Paper
Friday, July 23, 2004
This presentation is part of : Caregiving Behaviors
Development and Testing of Objective Structured Clinical Examinations (OSCE) for Use in Education of Lay Caregivers of Blood and Marrow Stem Cell Transplant (BMSCT) Recipients
Judith Heermann, PhD, RN1, June Eilers, PhD, RN2, Danielle L. Geiger, BSN, RN1, and Susan M. Wardian, MSN, RN, OCN3. (1) College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA, (2) Nebraska Medical Center, Omaha, NE, USA, (3) Cowdery Patient Care Center, Nebraska Medical Center, Omaha, NE, USA
Learning Objective #1: Describe use of Objective Structured Clinical Examinations (OSCE) as an evaluation approach that can be integrated into health education programs for lay individuals
Learning Objective #2: Discuss the process for testing the reliability and validity of OSCEs
Objective: 1) To develop an objective approach for evaluating lay caregiver learning. 2) To construct and test five OSCEs for assessing caregivers’ knowledge and skills necessary for managing care of BMSCT recipients.

Design: Methodological pilot to test content validity and reproducibility of simulated performances, and scoring accuracy.

Population: Lay caregivers of BMSCT recipients. Sample: Purposeful sample of 5 lay caregivers for testing each OSCE. Setting: Cooperative Care (an alternative acute care delivery model) at Nebraska Medical Center Years: 2002-03.

Concept or Variables Studied: Use of OSCEs with lay caregivers to supplement education and evaluate competency to assume responsibility for care.

Methods: A research team developed five OSCEs (central line care, mouth care, assessment and monitoring, infection control, and symptom management). Two observers independently scored caregiver performance for each OSCE using a checklist. A minimum of 5 participants to replicate encounters has been established to adequately test the reproducibility and accuracy of an OSCE (Carney et al., 1995).

Findings: The OSCEs contained a total of 174 competencies. Inter-rater agreement for the caregivers’ performance of the competencies was adjusted for agreement that might occur by chance using the kappa statistic. Eight kappa coefficients ranged from .29-.69, with the remaining 166 (95%) having a kappa of 1.0 indicating excellent agreement. Caregiver performance on the five OSCEs ranged from 85% to 95%.

Conclusions: Items requiring revision and additional testing were identified. Overall, the design of the OSCEs facilitated reliable scoring by raters. OSCEs allowed testing of lay caregivers’ competencies through their performance in simulated situations.

Implications: The evaluation of the ability of lay caregivers to provide health-related care is an important aspect of education provided by nurses. OSCEs as used in this BMSCT population should be considered for use in educational programs preparing lay caregivers of other populations requiring specialized knowledge and skills.

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