achievement record to date• Supports discussion of strengths and areas for consolidation and further
development• Supports discussion of relevant learning opportunities available to the student• Supports discussion of any additional student support requirements• Develops an outline plan for the practice learning experience
Interim review(s) and review of progress
• Supports mentor and student to jointly consider and record evidence of progress to date
• Supports review of the student’s strengths and areas for consolidation and further development
• Records any areas of concern raised by student or mentorFinal interview and assessment of performance
• Supports mentor and student in jointly reviewing the practice learning experience• Allows evaluation of evidence of achievement of NMC competencies in line with
learning development plan• Records mentor decisions regarding achievement of NMC competencies• Records future development needs of the student
Additional records • Records additional information relevant to the student’s learning experiences during practice, for example a link lecturer visit, or comments from a service user contributing to the assessment process
Attendance record • Provides accurate activity analysis of the practice learning experience, and demonstrates compliance with NMC requirement of a minimum 40% student/mentor working
Mandatory training record
• Ensures appropriate governance of a student’s practice during their practice learning experience
Cause for concern • A positive and supportive process providing a mechanism for students and mentors to raise concerns that may occur during the practice learning experience
Corecomponentsofanationalapproachtopracticeassessmentdocumentation
Each core component is presented, in terms of its purpose and content, to facilitate national consistency in practice assessment documentation. Templates for each document will be provided. The core components have been mapped, where possible, to demonstrate links to the Quality Standards for Practice Placements (NES, 2008b) and NMC Standards for pre-registration nursing education (NMC, 2010). Components that are not mapped to these two documents were identified by the working group during the strengths based review as good practice and considered appropriate to be incorporated nationally.
In addition to the core components identified, it was agreed that each university’s OAR would include an introductory section containing the following information:
• An outline of the overall document structure• Guidance for continuous assessment methods
used in the pre-registration programmes, including guidance for making reasonable adjustments in practice
• Methods of recording student’s achievement of competencies
• Cause for concern processes• Accident / incident reporting procedures,
and how this information is shared between placement providers and the university
• Brief programme outline, for example a diagrammatic representation of theory and practice
• Links to other relevant resources and contacts, for example, university website, mentor centre, practice education resources
CoreComponentsofaNationalApproachtoPracticeAssessmentDocumentation
Core Component Purpose
Links to NES Quality Standards for Practice Placements
Links to NMC Standards for Pre-registration Nursing Education
Record of signatories
• Facilitates readability of signatures and provides a comparison for documented signatures
• Allows an at-a-glance summary of mentors and others contributing to the practice assessment process during student learning experiences
A Record of signatories involved in supporting and assessing the student throughout their practice learning experiences. This should contain a sample full and abbreviated signature from relevant people involved in the assessment process. This may include service users and other professional colleagues.
Required information:• Print full name• Signature (full and abbreviated)• Designation / capacity• Practice learning experience location• Date
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Induction to practice learning environment should be completed with student at the beginning of each period of practice learning, addressing the following points and with particular emphasis on their own and others’ safety:
• Introduction to staff, including identification of named mentor• Geographical layout of area • Fire, health and safety procedures • Environmental and personal risk assessment (e.g. infection control, lone working, pregnancy, allergens, deployment of young people under 18) • Emergency procedures and equipment • Client confidentiality and disclosure policies• Professional behaviour (e.g. dress code, time keeping, mobile phone usage, social networking, NMC guidance for students) • Shift patterns and meal breaks / facilities • Sickness / absence reporting procedure• Accident / incident reporting procedures and systems• Specific policies and legal frameworks relevant to area (e.g. infection control, moving and handling, any field specific example)• Review student’s mandatory training record• Procedure for receiving and referring messages and enquiries
Core Component Purpose Links to NES Quality Standards for Practice Placements
Links to NMC Standards for Pre-registration Nursing Education
Practice learningexperience information
• Provides a concise and current summary of information relevant to the practice learning experience
1.4, 1.11
2.11
Practice learning experience information is to be available at the start of each placement section and be completed by student and mentor.
Required information:• Practice learning experience location• Dates of practice learning experience (duration / length)• Stage of experience in relation to overall programme and in relation to progression points• Student identification • Associated PEF contact for this practice learning experience• Associated university contact for this practice learning experience (e.g. personal tutor, module co-ordinator, link lecturer)• Named mentor(s)• Detail of accreditation if appropriate
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Core Component Purpose Links to NES Quality Standards for Practice Placements
Links to NMC Standards for Pre-registration Nursing Education
Induction to practice learning environment
• Orientates students to their practice learning environment, ensuring appropriate areas of governance are addressed
• Welcomes and supports students in practice
1.4, 1.6
2.9
Interim review(s) and review of progress occurs at least once, midway through the practice learning experience. Additional reviews can be held and recorded as required.
The review should be a joint process between student and mentor, where they consider and record evidence of progress to date, including strengths, areas for development, areas of concern if appropriate, and agreed actions.
The mentor should provide guidance and constructive feedback on the student’s performance and progress.
The summary of discussion should record the main elements of the review, which should then be reflected appropriately in the action points.Action points should be time limited and identify who is responsible for the action.
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Core Component Purpose Links to NES Quality Standards for Practice Placements
Links to NMC Standards for Pre-registration Nursing Education
Learning development plan
• Supports mentor and student to jointly review ongoing achievement record to date
• Supports discussion of strengths and areas for consolidation and further development
• Supports discussion of relevant learning opportunities available to the student
• Supports discussion of any additional student support requirements
• Develops an outline plan for the practice learning experience
1.4, 1.5, 1.6, 1.7, 1.10, 1.12, 1.13
2.2, 2.3, 2.4, 2.9
4.7
R2.2, G2.2a
G4.1.1
R5.4, G5.4, R5.5
R8.2.3
A Learning development plan should be developed jointly by the student and mentor following discussion around the following areas:• Review ongoing achievement record to date• Identification of strengths and areas for development• Discuss expectations of student and mentor during practice learning experience, including relevant learning opportunities for stage of programme• Discuss and record any additional student support requirements for achievement of relevant NMC competencies • Include space for summary of discussion and formulation of action points• Agree processes for ongoing constructive feedback, including mid and final assessments
The summary of discussion should record the main elements of the review, which should then be reflected appropriately in the action points. Action points should be time limited and identify who is responsible for the action.
Core Component Purpose Links to NES Quality Standards for Practice Placements
Links to NMC Standards for Pre-registration Nursing Education
Interim review(s) and review of progress
• Supports mentor and student to jointly consider and record evidence of progress to date
• Supports review of student’s strengths and areas for consolidation and further development
• Address any areas of concern raised by student or mentor
1.4, 1.6, 1.7, 1.8, 1.9, 1.10, 1.13, 1.14
2.2, 2.3, 2.4, 2.5, 2.10
4.2, 4.7
G5.4, R5.5
R8.2.3, G8.2.3a, G8.2.3b
Core Component Purpose Links to NES Quality Standards for Practice Placements
Links to NMC Standards for Pre-registration Nursing Education
Final interview and assessment of performance
• Supports mentor and student in jointly reviewing the practice learning experience
• Allows evaluation of evidence of achievement of NMC competencies in line with learning development plan
• Records mentor decisions regarding achievement of NMC competencies
• Records future development needs of student
1.4, 1.6, 1.7, 1.8, 1.9, 1.10, 1.13, 1.14
2.2, 2.3, 2.4, 2.5, 2.10
4.2, 4.7
R8.2.3, R8.2.4, G8.2.4
Final interview and assessment of performance is conducted through a joint mentor and student review of the practice learning experience.The following areas should be discussed and recorded:
• Evaluation of evidence of achievement of NMC competencies in line with the learning development plan• Mentor decision regarding achievement of required NMC competencies (including progression point criteria if appropriate)• Mentor summary which should reflect all aspects of student performance throughout the practice learning experience, and include an
opportunity for the student to comment • Future development needs of student
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Additional records should be used where additional meetings have occurred relevant to the student’s learning experience during practice. This may include link lecturer visits, interprofessional learning opportunities, or contributions from service users / carers to the assessment process. Please ensure that anyone writing these records also signs the record of signatories.
These records should not be used to record cause for concerns; specific cause for concern documentation should be used for these purposes.
Core Component Purpose Links to NES Quality Standards for Practice Placements
Links to NMC Standards for Pre-registration Nursing Education
Additional records • Records additional information relevant to the student’s learning experiences during practice, for example a link lecturer visit, or comments from a service user contributing to the assessment process
1.9 R8.2.3, G8.2.3a, G8.2.3b
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Core Component Purpose Links to NES Quality Standards for Practice Placements
Links to NMC Standards for Pre-registration Nursing Education
Attendance record • Provides accurate activity analysis of the practice learning experience, and demonstrates compliance with NMC requirement of a minimum 40% student/mentor working
1.6, 1.13
4.6, 4.7
R4.2.1, R4.6, R4.6.1
R5.2.4
R6.5.3, G6.5.3
Attendance record should be completed, verified and signed by the practice learning area. The following information should be recorded:• Student name, identification and intake• Practice learning experience location• Stage of experience in relation to overall programme• Hours per day and per week (present/absent/sick)• Weekly total of hours• Final total of hours• Total absence / sick time / pattern• Identification of mentor contact ratio in order to evidence requirements of NMC Standards to support learning and assessment in practice (NMC, 2008)
Abbreviations for completion:P = Present (hours) M = Mentor (min 40% of time) U = University / College S = Sick A = Absent (not sick) DO = Day Off N = Nightshift (hours) C = Compassionate Leave T = Time Made Up
Attendance record should be verified each week by the practice learning area, with university staff verifying ‘University’ days.
Universities should have the means of recording accredited simulated practice learning that contributes to overall practice learning experience hours.Please note, students are supernumerary during all practice learning experiences.
Core Component Purpose Links to NES Quality Standards for Practice Placements
Links to NMC Standards for Pre-registration Nursing Education
Mandatory training record
• Ensures appropriate governance of student’s practice during their practice learning experience
1.12, 1.13
4.2, 4.4
G5.3.8d
A Mandatory training record, completed / undertaken during each stage of the pre-registration programme and including any field specific topics, should be available within the OAR. The mandatory training record should cover health and safety training, and clinical skills training, for example moving and handling, fire safety, therapeutic management of violence and aggression, cleanliness champions, basic life support, numeracy.
Indicative content of training for each stage of programme should be included. A university departmental signature must be obtained on completion of each session.
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Core Component Purpose Links to NES Quality Standards for Practice Placements
Links to NMC Standards for Pre-registration Nursing Education
Cause for concern • A positive and supportive process providing a mechanism for students and mentors to raise concerns that may occur during the practice learning experience
1.4, 1.6, 1.8, 1.9, 1.10, 1.11, 1.13, 1.14
2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.11
3.4, 3.5
4.2, 4.5, 4.6, 4.7
R1.3, R1.4, R1.4.1
G5.3.8d
Cause for concern processes and documents should be available within the OAR. Equality and diversity matters should be considered at each stage, and consulted upon as appropriate. Key information should be provided with signposting to additional sources of information as appropriate, for example the university website.
Processes and documents should include:• A supportive statement briefly outlining the process• A user friendly flowchart outlining key stages of process for students and/or mentors to raise concerns, including outcomes and governance processes for
example Fitness for Practice referral• A recommendation of a tripartite approach, including a summary of roles and responsibilities of relevant people involved and governance mechanisms for
updating and reporting to service partners• Action plan outlining the issues to be addressed, actions to be taken, reviews and timescales for achievement• A record of final outcome, actions and feedback
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This information, based on the findings of a NES commissioned literature review, is provided as guidance to Programme Providers in Scotland to facilitate meaningful engagement in planning service user and carer involvement in the assessment of student’s practice in their pre-registration nursing programmes and should be read in conjunction with the final report of the literature review.
The involvement of carers and service users is at the heart of the Scottish health care policy, Better Health, Better Care (SGHD, 2007b). In order to inform the development of a national approach to practice assessment documentation for the pre-registration nursing programmes in Scotland, NHS Education for Scotland commissioned a literature review exploring issues of service user and carer involvement in the assessment of students’ practice.
The review, which spanned a wide range of professional and lay groups, was carried out by Edinburgh Napier University with the purpose of exploring:
• What methodologies are used when service users and carers are involved in the assessment of students’ practice?
• What are the challenges, opportunities and limitations when service users are involved in the assessment of students’ practice?
• What is the nature of the impact of the above on students, service users and carers?
• What are the issues related to reliability, quality and context of assessment when involving service users and carers?
• What are the implications for preparation and support of service users and carers in the assessment of students’ practice?
The following recommendations, based on the findings of the literature review, are provided as guidance to Programme Providers in Scotland to facilitate meaningful engagement in planning service user and carer involvement in the assessment of student’s practice in their pre-registration nursing programmes.
• Consider referring to service user and carer assessment of students’ practice as reviewing rather than assessing, so as to minimise student complaints of feeling disempowered and rejecting the feedback.
• Provide service users and carers with written information that can be read and retained for future information, including the reason for seeking feedback, how it will be used, how long any forms or recordings will be kept, and confidentiality in terms of the feedback.
• Service user and carer feedback should be used to enhance the learning experience and should be mandatory in all practice assessments.
• The selection of the service user / carer from which the feedback will be elicited should be a joint process between the mentor and the student and not the student’s selection alone.
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ServiceUserandCarerInvolvementinPracticeAssessment• Informal processes such as witness
statements, reflective writing and other portfolio items should be used to elicit service user / carer feedback. This will minimise the requirement for more planned training in forming and giving feedback, which may also require mentor involvement to aid the feedback process.
The consensus within the literature is to involve service users and carers in the formative assessment (or review) of students in the practice setting. The use of protocols and structured easily understood and implemented tools are recommended as is the inclusive and appropriate level of engagement training for all stakeholders involved in the process.
The final report of the literature review can be accessed at:Exploring Service User and Carer Involvement Volume 1
and associated appendices accessed at:Exploring Service User and Carer Involvement Volume 2
Additionally, the NMC have issued guidance on service users’ and carers’ contribution to the assessment process which outlines a number of considerations that should be made and offers examples of innovative ways programme providers can enable service users and carers to make an effective contribution to the assessment of students (NMC, 2010).
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This information, based on the findings of a NES commissioned literature review, is provided as guidance to universities in Scotland and should be read in conjunction with the final report of the literature review.
Grading practice reflects the conclusion of a decision making process which indicates how well a student is progressing in respect to a standard or criteria and flags up areas where students can improve. NHS Education for Scotland commissioned a literature / evidence review aimed to inform the development of a National Approach to Practice Assessment documentation for the Preregistration Nursing programmes in Scotland.
The review, which spanned fourteen professional groups, was carried out by Edinburgh Napier University with the purpose of exploring:
• What are the issues in grading of professional practice?
• What are the issues related to reliability and validity in grading of professional practice?
• What are the implications for mentor preparation and support in respect to grading of professional practice?
There are a number of documented challenges within the literature, some of which are not specific to grading practice e.g. consistency of assessors’ judgements. Those which are specific relate to validity and reliability issues of the tools used and grade inflation. Various grading tools or systems are presented in the literature; however evaluation
of these tools is under-developed in terms of their effectiveness, usefulness, reliability and validity. Grade inflation is well documented and, whilst there are some suggested methods to control this, these are not fully evaluated.
The level of evidence presented on grading of clinical practice across the literature leans towards the lower end of the evidence band, i.e. the usefulness, reliability, validity and effectiveness of grading of practice has still to be proven.
Recommendations, based on the findings of the review, are provided as guidance to universities in Scotland in relation to grading of practice in their pre-registration nursing programmes. Where grading of practice is being considered, the following points need to be addressed:
• Robust development and testing of the use of rubrics (formatively and summatively)
• Use of a multi-method approach to assessment
• Comprehensive and focused training and updating of mentors
• Ongoing evaluation and monitoring of the grading process used
• Acknowledgement of the significant resource implications for universities and placement providers.
The final report can be accessed at:Grading in Practice Volume 1
GradingofPracticeand associated appendices accessed at:Grading in Practice Volume 2
Adapted from Advice and supporting information for implementing NMC Standards for pre-registration nursing education (NMC, 2011)
Supportingstudentswithdiverseneeds
The NMC Standards for pre-registration nursing education require nursing students with diverse needs to be supported appropriately in both practice and academic environments. This means that their needs are assessed and responded to in a timely and appropriate manner. It is important to stress that although programme providers need to support nursing students and meet their diverse needs, it may not be possible to meet all their needs. The Standards stress the importance of recognising where support would be inappropriate, or where a diversity issue might interfere with the delivery of safe, competent nursing care. It is also important to remember that, by law, reasonable adjustments need only be applied to people with disabilities and not to people with other diverse needs. Programme providers will want to support all students with a wide range of learning needs, but they should remember that it is against the law to treat one student more favourably than another unless the reason relates to a disability.
Disability,reasonableadjustmentsandgoodhealth
The Equality Act 2010 states that students with disabilities are entitled to reasonable adjustments. Guidance for this explains that the duty to make reasonable adjustments is triggered when a person with a disability is put at a disadvantage.
Failure to comply with this duty cannot be justified. Disadvantage in this case will not be defined as ‘minor or trivial’.
There are three aspects to be considered in relation to the ‘duty’ to make reasonable adjustments. These include: changing a provision, criterion or practice; avoiding the disadvantage caused by a physical feature or obstacle (such as removing, altering or avoiding the item); and providing an auxiliary aid or service. More information is available from Skill: National Bureau for Students with Disabilities
Howtodecidewhatisreasonable?
Programme providers are not expected to make adjustments which are unreasonable. When considering whether an adjustment is reasonable or not, the Equality and Human Rights Commission suggest that the following are considered:
• The cost of the adjustment• Its effectiveness• The practicality of making it• The appropriateness of making the
adjustments• Its effect on others, whether colleagues or
patients, as well as the person with disabilities• Health and safety concerns
Public safety, the health and safety of patients and colleagues and the rights of the patient or service user to receive competent quality care must always come first when considering if an adjustment is reasonable. Programme providers are encouraged to work closely with disability
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SupportingStudentswithDisabilitiesThroughAssessmentofProfessionalPracticeservices and to be creative in the ways in which programmes can be delivered and competencies met. Students with disabilities are entitled to have reasonable adjustments considered in relation to their academic work and their practice learning. However, while reasonable adjustments may be made to the way that a student meets a competency or standard, the competency or standard itself cannot be adjusted.
There will be occasions when an adjustment is not reasonable and this could result in the student not being able to meet the requirements to qualify and register as a nurse. For this reason it is advised that the student’s needs are considered as soon as possible, involving the student and the expertise of disability service teams and advisors, to explore different types of adjustments and how they might best be applied. If a solution cannot be found then the disability services team (or other support services) might help the student find other options available to them, including looking at alternative careers.
PracticelearningenvironmentsUniversities are required to find practice learning environments that give students with disabilities the best chance of showing how they meet NMC standards. Organisations that provide practice learning experiences also have a direct duty not to discriminate against people with disabilities under the Equality Act 2010.
To make sure that the rights of students with disabilities are protected, it is recommended that universities give specific information to
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their placement providers about supporting these students. This may include information about supporting students with disabilities being incorporated in mentor preparation programmes, or processes to find specific placements which meet the needs of individual students.
To ensure that responsibilities under the Equality Act 2010 are met, it is strongly recommended that a record is kept of the decision-making process relating to individual students, including the people whose opinions and advice were sought and the reasons for any decisions made. Students can be asked to sign and verify that the information written down is correct, whether they are happy for it to be passed on, to whom and for what purpose. Once a record has been made, this information must be kept confidential. By keeping this information, relevant individuals will be able to refer to the process and the information received if questioned about any of the decisions.
When making reasonable adjustments in practice, these must be clearly documented in the assessment process as part of a transparent assessment. Therefore, within the documentation, it is necessary to:
• Outline the timeframes for achieving / implementing reasonable adjustments
• Record the adjustment made rather than the impairment, especially if this is necessary to achieve the competency
• Record compliance / non-compliance with the adjustment
• If relevant, document why the adjustment
cannot be made (for example, risk of compromising patient safety, level of impact on staff)
Equalityanddiversityrelatedtopracticelearningopportunities
Central to the standards is the need for nursing students to learn in community and other non-traditional settings as services are reconfigured. This will give students experience of diverse communities that are different from theirs. It will help them understand and learn about cultural and social diversity in its broadest sense. This is not just about experiencing different racial groups and cultures, although this is important, but also relates to exposure to other elements of diversity such as: gender, disability, religion, age and sexual orientation in local communities. Identifying suitable learning opportunities can be challenging. Issues such as cost, geographical location, access to public transport and safety need to be considered for all students, but may cause particular problems for students with disabilities.
Linkstofurtherinformation
Advice and supporting information for implementing NMC standards for pre-registration nursing education
NMC Good Health and Good Character: Guidance for approved education institutions
ReferencesCarlisle C Calman L Ibbotson T (2008) Evaluation of the Practice Education Facilitator Project [Online] Available: http://www.nes.scot.nhs.uk/media/3783/190908evaluation_of_pef_project_final_feb2008.pdf [Accessed 3 May 2011]
Equality Act 2010 2010 Chapter 15 [Online] Available: http://www.opsi.gov.uk/acts/acts2010/pdf/ukpga_20100015_en.pdf [Accessed 3 May 2011]
Lauder W Roxburgh M Holland K Johnson M Watson R Porter M Topping K Behr A (2008) Nursing and Midwifery in Scotland: Being Fit for Practice The Report of the Evaluation of Fitness for Practice Pre-registration Nursing and Midwifery Curricula Project [Online] Available: http://www.nes.scot.nhs.uk/media/6962/ffpfinalreportsept082.pdf [Accessed 3 May 2011]
NHS Education for Scotland (2008a) Nursing and Midwifery in Scotland: being fit for practice [Online] Available: http://www.nes.scot.nhs.uk/media/6963/nesffpresponse_08.pdf [Accessed 3 May 2011]
NHS Education for Scotland (2008b) Quality Standards for Practice Placements [Online] Available: http://www.nes.scot.nhs.uk/media/7005/qspp_leaflet.pdf [Accessed 3 May 2011]
NHS Education for Scotland and Scottish Government Health Directorates (2008) The National Framework for the Pre-registration Mental Health Nursing Programmes in Scotland [Online] Available: http://www.nes.scot.nhs.uk/media/5853/preregframework.pdf [Accessed 3 May 2011]
Nursing and Midwifery Council (2008) Standards to support learning and assessment in practice [Online] Available: http://www.nmc-uk.org/Documents/Standards/nmcStandardsToSupportLearningAndAssessmentInPractice.pdf [Accessed 3 May 2011]
Nursing and Midwifery Council (2010) Standards for pre-registration nursing education [Online] Available: http://standards.nmc-uk.org/PreRegNursing/statutory/Standards/Pages/Standards.aspx [Accessed 3 May 2011]
Nursing and Midwifery Council (2011) Advice and supporting information for implementing NMC standards for pre-registration nursing education [Online] Available: http://standards.nmc-uk.org/PreRegNursing/non-statutory/Documents/Advice%20and%20supporting%20information%20for%20SPNE%2020110325.PDF [Accessed 3 May 2011]
Scottish Government Health Directorates (2007a) ‘Recruitment and Retention’ Report of the ‘Facing the Future’ Sub-Group and Working Groups [Online] Available: http://www.scotland.gov.uk/Resource/Doc/924/0054997.pdf [Accessed 3 May 2011]
Scottish Government Health Directorates (2007b) Better Health Better Care: Planning Tomorrow’s Workforce Today [Online] Available: http://www.scotland.gov.uk/Resource/Doc/206845/0054945.pdf [Accessed 3 May 2011]
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Appendix1:RecruitmentandRetentionDeliveryGroupandShortLifeWorkingGroupInitiatives
Universities & Colleges Government NHS Boards
Delivery Group NES
Data Enhancement Recruitment & Selection
Retention Practice Learning Careers & Image Other
Consistent and enhanced N & M student dataset,
Links to HESA and ISD data.
Data Set development and links to Non-NHS
sector
Best Practice Guidance
Pupil access to healthcare project
SchoolsEngagement
R & S Development support
Interviewing impact research
Pastoral Support
Student review record
KELPIE - absence management
Leave of Absence review
National strategy for practice placement
National approach to assessment documentation
New approaches to placement provision
PEF support to Learning in Care
Homes
Web repository of resources for
Mentors / educators
National approach to assessment documentation
Development of national N & M Careers web
resource
Materials support to Universities,
Careers Service, stakeholders
National approach to student
engagement
Distributed Programme model -
LD Pilot
Evaluation
Dissemination
References
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Practice Learning Short Life Working Group
Michael Brown Nurse Consultant, NHS LothianIain Burns Head of Practice and Professional Development Unit, NHS FifeStuart Cable Director - Scottish Common Core Curriculum (ScCore) Project, Queen Margaret UniversityJayne Donaldson Head of School (Nursing, Midwifery and Social Care), Edinburgh Napier UniversityKathy Duffy Senior Lecturer, Glasgow Caledonian UniversityColette Ferguson Associate Director of Nursing and Midwifery, NESSusanne Forrest Programme Director, NESDenise Gray Educational Projects Manager, NESVikki Melaragni Project Leader, NESJames Myles Practice Education Facilitator, NHS Wester IslesIrene Niven Practice Education Facilitator, NHS LothianSusan Polding-Clyde Nurse Consutant, Care CommissionMike Sabin Programme Director, NESGill Smith Practice Education Facilitator Team Leader, NHS TaysideLesley Whyte Programme Director, NESAlice Wilson Associate Nurse Director, NHS Dumfries and Galloway
National Approach to Practice Assessment Working Group
Claudette Comeramasy Undergraduate Programme Director, University of GlasgowSue Cowan Lecturer, University of AbertayPam Dixon Curriculum Leader, Jewel & Esk Valley CollegeFiona Doherty Practice Placement Co-ordinator, University of StirlingKaren Drew Practice Education Facilitator, NHS TaysideKathy Duffy Senior Lecturer, Glasgow Caledonian UniversityMarie Elen Lecturer, Edinburgh Napier UniverstiySusanne Forrest Programme Director, NHS Education for ScotlandCaroline Gibson Lecturer, Queen Margaret UniversityBrian Gordon Personal and Professional Development Advisor, University of DundeeDenise Gray Educational Projects Manager, NHS Education for ScotlandAnn Grodzicka Lecturer, University of AbertayLiz Hastie Lecturer, Glasgow Caledonian UniversityFiona Jean Howson Programme Leader (Adult), Edinburgh Napier UniversityIrene Jones Senior Lecturer, Glasgow Caledonian UniversityMhairi Kidd Senior Lecturer / Programme Leader, University of the West of ScotlandLin McDonagh Assistant Head of Department (Nursing), The Open UniversityAlison McLennan Senior Lecturer, Robert Gordon UniversitySandra Macfarlane Practice Placement Co-ordinator, University of StirlingVikki Melaragni Project Leader, NHS Education for ScotlandLucie Page Practice Education Facilitator, NHS BordersAnn Payne Programme Manager (Mental Health), University of DundeeHelen Riddell Lecturer, Queen Margaret UniversityEileen Salmon Practice Education Facilitator, NHS Greater Glasgow & ClydeJulia Scott Director of Learning, Teaching and Quality Enhancement, University of StirlingAnnetta Smith Associate Head of Department, University of StirlingJenni Tocher Lecturer, University of EdinburghAlison Toner Lecturer in Mental Health Nursing, University of the West of ScotlandElaine Walker Staff Tutor (Nursing), The Open University in Scotland
Appendix2:GroupMembership
Developing a National Approach to Practice Assessment Documentation for the Pre-registration Nursing Programmes in Scotland
Published May 2011
NHS Education for ScotlandThistle House91 Haymarket TerraceEdinburgh EH12 5HDtel: 0131 313 8060www.nes.scot.nhs.uk
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