Reflection Paper on Current Clinical Assessment Practices - Essay Example

Reflection Paper on Current Clinical Assessment Practices There are a variety of issues that need to understand when they are learning whatto do in a clinical setting. Within any program there is a lot of information to take in and digest. All students must learn a certain amount of this information in order to pass their coursework and later to pass the state exam. There are a variety of methods that can be used with some being more effective than others. One issue that is important to study is the fact that students have different learning styles. Because of this different methods of teaching will work with different students. It should not be misconstrued that one type of learning must be followed to help every student learn. Central to learning styles for any student is to find those models of teaching that work most effectively for the individuals learning style so that they become more instantly ready to understand the coursework and do well on a test. The research shows that there are many methods currently being used. There are several basic ways that a student must learn different types of material. As an example, some pieces of knowledge must be memorized. This would include lists of facts or aspects of the human body and body systems that are important to know when you are working with patients. Azzarello (2007) points out that there are three stages of knowledge that students must develop. In the first stage, the declarative stage of learning, students find these lists and common knowledge important. They must not only learn the material, but be able to apply the knowledge to their clinical studies. In stage two, called the procedural stage, students must take the knowledge they have and apply it to situations that may not have come up in other settings. With this knowledge, they must use critical thinking and problem solving to add to the knowledge they have about the situation. In the last stage, which the author calls structural knowledge, a student must understand how procedural knowledge and declarative knowledge relate to one another. This basically means that students will need to understand an organized way of bringing the knowledge together (Azzarello, p. 3). The author suggests that in order to understand what students are learning structurally that Pathfinder scaling techniques can be used. A study was conducted to see whether this was feasible and found that it was one way that students could be evaluated. This is a stronger way to evaluate than concept mapping and most students in the study thought some of the work was helpful. Students also have to be able to see an assessment of their skills that is unbiased when they are in the clinical setting. In 2007, Kevin, Downie, Kendall and Latrobe created a study to see if video would be helpful for nursing students in the assessment of clinical competence. The study was first applied to teachers to see whether video could show the strengths and weaknesses of clinical teachers to assess student nurses (p. 5). There were many things that the video pointed out to help clinical teachers and it was decided that the use of video was underused in nursing assessment. In another study in 2006, Schoening, Sittner and Todd studied the role of Simulation in the training of nursing students. They particularly studied the idea of Simulation as a technique for assessment because of the lack of other research in this area. They suggested that "Simulation not only provides an effective method of teaching but may also prove to be more enjoyable to the participants" (Schoening et. al., p.4). This study had three phases that students performed. In the first phase students were oriented to the process of Simulation and told what to expect. In the second phase, a two week program of Simulation was begun and students became either the "nurse" or the "observer." The expectations were the same as they were for any other clinical situation and they would receive feedback as usual on their weekly clinical evaluation (Schoening et. al., p. 6). They were also informed that they were to speak to the simulator as though it were a real patient. In the third phase, the actual Simulation Operations were conducted in 1-2 hour increments in two sessions. At the end of the two weeks, students were debriefed, asked to talk about their feelings during the training, review a videotape of the training and the also "had the opportunity to evaluate their own behaviors, communication patterns, and assessment skills" (Schoening et. al, p. 7). They were also asked to fill out a 10 question evaluation of the SCE and the items were based on a 4 point Likert Scale. The outcome of the study showed that students enjoyed working together in a Simulation and they felt that it encouraged team work. They also understood their own strengths and weaknesses better and many were able to make plans for their own improvement in certain areas. As I read through the various ideas in these studies I found that there are many different ways to assess the competency of nursing students. Each area of study that was listed in the studies I read was viable in my opinion. I thought that video is an excellent way for students to understand what they are doing. So often when we are working in a clinical setting we are focused on what we are supposed to do and how we are doing it without regard to how it looks on the outside. When nursing students are told their strengths and weaknesses it is often difficult to reflect on what we did or did not do. With video we could see exactly what we had done and how it related to what the supervisor was saying. We could also have a way to take notes on what we could do for the next time. In some cases this may take more time than a teacher has for the process, but I think it would be very valuable to the student. Another way this would be helpful is that students could actually take the video and review it at their leisure making note of these things that they did well versus those things they want to improve. This may give way to other questions they may have about a process or a procedure. I would think that videos would be best for the clinical portions of nursing training and it would give an opportunity for the student to see what the supervisor sees in the process. I think this would help the student become better rounded in their total learning. I also think it would help them gain the structural knowledge that one of the other studies suggests. It is one thing to think that you did something correctly and its another thing to see that it was actually done in the way that you had learned. Of course you would not see how you were doing in a regular hospital setting, but that is why you are in school -- to see what you need to do before you get into a regular hospital setting. I am not convinced that the Pathfinder program that Azzarello suggests would be easily implemented. I think we have a lot of standardized testing mechanisms that help us to practice the knowledge we have memorized and those methods arent easy for all students. I thought it was interesting that she differentiated between high performing and low performing students because I wondered what this meant to the study. Did the Pathfinder Program help all students achieve better when seen in both the beginning and end of the study? The results said they did but I wasnt sure. Also, I wasn’t sure what they said about the fact that "Pathfinder transforms the judgments into a visual representation of structure by transforming the raw relatedness ratings into link-weighted networks (PFNets)" (Azzarello, 2007, p. 3). I wasn’t sure conceptually how this would work because each student understands differently and this may make this type of assessment more subjective than objective. I did not feel that this one would be the most effective. In the third article the idea of Simulation was perfect as far as I was concerned. The biggest challenge for nursing students in my opinion is to take all the knowledge you have and formulate it into knowledge you can use. The nursing program seems to go by so quickly that it is difficult to really understand all of what you know until you get into a situation. The idea of using Simulation in a group setting made sense to me. I could see bringing together a small group of students to work on a simulation for two weeks. During that time everyone would get the change to be the "nurse" or the "observer" and this would greatly improve everyones performance. There are many reasons that this would happen. First of all, you are being evaluated by your team in some way (or that could be a part of the entire simulation piece) and you want to perform well within the team. You would also want to make sure you observed everything as the observer in order to help your teammates. As a nurse, you would be more focused on what you were doing because you would want to make sure that you were performing in a way that you would be able to see later. I thought that the use of video with simulation would be the perfect way to assess clinical skills because the student would have the best of both worlds. You could see yourself perform, but also have knowledge of what it looked like outside of the clinical setting. I think that students are harsher judges of each other so we would have to get some training as to how to observe and how to work with one another in giving feedback, but I think these two situations would be essential to our progress. I think that students should have at least two roles in the assessment process. The first role would be to assess them. There would be some set of criteria to assess their own skills and to assess their own knowledge. Sometimes this is difficult because students have so many other things going on in their lives that it may be difficult for some to understand how to assess themselves properly. However, it would be important for each student to have some sort of checklist perhaps to help them decide how their own skills measure up to the checklist. Perhaps this would be an assessment at the beginning, middle and end of their training. Secondly, their role should be in a peer to peer process. There should be some type of teamwork evaluation where we are able to look at each other via a set of criteria and do an assessment. I do not think that a peer assessment should be graded but it should be used as one more bit of feedback for each student going through training. I would think that this kind of feedback may be a part of any class. Perhaps we could use some sort of rubric that would have certain skills as we go through the process. Another way that we might help each other would be through focus groups or something to that effect where we talk to one another and assess what we just learned. I think that these types of assessments would be constructive and may help more students integrate information as we go towards the process of the state test. In terms of who should assess us in outside of the classroom, this is a difficult task. I think on the one hand that it should be RNs who are very qualified in the areas that we are supposed to learn. I would feel most comfortable with an RN working in the clinical setting who had years of experience, was competent and who was doing professional development to keep up with the changes in nursing. This individual would need to have information about our course curriculum to relate to the clinical setting. The challenge I think is that often we are put into a setting where some of what we know is used and some may not be used in the same way. If an RN has the knowledge of our curriculum they can give us the training we need in that particular setting. Word Count 2,092 References Azzarello, J. (2007). Use of the Pathfinder Scaling Algorithm to measure students structural knowledge of community health nursing. Journal of Nursing Education, 46(7), 313-318. Retrieved June 30, 2008, from the ProQuest research database. Kevin, J., & Downie, J. (2007). Video as a strategy to evaluate and assist clinical teachers with student assessment. Journal for Nurses in Staff Development, 23(5), 223- 228. Retrieved June 25, 2008, from the Journals at OVID research database. Lunney, M., Gigliotti, E., & McMorrow, M.E. (2007). Tool development for evaluation of clinical nurse specialist competencies in graduate students: A pilot study. Clinical Nurse Specialist, 21(3), 145-151. Retrieved July 1, 2008, from the Journals at OVID research database. Schoening, A.M., & Sittner, B.J. (2006). Simulated clinical experience: Nursing students perceptions and the educators role. Nurse Educator, 31(6), 253-258. Retrieved July 1, 2008, from the Journals at OVID research database. Read More