NurxEduc~~mz Today (1991) II,4652 0 Longman Group UK Ltd 1991
The assessment of student nurses Sylvia Hepworth
This paper starts from the personal view that there are a number of issues related to the process of assessment which require investigation. It is suggested that a model of the assessment process might help clarify the present situation. The Brunswik lens model is explained and then expanded and adapted to facilitate its application to the assessment of student nurses in the clinical environment. Finally an ‘armchair’ evaluation of the model is undertaken with suggestions being offered for future investigation strategies.
also presents
INTRODUCTION
difficult
This paper starts from the premise that the nursing profession faces a number of philosophical and methodological problems related to the assessment of its practitioners. The ideas presented in this paper can be applied to the assessment of the skills and knowledge of both students and qualified practitioners. However in order to aid clarity they will be expressed in the context of the assessment of the student nurse.
novelty every
and
with a number
Nursing
individuality
is based which
relationship
value, worth or appropriateness bound
up in the differing
on
arises and
of the
from
nursing
is inextricably
perceptions
of the
nurse and the patient, in the knowledge held by both, and in their attitudes which may be supported by differing This
means
that
clinical nursing
or conflicting the
assessor
and
from
her
1989).
make a judgement is far
value systems. of a student’s
skills can only assess the student
in the light of her own perception (Hepworth
Nursing ability and skill can be demonstrated through the act of delivering nursing care and therefore must be seen as context dependent. The importance of the contextual setting has
assessor
nurse/patient
situation,
THE NEED FOR A MODEL
the
problems.
own
The
of the nursing
nursing
assessor
expertise
is required
to
and this implies that the task
simple.
Given
this situation
it is
reasonable to suggest that a model which helps elucidate the complexity might assist with clarification and might help direct future research.
been highlighted by the work of Benner (1982 and 1984). Observing the student in the clinical setting clearly has high ecological
validity but it
Sylvia Hepworth RGN Dip N London RCNT Cert Ed RNT Nurse Tutor, The West Yorkshire College of Health Studies, Dewsbury District Hospital, Healds Road, Dewsbury, West Yorkshire (Requests for offprints to SH) Manuscript accepted 1 July 1990
46
THE LENS MODEL The Brunswik lens model uses the concept of a convex lens to illustrate the relationship between the conclusions reached by a ‘judge’ and the object of his perceptions. (The word ‘judge’ is being used here to mean the person making a
CUES
TRUE
FIGURE
4b
I
STATE
The
simultaneous
model
of
the model
commonalty
with the concept
action as described to Brunswik festation
by Schon
the
cues
are
1955). In
to have
perceives
some
of knowledge (1983).
in
According
an indirect
maniof the
Each of the cues have a ‘true’ weight
in relation
to the state being judged. these cues, attaches
he considers
The judge
the weight which
to be most appropriate
leads to his decision According conclusion
in which about
perceive,
directly
arrives
which
at a
he cannot
on the basis of cues which he
perceive.
This
and Bordage
model
of medical (1979)
In this context,
has
and Wigton
this true
been
diagnosis state
the cues are the patient’s
by et al
is the signs
and symptoms and the judged state is the doctor’s diagnosis. The degree to which the doctor’s diagnosis is ‘correct’ or is a true reflection of the disease doctor’s
accuracy
state is dependent
in attending
THE LENS MODEL DEVELOPED TO REPRESENT THE CLINICAL ASSESSMENT OF STUDENT NURSES The
purpose
reference
on the
to the available
cues, selecting the relevant cues and/or applying the correct weights to the cues and his ability to assemble the cues into the judged state.
of
conceptualisation the
this
states’.
The
The
is to provide
which
will help
of the assessment
understanding
involved.
model
framework
of
model
the
of a ‘true
which
The term behaviour context.
process and
uses the concept
concept
human
issues of ‘true
state’ is hypothe underlying
behaviour
stems.
is being used in a very wide
It is taken to include anything
be directly
a
in the
cognitive
thetical and it is used to represent factor/s from
is a cogni-
the judge
something
to the process
disease process,
and this
(Fig. 1).
to this model, judgement
tive process
(1986).
appears
as a
different
of the state which is the subject
judgement.
Elstein
many
or cues (Brunswik
this respect
can
l
views judgement
assessment
items of information
applied
STATE
1
judgement).
directly
JUDGED
Me-
perceived
by another
which can person.
It
provides the cues to the ‘true state’. The model is congruent
with systems
punctuation made
theory
of the assessment
and the initial process
at the level of the triad.
situation
can be
In the clinical
this triad consists of the patient receiv-
ing nursing care, the student delivering nursing care and the assessor observing. The model is flexible in that it can be expanded to accommodate
punctuation
of the
process
at different
levels. For example it can be extended to include the student’s tutor, the assessor’s supervisor, the management
structure
of the
institution
even the relevant professional bodies. Application of these ideas to the
and
student/
48
NURSE EDUCATION
patient’s
TODAY
perceived
state
/m\
cues
patient’s FIGURE
patient
true
state
2
interaction
suggests
that
the
student
state to be against her own (the assessors)
assumes that the patient has a ‘true state’ and in
ment of the patient’s
terms of a nursing orientation
perceptions
complex
state.
‘given off student
The
student
by the patient.
judges
the
the cues
these cues the
‘state’
(perceived
care for the patient
line with her judgement.
In the terms
in
of the
process this could be said to be synony-
mous with patient/nursing the nursing cognitive
observes
From
patient’s
state) and then provides nursing
this may be a very
assessment.
it (Fig. 2).
If we now add the assessor to the model we begin to conceptualise
the complexity.
According
to
the model the assessor assumes that the students have a ‘true state’ in relation competence. composed
The
students’
of their
to their
nursing
true ability state is
knowledge,
values and the appropriateness
skills, attitudes, of their assess-
ment of the patient’s ‘state’ plus the assessment of any relevant situational and environmental factors. The student’s ‘true state’ in relation to all of these factors assessor.
The
nursing
related
is not directly assessor
observes
behaviour
available the
and from
to the
student’s the cues
available judges the student’s ‘competence state’ (perceived state). This judged state or perceived state is not merely dependent on the observed cues since the assessor compares perceive the student’s assessment
available are
to them.
involved
and
place this corroboration perceptual because
distortion
own
state are the only Even if other corroboration
inditakes
is also subject to possible at each stage of the process
the involvement
of others
introduces
more lenses into the model (Fig. 3).
the
of this activity. It is hoped
that this model will at least highlight
viduals
of the patient’s
assess-
assessor’s
However
process does not really examine
complexity
measures
state. The
with what they of the patient’s
THE MAIN ASSUMPTION UNDERLYING THE MODEL The assumption
of ‘true states’
The model described
above assumes that assess-
ors of the student
nurse make decisions
student’s
ability
nursing
about a
as if the student
has
some underlying ‘true state’. This assumption is difficult to support or refute but there are a number of issues which can be discussed. Firstly attribution theories have suggested that people do tend to explain
the actions of others in terms
of internal causality. Around 1940 psychologists began to suggest that people explain other people’s actions by attributing what they do to internal causes. Heider (1958) argued that there must be a potentially complementary set of external causes and that the task of the ordinary explainer is to decide whether a given action
student’5 true competence state
student’s behaviours (cues)
student’s
perceived competence state
a55e550r15 judgerent
/
Environmental factor5
Skill5
Skills -
‘Knowledge Mti tudes
Attitudes-
Value5 Situational
patient’5
Situetional factors
factors
perceived
state
patient’s behavioufs (cues)
patient’5
true
rtate
Situational factor5
Historic;1
Developrental
factor5
factor5
Knowledge factor5
50
NURSE EDUCATION
TODAY
springs from something
within the person who is
performing it, or from outside, environmental pressure. This is the core of attribution theory. The
author
because and
of this work refers
it appears
the theory
everyday people
make
to this theory
to have
However decisions
the
relevance
state
in the case
competence her
that
on the assumption
‘true states’ uses a slightly different true
of the
concept.
student
motor
abilities,
her
of The
nurse’s
includes the student’s internal
skills and
abilities
factors
ities. However not
the
relevant
to her nursing
what is at question
extent
to
whether
it is helpful
actually
occurs.
or desirable
If this issue
relation to the performance we
must
ask
student’s
do
or
but whether
is considered ever
attribute
attitudes
the stress caused by the presence
a and
or values or
of the assessor.
do make this type of response
they are using cognitive
it in
to lack of knowledge
skill, lack of appropriate If assessors
process
of the student nurse
assessors
behaviour
the
activ-
in this work is
of this attribution
then
activities as depicted
However
model
subjective explicit
the
The
in
as being
central factors
the reason
could be argued suggests
that the widespread that
people
within
use of this the nursing
profession
assume that there is some true state,
i.e.
which
‘safe,’
practice
can
be defined
in terms
and which can by some means or other
be identified.
If this is not so then the whole logic
of assessment
must be challenged.
If a true state
does not exist then assessing the student’s to give care to a particular patients
of
today
would
mean
patient
ability
or group
of
that we know the
played
highlights
the
since it makes
by observation
depicts
which
and
these processes
to assessment
and
may
objectivity.
the model
be
suggests involved.
One could argue that
fails to do this with the
same ease is that objectivity absolute
but rather
does not exist as an
as a point on a continuum.
Judgements are never completely free from centrally held values anchored in experience, socialisation
and cognitive
function
(Hepworth
1989). It could be said that the model presented in this paper
offers
a framework
these values explicit and therefore examination. The assessor
of the student
for making open to peer
nurse
might
be
subject to role conflicts and this can be depicted through the model by adding more lenses to show the relationship
experience
term
are
it is much more difficult to see how the
model handles
the currently
It
above
model
personal
their colleagues,
term ‘safe to practise’.
resources
of assessment
part
perception.
the above model. Before leaving this issue it is useful to consider popular
before
proposed
aspects
However
state,
perceive and to act, and her ability to control external
The
to
suggestion
required.
invested in such activities it appears reasonable to undertake a preliminary ‘armchair’ examination.
to have stood the test of time appears
life.
be
bodies.
between
the institution,
It also highlights
how the assessor
conflict due to their perception
student’s
needs as opposed
fessional
responsibility.
The benefit
the assessor
examination from
of any problem
issues from different
may of the
to his/her own pro-
a consideration
which are confined
and
and professional
is likely to
of the pertinent
levels of analysis. Theories to a single level are likely to
be vacuous.
It could
introduction
of
be argued
additional
lenses
that
by the
the
model
which has been presented in this paper could be used as an aid to the clarification of thinking at
student is safe/not safe to carry out that care today but we know nothing of her ability to care
any relevant
for the same group of patients or a similar group
within the framework include socialisation through assessment, the maintenance of the
of patients
tomorrow.
Other
level of analysis.
issues
which
can
be accommodated
status quo, power relationships,
THE RANGE OF CONVENIENCE THE MODEL
OF
If the usefulness of the proposed model is to be investigated then recourse to empirical data will
the use of assess-
ment to monitor professional competence or as a disciplinary tool, the hedonic value of the student nurse’s actions in relation to the trained nurse’s work load and the suggestion that different information may be available to the student as an ‘actor’ or ‘doer’ and the assessor
NURSE F.DC~:.~l~lOh TODAY an observer.
who is essentially
As Jones
and
information pro‘we believe that important cessing differences exist for the basic reason that different aspects of available information are salient for “actors” and observers differential outcome
salience
affects
of the attribution
Nishett,
the
and this
course
process’
and
(Jones
&
1972).
the assessment
Perhaps
it to its component
nurse assessors instinctively
istic approach
to patient
nurse assessment. why assessment produce
anxiety
assessor.
Those
to this view then surely
of a student’s
self assessment
client. Anything
competence
and assessment
must by the
care
and assessment
for both the student involved
activity compares
empirical
research
is now required.
ation of the problems assessors
could
grounded
theories
that recourse
An examin-
faced by both students and
lead
to
the
development
about the nature, of assessment
could
that the profession
,iccept the subjective also to accept that
of
the validity
and the reliability be argued
to
procedures. needs
procedures.
of how well this intuitive
of the
of these issues and an examinmodel
presented
suggests
that the assessor
progress
and abilities
cognitive
task
_judgements
and
on
received
the
cognitive
is faced that
with a complex
he/she
bases
has
of
and it would appear
student
nurse
thinking.
According
and
assessment
Dreyfus
induces
(1986)
characteristic highlights
people and developments
in this area should be
contextual
elements
r-ecognised
to the
assessment
process
student
as pertinent
educationalists helping standing
assessment
of
nurses. With these issues in mind nurse should
look
towards
all those involved improve of the cognitive
processes
ways of
the complexity
(19X4) and Drey-
dependent
thinking skills and is
It appear-s reasonin this papel
and individuality
which and
ot
intuitive
intui&e
of the expert.
are
that the nature
to Benner
context
way to study
method’ may not be an appropriate
10
mode used by the assessorljudge
to
scientific
data
According
able to say that the model presented
‘the
to make
multiple
towards
that
papel nurse’s
(1978) the nature of‘ the task and the
related
fus
in this
of a student
simultaneously.
Hammond
their nursing
involves complex
acceptance
we want
parts.
inversely related to validity and reliability. The social science disciplines are rapidly moving the
of do
It also raises the issues
It
nature of assessment and subjectivity need not be
intuitively
with quasi objective assessment
A consideration
been suggested
be
nurses to think in holistic terms and if we do is it
ation
It has already
may
forms and the
aware that the ‘parts’ do not reHect the whole.
activities into component
A POSSIBLE WAY FORWARD
use an hol-
and to student
logical to assess them by dissecting
less than this is unsupportable.
parts.
If this is so one can readily see criteria
This begs the question
It ther-e is any substance include
assess an holistic activity or an holistic approach to nursing by reducing
Nisbett put it:
51
impinge
thereforr
potential to provide a framework
of’
on
the
ir has
the
to guide future
enquiry.
their underinherent
in
rhe task. Finally one needs to consider the implications of current nursing philosophy which advocates practise of holistic care. The holistic approach is congruent with the empirical work
the
of Benner (1984) and the Dreyfus and Dreyfus theory of skill acquisition (1986). In support of holistic nursing it is often claimed that the whole is more than the sum of the parts and that the parts do not of necessity reflect the whole. One could then argue that it hardly seems logical to
References Benner P 1984 From Novice to Expert.
.iddisonWestley. London Benner P 1982 Issues in competency-based testing. Nursing Outlook May 1982: 303-309 Brunswik E 1955 Representative design and probabilistic theory in a functional psychology. Psychological Review 62: 193-2 17 Dreyfus H I, Dreyfus S E 1986 Mind O\er Machine New York MacMillan, The Free Press Elstein S, Bordage G 1979 Psychology ot clinical reasoning In: Stone G et al Eds Health psvchology A Handbook. Jossey-Bass pp 333. 67
-
52
NURSE EDUCATION TODAY
Hammond K R 1978 Towards increasing competence of thought in public policy formation. In: Judgement and Decision In Public Policy Formation. Westview Press Heider F 1958 The Psychology Of Interpersonal Relations. Wiley & Sons, New York Hepworth S 1989 Professional judgement and nurse education. Nurse Education Todav 9: 408-4 12 Jones E E, Nisbett R E 1972 The actor and the
observer: divergent perceptions of the causes of behaviour. In Jones E E et al Attributions. New Jersey General Press, p 85 Schon D A 1983 The Reflective Practitioner: How Professionals Think in Action. Basic Books Inc Wigton R S et al 1986 How physicians use clinical information in diagnosing pulmonary embolism. In: Medical Decision Making ” 6: 2-l 1.
The assessment of student nurses Sylvia Hepworth
This paper starts from the personal view that there are a number of issues related to the process of assessment which require investigation. It is suggested that a model of the assessment process might help clarify the present situation. The Brunswik lens model is explained and then expanded and adapted to facilitate its application to the assessment of student nurses in the clinical environment. Finally an ‘armchair’ evaluation of the model is undertaken with suggestions being offered for future investigation strategies.
also presents
INTRODUCTION
difficult
This paper starts from the premise that the nursing profession faces a number of philosophical and methodological problems related to the assessment of its practitioners. The ideas presented in this paper can be applied to the assessment of the skills and knowledge of both students and qualified practitioners. However in order to aid clarity they will be expressed in the context of the assessment of the student nurse.
novelty every
and
with a number
Nursing
individuality
is based which
relationship
value, worth or appropriateness bound
up in the differing
on
arises and
of the
from
nursing
is inextricably
perceptions
of the
nurse and the patient, in the knowledge held by both, and in their attitudes which may be supported by differing This
means
that
clinical nursing
or conflicting the
assessor
and
from
her
1989).
make a judgement is far
value systems. of a student’s
skills can only assess the student
in the light of her own perception (Hepworth
Nursing ability and skill can be demonstrated through the act of delivering nursing care and therefore must be seen as context dependent. The importance of the contextual setting has
assessor
nurse/patient
situation,
THE NEED FOR A MODEL
the
problems.
own
The
of the nursing
nursing
assessor
expertise
is required
to
and this implies that the task
simple.
Given
this situation
it is
reasonable to suggest that a model which helps elucidate the complexity might assist with clarification and might help direct future research.
been highlighted by the work of Benner (1982 and 1984). Observing the student in the clinical setting clearly has high ecological
validity but it
Sylvia Hepworth RGN Dip N London RCNT Cert Ed RNT Nurse Tutor, The West Yorkshire College of Health Studies, Dewsbury District Hospital, Healds Road, Dewsbury, West Yorkshire (Requests for offprints to SH) Manuscript accepted 1 July 1990
46
THE LENS MODEL The Brunswik lens model uses the concept of a convex lens to illustrate the relationship between the conclusions reached by a ‘judge’ and the object of his perceptions. (The word ‘judge’ is being used here to mean the person making a
CUES
TRUE
FIGURE
4b
I
STATE
The
simultaneous
model
of
the model
commonalty
with the concept
action as described to Brunswik festation
by Schon
the
cues
are
1955). In
to have
perceives
some
of knowledge (1983).
in
According
an indirect
maniof the
Each of the cues have a ‘true’ weight
in relation
to the state being judged. these cues, attaches
he considers
The judge
the weight which
to be most appropriate
leads to his decision According conclusion
in which about
perceive,
directly
arrives
which
at a
he cannot
on the basis of cues which he
perceive.
This
and Bordage
model
of medical (1979)
In this context,
has
and Wigton
this true
been
diagnosis state
the cues are the patient’s
by et al
is the signs
and symptoms and the judged state is the doctor’s diagnosis. The degree to which the doctor’s diagnosis is ‘correct’ or is a true reflection of the disease doctor’s
accuracy
state is dependent
in attending
THE LENS MODEL DEVELOPED TO REPRESENT THE CLINICAL ASSESSMENT OF STUDENT NURSES The
purpose
reference
on the
to the available
cues, selecting the relevant cues and/or applying the correct weights to the cues and his ability to assemble the cues into the judged state.
of
conceptualisation the
this
states’.
The
The
is to provide
which
will help
of the assessment
understanding
involved.
model
framework
of
model
the
of a ‘true
which
The term behaviour context.
process and
uses the concept
concept
human
issues of ‘true
state’ is hypothe underlying
behaviour
stems.
is being used in a very wide
It is taken to include anything
be directly
a
in the
cognitive
thetical and it is used to represent factor/s from
is a cogni-
the judge
something
to the process
disease process,
and this
(Fig. 1).
to this model, judgement
tive process
(1986).
appears
as a
different
of the state which is the subject
judgement.
Elstein
many
or cues (Brunswik
this respect
can
l
views judgement
assessment
items of information
applied
STATE
1
judgement).
directly
JUDGED
Me-
perceived
by another
which can person.
It
provides the cues to the ‘true state’. The model is congruent
with systems
punctuation made
theory
of the assessment
and the initial process
at the level of the triad.
situation
can be
In the clinical
this triad consists of the patient receiv-
ing nursing care, the student delivering nursing care and the assessor observing. The model is flexible in that it can be expanded to accommodate
punctuation
of the
process
at different
levels. For example it can be extended to include the student’s tutor, the assessor’s supervisor, the management
structure
of the
institution
even the relevant professional bodies. Application of these ideas to the
and
student/
48
NURSE EDUCATION
patient’s
TODAY
perceived
state
/m\
cues
patient’s FIGURE
patient
true
state
2
interaction
suggests
that
the
student
state to be against her own (the assessors)
assumes that the patient has a ‘true state’ and in
ment of the patient’s
terms of a nursing orientation
perceptions
complex
state.
‘given off student
The
student
by the patient.
judges
the
the cues
these cues the
‘state’
(perceived
care for the patient
line with her judgement.
In the terms
in
of the
process this could be said to be synony-
mous with patient/nursing the nursing cognitive
observes
From
patient’s
state) and then provides nursing
this may be a very
assessment.
it (Fig. 2).
If we now add the assessor to the model we begin to conceptualise
the complexity.
According
to
the model the assessor assumes that the students have a ‘true state’ in relation competence. composed
The
students’
of their
to their
nursing
true ability state is
knowledge,
values and the appropriateness
skills, attitudes, of their assess-
ment of the patient’s ‘state’ plus the assessment of any relevant situational and environmental factors. The student’s ‘true state’ in relation to all of these factors assessor.
The
nursing
related
is not directly assessor
observes
behaviour
available the
and from
to the
student’s the cues
available judges the student’s ‘competence state’ (perceived state). This judged state or perceived state is not merely dependent on the observed cues since the assessor compares perceive the student’s assessment
available are
to them.
involved
and
place this corroboration perceptual because
distortion
own
state are the only Even if other corroboration
inditakes
is also subject to possible at each stage of the process
the involvement
of others
introduces
more lenses into the model (Fig. 3).
the
of this activity. It is hoped
that this model will at least highlight
viduals
of the patient’s
assess-
assessor’s
However
process does not really examine
complexity
measures
state. The
with what they of the patient’s
THE MAIN ASSUMPTION UNDERLYING THE MODEL The assumption
of ‘true states’
The model described
above assumes that assess-
ors of the student
nurse make decisions
student’s
ability
nursing
about a
as if the student
has
some underlying ‘true state’. This assumption is difficult to support or refute but there are a number of issues which can be discussed. Firstly attribution theories have suggested that people do tend to explain
the actions of others in terms
of internal causality. Around 1940 psychologists began to suggest that people explain other people’s actions by attributing what they do to internal causes. Heider (1958) argued that there must be a potentially complementary set of external causes and that the task of the ordinary explainer is to decide whether a given action
student’5 true competence state
student’s behaviours (cues)
student’s
perceived competence state
a55e550r15 judgerent
/
Environmental factor5
Skill5
Skills -
‘Knowledge Mti tudes
Attitudes-
Value5 Situational
patient’5
Situetional factors
factors
perceived
state
patient’s behavioufs (cues)
patient’5
true
rtate
Situational factor5
Historic;1
Developrental
factor5
factor5
Knowledge factor5
50
NURSE EDUCATION
TODAY
springs from something
within the person who is
performing it, or from outside, environmental pressure. This is the core of attribution theory. The
author
because and
of this work refers
it appears
the theory
everyday people
make
to this theory
to have
However decisions
the
relevance
state
in the case
competence her
that
on the assumption
‘true states’ uses a slightly different true
of the
concept.
student
motor
abilities,
her
of The
nurse’s
includes the student’s internal
skills and
abilities
factors
ities. However not
the
relevant
to her nursing
what is at question
extent
to
whether
it is helpful
actually
occurs.
or desirable
If this issue
relation to the performance we
must
ask
student’s
do
or
but whether
is considered ever
attribute
attitudes
the stress caused by the presence
a and
or values or
of the assessor.
do make this type of response
they are using cognitive
it in
to lack of knowledge
skill, lack of appropriate If assessors
process
of the student nurse
assessors
behaviour
the
activ-
in this work is
of this attribution
then
activities as depicted
However
model
subjective explicit
the
The
in
as being
central factors
the reason
could be argued suggests
that the widespread that
people
within
use of this the nursing
profession
assume that there is some true state,
i.e.
which
‘safe,’
practice
can
be defined
in terms
and which can by some means or other
be identified.
If this is not so then the whole logic
of assessment
must be challenged.
If a true state
does not exist then assessing the student’s to give care to a particular patients
of
today
would
mean
patient
ability
or group
of
that we know the
played
highlights
the
since it makes
by observation
depicts
which
and
these processes
to assessment
and
may
objectivity.
the model
be
suggests involved.
One could argue that
fails to do this with the
same ease is that objectivity absolute
but rather
does not exist as an
as a point on a continuum.
Judgements are never completely free from centrally held values anchored in experience, socialisation
and cognitive
function
(Hepworth
1989). It could be said that the model presented in this paper
offers
a framework
these values explicit and therefore examination. The assessor
of the student
for making open to peer
nurse
might
be
subject to role conflicts and this can be depicted through the model by adding more lenses to show the relationship
experience
term
are
it is much more difficult to see how the
model handles
the currently
It
above
model
personal
their colleagues,
term ‘safe to practise’.
resources
of assessment
part
perception.
the above model. Before leaving this issue it is useful to consider popular
before
proposed
aspects
However
state,
perceive and to act, and her ability to control external
The
to
suggestion
required.
invested in such activities it appears reasonable to undertake a preliminary ‘armchair’ examination.
to have stood the test of time appears
life.
be
bodies.
between
the institution,
It also highlights
how the assessor
conflict due to their perception
student’s
needs as opposed
fessional
responsibility.
The benefit
the assessor
examination from
of any problem
issues from different
may of the
to his/her own pro-
a consideration
which are confined
and
and professional
is likely to
of the pertinent
levels of analysis. Theories to a single level are likely to
be vacuous.
It could
introduction
of
be argued
additional
lenses
that
by the
the
model
which has been presented in this paper could be used as an aid to the clarification of thinking at
student is safe/not safe to carry out that care today but we know nothing of her ability to care
any relevant
for the same group of patients or a similar group
within the framework include socialisation through assessment, the maintenance of the
of patients
tomorrow.
Other
level of analysis.
issues
which
can
be accommodated
status quo, power relationships,
THE RANGE OF CONVENIENCE THE MODEL
OF
If the usefulness of the proposed model is to be investigated then recourse to empirical data will
the use of assess-
ment to monitor professional competence or as a disciplinary tool, the hedonic value of the student nurse’s actions in relation to the trained nurse’s work load and the suggestion that different information may be available to the student as an ‘actor’ or ‘doer’ and the assessor
NURSE F.DC~:.~l~lOh TODAY an observer.
who is essentially
As Jones
and
information pro‘we believe that important cessing differences exist for the basic reason that different aspects of available information are salient for “actors” and observers differential outcome
salience
affects
of the attribution
Nishett,
the
and this
course
process’
and
(Jones
&
1972).
the assessment
Perhaps
it to its component
nurse assessors instinctively
istic approach
to patient
nurse assessment. why assessment produce
anxiety
assessor.
Those
to this view then surely
of a student’s
self assessment
client. Anything
competence
and assessment
must by the
care
and assessment
for both the student involved
activity compares
empirical
research
is now required.
ation of the problems assessors
could
grounded
theories
that recourse
An examin-
faced by both students and
lead
to
the
development
about the nature, of assessment
could
that the profession
,iccept the subjective also to accept that
of
the validity
and the reliability be argued
to
procedures. needs
procedures.
of how well this intuitive
of the
of these issues and an examinmodel
presented
suggests
that the assessor
progress
and abilities
cognitive
task
_judgements
and
on
received
the
cognitive
is faced that
with a complex
he/she
bases
has
of
and it would appear
student
nurse
thinking.
According
and
assessment
Dreyfus
induces
(1986)
characteristic highlights
people and developments
in this area should be
contextual
elements
r-ecognised
to the
assessment
process
student
as pertinent
educationalists helping standing
assessment
of
nurses. With these issues in mind nurse should
look
towards
all those involved improve of the cognitive
processes
ways of
the complexity
(19X4) and Drey-
dependent
thinking skills and is
It appear-s reasonin this papel
and individuality
which and
ot
intuitive
intui&e
of the expert.
are
that the nature
to Benner
context
way to study
method’ may not be an appropriate
10
mode used by the assessorljudge
to
scientific
data
According
able to say that the model presented
‘the
to make
multiple
towards
that
papel nurse’s
(1978) the nature of‘ the task and the
related
fus
in this
of a student
simultaneously.
Hammond
their nursing
involves complex
acceptance
we want
parts.
inversely related to validity and reliability. The social science disciplines are rapidly moving the
of do
It also raises the issues
It
nature of assessment and subjectivity need not be
intuitively
with quasi objective assessment
A consideration
been suggested
be
nurses to think in holistic terms and if we do is it
ation
It has already
may
forms and the
aware that the ‘parts’ do not reHect the whole.
activities into component
A POSSIBLE WAY FORWARD
use an hol-
and to student
logical to assess them by dissecting
less than this is unsupportable.
parts.
If this is so one can readily see criteria
This begs the question
It ther-e is any substance include
assess an holistic activity or an holistic approach to nursing by reducing
Nisbett put it:
51
impinge
thereforr
potential to provide a framework
of’
on
the
ir has
the
to guide future
enquiry.
their underinherent
in
rhe task. Finally one needs to consider the implications of current nursing philosophy which advocates practise of holistic care. The holistic approach is congruent with the empirical work
the
of Benner (1984) and the Dreyfus and Dreyfus theory of skill acquisition (1986). In support of holistic nursing it is often claimed that the whole is more than the sum of the parts and that the parts do not of necessity reflect the whole. One could then argue that it hardly seems logical to
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52
NURSE EDUCATION TODAY
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