Los jornaleros y el trabajo fabril

The aims of this element of the evaluation were to: a) measure competence, self-report competence and self-efficacy; b) explore any differences between cohorts and student entry gates; and c) explore the relationship between competence, self-report competence and self-efficacy.

2.4.8 Sampling

Participants in this phase were student nurses and midwives from 2004 cohort (n = 44) and 2005 cohort (n = 55) from Scottish HEIs whose pre-registration programmes were funded through the SGHD contract. All participants who returned the questionnaire from the phase 1 postal survey were then invited to take part in this phase and 99 participants eventually completed agreed.

The extent to which this sub-sample was representative of the larger sample from which they were sampled, was tested by Mann Whitney U-Test, Chi-Square Test or Student’s T- Test. The sub-sample of students in this element of the study differed significantly from the main sample in terms of their programme (χ² = 13.196, df = 4, p = 0.01), entry qualifications (χ² = 6.387, df = 1, p = 0.011), greater age (U = 24245.0; p < 0.001) and higher self-report- competency scores (t = 2.431, df = 688, p = 0.02). Self-efficacy scores did not differ significantly between sub-sample and main sample (U = 29541.5, p = 0.673).

2.4.9 Data Collection

The OSCE assessors undertook training prior to the main data collection point. Two pilot sessions with student nurses were also undertaken and as a consequence, changes were made to the design of all the tests. Students who returned completed questionnaires as part of the earlier postal survey were given a date and time to arrive at the clinical skills centre in their HEI. On arrival each student was fully informed of the procedure, asked once again if they wished to participate and, if they agreed, to provide written informed consent. Then the two-station OSCE and pencil-and-paper test then commenced. There was one examiner at each station and one person who ensured that all the stations ran efficiently. Stations lasted between five to ten minutes. There was no set order of processing through stations and once the student completed a station they were then directed immediately to the next station. Students had been informed they would receive a £10 book token for participating. This amount is generally thought to be large enough to act as an incentive but not sufficiently large to influence behaviours.

2.4.10 Measures 2.4.10.1 Demographics

A range of demographic data were collected which included age, gender, programme and cohort. Two single-year cohorts from the 2004 and 2005 intakes were recruited. Entry gate was a dichotomous variable with the NMC minimum entry gate of five standard grades and above group and a wider access group. The wider access group includes all students who entered the course from any route other than the NMC minimum entry requirement of five standard grades and above.

2.4.10.2 Competency

Competency was measured in a two-station OSCE and a paper-and-pencil numeracy test which reflected a pragmatic selection of three core dimensions of the NHS Knowledge and Skills Framework (DH 2003), which is a framework for the knowledge and skills for NHS staff. The skills selected are fundamental skills taught and assessed in both nursing and midwifery curricula.

The measures used in this phase complement and extend the self-report competency measure employed in the postal survey and thus, provide an opportunity for methodological and theoretical triangulation of competency measurement. The communication skill OSCE (Appendix 2) was adapted by the research team from Simulated Client Interview Rating Scale (Arthur 1999). The original scale had 39 items and measured basic communication and motivational interviewing skills. The adapted version of the Simulated Client Interview Rating Scale consisted of 11 items. These items represent core communications skills, which apply across many clinical contexts. Items on the revised scale were scored on a three-point response format (‘not done’ ‘done’ ‘done well’). The potential scores ranged from 11-33; with higher scores representing greater levels of competence Cronbach’s alpha for this survey was 0.85.

The paper-and-pencil numeracy test (Appendix 3) was adapted by the research team from the instrument developed by Wright (2005). Paper-and-pencil tests have a long-established track record in testing ‘clinical’ skills and have been reported to have a very high correlation (г = 0.89) with performance tests in final year medical students (van der Vleutan et al 1989). The test focused on testing basic numeracy skills such as proportions, ratios, percentages, fractions and problems solving. The adapted version consisted of 24 items. All the drug names used in the test were fictional as the main focus was on the numerical skills of the students. The potential scores ranged from 0-24, with higher scores representing greater levels of competence. Cronbach’s alpha for this survey was 0.87.

The hand decontamination OSCE (Appendix 4) was adapted by the research team from the work of Major (2005). The adapted version consisted of a hand decontamination procedure that was viewed as having ten separate and observable actions, each of which were scored on a dichotomous ‘unsatisfactory’ or ‘satisfactory’ response format. The potential scores ranged from 0-10, with higher scores representing greater levels of competence.

2.4.10.3 Self-efficacy

Self-efficacy was measured by the General Perceived Self-Efficacy Scale (GPSE). This measure has been described previously.

2.4.10.4 Self-report competence

Self-report competence was measured by the Short Nursing Competencies Questionnaire (SNCQ). This measure has been described previously.

2.4.10.5 Support

Support was measured by four-item scale developed for the project. This measure has been described previously.

2.4.11Data Analysis

Data were analysed using the SPSS programme. Kolmogorov-Smirnoff Tests of normality revealed that variables in the analysis, with the exception of self-efficacy, had a non-normal distribution. Attempts at transformation using log-10 and square root transformations were unsuccessful and consequently non-parametric tests were used with these variables. The non-normal distributions were expected as the whole point of assessment of skills in a curriculum is to get as many students close to the maximum as possible and, therefore, a strong ceiling effect may be inevitable in many specific competencies. Descriptive tests reported include modes and quartiles. Tests of difference include Chi-Square Test, Mann- Whitney-U Test and the Kruskal-Wallis Test for variables with non-normal distributions and Student’s T-Test used in the normally distributed variable. Tests of association include Spearman and Pearson.