VALIDATION OF A SUBJECTIVE KNOWLEDGE ASSESSMENT INSTRUMENT Cecelia Beisner Ph. D, RN Assistant Professor OU College of Nursing
INTRODUCTION & MOTIVATION Previous research identified a gap between academic and professional practice The transition phase of the student to the professional role of the RN has often failed Led to the unsuccessful adaptation of the new graduate as a professional registered nurse (Marshburn, Engelke, & Swanson, 2009; Dyess & Sherman, 2009; Halfer & Graff, 2006; Letvak & Buck, 2008; Wyngreeren & Stuart, 2009; Jimenez, Navia-Osorio, & Diaz, 2010; Reising, 2002). 1
INTRODUCTION & MOTIVATION Many qualitative studies focused on new graduate transition into professional Few quantitative studies regarding transitions No studies were found to measure transitions using quantitative instruments (Anderson & Edberg, 2010; Mc. Kenna & Newton, 2008; Ellerton & Gregor, 2003; Halfer & Graff, 2006; Doody, Tuohy, & Deasy, 2012). 2
PURPOSE OF THE DESCRIPTIVE CORRELATIONAL STUDY § Determine the validity of the Subjective Knowledge Assessment Tool (S-KAT), a newly developed instrument § Categorize the skills of RNs into proficiency levels ranging from novice to expert § Support Benner’s model of the transition from novice to expert § Contribute to the documentation regarding the progression of RNs through those levels and provide suggestions of educational opportunities needed to assist RNs during transitions between levels 3
RESEARCH QUESTIONS Is the S-KAT a valid and reliable tool to measure Benner’s five stages of Novice to Expert? Is there a relationship between the five levels of practice as defined by Benner and years of nursing practice? 4
LITERATURE REVIEW The first three to six months are the most critical and stressful times Turnover = 35% to 75% within the first year of practice New graduate RNs are challenged due to the lack of time to gradually make the transition from student to RN (Delaney, 2003; Anderson & Edberg, 2010; Hillman & Foster, 2011; Trepanier, Early, Ulrich, & Cherry, 2012) 5
HISTORICAL BACKGROUND OF TRANSITIONS The length of time from graduation until licensure was longer Practiced as a GN until passed NCLEX Offered more time to adapt and practice Gained more exposure to the environment Allowed time for the critical transition into professional practice 6
TRANSITIONS TODAY New graduates take the NCLEX electronically within weeks of graduation Receive results within days Are licensed and practicing within weeks of graduation Rapid deployment has led to increased stress and strain for the new graduate (Dyess & Sherman, 2009)
LITERATURE REVIEW New graduates indicated they felt ill prepared § Self-doubt, feelings of inadequacy, and inability to proficiently perform skills § Sense of guilt and failure Resulted in: § Nurses opted out of the nursing profession altogether § Contributed to the nursing shortage Tapping, Muir, & Marks-Maran, 2013; Dotson, Dave, & Cazier, 2012 8
NURSING SHORTAGE Identified in 1999 RN vacancies outnumbered the enrollment in nursing schools Lack of faculty __________________ RN vacancies - 800, 000 by 2020. (Ulrich et al. 2010; Stanton, 2004; Weaver, 2013; Williamson, Cook, Salmeron, & Burton 2010; Weaver, 2013) 9
NURSING SHORTAGE Nursing shortage = great challenges Affects the quality of healthcare delivery Does not support the goals of the new healthcare reform § Expanding access to care § Improving the quality and safety of care § Controlling the costs of healthcare (Marshburn, Engelke, & Swanson, 2009; Zinn et al. , 2012). 10
THE COST OF RETENTION Cost of turnover per nurse = $22, 420 to $77, 200 Annual turn over cost for the organization per year = $300, 000 Hatler, Stoffers, Kelly, Redding, & Carr, 2011; Ulrich et al. , 2010) 11
THEORETICAL UNDERPINNING Benner’s Model of Novice to Expert Qualitative Interpretive Phenomenological Approach Described and synthesized the meaning of lived experiences of the transitions Provided detailed explanations of how knowledge and skills were obtained Benner, 2001; Altman, 2007 12
Expert Proficient Competent Advanced Beginner Novice • Attained the critical thinking skills to function skillfully • Has an intuitive grasp of each situation as it occurs • In critical situations, the expert nurse can positively affect patient outcomes • Developed the ability to recognize whole situations and events which can be expected in a given situation • Able to respond and modify care to meet the needs of the patient • Has developed the ability to recognize whole situations and events which can be expected in a given situation • Lacks speed and flexibility but is able to analyze a clinical situation and effectively problem solve • Demonstrated marginally acceptable competency in some situations • Perceives actions taken in terms of long-range goals • Requires continued support to prioritize different clinical situations • No experience in the situations in which they are expected to perform • Limited and inflexible • Rules must be present to guide performance
STUDIES USING SUBJECTIVE JUDGMENT & THE DELPHI TECHNIQUE TO VALIDATE INSTRUMENTS Bruce & Lack (2009) - 8 experts & the Delphi Technique = Tutorial Performance-evaluation Instrument to measure student performance Halcomb, Caldwell, Salamonson, & Davidson (2011) – 8 experts & the Delphi Technique = Instrument to measure consumer satisfaction with nursing care Later used in a large study in Australia 14
STUDIES USING SUBJECTIVE JUDGMENT & THE DELPHI TECHNIQUE TO VALIDATE INSTRUMENTS Chiu et al. (2010) – Translational validation study of a quality of life in dementia instrument 6 experts to translate then 5 experts to validate content and validity Small pilot study 15
STUDIES USING SUBJECTIVE JUDGMENT TO VALIDATE INSTRUMENTS Candela and Bowles, 2008 § Investigated perceptions of the new graduate § An extensive literature review failed to provide an adequate tool § Created a new instrument § Validated and revised after a pilot study § Further validated with a larger study 16
DEFINING THE EXPERT Using an expert panel is a valid practice The term expert was not clearly defined The literature provides clarity in describing the characteristics § One who can apply cognitive knowledge to practice § Patient centered § Uses intuition to guide practice § Uses critical thinking skills to guide appropriate actions § Five years of practice was an appropriate time frame for nurses to develop expertise in basic procedure (Morrison & Symes, 2011; Benner, 2001; Taylor, 2002) 17
DEVELOPMENT OF THE SUBJECTIVE KNOWLEDGE ASSESSMENT TOOL S-KAT Skills inventory of commonly used hospital wide equipment Inventory of common diagnosis, policies and procedures Research! 18
DEVELOPMENT OF THE SUBJECTIVE KNOWLEDGE ASSESSMENT TOOL S-KAT The final instrument for study = 297 items Included commonly used equipment, diagnosis, and skills Focused on medical/surgical units, ICU, and ED 19
SUBJECTIVE SELF ASSESSMENT Based on Benner’s Model of Novice to Expert Nurses rated their experience of each item using a 6 point Likert scale § No experience = 0 § Novice = 1 § Advance Beginner = 2 § Competent = 3 § Proficient = 4 § Expert = 5 20
S-KAT SCORING The total scores of the chosen Likert scale indicate the level of experience of the nurse Novice Expert Score equals Level of Experience Proficient Advanced Beginner Competent
S-KAT Categorize nurses into proficiency levels Provide evidence of educational needs Based on grounded theory (Benner) However…………. . Newly developed instruments must pass the test of Reliability and Validity Using Research & Statistical Evidence! 22
METHODOLOGY Delphi Technique Panel of 12 experts Three rounds § First round: Explored items to determine significance of the items § Additional spaces were provided to add items § Second round determined the significance of SCDs § Third round explored what areas the items were more specific for § Med/surg § ICU § ED 23
EDUCATION LEVELS DELPHI TECHNIQUE ) % 6. 7 N 1 0 (8 3. 3% ) 1 2( N 24
TITLES DELPHI TECHNIQUE ) N 5 ( % 1. 7 4 25
AREA EMPLOYED DELPHI TECHNIQUE N 6 (50%) 26
RESULTS OF THE DELPHI Determined content validity Frequencies and percentages determined that all items were significant to retain Coefficient alpha revealed an internal consistency reliability of. 967 which indicated good overall internal consistency Flesch-Kincaid grade level indicated reading ease at a 9. 7 grade level 27
PILOT STUDY Convenience sample of RNs throughout the state of Oklahoma Survey Monkey Paper Surveys 220 surveys were collected 192 were suitable for analysis § minimal sample size needed = 76 Inclusion Criteria § Must be an RN § Must be employed full-time 28
EDUCATION LEVELS PILOT STUDY %) (26 7( N 5 N 3 19 . 3% ) ) ( 56 N 2% 29. ) . 8% (6 3 N 1 N 81 (42 . 2% 29
YEARS OF EXPERIENCE PILOT STUDY 30
AREA EMPLOYED PILOT STUDY . 8) 9 N 1 8( 3 N 21 (10. 9%) N 17 (8. 9 %) 31
EXPERT LEVELS PILOT STUDY Novice N 3 (1. 6%) %) 3 1 5( 2 N 57 (2 9. 7%) N 4 4( 22 . 9% ) N 32
STATISTICAL TESTS CHOSEN Chi-square – examined the relationship between the five levels of practice as defined by Benner and years of nursing experience Pearson’s Correlation analysis examined the relationship between years of experience and the level of practice Multiple regression analysis examined whether years of experience and education level affected overall experience ANOVA tested for normality and homogeneity 33
CHI-SQUARE TESTS Value df Pearson Chi. Square Likelihood Ratio 102. 156 28 Asymp. Sig (2 -sided). 000 111. 123 28 . 000 Linear-by-Linear Association 54. 439 1 . 000 34
CORRELATIONS Pearson Correlation Sig (1 -tailed) N Years of Experience Level Years of Experience 1. 000. 534. Experience Level. 534 1. 000 192 35
ANOVA Model Sum of Squares Regression 364. 345 Residual 913. 967 Total 1278. 312 df 1 190 191 Mean Squares 364. 345 4. 810 F 75. 742 Sig. . 000 36
NORMAL P-PLOT 37
CONCLUSIONS The results indicated § There was no likelihood that the results found were due to sampling error § Statistical testing supported the case in favor of a true relationship for the population from which the sample was drawn § This study determined that the S-KAT was a valid and reliable tool to measure Benner’s five stages of Novice to Expert § The statistical relevance of this study concluded that the S-KAT was a significant quantitative tool to support Benner’s Novice to Expert model and answer the research questions 38
CONCLUSIONS Provided measurable data Demonstrated evidence of reliability and validity with the statistical tests chosen Quantitatively categorized nurses into Benner’s Model of Novice to Expert Supported Benner’s Model 39
RECOMMENDATIONS Replication of the Pilot Study with a much larger sample size to represent the population and provide further evidence of reliability and validity Factor Analysis – may extract unnecessary variables (items) Change the inclusion criteria to reflect only those in the hospital setting Provide further evidence of reliability and validity of the S-KAT 40
SUCC ESSFUL TRANSITI ONS OF NEW GRADUATE RNS ENT ERI NG PROFESSI ONAL PRACTIC E CONTRIBUTE TO DECREASI NG T HE CRITICAL SHORTAGE IN NURSING Increased Education = Positive work environments Retention! Satisfaction Attitude (Cooper 2009: Dellasega et al. 2009) Intent to Stay
FINAL THOUGHT Research provides four things: ü 1 st : brains with which to think ü 2 nd : eyes with which to see ü 3 rd : machines & instruments with which to measure and……… ü 4 th : money Albert Szent-Gyorgyi Revised by Cindy Beisner http: //www. brainyquote. com/quotes/a/albertszen 390010. html#b 3 Wb 2 Xw. HOEM 6 IWb. F. 99 42
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