Structured Observation and Assessment of Practice SOAP

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Structured Observation and Assessment of
Practice (SOAP)
Presenter Dr Tracy Levett-Jones Bachelor of
Nursing Program Convenor, The University of
Newcastle.
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Outline of Presentation

• Defining Competence
• Purpose
• Process
• Progress

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Competence
The combination of skills, knowledge, attitudes,
values and abilities that underpin effective
and/or superior performance in a
profession/occupational area (Australian Nursing
and Midwifery Council, 2005, p. 8).
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Purpose

• To provide confirmation of final semester
  students readiness and fitness for practice.
• To enhance students confidence
• To assess and develop students competence

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Structured Observation and Assessment of Practice
(SOAP) The Process
SOAP
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Observation

• During the 2 hour observation each discrete
  nursing behaviour is documented using a SAO
  (situation, action, outcome) format.

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SAO Number 1. Situation Student entered Mrs
Xs room, a 67 year old client with rheumatoid
arthritis. Action Student asked How are you,
did you sleep well? Outcome Client responded
I had a terrible night with the pain and only
slept on and off I still have a lot of pain.
Related ANMC competency 7.2, 11.3
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SAO Number 2. Situation Client has stated
I had a terrible night with the pain and only
slept on and off I still have a lot of pain.
Action Student responded Oh youll feel
better when youve had a shower. Come on .. Up
you get. Outcome Communication inadequate..
Clients condition not assessed. Related ANMC
competency 7.3, 11.2 (negative instances).
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VIVA

• Probing and open ended questions are used to
  elicit the intentions, knowledge, attitudes and
  values underpinning a range of the most
  significant behaviours observed.

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VIVA Example 2 Question Can you tell me
about your rationale for prompting Mrs X to have
a shower even though she had stated that she was
in pain? Response I have cared for Mrs X for
the past 3 days and I know that after she has a
shower her pain is much improved. She had
analgesics and anti-inflammatory medications at
0800 and following her shower Ill rub Voltaren
into her aching joints. Perhaps my communication
with her was not appropriate though.
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Mapping and Documentation

• Behaviours are mapped against the ANMC National
  Competency Standards for the Registered Nurse.
• The evidence may be a positive or negative
  instance of competency.
• The results are mapped on a matrix to identify
  trends and patterns of behaviour.

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Debriefing Formative Feedback

• During the debriefing formative feedback is
  provided by identifying the students clinical
  strengths and areas requiring further
  development.
• Strategies (remediation) for improvement are
  discussed with the student and their clinical
  mentor.

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Summative Results

• A summative result is determined by comparing
  the evidence gathered during the observation and
  VIVA with the ANMC Competency Standards.
• Summative results are recorded as either
• Competent on this occasion
• Competent pending completion of specified
  remediation, or
• Not competent on this occasion and requiring
  reassessment.

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Student results from the first trial of the SOAP
50
40
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Student feedback

• The following comment typifies the
  qualitative feedback received
• I was pretty anxious to start with but I
  tried to be positive and remember that the
  assessor was there to identify my strengths and
  weaknesses. The assessors attitude and approach
  were extremely positive, enthusiastic and
  encouraging. She documented a range of areas that
  I am competent in and I received lots of positive
  feedback. She clearly identified some areas that
  I need to improve on and provided strategies for
  me to achieve this. There is some remediation
  that I need to do but it was great to get this
  feedback now and to know that Im on the right
  track. I now feel more confident in becoming a
  registered nurse. Personally I feel this clinical
  assessment has been the most beneficial and
  meaningful aspect of my clinical learning to
  date.

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This assessment increased my confidence in my
clinical competence and readiness for practice
(Items 24 25).
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This assessment helped me to think more
critically about my practice, developed my
clinical ability, and allowed me to apply my
knowledge to new situations (Items 24-27).
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The assessor provided effective and constructive
feedback, clear explanations, and demonstrated a
professional and supportive manner (Items 1,7,8
16).
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Document analysis

• Analysis of students previous clinical
  assessment records demonstrated that there is
  strong agreement between the results of this
  assessment , appraisals completed by clinical
  mentors, and student's previous clinical and
  academic results.

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References

• Australian Nursing and Midwifery Council. (2005).
  ANMC National Competency Standard for the
  Registered Nurse. Online http//www.anmc.org.au
  .