Assessment of practice

1. Assessment of practice John Schostak

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

3. 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)

4. 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

5. Education and Information Local Knowledge Management Education Global

6. 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

7. Ideally • no they’re not trained (...) there was a further three came on. Well there was four originally then one got moved to another ward because they didn’t 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 you’ve 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 patient’s personal care feeding them .. anything like that that needs doing. You do that, that takes up predominantly most of the morning.

8. Conceptual framework of the days work pattern Mechanisms, procedures to enact the plan Resources required Desired outcomes

9. In Reality: • JFS: you said ideally • P: ideally • JFS: so what happened? • P: Yesterday, however this didn’t happen which was we didn’t 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

10. From Information to Action

12. 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.

13. 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…….

14. 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)

15. 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

18. 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 perspective:strategic and tactical action

19. 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.

20. 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.

21. 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 registrar;Employ 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

22. Concluding Remarks • Situated understandings • Learning environment • Requirements for educational assessment

23. 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’

24. 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

25. 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