Assessing students' clinical performance

Pharmacy Students' Perceptions of Reflective Portfolios and their Effect on Students' Deep Information-Processing Skills

Objective. To evaluate pharmacy students' perceptions of the educational value of reflective portfolio and to gain an understanding of the factors that might influence these perceptions. Methods. Bachelor of Pharmacy (BPharm) students' perceptions of using reflective portfolios were evaluated by administering the same questionnaire at the beginning of years 2, 3 and 4 of the curriculum. Statistical analysis was carried out to determine the differences among the perception scores of different academic years. Semi-structured interviews were completed with fourth-year students to further explore their experiences with the reflective portfolio. Students' deep information processing (DIP) skills were compared with those of students from another pharmacy cohort whose curriculum did not include a reflective portfolio. Results. The students' perceptions of the reflective portfolio improved significantly as they progressed from year 2 to year 4 of the curriculum. The factors that contributed to a positive experience were a clear understanding of objectives and guidelines for the reflective portfolio, useful mentor feedback, a positive learning attitude and motivation, and having a user-friendly technology platform for submission of the portfolio. The students' DIP skills after completing the reflective portfolio were higher than those of students who did not have a reflective portfolio assignment in their curriculum. Conclusion. Pharmacy students' appreciation of the educational value of a reflective portfolio increased as they progressed to their final year, and their DIP skills improved. These findings support the use of a reflective portfolio as a learning tool for BPharm students' personal and professional development.

Summative assessment of clinical practice of student nurses: A review of the literature

OBJECTIVES

To provide an overview of summative assessment of student nurses' practice currently in use.

DESIGN

Narrative review and synthesis of qualitative and quantitative studies.

DATA SOURCES

With the support of an information specialist, the data were collected from scientific databases which included CINAHL, PubMed, Medic, ISI Web of Science, Cochrane library and ERIC published from January 2000 to May 2014. Sources used in all of the included studies were also reviewed.

REVIEW METHODS

725 articles concerned with student nurse clinical practice assessment were identified. After inclusion and exclusion criteria, 23 articles were selected for critical review.

RESULTS

Findings suggest that the assessment process of student nurses' clinical practice lacks consistency. It is open to the subjective bias of the assessor, and the quality of assessment varies greatly. Student nurses' clinical assessment was divided into 3 themes: acts performed before final assessment, the actual final assessment situation and the acts after the final assessment situation. Mentors and students need teachers to provide them with an orientation to the assessment process and the paperwork. Terminology on evaluation forms is sometimes so difficult to grasp that the mentors did not understand what they mean. There is no consensus about written assignments' ability to describe the students' skills. Mentors have timing problems to ensure relevant assessment of student nurses. At the final interview students normally self-assess their performance; the mentor assesses by interview and by written assignments whether the student has achieved the criteria, and the role of the teacher is to support the mentor and the student in appropriate assessment. The variety of patient treatment environments in which student nurses perform their clinical practice periods is challenging also for the assessment of student nurses' expertise.

CONCLUSIONS

Mentors want clinical practice to be a positive experience for student nurses and it might lead mentors to give higher grades than what student nurses in fact deserve. It is very rare that student nurses fail their clinical practice. If the student nurse does not achieve the clinical competencies they are allowed to have extra time in clinical areas until they will be assessed as competent. Further research needs to be carried out to have more knowledge about the final assessment in the end of clinical practice. Through further research it will be possible to have better methods for high quality assessment processes and feedback to student nurses. Quality in assessment improves patient safety.

The who and where of clinical skills teaching: a review from the UK perspective

Over the years, the debate on clinical skill acquisition in Nursing is one that has been subject to constant scrutiny within educational settings, locally and globally. Indeed, the Nursing and Midwifery Council (NMC) have endeavoured to provide some clarity with the publication of the Essential Skills Cluster statements [NMC, 2006. Advance Information Regarding Essential Skill Clusters for Preregistration Nursing Programmes (NMC Circular 35/2006). NMC, London] and the recently updated Standards to Support Learning and Assessment in Practice [NMC, 2008. Standards to Support Learning and Assessment in Practice: NMC Standards for Mentors, Practice Teachers and Teachers, second ed. NMC, London]. In this paper, we seek to provide a review of the evidence and debate produced thus far surrounding skills acquisition in general and the role of the nurse lecturer in particular from a UK perspective.

Using portfolios for clinical practice learning and assessment: the pre-registration nursing student's perspective

Portfolios have been introduced to help to integrate theory and practice and thereby address the issue of the theory-practice divide. Although there has been much theoretical discussion about portfolio use in clinical placements, few studies have focused on the students' perceptions regarding their use. To obtain adult branch pre-registration nursing students' perspectives on using portfolios for their clinical practice learning and assessment, postal questionnaires were sent to 253 diploma of nursing students with a reminder to all students three weeks later. The response rate was 69% (174/253). This paper reports on the qualitative findings of the study, which employed both quantitative and qualitative methods. Although students stated that portfolios helped them in their development of self-awareness and independent learning, they indicated that portfolios do not sufficiently address the assessment of their clinical skills and the integration of theory and practice. They considered that portfolios could be greatly improved in three areas, namely in the conflict between using portfolios for both assessment and learning, the amount of support and guidance students feel they receive with their portfolio use and the portfolio design.

Assessing undergraduate nursing students in clinical practice: do preceptors use assessment strategies?

Health care organisations such as the World Health Organisation (WHO) and An Bord Altranais (ABA, The Irish Nursing Registration Board) demand higher standards of new graduate nurses than heretofore. This is in conjunction with the implementation of degree programmes for undergraduate nurse education. These organisations stipulate that graduates must be well-educated, accountable, and can demonstrate the skills of a safe, caring and competent decision-making practitioner. The Bachelor of Science (BSc) four-year degree programme for undergraduate nurse education was introduced in Ireland in 2002, and is provided in universities and colleges of higher education throughout The Republic of Ireland. During the implementation process, each university and college of higher education developed a range of assessment strategies to clinically assess students. Preceptor nurses were subsequently assigned the responsibility of clinically assessing students, a remit previously undertaken by Clinical Ward/Unit Nurse Managers. Preceptors are qualified nurses, working in clinical units who are specially prepared to support BSc students during clinical placements. The purpose of this study was to explore to what extent preceptor nurses use the devised assessment strategies to clinically assess BSc students in one university in The Republic of Ireland. Data were collected by using a questionnaire distributed to all known preceptors in General, Psychiatric and Intellectual Disability nursing, during year four of the first cycle of the BSc programme. Findings from this descriptive study revealed that many preceptors were inexperienced, did not fully comprehend the assessment process and were not applying all of the recommended assessment strategies when assessing students in clinical practice. In light of these findings suggestions are made in the context of further research, management and education.

Students’ perceptions on the use of portfolios in pre-registration nursing education: A questionnaire survey

BACKGROUND

Portfolios encourage both personal and professional development through the process of reflective practice and critical analysis. In clinical placements portfolios are used both as a learning tool and as an assessment tool.

OBJECTIVES

To determine nursing students' perceptions on the use and effectiveness of portfolios in their education as well as their perceptions on the use of the portfolio as both an assessment and learning tool in clinical placement.

DESIGN

Postal questionnaire survey.

SETTINGS

Higher Education Institute in the UK.

PARTICIPANTS

90 first and 84 third year pre-registration diploma of nursing students.

METHODS

Postal questionnaires were sent to 131 first year and 122 third year students, with a reminder 3 weeks later. The total response rate was 69% (174/253), with a response rate of 69% (90/131) for first year students and a response rate of 69% (84/122) for third year students.

RESULTS

Students felt that portfolios were very time-consuming, causing them a great deal of anxiety, and were not very effective in developing and assessing their learning and competence. Using portfolios for both assessment and learning creates a conflict. Any assessment reduces the honesty and learning value of reflective writing and of the portfolio. Additionally, students become increasingly demoralized with portfolio use over time with experience. The study suggested three main linked reasons for this, namely the conflict between using portfolios for both assessment and learning, the design of the portfolio and the amount of support and guidance students feel they receive with their portfolio use.

CONCLUSIONS

Portfolios can be very effective as an assessment and learning tool, but it is essential that both students and mentors receive clear guidelines on and comprehensive support with their use. They should be designed in such as way that they are relevant, clear and user-friendly for both students and mentors.

Assessment of clinical practice in intensive care: a review of the literature

Nursing is a practice-based discipline, with clinical practice forming the heart of any programme of study. The major goal of all programmes should be on facilitating students to develop the skills necessary for competent and compassionate practice. Assessment of clinical competence is a fundamental aspect of programme development and as such deserves attention during the curriculum design process. The literature on assessment of students in clinical practice suggests that the tools used have evolved through various stages, ranging from the use of simple check list and rating scale to the development of competence assessment tools. Each stage has been fraught with difficulties and has taxed nurse educators, clinical assessors and students alike. The literature also indicates that there is a limited range of research available on clinical assessment tools, especially with an intensive care context. In part one of this two-part paper, the literature on assessment of clinical practice is explored, with specific emphasis on the assessment of competence with the Intensive Care environment. Part two of the paper reports on the findings of a study on students perceptions on a clinical competence assessment tool, used in an Intensive Care environment.

Portfolios and assessment of competence: a review of the literature

BACKGROUND

The literature review presented here was conducted as part of an English National Board for Nursing, Midwifery and Health Visiting funded project to evaluate the use of portfolios in the assessment of learning and competence. Initial consideration of the topic revealed the need to clarify the terminology and approaches used to assess competence using portfolios, and therefore the literature review was conducted to inform the study.

AIMS

To clarify definitions, theoretical bases and approaches to competence and the use of portfolios in the assessment of learning and competence in nursing education.

METHODS

A comprehensive literature review was conducted using the CINAHL and MEDLINE databases and the keywords competenc*, portfolios and nursing. Articles published in the period 1989-2001 in English were obtained and their reference lists scrutinized to identify additional references. Twenty articles were found using a combination of the keywords competenc* and portfolios, and 52 using the combination portfolios and nurse education. Articles were included in the review if they focused on the use of portfolios in nursing, and those concerned with professional or transitional portfolios were excluded. This article will analyse definitions of and approaches to competence and its measurement and to portfolios and their use as discussed in the articles identified.

RESULTS

Three approaches to competence were identified, each with its appropriate forms of assessment. With regard to portfolios, a number of definitions were again found, but there was a consensus that the theoretical basis of their use is theories of adult learning. A number of reasons for and advantages and disadvantages of their use were found, as well as varying ideas about what a portfolios should consist of and how it should be assessed.

CONCLUSION

A holistic approach to competence seems to be compatible with the use of portfolios to assess competence in nursing students, but the concept and its implementation is still evolving. A variety of assessment methods are needed for assessment and portfolios appear to have the potential to integrate these. Reflection is an essential component of a portfolio, as are the student-teacher relationship and explicit guidelines for constructing the portfolio. Issues of rigour in assessment of portfolios need to be addressed, but the assessor's professional judgement will inevitably enter into this assessment.

Assessing student nurse clinical competency: will we ever get it right?

In 1997, a revised system was introduced at the University of Glamorgan, Wales, to assess student nurse clinical competency. This was firstly as a result of concerns that the previous system was based on limited documentary evidence, and, secondly as the Welsh National Board for Nursing and Midwifery issued new competency statements. This article reports an evaluative research study which aimed to determine whether the revised system was an effective measure of clinical competency. A series of focus groups were conducted with students, tutors and clinical preceptors to discuss their experiences of using the revised system. A content analysis was conducted of all evidence written by students to support the achievement of clinical competency. The findings of the focus groups indicated that each group had some initial problems with the assessment process. The main concern for all groups was lack of consistency and uncertainty in the assessment process. Although the introduction of written evidence to support clinical competency was welcomed, many felt that too much evidence was required. Content analysis of competency documentation aimed to compare student evidence and to determine whether there were inconsistencies in the assessment process. There were many variations in the evidence obtained from students, in particular the amount of evidence written by each student. The findings clearly indicate that further revisions are necessary to ensure that the system is implemented in the most effective way. The Fitness for Practice report (UKCC, 1999) has ensured that competency-based assessment is here to stay in the UK. Evaluative research of this type is important to ensure that we adopt the most suitable approach to assessing clinical competency.

Reflecting on the use of student portfolios

The use of portfolios in nursing has increased during recent years. We reflect upon the design and implementation of a portfolio for pre-registration nursing students in the School of Care Sciences(1)at the University of Glamorgan. The portfolio was introduced as the result of the need to address the theory-practice divide and to provide nurse students with the skills to maintain a professional profile upon registration. We also discuss other potential benefits associated with using the portfolio. These include the use of a portfolio as a focus for discussion between the student and their preceptor or personal tutor, a vehicle for the development of reflective skills and a means of assessment. We acknowledge that along with benefits, there are a number of potential problems and limitations in their use, for example, an increase in the workload for the student, preceptor and personal tutor. We include preliminary findings of an evaluation of our portfolio, revealing that both students and staff value the introduction of the portfolio, although currently it is not a high priority in terms of the course as a whole.