The role of performance feedback in the self-assessment of competence: a research study with nursing clinicians

Performance feedback has the potential to contribute to a nurse's self-awareness and, in turn, their ability to self-assess their level of competence. Because a declaration of self-assessment of competence is a current requirement for continuing nursing registration within South Australia, Queensland and Tasmania, the search to identify sources and processes that may assist nurses to self-assess their performance is potentially of benefit to the profession. This paper is based on one aspect of a PhD study exploring the utility of performance feedback primarily from a nursing clinicians' perspective. Focus group interviews were conducted with hospital-based nursing clinicians and the data were analysed using a process of thematic analysis. Findings highlighted that nursing clinicians frequently engaged in a process of performance self-monitoring that was a balance between feeling competent and feeling uncertain in relation to their own level of clinical competence. On a daily basis, nursing clinicians held an assumption of competence to practise that was based on their ability to act in a situation, receiving positive feedback from others and in the absence of evidence to the contrary. At times feelings of doubt or uncertainty intervened especially in situations that were unfamiliar or challenging or when receiving feedback from others that questioned their own perceptions of competence. The findings of the study provide support for the types of self-monitoring processes that serve to enhance both the relevance of feedback for nurses and the quality of evaluative data regarding ongoing competence.     

Interpreting the value of feedback: Older adult voices in nursing education

As patients, older adults are often involved informally with the teaching of nursing students in clinical environments. This involvement is recognised as valuable; however, the role of the patient is often passive. In recent years there has been recognition of the value that real people's lives, and health experiences can bring to student education, so much so that many programs now incorporate real patients into the formal education of students. In this educational initiative, older adults, from a Residential Aged Care Campus (RACC), participated as simulated patients in scenario based clinical learning activities, providing feedback to nursing students on the carative aspects of the learning activities.The aim of this study was to contribute toward the body of knowledge in engaging older adults in simulated clinical activities, specifically in the provision of feedback to nursing students. A qualitative interpretive methodology was applied to capture the older adults’ experiences of providing feedback as simulated patients. This included the collection of data through participant observation, recording of field notes, collection of a written feedback form and semi-structured interviews with the participants. Thematic analysis was undertaken to identify emergent themes in the data.Findings from this study have emphasised the value of including the patient voice in nursing education. The provision of feedback by older adults during direct care interactions supports and nurtures student awareness of the patient and the caring process of nursing. Unique to this study, was the finding that although the participants received no formal training in the delivery of feedback, all utilised a clear process recognised within the literature. A recommendation linked to this finding is that a feedback training program would be of benefit in reducing some of the feelings of uncertainty expressed by the older adults when giving feedback and better equipping them to deliver constructive feedback.     

护理专业文理科学生学习成绩的对比分析研究

目的探讨护理专业文理不同来源学生的学习成绩是否存在差异，为护理高等教育提供参考。方法将护理专业文理不同来源学生在校4年所学的全部课程成绩进行统计对比分析。结果文理不同来源学生在基础课学习成绩中部分存在差异，专业课成绩差异无统计学意义。结论对学习成绩存在差异的课程作适当的教学调整，可消除这些课程学习成绩的差异，使文理不同来源的学生达到一致的教学目标。护理专业文理科兼招是可行的。     

Nurses’ perceptions of feedback to nursing teams on quality measurements: An embedded case study design

BackgroundProviding nursing teams with feedback on quality measurements is used as a quality improvement instrument in healthcare organizations worldwide. Previous research indicated contradictory results regarding the effect of such feedback on both nurses’ well-being and performance.ObjectivesBuilding on the Job Demands-Resources model this study explores: (1) whether and how nurses’ perceptions of feedback on quality measurements (as a burdening job demand or rather as an intrinsically or extrinsically motivating job resource) are respectively related to nurses’ well-being and performance; and (2) whether and how team reflection influences nurses’ perceptions.DesignAn embedded case study.SettingsFour surgical wards within three different acute teaching-hospital settings in the Netherlands.MethodsDuring a period of four months, the nurses on each ward were provided with similar feedback on quality measurements. After this period, interviews with eight nurses and the ward manager for each ward were conducted. Additionally, observational data were collected from three oral feedback moments on each of the participating wards.ResultsThe data revealed that individual nurses perceive the same feedback on quality measurements differently, leading to different effects on nurses’ well-being and performance: 1) feedback can be perceived as a job demand that pressures nurses to improve the results on the quality measurements; 2) feedback can be perceived as an extrinsically motivating job resource, that is instrumental to improve the results on quality measurements; 3) feedback can be perceived as an intrinsically motivating job resource that stimulates nurses to improve the results on the quality measurements; and 4) feedback can be perceived neither as a job demand, nor as a job resource, and has no effect on nurses’ well-being and performance. Additionally, this study indicates that team reflection after feedback seems to be very low in practice, while our data also provides evidence that nursing teams using the feedback to jointly reflect and analyse their performance and strategies will be able to better translate information about quality measurements into corrective behaviours, which may result in more positive perceptions of feedback on quality measurements among individual nurses.ConclusionsTo better understand the impact of feedback to nursing teams on quality measurements, we should take nurses’ individual perceptions of this feedback into account. Supporting nursing teams in team reflection after them having received feedback on quality measurements may help in eliciting positive perceptions among nurses, and therewith create positive effects of feedback on both their well-being and performance.     

Mental health nursing students differ from other nursing students: Some observations from a study on stress and coping

The study reported here is taken from a wider investigation into stress among preregistration nursing students, undertaken in the nursing department of a large university in northern England. British nursing is divided into four specialties or 'branches': adult, mental health, children's, and learning disability nursing, and the aim of the study was to explore interbranch differences among the students in terms of the sources of stress they identify, the levels of stress they experience, and the ways in which they cope. A cross-sectional survey of all nursing students on the department's roll (n = 1362), using a range of self-report measures bound together in a 'questionnaire pack', was undertaken. The questionnaire pack contained formal measures of sources of stress (Student Nurse Stress Index), stress (specifically, psychological distress) (General Health Questionnaire) and coping (Coping Inventory for Stressful Situations), as well as a set of questions that enabled data on a range of pertinent variables, including the nursing branch being pursued, to be collected. The findings revealed that mental health nurses were notably different from the other three branches in terms of the quantity and characteristics of the sources of stress they faced, the levels of stress they experienced, and the ways in which they coped. These differences were largely advantageous to the students' well-being and speculations are made as to whether the concept of 'hardiness'- especially its focus on a sense of being in control - plays a role in explaining the findings.     

我院聘用护士工作现状的调查与分析

目的了解聘用护士在工作态度、工作表现及专业技术水平、具备能力和绩效等方面存在的问题。方法对聘用护士与正式编制护士的理论、操作考试成绩及每个结构的要素条目逐一进行统计学分析。结果聘用护士的各项得分较正式编制护士低。理论成绩、智力结构、能力结构3项差异具有统计学意义(P<0.05),智力结构、能力结构中的大部分测评要素,专业知识、操作水平、处事能力、表达能力、应急能力、创新能力差异具有统计学意义(P<0.05),表明聘用护士在上述方面与正式编制护士存在差异。结论通过综合测评,管理者从源头去寻找管理方法、手段和激励机制,以激发聘用护士以最好的工作态度、最佳的技术水平投入护理工作。     

The relationship between feedback and evaluative judgement in undergraduate nursing and midwifery education: An integrative review

AimThis integrative review aims to explore the relationship between feedback and evaluative judgement in undergraduate nursing and midwifery education.BackgroundResearch in higher education has shown that feedback practices can lead to students’ developing evaluative judgement; thought critical for performance improvement and life-long learning. While literature in nursing and midwifery education has not yet employed the term ‘evaluative judgement’ explicitly, there might be similar concepts and practices that seek to develop students’ judgement of performance that sustain learning beyond the immediate task.DesignAn integrative review of the nursing and midwifery feedback literature.MethodsIn February 2020, six online databases (CINAHL, ProQuest, Scopus, ERIC, PsycINFO, Ovid MEDLINE) were systematically searched for literature published between January 1989-February 2020. Synonyms for feedback and evaluative judgement were used to inform our search. This review included a rigorous team-based, five-stage approach: (1) identifying the problem; (2) conducting the search; (3) evaluating the data; (4) analysing the data; and (5) presenting the integrative review.ResultsA total of 1408 studies were initially retrieved with 543 duplicates. 865 abstracts were screened using eligibility criteria, resulting in the exclusion of 835 studies. Thirty full-text studies were appraised for quality. Eighteen studies with diverse methodologies achieved a medium-high quality score for inclusion in data analysis. Conceptions of feedback and evaluative judgement were identified in all studies; despite none using the term 'evaluative judgement' explicitly. Thematic analysis of the studies resulted in seven themes: conceptions of feedback, purposes of feedback, sources of feedback, modes of feedback, conceptions of evaluative judgement, purposes of evaluative judgement and relationships between feedback and evaluative judgement.ConclusionsWhile our findings supported contemporary higher education research, the feedback-evaluative judgement relationship is novel in nursing education. We encourage educators to design feedback activities privileging students’ active engagement through dialogic feedback, reflection and self-assessment, to develop their evaluative judgement of practice.     

结构化引导性反馈在高仿真情景模拟护理教学中的应用

目的评价结构化引导性反馈在高仿真情景模拟护理教学中的应用效果。方法2017年8月—2019年6月,采取方便抽样的方法,选择2016级护理本科班学生为试验组,共70人;选择2015级护理本科班学生为对照组,共62人。对照组仅采用引导性反馈方法,试验组实施结构化引导性反馈方法。采用护理高仿真模拟教学学生行为表现自评量表、考核成绩比较干预的效果。结果课程结束后,试验组学生护理高仿真模拟教学学生行为表现自评量表得分高于对照组,差异有统计学意义(P<0.05)。两组学生情景模拟成绩及总成绩比较,差异无统计学意义(P>0.05)。结论结构化引导性反馈能提高学生的临床能力,改善教学效果,但仍有改善的空间。     

Enhancing nursing students' clinical placement experiences: a quality improvement project

Clinical experience is recognised as the core of nursing education. Quality clinical placements across a variety of venues are vital to the development of capable and competent professionals. However there is evidence, both anecdotal and empirical, suggesting that students' clinical placement experiences are fraught with problems. The quality improvement project described in this paper aimed to improve the clinical learning experience of nursing students by strengthening communication and partnerships between the university and the two local health services. To achieve this goal, clinicians' perceptions of the problems related to clinical placements and their recommendations for improvement were explored. Focus groups, brainstorming sessions, personal interviews and surveys were used to collect qualitative and quantitative data. Problems and priority issues were identified as more than five hundred clinicians expressed their concerns, claims and issues. Key findings from the project are described under five themes: communication breakdown between the university and clinicians; mentorship; preparation for clinical placements; clinical competence; and graduates' readiness for practice. Utilising a quality improvement framework this project promoted vigorous debate and dialogue between university and health service partners. The nature and extent of the problems surrounding clinical placements were examined, high priority issues targeted for improvement, and the subsequent results measured through feedback from clinicians and students. The success of this project, although impressive in the early stages, will depend upon ongoing communication and evaluation to ensure sustainability of the improvements made.     

Nursing practice draws upon several different ways of knowing

? This paper explores the proposition that nursing practice draws upon several different ways of knowing. ? It highlights difficulties often faced by practising nurses in defining what they do and hence what it is that constitutes nursing practice. ? Following formal definition and analysis of sources of literature regarding nursing knowledge, issues such as the origins of knowledge and the sources of nursing knowledge are addressed. ? The types of knowledge required to enhance nursing practice are discussed, focusing upon future opportunities and innovations in the generation of knowledge for nursing. ? Finally, recommendations are made regarding the way forward for nurses endeavouring to communicate the complexities of nursing practice.     

Applications of generalizability theory to estimate the variance components in basic nursing technical tests

The purpose of this study was to estimate the variance components in basic nursing technical tests by applying the generalizability theory. The 55 subjects in this study were selected at random from among second year nursing students enrolled at a 5-year junior college. A two-facet crossed design (i.e. p x i x r design) in the Generalizability Theory was used for this study, with students treated as the objects of measurement and items and raters treated as measurement facets. GENOVA software was used as the primary data analysis tool, followed by two additional steps, i.e., the G and D studies. G study findings were as follows: the examinee was the main source of variation was the examinee, with p x r representing a secondary source and the interaction of p x i x r representing a third. Nearly all variance (97.77%) was represented by these three factors. Another four sources of variation identified had only insignificant effect. The finding in the D study was that increasing rater numbers can promote reliability in basic nursing technical performance assessments. These findings are expected to provide a reference for teachers charged to develop or revise basic nursing technical tests.     

Strategic planning for nursing

Strategic planning is a systematic approach to decision making. Nurse administrators who rely on formal planning and measurement of outcomes are more likely to assure consistent high performance from their departments than those who rely on intuition. Planning can serve as motivation for nursing personnel if they are allowed to have some input into it. Not only is nursing practice advanced by strategic planning, as this article shows, but scarce resources can be conserved.     

Teaching undergraduate students community nursing: using action research to increase engagement and learning

Nurses play a pivotal role in responding to the changing needs of community health care. Therefore, nursing education must be relevant, responsive, and evidence based. We report a case study of curriculum development in a community nursing unit embedded within an undergraduate nursing degree. We used action research to develop, deliver, evaluate, and redesign the curriculum. Feedback was obtained through self-reflection, expert opinion from community stakeholders, formal student evaluation, and critical review. Changes made, especially in curriculum delivery, led to improved learner focus and more clearly linked theory and practice. The redesigned unit improved performance, measured with the university's student evaluation of feedback instrument (increased from 0.3 to 0.5 points below to 0.1 to 0.5 points above faculty mean in all domains), and was well received by teaching staff. The process confirmed that improved pedagogy can increase student engagement with content and perception of a unit as relevant to future practice.     

An empirical analysis of a clinical assessment tool

A tool to measure clinical performance was required by a college-based programme for undergraduate nursing students. Multiple tools currently exist, but after extensive literature review the researchers decided that no tool exactly fitted the requirements of this nursing course. The tool developed by Bondy (1983) was most aligned to our purposes and was used as the basis for the ongoing development of the Clinical Performance Assessment instrument. The CPA measures four dimensions of clinical performance against a 5-point rating scale. Each Likert point has specific criteria for the level relating to the dimensions. The clinical facilitator compares student behaviours against the performance levels of the dimensions for a variety of nursing procedures which are determined by the stage of the program the student has reached. Scores are given for the four dimensions and immediate student feedback is available. Measures were taken on six separate clinical occasions across 2 years on over 100 students in an attempt to determine validity and reliability indices. Relations between variables that appeared to have logical/theoretical connections with the clinical scores were assessed. The findings indicated that scores lacked reliability across the six occasions of measurement and hence validity could not be established. The need to improve the specificity of critical dimensions in clinical performance for the purposes of providing reliable measurement and accurate student feedback was acknowledged by academic staff and the researchers.     

Feedback: an essential element of student learning in clinical practice

Clinical practice is an essential component of the nursing curriculum. In order for the student to benefit fully from the experience regular performance feedback is required. Feedback should provide the student with information on current practice and offer practical advice for improved performance. The importance of feedback is widely acknowledged however it appears that there is inconsistency in its provision to students. The benefits of feedback include increased student confidence, motivation and self-esteem as well as improved clinical practice. Benefits such as enhanced interpersonal skills and a sense of personal satisfaction also accrue to the supervisor. Barriers to the feedback process are identified as inadequate supervisor training and education, unfavourable ward learning environment and insufficient time spent with students. In addition to the appropriate preparation of the supervisor effective feedback includes an appreciation of the steps of the feedback process, an understanding of the student response to feedback and effective communication skills.     

Upward feedback in nursing: A matter of giving,taking and asking

The educational program for nurses takes place in school and at the workplace. At the workplace, student nurses and their supervisors work together while providing the best care for their patients. In this context, it is important that both, students and supervisors, provide feedback to each other. However, it can be difficult for nursing students to provide feedback to professionals who are higher up in the hierarchy. The goal of this study is to investigate the factors that facilitate nursing students to provide so-called upward feedback and nursing supervisors to receive it. Seven focus groups of nursing students (n = 40) and two focus groups of nursing supervisors (n = 12) were organized. The qualitative data analyses of the focus group interviews and a literature study show that a feedback-friendly culture is essential in enabling upward feedback. The following aspects contribute to a feedback-friendly culture: (1) the role of the feedback receiver, (2) the role of the feedback provider, (3) relations between feedback receivers and providers and (4) the context. This study shows that nursing students and supervisors are open to provide and receive upward feedback. However more attention is needed in nursing education for the factors that facilitate this process.     

Being a nurse in nursing home for patients on the edge of life

Nurses in nursing homes care for patients with complex health problems that need to be followed up by medical treatment. Most patients benefit from the treatment, but for some the treatment seems only to lengthen their death process. Sometimes questions are raised as to whether life-sustaining treatment should be withheld/withdrawn. Decisions related to such questions are difficult to make as some patients are 'on the edge of life', which is understood as a transition between living and dying with an unpredictable outcome, whether the illness will lead to recovery or dying. The aim of this study was to acquire a deeper understanding of what it is to be a nurse in a nursing home for patients on the edge of life. The research design was qualitative, based on hermeneutic phenomenology. Fourteen nurses at two nursing homes were interviewed twice. The result shows that when facing a patient on the edge of life, the nurses were challenged as professionals and as human beings. Two main themes were identified, which included two sub-themes each. The first main theme: 'striving to do right and good for everyone' included the sub-themes 'feeling certain, but accompanied by uncertainty' and 'being caught between too much responsibility and too little formal power'. The second main theme: 'being a vulnerable helper – the prize and the price', contained the sub-themes 'needing emotional protection in professional commitment' and 'feeling undervalued in spite of professional pride'. The essence was: 'being a lonely and enduring struggler between opposite poles'. The findings revealed paradoxes in nurses' work which might threaten nurses' professional identity and put heavy demands on their professional performance. There is a need for formal involvement in end-of-life decisions from nurses, further education and support to nurses related to patients on the edge of life.     

护理人员学历教育现状及需求调查

目的 :为了解护理人员学历教育现状和对学历教育的需求。方法 :采用问卷对6所医院 2 63名护理人员进行调查。结果 :不同年龄组护理人员的学历程度以及参加学历教育的人数均具有统计学意义 (P <0 .0 5 )。护理人员在学习中遇到的困难依次为 :工学矛盾、缺少老师辅导、缺乏信心及基础差学习困难。没有时间和精力是影响护理人员参加学历教育的主要因素。结论 :护理管理者必须制定有效的激励机制 ,以提高护理人员参加学历教育的积极性     

360度反馈评价表在重症医学科护理岗位管理中的应用

目的通过有效的评价方式促进护理岗位管理工作的顺利开展。方法采用360度反馈评价方法设计评价表,分别以护士长、医生、责任组长、同事、本人5个角度,对工作业绩、工作能力、工作态度3方面进行评价,分别以10%~40%的权重获得总分,纳入岗位考核,成为晋升晋级的参考指标。结果评价表回收率为70.77%,主管护师与护师及护士之间有显著性差异,评分结果与年龄、工龄明显正相关,年资越高,评分越高。结论 360度反馈评价方法是一种科学的评价手段,能够客观公正地对护士能力及态度进行判断,有利于护理岗位管理工作的开展。     

Using a nursing balanced scorecard approach to measure and optimize nursing performance

The authors give an overview of one healthcare organization's experience in developing a nursing strategic plan and nursing balanced scorecard (NBS) using a focused planning process involving strategy mapping. The NBS is being used at this organization to manage the nursing strategic plan by leveraging and improving nursing processes and organizational capabilities as required, based on data and transparent communication of performance results to key stakeholders. Key strategies and insights may help other nurse leaders in developing or refining strategic approaches to measuring nursing performance. Vital to the success of an organization's strategic plan are ongoing endorsement, engagement and visibility of senior leaders. Quality of decisions made depends on the organization's ability to collect data from multiple sources using standardized definitions, mine data and extract them for statistical analysis and effectively present them in a compelling and understandable way to users and decision-makers.