Outcomes assessment is an essential process, serving as a measure of not only the effectiveness of a curriculum and its courses but also the quality of a program's graduates. Mandated by national accreditation organizations, outcomes assessment challenges nursing faculty to identify and define outcome criteria and measurement tools appropriate to the program's particular curriculum and student population. In this article, the findings of an assessment study to determine changes in the selfreported professional development of RN students from the time of entry to graduation from a BSN program designed for RNs are presented.
Establishing Context for Assessment
One of the goals of baccalaureate education in nursing is to develop a sense of professionalism among nurses (Davidbizar & Vance, 1999; Kelly & Joel, 1999). Most professional organizations view the BSN as the minimum level of education necessary for professional nursing practice (Leddy & Pepper, 1998; Ryan & Brewer, 1997), and characteristics necessary for the practice of professional nursing have been addressed frequently in nursing literature. Common attributes include knowledge, critical thinking ability, communication skills, leadership ability, participation in and use of research in practice, and involvement in professional nursing organizations (Czerwinski, Blastic, & Rice, 1999; Haffer & Raingruber, 1998; Krejci & Malin, 1997; Kyzer, 1996; Maynard, 1996; Oermann, 1998; Warren & Heermann, 1998; Wilson, 1999).
Inherent in the process of professional development is the concept of professional socialization, a lifelong process by which nurses learn the expectations of the profession, acquire the skills necessary to practice, and adopt the values and beliefs specific to the profession (Hayden, 1995; KeUy & Joel, 1999). The health care environment is changing rapidly in the United States. Restructuring, downsizing, mergers, and job redesign are common in the health care arena. Because of changes in health care delivery, nurses' roles also are changing (Davidhizar & Vance, 1999; KellyThomas, 1998). As nurses progress through their careers, each time a role change is experienced a period of socialization to that new role occurs (Harrington, 1995). To remain marketable in such an environment, many nurses return to school.
Given the nature of an RN completion program, which has as its authence RN students, the faculty in the Department of Nursing at Millersville University determined that professional socialization was a major focus of the nursing curriculum and that the measurement of professional development was vital to assuring the program was achieving one of its major goals.
Measuring Professional Development
Following an extensive literature review, the faculty adopted the definition of professional development as stated by Beeler, Young, and Dull (1990). Professional development is a process consisting of four developmental levels, subdivided into five dimensions of professional nursing practice. The four developmental levels are:
* Professional awareness (Level 1).
* Professional identification (Level 2).
* Professional maturation (Level 3).
* Professional mastery (Level 4).
Competencies within each of these four levels were identified and grouped by the five dimensions of professional nursing practice, which include nursing practice/process, communication/collaboration, leadership, professional integration, and research/evaluation. The concept of professional development was operationalized in the professional development self-assessment matrix (PDSAM), as described by Beeler et al. (1990) and adapted from the work of Sovie (1982, 1983), in a brief grid format designed for self-report, depicting the four levels and five dimensions of professional development. Individuals rate themselves as being at one of the four levels on each of these five dimensions.
Nursing staff development educators used the PDSAM to assess the effectiveness of staff development programs for hospital-based nursing staff (Beeler et al., 1990). Recognizing that nurses within the hospital had different backgrounds and various experience levels, Beeler et al. (1990) sought to develop a tool applicable to all and determined that individual selfassessment of professional development according to set guidelines would be the most feasible and effective method.
Millersville University's student population is composed of RNs, a large proportion of whom are working as hospital staff nurses while attending the BSN program. Because the students have various educational backgrounds and levels of experience, the faculty felt the PDSAM would be easily adaptable for use with this population. The faculty developed a scoring instrument depicting a grid, on which students would identify their current developmental level for each of the five dimensions of professional nursing practice.
Implementing the Assessment Plan
The faculty was interested in learning whether students rated their professional development differently as they progressed through the BSN program. Therefore, a pretest-posttest assessment design was proposed. In the initial nursing course, Conceptual Bases of Professional Nursing Practice, students discussed the concept of professional development as defined by Beeler et al. (1990) and explored the implications of such development for professional practice. After this introduction, students completed the PDSAM during a class session. During subsequent semesters, students enrolled in required nursing courses in which professional role development (a vertical strand in the curriculum) was emphasized in both theoretical and practical learning experiences. A culminating course, Issues in Nursing, again provided a major discussion of professional development and its dimensions. Late in the semester in which students were scheduled to graduate, they again completed the PDSAM.
In completing the PDSAM, students provided a score from 1 = Level 1 to 4 = Level 4 on each of the five dimensions. The range of scores is 1 to 4, with 1 representing beginning professional awareness and 4 representing professional mastery. After working with the instrument for several years, the faculty established specific outcome benchmarks for each of the five dimensions of professional nursing practice. These benchmarks were determined following a literature review, with particular emphasis on the competencies established by Beeler et al. (1990) for each level of each dimension, compared to curriculum objectives and outcomes for the BSN program.
For the first four dimensions, the benchmark self-assessment mean score was 2.0 (professional identification = Level 2). For the research/evaluation dimension, a benchmark mean score of 1.5 was established (i.e., students rated themselves in the range of professional awareness to professional identification). Each year, graduates' performance on the exit assessment is compared with the established benchmarks to determine whether they have achieved the minimum benchmark score. Achievement of the minimum benchmark score indicates that curricular emphases on professional development issues are acceptable.
Scores of entering and graduating students are aggregated and compared periodically to determine whether positive growth in scores occurs. This pretestposttest approach is important because faculty thought it imperative to obtain a baseline measurement of students' scores so the mean scores at graduation could be compared to these baseline scores to determine whether positive change in selfassessment had occurred. G-test analyses using the Statistical Package for the Social Sciences (SPSS) were performed to determine whether differences were evident.
The most recent analysis was conducted using the scores of 223 entering and 168 graduating students during 1995 to 1998. T-test analyses indicated that scores of graduating students were significantly higher on all five professional development dimensions than pretest scores. Findings for each dimension were:
* Nursing practice/process (t = 12.01, p = .000).
* Communication/collaboration (t = 10.33, p = .000).
* Leadership (t = 11.18, p = .000).
* Professional integration (t = 11.58, p = .000).
* Research/evaluation (t = 6.92, p = .000).
Because faculty did not compare the scores of intact groups, they assessed whether the pretest scores of students who completed the program differed from those of students who either remained in or withdrew from the program (i.e., because it is an RN completion program, student progression toward the degree is rarely uniform). Pretest groups exhibited similar results.
The faculty has conducted a psychometric evaluation of the PDSAM. Careful analysis of the work of the instrument's authors, a review of relevant literature, and a determination of the measure's content validity via a determination of interrater agreement indicated the PDSAM demonstrates content validity. An analysis of students' scores on the PDSAM in 1995 provided initial reliability estimates of .8990, using Cronbach's alpha for internal consistency reliability. The data analysis in 1999 indicated reliabilities of .9193 on the pretest and .8788 on the posttest.
This outcomes assessment experience has sparked much interest and demonstrated promise in an ongoing program of assessment activities designed to measure professional development of nursing students. If nursing is to advance as a profession, nurses must view their ongoing development as a necessary component of their professional Uves. These findings have been used to evaluate the curriculum of the RN-to-BSN program to determine its relevance in stimulating the professional development process and, ultimately, in positively influencing the professional development activities of program graduates. It is hoped that other nursing programs will use the PDSAM in the assessment of students' professional development. This would further enhance the determination of the psychometric properties of the PDSAM and foster discussions and activities in nursing programs to stimulate the process of professional development in RNs.
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