With Reference to the NMC (Nursing and Midwifery Council, UK) Standards, Critically Discuss the Factors that Determine the Effectiveness of the Assessment Process in the Professional Practice
Introduction:
Standards, once thought as an exercise with little impact have become a significant impact and statement about professional nursing practice, well-being of the patients, and the organizations that are so complex within which the nurses practice. Increasingly innovative approaches to standards and quality control are demonstrating their essential nature in healthcare today. Standards as outlined by the regulatory authorities are no longer segregated from practice. The standards for professional practice and their continuous evaluation lead to discrete outcomes that relate to and speak of established norms surrounding organizational goals around which patients, families, multidisciplinary teams, and organizational teams must rally.
Standards, professionally, are keys to excellence in practice. Standards provide guidance and define directions and professional accountability. Some, however, dispute that guidelines for standards enumerated by accreditating bodies are considered and treated as sparsely used documents that speak of utterly unrealistic expectations and unachievable standards of care. Standards are supposed to be creating expectations about what one receives and how one judges what is good. In this relation, the concept of quality can be dealt with. The quality is defined on the basis of pre-existing measures of excellence that are in conformity with requirements. Therefore, it must be judged in relation to what it is intended to be, that is, in relation to standards (NMC, 2006).
For nurses within an agency, successful models of standards with a goal of making a clinical impact, this is all about creating a shared vision of professional practice, creating an approach to defining practice and care, and creating a system for integrating standards into day-to-day practice. Standards also reflect values and context. They reflect the unique needs of the patient groups to whom the nurses deliver care. This also implies abilities and resources of the professional staff with whom the nurses practice. Therefore, this encompasses the focus of professional nursing within a given setting. This approach of standards reflects the values and visions of the professional staff as a whole. The clinical expertise and the experience that develops in the professional nurse as a result of daily practice lead to development of a shared vision for practice. Practicing professional staff nurses must play a major role in creating this shared vision of what must be done to help patients achieve positive clinical outcomes and to help the junior nurses to achieve the standards (NMC, 2006).
Nursing standards are the supporting structures of the nursing department and nursing service. These provide the underlying framework for all activities performed by the nursing staff. For example, the Nursing and Midwifery Council (NMC) is the regulatory body for the nurses, midwives, and specialist community public health nurses. In order to protect the public, the council sets the standards for the education, training, conduct, performance, and ethics. These standards assist the providers of healthcare to deliver patient care based on adherence to generally accepted contemporary practices designed to achieve specific outcomes for a particular service, process, diagnosis, and/or clinical state or problem. It has been suggested that the standards of quality are as expansive or bounded and are as acceptable or questionable as the concepts from which they originate. The intent and aim of nursing standards is, therefore, to specify the agreed-on level of quality or merit that the profession of nursing can use to judge the appropriateness, performance, and outcomes of the practices in which the nurse is engaged. Therefore, the actual process used to develop and agree on statements that serve as nursing standards must be a validation process. If this validation process proceeds in an orderly, well-thought-out manner and involves nursing practitioners who have experience and expertise in this specific area, the outcome would be valid nursing standards out of this agreement process(NMC, 2006).
Can this process assure that the type of nursing care provided in a specific institution adequately and efficiently? This can be difficult and evidently a complicated task. To be able to do this, the nursing staff must understand the purpose and function of nursing standards and its commitment to delivering nursing care based on those standards that are the vital elements of the successful implementation of nursing standards in daily patient care delivery practices. Medical institutions and nursing systems are charged with training healthcare professionals and nurses with advanced learnings in clinical care, research, and evidence-based experiential education. This needs a mentor, and mentoring has long been known as a core component of the duties of the nursing faculty to facilitate successful fulfillment of this process of academic mission. Mentoring has long been recognized as a catalyst for career success, and mentoring relationships have been cited as important in facilitating career selection, advancement, and productivity in a nurse’s career. To enhance the development of mentorship within the clinical area and to prevent further erosions in these vital relationships, it is also equally important to understand the effects of mentorship on the mentees and the mentors, the variables associated with mentoring process and success in that it can have impact mentoring interventions on career satisfaction and productivity (Kurtzman, E.T. and Corrigan, J.M., 2007).
There is a single developmental framework to support learning and assessment in practice. NMC defines and describes the knowledge and skills that registrants need to apply in practice when they support and assess students undertaking the NMC approved programmes that lead to registration or a recordable qualification on the register. The NMC has identified and listed outcomes for mentors so that there is clear accountability for making decisions that lead to entry to the register. These spread over domains, such as, establishing effective relationship, facilitating learning, assessment and accountability, evaluating learning, creating an environment and fostering learning, directing the mentees towards the context in practice and guiding toward evidence-based practice, and leading. This framework has been designed for application within the context of inter-professional learning and working in modern healthcare. The design of the framework is such that it gives service and education providers opportunities to develop other roles that meet local requirements for supporting learning and assessment in practice (Karpuk, L., Manning, K., Larson, J., Benedict, L., and Yockey, J., 2005).
The NMC has established standards that require identification of the mechanisms by which to evaluate the care given by nurses based on these predetermined statements. To understand the structure and content of nursing standards, it is important to understand their many characteristics. One approach is to describe standards on the basis of how they are developed – normatively or empirically. Normative standards are based on what the best informed sources suggest ought to be done. Empirically derived standards represent what is actually done in practice and can be demonstrated as attained. Standards can be affected by expectations of the patient and the patient’s family members, the provider institution’s mission, the patient and the staff mix, the patient volume, the types and numbers of high-risk and high-volume procedures performed, the existence of problem-prone activities, the national and regional norms and criteria for care delivery, and the types of technologies available to assist in meeting the patients’ needs. It is to be remembered that the target and scope of each standard must be validated first and must be investigates first whether they have reliability (NMC, 2006).
Under the supervision of a mentor, a mentee assumes responsibility for the care of the patient. The care includes conducting a complete, accurate initial assessment of the patient’s condition, identifying current patient problems, and developing, implementing, and evaluating a plan of care. The mentor works to develop the psychomotor, critical thinking, and clinical decision making skills of the mentee. To promote the optimal patients outcomes, the mentor enhances the mentees’ application of content learned in academic learning and orientation classes and the subjects learned in anatomy, physiology, pathophysiology, and pharmacology. It is important to incorporate scientific concepts into the patient’s plan of care. Once these concepts can be applied into clinical decision making, an appreciation develops of how utilization of these concepts is effective in moving the patient along the continuum of care toward optimal patient outcomes. Therefore, a mentor must have certain competencies. The most significant of them are collaboration and facilitation of learning. The mentor as an executor would promote clinical judgment, clinical enquiry, advocacy, and moral agency. The other facets of this function that emanate are planning and developing education programmes as they relate to unit and departmental operations, staff competencies, staff development, and practicing trends in healthcare that require multidisciplinary collaboration. Based on identified needs of the patients, it is often essential to develop programmes that involve working with other nurse experts, physicians, respiratory therapists, social workers, and pharmacists. The goal of these programmes is to ensure that quality care is delivered that is centered on the needs of the patients, families, and significant others.
Teamwork is an essential component of the whole nursing care. Teamwork is an important practice that needs to be learned and cultivated in the trainees. Teamwork in collaboration with other personnel is pivotal in promoting a safe and harmonious working environment. The mentor is responsible for developing educational interventions for staff training, changes in the unit processes, standards of care, and policies and procedures to meet unit needs. A nursing student’s time, thus, is divided in receiving education through training programmes, lectures, and workshops. The guided self-directed learning process and one-on-one instruction account for a significant proportion of time in the whole curriculum. Through course delivery and instruction and through contribution to ongoing unit developments that incorporate identifications of trends and processes that impact unit operations, the mentor is thus the facilitator of learning (Yancey, N.R., 2005).
Any learning process must have in-built tools for evaluation and development. Staff assessment and development entail providing initial and ongoing assessment of an individual’s skills, knowledge, behaviours, and ability to provide pertinent and appropriate patient care. This encompasses several standards and competencies. These include caring practices, clinical judgment, facilitator of learning, collaboration, clinical enquiry, and advocacy and moral agency.
Thus the assessment of standards of practice is not an easy job. They are both responsible and accountable for organizing and co-ordinating student learning activities in practice. The mentors must supervise the students in different clinically significant learning situations and guide learning. In order to guide learning from clinical care activities, the mentor must know the art of providing constructive feedback on their achievements. These achievements can be promoted by setting the standards in front of the students, and this must be monitored in each and every step so a realistic learning objective is achieved. It has been highlighted before that the ultimate outcome is patient’s care is performance in the clinical area. So the total performance is to be assessed, and this includes not only skills, but also attitudes and behaviours. The nurse mentor must provide evidence whether or not standards have been achieved. This needs meticulous and impartial assessment practices that must be learned by the mentors. For the nursing student, this actually points to an all-round development in every step. Thus the assessor’s responsibilities are not expected to end with just the initial assessment. This involves an all-round and holistic programme that involves liaising on the part of the mentor with other levels, such as, mentors, sign-off mentors, practice facilitators, practice teachers, personal tutors, and programme leaders and to provide feedbacks to them mainly in order to identify any concerns about the student’s performance and plan actions as appropriate. At the end of the programme, they need to make decisions about achievement of proficiency and provide evidence for such (Miller, J.F., 2006).
The challenges of the assessors would spring from some other aspect of their work role and responsibilities. The most important of them is establishing a very effective working relationship. In fact, the intensity of the relationship is a marker of the intensity of learning. Thus an effective relationship based on mutual trust and respect is the goal and the challenge. They must demonstrate an understanding of factors that influence how students integrate into practice settings. In the clinical setting, there is always a dynamic transition of the students from one learning environment to another. In this critical phase, the mentor is expected to provide ongoing and constructive support to facilitate transition from one learning environment to another.
Another challenge is to know the students baseline at the time of beginning of training. The knowledge about the student’s stage of learning is important since that directs a selection of appropriate learning opportunity to meet the individual needs of the students. This also would be a determinant factor for facilitation of selection of appropriate learning strategies to integrate learning from practice and academic experiences. The experiential approach to learning demands a critical reflection upon their learning experiences in order to enhance future learning (Hayden, J., 2006).
This system is designed to foster professional growth, personal development, and accountability through support of students in practice. The mentors must understand the assessment process very thoroughly and are required to demonstrate a breadth of understanding of the assessment strategies and should have ability to contribute to the total assessment process as a part of the teaching team. The assessment process would identify the standards, and the deficits in learning would be identified in a pin-point manner in this process. Depending on that, the assessor would provide constructive feedback to the students, and the job would not end there. It necessitates an involved assistance in identifying the future learning needs and actions necessary to achieve them. The problem area is dealing with the failing student. They need special care, caution, and expertise. The mentors need to manage them so that they may either enhance their performance and capabilities of safe and effective practice by means of understanding of the failure, reasons of them, and the deviations of their practice standards from the acceptable standards of practice and competencies. The most important challenge is maintenance of accountability. The mentor has a unique position to maintain accountability to both the mentees and the NMC. Thus being accountable essentially means confirming the students whether they have met or not met the standards NMC competencies in practice in order to deliver safe and effective patient care (NMC, 2006).
It is to be noted that proper system design and sufficient resources are the most important means of protecting and prioritizing quality nursing care. Having standards of care and assessing them without the proper system design will not alter practice or outcomes in the patient care. Transforming the theory into clinical reality of practice requires complete and integrated system design that supports the process and scope of practice. It begins with the scope of clarity in practice coupled with establishment of a process whereby the staff governs their practice and holds each other responsible to the scope of practice.
Assessment of learning is hence important since it contributes to evaluation of student learning and assessment experiences. This can also open avenues for proposing aspects for change as resultants of such evaluations. The students must participate in self and peer evaluation to facilitate personal development, and that would initiate a process of contribution to the development of others.
Research is an important component in development of practice. The mentor is required to identify and apply research and evidence-based practice to the area of practice. This evidence base would contribute to the strategies to increase the evidence base to support practice. The mentors would continuously innovate processes that would support the students to apply an evidence base to their own practice.
The failing student or the disable student is a special area, and the mentor needs to facilitate their personal development specifically. This springs from the NMC principles of supporting all students to achieve their full potential in both practice and academic learning environments. The mentors meet this challenge by disability equality training. The learning environment ideally needs to enable the students to be confident that disclosure of their specific needs without fears for discrimination. The mentors should allocate special slot of time for these students.
In conclusion, the developmental framework for the nursing training is designed to facilitate personal and professional development that inculcates the implementation of experiential learning through mentorship, evidence-based learning, facilitation and support for learning, assessment of standards, and implementation of changes in practice with special attention for the disable and failing students in order to develop competency and standards of practice as enumerated by the guidelines by NMC.
References
Hayden, J., (2006). Mentoring: Help With Climbing the Career Ladder. Health Promotion Practices; 7: pp. 289 – 292.
Karpuk, L., Manning, K., Larson, J., Benedict, L., and Yockey, J., (2005). Nursing Education and Nursing ervice Partnership: Teaching Leadership Online. Home Health Care Management Practice; 18: 27- 32.
Kurtzman, E.T. and Corrigan, J.M., (2007). Measuring the Contribution of Nursing to Quality, Patient Safety, and Health Care Outcomes. Policy Politics Nursing Practice; 8: 20 – 36.
Miller, J.F., (2006). Opportunities and Obstacles for Good Work in Nursing. Nursing Ethics; 13: pp. 471 – 487.
NMC (2006). Standards to support learning and assessment in practice NMC standards for mentors, practice teachers and teachers. Standards.08.06. Accessed from www.nmc-uk.org Retrieved December 24, 2007.
Yancey, N.R., (2005). The Experience of the Novice Nurse: A Human Becoming Perspective. Nursing Science Quarterly; 18: 215 – 220.
