Learning Outcomes and Self Affessment of Baccalaureate Students in an Introduction to Nursing Course
The Journal of Scholarship of Teaching and Learning
This study investigated how students (N=64) assessed the process and meaning of their learning of course competencies, using critical reflective inquiry. At the conclusion of an introduction to nursing course, beginning students were asked to reflect upon what and how they had learned, to consider what course competencies they had met, and to identify the learning experiences that facilitated them. Written responses were categorized and coded by course competencies using the selective coding
... hod, and then ranked for degree of self-assessment (SACD). A significant relationship was found between final grade in the course and SACD (r=.676, p <.000.), as well as GPA at beginning of junior year (r=.420, p< .037). This study of student reflexive practice contributes to an understanding of the process of competency development in nursing students as they progress from novices to competent generalists 3 Learning outcomes and self-assessments of Baccalaureate students in an Introduction to Nursing course Expertise arises from constant examination and analysis of performance through active purposeful reflection (Andrews, 1996, p. 513). INTRODUCTION Expertise is a prized attribute in nurses that is developed over time and practice, and cannot be taught in one classroom. It is the culminating step in the ongoing evolution of a nursing student from beginner to expert clinician. Nursing education has as its goal the creation of competent providers of basic nursing care, and is also concerned with this evolution of the novice nursing student into a competent generalist by graduation, and ultimately an expert nurse. An attribute of an expert nurse is one who uses mindful practice to reflect upon one=s skilled nursing care practices, decisions made and patient-family-health care team interactions (Benner, 1982; Epstein, 1999) . Mindful practice is a reflective experience that transforms immediate experience through its automatic cognitive processing (King & Hibbison, 2000) . One learning strategy that can be used by educators to support the development of mindful practice in students is reflexive practice, which provides opportunities for critical reflexion on events, interactions, choices made and outcomes of one=s choices through the use of diaries, journals, class and small-group discussion, and other critical reflection exercises (Brookfield, 1995) . Little is known, however, about how these reflexive practice activities are associated with nursing students' learning processes as they progress from novices to competent generalists, and then to experts in nursing care. Specifically, little is known about how beginning nursing students evaluate their own learning of the competencies that demonstrate their understanding and 4 application of course content, and how this self-evaluation relates to their success in each course and in their academic program. The purpose of this non-experimental field study is to investigate how students in a beginning nursing course self-assess their learning of course competencies without prodding or cueing, using the process of critical reflective inquiry. Naturalistic inquiry was the method used to investigate this process of academic development. Naturalistic inquiry is a process of observation and questioning that attempts to not disturb or manipulate the naturally occurring phenomenon under study (Streubert & Carpenter, 1995) . The phenomenon under study was: (1) the degree of mindfulness that students displayed about their own academic growth, and (2) the ability to link their learning activities to the degree of personal learning they experienced. The primary research question that guides this naturalistic inquiry is: Is ability to critically reflect, demonstrated by richness of recall, description, explanation and insight, associated with other indices of academic success? Sophomore students in a baccalaureate nursing program at a North American university were the subjects of this study. The independent variable used for general linear model multivariate regression analysis was self-reflection ability as demonstrated through responses to a critical reflective inquiry exercise (Self Assessment Content and Description, or SACD). Contextual variables were: count and richness of description of competencies that each student claimed he/she had learned, high school standardized academic testing (SAT) total score, age and gender of student. The dependent variables were: progression in the program as measured by course final grade, GPA at beginning of junior year, and registration in junior year courses. Results of this study describe the beginning stages of the process by which students become 5 competent and aware of their competence as providers of basic nursing care. Results also contribute to the body of nursing knowledge about this process of competency development in nursing students as they progress from novices to competent practitioners of general nursing care. LITERATURE REVIEW The conceptual framework that guides this study is based upon Pat Benner=s (1984) model of skill acquisition as a developmental process in nursing students as they progress from novices to experts (Carlson, Crawford & Contrades, 1989) . This model was, in turn, adapted from the Dreyfus model of skill acquisition which postulates that skills are learned and performed in a progressive manner, by which the learner progresses through five stages of proficiency: novice, advanced beginner, competent, proficient and expert (Benner, 1984; Dreyfus & Dreyfus, 1980) . The expert is defined as Aa reflective practitioner who works intuitively, drawing almost unconsciously on a repertoire of context-specific paradigm cases@ (Rolfe, 1997, p. 93). Key to this process is the role of experience as the engine that drives the progression, as nursing students begin to test and refine their hypotheses and skills and challenge their assumptions and expectations. This phenomenon is considered the students= immediate, or primary experience of any event, and it is the transaction between this immediate experience and the students= interpretation of it that generates the learning that occurs (Ryan, 1994) . Reflection has been defined as: Athe retrospective contemplation of practice undertaken in order to uncover the knowledge used in a particular situation, by analyzing and interpreting the information recalled@ (Fitzgerald, 1994, p.67), or Athinking back about something of interest@ (Pierson, 1998, p. 165). The student uses reflection as the primary process that imbues experiences and cognitions with personal meaning. It is this experiencing of an event and its library services to enhance their communication. For the competent care provider competencies, 11.5% said they had identified nursing resources for consultation and learning. For the professional role model competencies, 15.4% said they had exhibited professional behaviors that fostered a positive image, and 3.8% said they had recognized nursing=s contribution to public health and wellbeing. For the manager of care competencies, 34.6% said they had assumed personal responsibility for meeting course expectations, 26.9% said they had evaluated their own actions in carrying out course assignments, and 3.8% were able to identified job descriptions for adjunct health care providers. To summarize, 100% of the critical thinking, cultural, coordinator of resources, and effective communication competencies, 75% of the professional role model competencies, 50% of the competent provider of health care competencies, 50% of the political awareness competencies, 37.5% of the manager of care competencies and 30% of the ethical and legal competencies had been identified by a student or students as having been learned in this course.