Patricia Hill Bailey

Objective structured clinical evaluation of clinical competence: an integrative review

AIM This paper presents an integrative literature review conducted to describe the utility of the objective structured clinical evaluation (OSCE) as a strategy of measuring one form of clinical competence in nursing. BACKGROUND The emergence of the OSCE, one form of evaluation of clinical competence used in medicine, is gaining more scrutiny and consideration in nursing education. DATA SOURCES The review was conducted through an initial search of computerized databases CINAHL, Cochrane Database of Systematic Reviews, Academic Search Premier and MEDLINE for the period from 1960 to 2008. METHODS An integrative review was performed and 41 papers met the inclusion criteria. RESULTS The complexities of evaluating clinical competence can be addressed through use of an OSCE process. Concerns related to the conceptual limitations and the lack of psychometric properties of the tools available for measurement in nursing education have been identified. CONCLUSION Major gaps exist in the nursing literature regarding the examination of the psychometric properties of the OSCE, the suitability of the design of the OSCE structure and tools for nursing to measure clinical competency, and the associated costs in the application of this evaluative method. Research conducted on the psychometric properties of the OSCE tool used and correlations to other evaluative methods currently used to evaluate nursing clinical competence would inform educational practices.

Chronic Obstructive Pulmonary Disease as Disability: Dilemma Stories

The purpose of this work was to develop an understanding of the meaning of disability for individuals living with chronic obstructive pulmonary disease (COPD) in a Canadian midwestern community from an emic perspective. A focused ethnographic design was used. Fifteen individuals participated in interviews. Narrative analysis was used to examine the interview data. Data analysis revealed 65 dilemma stories consisting of two structural components: the impairment, and the justification/explanation of the impairment. Participants’ impairment might or might not have been known to others. In both situations, individuals were faced with choices of whether to explain/justify or attempt to conceal the impairment. Participants told these dilemma stories to convey the meaning of COPD as a disability invisible to others, and at times, to themselves. The information gained from this research will serve as an essential complement to the existing knowledge about this important yet often invisible chronic illness.

Supported housing programs for persons with serious mental illness in rural northern communities: A mixed method evaluation

BackgroundDuring the past two decades, consumers, providers and policy makers have recognized the role of supported housing intervention for persons diagnosed with serious mental illness (SMI) to be able to live independently in the community. Much of supported housing research to date, however, has been conducted in large urban centers rather than northern and rural communities. Northern conditional and contextual issues such as rural poverty, lack of accessible mental health services, small or non-existing housing markets, lack of a continuum of support or housing services, and in some communities, a poor quality of housing challenge the viability of effective supported housing services. The current research proposal aims to describe and evaluate the processes and outcomes of supported housing programs for persons living with SMI in northern and rural communities from the perspective of clients, their families, and community providers.MethodsThis research will use a mixed method design guided by participatory action research. The study will be conducted over two years, in four stages. Stage I will involve setting up the research in each of the four northern sites. In Stage II a descriptive cross-sectional survey will be used to obtain information about the three client outcomes: housing history, quality of life and housing preference. In Stage III two participatory action strategies, focus groups and photo-voice, will be used to explore perceptions of supported housing services. In the last stage findings from the study will be re-presented to the participants, as well as other key community individuals in order to translate them into policy.ConclusionSupported housing intervention is a core feature of mental health care, and it requires evaluation. The lack of research in northern and rural SMI populations heightens the relevance of research findings for health service planning. The inclusion of multiple stakeholder groups, using a variety of data collection approaches, contributes to a comprehensive, systems-level examination of supported housing in smaller communities. It is anticipated that the studys findings will not only have utility across Ontario, but also Canada.

Locating Carper's Aesthetic Pattern of Knowing within Contemporary Nursing Evidence, Praxis and Theory

Carpers (1978) seminal work has been used in nursing education for many years as a method for introducing students to the multitude of ways of knowing that support nursing practice. This manuscript focuses on the aesthetic pattern of knowing and the ongoing debate in nursing literature surrounding aesthetics, evidence and nursing practice. Writers will describe and critique a strategy used to introduce first year undergraduate nursing students to this pattern of knowing. The implications of the critique of the project and the ongoing debate in relation to Carpers (1978) work, evidenced based practice and nursing praxis are discussed.

The novice objective structured clinical evaluation tool: psychometric testing

AIM This paper is a report of a study of the psychometric properties of the Novice Objective Structured Clinical Evaluation Tool. BACKGROUND A collaborative undergraduate nursing programme is currently using an objective structured clinical evaluation at the conclusion of the first nursing clinical course to determine student competence as a component of quality and safety education. However, the reliability and validity of the assessment tool has not been established. METHODS Psychometric testing was conducted with a convenience sample of 565 nursing students. Data were collected during three consecutive years from 2002 to 2004. Exploratory factor analysis and reliability testing were conducted on this 25-item tool. RESULTS Principal axis factoring method identified two factors through the orthogonal, oblimin and promax rotations: Factor 1 Safety and Factor 2, Anticipation. Spearman-Browns result for Factor 1 was 0·93 and for Factor 2 was 0·77. Cronbachs alpha was.94 for Factor 1 and 0·71 for Factor 2. CONCLUSION The tool was found to have adequate construct validity and reliability. Its stability should be tested by conducting test-retest analysis. Equivalency dimensions of reliability should be evaluated by looking at interrater reliability. This tool shows merit for assessing elements of quality and safety education.

A description of a process to calibrate the Morse fall scale in a long-term care home.

The purpose of this article is to describe the process of calibrating the Morse Fall Scale in a Canadian long-term care home as one aspect of a complex fall prevention program. The authors propose that the implementation of a calibration process of a fall risk assessment tool enables care providers to identify residents at greatest risk for falling. The authors further suggest that the ability to identify those residents most likely to experience a fall facilitates tailoring of fall prevention strategies for these individuals at greatest risk.

Homelessness, a State of Mind?: A Discourse Analysis

This article presents a discourse analysis of a womans written account of mental illness and homelessness. In her preparation as a co-presenter at a conference for decision- and policy-makers, Anna wrote eight distinct drafts of her speaking notes; each time emphasizing different aspects of her experiences with mental illness and homelessness. By sharing her preparatory writings, Anna offers a rare insight into the ‘evolution’ of the thinking that went into representing her story to an audience of professionals. In addition, this analysis represents an interpretation and alternative forum to learn from Annas story.

Emergency department boarding times for patients admitted to intensive care unit: Patient and organizational influences

INTRODUCTION Critically ill patients can be subject to prolonged stays in the emergency department following receipt of an order to admit to an intensive care unit. The purpose of this study was to explore patient and organizational influences on the duration of boarding times for intensive care bound patients. METHODS This exploratory descriptive study was situated in a Canadian hospital in northern Ontario. Through a six-month retrospective review of three data sources, information was collected pertaining to 16 patient and organizational variables detailing the emergency department boarding time of adults awaiting transfer to the intensive care unit. Data analysis involved descriptive and non-parametric methods. RESULTS The majority of the 122 critically ill patients boarded in the ED were male, 55 years of age or older, arriving by ground ambulance on a weekday, and had an admitting diagnosis of trauma. The median boarding time was 34 min, with a range of 0-1549 min. Patients designated as most acute, intubated, and undergoing multiple diagnostic procedures had statistically significantly shorter boarding times. DISCUSSION The study results provide a profile that may assist clinicians in understanding the complex and site-specific interplay of variables contributing to boarding of critically ill patients.