The learner as co-creator: A new peer review and self-assessment feedback form created by student nurses

BackgroundEngagement with peer review and self-assessment is not always regarded by student nurses as an activity that results in a positive learning experience. Literature indicates that withdrawal from the learning process becomes attractive to individuals affected by a negative experience of peer review. Literature also provides examples of student nurses' feeling ‘torn to shreds’ during the process of peer review, resulting in loss of confidence and self-esteem. An influencing factor in such situations appears to be the absence of specific learner-driven criteria against which student nurses can assess peer and self-performance. The idea was thus ignited, that creation and utilisation of a learner-driven feedback form might potentially prevent, or at least minimise, the possibility of negative peer review experience.ContextSet within the context of a pre-registration nursing programme, within a Higher Education institution, student nurses (n = 25), created a peer review/self-assessment feedback form. Its potential cross-discipline, global applicability is reasonably speculated.MethodsPurposive sampling, followed by Stratified Random sampling, maximised participant variation. Data collection took place on 34 occasions, utilising focus group discussions using Nominal Group Technique, a practical task which was video recorded for mediating artefact purposes, and individual interviews. Analysis was concept and theme driven.FindingsThe study found that participants desired a new feedback form that specifically asks the evaluator to judge human qualities, such as ‘compassion’ and ‘kindness’, in addition to the skills and knowledge criteria that any peer review or self-assessment form used currently had incorporated.ConclusionProviding the participants with the opportunity to develop criteria, against which performance could be measured, with emphasis being afforded to student inclusivity and resultant shift in power balance from the educator to the learner, embraces the idea of teaching and learning in the 21st Century.     

Dynamic online peer evaluations to improve group assignments in nursing e-learning environment

ObjectivesThe purpose of this research was to evaluate the use of online peer evaluation forms for online group activities in improving group project outcomes.DesignThe investigator developed and used a web-based Google Forms® self and peer evaluation form of 2 group assignments' rubric for junior and senior nursing students. The form covered elements of the assignments including: research activity, analysis of the literature, writing of report, participation in making of presentation, overall contribution to the project, and participation in the weekly group discussions. Items were rated from 1 (did not contribute) to 5 (outstanding contribution) in addition to NA when one activity did not apply.ProcedureThe self and peer evaluation process was conducted twice: once after group assignment 1 and once after group assignment 2. The group assignments final products were done in the form of VoiceThread online presentations that were shared with the rest of the class reflecting the groups' work on a health informatics topic of interest.Data sourcesData collected as the students completed self and peer evaluations for group assignments 1 and 2. Also, optional comments regarding member performance were collected to add contextual information in addition to ratings. Students received credit for completing the peer evaluations and the grade for the particular assignment was affected by their performance based on peer evaluations of their contributions.ResultsStudents' peer evaluations showed in a color-coded spreadsheet which enabled the course faculty to view real time results of students' ratings after each assignment. The faculty provided timely and tailored feedback to groups or individuals as needed, using positive feedback and commending high performance while urging struggling individual students and groups to improve lower ratings in specific areas. Comparing evaluations of both assignments, there were statistically significant improvements among all students. The mean scores of the entire sample were skewed toward the higher end of the scale, suggesting an overall high performance group. However, analysis of the lower performing individuals showed consistent and statistically significant improvements in all areas of the evaluation criteria.ConclusionsAnonymous peer evaluation activities and timely faculty feedback in e-Learning environment can be a useful tool to faculty to improve group performance over time by engaging the learners within their groups. Peer evaluations provided real time view of group mid-semester formative evaluations that allowed the faculty to provide timely and tailored feedback on student performance which allowed for better outcomes.     

Medication administration evaluation and feedback tool: Inter-rater reliability in the clinical setting

AimsThis study assessed the inter-rater reliability, acceptability and usability of the Medication Administration Evaluation and Feedback Tool for nurses in the clinical setting.BackgroundMedication administration is a complex nursing task requiring multiple steps to ensure safe and accurate delivery of medications to patients. Currently, registered nurses are not routinely provided the opportunity for regular review of their practice. The Medication Administration Evaluation and Feedback Tool has been previously validated in the simulated environment.MethodsFour nurse observers were trained to use the tool. Thirty nurses participated to be observed in the clinical setting. Each nurse was assessed simultaneously by two observers. Inter-rater reliability was assessed using Fleiss’ Kappa coefficient. A postobservation survey was conducted to assess user acceptability. The Guideline for Reporting Reliability and Agreement Studies Enhancing the Quality and Transparency of Health Research was used.ResultsThe observed agreement between observers using the Medication Administration Evaluation and Feedback Tool in clinical practice was 0.90 and Fleiss’ kappa coefficient was 0.77 demonstrating excellent agreement and inter-rater reliability. Both nurses and observers reported the tool was useful and practical for use in evaluating medication administration practice in the clinical environment.ConclusionsInter-rater reliability testing of the Medication Administration Evaluation and Feedback Tool in the clinical environment demonstrated it is a reliable and valid tool when used by different observers. Both nurses and observers found using the tool a positive and useful experience when evaluating medication administration practice.     

The experience of nurses participating in peer group supervision: A qualitative systematic review

AimThis systematic review will identify, appraise, and synthesise the best available qualitative studies exploring nurses’ experiences of peer group supervision. The review purpose draws from the synthesised evidence recommendations to enhance policy and implementation of peer group supervision in practice.BackgroundClinical Supervision is increasing in acceptance as a means of professional and best practice support in nursing. Peer group supervision is a non-hierarchical, leaderless model of clinical supervision delivery and is an option for implementation by nursing management when prioritising staff support with limited resources. This systematic review will provide a synthesis of the qualitative literature regarding the nursing peer group supervision experience. Understanding the experience of peer group supervision from those participating may provide constructive insights regarding implementation of this practice to benefit both nurse and patient driven outcomes.DesignIncluded are peer reviewed journals focused on nurses’ experiences of participating in peer group supervision. Participants are registered nurses of any designation. Qualitative articles, written in English and relating to any area of nursing practice and/or speciality are included.The standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement were used to guide the review. Two investigators independently screened titles, abstracts and selected full text studies describing the experience of peer group supervision. Pre-designed data extraction tools were utilised, and the review followed the Joanna Briggs Institute qualitative meta-aggregation approach with a hermeneutic interpretive analysis.ResultsResults identified seven studies that met the inclusion criteria. A total of 52 findings that described the experiences of nursing peer group supervision are synthesised into eight categories. Four overarching synthesised findings resulted: 1. facilitating professional growth 2. trusting the group 3. professional learning experience and 4. shared experiences. Benefits such as sharing of experiences whilst receiving feedback and support were identified. Challenges identified related to group processes.ConclusionsThe paucity of international research into nursing peer group supervision poses challenges for nurse decision makers. Significantly, this review provides insight into the value of peer group supervision for nurses regardless of clinical context and setting. The ability to share and reflect with nursing peers enhances both personal and professional aspects of practice. The worth of the peer group supervision model varied across studies however the outcomes provided important insights into facilitating professional growth, enabling a space to share experiences and reflect, and to build teams where trust and respect develops in groups.     

Effect of performance feedback on tracheal suctioning knowledge and skills: randomized controlled trial

Title. Effect of performance feedback on tracheal suctioning knowledge and skills: randomized controlled trial. Aim. This paper is a report of a study to determine whether individualized performance feedback improved nurses’ and physiotherapists’ knowledge and practice of tracheal suctioning. Background. Nurses’ knowledge and practice of tracheal suctioning is often deficient. Whilst teaching has been shown to improve suctioning knowledge and practice, this is not sustained over time. Method. Ninety‐five qualified healthcare professionals (nurses and physiotherapists) in two acute hospitals were randomly allocated to receive either individualized performance feedback or no additional feedback after a standardized lecture and practical demonstration of tracheal suctioning. Randomization was stratified by profession, seniority and site. Data were collected in 2005 in a clinical setting involving patients and a simulation setting. The outcome measures were knowledge and practice of tracheal suctioning, assessed by self‐completion questionnaire and structured observation. Results. In both settings, intervention groups performed statistically significantly better in terms of knowledge (P = 0·014) and practice (P = 0·037) at final follow‐up. Those who received performance feedback had statistically significantly higher knowledge (P = 0·004) and practice (P < 0·01) scores than the control group. For practice, there was also a relationship between professions (P < 0·01), with physiotherapists performing better than nurses overall, and an interaction between group and setting (P < 0·01), with performance feedback showing a stronger positive effect in the simulation setting. Conclusion. Retention of knowledge and tracheal suctioning practice is improved when training is followed up by tailored feedback on performance. Further research would shed light on how long such improvements are sustained, and whether the improvements seen in a simulated setting can be generalized to clinical settings.     

Exploring the contribution and impact of master’s education for leadership development in adult general nursing: A scoping review

AimThe aim of this scoping review was to explore the evidence relating to master’s education for leadership development in adult/general nurses who are not in advanced practice or leadership roles and its impact on practice.BackgroundThe importance of effective, clinical leadership in nursing and health care, has been highlighted following failings reported by Public Inquiries both nationally and internationally. While initiatives have been implemented to address these, the provision of safe, quality care remains problematic. Complex care requires highly skilled professionals to challenge and lead improvements in practice. Master’s education results in graduates with the skills and confidence to make these changes and to become the clinical leaders of the future.MethodsAn a priori scoping review protocol was developed by the review team. This was used to undertake searches across CINAHL Ultimate; Medline (Ovid), Scopus and ProQuest Complete databases, chosen due to their relevance to the subject area. Articles were limited to those in the English Language, peer reviewed and published since 2009. Citation chaining via the reference lists of frequently identified articles were also searched. A further search for relevant grey material using the same relevant keywords and phrases was performed using the limited, Trip Database and Google Scholar.ResultsEight articles were selected for data extraction, and these were published between 2011 and 2019. The articles were predominantly from the UK and Europe, with a focus either on master’s education or on aspects of leadership in nursing and healthcare. Themes identified: a) The need for clinical leadership; b) master’s education for clinical leadership skills; and c) master’s education for professional and organisational outcomes.ConclusionsThe scoping review identified that there is a need for strong clinical leadership in the practice setting. Evidence shows that effective nursing leadership can improve patient outcomes as well as enhancing workplace culture and staff retention. The review has shown that the skills required for clinical leadership are those produced by master’s education. Studies of the impact of master’s education are often self reported and tend to focus on nurses in advanced practice roles. More research is required into master’s education for adult/general nurses not in advanced roles and in examining the link between master’s education and improved patient, professional and organisational outcomes.     

Summative assessment of clinical practice of student nurses: A review of the literature

ObjectivesTo provide an overview of summative assessment of student nurses’ practice currently in use.DesignNarrative review and synthesis of qualitative and quantitative studies.Data sourcesWith the support of an information specialist, the data were collected from scientific databases which included CINAHL, PubMed, Medic, ISI Web of Science, Cochrane library and ERIC published from January 2000 to May 2014. Sources used in all of the included studies were also reviewed.Review methods725 articles concerned with student nurse clinical practice assessment were identified. After inclusion and exclusion criteria, 23 articles were selected for critical review.ResultsFindings suggest that the assessment process of student nurses’ clinical practice lacks consistency. It is open to the subjective bias of the assessor, and the quality of assessment varies greatly. Student nurses’ clinical assessment was divided into 3 themes: acts performed before final assessment, the actual final assessment situation and the acts after the final assessment situation. Mentors and students need teachers to provide them with an orientation to the assessment process and the paperwork. Terminology on evaluation forms is sometimes so difficult to grasp that the mentors did not understand what they mean. There is no consensus about written assignments’ ability to describe the students’ skills. Mentors have timing problems to ensure relevant assessment of student nurses. At the final interview students normally self-assess their performance; the mentor assesses by interview and by written assignments whether the student has achieved the criteria, and the role of the teacher is to support the mentor and the student in appropriate assessment. The variety of patient treatment environments in which student nurses perform their clinical practice periods is challenging also for the assessment of student nurses’ expertise.ConclusionsMentors want clinical practice to be a positive experience for student nurses and it might lead mentors to give higher grades than what student nurses in fact deserve. It is very rare that student nurses fail their clinical practice. If the student nurse does not achieve the clinical competencies they are allowed to have extra time in clinical areas until they will be assessed as competent.Further research needs to be carried out to have more knowledge about the final assessment in the end of clinical practice. Through further research it will be possible to have better methods for high quality assessment processes and feedback to student nurses. Quality in assessment improves patient safety.     

Using peer feedback to enhance nursing students’ reflective abilities,clinical competencies,and sense of empowerment: A mixed-methods study

AimTo assess the use of a framework to provide structured peer feedback and compare the effects of peer video feedback, peer verbal feedback versus faculty feedback on nursing students and peer tutors’ learning outcomes and experiencesBackgroundPeer feedback has been utilized widely in health professions education to fill the gap for timely feedback, but some students were concerned with its quality, leading to perceptions that peer feedback may not be useful.DesignSequential explanatory mixed-methods studyMethodsThe study took place from January to February 2022. In phase 1, a quasi-experimental pretest-posttest design was used. First-year nursing students (n = 164) were allocated to peer video feedback, peer verbal feedback or faculty feedback arms. Senior nursing students (n = 69) were recruited to be peer tutors or the control group. The Groningen Reflective Ability Scale was used by first-year students to assess their reflective abilities, while the Simulation-based Assessment Tool was used by peer or faculty tutors to evaluate nursing students’ clinical competence of a nursing skill during the simulation. The Debriefing Assessment for Simulation in Healthcare-Student Version was used by students to assess their peer/faculty tutors’ feedback quality. Senior students’ empowerment levels were measured using the Qualities of an Empowered Nurse scale. In phase 2, six semi-structured focus group discussions with peer tutors (n = 29) were conducted and thematically analyzed.ResultsPeer video feedback and peer verbal feedback significantly improved students’ reflective abilities but not in the faculty feedback arm. Students’ clinical competence in a technical nursing skill significantly improved in all three arms. Improvements were significantly larger in those receiving peer video feedback and peer verbal feedback than faculty feedback, with no significant differences between peer video feedback and peer verbal feedback. Debriefing Assessment for Simulation in Healthcare-Student Version scores were not significantly different among the 3 arms. Empowerment levels of peer tutors significantly improved after providing peer feedback but not those in the control group. Seven themes were generated from the focus group discussions.ConclusionsAlthough peer video feedback and peer verbal feedback were similarly effective in improving clinical competencies, peer video feedback was more time-consuming and stressful to students. The use of structured peer feedback improved peer tutors’ feedback practices and were comparable to quality of faculty feedback. It also significantly increased their sense of empowerment. Peer feedback was widely supported by peer tutors who agreed that it should supplement faculty teaching.     

我院护理给药差错管理办法的实施与效果

目的有效控制护理给药差错的漏报率，提高住院病人的安全。方法成立护理给药差错评定小组，强化护理人员的安全意识，扩充有效的给药差错报告渠道，细化奖惩细则及评价标准。结果实施护理给药差错管理办法后，给药差错漏报率有明显降低，差异具有统计学意义（P〈0．01）。结论合理的护理给药差错管理办法能激励当事人和科室管理者主动上报差错的发生情况，使护理给药差错管理纳人良性循环。     

Association between nurses’ perceived self-confidence in performing family witnessed resuscitation and implementation of the practice at Siaya County Referral Hospital in Kenya

ObjectivesThis study aimed to identify the relationship between nurses’ perceived self-confidence in performing family-witnessed resuscitation and the implementation of the practice among nurses and to describe nurses’ preferences regarding family-witnessed resuscitation practice.MethodsThis study was a cross-sectional survey. A stratified random sampling design was used to obtain study participants from various units within the medical-surgical departments of the hospital. Data was collected using the Family Presence Self-confidence Scale designed by Twibel et al. Chi-square test and binary logistic regression were used to analyze the association between levels of perceived self-confidence and the implementation of family-witnessed resuscitation practice.ResultsThere was a significant association between nurses’ perceived self-confidence (χ² = 8.06, P = 0.01) and the implementation of family-witnessed resuscitation practice. The nurses who were quite/very confident were 4.9 times more likely to perform witnessed resuscitation than those who were somewhat confident (OR = 4.94, 95% CI 1.07–22.71)ConclusionThe perceived self-confidence in performing family-witnessed resuscitation varied widely among nurses. To achieve successful implementation of family-witnessed resuscitation practice, medical-surgical nurses should get higher levels of perceived self-confidence in the presence of patients’ families through advanced specialized training and practice on resuscitation.     

Retrospective evaluation of medication appropriateness and clinical pharmacist drug therapy recommendations for home-based primary care veterans

Background:The Medication Appropriateness Index (MAI) has demonstrated reliability in several outpatient settings. Clinical pharmacists play key roles as members of an interdisciplinary team in determining medication appropriateness.Objective:The goal of this study was to examine medication appropriateness using the MAI and the degree of recommendation acceptance associated with clinical pharmacist medication reviews for veterans enrolled in the Home-Based Primary Care (HBPC) program.Methods:A retrospective analysis of clinical pharmacist medication reviews was performed by accessing the computerized patient medical record. Patients included in the study were enrolled in the HBPC program between March 2002 and January 2004. The data were examined to determine a total MAI score associated with medication recommendations after each review. The number and types of pharmacist recommendations, their acceptance rate, and the total number of medications discontinued were also evaluated.Results:Seventy-nine patients (mean [SD] age, 75.3 [10.3] years) identified through the pharmacy database met the inclusion criteria and were included in the study. No patients identified were excluded from the analysis. A statistically significant decrease in the overall MAI score was observed from the initial review to the end of the study (P < 0.001). Recommendations to patients' primary care providers included medication initiation/discontinuation, laboratory monitoring, dosage adjustment, and other issues associated with appropriate prescribing that could be categorized using the MAI. Recommendations to home health nurses included monitoring for medication adherence, efficacy, and adverse events. Pharmacist recommendation acceptance rates for primary care providers and home health nurses were 69% and 56%, respectively. Overall, 121 medications were discontinued during the study period.Conclusions:By using the MAI for evaluation, pharmacist recommendations significantly improved the appropriateness of medication use among veterans receiving home health care. A majority of pharmacist recommendations were accepted.