NUR5194 Module 2 education needs assessment example

Two Hundred Fourteen Questions, Mostly What and Which: A Needs Assessment of Clinical Post-Conferences in a Junior-Level Adult Health Course

Student Name

American College of Education

NUR5194: Capstone Practicum for Role of the Nurse Educator

Module 2 Assignment

Instructor Name

September 26, 2028

The Question

The practicum plan in Module 1 identified a possible problem from two observed post-conferences: instructors asked mostly recall questions, and students described what they had done rather than reasoning about what they had seen. Two observations cannot establish a problem. This needs assessment asks whether, across the course's clinical groups, post-conferences develop students' clinical judgment, and if not, why not. It was carried out in weeks two to four of the semester with the mentor's approval and with the instructors' and students' consent to observation and surveys, and the university's review board determined that it was an educational quality improvement activity not requiring full review.

Sources and Methods

Four sources were used. First, the author observed eight post-conferences, two in each of four clinical groups, and recorded every question the instructor asked. Each question was coded by cognitive level using the revised taxonomy of educational objectives, on the six-step scale of the revised Bloom taxonomy (Anderson & Krathwohl, 2001), and the proportion of time in which students, rather than the instructor, were speaking was estimated at one-minute intervals. A second rater, the mentor, coded the questions from two of the conferences independently, and the two agreed on 88% of codes. Second, all 64 students were invited to complete a short anonymous survey about post-conference, and 52 did. Third, the author interviewed six of the eight clinical instructors for about 20 minutes each. Fourth, the mentor provided de-identified midterm clinical evaluation scores for all students by evaluation item.

Findings

Instructors' questions. Across eight conferences, instructors asked 214 questions. Of these, 152, or 71%, were at the levels of remembering and understanding, such as what is the normal range for potassium or what class of drug is metoprolol. Thirty-eight, or 18%, asked students to apply knowledge, and only 24, or 11%, asked them to analyze or evaluate, such as why a patient's heart rate might have risen or what they would watch for overnight. Students spoke for an estimated 38% of conference time, mostly while reporting on their patients. The pattern mirrors the findings of a qualitative study of post-conferences in which faculty asked mostly lower-level questions and discussions were largely task-oriented (Hsu, 2007).

Students' views. Of the 52 respondents, 62% said post-conference was useful only sometimes, and 21% said it was rarely useful. Asked what would make it more useful, the most common responses were discussing one patient in depth, working through what to do if a patient got worse and hearing how the instructor thinks through a situation. Several wrote that post-conference felt like an oral quiz.

Instructors' views. All six instructors interviewed said they valued post-conference, and none had received preparation in leading it. Five described modeling their conferences on those they experienced as students. Four said they asked recall questions because they could check the answer quickly and because students were tired after a long clinical day. Three said they would welcome a structure or examples.

Clinical evaluation data. On the course's clinical evaluation tool, which rates students from one to four on each item, the lowest midterm mean, 2.4, was on the item for interpreting patient data and recognizing changes in condition. Items for performing skills safely and communicating with patients averaged 3.1 and 3.2. Lasater (2007), developing a rubric for clinical judgment based on Tanner's model, found that interpreting was where students' judgment most clearly lagged in the early stages of their development, a pattern consistent with these scores. The course's weakest outcome and its least used teaching time point at the same skill.

What the Better Conferences Did

The averages hide an important variation. Of the 24 higher-level questions, 9 came from a single instructor, in both of whose conferences students spoke for more than half the time. Her conferences had a different shape. Instead of asking each student to report on every patient, she asked one student to present one patient briefly and then posed questions to the whole group: what do you notice in these findings, what could explain the rising heart rate, what would you expect to see overnight if you are right, and what would make you call the provider. Students who had not cared for the patient joined in, and the presenting student corrected or defended their peers' interpretations. When asked about her approach, she said she had learned it from a mentor at a previous school and had never been asked to describe it. Her group's midterm mean on the interpreting item was 2.9, the highest in the course, although with eight students the difference may reflect chance as much as teaching. The observation matters for the project because it shows that a better post-conference is already possible within the course's constraints, with the same students, the same clinical day and the same hour. The solution may not need to be invented so much as made explicit and shared, and the instructor has agreed to help develop it.

Triangulation and Problem Statement

The four sources agree. Instructors ask mostly recall questions; students find post-conference of limited use and want to reason through patient situations; instructors have had no preparation and would welcome a structure; and students' weakest area of clinical performance is interpreting data, the very skill that higher-level questions in post-conference could practice. The needs assessment also rules out some explanations. The problem is not instructors' commitment, which is strong, or students' willingness, since they asked for more challenging discussion. It is the absence of a shared structure and preparation for leading post-conference as a clinical judgment exercise.

Problem statement: In NURS 3320, clinical post-conferences are led without a shared structure or instructor preparation, and consist mainly of recall questions and patient reports, so that post-conference time does little to develop students' interpretation of patient data, the area of clinical performance in which students score lowest.

Limits of the Assessment

Several weaknesses in the data deserve to be stated before the project relies on them. Eight conferences in four groups are a small sample, and instructors who knew they were being observed may have taught differently than usual. The survey response rate was high, but students may have answered more critically because the survey was anonymous and came from someone outside the course. The clinical evaluation scores are ratings by different instructors, whose standards vary. Because every source points the same way, these weaknesses do not overturn the conclusion, but they mean the project's evaluation should use the same methods before and after the change so that comparisons are fair.

Requirements for a Solution

The needs assessment also defines what a solution must do. It must give instructors a simple, shared structure for post-conference that can be learned in a short session, since most are part-time. It must shift the balance of questions toward interpretation and analysis without adding preparation time. It must be usable at the end of a long clinical day, which argues for a short, predictable format. It must connect to the language of clinical judgment students will meet in the rest of the curriculum. And its effect must be measurable with data similar to those collected here, question levels, student views and clinical evaluation scores, so that the project can be evaluated honestly. Module 3 reviews the literature and proposes a project designed to meet these requirements.

References

Anderson, L. W., & Krathwohl, D. R. (Eds.). (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom's taxonomy of educational objectives. Longman.

Hsu, L.-L. (2007). Conducting clinical post-conference in clinical teaching: A qualitative study. Journal of Clinical Nursing, 16(8), 1525-1533. https://doi.org/10.1111/j.1365-2702.2006.01751.x

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. https://doi.org/10.3928/01484834-20071101-04