Completing students Assessment of Practice Record and Continuity of Practice Assessment [ongoing record of achievement]

A Guide to Roles and Responsibilities for Mentors, Students and Teachers

The School of Nursing strongly encourages students to accept responsibility for their own learning and self-assessment.

The Assessment Process:

First Week

  • During the first week of placement the student must negotiate with their mentor time for the preliminary interview to set learning objectives, action plan and dates for intermediate and final interviews. Preliminary interview and orientation records to be completed in Assessment of Practice Record.
  • The student to identify with their mentor specific learning objectives for the placement. They must share with their mentors the action plan from their previous placement contained in their Continuity of Practice Assessment Record [CPAR]. This is a mandatory requirement of the Nursing and Midwifery Council [NMC Circular 33/2007].
  • During the placement the student should work with a range of health and social care professionals, gaining experience to develop knowledge, attitude and skills. The student should also work at least 40% of the time on placement with their mentor and a full range of shifts.
  • The student should consistently demonstrate development and achievement of practice outcomes and/or standards of proficiency in conjunction with their assessment and completion of skills schedule. These outcomes and standards of proficiency are those provided by the Nursing and Midwifery Council [NMC 2004].
  • Utilising their own enquiry based learning skills and the guidance of their mentor, the student will gather evidence such as reflections on care intervention, notes of reflective discussions, observed learning record, application of knowledge and understanding to care delivery under direct observation, and the application of protocols, policies and procedures to patient/clients in practice. This portfolio of activity, when enhanced with sources of evidence e.g.reference to literature, protocols, etc, can then be used by the student to demonstrate evidence of achievement of practice outcomes or standards of proficiency. This must be retained in the student’s portfolio.

Intermediate Period

  • The intermediate interview provides a formative opportunity to review progress,of learning outcomes/standards of proficiency, identify any areas of concern and update action plans. It should include an exploration of what has been learnt, what still needs to be learnt,guidance on gathering evidence andthe quality of the evidence of achievement the student has collected.
  • At the intermediate interview the mentor mustprovide constructive feedback to the student in relation to their punctuality, interpersonal skills, professionalism, attitude [referral to previous professional progress record may be made in the Continuity of Practice Assessment Record], care delivery and/or management skills,

knowledge, understanding and application to care interventions. Comment should be made of student strengths and areas that require strengthening and recorded in the Assessment of Practice Record. If required both mentor and student should negotiate a revised learning action plan. This will provide the student with identified opportunity to improve. Thus it provides opportunity for looking back and forward. The student and/or mentor may wish to involve the PLT Educational Representative or Personal Tutor.

  • The intermediate interview may provide the opportunity for the mentor to assess some of the evidence the student is submitting against the criteria for competence within the Skills Escalator Practice Level.
  • At the intermediate interview there should be confirmation of the date and time for the student to present their portfolioof evidence for achievement of outcomes or standards of proficiency in their final week of placement.
  • The mentor should continue to monitor and assess the student, with contributions from other health and social care professionals.

Final Week

  • The final interview must take place during the students last week on placement and at a time convenient to both mentor and student.
  • The student will submitthe CPAR, portfolio of evidence and completed Assessment of Practice Record to the mentor, identifying in the appropriate boxes the type and location of evidence being submitted to demonstrate the achievement of outcomes or standards of proficiency. The student must complete the self assessment of overall performance and achievement on the final interview sheet within the Continuity of Practice Assessment Record.

The mentor will assess the appropriateness of the evidence submitted determining that the student:

Achieved - Competently, safely, effectively and consistently through the allocation.

Indicating Practice Level of Achievement.

Not achieved (a) – No opportunity – the type and kind of placement did not present opportunity of achievement.

Not achieved (b) Inadequate/inappropriate evidence – The student fails to submit sufficient and appropriate evidence of achievement. Advised of improvements to be made in the next placement.

Not achieved (c) Poor/unsafe practice – The student has demonstrated poor/unsafe practice throughout the period of practice.

  • When assessing the student as not achieving as in a, b or c above, the mentor must qualify the rationale for this on the ‘Record of Outcomes/Standards of Proficiency Not Achieved’sheet. Supporting reports may be required and the mentor should discuss ‘not achieved’ in either b or c with the Educational Practice Learning Team representative or student’s Personal Tutor and/or involves either in the Final Interview. Following a first attempt failure in any outcome/standard of proficiency the student will be allowed a further attempt before a recommendation can be made for discontinuation from the course.
  • The mentor and the student should discuss the outcomes/standards of proficiency and complete the Assessment Results sheet in the CPAR indicating the Practice Level achieved and signing in full against each outcome or standard of proficiency.
  • The mentor should make comment of the student’s overall performance and record any absences on the Final Interview sheet. The student and mentor should formulate an action plan of learning for the next placement. This ensures the ongoing achievement of practice assessment process.
  • The student should be requested to sign the CPAR Record sheets in recognition of completion of the assessment and the placement.
  • The student will submit the CPAR to the Assessment Clerk in accordance with Cohort Assignment Submission Schedule. Some students may also be required to submit their Portfolio of Evidence and Assessment of Practice Record.
  • The School of Nursing will randomly audit CPAR’s and verify authenticity.

Final Placement of the Course

  • In the student’s final placement the NMC require the ‘sign off’ mentor to make the declaration that they “have had the opportunity to review the student’s Continuity of Practice Assessment Record and where appropriate, through the student or their personal tutor have accessed evidence in support of achievement of standards of proficiency. The sign off mentor confirms that the named student has successfully completed all practice requirements and is capable of safe and effective practice at the end of the programme” (NMC 2006). This forms part of the formal process leading to Registration with the NMC.
  • The ‘sign off’ mentor is accountable for their decision in the above declaration. The Continuity of Practice Assessment Record provides a robust record of the student’s progress and aims to support the ‘sign off’ mentor by providing documentation of the student’s practical developmental needs and progress throughout the programme. It permits the ‘sign off’ mentor to track the student’s placements, follow their progress and contact previous mentors and the student’s Personal Tutor if appropriate.

The Assessment of the student against the Practice Levels of the Skills Escalator [Bondy 1983].

In developing the NMC [2006] requirement for an ‘ongoing record of achievement’ (Continuity of Practice Assessment Record) it was considered also appropriate to review the current assessment tool in practice as the assessment of clinical competence of pre-registration nursing students is often considered subjective and inconsistent. Although themodified Benner stepped approach has been used successfully for several years by the University of Nottingham, School of Nursing it was believed that a more objective tool might be available. Bondy’s Levels of Competency [Bondy 1983] are currently used by several of the HEI’s providers in this region (Derby and Open University). The levels appear to be more easily interpreted, with less room for subjectivity and seem to be congruent with the idea of using a skills escalator for practice teaching, learning and assessment.

Bondy [1983] identified five levels of competency, descriptively labelled: Dependent; Marginal; Assisted; Supervised and Independent. These have beenmodified by the School of Nursinginto four Practice Levels: practises independently, practises with decreasing supervision, practises with assistance and practises with constant supervision. It is these four Practice Levels which have been adopted by the University of Nottingham, School of Nursing in the development of a skills escalator as it will allow:

  • Setting a minimal practice level of achievement of outcomes/standards of proficiency encouraging the more able student to achieve at a higher level where appropriate.
  • Movement on the escalator permitting students to achieve at a minimal practice level where the placement may be specialised and achievement of outcome/standard of proficiency at a higher level is not appropriate.
  • Provision of criterion for assessment of the student in practice facilitating a more objective assessment of student competence in practice.
  • Consistency of language for mentors that may be assessing students from more than one Higher Education Institution (Open University, University of Derby).
  • Self assessment by the student when considering the statements and how to achieve them and the quality of evidence to support achievement at that Practice Level [Gannon et al 2001, Redfern et al 2002].
  • Mentors to indicate Practice Level of competence obtained within the outcomes/standards of proficiency [Watson, Stimpson, Topping & Porock 2002].

Assessment of Student Competence against the Practice Levels of the Skills Escalator:

  • Behaviour in placement should reflect the philosophy of the School, course objectives and content and the Practice Level of the student.
  • The skills escalator reflects
  • psychomotor learning (NMC Domains of Care Delivery/Care Management);
  • affective learning – professional socialisation and development (NMC Domains of Professional and Ethical Practice/Personal and Professional Development).
  • The student has to achieve applicable outcomes/standards of proficiency by the end of each semester at the required Practice Level or above.
  • Measurement of competence in practice takes into consideration:
  • Professional standards and procedures for the behaviour
  • Qualitative aspects of performance
  • Level of assistance required to perform the behaviour
  • The student’s practice competence will be assessed against the indicatorsfor the four Practice Levels .
  • The student will be assessed in the NMC (2004) four domains of practice:
  • Professional and Ethical Practice
  • Care Delivery
  • Care Management
  • Personal and Professional Development
  • The NMC have created these statements to produce a practitioner who has:
  • acquired a knowledge base
  • has developed therapeutic and interpersonal skills
  • has acquired values and attitudes that characterise the nursing profession
  • is safe and competent for the public and society
  • reflects the philosophy of the School and University.
  • The student will be continuously observed during placement and assessed against the Practice Levels in achieving outcomes/or standards of proficiency.
  • There needs to be consideration of EFFECT; i.e. achieving the intended purpose of the behaviour. For example if the desired effect of interviewing a client is to assess nutritional status, the evaluation of the students performance is whether sufficient information has been requested and obtained to produce a comprehensive nutrition action plan.
  • There needs to be consideration of AFFECT; i.e the way in which the behaviour is performed and the professional manner of the student.
  • The behaviour must be safe, not only for the client but practice staff and others in the environment. It also needs to be accurate with the appropriate AFFECT and EFFECT each time.
  • When assessing the qualitative aspects of behaviour i.e. attitudes and values, it should be remembered that skills acquisition is developmental.
  • It is recognised that the degree of assistance needed by the student from the supervisor/mentor to demonstrate the required level of competence in the Practice Levels will decrease as the student progresses. Assistance can be supportive or directive.
  • The Practice Level descriptors are the foundations of behaviour that will be continued into the next Practice Level and developed further.
  • Over the placement experience the student will demonstrate patterns of development. It is expected that when a student is presented with new or more complex activities, the student’s level of competence is initially low, increasing as they learn to demonstrate the expected behaviour and knowledge. It is expected that the student is consistent in progressing with the expected Practice Level of behaviour.

References:

Bondy NK, [1983] Criterion-Referenced definitions for rating scales in Clinical Education, Journal of Nursing Education, 22(9) 376-382

Gannon FT, Draper PR, Watson R, Proctor S, & Norman IJ [2001] Putting portfolios in their place, Nurse Education Today 21 534-540

NMC [2004] ‘Standards of proficiency for pre registration nursing education’, London, Nursing and Midwifery Council.
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NMC [2006] Standards to support learning and assessment in practice; NMC standards for mentors, practice teachers and teachers, London, Nursing and Midwifery Council.

NMC [2007] “Ensuring continuity of practice assessment through the ongoing record of achievement” Circular 33/2007 London, Nursing and Midwifery Council

Redfern S, Norman I, Calman L, Watson R & Murrells T [2002] Assessing competence to practice in nursing: a review of the literature, Research Papers in Education 17 51-77

Watson R, Stimpson A, Topping A, & Porock D, [2002] Clinical competence assessment in nursing: a systematic review of the literature, Journal of Advanced of Nursing 39 (5) 421-431

Skills Escalator Pre-Registration Nursing Courses

Adapted from Bondy (1983)


Time Plan
A. Placements (First week) /
  • Student presents Continuity of Practice Assessment Record to mentor
  • Previous placement reviewed and action plan noted
  • Orientation, preliminary interview and action planning completed and documented in the Assessment of Practice Record

B.
Intermediate Interview
(Half way) /
  • Review action plan and learning needs of student
  • Identify new learning plan
  • Involve academic PLT or Personal Tutor if appropriate or concerns that student will not achieve some or all outcomes/standards of proficiency or their professional behaviour
  • If appropriate evidence is presented some outcomes/standards of proficiency can be signed as achieved

C.
Final Interview (during last week) /
  • Student has responsibility to gather and present all forms of evidence to mentor
  • Student will complete Assessment of Practice Record identifying type and location of evidence presented in support of achieving outcomes/standards of proficiency
  • Mentor will review evidence and accept accountability in assessing student as competent, or not in those outcomes/standards of proficiency at the appropriate Practice Level
  • If not competent and therefore failing mentor to involve academic link/personal tutor.

D.
Mid Semester
(if more than one placement per semester) / Student is responsible for taking the Continuity of Practice Assessment Record to the next placement and commence the process again from A.
E.
End of semester / At the end of EACH semester the student MUST submit the Continuity of Practice Assessment Record to the Assessment Clerk in accordance with cohort Assignment Submission Schedule
F. / Assessment Clerk forwards Continuity of Practice Assessment Record to Personal Tutors
G. /
  • Student responsible to make appointment to see Personal Tutor with collected evidence and Assessment of Practice Record to discuss achievement of Continuity of Practice Assessment Record
  • Personal Tutor responsible for removing yellow copy of placement records and arrange filing in student’s file
  • Personal Tutor at end of year advise appropriate Programme Leaders of any students that have not achieved outcomes or standards of proficiency
  • Exams office will contact Programme Leaders for confirmation of students that have and have not achieved prior to progression
/ Exams office will randomly select sample of Continuity of Practice Assessment Record and Portfolio for internal moderation that will:
  • Check authenticity of document
  • Review equity and quality of evidence submitted
  • Formulate internal moderation report and feedback to mentors via PLTs
  • Exams Office forward sample to External Examiner

H. / Student to present Continuity of Practice Assessment Record to mentor of next placement and continue process from A.
I.
Final Placement /
  • In the final placement during the last week the student is responsible for presenting collected evidence, Assessment of Practice Records and Continuity of Practice Assessment Record to their ‘sign off mentor’. If required the student should provide any additional evidence from previous placements.
  • The ‘sign off mentor’ will satisfy their accountability in the NMC declaration.
  • Process as in E, F and G to be followed.

J. / The student following a personal tutorial will retain the original document as part of their practice portfolio. The School of Nursing will over the course of the programme have retained the yellow copies of the NCR in the student’s file.

Future Developments

With the introduction of Practice Levels there is now an opportunity to develop a method of awarding merits and distinctions for practice. This is currently being explored through the Practice Learning Committee.

The school of nursing in collaboration with its partners is further considering awarding credits to students for achievement of standards of proficiency.