Journal of Nursing Education

Meeting the Terminal Functions of a Baccalaureate Curriculum: The Students' Perception

Linda Moore, RN, EdD; Marlyn D Boyd, RN, PhD

Abstract

ABSTRACT

Nursing faculty have established terminal functions which graduates are expected to be able to accomplish after successfully completing the nursing program. Students have asked themselves and faculty if they are ready to perform as professional nurses after graduation. This study utilized the terminal functions established by one mediumsize state university to obtain data regarding the students' perceptions of their competencies based on the terminal functions. The assessment was conducted at the time of graduation and again one year post-graduation. The data may provide other faculty with a method to further evaluate nursing curricula and illustrate the changes in graduates' perceptions of their abilities over time.

Abstract

ABSTRACT

Nursing faculty have established terminal functions which graduates are expected to be able to accomplish after successfully completing the nursing program. Students have asked themselves and faculty if they are ready to perform as professional nurses after graduation. This study utilized the terminal functions established by one mediumsize state university to obtain data regarding the students' perceptions of their competencies based on the terminal functions. The assessment was conducted at the time of graduation and again one year post-graduation. The data may provide other faculty with a method to further evaluate nursing curricula and illustrate the changes in graduates' perceptions of their abilities over time.

Introduction

Nursing is a practice discipline; therefore, the criterion for validation of nursing theory is the degree of its applicability in practice (Woolley, 1977). Self-evaluation is a method which can assist baccalaureate nursing students in assessing the degree to which they have positively correlated theory and practice. In addition, self-evaluation can help students develop the ability to identify learning needs. Many schools have placed emphasis on the use of student self-evaluations; however, little has been written about students' perceptions of how well they have integrated theory and practice as students and as graduates.

A review of educational literature indicates a discrepancy exists between student self-evaluations and teacher evaluations. Herold and Thomas (1981) found that most studies used the test-retest method to determine change and not self-evaluations when evaluating the learning process. When the results of self-reported evaluations were analyzed with computed measures of academic growth results varied. Moreland found that academically poor students were less accurate in assessments of their achievements than better students (Moreland, Miller, & Lavakea, 1981). Herold and Thomas (1981) assert that computed measures do not reveal complete information in assessing attitude changes which occur with academic growth. These attitude changes can not always be evaluated with computed test measures.

Self-evaluation has been considered as an important factor in adult education. Knowles (1975) recognized selfevaluation as a basic component of adult education. In Cross' (1981) chain-of- response model for adult motivation of learning, self-evaluation is the beginning and the end; self-evaluation directs educational activities. Infante (1975) noted that students must be allowed to evaluate their own activities as part of their nursing education.

The literature supports the need for self-evaluation but little has been documented in regard to changes in students' self-perceptions over time, based upon terminal practice functions outlined within a curriculum. Many baccalaureate nursing students voice concern about their potential performances as professional nurses although their nursing curriculum may define nursing practice functions which must be mastered before the students can graduate. By meeting these terminal objectives or functions the potential graduate will evidence a sound theory variety of observations and from the background and training of the evaluator" (Sax, 1974, p. 3). Not only have the value judgments made by faculty been important in considering the performance of students, but also those value judgments made by the students in their growth as professional nurses were considered important. Developing value judgments is an ongoing process requiring information from numerous sources including one's own perceptions.

The authors' review of the literature supported the need for students to use self-evaluations in assisting them to diagnose their performance and learning needs. Likewise, the literature supports the research questions which were considered in this study:

1. To what degree do baccalaureate nursing students perceive their level of competency in meeting their curriculum's terminal functions?

2. Do the students' perceptions of competency in meeting the curriculum's terminal functions change over the year following graduation?

Methods

The population for this study was the 111 students of a 1980 baccalaureate nursing school class from a mediumsize state university. The students were asked to complete a questionnaire on the students' perceptions of being able to meet the curriculum's terminal functions during their last nursing class period prior to graduation.

The self-competency questionnaire included the curriculum's 25 terminal functions for nursing practice expected of the graduates. The students were asked to rank themselves using a three-point Likert-type scale as to how they perceived their level of competency on each of the 25 terminal functions. The three categories were: incompetent; somewhat competent; and very competent.

The students were asked to voluntarily complete the questionnaire (Phase I). The questionnaires were coded to assure matching responses following graduation. The students provided addresses for the one-year follow-up mailing.

One year following graduation the questionnaire was mailed to the initial respondents to be completed based upon their perceptions of how the baccalaureate program contributed to their competency on the 25 terminal functions (Phase II).

Results

A descriptive analysis was done with the data on both sets of competency ratings. This information provided frequencies of the data. The first analysis used a paired ttest to compare the means of all the terminal functions on the pre- and post-graduation responses with a significance level of .01. The second analysis consisted of studying the responses on the 25 individual terminal functions. The scores on the self-perception competency questionnaire at the time of graduation were compared with the postgraduation scores for all 25 items. The information was compared using a t-test with a significance level of .001. This level was reduced because separating the terminal functions into individual items increased the number of comparisons being made which would increase the possibility of chance significance.

The descriptive analysis indicated that 53 students out of a population of 111 students completed the first assessment tool at the time of graduation for a total of 48% of the population. Most of the functions were rated at the "somewhat competent" level. Those functions in which more than two-thirds (67%) of the students perceived that they were "very competent" included:

1. Determine the factors which affect health status of individuals and families ................ 73.6%

2. Maintain competence by participating in educational activities ........................ 67.9%

3. Meet the ethical standards of professional practice ....................................... 90.6%

4. Function as a client advocate ........... 84.9%

5. Understand role and responsibilities of the professional nurse in today's society .......... 71.7%

Those functions in which more than 10% of the students perceived that they were "incompetent" in carrying them out included:

1. Intervene during a crisis situation to deliver basic emergency nursing care ................ 18.9%

2. Strive for resolutions of nursing and health related issues ........................... 15.1%

3. Participate in the educational preparation of professional nursing students ............... 11.5%

4. Participate in the formulation and application of standards of professional practice ........ 15.1%

5. Supervise non-professional nursing personnel ........................................ 15.1%

6. Contribute to the knowledge base of the profession by sharing information gained by own professional activities ......................... 11.3%

7. Assume a leadership role in the provision of nursing care ........................... 18.9%

8. Assume a leadership role, when appropriate, in the provision of health care ............. 13.5%

The total number of students and percentages for student rankings on the individual functions are found in Table 1. The table includes the 25 functions considered necessary by the faculty for graduates of the program. The columns following the functions indicate whether the students ranked themselves as "incompetent" (IC), "somewhat competent" (SC), or "very competent" (VC). Raw data indicating the number of student responses preceed the percentages of answers in the columns. Several functions were not ranked by some students. The percentages provided were the adjusted percentages to account for the several students who did not respond (Table 1).

The self-perceived competency assessment tool was mailed one year after graduation to the 53 students who had completed Phase I of the study conducted at the time of graduation. There were 35 (66%) questionnaires completed and returned (Phase II). No follow-up was made of those who did not return the questionnaires. Several of the questionnaires were returned because of no forwarding address.

Table

TABLE 1GRADUATION COMPETENCY IN NURSING FUNCTIONS

TABLE 1

GRADUATION COMPETENCY IN NURSING FUNCTIONS

The following functions were ranked at the "incompetent level" by more than 10% of the students at one year postgraduation:

1. Improve the level of nursing services through participation in organized professional activities ........................................ 18.2%

2. Secure support for the professional by functioning as an advocate for professional nursing . 11.8%

3. Strive for resolutions of nursing and health related issues .......................... 20.6%

4. Participate in systematic inquiry designed to improve health care .................... 12.1%

A descriptive analysis of the rankings by the students one year after graduation is found in Table 2. The number of returned questionnaires was 35 (66%). The functions were listed followed by the raw data of students who selected the responses of "incompetent" (IC), "somewhat competent" (SC), or "very competent" (VC). The percentages of responses are included within the parentheses (Table 2).

When comparing the sum of the rankings on the 25 functions for time of graduation and for one-year postgraduation, one can analyze the data to note the changes and skills base needed to begin professional practice.

Table

TABLE 2ONE-YEAR POST-GRADUATION COMPETENCY IN NURSING FUNCTIONS

TABLE 2

ONE-YEAR POST-GRADUATION COMPETENCY IN NURSING FUNCTIONS

One school of nursing has listed 25 terminal functions for nursing practice which a graduate of the program would be expected to accomplish in his or her role as a professional nurse. The functions denote entry level knowledge and skills for the graduate.

Evaluation of these terminal functions may not be an easy task. Evaluation has been described as a "process through which a value judgment or decision is made from a over time in the rankings. Using the 35 responses for a paired t-test, the mean of the graduation scores was 59.83 and the mean of the one-year post-graduation scores was 64.29. The mean difference was - 4.4571, with a t-value of -3.13. The t-value was significant at .01. The results indicated the difference between the means was significant and that students' self-perceptions changed over the oneyear time span. Combining the information with the descriptive analysis indicated that the rankings were at a higher level of competence at the end of one year postgraduation.

Further analysis consisted of evaluating each of the 25 terminal functions to determine differences between graduation and one year post-graduation. Each of the function's rankings was analyzed and .001 level of significance was used to decrease the possibility of significance by chance. The functions which were statistically significant at .001 are shown in Table 3.

In those remaining nineteen functions compared, the mean differences from graduation until one year postgraduation could not be found to be statistically different.

Table

TABLE 3SIGNIFICANT CHANGES IN COMPETENCY LEVELS ON NURSING FUNCTIONS

TABLE 3

SIGNIFICANT CHANGES IN COMPETENCY LEVELS ON NURSING FUNCTIONS

Conclusions

This study indicated that some students at the time of graduation and one year post-graduation ranked themselves as being "very competent" in certain areas of the terminal nursing functions expected of all the curriculum's graduates. The areas in which respondents felt "very competent," both at the time of graduation and at one year post-graduation included: determining the factors affecting health status of individuals and families; maintaining competence by participating in educational activities; meeting the ethical standards of professional practice; functioning as a client advocate; and understanding roles and responsibilities of the professional nurse in today's society. The areas rated as "incompetent" by the respondents at one year post-graduation included: improving the level of nursing services through participation in organized professional activities; securing support for the professional by functioning as an advocate for professional nursing; striving for resolution of nursing and health related issues; and participating in systematic inquiry designed to improve health care.

The only function rated by more than 10% of the respondents both at graduation and one year post-graduation as "incompetent" was to strive for resolutions of nursing and health related issues. In addition to the preceding function, eight other functions were ranked at the "incompetent" level at the time of graduation by more than 10% of the respondents. These eight functions were not ranked at the "incompetent" level, however, one year post-graduation. These terminal functions included: intervening during a crisis situation to deliver basic emergency nursing care; participating in the educational preparation of professional nursing students; participating in the formulation and application of standards of professional practice; supervising non-professional nursing personnel; contributing to the knowledge base of the profession by sharing information gained by own professional activities; and assuming a leadership role in the provision of health care.

The data indicated all statistically significant changes in the rankings moved from an "incompetent" level at the time of graduation to a "competent" level one year postgraduation. None of the data statistically indicated that students who believed themselves competent at the time of graduation described themselves as incompetent one year post-graduation.

Herold and Thomas (1981) indicated that computed measures do not reveal complete information in assessing the attitude changes which occur with academic growth. The perceptions obtained at the time of graduation and one year post-graduation give an indication of the attitudes toward learning experiences. According to Knowles (1975), the self-assessment is a very basic part of education. Observing the respondents self-perceptions at the time of graduation and at one year post-graduation provides the opportunity for faculty to evaluate students' perceptions of their competencies according to the curriculum's terminal functions. Although this is only one school's terminal functions and the students' perceptions of their competencies based on these functions, all educational settings may want to evaluate more closely the students' perceptions of their abilities both at graduation and following graduation in order to obtain a more indepth evaluation of the nursing curriculum.

References

  • Cross, KP. Adults as learners. San Francisco: Jossey-Bass Publishers, 1981.
  • Herold, E. S. & Thomas, R.E. Perceived versus computed changes: Can perceived measures tell us something that computed measures cannot? Educational Psychological Measurement, 1981, 41, 701-707.
  • Infante, M.S. The clinical laboratory in nursing education. New York: John Wiley & Sons, Inc., 1975.
  • Knowles, M.S. Self-directed learning: A guide for learners and teachers. Chicago: Association Press, Follett Publishing Company, 1975.
  • Moreland, R.; Miller, J .; & Lavakea, F. Academic achievement and self-evaluation of academic performance. Journal of Educational Psychology, 1981, 73, 335-344.
  • Sax, G. Principles of educational measurement and evaluation. Belmont, California: Wadsworth Publishing Company, Inc., 1974.
  • Woolley, AS. The long and tortured history of clinical evaluation. Nursing Outlook, 1977, 25, 308-315.

TABLE 1

GRADUATION COMPETENCY IN NURSING FUNCTIONS

TABLE 2

ONE-YEAR POST-GRADUATION COMPETENCY IN NURSING FUNCTIONS

TABLE 3

SIGNIFICANT CHANGES IN COMPETENCY LEVELS ON NURSING FUNCTIONS

10.3928/0148-4834-19851001-05

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