CONCLUSIONES GENERALES

her progress assessment form.

C . Educational Issues:

4.12 A summary of educational issues is given below: Sixty-eight per cent of assessors stated they received no preparation to carry out progress assessments (p<0.05)

(3.8). Five assessors (i.e. one-ninth of the sample) felt that the preparation they had received had not been helpful (3.8). This preparation had consisted only of

(S20): LANGE, C.M. (1978):

Using media in evaluation.

administrative aspects to do with the completion of the progress assessment form (3*8). There had been a gener­ al lack of discussion of the processes of assessment in their preparation (3.8). Although RGNs and SRNs parti­ cipated in progress assessments, they received no formal preparation for this role (3.8). Assessors generally felt that it was ’their job’ to fill in the progress ass­ essment form alone; an issue which may be considered to affect the validity of an assessment which relies to some extent on the observations of other members of the ward team (3.15). Students tend to ’lose their feet' at first during placements where a heavy workload is in­ volved (3.22, 3.23).

The largely retrospective, summative nature of the report throws into question the validity of the progress assess­ ment as a progressive (i.e. formative) process (3.24). Although the modal 10-20-minutes allocated for discussion of the assessment with a student appeared to be a very short time, assessors 'saw no difficulty’ about this (3»25)• Very little time was spent in discussing the assessment with the student nurse. Only 18 per cent of the sample spent a period in excess of half-an-hour doing this (3.26). Assessors did not feel the need to go out­ side the ward ambience for help in assessments (3.28). Seventy-seven per cent of assessors felt the progress assessment to be ’beneficial’ to the student nurse; but were vague as to why this was the case (3.32). Opinions as to the value of the progress assessment were very ambivalent (3.33) • There was an obvious team approach to progress assessment at ward level; but it appeared to be casual and unstructured, without full participation by other team members, which assessors appeared reluctant to allow (3.15

1

Administrative nursing staff appear to be.excluded from the assessment process (3.28, 3»44> 3.46^. There was also an 80 per cent exclusion of teaching staff from the ass­ essment (’I t ’s our assessment!') (3.45). There was a feeling that nurse managers might ’over-react’ to crit­ ical comments made by the assessor on a student’s per­ formance (3.46).

There was a general dearth of creative ideas concerning how the present system might be improved, although many recognised that it needed improvement (3.54)• There is a need for student nurses to be more closelv involved in their own assessment procedures (3.54* 3.86). Assessors tended to regard the ’average’ category (when it existed) pejoratively as a minimum criterion of acceptability

(3.92, 3«95> 3.96). In the absence of objective behav­ ioral criteria at each category on the progress assess­ ment form, the likeliest factors responsible for the observed differences are a combination of assessor sub­ jectivity (3.96); and a related lack of sensitivity in the four-point scale used in Centre A (3.99). If the

problems of subjectivity and sensitivity identified in Para. 3.100 are confirmed as major problems, then there is a need for further research into educational methods for achieving higher levels of reliability between ass­ essors ( .

4-. 13 Of the issues concerning preparatory courses for assessors, it is worthy of note that 68 per cent of assessors in the present sample stated that they had received no preparation for their task as an ass­ essor. Amongst those who had attended a course, there was some ambivalence regarding the helpfulness of the preparation received. Some stated that it had concerned administrative aspects (i.e., how to complete the form; who to send it to, and so on) only: and that there had been a lack of discussion of the psychological and prac­ tical processes involved in assessment: e.g. the tend­ ency which some students might experience to 'lose their feet' when coming onto a busy ward; and the need for the assessor to be aware of this, and similar, personal stresses throughout the placement.

4.14 The findings make it clear that, in addition to a dearth of preparation for ward sisters acting as ass­ essors in progress assessments, there is no preparation whatsoever for other senior trained staff - RGNs or SENs - who may from time to time participate in such assessments This is clearly a deficit, especially in view of the reliance which assessors clearly place on the informal 'assessment network' in which such staff play an important part. The data would indicate a need for greatly increased provision of appropriate courses

both for assessors themselves and for collaborating members of the ward team. Regarding the content of such courses, a tendency'towards a somewhat functional approach has been noted (cf Para. 4•13» above); and this may in some cases need counterbalancing with more discussion of the processes underlying progress assessment. For example, any current research into methods for achieving higher levels of reliability between assessors’ ratings should become one of the focal discussion areas in future preparatory courses. 4.15 Of those educational issues concerning the process of progress assessment, a number are implicit in some of the organisational and assessment issues already discussed. Thus the validity of an assess­ ment which relies to some extent on the observations of other members of the ward team is currently quest­ ionable if those members have received no adequate preparation for this task. There are a number of issues to do with the process of progress assessment which need raising to the level of conscious awareness

of the group as a whole: e.g. the retrospective, sum- mative nature of the report and the need for assess­ ment of progress; the fact that currently very little time is spent talking with the student about her assess­ ment; the need for some formalisation of the casual, unstructured approach involving other train.ed staff; the need for student nurses to be more fully involved in their own progress assessment procedures; the

of subjectivity and sensitivity affecting the processes of progress assessment.

4.16 Regarding attitudes to progress assessment, it was noted that a high percentage of assessors felt that it was ’their job’ to fill in the progress assessment form alone; felt ’no ne e d ’ to go outside the ward amb­ ience for help in progress assessments; and saw 'no difficulty’ concerning the relatively brief discussions with student nurses concerning their progress assessment. These attitudes seem to reflect some degree of exclusive­ ness and complacency concerning some questionable aspects of the current situation which might with advantage be subjected to scrutiny in the educational context of the preparatory course. Similar considerations concern the current reluctance to allow full participation by other team members and the tacit exclusion of nurse managers and partial exclusion of teaching staff from the assess­ ment situation on questionable grounds. Clearly the provision of adequate educational preparation and cont­ inued support could go some way towards dispelling ambi­ valence regarding the value of progress assessment; deal­ ing with the widespread vagueness as to its ’beneficial’ nature; and overcoming the general dearth of creative ideas in the group on possible ways of improving the

present system, which exists in parallel with the group's recognition of the need for improvements.

Overview of Implications Regarding Educational Issues: 1. All assessors should receive a preparatory course. 2. Where appropriate, the content of such courses

should be reviewed to include (e.g.) a discussion of the psychological and educational processes underlying progress assessment.