Assessment of Practice in Pre-Registration Undergraduate Nursing Programmes. Phase 2 Evaluation: Survey of students’ and mentors’ experiences of grading student competence in practice.

Executive Summary Context Local and national concerns regarding competency in newly qualified practitioners provided the impetus for the undergraduate nursing programme team at Bournemouth University to radically change the practice assessment tool as part of a curriculum rewrite in 2005. Alongside the introduction of the new practice profile, an evaluation strategy was implemented with two stages; Phase One focused on year one of implementation and reported at the end of that year (2005-6). These findings were used to inform mentor education and to amend the tool for new students and those moving into year two. This phase used a qualitative approach to collect data from focus groups with students and mentors (Adult Branch only), and practice/HEI educators concerning their experiences of using the grading practice assessment scheme. Phase Two utilised the qualitative findings to develop a questionnaire survey. Questionnaires were selected as the research tool in order to access greater numbers of students and mentors from across all branch programmes. Education staff was not surveyed in this phase. Purpose and project aim The purpose of the project was to evaluate the impact of the new practice assessment scheme from the perspective of the users and to make suggestions to key stakeholders for quality improvement where necessary. Phase One of the evaluation involved small numbers and only Adult branch students; whilst the findings were informative, it seemed important to test these out on a wider sample. The aim of Phase Two of the grading practice evaluation was to explore: • mentor and student experiences of using the assessment tool across all nursing branches • the impact of quality assurance processes Pertinent literature An overview of the historical and current context of practice assessment for nurses in the UK was provided, including the policy literature from the statutory body. Research on practice assessment in nursing was found to be relatively limited particularly concerning the grading of practice. Key studies include Bondy (1983; 1984) and Hillegas & Valentine (1986) from the USA, Glover et al. (1997) from Australia; from the UK, Burns (1992) and Scammell et al. (2007). All studies had limitations but generally the notion of grading practice was well received by users; however there were concerns about quality assurance processes particularly around reliability as well as issues concerning mentor/practice assessor preparation. In light of an increased national emphasis on nurses’ competency in practice, empirical work that evaluates a new practice assessment initiative is timely. Whilst of value locally in terms of reviewing and improving processes, the findings may also interest colleagues elsewhere. Project design A questionnaire survey of mentors and year two and three nursing students was undertaken to investigate their experiences of using the grading practice assessment tool. All branches of nursing were successfully targeted for inclusion using convenience sampling, but no learning disability students opted to participate. Mentors were accessed via an annual mentor conference; students were accessed via tutor groups. 112 (86%) of the 130 mentors available, completed and returned the questionnaire. The branch representation was adult nursing (62.5%; n=70), Mental Health (21.4%; n=24), Child Health (17%; n=19) and Learning Disability (1.8%; n=2). Questionnaires were distributed to 210 students; 107 were completed (51% response). The sample comprised Adult branch (72%; n=77), Mental Health (19.6%; n=21) and Child Health students (8.4%; n=9). The response rate broadly reflected the proportion of students enrolled within each branch of the targeted cohorts. Most student respondents were undertaking year 3 of their programme (70.1%; n=73); the exception was Child Health where all students were undertaking year 2. As an evaluation study, formal ethical approval was not sought; however permission was granted to conduct the evaluation by the Associate Dean for Nursing, and the educational leads within placement areas. There was a project steering group with representatives of all parties including students and mentors; their role was to oversee the project process and to liase with colleagues within their organisations. Quantitative data was coded and inputted into the Statistical Package for the Social Sciences (SPSS for Windows version 15.0); where possible chi-square analysis was undertaken to explore whether the results were significant. Qualitative aspects of the questionnaire were transcribed and a content analysis was undertaken. Given the sample size, it is not possible to generalise from this evaluation. Others may judge transferability to other settings. In reviewing the findings, a number of limitations must be acknowledged. The most significant limitations are that no Learning Disability students opted to participate and the response rate generally from students was not as high as anticipated (51%). This is however a reasonable response rate for a questionnaire survey but if time had permitted, an extension to the convenience sampling may have been beneficial. Other limitations include the fact that findings were generated from reported practice and, as such, may be subject to distortions of memory. Findings Five key areas emerged from the findings: questions around mentor education indicated that participation in updates was high although the sampling process may have introduced some bias. Indeed poor uptake was identified in Phase One, reflecting other studies and anecdotal evidence for the programme team. The findings around support for practice education were mixed; mentors appeared to want more support than was available. Student experience varied according to branch – Mental health students feeling most supported and Child Health the least. However the use of neutral grades was high in both mentor and student groups indicating some cause for concern. Perception on use of the profile in terms of whether it was fit for purpose indicated positive responses overall but some confusion from both students and mentors as to the status of the written sections in comparison with skills performance; the latter was perceived as the top priority. The fourth area focused on how grading ‘worked’ and yielded some valuable perceptions. Generally respondents liked and wanted to grade or be graded in practice. Whilst the majority of mentors claimed to use the descriptors and found them useful, the number who did not use them was of concern. There were mixed perceptions of the appropriate use of second marking, some students perceiving that they were given middle grades due to logistical problems in accessing second markers, although this was not supported by the mentor data. The vast majority of mentors expressed confidence in grading students. However a significant minority responded neutrally or negatively or did not answer the question when asked whether they felt confident to fail a student. This finding is important when considered alongside the neutral response to feeling supported. Finally accountability within the assessment process appeared strong, although at times profiles were signed by staff who had not worked with the student. It is unclear however whether these mentors were primary mentors or those functioning as second markers. Overview of discussion The Phase Two evaluation was broadly supportive of the Phase One findings but extended these to other nursing branches and has provided more useful detail on some of the issues underpinning the grading practice scheme. Quality assurance is a prime issue: the evaluation has shown that reliability of the tool could be improved if the descriptors are clear and robust processes are in place to ensure these are consistently applied. Second marking is another feature of reliability and perceptions varied as to whether this was utilised as much as required and is an issue for programme and placement staff to consider, particularly in the light of inter-branch discrepancies. Students and mentors should be encouraged to constructively make any concerns known. Education around grading and support for mentors was another key area; there perhaps can never be enough support but if any staff have concerns around failing students, this needs to be addressed. The reasons for differing perceptions of support across branches, needs to be explored further. Overall the grading of competency in nursing practice yields far more benefits than problems. It is an innovative scheme, not without challenges; both evaluation phases provide valuable data to focus quality improvement effectively. Conclusion The evaluation captured the views of mentors and students representing all nursing branches, with the exception of Learning Disability students. The issues raised across the branches were broadly similar, notably that the notion of grading practice was welcomed as a means of valuing the practice element of the programme, although implementation was not without challenges. These are reflected in the focus on the quality assurance processes and in fact this is where the branch experience differs most. Mental Health students felt the most supported in placement, were the most likely to receive grades that required to be second marked (indicating full use of the grading range) and were most satisfied that mentor comments matched the grades awarded. In contrast Child Health students were the least satisfied in all these parameters. Adult branch students gave mainly neutral responses which indicate some underlying issues worthy of further investigation. It can be concluded from the mentor data that experience across branches did not differ markedly. The sample accessed updates and most felt confident in grading practice. However almost 18% did not feel confident about failing students and almost another 20% gave a neutral response to this question, indicating a need for further staff development in this area as well as a review of processes designed to support mentors in making these judgements. Recommendations • Explore ways of engaging learning disability students in sharing their perspective on the practice assessment tool and processes. • Increase transparency of communication channels between placement providers and the university regarding practice assessment. - Flowcharts or algorithms for mentors and students might be useful - Include these on the back of each practice profile • Review support mechanisms for students within placements. Identify best practice and include minimal standards on the clinical audit documentation to increase parity between placements and branches. • Investigate peer support schemes for students in practice which include preparation and support for those undertaking this role. • Child Health programme team should review support for students with practice partners to identify specific issues for improvement. • Review level descriptors with students, mentors as well as programme teams to ensure clarity of language and processes. • Re-emphasise the use of descriptors in mentor education as well as student preparation for placement • Review criteria and processes for second marking and emphasise within mentor education. • Disseminate HSC audit of practice profiles on a placement provider organisation basis and include a focus on quality of feedback in relation to grade awarded. • Review current practice around preparing and supporting mentors in failing students and develop an action plan for implementation over the next academic year

The Poverty of Posner\u27s Pragmatism: Balancing Away Liberty After 9/11

This review of Richard Posner\u27s Not a Suicide Pact: The Constitution in a Time of National Emergency argues that Posner\u27s particular brand of pragmatic utilitarianism is particularly ill-suited to constitutional interpretation, as it seems to negate the very idea of precommitment that is so essential to constitutionalism. Instead, Posner treats the Constitution as little more than an invitation to pragmatic policy judgment, and then employs that judgment through speculative cost-benefit balancing to find constitutionally unobjectionable most of what the Bush Administration has done thus far in the war on terror, including coercive interrogation, incommunicado detention, warrantless wiretapping, and ethnic profiling. Indeed, Posner\u27s Constitution would permit the Administration to go much further than it has - among other things, he defends indefinite preventive detention, banning Islamic extremist rhetoric, mass wiretapping of the entire nation, and making it a crime for newspapers to publish classified information. All of this is permissible, Posner argues, because unless the Constitution bend[s] in the face of threats to our national security, it will break. Ironically, Posner reaches these results with a constitutional theory more in keeping with Chief Justice Earl Warren than Justice Antonin Scalia. Eschewing popular conservative attacks on judicial activism, Posner argues that given the open-ended character of many of the Constitution\u27s most important terms, it is not objectionable, but inevitable, that constitutional law is judge-made. He dismisses the constitutional theories of textualism and originalism favored by many conservative judges and scholars as canards. But having rejected textualism and originalism, Posner proceeds unwittingly to offer a book-length demonstration of what textualists and originalists most fear from constitutional theorists who emphasize the document\u27s open-ended and evolving character. In Posner\u27s approach, the Constitution loses almost any sense of a binding precommitment, and is reduced to a cover for judges to impose their own subjective value judgments on others. The review first discusses Posner\u27s analysis of several specific security-liberty issues, in order to illustrate how his method works in concrete scenarios. I then turn to the broader implications his theory has for constitutional law, which in my view are quite dangerous

Configuring the caller in ambiguous encounters: volunteer handling of calls to Samaritans emotional support services

This paper discusses volunteer strategies for handling and assessing calls to Samaritans emotional support services for the suicidal and despairing. It presents findings from the qualitative components of a two year mixed methods study based on an online caller survey, branch observations and interviews with volunteers and callers throughout the UK. A thematic analysis of the qualitative data analysis was undertaken using the principle of constant comparison. Many calls fell beyond the primary remit of a crisis service, and called for rapid attribution and assessment. Uncertainty about identifying ‘good’ calls and recognizing those which were not caused difficulty, frustration and negative attribution towards some callers. This paper presents our analysis of volunteers’ accounts of how they configure the caller in intrinsically uncertain and ambiguous encounters, and how such strategies relate to the formal principles of unconditional support and non-judgemental active listening espoused by the organization

A Multiple Criteria Framework to Evaluate Bank Branch Potential Attractiveness

Remarkable progress has occurred over the years in the performance evaluation of bank branches. Even though financial measures are usually considered the most important in assessing branch viability, we posit that insufficient attention has been given to other factors that affect the branches’ potential profitability and attractiveness. Based on the integrated used of cognitive maps and MCDA techniques, we propose a framework that adds value to the way that potential attractiveness criteria to assess bank branches are selected and to the way that the trade-offs between those criteria are obtained. This framework is the result of a process involving several directors from the five largest banks operating in Portugal, and follows a constructivist approach. Our findings suggest that the use of cognitive maps systematically identifies previously omitted criteria that may assess potential attractiveness. The use of MCDA techniques may clarify and add transparency to the way trade-offs are dealt with. Advantages and disadvantages of the proposed framework are also discussed.

The Emotional Self-Efficacy Scale: Adaptation and Validation for Young Adolescents

Emotional self-efficacy (ESE) is an important aspect of emotional functioning, with current measures for children and adolescents focused on the measurement of self-beliefs in relation to the management of emotions. In the present study, we report the psychometric properties of the first adaptation of the Emotional Self-Efficacy Scale for youth (Youth-ESES) that measures additional aspects of ESE, such as perceiving and understanding emotions and helping others modulate their emotions. Participants were 192 young adolescents aged 11 to 13 years from a U.K. state school. They completed the Youth-ESES and measures of ability emotional intelligence (EI) and cognitive ability. Results support the same four-factor structure that has been previously documented using the adult version of the ESES, with the four subscales being largely independent from cognitive ability and only moderately related to ability EI. However, the four subscales were less differentiated in the present study compared with adult data previously published, suggesting that there is a strong general factor underlying young adolescents’ ESE scores. Overall, the results suggest that the adapted Youth-ESES can be reliably used with youth, and that confidence in how a young person feels about his or her emotional functioning remains distinct from emotional skill

Profitability as a basic criterion of efficient management

The paper deals with the application of the basic indicator of evaluating profitability in the context with alternative costs. The aim of this paper is the evaluation of the efficiency of handling financial means of stockholders with companies traded on the stock exchange by means of the basic comparative indicator of profitability of equity in cooperation with statistical functions and its comparison with the values of costs of equity and safe interest rate.profitability, return on equity, cost of equity, safe interest rate, stock exchange

Interpreting Performance in Small Business Research

For obvious reasons, researchers and policy-makers alike have an interest in assessing the performance of small firms as well as in understanding the factors that contribute to it. Attaining such knowledge is not a trivial undertaking. Researchers have pointed out that the performance of small firms can be difficult to assess (Brush & Vanderwerf, 1992)—e.g., because reliable data cannot be obtained—and also difficult to predict (Cooper, 1995). In this paper I will discuss the equally important and difficult issue of how research results regarding small business performance and its predictors can or should be interpreted. In particular, I will discuss whether commonly used performance indicators like survival vs. non-survival and growth vs. non-growth really reflect ‘good’ vs. ‘bad’ performance, as is commonly assumed. Although theory and other researchers’ findings will also be used to some extent, my exposition will rely primarily on experiences and illustrations from a number of research projects I have been directly involved in during the last 20 years. The paper proceeds as follows. I will first question the assumption that business discontinuance—often called ‘failure’—is a ‘bad’ outcome that best should be avoided from the aggregate perspective of the economic system. I will then continue to discuss ‘failure’ from more of a micro-perspective, arguing that most instances of discontinuation of new or emerging firms are not associated with substantial financial losses and do not necessarily represent efforts that should have been avoided. Staying at the micro level I will then turn to the issue of firm growth and the conditions under which growth represents a ‘good’ outcome from the perspective of the firm’s principal stakeholders. I will then return to the aggregate level and discuss the extent to which firm level employment growth translates to net increases of employment in the economy. Finally, the implications of the issues raised in the paper will be restated and discussed in the concluding section of the paper

On Essence and Masurement of Changes in Competitiveness of the Accession Countries. Critical Review of Literature

Although competitiveness is a world very often used in literature it is seldom to be found in economic textbook which prefer the term comparative advantage much narrowly defining formula describing international specialization. As Porter underlines comparative advantage and competitiveness (competitive advantage) do not overlap because competitiveness is much wider concept. Competitiveness is an ambiguous notion. In literature there are many approaches to competitiveness and many ways of defining and measuring it. Partly it is a result of the lack of general theory of competitiveness and the fact that this category is of business rather than theoretical origins. Paper systematizes and presents results of analysis on competitiveness of the accession countries which are based on three approaches to competitiveness: macro, micro and trade approach.competitiveness, productivity, transition economies, manufacturing industry, EU integration

In silico modeling of oxygen-enhanced MRI of specific ventilation.

Specific ventilation imaging (SVI) proposes that using oxygen-enhanced 1H MRI to capture signal change as subjects alternatively breathe room air and 100% O2 provides an estimate of specific ventilation distribution in the lung. How well this technique measures SV and the effect of currently adopted approaches of the technique on resulting SV measurement is open for further exploration. We investigated (1) How well does imaging a single sagittal lung slice represent whole lung SV? (2) What is the influence of pulmonary venous blood on the measured MRI signal and resultant SVI measure? and (3) How does inclusion of misaligned images affect SVI measurement? In this study, we utilized two patient-based in silico models of ventilation, perfusion, and gas exchange to address these questions for normal healthy lungs. Simulation results from the two healthy young subjects show that imaging a single slice is generally representative of whole lung SV distribution, with a calculated SV gradient within 90% of that calculated for whole lung distributions. Contribution of O2 from the venous circulation results in overestimation of SV at a regional level where major pulmonary veins cross the imaging plane, resulting in a 10% increase in SV gradient for the imaging slice. A worst-case scenario simulation of image misalignment increased the SV gradient by 11.4% for the imaged slice