Feedback in clinical practice: Enhancing the students' experience through action research.

Feedback within clinical practice is known to be central to the learning and development of student nurses and midwives. A study that focused on student experience of assessment identified that a high proportion of students reported that they had received insufficient feedback whilst on clinical placement. In response to this academics and members of the clinical education team set out to explore this with a view to improving the student experience using action research. Key findings indicated that responsibility for feedback on clinical placement lies with both students and mentors, distinct factors can enable effective feedback and that positive outcomes for mentors and students resulted through engaging with the project. The process, outcomes and actions taken to improve practice are the focus of this paper.

Towards a values-based person specification for recruitment of compassionate nursing and midwifery candidates: a study of registered and student nurses' and midwives' perceptions of prerequisite attributes and key skills.

Selection and retention of preregistration nursing and midwifery students are issues that exercise educators, universities and commissioning bodies both nationally and internationally. It has recently become an expectation that a values-based approach is used within recruitment and selection activities in the UK. The desirability of a person specification to support transparent recruitment and selection is well recognised. An online survey of registered and student nurses and midwives found consensus around the desirability of several personal attributes and key skills. There was consensus in the top seven ranked attributes which were honesty and trustworthiness, communication skills, being a good listener, patience and tactfulness, sensitivity and compassion, the ability to seek and act on guidance and being a good team worker; this was between registered and unregistered nurses and midwives and also between participants representing all fields of nursing and midwifery practice. Some of the responses from Practice Education Facilitators (PEFs) (n=5) and senior managers (n=15) differed from those of other registrants surveyed. The attribute 'Able to draw on knowledge and experience' was considered more important by PEFs and 'Observant and able to act on your own initiative within your level of responsibility' and 'Able to draw on knowledge and experience' were ranked more highly by senior managers.

Systematic review of grading practice: is there evidence of grade inflation?

This paper describes the outcomes of a systematic review of literature pertaining to the grading of practice within nursing, midwifery, medicine and allied health professions. From a total of 215 papers, 147 were included and data were extracted using a systematic data extraction tool. The focus of this paper relates to one of the emerging themes: the issue of grade inflation. The paper examines the grade inflation phenomenon: it discusses the reasons for grade inflation from a variety of perspectives. The paper reports on the suggestions made within the literature on how to control grade inflation, but these, the authors conclude, are not fully evaluated and should be adopted only where rigorous evaluation can carried out. It is imperative that evaluations include the usefulness, reliability and validity testing of rubrics or any other solutions to grade inflation that are adopted by clinicians and educators.

The experience of critiquing published research: learning from the student and researcher perspective.

This paper commences with affirmation of the importance of research critique within academic programmes of study, and the context of this skill within the nursing profession. Judie (student) shares an experience from a Professional Doctorate in Education (EdD) assignment that involved selecting and critiquing a piece of published research. "The qualities of an effective mentor" (Gray and Smith, 2000) was critiqued using the Critical Appraisal Skills Programme (CASP, 2006) framework. Morag was the researcher and co-author (Gray and Smith, 2000) and was subsequently contacted by Judie for the purposes of validating her critique assignment. On the tenth anniversary since publication of her PhD research findings Morag reflects on the original article in the light of Judie's critique and shares evaluative comments. Some of the assignment critique is validated by Morag, whilst some of the evaluation demonstrates unreliability of critique shown by Judie. Discussion surrounding sufficiency of research critique through systematic examination of a published article, versus an original research report such as a thesis ensues. The student and researcher/author reveal their learning from this collaborative experience and conclude with recommendations for; setting critique assignments; authors publishing their research findings; and students undertaking critique assignments.

Integrating physician assistants into the practice setting.

The role of anaesthetic practitioner was established in England using the National Anaesthesia Practitioner Curriculum Framework (Department of Health 2005) and is now being adopted in Scotland. This article reports part of a 29-month evaluation of the first two cohorts of physician assistant (anaesthesia) students as they progressed through their education programme, and discusses the management of integrating this role in clinical practice.

Making portfolios work in practice.

BACKGROUND: A portfolio captures learning from experience, enables an assessor to measure student learning, acts as a tool for reflective thinking, illustrates critical analytical skills and evidence of self-directed learning and provides a collection of detailed evidence of a person's competence. AIMS: This paper reports data on how assessors and nursing students match learning outcomes and/or competencies to their practice and then reconstruct those experiences into the format required by the portfolio documentation. The data were gathered as part of a larger study to evaluate the use of portfolios in the assessment of learning and competence in England. METHODS: This three phase stakeholder evaluation was designed to gain the views of those involved in designing, implementing and using portfolios in nurse education. In phase 2, 122 students and 58 nurse teachers were interviewed about their perceptions of portfolio use, and a further 32 students and 26 assessors were interviewed after they had been observed taking part in an assessment process. Thematic data analysis was used. FINDINGS: Assessors and students underwent a complex process of deconstructing learning outcomes/competences to fit these to their practice. These then had to be reconstructed through the written medium to fit the structure of the portfolio. Confirmation that this met teachers' expectations was essential to allay feelings of insecurity. CONCLUSIONS: To achieve maximum benefit from the portfolio as a learning tool to link theory and practice, there needs to be a clear fit between the model of portfolio and the professional practice that is to be assessed. Outcomes and competences, as well as the type of evidence required to demonstrate their achievement, and integration of the whole experience should match the students' stage of professional and academic development. Over-complex approaches to practice assessment, particularly in the early stages of students' careers, can detract from clinical learning in favour of learning how to complete the portfolio successfully.

Lifestyle factors for promoting bone health in older women.

BACKGROUND: It is accepted practice to recommend a calcium-rich diet, weight-bearing exercise, cessation of smoking and limited alcohol intake to promote bone health. Although one in three women over 50 years old are at risk of osteoporosis, the lifestyle practices of older women in Scotland are not well documented. AIM: To investigate the lifestyle practices of a group of older women who had received lifestyle advice a year previously whilst participating in research identifying the individual risk of osteoporosis. METHODS: A mainly quantitative approach was taken from the perspective of the empirical-analytical paradigm. A descriptive survey research design was used and the primary method of data collection was postal questionnaire. Additional qualitative data obtained from a telephone interview of a small number of respondents were content analysed. FINDINGS: The questionnaire was sent to 320 women. The response rate was 92.5% (n = 296). The majority of women were non-smokers, had no alcohol problems and were participating in regular weight-bearing exercise. However, most had not been taking a calcium-rich diet in the previous year, and only 21.2% (n = 58) had changed their diet following identification of risk of osteoporosis. CONCLUSION: The findings in relation to diet, smoking, exercise and alcohol were supported by previous research. We recommend that further research with larger samples in the United Kingdom explores the reasons why older women do not have adequate calcium intake. A statistically significant finding was that women at high risk of osteoporosis were the least likely to have made changes in lifestyles. Further research is required to address the information needs and lifestyle practices of older women who are at high risk of osteoporosis.

Using portfolios in the assessment of learning and competence: the impact of four models.

This paper discusses the diversity of portfolio use highlighted in a study funded by the English National Board for Nursing, Midwifery and Health Visiting exploring the effectiveness of portfolios in assessing learning and competence (). Data collection was undertaken in two stages: through a national telephone survey of Higher Education Institutions (HEIs) delivering nursing programmes (stage 1); and through four in-depth case studies of portfolios use (stage 2). Data collection for stage two was undertaken through field work in four HEIs purporting to use portfolios as an assessment strategy, and their associated clinical placement settings. Four approaches to the structure and use of portfolios were evident from the stage 2 case study data; these were characterised as: the shopping trolley; toast rack; spinal column and cake mix. The case study data also highlighted the evolutionary nature of portfolio development and a range of additional factors influencing the effectiveness of their use, including language of assessment, degree of guidance and expectations of clinical and academic staff.

Evaluating portfolio assessment systems: what are the appropriate criteria?

PURPOSE: The purpose of this paper is to discuss how portfolio assessment processes should be evaluated. BACKGROUND: Articles in the nursing literature discuss the use of validity and reliability as criteria for evaluating portfolio assessment processes, and recommendations include tighter specification of grading criteria, a standardized national approach to assessing clinical competence in nursing students, and inter-rater reliability checks. On the other hand, some general practitioner educators suggest that these may not be the appropriate criteria because the nature of the evidence in portfolios is descriptive and judgement-based rather than quantifiable. METHOD: Drawing on multi-method case study data from a recent study evaluating the use of portfolios in the assessment of learning and competence in nursing education in England, we suggest that criteria developed to evaluate qualitative research may be more appropriate for evaluating portfolio assessment processes. DISCUSSION: Multiple sources of evidence from the varied perspectives of students, teachers, practice assessors and external examiners are tapped as part of the portfolio assessment process. Tripartite meetings between students, teachers and clinical assessors to review placements are crucial in verifying both the written evidence and students' ability to communicate and critically analyse their performance. The variety of evidence collected would potentially allow monitoring, using qualitative research evaluation criteria, both of the portfolios themselves and the systems by which they are monitored and evaluated. However, not all this information is collected consistently and systematically, as called for in curriculum documents. CONCLUSIONS: Use of qualitative research evaluation criteria offers a potentially productive way forward in evaluating portfolio assessment processes but some aspects of current practice need to be tightened, particularly double marking, internal moderation and external examining.

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.

Introducing single case study research design: an overview.

An overview of case study research The use of case study design in research has a long and distinguished history in many disciplines ( 1 ). It is used in law, education, history, medicine, psychology and business ( 2 ). Yin ( 3 ) stated that case studies are essential for social science and that they are used extensively in practice-oriented professions. Examples of studies include those of Freud, from which he derived his theories of personality ( 4 ), and Whyte's study of neighbourhood gangs in Chicago ( 5 ), which was found by other researchers ( 6 ) to be a typical case and again, as in the example of Freud, led to the development of theory. The term 'case study' refers to both a process of inquiry - that is, studying a case or designing and executing a case study - and its end product, the case study or 'case report' ( 7 ).

Personal experience of conducting unstructured interviews.

I am at present conducting a PhD study into the effects supernumerary status and mentorship on student nurses. The purpose of this article is to share some of my experiences, and suggest some pointers for planning and conducting unstructured interviews.