|Lee, Po Man
|Continuous clinical assessment : an interpretive description of the experience of mentors and students in pre-registration nursing education
|Chiang, Vico (SN)
|Nurses -- In-service training -- China -- Hong Kong
Nursing -- Study and teaching (Continuing education)
Mentoring in nursing
Hong Kong Polytechnic University -- Dissertations
|Faculty of Health and Social Sciences
|164 pages : illustrations
For many countries around the world, professional registration for nursing practice is provided after higher education. Success of nurses in passing the required assessments is stipulated by their respective authorised bodies. In Hong Kong, similar to other major countries, the syllabus of the accredited programme for Registered Nurse (RN) must consist of the theory and clinical practice components. While written assessment is used in the theoretical component, continuous clinical assessment (CCA) is deployed in clinical practice to assess the competence of students. Although nurse educators confirm the importance of CCA, feedback on the problems of the clinical assessment process is not uncommon. Literature on CCA implementation is relatively limited. On the other hand, commonality revealed from the literature related to CCA often points to mentors and their practices. In clinical education, mentors supervise, teach, and assess nursing students through mentoring. The mentor and student relationship, alternatively mentorship, forms the foundation of pre-registration nursing education in a clinical setting. After a decade, the term "mentor" was revised by the Nursing and Midwifery Council (NMC) in the UK in 2019, as practice supervisor, practice assessor, and academic assessor. While this change is an attempt to segregate the roles of supervision, teaching, and assessment traditionally vested in clinical mentors, mentorship still remains as the foundation in pre-registration nursing education.
Study Aim, Objectives, and Significance
This study aimed to gain insights from the current practice and complexities inherent in CCA implementation so as to recommend practice implications and future research directions. Key study objectives are, 1) to describe the outcomes of CCA implementation perceived by students and mentors, 2) to identify commonalities and differences between the concepts and actual practice of CCA for the factors that affect CCA implementation, and 3) to generate the themes that fill the gap existing in the body of literature about success in CCA practice and development for pre-registration nursing education. Since mentorship forms the foundation of pre-registration education, reviewing and exploring the elements of effective mentorship, and its relationship with CCA, can contribute to the existing body of knowledge for CCA deployment by mentors, more appropriately and effectively.
This study adopted the interpretive descriptive methodology (Thorne, 2016) to explore in depth, and gain insights, into the CCA experiences of mentors and students. Twenty-two participants (11 mentors and 11 students) were recruited for individual interviews. Data obtained were transcribed and analysed through the constant comparative analysis approach in a cyclic process by primary understanding of the text, analysis of the descriptive reflection, and interpretive reflection to unravel participants' CCA experiences.
According to Sandelowski & Barroso's (2002) taxonomy of qualitative findings, the product of an interpretive descriptive study should generate a conceptual or thematic description or interpretive explanation that clarifies thematic linkages within the phenomenon (Hunt, 2009; Thorne, 2016). Through the iterative process of data collection and analysis, it resulted in the emergence of three themes from this study: 1) 'relation' without relationship, 2) stand behind the yellow line, and 3) the sound of silence. These themes are important structural components in identifying the main theme, shades of grey, which contextualises and personifies the subtleties of the CCA experiences of nursing students and mentors in pre-registration nursing education (Sandelowski & Barroso, 2002; Thorne, 2016).
The findings of this study unveil the phenomenon of diversity in CCA. Although the aim of CCA appears to be unambiguously straightforward, its practice and implementation vary. The practice of CCA is not absolute under a 'black and white' proposition. Incorporating the unique experiences of mentors in CCA implementation, this study reveals the spectrum in perceptions and judgement of mentors to sustain the continuity and impartiality of clinical assessment in a practice setting. Such a spectrum is categorised and analysed in terms of the elements in its relationship, practice standards, and feedback. Commonality is clearly illustrated in the findings that no decision is made at the polar ends, but rather at the points selected in between. The key for improvement in CCA practice is thus illuminated on how mentors and nursing students can strike a balance between black and white, while upholding the ultimate aim of nursing education and CCA to nourish competent nurses who ensure safe nursing practices for patients. The thematic schema developed for effective mentorship seems to be a sound basis for the establishment of guidance that strikes the balance in the practice diversity of CCA. With the results of this study and in reference to the new standard stipulated by NMC in 2019, further research on CCA practice should focus on the continuous development of programme curriculum in pre-registration nursing education, and mentoring education for clinical mentors. Practically, the ways in which different stakeholders cooperate are significant in facilitating implementation. Inquiries on policy details and alignment in the practice of CCA by relevant stakeholders are other potential directions for further research.
This study discovered in depth the current practices and complexities inherent in the CCA implementation, and reveals the importance of developing complete and practical guidance in implementing CCA in nursing education based on the foundation of effective mentorship. Better clinical teaching and learning activities may then be translated to achieve better competence and fitness of nursing students for their practice after such education, hence better assuring patient safety.
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