developing the clinical skills of nurses working in the field of aids palliative care
TRANSCRIPT
NuneEducuIima Today (1993) IS, 180-188 @ Lnngman Group UK Ltd 1993
Developing the clinical skills of nurses working in the field of AIDS palliative care
Lynne Jump and Doris M Dunn
The study reported here investigated the value of the Self Assessment, Identification of Need and Teaching (SAINT) system in assessing and teaching qualified nurses at work in the field of AIDS palliative care. Primary and community nurses were asked to use the SAINT system to make an assessment of their own nursing skills, identify learning needs and the teaching which they felt was required. Each wrote down their own findings and presented them individually to the researcher; one at a time and, within a group. Under both conditions these nurses were able to assess their skills, identify their needs and suggest teaching. Identification of needs and teaching were found to be more readily available when findings were presented to a group.
INTRODUCTION
A hospital providing care for patients with AIDS
identified a need to assess and to develop the skills of its nursing staff. Primary nursing was in use and individualised care used in planning for patients. In most cases this involved each patient taking a leading role in identifying and in stating his or her own needs as and when they arose, changed, or varied.
Staff involved in developing and in carrying
out care programmes were qualified nurses. In much of their work they were asked to apply developed nursing skills in new directions to meet this totally individualised care. Under these
Lynne Jump BSc (Hans) RGN RCNT ENB 934, Assistant Head of Education Services, Mildmay Mission Hospital, Hackney Road, London E2 7NA, UK and Doris M Dunn, M Phil BSc (Hans) RGN RNT, Freelance Consultant, 18 Hilton Park Drive, Leabrookes, Derbyshire DE51 1 ND, UK (Requests for offprints to LJ) Manuscript accepted 26 January 1993
180
conditions it was felt that each nurse must assess
his or her own ability to apply nursing skills and
to identify what needed to be learnt in order to meet the needs of the patient in any prevailing
circumstance.
The teaching of nursing in clinical settings had
been seen to present problems. Fretwell (1980),
Ogier (1982), Ogier & Barnett (1985), all found that the amount and quality of the information
offered, or made available to students of nursing
varied from one setting to another. All findings noted that the sister was the key person in controlling the learning environment. Fretwell
(1980) found that a hierarchical system, with the
need to ‘get work done’ could prohibit teaching and limit learning opportunities. Ogier (1982)
had found that the sister’s management style could affect the importance given to teaching. These findings were supported by her latter findings, Ogier and Barnett (1985) which sug- gested that sisters who were proficient at apply- ing the nursing process did not always see the importance of talking with students and giving
NURSE EDUCATION TODAY 18 1
them opportunity to learn from every day experiences.
A system of assessment was devised within a college of nursing which it had been felt might help to overcome some of these problems. A Behaviourally Anchored Rating Scale (BARS), (Smith & Kendall 1963), had been devised and was used to assess the developing clinical skills of students (Dunn 1984). The system, when applied, had offered the clinical nursing staff six skills of nursing, against which to assess their students. The skills represented were social, communication, management, practical, teamwork and teaching. Statements rep- resenting the type of behaviour which nurses had said denoted ‘good’ through to ‘not so good’ nursing in each skill formed the nine ranked indices against which assessment was made. For an example of a BARS see Table 1.
Dunn (1982) stated that this BARS system had been selected, developed and applied to give students an opportunity to assess themselves against stated ‘good’ to ‘not so good’ nursing behaviour. From such an assessment they could
identify their own learning needs and seek help in meeting them. This process, Jacobs et al (1980) had suggested, should lead to improved teaching at work. Students would take some responsibility for making use of learning oppor- tunities, or for creating them. Teaching at work, should become student based, more consistent with individual need and less dependant on the sister’s concept of need. The system was used to assess the students at work (Dunn 1986), but Dunn (1992) reported that student self assess- ment and consistently improved teaching by the trained nurses had not been noted.
The BARS system had met only part of the students’ needs. The important need to be taught at work as and when the need arose had not been met. The system had to be developed if this important need was to be met. Dunn (1992) asked seven sisters to state what they thought they would say with regards to student’s nursing ability and potential at each of the nine behav- ioural levels in each of the skills. She also asked these sisters what they thought might help to improve the student. When these data were collected and analysed it was found that the
sisters had stated why the nurse might be func- tioning at each particular level and they had proposed teaching which may be required in order for the student to improve. When 40 staff nurses had each been asked to assess and to teach a student after reading the sisters’ statements, Dunn (1992) reported that their perceived ability to assess and to teach had been signifi- cantly improved.
The statements collected from the sisters were used as the basis of an assessment system for nurses. Dunn (1992) proposed that this system would allow nurses to make a self assessment, identify their needs and to seek teaching. The SAINT system was devised Dunn (1991), an example of which can be seen in Table 2.
The study reported on here was undertaken in order to determine whether nurses working in the field of AIDS palliative care could use SAINT to assess themselves, identify their own learning needs and to seek teaching. It was also carried out to evaluate the effects of presenting assessment findings to an individual and to a group.
METHODOLOGY
Qualitative and descriptive data relating to the issues in their study were gathered using the SAINT system applied in the wards, depart- ments and community services of a Hospital providing care for patients with AIDS in the East End of London. Two pilot studies were unertaken:
Study one - clinical practitioners working in the wards and departments were recruited to this study. Study two - community practitioners, members of the Hospital’s community nursing service were recruited to this study.
DATA COLLECTION
Pilot study one
Six nurses, each working as a primary nurse in different clinical areas within the Hospital, were
182 NURSE EDUCATION TODAY
recruited to this study. They were each given a
book containing the SAINT system and were asked to read it. They were each asked, to assess
themselves in all of the six skills. They were then
asked to read the advice offered by the ‘where are you’ and ‘what to do’ statements at the level at
which they had placed themselves and to identify what they felt they might need to do in order to
improve in each skill, that is to identify their own
learning needs. They were asked to write down
their findings and to bring them to the re-
searcher individually and to talk about them.
Pilot study two
Four nurses, members of the Hospitals com- munity nursing services, who worked closely
together on a day to day basis, were recruited to
Table 1 A Sehavioumlly Anchored Rating Scale Used to Measure Management Skills in 213 Year Student Nurses in the College of Nursing
Management skills
Optimal behaviour signifies: an ability to recognise and identify important issues as they arise, maturity to appreciate their implication to others, use of initiative to attempt to deal with them, and the organisational ability to assist others.
If this student was working with a doctor on an emergency admission he/she could be expected to get trays as required, send off well labelled specimens, and set up any investigation required, on hidher own initiative
If this student was attending to a patient undergoing an intravenous infusion he/she could be expected to keep to the prescribed regime according to changes in the patient’s treatment
When changing a patient’s bed linen, this student could be expected to place the bed cradle and dirty linen on the floor beside the patient’s bed
If a patient required a catheter drainage bag to be replaced, this student could be expected to place the used bag on the floor by the bedside whilst applying the new one and then forget to remove it
Pre Mid End 1 2 3
,
I
I
If this student found a wheelchair in front of a fire door he/she could be expected to remove it, and to advise other staff not to obstruct these exits with equipment
If this student was caring for several patients he/she could be expected to organise his/her own work and be able to allocate aspects of care appropriate to their stage of training to his/her junior colleagues
If this student was carrying out the post- operative care of a patient he/she could be expected to include in the care - observations of vital signs, care of intravenous fluids, urinary and other drainage and to attend to the patient’s overall comfort
If this student was assisting a patient who had a skin ulcer to get out of the bath and return to bed, he/she could be expected to leave the wound uncovered prior to taking the patient for a dressing to be applied
If a completely dependent patient needed a wash, this student could be expected to give them a bowl of water, close the curtains around them and leave them for % of an hour without attempting to offer any assistance
1 2 3 Pre Mid End
Tab
&
2 S
AIN
T
dev
elo
ped
to
sel
f ass
ess,
iden
tify
nee
d an
d te
ach
man
agem
ent
skill
s in
213
yea
r st
uden
t nu
rses
Man
agem
ent
skill
s W
her
e ar
e yo
u
Wh
at
to d
o
I am
told
th
at
I h
ave
a th
oro
ug
h
lack
of
kno
wle
dg
e,
and
th
at
I am
u
nab
le
to
thin
k lo
gic
ally
an
d t
his
mak
es
it
imp
oss
ible
fo
r m
e to
id
enti
fy
even
th
e m
ost
b
asic
nee
ds
of
my
clie
nts
/ p
atie
nts
.
Th
e p
eop
le
wit
h
wh
om
I w
ork
te
ll m
e th
at
I am
u
nab
le
to p
erfo
rm
and
do
th
ing
s p
rop
erly
o
r in
a p
arti
cula
r w
ay.
Th
ey
say
that
m
y b
ehav
iou
r sh
ow
s a
lack
of
kno
wle
dg
e an
d t
hat
I
nee
d t
o
take
m
ore
ca
re
as t
his
is
no
t o
nly
u
nh
elp
ful
for
clie
nt/
pat
ien
ts,
bu
t g
ives
ex
tra
wo
rk
to m
y co
lleag
ues
.
I am
fin
din
g
it d
iffi
cult
to
th
ink
abo
ut
the
job
as
a w
ho
le.
At
the
mo
men
t I
am
hav
ing
to
co
nce
ntr
ate
on
eac
h t
ask.
I
can
no
t th
ink
thro
ug
h
the
wh
ole
p
roce
du
re
yet.
My
pre
sen
t la
ck o
f kn
ow
led
ge
and
ex
per
ien
ce
sho
ws
itse
lf a
s an
in
abili
ty
to p
rio
riti
se
my
wo
rk.
I ca
nn
ot
anti
cip
ate
pro
ble
ms
wh
ich
m
ay
aris
e ye
t.
I ca
n p
erfo
rm
taks
on
e at
a t
ime
wel
l en
ou
gh
to
get
by.
Yo
u
lack
in
sig
ht.
Y
ou
are
n
ot
seei
ng
Y
ou
n
eed
to
tal
k o
ver
wh
ere
you
ar
e an
d
ho
w
you
fee
l th
ing
s.
Yo
u a
re
no
t lo
oki
ng
af
ter
you
r w
ith
a
sen
ior
per
son
w
ho
m
you
fee
l yo
u c
an t
rust
. T
alk
pat
ien
ts,
you
ar
e n
ot
do
ing
w
hat
yo
u
wit
h
you
r p
erso
nal
tu
tor.
Y
ou
n
eed
to
ask
yo
urs
elf
ho
w
say
you
h
ave
do
ne.
Y
ou
ap
pea
r to
be
you
w
ou
ld
be
able
to
man
age
a w
ard
o
r an
y w
ork
ar
ea
if
un
able
to
id
enti
fy
pro
ble
ms
and
are
yo
u w
ere
beh
avin
g
in t
his
way
. H
ow
yo
u w
ou
ld
dea
l fr
igh
ten
ed
to a
lev
el w
her
e yo
u
are
wit
h
pro
ble
ms.
Y
ou
n
ow
h
ave
to l
earn
h
ow
to
tak
e in
com
pet
ent.
Y
ou
r co
lleag
ues
fe
el t
hat
re
spo
nsi
bili
ty
for
oth
er
peo
ple
. A
sk y
ou
rsel
f w
hat
w
ou
ld
you
wo
uld
n
ot
reco
gn
ise
a p
rob
lem
if
it
hap
pen
if
yo
u w
ere
resp
on
sib
le
for
oth
er
peo
ple
w
ho
w
ere
rig
ht
in f
ron
t o
f yo
u.
wer
e n
ot
do
ing
th
eir
wo
rk,
or
rep
ott
ing
to
yo
u.
Yo
ur
beh
avio
ur
is i
nad
equ
ate
and
yo
u
are
un
awar
e o
f th
is.
Yo
u j
ust
le
ave
thin
gs
to o
ther
s.
Yo
u d
o n
ot
see
anyt
hin
g
as b
ein
g
you
r p
rob
lem
o
r re
spo
nsi
bili
ty.
Yo
u
lack
co
nfi
den
ce
bu
t th
is m
ay
be
du
e to
a l
ack
of
bas
ic
kno
wle
dg
e an
d o
f p
ract
ice
in
man
agem
ent.
Co
nta
ct
you
r p
erso
nal
tu
tor,
as
k w
hat
re
adin
g
you
m
igh
t d
o,
ask
for
som
e g
uid
ed
stu
dy.
Y
ou
m
ust
d
iscu
ss
wit
h
a se
nio
r p
erso
n
wh
at
con
stit
ute
s th
e re
spo
nsi
bili
ties
o
f a
sen
ior
stu
den
t.
Th
ink
wh
at
wo
uld
h
app
en
if e
very
bo
dy
beh
aved
as
yo
u
do
wh
en
in c
har
ge.
A
sk
if y
ou
ca
n w
ork
w
ith
a
trai
ned
p
erso
n
for
a p
erio
d
to l
earn
b
asic
day
to
d
ay
man
agem
ent.
T
hen
ta
ke
resp
on
sib
ility
fo
r a
gro
up
o
f p
atie
nts
o
r cl
ien
ts
in a
clin
ic w
ho
d
on
’t
pre
sen
t to
o
hea
vy
a w
ork
lo
ad.
Ask
if
yo
u
can
tal
k yo
ur
wo
rk
ove
r at
th
e en
d o
f th
e sh
ift.
Yo
u a
re
able
to
car
e fo
r a
limit
ed
nu
mb
er
of
pat
ien
ts/c
lien
ts
acco
rdin
g
to
care
p
lan
s.
Yo
u c
an m
anag
e th
e o
bvi
ou
s b
ut
no
t m
ore
. Y
ou
r co
lleag
ues
fe
el t
hat
yo
u
are
infl
exib
le
and
yo
u
are
un
able
to
th
ink
abo
ut
det
ails
an
d h
ow
yo
u c
ou
ld
inco
rpo
rate
ch
ang
e in
to
situ
atio
ns
and
see
new
p
rio
riti
es.
Yo
u c
an n
ow
as
sess
p
rio
riti
es
bu
t yo
u
are
no
t ab
le t
o c
om
ple
te
tho
se
thin
gs
wh
ich
yo
u
iden
tify
. It
may
b
e th
at
peo
ple
ar
e as
kin
g
too
m
uch
o
f yo
u
and
yo
u a
re t
ryin
g
to m
eet
all
of
thei
r n
eed
s.
Th
is
is c
ausi
ng
yo
u
stre
ss w
hic
h
inh
ibit
s yo
u f
rom
ca
rryi
ng
th
ing
s th
rou
gh
, so
yo
u
are
go
ing
ar
ou
nd
in
ci
rcle
s.
At
the
end
of
the
day
n
oth
ing
is
co
mp
lete
o
r ri
gh
t an
d y
ou
do
n’t
kn
ow
w
hy.
Yo
u
nee
d
to a
sk a
mo
re
sen
ior
per
son
if
he/
she
wo
uld
w
ork
th
rou
gh
p
lan
nin
g
care
wit
h
you
at
th
e b
egin
nin
g
of
each
sh
ift
in o
rder
to
id
enti
fy
pri
ori
ty
area
s.
Use
th
e ca
re
pla
ns
to r
epo
rt
bac
k d
uri
ng
th
e sh
ift
and
ad
d t
o t
hem
as
n
eces
sary
. O
nce
yo
u f
eel
mo
re
con
fid
ent
pra
ctic
e th
e sk
ill y
ou
rsel
f,
wit
h
som
e h
elp
wo
rk
wit
h
a ju
nio
r co
lleag
ue,
p
lan
th
e w
ork
fo
r b
oth
of
you
. E
xpla
inin
g
pri
ori
ties
to
so
meo
ne
else
m
ay
clar
ify
thin
gs
and
pro
mp
t yo
u
into
th
inki
ng
o
f d
etai
ls
and
ch
ang
e in
nee
ds.
A
SK
F
OR
HE
LP
IF
YO
U
NE
ED
IT
.
Th
is
is a
dif
ficu
lt
pro
ble
m
wh
ich
is
har
d t
o d
eal
wit
h.
Tal
k w
ith
a
mo
re
sen
ior
per
son
ab
ou
t yo
ur
wo
rk,
ask
him
/her
to
tel
l yo
u w
hen
yo
u
are
leav
ing
th
ing
s in
com
ple
te
and
ta
lk w
ith
h
im/h
er
abo
ut
ho
w
else
yo
u
mig
ht
hav
e ap
pro
ach
ed
the
situ
atio
n.
Wh
enev
er
you
’ve
go
t it
rig
ht
feel
p
rou
d
of
you
rsel
f.
It i
s a
har
d
step
to
tak
e.
Tab
le
2 co
ntin
ued
Man
aaem
ent
skill
s W
her
e ar
e Y
OU
W
hat
to
do
I lo
ok
at e
ach
tas
k o
ne
at a
tim
e ju
st
bef
ore
I
per
form
it
. I
do
n’t
h
ave
the
abili
ty
to p
lan
yet
. I
wo
uld
n
ot
feel
ab
le
to s
ay h
ow
th
e w
ork
sh
ou
ld
con
tin
ue
afte
r I
had
fin
ish
ed
for
the
day
.
I can
no
w
pla
n
my
wo
rk
and
org
anis
e m
ysel
f ac
cord
ing
ly,
I ca
n d
o m
y w
ork
w
ell
eno
ug
h.
I mig
ht
ask
som
eon
e if
I fe
lt t
hat
I
nee
ded
so
me
hel
p w
ith
m
y w
ork
.
I can
no
w d
iscu
ss
my
wo
rk
wit
h
som
eon
e el
se a
nd
can
wo
rk
ou
t th
e b
est
way
to
mee
t th
e p
atie
nt’
s n
eed
s.
I ca
n a
dap
t m
y w
ay
of
wo
rkin
g
acco
rdin
gly
.
I n
ow
u
nd
erst
and
m
y o
wn
w
ork
an
d
the
man
ager
ial
skill
s re
qu
ired
. I
feel
co
nfi
den
t en
ou
gh
to
qu
esti
on
m
y o
wn
ab
ility
an
d k
no
wle
dg
e an
d f
eel
that
I
hav
e a
resp
on
sib
ility
to
ask
fo
r h
elp
. In
itia
tive
is
no
w
par
t o
f m
y m
anag
eria
l sk
ills,
b
ut
I mu
st
be
awar
e o
f m
y lim
itat
ion
s.
Yo
u
are
able
to
att
end
to
th
e n
eed
s o
f p
atie
nts
an
d y
ou
h
ave
the
kno
wle
dg
e to
id
enti
fy
pri
ori
ties
. Y
ou
ar
e ab
le t
o
sup
eriv
se
jun
ior
colle
agu
es
in a
n
un
chan
gin
g
situ
atio
n,
bu
t yo
u
may
b
e th
row
n
by
sud
den
ch
ang
es.
Yo
u d
o n
ot
yet
thin
k ab
ou
t ch
ang
e b
ut
wai
t fo
r so
meo
ne
else
to
gu
ide
you
.
Yo
u c
an c
orr
ect
you
rsel
f in
a c
han
gin
g
envi
ron
men
t an
d y
ou
ca
n
com
mu
nic
ate
and
lia
ise
wit
h
oth
er
nu
rses
. Y
ou
can
act
on
in
form
atio
n
wh
ich
yo
u
are
giv
en
no
w
and
can
su
gg
est
chan
ge
alth
ou
gh
yo
u
may
n
eed
h
elp
in
im
ple
men
tin
g
it.
Yo
u a
re
able
to
wo
rk
wit
h
oth
er
nu
rses
an
d
sup
ervi
se
jun
ior
colle
agu
es
relia
bly
, b
ut
you
la
ck a
war
enes
s o
f th
e w
ork
o
f o
ther
p
rofe
ssio
nal
s.
Yo
u a
re a
ble
to
tea
ch
no
w,
you
ap
pre
ciat
e th
at
peo
ple
ar
e at
dif
fere
nt
leve
ls.
Jun
ior
staf
f w
ho
m
you
ar
e su
per
visi
ng
w
ou
ld
be
able
to
lo
ok
afte
r a
gro
up
o
f p
atie
nts
o
r cl
ien
ts
wel
l. Y
ou
w
ou
ld
giv
e th
em
con
fid
ence
to
co
me
to
you
fo
r h
elp
an
d a
dvi
ce.
Yo
u a
re a
ble
to
co
rrec
t n
ot
on
ly
you
rsel
f b
ut
oth
ers
in a
ch
ang
ing
en
viro
nm
ent,
n
ow
yo
u
kno
w
wh
y an
d
ho
w
chan
ge
occ
urs
, an
d
ho
w t
o a
ct t
o m
eet
nee
ds.
Yo
u a
re a
ble
to
use
yo
ur
ow
n
init
iati
ve
and
to
act
in
a m
atu
re
man
ner
. Y
ou
ap
pre
ciat
e th
e im
plic
atio
ns
of
you
r o
wn
w
ork
an
d a
ctio
ns
in r
elat
ion
ship
to
o
ther
s.
Yo
u a
re
no
t ju
st a
war
e o
f o
ther
s n
eed
s,
bu
t ca
n a
nti
cip
ate
wh
at
oth
ers
will
n
eed
in
ord
er
to d
o t
hei
r w
ork
. N
ow
yo
u
can
th
ink
thro
ug
h
a si
tuat
ion
an
d w
hat
it
in
volv
es.
Yo
u
nee
d
mo
re
pra
ctic
e in
man
agin
g
oth
ers
eg.
mo
re
jun
ior
colle
agu
es,
this
will
h
elp
yo
u t
o d
eal
wit
h
chan
ge,
b
ut
do
n’t
fo
rget
to
ask
fo
r th
e su
pp
ort
o
f yo
ur
sen
ior
colle
agu
es.
Tak
e ev
ery
op
po
rtu
nit
y to
tea
ch
jun
ior
nu
rses
an
d t
o a
nsw
er
thei
r q
ues
tio
ns
abo
ut
the
care
th
ey
are
giv
ing
. T
his
will
h
elp
yo
u t
o t
hin
k o
ne
step
ah
ead
an
d
to a
nti
cip
ate
chan
ge.
If y
ou
fee
l th
at
chan
ge
in y
ou
r p
atie
nt’
s o
r cl
ien
t’s
care
is
n
eces
sary
o
r im
min
ent
i.e.
a ch
ang
e in
die
t is
ad
visa
ble
, th
en
ask
ho
w
you
ca
n d
eal
wit
h
this
. If
a p
atie
nt
is t
o b
e d
isch
arg
ed
or
his
/her
h
om
e co
nd
itio
ns
chan
ge,
p
lan
ah
ead
. A
sk
if y
ou
m
igh
t co
nta
ct
oth
er
serv
ices
. O
bse
rve
the
role
s o
f o
ther
s,
i.e.
ph
ysio
ther
apis
ts,
soci
al
wo
rker
s,
teac
her
s.
Ask
to
att
end
w
ard
ro
un
ds,
m
eeti
ng
s,
so t
hat
yo
u
can
see
ho
w
chan
ge
occ
urs
. N
ow
yo
u
nee
d t
o
dev
elo
p
you
r kn
ow
led
ge
on
ho
w
chan
ge
occ
urs
an
d t
he
role
s o
f th
e h
ealt
h
care
tea
m
mem
ber
s.
Tak
e ev
ery
op
po
rtu
nit
y w
hic
h
pre
sen
ts
itse
lf t
o w
ork
w
ith
an
d t
o o
rgan
ise
oth
ers.
In
th
is w
ay
you
w
ill
lear
n
to
giv
e in
div
idu
al
care
to
yo
ur
colle
agu
es
as w
ell
as t
o t
he
pat
ien
ts
and
clie
nts
. W
hen
so
met
hin
g
hap
pen
s as
k yo
urs
elf
ho
w
you
sh
ou
ld
act
and
if
nec
essa
ry
chan
ge
to
mee
t o
ther
s’
nee
ds.
A
sk
if y
ou
can
h
ead
th
e w
ard
te
am
or
advi
se
in a
clin
ic
un
der
su
per
visi
on
so
th
at
you
can
g
ain
in
sig
ht
into
th
e ro
le o
f th
e tr
ain
ed
per
son
.
Ask
if
yo
u
mig
ht
run
th
e w
ard
o
r cl
inic
u
nd
er
sup
ervi
sio
n.
Tak
e ev
ery
op
po
rtu
nit
y to
tea
ch
you
r ju
nio
r co
lleag
ues
th
e p
roce
ss
of
man
agin
g
care
. Y
ou
m
ust
as
k q
ues
tio
ns
and
re
ad
on
th
e w
ider
is
sues
of
man
agem
ent
e.g
. h
ealt
h
an s
afet
y,
sto
ck l
evel
s,
bu
dg
etin
g.
Co
nti
nu
e to
as
k fo
r an
d t
o t
ake
gu
idan
ce
wh
enev
er
you
n
eed
it
an
d
be
will
ing
an
d
able
to
off
er
it w
hen
ap
pro
pri
ate.
NURSE EDUCATION TODAY 185
the study. One team leader and three team members were represented in this sample. Each was given a SAINT book to read. They were each asked individually to assess their own present position, that is to make their own self assessment in each skill. Using ‘where are you’ and ‘what to do’ to identify (from the level at which they assessed themselves to be) what they needed to do in order to improve, that is, to identify and write down their own learning needs. They were all asked to bring their findings to a group meeting and talk about them. The researcher was present.
RESULTS
Pilot study one
Three subjects assessed themselves and identi- fied their learning needs. Each brought their findings to the researcher individually. All three subjects had each individually scored their present performance in each of the six skills in the top quartile of the nine ranked statements; scoring at levels eight or nine. When asked to talk about the results each of the three subjects identified levels at which they needed to learn in five of the skills within the upper and upper middle quartiles; scoring at levels six, seven, eight, or nine.
In the sixth skill, one subject identified a need to learn ‘to interact with people within a group, to work suitably with groups of staff, either peer groups or subordinates.’ This need, the subject stated, placed his or her learning needs in the lower middle quartile in social skills; scoring at levels four or five. Another subject identified a need for help in ‘developing his or her ability to share the knowledge which he or she had’ to this end a learning need in the lower middle quartile in teaching skills was identified; scoring at levels four or five. The third subject identified that management skills might present him or her with problems. He or she stated a need to extend an ‘ability to delegate and to involve others in decision making’ but was unable, at the time of the study, to state learning needs. The subjects each identified a mentor or teacher for them-
186 NURSE EDUCATION TODAY
selves from within their own working environ- ment. They chose someone whom they felt might help them to develop the skill in which they felt themselves to be least able.
Pilot study two
Four subjects assessed themselves individually.
Each brought a statement of his or her own assessment and the learning needs, which he or she had identified, to a group meeting. Each person presented the findings to the group one at a time. The group decided which subject should present findings first and in what order the others should follow. Three subjects scored themselves at levels in the upper and upper middle quartiles in the six skills; scoring at levels six, seven, eight or nine. Each subject identified learning needs at the level appropriate to his or her own assessment. One subject assessed him or herself to be in the lower middle quartile in social and in management skills; scoring at levels four or five in both skills. The other four skills were not assessed. Members of the group talked together about the assessment which they had made and the learning needs which they had identified. They agreed with some of the statements made and disagreed with others. When it was warranted the group encouraged those who found difficulty in seeing themselves as able. They offered proposals and suggestions for teaching and support when such need was identified. They were able as a group to encou- rage the acceptance of support and teaching even when individuals had not seen a particular aspect as a part of their learning needs. None of the subjects overtly restated their learning needs. None asked for, or sought, a mentor, all felt, under the conditions in this study, that the group offered them adequate support and teaching.
DISCUSSION OF RESULTS
Pilot study one
Six subjects had been invited to make an assess- ment to bring to the researcher. Three subjects
had not been able to do this and three subjects
had made the assessment. They had scored themselves at the highest levels. They had stated themselves able ‘to totally understand other people; to allow others to explore their own needs; to organise themselves and to think of the needs of others; to use initiative in planning work.’ These are some of the highest levels of achievement noted in SAINT, Dunn (1991). When they talked with the researcher about their learning needs two subjects identified needs at less skilful levels. They identified a need to seek advice/teaching on ‘how to share their feelings; how to involve others in planning work; how to learn what others needed, both patients and staff.’ Some of the advice offered in the ‘what to do statements’ was at the levels which the subjects identified as their learning needs. They had stated themselves able to perform at the highest levels of professional competence, however, when each questioned their own know- ledge and ability, both felt a need to learn and to seek teaching.
The third subject, whilst stating that he or she might not be as competent as at first thought, said that time was needed to review the statements ‘where are you’ and ‘what to do’ before making a decision on learning needs. All three subjects decided to seek a mentor for themselves whom they felt could help them to improve in the skill in which they felt themselves
to be least able.
Pilot study two
Four subjects carried out the self-assessment and identified their learning needs. They scored themselves using a wide range of stated competence when making their initial assess- ment. They debated and discussed their learn- ing needs freely with each other. Subjects at all management levels within the group took part. They talked about their knowledge and abilities. Three subjects identified their learning needs and did not overtly restate the level at which they felt themselves to be performing. One subject identified a need to learn at a level of competence which identified for him or her a requirement for substantial support and
NURSE EDUCATION TODAY 187
teaching in two skills. Each subject was able to offer peer group assistance and teaching. No mentorship outside the group was sought.
GENERAL DISCUSSION
In both pilot studies all subjects who took part had been able to make an assessment of their performance in each of the six skills. In the first study two of the subjects had identified their own learning needs while talking about their assess- ment with the researcher. They were both able to see how their need might be met and with whom they might work to develop or redirect their skills. The third subject could see what help was needed, but was less sure of how to achieve outcomes.
In the second study all subjects had identified their learning needs when in discussion with each other, the researcher had not been invited to take part. The group had felt themselves able to meet learning needs from what ever level they had been set. Peer group interdependence on each others’ skills appeared to dominate.
From her work Fretwell (1980), had found that many student nurses did not identify a need to learn while they were working, they felt that when they had repeated basic nursing tasks numerous times they were fully competent. Possibly it had been this affect which had caused the subjects who took part in the first study to score themselves at the highest level when making their self-assessment, they were experi- enced nurses and had repeated these nursing tasks many times. They were however, able to review their position when they read ‘where are you’ and ‘what to do’ at the highest levels of competence in SAINT. Each had identified a need to learn.
Ogier (1983), had found that management styles affected the perceived need for teaching. In questioning the affects of the introduction of the nursing process on ward teaching Ogier and Barnett (1985) suggested that the nurse who could be expected to implement successfully the nursing process was not of necessity the best person to help students to identify and to take
advantage of learning opportunities. The nurses who took part in the first study were all primary nurses. Possibly a particular style of manage- ment is required of these nurses which might affect their ability to readily identify their own learning needs. In the second study more than one management level was represented, possibly no management style was prevalent.
In 1966 Revans proposed a system of ‘Action Learning’ which has been successfully applied in management teaching. He suggested that subjects, under the guidance of a leader, should
identify problems which confronted them at work. They should meet together as a group; discuss each others’ problems and offer advice in the light of their own experience. They should return to work, each attempt their own solution based on the discussion and advise and bring back the findings for review. The second study reported here tended to follow the format as proposed by Revans. The study was not extended to allow subjects to report back on their findings, however it was felt, from the results of this limited study, that if used in conjunction with SAINT this type of group learning could offer a successful way of allowing senior experi- enced nurses to identify and express any lack of competence or knowledge which they might have. It could allow them to seek advice on how to identify their own learning needs and to offer teaching to each other.
Smith & Kendall (1963) had proposed that using a BARS assessment system would help to promote self assessment and the identification of learning needs. Dunn (1992) had not found these effects when she evaluated a system used to assess student nurses.
Using the SAINT system, an extension of BARS, had allowed all the nurses taking part in the present studies to assess themselves, identify their own learning needs and to seek teaching. When comparing the results of these two studies it could be suggested that of the two methods used, peer group discussion produced the more satisfactory results.
All the nurses who took part in both studies stated that they had found the whole process of self-assessment, identification of needs and look- ing for teaching to be non-threatening. In using
188 NURSE EDUCATION TODAY
SAINT they had found the process to be under their control at all times.
CONCLUSION
When using SAINT, nurses who work in an AIDS environment could assess their own skills at work. They could take their findings to another person, or persons, and discuss them. Identification of learning needs and teaching was found to be more readily available when individuals discussed their assessment and per- ceived needs within a group. These pilot studies were undertaken with small sample groups, in a specific environment and with little control. The findings do however suggest that further enquiry into the complex issues of assessment and teaching at work, along the lines used in these pilot studies, would be valuable.
References
Dunn D M 1984 Have you done my report please sister? Nursing Times 4 (2): 56-59
Dunn D M 1986 Assessing the developing of clinical nursing skills. Nurse Education Today 6: 28-35
Dunn D M 199 1 SAINT - Self Assessment, Identification of Need and Teaching of work skills. Assessment Dunn, Kent
Dunn D M 1992 Assessing and training at work, Health Manpower Management, M B C University Press 18 (3): 7-14
Fretwell J E 1982 Ward teaching and learning. RCN, London
Jacobs R, Kafery D, Zedeck S 1980 Expectations of Behaviourally Anchored Rating Scales. Personnel Psychology 33: 595-640
Ogier M E 1983 An ideal sister? RCN, London Ogier M E, Barnett D 1985 Unhappy learners ahead?
Nursing Mirror 161 (3): 18-20 Revans R W 1966 The theory of practice in
management. Macdonald, London Smith P C, Kendall L M Retranslaton of expectations.
Journal of Applied Psychology 47 (2): 149-55.