1. A three-phase evaluation study to explore nursing students’ assessment skills.
Deborah Coleman

2. Content overview
Flowchart of study How I developed research topic Aim of study Workbook development- intervention Systematic literature review Objective -1 literature review- chapter 2 Objective 2+3 –literature review- chapter 3 Study results

3. Rest of session describes how I got this structure

4. Research topic Ageing population
This 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.
My background- older people interest – MDT work, assessment of need, NISAT, specialist practice.
Major client group for all disciplines
More time spent by all professions assessing patients/clients than anything else
PCC- move from service led to needs led
An essential part of higher education is the preparation of health care professionals to care for individuals with multifaceted problems related to physiological, psychological and social ageing processes which require specialist knowledge and skills, with an increasing emphasis on the importance of patient assessment.
NMC-2010 comprehensive, systematic assessment
Move to community care- acutely ill older people in hospital- decreased opportunities to practice assessment skills, plus increase in pre- written care-plans

5. Aim:
To explore second year nursing students’ assessment skills with older people.
1st year concentrate on more fundamental skills
2-3rd year becomes a competency
Need to rule out confounding variables- will explore with other years/fields in further work

6. 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?
Guided development of workbook- behaviourism, SDL, reflection and constructivism
Needed tools to measure
Developed questionnaire to ascertain this after workbook completion

7. Workbook development
The 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 .
As part of doctorate- must develop and test an intervention
The workbook is thirty four pages long and is an educational tool that encourages students to think and reflect on good assessment skills and the holistic needs of older people- OPAF built in to guide.

8. Initial literature searches
Nursing 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
Many tools but not valid and reliable- usually focus on newly graduated nurses. Meant I had no scale to use as a reliable and valid method so study became exploratory, as preparation for an RCT of complex intervention
This gave direction for systematic review title
Initial literature searches showed lack of evidence for T&L strategies used- Francis report

9. 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.
Essentially a multi-disciplinary activity so needed to look at medical, nursing and social work.

10. Systematic literature review (2)
Search Methods
A 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.
Advised by both post graduate nursing librarian and education librarian regarding database choice to capture literature from the 3 disciplines

11. Systematic literature review (3)
PICOS Review questions/key words.
Population: nursing students, medical students or social work students
Intervention: teach, learn, experience, workbook, portfolio, lecture, simulation, demonstrate, observe, perform, reflect, train, educate, support or mentor.
Comparison: None
Outcome: holistic, or person centred, or patient centred or client centred, individual or psychosocial, comprehensive history taking or patient assessment with older people.

12. Systematic literature review (4)
Inclusion/exclusion criteria
Studies: 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.
The rationale for limiting inclusion to experimental or quasi-experimental studies is that these studies will provide evidence regarding the effectiveness of the educational interventions.
Most studies examine/explore perceptions/opinions of usefulness NOT effectiveness

13. Systematic literature review (5)
Inclusion/exclusion criteria
There 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.
No studies found that met the inclusion criteria- shows need for work

14. 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.
Issues of defining and measuring competence- chapter 2 of thesis
Criticisms of self-assessment although main method

15. 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 CINAHL
Reference lists of relevant articles and reviews were also searched.
Lit review focused on tools for nursing students- chose 2 to test

16. 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 This timeframe was selected to reflect the adoption of the concept of competence in nurse education within the UK.
Discuss key words - PICO

17. 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

18. 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.

19. Literature review-objective 1(5)
Identification
Screening
Eligibility
Included
Talk through each stage using- PRISMA flowchart to show how I got to papers included
Moher, D., Liberati, A., Tetzlaff, J., Altman, D., G. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. British Medical Journal

20. 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.
Chapter 3 of thesis- did it make a difference?
Content analysis to see how I could improve workbook usefulness

21. Objective 3:
To explore nursing students’ use and opinions of an older persons’ assessment educational workbook.
Students will not use if they do not perceive workbook as useful, easy to use etc
Liked workbook but found reflection least useful. Why ?

22. 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 CINAHL
Reference lists of relevant articles and reviews were also searched.

23. 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: None
Outcome: self-efficacy or competenc* or self assess* or perform* or skill* or proficienc*.

24. 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

25. 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

26. 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.

27. Literature review- objective 2+3(6)
Identification
Screening
Eligibility
Included
Talk through each stage using- PRISMA flowchart to show how I got to papers included

28. Study results
Objective 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.

29. 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.
It is hoped that the workbook would support the learning of holistic patient assessment skills- benefit could be increased quality of care/ accurate identification of needs. Impact on health outcomes.

30. 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.

31. 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.

32. 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.

33. 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.

34. Challenges of the study
Time restriction due to academic requirements Ethical process Literature searches P/T study plus full time job = no life at times! Steep learning curve Lack of confidence in ability Small sample
Similar to any student!

35. Survival! Do not underestimate how long it takes Wide reading/focus
Follow the guidelines
Break down into manageable pieces
Seek help- academic staff, librarians, SGC
Peer/ family support
Work life balance
GOOD LUCK!
Spend a lot of time on this so ensure it is something that you are really interested in!