Journal of Nursing Education

Process Evaluation: A Second Look at Psychomotor Skills

Mary Ann Sweeney, RN, PhD; Barbara Hedstrom, RN, MS

Abstract

These findings raise several issues. The results support the fact that the skills that are considered essential learning for students are not clearly defined, especially in the more technically complex areas of nursing skills. In fact, the faculty did not reach consensus about the priority which should be placed on more than half of the skills on the complete list. The researchers administering this survey saw this as a potential problem for the new graduate seeking employment in a hospital setting. If many of these more complex skills are not seen as essential by faculty, they may not be taught and the student will not be able to perform them comfortably in the work setting. This highlights the controversy previously mentioned between schools of nursing and hospital institutions in regard to the acquisition of skills. Who is responsible for teaching psychomotor skills? Should schools of nursing be expected to teach all skills? Are there specific ones that hospitals would be willing to teach in staff development programs, if certain basic skills are previously learned by new graduates in their educational programs? A further study is currently underway to investigate the priority ratings of these same 291 skills by nursing supervisors and head nurses who work with the new baccalaureate graduate. Further clarification of this issue would encourage more understanding of the role advocated by individuals in education and in practice settings. A dialogue between these two groups related to specific aspects of psychomotor skills might contribute to a smoother transition of a new graduate, and might clarify the roles of individuals in practice and educational settings.

The researchers questioned faculty members after their participation as to why they did not see some of the more complex or more commonly expected skills as essential. Some of the faculty in the survey found difficulty with the manner in which skills were worded. They expressed that words such as "assists with" and "prepares a patient" were unclear regarding expected student behaviors. They also expressed difficulty in categorizing skills for the overall program because of the limited vantage point of clinical settings or the level of the program in which they instruct students. In many instances, faculty reported that skills such as postural drainage, colostomy care, and working with traction were performed by either clinical nursing specialists or trained technicians. Therefore, they did not teach these skills or expect students to learn them, yet they did not consider them to be graduate level or non-nursing skills. They could not respond to the issue of these students later working in other institutions where this type of skill iscommonly expected of nursing personnel.

Faculty taking part in this survey also expressed that they thought more about the theoretical rather than the practical application of skills in doing the card sort and in participating in the Delphi process. This attitude and practice is likewise supported by the literature. This led many faculty in the card sort phase to choose one skill as essential out of several listed in a specific category. They explained that if a student understood the principles behind one skill, that knowledge would carry over into another area which utilized similar techniques. For example, after performing a sterile dressing successfully under supervision, many faculty suggested that the student should be able to perform a catheterization procedure by transferring the previously utilized knowledge and skills to the new situation. This point of view on the part of numerous faculty suggests that a further study may be indicated to determine if this idea about transference of knowledge in the application of psychomotor skills is valid.

The…

This study was designed to investigate the priority baccalaureate nursing faculty placed on teaching psychomotor skills in an undergraduate program. A modified Qsort and Delphi technique were carried out with 15 randomly selected faculty. The 291 skills were rated according to whether the faculty thought they were: essential, bonus, graduate level or non-nursing skills. Data analysis revealed that 121 skills were rated as essential by at least 90% of the faculty. No skills reached 90% agreement in. the graduate or non-nursing categories, while four skills were classified as bonus by the entire group. Thus, a lack of faculty agreement regarding the importance of teaching over half of the skills included in the stud y iva s noted. Th e largest percentage of essential skills identified were in the less technically complex area such as providing basic physical care, activities of daily living, and general comfort measures. The 170 skills not categorized as essential were notable in that many may be considered routine expectations in employers in health care settings. Suggestions for further study in this area are pointed out.

Faculty members in baccalaureate nursing programs have been concerned for many decades with the evaluation of cognitive, affective, and psychomotor aspects of the clinical performance of the students under their tutelage. Although a number of suggestions for evaluating clinical competencies have been cited in the literature in recent years, the topicdeserves further investigation since it is a complex process which has numerous facets. Faculty have described the utilization of creative methods of evaluating clinical performance of students. Some authors have successfully utilized written descriptions of simulated clinical situations to test student's abilities.'"3 Even though the main evaluative focus with the written material was on problem-solving or decision-making skills, the simulated context was used to make the performance element a part of the overall clinical picture. Kubo et al4 provided a simulated nursing experience by using films to enhance students' perceptions of realistic patient-care problems. Clinical performance was then evaluated by the student's written plan of nursing action based on the patient situation depicted in the film. Huckabay et al5 used computer simulation techniques to evaluate patientrelated nursing actions. It is important to note that, although all of these methods related to the measurement of clinical performance, they are, in essence, limited primarily to an evaluation of the cognitive, and sometimes affective aspect of clinical performance.

In an attempt to ascertain the methods and tools that have been devised to evaluate the psychomotor skills of baccalaureate nursing students and new graduates, it was found that very little had been written about performance evaluation. Perhaps this is not surprising when one considers the difficulties posed in determining the behaviors indicative of effective performance of the myriad of techniques practiced by nurses in varied settings. Moreover, the heavy emphasis on psychosocial behaviors in baccalaureate programs, and on the acquisition of teaching, communication, research, and leadership skills, appears to have created a decreasing concern about teaching the technical aspects of nursing care. One educator has stated that some nursing programs have de-emphasized technical skills to the point that "students may graduate without ever having learned or done many of the procedures they would be required to know as staff nurses in a general hospital/'6

Historically, when nursing education was hospital-sponsored and controlled, the practice aspect of patient care was stressed as much as or more than the theoretical aspects. Manual techniques were thought to be the mainstay of nursing performance. Students were exposed to a "probationary" or "preclinical" period during which they learned to master the practical aspects of nursing procedures. Most of this preclinical period was spent in the classroom or laboratory although brief encounters with actual patients were included. Nursing Arts or Fundamentals instructors taught the principles underlying manual procedures and gave precise demonstrations of each one. They supervised students in doing the same procedure numerous times in both laboratory and clinical settings until expertise developed. It was not unusual for the instructor to be highly exacting when rating the students' performances. The prevailing framework was one of "practice makes perfect." During this time, psychomotor skills were considered so essential for safe practice that they were evaluated in addition to cognitive skills in Registered nurse licensure examinations.

Educational practices in nursing programs have undergone an evolution which has been influenced by changing societal and health care trends. The focus for successful student achievement slowly shifted from a clear emphasis on manual performance to broader application of cognitive skills. There were many factors which influenced the educational planning for baccalaureate programs in particular. These factors may have worked in combination with changes in health care delivery to produce a de-emphasis on psychomotor skills. Some of the factors were:

* The need to incorporate liberal arts into nursing education, the additional theoretical segment of nursingcourses, and the credit hour allotment for laboratory and clinical time led to a diminution of actual experience in acquiring performance skills.

* The utilization of multiple pradice sites for baccalaureate education. The differences in procedures from one setting to another could have contributed to a general de-emphasis on learning to follow procedural steps in an exacting way.

* The strong association of technical skills with non-baccalaureate nursing programs.

* The evolution of inservice education or staff development departments in clinical sites made it possible to acquire assistance in learning some types of technical skills after graduation.

* Some educational philosophies focused on practice for the future rather than on acquisition of technical skills for the present based on the premise that overall changes in medical technology produced a rapid rate of obsolescence.

* The placement of baccalaureate students and graduates in areas of nursing practice in which technical skills were not as commonly used as in acute care settings. These areas included practice in public health settings, psychiatric settings, schools, industries, and clinics.

* The overall academic- atmosphere put a high value on cognitive development rather than on manual training.

* In general, evaluation of performance skills is more time consuming,, more expensive, and not easily measured.

Wooley commented on the situation by stating that educators, "see the professional nurse as the thinker and the planner for health care, while the two and three year nurses carry out the technical details."6

Although much of the literature dealing with clinical performance evaluation does not emphasize measurement of manual skills, a few writers make some allusion to that aspectof evaluation. Sumida7 described an instrument which evaluated the cognitive aspects of clinical performance skills. The tool entailed a list of 54 behaviors which were grouped into four categories. One of these categories, "Manipulation," included 12 items which were constructed solely to rate manual skills. A computerized test was constructed to evaluate technical performance in simulated clinical situations. Although attention was accorded to manual skills, the tool i6 limited to evaluating only cognitive aspects of this type of performance.

A number of rating scales and checklists have been devised to measure the nurses' performances in the clinical area by means of direct observation or self-evaluation. Litwack8 described a checklist which was designed to meet level objectives. After the identification of common themes for the program, a checklist was formulated giving a brief clear description of behaviors which would satisfy the objectives for each semester. Behaviors were grouped by categories, some of which pertained to psychomotor competencies. Some of the categories included: Meeting Hygienic Needs, Safe Administration of Medicines, and Provision for Circulatory and Elimination Needs.

Dunn was quite explicit in describing a rating scale which was devised to measure "the professional nurse's skill in the application of nursing principles as reflected in her behavior in completing specific nursing procedures.' The five procedures selected for scrutiny were the performance of tracheal suctioning, and the administration of oral tube feedings, oral medications, intramuscular medications and intravenous solutions. Perusal of the Slater Rating Scale10 indicated that, although the instrument is quite detailed and purports to measure all nursing performance competencies, it de-emphasized psychomotor skills. This is indicated by the fact that only three of the 84 items appraised technical nursing competencies. These behaviors are described as: "Attends to daily hygienic needs for cleanliness and accepta ble appea rance," (item 33); "Demonstrates understanding of both medical and surgical asepsis," (item 41); and "Carries out established techniques for the safe administration of medications and parenteral fluids," (item 44). These items appear rather global in nature. The cues accompanying each item indicate very few examples of the many possibilities inherent in each of the stated behaviors. There are a number of other items in the scale that relate less directly to the performance of actual nursing techniques. These items pertain to the adaptation of procedures (or nursing activities) to individual patient needs, provision for appropriate safety measures, institution of diversional and treatment activities, and encouragement of rest, exercise and adequate dietary intake. Thus, many of the available rating scales and checklists appeared to minimize the rating of actual performance of psychomotor skills when evaluating clinical competency.

One of the difficulties encountered in reviewing the literature was the lack of a clear distinction as to whether the cognitive or manual elements of nursing performance were being evaluated. Schneider" indicated that a frequent problem in the use of clinical performance tools is the inappropriate application of some items used to evaluate a nurse's performance. She states unequivocally that,

If cognitive objectives were eliminated (to the degree possible) from clinical performance evaluation tools, and if only psychomotor objectives were included, the instructors could focus on the nurse's performance. The result would be more meaningful and valid and would provide useful information about the student's ability to perform."

According to Tate, "competence in theory and competence in practice do not necessarily go hand in hand."1" Evaluation of clinical competencies would be a relatively simple problem if they did, because much work has already been done on the formulation of tests for measuring theoretical competence.

Evaluating what the nurse can do is beset with difficulties, according to Schneider." Even when the instruments designed to measure behaviors were well constructed, the problem of the necessity of direct observation of the nurse's performance by a rater remained. This holds true even when evaluating the performance of a nurse on videotape. The observation time required to check the behaviors of a single nurse is extensive. Schneider also believed that part of the problem of ineffective performance evaluation was due to the fact that many aspects of performance were evaluated in the clinical setting when the college learning laboratory could have been utilized. This, she states, is particularly true in evaluating the student's ability to perform basic psychomotor skills."

The return to the use of the classroom laboratory for the evaluation of psychomotor skills were predicted by Wooley who stated that, "The fact that so many schools are in competition for laboratory facilities has forced faculty to find better ways of using clinical time."" Audiovisual labs are also a resource that can be used by students to learn and practice skills to be utilized in the clinical setting. This system has several advantages. Patients are protected from inexperienced students, and the students are able to be awkward at first in a private, learning situation without undue stress.

In "Evaluation in the Nursing Laboratory: An Honest Appraisal,"13 Paduano described in detail, efforts made to utilize the classroom laboratory to evaluate students' performances of technical skills. Five competencies: medical asepsis, surgical asepsis, vital signs, positioning, and body mechanics were developed along with a list of acceptable behaviors for each. Students were given a paper and pencil examination to test their knowledge of the principles behind the competencies and a laboratory experience was designed to test theirapp/icetion of principles by appraising skills in each of the areas. Test situations were set up for evaluating motor skills by having students perform them on each other under faculty supervision. Despite elaborate plans and precautions, the experiment was unsuccessful.

One of the most enlightening and rewarding aspects of this effort was the conscientious determination to ascertain what went wrong. Discussion of the experience with the faculty involved raised questions about the validity of the measurement devices, feelings of inadequacy in acting as observers, dissatisfaction with the grading system, variation among faculty regarding expectations about student performance, and a lack of agreement on the objectives of the laboratory evaluation. A majority of faculty, however, expressed interest in giving the evaluation tool a second chance and theauthor optimistically outlined plans for improving the experience.

The many concerns listed by the faculty in the evaluation project previously cited highlight a number of important concerns of baccalaureate faculty. The dearth of literature pertaining to evaluation of actual psychomotor skills in the college laboratory or clinical placement site permits little communication about the similarity or differences of faculty concerns in similar situations.

The present study was undertaken as a result of a lengthy discussion at a faculty meeting about the placement of psychomotor skills in an undergraduate program. The "integrated" curriculum approach had caused some confusion about the types of skills that should be required as well as where and when the basic psychomotor skills should be taught, practiced, and performed in the various levels of the curriculum. It was finally decided that a tool was needed for collecting data on the performance of clinical skills. Faculty agreed to contribute the varied lists of skills they each focused on incuneai or laboratory instruction so that a comprehensive list could be devised which would span the entire program. A simple checklist format was desired for ease in using the skill booklet.

Although the investigators used the skill lists contributed by the faculty as a basis for the checklist, the majority of the content came from various references in the literature.14"20 Each source provided a list of skills even though no one source was thought to be comprehensive enough to be used alone. The 290 skills were identified by this process. They were subsequently categorized into three major categories: Fundamental Nursing Procedures, General Therapeutic and Diagnostic Procedures, and Specialized Therapeutic and Diagnostic Measures.

The size and comprehensiveness of the list was su rprising at first since much of the literature focused on ten skills or less. As soon as the resulting Clinical Competency Checklist of Nursing Procedures was ready for pilot testing with selected undergraduate students, the investigators turned their attention to the views of faculty about the utility of each item on the checklist.

Therefore, this study was designed to investigate the views of faculty regarding the teaching of various types of psychomotor skills to nursing students in an undergraduate program. More specifically, the purpose was to investigate the priority placed on teaching a comprehensive list of specific psychomotor skills to undergraduate nursing students.

Method

Sample: A list of full-time undergraduate faculty was screened to eliminate individuals connected with the grant project as well as those who did not have a clinical teaching assignment. This screening resulted in a list of 49 faculty who could provide the requisite information. A table of random numbers was used to select a sample of 15. Each individual selected was contacted personally by the researchers for an explanation of both the nature of the study and the considerable time commitment it would involve. Fourteen agreed to participate, and the one prospective subject who declined due to a lack of time was replaced by the first alternate. Fourteen subjects formed the final sample after one individual withdrew at the midpoint because of a combination of scheduling problems and subsequent termination of teaching responsibilities. Representation from all clinical specialty areas and all the four semesters of the undergraduate nursing major was noted. Amount of teaching experience of the sample group covered a span of one year to 25 years.

Procedure: The skills, extracted verbatim from the Clinical Competency Checklist of .Nursing Procedures, were listed individually on 3 ? 5 index cards. This process resulted in a total of 290 skill cards. The subjects were asked to sort the individual skill cards into one of four categories which were defined as follows: Essential: Every student needs to perform this procedure safely prior to graduation; Bonus: Would be nice if every student had the opportunity to perform this procedure, but it is not essential; Graduate:' Complex procedure which needs greater understanding, guidance and practice than can be provided in an undergraduate nursing program; NonNursing: Procedure which should be performed by personnel other than nurses.

Blank cards were provided in the event that a subject wished to add a skill that had been unintentionally omitted. Subjects were instructed to place their "write-in" suggestions, if any, in one of the four official categories. Subjects were asked to conduct the card sort in a conference room which was free from the normal office distractions and intrusions. Each individual was given specific instructions for completing the task and was asked to sort several skills with the researcher in the room so that understanding of the procedure was assured. The card sorting procedure was untimed and took an average of 40 minutes for completion. The researchers asked the subject for any general comments about the skills at the termination of the session, and then recorded the ratings on a master skill list.

An Arabic number was assigned to each subject in the study. That number was placed on the master skill list to designate the category selected by the subject for each of the skills. When all 14 subjects completed the card sort, the master lists were duplicated and each received a copy as well as notification of their own identification number. They were requested to study the master list to review their decisions regarding the rating of each skill and to compare their ratings with those of the other subjects. All were asked to designate a rating for the one additional skill which had been a "write-in" of several subjects if they had not done so already. The 291 skills were subjected to two further rounds utilizing a Delphi Technique. The final round was conducted in group sessions in which the researchers encouraged discussion of the skill ratings. The original ratings of some skills were noticeably scattered on the master skill list as can be noted in the excerpt in Table 1.

Table

TABLE 1FACULTY RATINGS OF SKILLS AT THE COMPLETION OF THE INITIAL CARD SORT

TABLE 1

FACULTY RATINGS OF SKILLS AT THE COMPLETION OF THE INITIAL CARD SORT

Table

TABLE 241 SKILLS IDENTIFIED AS ESSENTIAL BY 100% OF THE FACULTY ON THE INITIAL CARD SORT

TABLE 2

41 SKILLS IDENTIFIED AS ESSENTIAL BY 100% OF THE FACULTY ON THE INITIAL CARD SORT

The discussion by subjects about skills receiving ratings with wide discrepancies was encouraged actively by the researchers and remarks were recorded during the Delphi rounds. The degree of agreement about the skill ratings increased with the ensuing rounds. The time involvement of subjects in the Delphi procedure varied from approximately 1V4 to 4 hours.

Results

In the first phase of the survey, the modified Q-sort, consensus on the "essential skills" category was reached by all faculty on 41 of the 290 skills, a total of 14%. Table 2 identifies those skills which were initially determined essential by all the faculty.

Ninety percent agreement by faculty on skills considered essential was reached on 35 additional skills. Therefore 76 of the 290 skills identified were considered essential by 90% of the faculty members surveyed.

Within the bonus category, 100% agreement was not reached on any skill. Ninety percent agreement of the faculty was reached on four skills which included: assisting with abdominal paracentesis, assisting with bone marrow aspiration, assisting with a liver biopsy and assisting with thoracentesis.

The ratings of the remaining 210 skills were scattered throughout all four categories. No skill reached 90% faculty agreement in either the graduate or the nonnursing category. One skill, assists with dangling, was added under the heading "Assistance with Mobility," by several faculty members during the Q-sort phase. This addition resulted in a total of 291 skills.

In the second phase of the survey, which consisted of the Delphi rounds, the 14 participating faculty members reached a total consensus on an additional 53 skills, for a total of 94 skills (32% of the skills on the complete list) that all faculty felt were essential for baccalaureate students to perform. The use of the Delphi technique caused an increase of 130% of the skills in the essential category. Table 3 identifies the additional 53 skills on which faculty reached a complete consensus.

Ninety percent agreement was reached on 27 skills that faculty thought were essential. Therefore in the final tabulation, 121 skills (or 42% of the complete skill list) were considered essential by at least 90% of the faculty surveyed. Table 4 identifies those skills from the Delphi Sort and the Q-sort considered essential by at least 90% of the faculty.

The four skills cited previously that had 90% agreement among faculty within the bonus category in the Q-sort had 100% agreement after the Delphi technique. The remaining 167 skills were rated in all four categories but the majority of these skills had ratings in either the essential or bonus categories rather than the graduate or non-nursing categories.

In order to more closely examine which categories the faculty chose most often as essential skills for nursing students to know, the data were compared according to the possible number of skills in each category and those actually rated as essential. Table 5 shows this comparison.

As can be noted by inspection of the table, the categories containing the largest percentage of ratings of essential skills were Fundamental Nursing Procedures and General Therapeutic and Diagnostic Measures. The psychomotor skill areas where the largest percentage of essential skills were identified were those concerned with the basic physical care of patients, activities of daily living, and procedures that provide comfort to patients. The last part of the analysis was involved with an inspection of the 170 skills which were not rated as essential by this group of faculty. A small number of these skills and the actual ratings for each have been recorded in Table 6.

Table

TABLE 353 ADDITIONAL SKILLS IDENTIFIED AS ESSENTIAL BY 100% OF THE FACULTY AT THE CONCLUSION OF THE DELPHI ROUNDS

TABLE 3

53 ADDITIONAL SKILLS IDENTIFIED AS ESSENTIAL BY 100% OF THE FACULTY AT THE CONCLUSION OF THE DELPHI ROUNDS

Table

TABLE 427 SKILLS IDENTIFIED BY 90% AGREEMENT IN THE Q-SORT AND DELPHI TECHNIQUE

TABLE 4

27 SKILLS IDENTIFIED BY 90% AGREEMENT IN THE Q-SORT AND DELPHI TECHNIQUE

Discussion

Ninety percent of the faculty in this study rated 121 psychomotor skills as essential for every baccalaureate nursing student to learn and perform during the course of an undergraduate nursing program. The fact that this number was less than half of the possible skills cited by various sources is surprising. The fact that four additional skills were rated by 90% of the faculty as bonus learning experiences produced a consensus on the disposition of less than half of the possible skills included in the study

Inspection of the skills actually rated as essential shows a large number of skills that are routinely performed in clinical settings by nurses' aides or auxiliary health workers. It was of further interest to note that the more technically difficult psychomotor skills such as those contained in the Specialized Therapeutic/Diagnostic Measures Area were not seen as frequently as being essential for a student to learn to perform.

Table

TABLE 5TOTAL NUMBER OF SKILLS CONTAINED IN EACH CATEGORY AND THE NUMBER OF SKILLS RATED AS ESSENTIAL BY AT LEAST 90% OF THE FACULTY

TABLE 5

TOTAL NUMBER OF SKILLS CONTAINED IN EACH CATEGORY AND THE NUMBER OF SKILLS RATED AS ESSENTIAL BY AT LEAST 90% OF THE FACULTY

Table

TABLE 6A SAMPLE OF SKILLS NOT RATED AS ESSENTIAL BY 90% OF THE FACULTY

TABLE 6

A SAMPLE OF SKILLS NOT RATED AS ESSENTIAL BY 90% OF THE FACULTY

These findings raise several issues. The results support the fact that the skills that are considered essential learning for students are not clearly defined, especially in the more technically complex areas of nursing skills. In fact, the faculty did not reach consensus about the priority which should be placed on more than half of the skills on the complete list. The researchers administering this survey saw this as a potential problem for the new graduate seeking employment in a hospital setting. If many of these more complex skills are not seen as essential by faculty, they may not be taught and the student will not be able to perform them comfortably in the work setting. This highlights the controversy previously mentioned between schools of nursing and hospital institutions in regard to the acquisition of skills. Who is responsible for teaching psychomotor skills? Should schools of nursing be expected to teach all skills? Are there specific ones that hospitals would be willing to teach in staff development programs, if certain basic skills are previously learned by new graduates in their educational programs? A further study is currently underway to investigate the priority ratings of these same 291 skills by nursing supervisors and head nurses who work with the new baccalaureate graduate. Further clarification of this issue would encourage more understanding of the role advocated by individuals in education and in practice settings. A dialogue between these two groups related to specific aspects of psychomotor skills might contribute to a smoother transition of a new graduate, and might clarify the roles of individuals in practice and educational settings.

The researchers questioned faculty members after their participation as to why they did not see some of the more complex or more commonly expected skills as essential. Some of the faculty in the survey found difficulty with the manner in which skills were worded. They expressed that words such as "assists with" and "prepares a patient" were unclear regarding expected student behaviors. They also expressed difficulty in categorizing skills for the overall program because of the limited vantage point of clinical settings or the level of the program in which they instruct students. In many instances, faculty reported that skills such as postural drainage, colostomy care, and working with traction were performed by either clinical nursing specialists or trained technicians. Therefore, they did not teach these skills or expect students to learn them, yet they did not consider them to be graduate level or non-nursing skills. They could not respond to the issue of these students later working in other institutions where this type of skill iscommonly expected of nursing personnel.

Faculty taking part in this survey also expressed that they thought more about the theoretical rather than the practical application of skills in doing the card sort and in participating in the Delphi process. This attitude and practice is likewise supported by the literature. This led many faculty in the card sort phase to choose one skill as essential out of several listed in a specific category. They explained that if a student understood the principles behind one skill, that knowledge would carry over into another area which utilized similar techniques. For example, after performing a sterile dressing successfully under supervision, many faculty suggested that the student should be able to perform a catheterization procedure by transferring the previously utilized knowledge and skills to the new situation. This point of view on the part of numerous faculty suggests that a further study may be indicated to determine if this idea about transference of knowledge in the application of psychomotor skills is valid.

The results of this study support the need to continue to identify specific psychomotor skills that are important and essential for baccalaureate students to perform before graduation. A lack of consensus within a program can lead to confusion about the expected skill performance which is amplified later when the graduate meets with the expectations of employers and the public. This research should be extended to determine the most efficient manner in which these skills can be taught, and in what type of setting: laboratory, clinical, or both.

With prominent issues such as patients' rights and students' rights, there is an even greater need for schools to determine the specific skills deemed essential to prepare new graduates to function effectively in their chosen work settings, and to safeguard the safety and promotion of health of the public for whom the new graduates will be caring. After such a determination is made regarding the identification of the essential nursing skills, evaluation of the performance of these specific skills must be carried out to assure minimal standards of competency.

Acknowledgment

This study was conducted as part of a Special Project Grant entitled, "Development of a Nursing Curriculum Evaluation Model" (1 DIO NU21004-01) from the Division of Nursing, United States Public Health Service, Department of Health Education and Welfare.

References

  • 1. De Tornyay R: Measuring problem-solving skills by means of the simulated nursing problem test. J Nurs Erf« 3-8, 1965.
  • 2. Dincher J, Stidger S: Evaluation of a written simulation format for clinical nursing judgment. Nurs Rts 25:280-28S, 1976.
  • 3. Mclntyre JM. McDonald F, Bailey J. et al: A simulated clinical nursing test- Nurs Res 21:429435. 1972.
  • 4. Kubo W, Chase L, Leton J: A creative examination. Nurs Outlook 19:S 24-326, 1971.
  • 5. Huckabay L, Anderson N, Holm D, et al: Cognitive, affective, and transfer of learning consequences of computer-assisted instruction. Nurs Res 28:228-233, 1979.
  • 6. Wooley A: The long and tortured history of clinical évaluation. N«rs ObiIimI 25:308-315, 1977.
  • 7. Sumida SVV: A computerized test for clinical decision making. Nurs Ouliook 458-461, 197Z.
  • 8. Litwack L: A system for evaluation. Nurs Outlook 24:45-48, 1976.
  • 9. Dunn M: Development of an instrument to measure nursing performance. Nurs Res 19:502503, 1970.
  • 10. Wandelt M, Stewart DS: Slaler Nursing Competencies Rating Scale. New York, Appleton-Century Crofts, 1975.
  • 11. Schneider JL: Evaluation of Nursing Competence. Boston, Little. Brown Co, 1979.
  • 12. Tate BL: Evaluating the nurse's clinical performance. Nurs Outlook 10:35-37, 1962.
  • 13- Paduano M: E valuation in the nursing labora tory: An honest appraisal. Nurs Outlook 22:702-705, 1974.
  • 14. Benner P, Benner R: The New Graduait: Perspectives. Practice and Promise. La JoIIa, The Coordinating Council for Education in Health Sciences for San Diego and Imperial Counties, 1975.
  • 15. Clincal Performance in Nursing Examination Study Guide. Albany, The University of the State of New York, Regents External Degree Programs, 1976.
  • 16. Lagerquist S (ed): Addison- Wesley 'sNursing Examination Review. Menlo Park, Addison- Wesley Publishing Co, 1977.
  • 1 7. T*r Lippincotl Manual of Nursing Predice. Philadelphia, i? Lippincott Co, 1974.
  • 18. Massachusetts General Hospital Manual of Nursing Procedures. Boston, Little, Brown Co, 1975.
  • 19. Orientation Checklist for Nursing Personnel. Massachusetts General Hospital, Department of Nursing Staff Education, 1974.
  • 20. Saperstein A, Frazier M: Study Guides for Self Instruction in Selected Clinical Activities. Boston University School of Nursing, 1974.

TABLE 1

FACULTY RATINGS OF SKILLS AT THE COMPLETION OF THE INITIAL CARD SORT

TABLE 2

41 SKILLS IDENTIFIED AS ESSENTIAL BY 100% OF THE FACULTY ON THE INITIAL CARD SORT

TABLE 3

53 ADDITIONAL SKILLS IDENTIFIED AS ESSENTIAL BY 100% OF THE FACULTY AT THE CONCLUSION OF THE DELPHI ROUNDS

TABLE 4

27 SKILLS IDENTIFIED BY 90% AGREEMENT IN THE Q-SORT AND DELPHI TECHNIQUE

TABLE 5

TOTAL NUMBER OF SKILLS CONTAINED IN EACH CATEGORY AND THE NUMBER OF SKILLS RATED AS ESSENTIAL BY AT LEAST 90% OF THE FACULTY

TABLE 6

A SAMPLE OF SKILLS NOT RATED AS ESSENTIAL BY 90% OF THE FACULTY

10.3928/0148-4834-19820201-03

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