Does Completing a Post Graduate Advanced Clinical Assessment Paper Influence Nursing Practice: An Exploratory Study?

The purpose of this research was to explore the influence a post graduate advanced assessment and clinical reasoning nursing paper may have on a registered nurses clinical practice. The post graduate paper, 773, has been available to registered nurses doing post graduate studies at the University of Auckland for over fifteen years. In this time, over 3000 nurses have completed this paper as part of their post graduate studies. It is often the first or second paper that a registered nurse completes as 50% of a post graduate certificate and is a compulsory paper for a clinical nursing masters or nurse practitioner pathway. The paper has a strong focus on clinical examination and diagnostic reasoning and students are required to perform a clinical examination as part of the assessment process. In addition they are required to complete an exam which assesses their knowledge and clinical application on a variety of blood tests and ECG interpretation. Therefore to successfully pass the paper all students must be at a certain level in their ability to perform a clinical examination and interpret diagnostic tests. What is unknown from the paper however, is whether students are able to take the clinical skills and the diagnostic reasoning knowledge and apply them to their area of clinical practice. The aim of this study was to explore whether advancing a nurses clinical examination skill and knowledge actually transitions into clinical practice 3 months after completion of the course.

The first part of the research included a questionnaire given to students at the beginning of the nursing paper and the same questionnaire repeated at the end of the paper. A total of 61 nurses completed the first questionnaire on day one of the course and 51 nurses completed the repeated version four months later at the completion of the course. The questionnaire used a combination of Likert scales and descriptive phrases to identify where nurses rated their clinical examination skills, including interpretation of ECGs and blood results. This part of the study has been entered into a data base and will be analysed using a comparative approach to the two questionnaires.

The second part of the research involved 13 nurses in two focus groups. The participants were recruited three months after completing the advanced assessment and clinical reasoning paper and the criteria was that they must be working within a clinical nursing role. The focus group facilitator directed the communication around clinical practice following completion of the paper. Specific emphasis included the everyday practice of clinical assessment, identification of the deteriorating patient and overall confidence in clinical assessment, including interpretation of blood results and ECG. This part of the study is currently being analysed using a thematic analysis approach. An early indication from the analysis is the paper develops a nurse’s confidence to perform clinical examination on a greater number of patients and to intervene earlier with appropriate care.