Assessment of practice

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Assessment of practice

• John Schostak

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Background

• School of Education and Professional Development
• Centre for Applied Research in Education
• Qualitative
• AR
• Evaluation
• Case Studies/ethnographic

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Relevant Research Projects

• ACE - Assessment of Competence in Nursing and
  midwifery, 1991-3
• TYDE - Evaluation of Three-Year Undergraduate
  Nursing and Midwifery programmes, 1992-5
• PANDA - Assessment of Practice at Diploma, Degree
  and postgraduate Level in Pre and Post
  Registration Nursing and Midwifery Education,
  1997-9
• PANDA 2 - Development of professional practice,
  1999-2000

(All co-directed with Terry Phillips)
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Practice and AssessmentPandA Project

• Products
• 1. Final Report (2000) Researching Professional
  Education
• Series No 16 - Practice and Assessment in
  Nursing and
• Midwifery doing it for real
• 2. Research Highlights No. 43, July 2000
• 3. Learning materials - in association with OU
  and ENB

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Education and Information
Local
Knowledge Management
Education
Global
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Education, Assessment,Curriculum

• Two sides edge of same coin education
  assessment, curriculum
• Curriculum
• Top-down - transmissive - policy driven
• Grounded - dialogic - practice driven
• Assessment for Judgement
• Judgement under uncertainty

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Ideally no theyre not trained (...) there
was a further three came on. Well there was four
originally then one got moved to another ward
because they didnt have any staff either. So we
ended up with um 6 staff 5 of which could work on
the ward. Um, so you do your drug round. Then
once the drugs are done, the trained staff then
obviously peel off. They .. ideally khuh if
youve got the correct amount of staff before you
start your drugs you prioritorise the care for
your team so you have a little team meeting and
say that needs doing this needs doing da di da di
da. (...) Then you go back into your team, um
carry out care that needs doing e.g., dressings
removing drains things like, anything that you
feel that you need to do, the patients personal
care feeding them .. anything like that that
needs doing. You do that, that takes up
predominantly most of the morning.
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Conceptual framework of the days work pattern
Mechanisms, procedures to enact the plan
Resources required
Desired outcomes
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In Reality JFS you said ideally P ideally JF
S so what happened? P Yesterday, however this
didnt happen which was we didnt have any staff
so I carry out the drugs, the other trained
member staff was trying to prioritorise the
people that needed to be done, sorted out at the
beginning of the morning. And then, from there
on in really, the untrained staff were supervised
by myself and the second trained was doing things
like taking all the clip, all the stitches out
of wounds she was doing all of that. All of that
sort of thing. And the untrained staff were
doing the basic care
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From Information to Action
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Curriculum and Assessment

• A curriculum or an assessment framework, adapting
  a phenomenological formula, is always of
  something for someone. This provides two initial
  directions for design strategies the something
  and the someone. A third direction is the act
  of engaging in a curriculum or in assessment
  itself.

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The Something

• Knowledge base, subject disciplines
• Personal development, interests, needs
• Professional development, interests, needs
• Social, cultural, political, economic etc
  requirements
• work practice and its circumstances
• changing work practices and circumstances
• the process of dynamic decision making
• The resources available staff, equipment, space,
  time...
• And so on.

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The who - the dramatis personae

• the individual (whether nominally student or
  teacher/mentor/assessor)
• the you as a specific source of otherness, or
  difference which requires handling either by
  excluding or by incorporation as an us or we
• the us or we (2 or more seen to be acting as
  a group) whether these are seen as
• productive of consensus',
• agreements to differ and to maintain debate, or
• for creative alternatives
• the authorities or them (that is, the
  personalised source defining what is to be
  taught/learnt)

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The act

• transmissive of set bodies of knowledge, skill,
  practice, values and attitudes. These can take
  the form of
• a) manifest
• b) hidden
• historical (that is, produced through acts of
  reflection upon the paths travelled) for
  organising present and future acts

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Levels

• Practitioner criteria different from academic
• No fragmentation
• No linear progression to competence
• Real-life, case-based development
• Now alternative now future
• Towards a wider perspectivestrategic and
  tactical action

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A Micro-Vignette
The student nurse (mental health branch) is
within 3 months of completing her course. Today
she is being formally assessed for the
"management component" of the curriculum the
culmination of the continuous assessment of
practice. This will entail her effectively taking
charge of the ward, organising the workload and
making the relevant decisions in relation to
care. Following handover from the night staff,
the student conducts a drug round with her
assessor, the remainder of the staff are occupied
with the care which she has assigned to them and
the student prepares for the psychiatric "ward
round". This is conducted as a series of mini
case-conferences in a room off the ward. The
student has to use her clinical judgement to
determine the most appropriate sequence and
present each patient in turn, describing their
nursing care and progress to date. Multi
disciplinary input and contributions from
patient, family and friends involved is sought.
The consultant psychiatrist summarises these
findings, using them to determine the continuing
treatment required. The student ensures all
relevant notes and any documentation needed for
follow-up are available, and that the patients
who have been seen are given appropriate support
on their return to the ward. On completion of
the "round", the assessor confirms to her that
she has done well and passed her assessment.
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A 65 year old builder is admitted to Casualty
with severe lower back pain, after falling from a
roof. The assessee (adult branch) works with his
assessor to move the patient and position him for
examination by the orthopaedic registrar his
first experience of the "log-rolling" technique,
performed under the explicit instructions of the
assessor. Following this, he feels sufficiently
confident to accompany the patient to X-ray where
he now takes the lead role, transferring the
patient from trolley to X-ray table and back.
They return to Casualty where a diagnosis of
fractured lumbar vertebrae is confirmed. The
assessee completes the nursing record, assessing
the patient for risk of tissue-damage and
performing and charting base-line and
neurological observations. The patient is to be
admitted to the orthopaedic ward, having a CT
scan en route. The assessee again accompanies
him, providing sensitive care and directing the
"log-rolling" procedure required for each
transfer. After giving ward staff a verbal
hand-over, he returns to Casualty, up-dates his
assessor and completes the departmental records.
This entire episode has lasted 3 1/2 hours during
which the assessee has been able to rely upon his
assessor's support and guidance regarding
learning opportunities presented.
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• Circumstances
• Place(s) Casualty X-ray Orthopaedic ward CT
  scan
• Resources Appropriate staff Time Equipment
  x-ray, CT scanner, trolly, bed etc
• Dramatis personae 65 year old builder assessee
  assessor orthopaedic registrar ward staff
• Orienting categories lower back pain fractured
  lumbar vertebrae
• Strategic Level
• Care Principle implicitly - traditional nursing
  practice? Provision of 'sensitive care'
• Education Principle implicitly - see one, do
  one? Instructional teaching
• Tactical Level events/procedures/outcomes
• Scene 1 Casualty Position patient for
  orthopaedic registrarEmploy procedure "log
  rolling Show procedure "log rolling" give
  explicit instructions
• Outcome(s) Performs procedure Increased
  confidence
• Scene 2 X-ray department Assessee takes lead
  Transfers patient from trolley to and from x-ray
  table
• Scene 3 Casualty Confirmation of diagnosis
  Completion of nursing record
• Scene 4 transfer to Orthopaedic ward Assessee
  accompanies Provides sensitive care Directs
  "log-rolling" procedure Gives verbal hand-over
• Scene 5 Casualty Up-dates assessor Completes
  departmental records
• Overall tactical outcome a) care provided b)
  support and guidance from assessor accomplished
• Overall strategic Outcome traditional nursing
  principle reproduced by assessee

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Concluding Remarks

• Situated understandings
• Learning environment
• Requirements for educational assessment

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Situated Understanding

• Varieties of knowledge and understanding
• Operational and ethical dilemmas
• Competing and contradictory demands
• Situated solutions involve (i) judgement (ii)
  prioritisation (iii) action
• Need for in-event assessment
• Structures to support working together

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Learning Environment

• Transformation of work environment into learning
  environment by
• Realist structure conceptual practices
  resources - underpinning
• Dialogic process mapping sharing information,
  knowledge, understandings research for evidence
  base making judgements framing action

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Educational Assessment requires

• Professional development for assessment in
  practice is essential this should take place in
  learning environment
• Appropriate relationships to be in place
  conceptual frameworks, procedures, organisational
  structures, resources
• Continuous curriculum development in relation to
  identifying educational opportunities in the
  workplace
• Development of situated narrative frameworks
  for knowing and acting
• Ensuring educational dialogue across all members
  of different professional discourse communities