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ILIAInnovative Learning in ActionIssue Four: New Academics engaging with Action ResearchSeptember 2005

Education Development Unit

Introduction

Dear Colleagues,

This edition of ILIA showcases fourpapers which were originally submittedas action research projects on thePostgraduate Certificate in HigherEducation Practice and Researchprogramme. Within the programme weoffer an environment where participantscan explore their unique teachingsituations – not to produce all-encompassing approaches to HigherEducation (HE) practice but to developan ongoing dialogue about the act ofteaching. In effect, there are no generalisable‘best’ methods of teaching becausethey never work as well as ‘locallyproduced practice in action’ (Kincheloe,2003:15). Thus rather than providingshort term ‘survival kits’ the programmeoffers new HE teachers a ‘frame’ forexamining their own and theircolleagues’ teaching alongsidequestioning educational purpose andvalues in the pursuit of pedagogicalimprovement.

This ‘frame’ is action research whichEbbutt (1985:156) describes as:

…The systematic study of attempts tochange and improve educationalpractice by groups of participants bymeans of their own practical actionsand by means of their own reflectionsupon the effects of their actions…

We promote ‘practitioner-research’ or‘teacher-research’ as a way offacilitating professional development fornew HE teachers, promoting changeand giving a voice to their developingpersonal and professional knowledge.Teachers as researchers embark upon anaction orientated, iterative andcollaborative process to interrogate theirown practices, question their ownassumptions, attitudes, values andbeliefs in order to better understand,influence and enrich the context of theirown situations.

The action researcher assumes thatpractitioners are knowledgeable abouttheir own teaching situations and thefact that they are ‘in-situ’ and not at‘arms length’ as the value-neutral,‘scientific’ researcher is often claimed tobe, does not invalidate their knowledge. Thus, practitioners are capable ofanalysing their own actions within a‘reflective practitioner’ modus operandi.Action research is on-going inconception and well suited toexamining the ever-changing andincreasingly complex HE practiceenvironment. Findings from actionresearch are always subject to revisionsince it intrinsically acknowledges theneed to constantly revisit widely diverseteaching situations and scenarios acrosseveryday HE practice. Teaching is notpredictable and constant, it alwaysoccurs in a contemporary microcosm ofuncertainty. Action research provides ananalytical framework for new HEteachers to begin to engage with this

unpredictability on a continuing basis,that is its purpose and also its perennialchallenge.

The papers presented here describe howfour relatively new HE teachers havebegun to address the challenge ofimproving their practice within theirlocally based settings utilising the actionresearch ‘paradigm’.

Ebbutt, D. (1985) ‘Educational ActionResearch: some general concerns onspecific responsibilities’ in Burgess,R.G. (ed.) Issues in Qualitative ResearchLewes :Falmer Press

Kincheloe, J.L. (2003) Teachers asResearchers: Qualitative Inquiry as aPath to EmpowermentLondon :Routledge Falmer

Bernard Lisewski

Programme Leader,

Postgraduate Certificate in HigherEducation Practice and Research

Innovative Learning in Action

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Contents

Innovative Learning in Action: Contents

Notes for contributors 2

Papers

Students' Perceptions of the Discontinuity between Tutorial and Examination Questions in an Engineering ProgrammeSteven Allison 4

Interdisciplinary engagements at the margin: Child & Adolescent Mental Health provision within Pre-Registration Child Health Nursing ProgrammesCeleste Foster 11

Assessment in the Diploma in Nursing Programme with Advanced Standing: Patchwork Text PossibilitiesJean Parnell 21

Encouraging a Deep Approach to Learning among Students of Prosthetics and OrthoticsMartin Twiste 35

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Notes for contributors

Innovative Learning in Action: Notes for Contributors

Submission details (forpapers and ‘snapshots’)We will be pleased to receive papers,case studies and ‘snapshots’ whichdemonstrate innovation in learningand teaching at the University ofSalford. Potential contributors new towriting might find the followingarticle ‘Writing Academic Papers: theClinical Effectiveness in Nursingexperience’ useful:

http://www.harcourt-international.com/journals/suppfile/flat/cein-writing.pdf

LengthPapers and case studies should be amaximum of 3,500-4,000 wordswithout references.

‘Snapshots’ should be a maximum of600 words without references.

For both papers and ‘Snapshots’authors should include a full wordcount, (preferably with and withoutreferences) with submission.

Page sizeAll submissions should be left-rightjustified on an A4 page with 3.5cmmargin on the left and 2.54 marginsat the top, bottom and on the right

Text formattingNormal text: 11 point Arial font

Title and Authors:

Title: Arial 14 point bold centredacross the full width of the page

Author(s) name(s): Arial 12 point non-bold. We also recommend you addyour e-mail address using thestandard house style.

Sections: headings in Arial 12 pointbold with only the initial letters ofsignificant words capitalised (Note:determiners such as ‘the’ ‘or’ ‘a’ arenot capitalised unless they are thefirst word of the heading).

Subsections: headings in Arial 11point bold (Note: determiners such as‘the’ ‘or’ ‘a’ are not capitalised unlessthey are the first word of theheading).

Sub-subsections: headings in Arial 11point italic (Note: determiners such as‘the’ ‘or’ ‘a’ are not capitalised unlessthey are the first word of theheading).

Page numbers, headers and footers,footnotes

DO NOT include page numbers andheaders/footers in your submission.These will be added when thepublication is assembled. Footnotesshould be in Arial 8 point.

AbstractPapers and case studies: an abstractof a maximum of 200 wordssummarising the context should beincluded.

‘Snapshots’ do not require anAbstract.

FiguresFigures or tables should be inserted atthe appropriate point in your text andhave a figure caption in normal Arial11 point font, at the bottom and leftjustified.

QuotationsUse single quotation marksthroughout unless quoting within aquotation. Substantive quotes shouldbe indented with no quotation marks.

KeywordsInclude three or four key words toincrease the likelihood of potentialreaders searching the literatureaccessing your article.

Language, style and contentPlease make sure that your paper is inclear, readable and proper English.Please make consistent use of Britishdialect of English. Please write for across-disciplinary and internationalaudience.

n Write in a straightforward style.Use simple sentence structure. Tryto avoid long sentences andcomplex sentence structure

n Use common and basic vocabularyand avoid jargon

n Briefly explain or define alltechnical terms

n Explain all acronyms the first timethey are used in your text

n Be careful not to use genderspecific pronouns (he, she) andother gendered words or phrases(‘chairman’, ‘manpower’, ‘theman in the street’) wherereference to both sexes isintended. Use language that isgender neutral (‘chairperson’,‘workforce’, ‘people in general’).For further advice and examplesregarding gender and otherpersonal attributes please visit theBritish Sociological Associationwebsite(http://www.britsoc.org.uk)

AcknowledgementsAcknowledgements should beincluded under a separate headingbefore the references at the end ofthe paper. For example,

We thank Dr. Joe Bloggs and Prof.Joanne Bloggs of the University ofSalford for their comments on earlierversions of this paper. This projectwas made possible by funding fromthe University of Salford TLQIS.

References and CitationsWithin the text, references should beindicated using (author, year). Ifseveral papers by the same authorand from the same year are cited, a,b, c, etc. should be put after the yearof publication.

If the reference is to a piece by twoauthors, both should be cited, forexample (Reynolds and Trehan, 2000).If there are more than two authors, etal should be used. The full list ofauthors should appear underReferences at the end of the paper.

The references should be listed in fullat the end of the paper in thefollowing standard form:

For Books: Barnett, R. (1992)Improving Higher Education: TotalQuality Care (Buckingham, SRHE &OU)

For Articles: Reynolds, M. and Trehan,

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Innovative Learning in Action: Notes for Contributors

K. (2000) Assessment: a criticalperspective, Studies in HigherEducation, 25, pp.267-278

For Chapters: Walker, R. (1987)Techniques for Research, in: R.Murphy& H.Torrance (Eds) EvaluatingEducation: Issues and Methods

For Websites:http://www.shef.ac.uk/alt/call/research.htm ALT-C 2003 Research PaperFormat Template

References should be publishedmaterials accessible to the public.Internal reports may be cited if theyare easily accessible.

Permission to reproduce borrowed materialWritten permission to reproduceborrowed material (illustrations andtables) must be obtained from theoriginal publishers and authors, andsubmitted with the typescript.Borrowed materials should beacknowledged in the caption in thisstyle: Reproduced by kind permissionof…(publishers)…from…(reference)

Copyright

Submitting an article to this journalwill not affect copyright. Thecopyright will remain with theauthor who will be able to publishthe article elsewhere.

Contributions are accepted forpublication on condition that thecontributor has obtained anynecessary permissions and paid anyfees for the use of other materialsalready subject to copyright.Contributors therefore undertakethat their material is not a violationof any copyright and undertake toindemnify the University of Salfordfor any loss occasioned to theuniversity in consequence of anybreach of this undertaking.

References for this documenthttp://www.harcourt-international.com/journals/nepr/

http://www.edu.salford.ac.uk

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Innovative Learning in Action: Papers

Students' Perceptions of the Discontinuitybetween Tutorial and Examination Questions inan Engineering Programme

Steven Allison, [email protected]

School of Computing, Scienceand Engineering

AbstractThis paper reports the findings of anaction research project examiningways to improve the connection forstudents between tutorial work andexam technique in a Level 2Aerodynamics module of a degreeprogramme in Engineering. Anintervention involving formative peerassessment, based on mock examquestions was supplemented by ‘pre-game’ and ‘post-game’questionnaires in order to gaugestudents’ perceptions of theassessment. Findings reveal severalpotential problem areas not least thestudents’ apparent shortcomings inproblem-solving skills, and theirdependence on past exam papers,with solutions, for revision.Conclusions suggest the need for afundamental curriculum ‘shift’ inengineering to make the teachingand learning of problem solving skillsmore explicit. Curriculum alignmentwithin engineering disciplines shouldbe geared more towards ‘process’rather than ‘product’ if learning is tobe appropriate to the ‘real world’ ofengineering. This ‘process’ orientationmay be supported by the use offormative peer assessment toencourage deep student learning andlure students away from adependence on past papers, therebyproviding effective feedback tostudents to promote engagementwith the subject material.

IntroductionThe recent expansion andrestructuring pervading the HE sectorpresages a paradigm shift in theconcepts of teaching and learning.University classes now tend to be

larger and have a much greaterdiversity in ability and skills as a resultof widening participation initiatives(Rust, 2002). Nonetheless, in somedisciplines (including engineering) thetraditional teaching and assessmentscenario of lectures, tutorials andexaminations prevails. During my briefexperience of teaching on anengineering degree programme at theUniversity of Salford I have come tofeel that there is a fundamental gapbetween the material that studentsare taught in lectures, and how theyuse that material to solve questions intutorials. As lecturer, I have tried tobridge that gap through the use of'worked examples' – devisingproblems the solution to which I workthrough with the class. Instinctively Ihave felt this to be a viable teachingmethod but wanted to engagestudents in action research to validatemy hunch. The first step in theprocess was to convene a group ofcollaborators and discuss myproposed line of inquiry with them.These initial discussions suggestedthat my learner collaboratorsperceived a significant misalignmentbetween tutorial questions andexamination questions. I had notanticipated such a response whichwas suggestive of Thomas andNixon’s argument that the way inwhich students react to assessment isvery much based on their perceptionsof that assessment. Whilst moststudents might appreciate thatassessment is an important part ofthe learning process, a lack ofunderstanding of how their work isassessed will adversely influence theirapproach to study (Thomas andNixon, 2004). The potentialdissonance between students', examwriters' and exam markers'perceptions and expectations of whatconstitutes different degreeclassifications etc. will also affectinteraction with the assessment.Therefore, the students' observationschanged the direction of this actionresearch the focus of which became

students' perceptions - both of themodule assessment (the exam) andthe 'bridge' between tutorials andassessment.

Research methodologyAction research is a practice thatinvolves data gathering, reflection onthe action, generating data from theevidence and making claims toknowledge based on the evidence(McNiff, 2003). It is an iterativeprocess, with the observations drawnfrom one cycle informing the researchof the next; a process of praxis – theaction altering the ‘knowledge base’which informs it. Norton (2001)observes that this ongoing naturemeans action research is particularlyappropriate in a pedagogical context.Importantly, the researcher is sitedwithin the research; 'a form ofpractitioner research characterised byimproving practice throughconstructing new knowledge'(Staniforth and Harland, 2003).

The focus of this action researchsuggests a potential shift in teachingand learning strategy thus it is crucialto identify the stakeholders whomight be affected by anyintervention. I have identified thestudents as the primary stakeholdersin the project, and recognise thattheir perceptions will influence myresearch and that they are thepotential beneficiaries. However,whilst the initial focus of andpotential benefits lie with thestudents and myself it is possible toanticipate future cycles that couldultimately involve and benefit a widerrange of stakeholders both withinand beyond the discipline.

In order to explore students’perceptions of exams and the bridgebetween tutorials and assessment Idesigned an intervention based onstudents engaging in mockexaminations during tutorials.

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The tutorials form part of the learningand teaching strategy for a level 2module in Aerodynamics. Formativepeer assessment was introduced withthe examination solution beingdistributed to enable students toassess each other’s scripts. I felt thatthe most effective way of gaugingstudents’ perceptions of the examwas to ask them about it, through aseries of questionnaires. At least twomock exam question sessions withcorresponding questionnaires weredevised to provide a means ofcomparison, I felt that 'pre-game' and 'post-game' questionnaires wereappropriate being distributed to thecollaborators before and after themock exam question. My purposewas to try to ascertain: theirperceptions prior to the test; whetherthose perceptions were met after thetest; their views of the assessmentprocess; their preparation, or revision,process; and, their thoughts on usingthe mock exam questions to 'plug thegap.' Thus a significant proportion ofboth questionnaires required thehonest, personal qualitative answerscharacteristic of small scale research(Cohen, Manion and Morrison, 2000).

The students were required toundertake the mock exam question (I stipulated 30 minutes for this),mark another's exam script, andcomplete two (moderately lengthy)questionnaires. In order to give thestudent group sufficient opportunityto engage in this process effectively, Ischeduled a two-hour slot tocomplete a mock exam questionsession. I intended to undertake two such cycles; two separate sets of data would give me a means of comparison.

Insights from the literatureThe concept of mock exam questionsassessed by fellow students could betermed 'formative peer assessment'.Formative assessment is an excellent

means for students to gauge howthey are doing, and where there isroom for improvement. Biggs (2003)observes that students are prone tomisconceptions regarding summativeassessment. Furthermore, manysummative examinations do notprovide any feedback on performanceto students thus there is nomechanism by which the lecturer caninform students of their progress(Heywood, 2000). Boud (2000) goesso far as to suggest that the focus onsummative assessment hasovershadowed the need for formativeassessment in higher education to theextent that the need to providefeedback is ignored and under-conceptualised.

In contrast formative assessmentallows students and teachers alike togauge progress and anticipatepotential problem areas. Ramsden(2003) remarks that the prudent useof model answers, such as thosespecifically written by the lecturer, isan excellent form of feedback.However, Rust (2002) states thatgiving feedback to students withoutrequiring them to actively engagewith it will only have limited effect.Formative peer assessment goesfurther in allowing students toachieve this engagement therebyacquiring a clearer understanding of assessment processes andencouraging more effectivepreparation for examinations by promoting ‘deep’ learning approaches.

Cottrell (2003) identifies ten commonpitfalls in revision which include:leaving revision to the last minute;reading the notes over and overagain; motivation; panic; boredomand Meyer (1995) cites the inability toconnect with material as erodingconfidence and undermining deeplearning. Although last minuterevision may be active, it promotessurface learning, which does not

serve the student's long-term learningneeds. Thus effective preparation for examinations and effectivelearning depends on students notonly adopting an active method, but also engaging their mind in acreative method, as opposed topassive revision whereby knowledge is absorbed without engagement (Tracy, 2002). Formative peerassessment may assist in these processes.

Discussion of findingsWhen conducting research, thevalidity of quantitative data is partiallydependent on the breadth ofsampling group, i.e. the number ofparticipants. When I conducted mymock exam I was somewhatperturbed that I only had sevenparticipants at each session. Almostinevitably I was drawn towardsspeculating why this should havebeen the case. The sessions tookplace on Friday mornings, and werethe only lectures scheduled for thestudents all day. However, thesessions merely replaced anAerodynamics lecture and tutorial,which usually had slightly betterattendance (an average of around 10students per session for thesemester). I conjectured whether ornot students were generally apatheticeither towards aerodynamics, ortowards their university career ingeneral. Did the missing studentshave no real desire to collaborate inthe action research, and it was easiersimply to stay away rather than riskgiving offence? I had stipulated,when explaining the research process,that participation was voluntary andnon-participants could still take themock tests, but was skipping thesession the least stressful choice? Wasmy explanation of the process unclearcontributing towards a lack ofunderstanding on their part thatdiscouraged them from collaboratingin the research? Did a lack ofunderstanding of the subject material

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discourage them from taking thetest? Perhaps they felt unable to dojustice to the test having failed to doany revision, and did not want to‘show themselves up’…but some ofthose who attended freely admittedto not revising (and it showed in theirmock test marks). Does it all simplycome down to student characters,and students' learning strategies?

In processing the data, one frequentlyrecurring theme throughout thestudents' responses was revision,particularly the idea of revising thesubject throughout the semester. All participants admitted that they do not follow this kind of learningstrategy, and many regarded this as a failing in their academic practice.Whilst summative testing throughoutthe semester, subjecting the studentsto a number of phase testsdistributed throughout the semestermight be useful it is likely thatformative, peer-marked assessmentwould be more effective and less burdensome.

Remaining on the subject of revisionthe data suggested that studentengagement with the formativeassessment process was poor in thatmany students did little or no revisionfor the mock exam question. Overallthere was more evidence ofpreparation for the second test thanthe first and this might have been acontributory factor in improvedoverall student performance. Theoverall group marks improved from aclass average of around 7 out of 25for the first test to 14 out of 25 forthe second. Extrapolating thisimprovement in student performanceit might be reasoned that: if thestudents were continually exposed toformative assessment acrossnumerous modules, they could adaptto an ongoing learning strategywhich would be more conducive to adeep learning process.

However, to simply assume thatimproved performance is due tobetter student learning may beanomalous. There are potentially anumber of reasons why the markswould show improvement. Forexample, the relative ease or difficultyof my mock exam questions mayhave been inconsistent. I hadformulated the questions at what Iconsider to be level 2 exam standard,but it may have been that the firsttest was more difficult for thestudents (or the second test easier).Equally, students’ perceptions of thedifferent subjects involved in thequestions may account for apparentimprovement - that is, if the studentsperceived the subject matter of thefirst question to be relatively difficult,they may not have felt confidentabout undertaking the question.Another possible reason for caution ininterpreting the improved results isthat rather than showing betterengagement with the material theymay simply spring from betterengagement with the method ofassessment. Students had been givenample notice of when the testsessions would be held (three weeksnotice for the first test, and two forthe second), and so, having adaptedto the first mock exam questionsmight have undertaken some lastminute revision to improve marks.Whilst aware of all these possiblepermutations it is nonethelesspossible that the students’performance looked improved for thesimple reason that it had improved.Individuals may have taken theopportunity offered to them and usedit to their advantage. Perhaps positiveengagement with formative peerassessment had served to engenderdeep learning. Certainly, when Italked informally with the studentsafter both test sessions they seemedmuch more satisfied with theirachievements following the secondtest. The students and I would nowneed to work together to build onthat feeling of achievement, tofurther enhance their learning.

Whilst enthusiastically anticipatingfuture collaborations with mystudents to enrich their learningexperience I became morepreoccupied with the validity ofresults I had derived from thisformative assessment strategy - am Iimproving student learning, or am Isimply improving how well they takeexams? Am I making assessment, andnot learning, the end product?Although in this first action researchcycle I referred to the tests as 'mockexam questions', and wrote the testsas such, there is no reason why itcould not be called, 'problem-solvingusing engineering principles,' and stillbe an effective formative assessmentIn its current format, an unseenquestion worth 25 marks attemptedby the student over 30 minutes underexam conditions which is thenevaluated by a peer, certainly doesbring the assessment to the fore.However, I need to know that theformative peer assessment isencouraging students to engage with the module material and use it to effectively solve engineering problems.

The broader educational issue here isthat students, prior to university, arenot being engaged with the processof problem-solving. Problem solvinghas generic as well as discipline-basedsignificance being highlighted in theDearing Report (NCIHE, 1997) as oneof the six key skills that highereducation should develop within allprogrammes to promote studentemployability, and representing thekeystone applied skill within theengineering discipline. However, achange in approach to teaching andassessment methods for ‘A’- levelshas diverted emphasis away fromlearning the process of problem-solving; the 'problems' settend to be largely single step tests ofknowledge of individual principles,and are not constructed as multi-stepproblems (Houghton, 2004). As the

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prior learning regime of the ‘traditional entry route’student has changed the need to radically reassesspractice in HE has been reinforced by the impact ofwidening participation. As more non-traditional groupsof students; students from social groups who do notnormally participate in HE learning enter university theincreasing diversity in academic ability and grasp of keyskills could well fuel a need for more formativeassessment strategies to encourage a continuouslearning approach to the subject (Thomas, 2000). I amleft wondering whether there is any correlation betweena decline in problem-solving skills and students' revisiontechniques. It may be the case that, when revising,students do not devote time to practicing solvingproblems, but to reading past papers to ‘spot’ andpredict questions and contrive almost ‘model’ answers.Had the student developed a commanding grasp ofproblem-solving, the particular style and format ofquestion would be less consequential.

For the teacher, promoting student learning throughformative peer assessment represents the transference of power from lecturer to students. In my limitedexperience many lecturers have difficulty in cedingterritory, viewing knowledge as power. Certainly manyof the topics engineers deal with are very complex yetinteresting and if there is to be a community of practicebased around these topics, the engineering knowledgeneeds to be there. Perhaps in seeing the subject throughmy eyes students can gain an appreciation of the holisticnature of engineering. If it is my responsibility to trainthe next generation of engineers who may eventuallydesign the civil aircraft I travel on, I would be reassuredif the designer had access to as much information aspossible! Nonetheless, from a personal standpoint, I amquite willing to yield this ‘power’ to students since I feelit important that we give them as many chances aspossible to succeed.

Evaluation of action research processesWhen first presented with the concept of actionresearch, I was less than enthused. The notion ofconducting research within infinitely redefinableboundaries did not initially appeal. Prandergast suggeststhat one's first action research project consists of sevenstages, and that during this first stage one is 'in thefog!' I would concur with this; however, in finallycommitting to the process I also found that there arebenefits to conducting research within infinitelyredefinable boundaries!

One of the problems was that I did not clearlyunderstand the iterative nature of action research in the early stages of the project, particularly when the cyclicalnature of the research can be represented like this:

Figure 1. The cyclical iterative nature of Action Research.

Figure 1 is, I feel, a fair representation of the cyclical, yetnot quite iterative, nature of action research, and isreferred to by McNiff, Lomax and Whitehead (2003) as‘a generative transformational evolutionary process.’ Iquite enjoy the irony that, explanative as the diagram is,it also resembles a cyclone, which has been myperception of action research at times!

It wasn't until I undertook the 'doing' stage, where'doing' is the whole point of action research, that Ibegan to feel more comfortable with the process, andfind it much more rewarding. The interaction betweentheorising and practical experience from which thegeneral principles of action research derive is intended toorientate and guide the practitioner, who has an activerole in praxiology (Johnston, 2003).

Designing the questionnaires, both for 'pre-game' and'post-game' was an important and difficult step in thisproject. The field of questionnaire design is vast,encompassing a number of key elements, including:ethical issues; planning and operationalising; theconcepts of structured, semi-structured and unstructuredquestionnaires; dichotomous, multiple-choice, rank-ordering and open-ended questions; piloting thequestionnaire; processing the data (Cohen, Manion andMorrison, 2000). In writing the pre-game questionnairefirst, I found the process of trying to consolidate myvarious ideas and themes into a cohesive structureextremely difficult. I then wrote the post-gamequestionnaire by using my first questionnaire as atemplate, with the slant of the questions now altered toestablish feelings after the event.

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Having designed some rough drafts, Iworked with my research supervisorto polish up the questions. Thisprocess of 'polishing' could looselycome under the definition of piloting.Piloting of a questionnaire, prior tocarrying out a full survey, is welladvised; it allows you to modify yourquestions in light of the responsesyou receive (Blaxter, Hughes andTight, 1996; 163). In terms of myown process, someone else readingthrough my work helped bring anyglaring errors to light, andmodifications were made accordingly.

After agonising over the writing ofthe questionnaires, the next worrywas whether the students wouldconnect with them. My particularconcern was how they would engagewith the open-ended questions: if Ishould have a poor turn-out for thetest (not an unlikely proposition), andthe students don't connect well withthe questionnaires, I would be leftwith a measly sampling of ineffectivequantitative data. Fortunately, thestudents engaged well with thequalitative parts of bothquestionnaires. I was extremelypleased by this; despite the low turn-outs for both tests, I did at least collect data which might giveme some insights.

Once I had run the mock examquestion sessions and collected all myraw data, I found the process ofsifting through all of this data,collating it and looking for patternswas a daunting experience! This couldhave been due to my badly organizeddata management system but it was,at least partially, attributable to thesheer volume of data collected. Onething that is abundantly clear is thatmy questionnaires were far too long.Despite the lack of attendance at themock exam sessions, I had collectedfar too much information, and not allof it has proved useful. Several of my

questions were redundant (the six orseven 'yes or no' questions on revisiontechniques could have been reducedto, 'what techniques do you use torevise?') and a few questions wereleading. It proved difficult at times tofind patterns amongst the data. Therewas definitely a lesson for me to learnin this incident – the need for moremanagement of the process prior toundertaking the research. Reflectingupon the process of designing thequestionnaires I would nowrecommend: rigorous questionformulation and construction - -changing 'tell me how you feelabout...' to 'give me your opinionon...' changes the whole tone of thequestion; the use of qualitative aswell as quantitative questions - even ifthe respondents don't answer the'why' questions, you still have thestatistics; make sure that questions donot implicitly support a particularagenda or line of reasoning.

In terms of research methodology ingeneral I am conscious of not havingtriangulated data sources.Triangulation can serve as a means ofmonitoring actions, when the data isscrutinised from multiple perspectivesin order to reach a reasonableconclusion (McNiff, 2003). One meansof triangulation I could haveemployed within this first cycle ofaction research had I considered it intime, was to ask the participants,once all of the tests had beencompleted, to complete a 'follow-up'questionnaire, the studentsthemselves reflecting on theexperience and giving me theopportunity to reflect on theirreflections. In the long runtriangulation could be achieved by forexample, comparison of students'exam marks (with previous cohorts,with different modules, etc) andconducting follow-up interviews orfocus groups. It might also be usefulto ask students to compare expectedand obtained grades, with the

discussion linked to the mock examquestions. As far as this first cycle ofaction research is concerned theaction research process seemed thatmuch more rewarding once I beganto see some patterns amongst the‘maelstrom’, and could begin to drawtogether some suppositions anddeductions. Ultimately, taking on therole of the ‘insider researcher’,tackling an issue pertinent to myteaching using action research andendeavoring to achieve knowledgethrough action, has indicated clearlyto me that action research can be achaotic process. However, as with allresearch, investigation undertaken atthe cutting-edge is likely to becomplex, should drive the researcherforward to break new boundaries,and will be messy.

Conclusions and furtherresearchIt is difficult to draw decisiveconclusions from the first cycle of anaction research project; the iterativenature precludes forming firmopinions after the first iteration.However, there are a number ofinteresting observations revealed bythe research: how engineeringstudents are contending withproblem-solving; the need for strictalignment within engineeringdisciplines to keep the assessmentfrom becoming the end product; theuse of formative peer assessment toencourage deep student learning andlure students away from adependence on past papers; the needfor effective feedback to students topromote engagement with thematerial. However, that all of theseobservations feed back into the actionresearch, and inform the second cycle,is the crucial issue here.

This research suggests the need for acurriculum shift in engineering - wemust make the teaching of problem-solving more explicit.

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Houghton (2004) identifies aprocedure for teaching problem-solving, both generic and subject-specific skills. It may require amodule, or part-module, for the Level1 students; it may just require thateach module explicitly highlightssituations requiring problem-solvingskills and acclimatizes the studentslocally, such that the skills are thenlearnt progressively.

Aerodynamics is a Level 2 module andthis infers that the students haveprogressed from Level 1 (orequivalent), and so are engaged in aprocess of development. This shouldbe reflected in an increasingcomplexity of the problems withwhich they interact, and infers afurther degree of intricacy will beexpected at Level 3. Students'understanding of the mechanism ofproblem-solving should mirror thisincreasing complexity.

Findings suggest the need to explorein greater depth the development ofstudents' problem-solving skills.Fundamentally, the acquisition ofproblem-solving as a 'must-have' skillshould be made more explicit, andshould be linked more directly to thetutorials. The students can developand apply their problem-solving skillsthrough use of the tutorial questions,and this skill will carry them throughthe assessment and their eventualcareer. The next cycle of actionresearch will examine the issues I haveencountered surrounding problem-solving in engineering. ‘Pre-game' and'post-game' questionnaires will bedesigned with a much narrowerfocus to facilitate the collection ofdata which has validity in terms of theoverall research question.

There is a clear indication thatstudents are willing to engage withformative peer assessment based onmock exam questions and, despite my

reservations about the prominentposition given to assessment, I thinkthis is an idea that has merit. At thisstage of development the feedbackinvolved no more than deciding amark out of 25. Whilst I do not yethave a firm idea about how todevelop more constructive anddiagnostic feedback processesbetween students I am aware thatstudents react more positively to thiskind of feedback rather than simplybeing told a number. Future actionresearch cycles need to explore this issue.

Since action research has focused onthe need to ‘bridge’ the gap betweentutorials and exams, as perceived bystudents it may be helpful toundertake a review of the alignmentbetween the module learningoutcomes and the assessmentmethod (i.e., the exam), and then ensuring constructive alignmentbetween the exam and teaching andlearning strategies (which willencompass the tutorials).

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ReferencesBiggs (2003) Teaching for QualityLearning at University, Secondedition, McGraw-Hill/OUP,Maidenhead.

Boud (2000) Sustainable assessment:rethinking assessment for the learningsociety, Studies in ContinuingEducation, 1(2):151-167.

Brown, Race, Smith (1996) 500 tipson assessment, Kogan-Page.

Cohen, Manion, Morrison (2000)Research Methods in Education,Fifth Edition. Routledge-Falmer.

Cottrell (2003) The Study SkillsHandbook, Second edition, Palgrave-Macmillan, Basingstoke.

Department of Education (1997),Report of national committee ofinquiry into higher education (Dearing Report) Norwich:Department of Education.

Heywood (2000), Assessment inHigher Education: Student learning,teaching, programmes andinstitutions, Higher Education Policy Series.

Houghton (2004). Learning andTeaching Theory for EngineeringAcademics, www.heacademy.ac.uk

Johnston (2003). Teaching andResearching Critical AcademicWriting: scrutiny of an action researchprocess. Educational ActionResearch. 11, (3): 365-387.

McNiff (2003), Action Research:Principles and Practice,Routledge-Falmer, London.

McNiff, Lomax, Whitehead (2003),You and Your Action ResearchProject, Second Edition. Routledge-Falmer.

Meyer (1995). A framework forevaluating and improving thequality of student learning.Improving student learningthrough assessment andevaluation, compiled by GrahamGibbs. Oxford Centre for StaffDevelopment.

Norton (2001). Researching YourTeaching: The Case for ActionResearch, Psychology Learning andTeaching, 1(1), pp. 21-27.

Prandergast. Seven Stages in my FirstAction Research Project.http://educ.queensu.ca/projects/actionresearch/michael.htm

Ramsden (2003), Learning to Teachin Higher Education, SecondEdition. Routledge-Falmer, Oxon.

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Rust (2002), The impact ofassessment on student learning,Active learning in highereducation, Sage, London.

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Thomas, Nixon (2004), Enhancingcommunication between academicstaff and students atundergraduate degree level with aparticular focus on assessmentrequirements,www.edu.salford.ac.uk/scd/tlqis/reports/thomas.rtf

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http://kerlins.net/bobbi/research/qualresearch/consent.html

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Interdisciplinary engagements at the margin:Child & Adolescent Mental Health provision withinPre-Registration Child Health Nursing Programmes

Celeste Foster

[email protected]

School of Nursing

Abstract The field of child and adolescentmental health (CAMHS) can beconsidered a ‘marginal’ disciplinejuxtaposed between two dominantdisciplines – child health and mentalhealth. The teaching of CAMHS withinpre-registration Children’s Nursingprogrammes lies at the intersection ofthree fields of enquiry: workforcestrategy, policy and practicerequirements and drivers; educationaltheory pertaining to effectivecurriculum design for learning andmulti / inter-disciplinary teaching.

As a CAMHS practitioner in the mentalhealth team of the School of Nursingmy predominant experience ofteaching CAMHS in Children’s Nursingprogrammes has been in providing‘bolt on’ sessions to child healthmodules of which I have little widerknowledge or understanding. This hashad negative consequences for mypersonal perception of my practice andof the student learning experience.

This paper reports the findings of anaction research project designed tovalidate or challenge my ownassumptions, to identify actions forimprovement in current practice and tobegin to explore the idea ofdeveloping an inter-professional‘community of practice’. Findingsfrom this small scale study based onquestionnaire, interview, documentaryand student evaluation data andanalysis, indicate the principles ofeffective curriculum design anddelivery are an essential underpinningfor a learning experience that informsprofessional practice and client care inthe workplace. Furthermore whilstcurrent practice may best be describedas multidisciplinary, a systematic

interdisciplinary approach may beencouraged by linking the principles ofcurriculum alignment andinterdisciplinarity together by means ofan adapted version of Biggs (1999)’SOLO taxonomy.

Introduction and rationaleThe mental health of children andyoung people is now a nationallyprioritised area of public health withGovernment guidelines andframeworks clearly outliningresponsibilities of all health & socialcare professionals who have contactwith children, regardless of theirspecialism (DoH, 2004). Nurses are thelargest single professional groupworking with child and adolescentmental health (CAMHS) difficulties,making up 25% of the workforce(Audit commission, 1999). Moreover,children with physical health problemsare up to four times more likely todevelop a mental health disorder(Meltzer, 2000), meaning that ChildHealth Nurses have a significant role toplay in the effective service provisionfor this client group. Yet a recentresearch report by the Royal College ofNursing (RCN), found that nursesworking with children and youngpeople considered their pre-registration training in mental healthneeds of this group inadequate interms of both practice and theory(Jones, 2004).

As a CAMHS practitioner recentlyemployed as a lecturer in the mentalhealth team of the School of Nursing Iwas very keen to teach my area ofpractice within the disciplines ofmental and child health, but especiallyin the child health programme.Instinctively I feel the field of CAMHSto be important in its own right - asmy area of specialism in which myprofessional identity is framed – but Iam also conscious of the potentialcontribution CAMHS can make to thediscipline of children’s nursing to

improve holistic care and earlyidentification of needs in young peoplein distress.

My predominant experience ofteaching CAMHS in Children’s Nursingprogrammes has been in providing‘bolt on’ sessions to child healthmodules of which I have little widerknowledge or understanding.Consequently, I generally feel unclear about the remit I have beengiven, dissatisfied with my personalevaluation of the sessions’ relevance and effectiveness andconcerned regarding the students’learning experience.

The field of child and adolescentmental health can be considered a‘marginal’ discipline that falls betweentwo dominant disciplines – mentalhealth & child health where ‘discipline’refers to the notion of a ‘legitimate’ or‘valid’ body of knowledge - in bothacademic and clinical practice arenas(Caruana & Oakey, 2004; Thomas,2000; Jones 2004). Furthermore, theteaching of CAMHS within pre-registration Children’s Nursingprogrammes lies at the intersection ofthree fields of enquiry:

• Workforce strategy, policy andpractice requirements and drivers

• Educational theory pertaining toeffective curriculum design forlearning

• Multi and Inter-disciplinary teaching

As a programme that awards both anacademic qualification and aprofessional registration the curriculumof the Pre-registration Nursingprogramme is significantly driven byworkforce/employer requirements andnational guidelines which include theexplicit requirement for PaediatricNurses to be able to identify andprovide care for young peopleexperiencing mental health difficulties

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(DoH, 2004). In my experience thisrequirement is not adequately reflectedin the wider curriculum, or embeddedwithin the programme or modulelearning outcomes and assessmentstrategies. Similarly, the Child HealthTeam themselves may have limitednotions of what teaching CAMHSentails since it is not their area ofexpertise. Thus I feel I am being askedto provide input to student learningthat is devoid of strategic thought andclarity, a feeling that is evidenced bythe breadth and ambiguity of thelearning outcomes I have designed forthese sessions.

According to Biggs, (1999) teaching isconducive to deep learning when it is‘constructively aligned’ to curriculumobjectives and assessment. The issuessurrounding my design of learningbecome more apparent when theteaching activity is mapped againstBiggs’ 3P model of teaching andlearning. Key issues of ‘presage’emerge from sessions not beingsequenced according to students’required prior knowledge andacademic ability - neither I nor theModule Organiser has extensiveknowledge of students’ prior learningin CAMHS. There is no implicitmotivational context as it appears thatthe subject is neither addressed in theoverall aims nor formally assessed.Wider organisational and politicaltensions exert their influence as thereis discrepancy between what isrequired of students to achieve theacademic component of the courseand what is required undergovernment legislation as registeredprofessionals. All of this serves toinfluence the ‘process’ throughambiguous and over-ambitiousintended learning outcomes and aneed to heavily front load the sessionwith engaging the students in itsrelevance to prompt motivation. Myown appraisal is that the ‘product’ istherefore more likely to be surfacelearning with little context or

transferability to students’ existing and developing knowledge.

The problems and tensions identifiedwithin my situated practice exist within a wider University and NHSinstitutional context andconceptualisation of multi and inter-disciplinarity. The University ofSalford’s Strategic Framework (2004/5)and Learning and Teaching Strategy(2002) both highlight the institution’scommitment to providing multi andinterdisciplinary learning and teachingenvironments, a strategy increasinglyespoused in educational theory andresearch as best practice (Committeeon Facilitating Inter-disciplinaryResearch, 2004). The National ServiceFramework for Children and MaternityServices in the NHS (DoH, 2004) setsmulti-disciplinary and interdisciplinarycollaboration and partnership as thecornerstone of its strategy to improvethe delivery of healthcare services tochildren & young people. This ismirrored at a practitioner level withresearch into the training needs ofChildren’s Nurses in the field ofCAMHS recommending that trainingat all levels should be multi-disciplinaryin nature (Jones, 2004).

Within an action research framework,utilising Biggs’ 3P model and theconcept of ‘constructive alignment’ asa frame of reference, but setting thiswithin the wider context ofinterdisciplinary education, I haveundertaken a small scale study toexamine the wider issues of ‘presage’in regard to the identified problem ofteaching the subject of CAMHS withinanother academic discipline’sprogramme. Through collaborativeenquiry engaging both members ofthe Mental Health & Child Healthacademic teams and representation of,and integration with, otherstakeholder voices (clinical practice andstudents) I hope to identify actions forimprovement in current practice andbegin to explore the idea of

developing an inter-professional‘community of practice’ (Wenger,1998) in relation to this specific issue,whereby the notion of ‘discipline’moves from a fixed body of dominantor legitimate knowledge to a morerelational construct negotiated throughinterpersonal activity across theinstitution imposed boundaries(Caruana & Oakey, 2004).

MethodologyThe enquiry utilises an action researchparadigm whereby researchmethodology is practitioner generatedstarting with an identified problem,seeking to improve practice throughpractical direction and action, involvingall stakeholders and examining thevalidity of key assumptions held by theresearcher (McNiff, 2002; Marton &Cooper, 2000; Thomas, 2000; DeKoning & Martin, 1996). Whilst theinitial focus of action research was myown teaching practice a series ofmuch broader and fundamentalproblems emerged when I engaged incritical reflection on structured peerobservation and considered the widerextrinsic influencing factors and goodpractice models of curriculum design.

Reflection on the initial problemelicited several core assumptions onmy part which may be summarised as follows:

• children’s mental health is a marginalsubject within the Children’s Nursing programmes

• it is not overtly expressed in thelearning outcomes or assessmentstrategies of constituent modules

• the academic team have limitedknowledge of the subject matter

• the students experience of learningthis subject is dislocated, withoutcontext and lacking integration withthe rest of the programme

• my experience as a teacher parallelsthat of the student

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These assumptions emerge from theinteraction of my professional identityand associated beliefs with myexperience of teaching in thedescribed context, but they are basedon a narrow window of experienceand thus may not stand up to scrutiny.Action research methodologies allowfor transparency of such beliefs,attitudes and values and action inawareness of them, thereby providingthe opportunity to overtly assess their foundations, impact and relative validity.

There are four main stakeholders inthe delivery of CAMHS teaching inpre-registration Children’s Nursingprogrammes:

• Child Health & Mental HealthAcademic practitioners

• Students

• CAMHS Nursing Workplace

It is argued that by engagingstakeholders rather than making themthe subject of the research, theirexperience is legitimised and can beused to challenge traditional ordominant knowledge (Thomas 2000).Furthermore, collaborative models ofenquiry like action research areeffective in improving practice becausethey not only acknowledge but alsoengages stakeholders in enquiry andsubsequent action (Norton, 2001;Meyer, 2000).

Finally, the subject of enquiry sitsacross the theory and practice divideand across several areas of researchand theory and action researchacknowledges the interaction betweentheory and practice by enabling theuse of multiple theories to illuminatepractical events (Johnston, 2003).

Data Collection and Analysis StrategyData collection and analysis was basedon the triangulation of four differenttypes of data from four differentsources to facilitate consideration ofthe problem from alternativestakeholder perspectives and todevelop a more complex ‘real world’view.

Triangulation has been described as:

“Viewing a statue from differentangles through different lenses”

(Wilding, 2003:119)

One of the criticisms of triangulation isthat its underlying assumption is thatthere is an empirical ’truth’ out theresomewhere waiting to be triangulated,which is in stark opposition to theunderlying philosophies andmethodology of action research.Nonetheless, within the context of this study I feel this tension can bereconciled if the following definition is applied:

“The use of multiple perceptions toclarify meaning, showing differenttruths about the phenomenon”

(Wilding, 2003:121)

The primary method of data collectionused was a questionnaire examiningacademic practitioners’ knowledge &perceptions of current practice andviews on strategies for change. 5 pointLikert scales were the main methodused to record responses to closedquestions/statements. The pivotalfactor affecting reliability ofquestionnaires is whether allparticipants understand the statementsand questions as they were intended.This is particularly pertinent in thisinstance given that the enquiry crossesdiscipline boundaries. Endeavours weretherefore made to avoid culturally ordiscipline biased language or

compound questions (Hutchinson,2004; Crano & Brewer, 2002). I wasconscious that whilst the use of openquestions may theoretically elicit morerich qualitative data, quality may bereduced when respondents are beingasked to engage with a disciplineother than their own. Furthermore, Ihoped the predominant use of Likertscales would increase the chance ofpractitioners responding to thequestionnaire since they are relativelyquick and easy to complete (Crano &Brewer, 2002). The obvious limitationof using quantitative responses tostatements constructed by theresearcher is the opportunity forstatements to be influenced by theresearcher’s beliefs and biases thus anumber of open ended questions werealso included to try to reduce thechances of respondents omittinginformation and ideas restricted by the limits of particular statements,particularly in relation to ideas forchange or improvement (Hutchinson, 2004).

The questionnaire was divided intofour sections:

• Practitioner views of the legitimacyof CAMHS subject knowledge withinthe pre-registration programmes andtheir view of current practice.

• The relationship between students’academic experience and therequirements of clinical practice.

• Subject teaching - Content

• Subject teaching – Delivery

The practitioner’s view of thelegitimacy of the subject knowledgewithin the programme and views onthe current practice predominateprimarily because learning “with, fromand about each other” has been citedas the starting place for effectiveinterdisciplinary practice. Secondly,these items were sequenced first inorder to try and reduce the influenceof other questionnaire items on thepractitioners’ responses (PIPE Project,

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2003; Hutchinson, 2004). Essentially Ihoped that information elicited in thissection would either validate orchallenge my assumptions about thecurrent delivery of CAMHS within theprogramme and improve myunderstanding of it.

The formulation of questions regardingcurrent academic practice was basedon the literature informing design forquality teaching & learning, includingthe concept of constructive alignmentof learning objectives, teaching andlearning strategies and assessment,and the 3P model (Biggs, 1999). TheDepartment of Health’s NationalService Framework for Child &Adolescent Mental Health (2004)provided essential informationregarding nurses’ responsibilities inpractice. For example:

“…those in contact with children needto be able to have sufficientknowledge of children’s mental healthto be able to: identify those who needhelp; offer advice & support to thosewith mild or minor problems; & havesufficient knowledge of specialistservices to be able to refer onappropriately when necessary”(DoH, 2004)

The RCN’s research into the trainingneeds of nurses working with children(Jones, 2004) which highlights sevenkey subject areas that Children’sNurses identified as missing from theirpre-registration training was used toframe the subject teaching contentitems. Finally, a review of the literaturein the field of inter-disciplinaryteaching helped to develop thestatements assessing views on how thesubject should be delivered. Thequestionnaire was distributed by emailto all module and programme leaderswithin the child branch and to thelecturers within the mental healthteam who have expertise in the fieldof CAMHS to try to gain a

cross-section of experience and viewsacross the whole programme whilstengaging those practitioners who hadinfluence to change current practice.

The use of the questionnairepotentially biases findings towards theviews of University employees ratherthan clinical practitioners thereforedocumentary analysis of good practiceguidelines and practice based researchwas deployed as a counterweight.Documents analysed include theChildren’s Nursing programmecurriculum, the DOH National ServiceFramework Standard 9 (Child MentalHealth, 2004) and the Royal College ofNursing research recommendationsregarding training needs of nursesworking with children.

A summary (rather than raw data) ofanonymous student feedback on theirexperience of teaching sessionsprovided the third method of datacollection representing the students’voice. The use of summary data is notideal as students provided thisfeedback in a rather different context,i.e. being asked to comment on thepositive and negative aspects of adiscrete teaching session rather thanthe wider issues being explored; thereis no opportunity for live or dynamicinput from them and there is noopportunity to corroborate theaccuracy of my interpretation of theirviewpoint (Hopkins, 1985).

Finally, an interview was conductedwith the professional lead forChildren’s Nursing. This had theprimary purpose of seeking support for the research, negotiating ways toprogress the study and to identifypotential ways in which any findings or recommendations could be takenforward in collaboration with theChildren’s Nursing team. In some sensethis action goes against models ofaction research in which the researcherseeks emancipation from the

organisational structures in which theyare bound. However, in terms ofworking for achievable improvementsor change I have found the version ofaction research in which the researcherworks within existing social structuresand power relations for change, moreuseful and realistic (Johnston, 2003).

ResultsQuestionnairesGiven the small numbers ofparticipants and the fact that theemphasis of this study is on identifyingaction for change a descriptive, ratherthan statistical, approach to dataanalysis has been taken. 14questionnaires were distributed and atotal of eight responses (57%) werereceived. Two responses were receivedfrom practitioners in the mental healthteam. The response from the children’snursing team included representationfrom all the diploma programmechildren’s branch modules and five outof the six degree modules.

Practitioner views regardinglegitimacy and practice

All respondents felt that the subject ofCAMHS should be addressed withinthe pre-registration children’s nursingcurriculum. However, one respondentalso felt that it would be moreappropriate to address the subject inpost-registration training. Norespondents agreed that CAMHS iscurrently adequately addressed withinthe programme, with five disagreeingwith this statement and the remainingthree being undecided.

Four respondents said that CAMHSwas taught in the modules ‘Essentialsof Children’s Nursing Practice’ in thediploma course and ‘Context of Care’in the degree programme. I currentlyprovide ‘one-off’ teaching input tothese modules as part of a one dayworkshop in the former case and aCAMHS dedicated teaching session in

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the latter. One respondent noted that within the ‘Context ofCare’ module, over and above the specific CAMHS teachingsession broader issues such as the impact of physical illnessand hostile environments on psychological health areincluded. Additional qualitative information tends toconfirm that issues of children’s mental health are explicitlytaught within particular modules and missing entirely fromothers. Indeed, seven respondents disagreed that theteaching of CAMHS is co-ordinated across the programme,with just one participant being undecided.

Of the four respondents identifying that CAMHS is taughtwithin their modules only two agreed that it is explicitlyaddressed within the module learning outcomes – thisrelated specifically to the ‘Essentials of Children’s NursingPractice’ module – and no-one felt that the subject area isexplicitly addressed within the assessment strategies of themodules that they lead or teach.

Relationship to Clinical Practice

Participants’ views of students’ competency in practice withregard to working with young people experiencing mentalhealth difficulties represented the broadest range ofresponses with no clear themes emerging. There appears tobe a very mixed view about student’s knowledge in this areaon completion of their studies. Responses indicate thatparticipants were more confident about students’ capacityto promote the well being of children and to refer tospecialist agencies as appropriate, than their ability toidentify early indicators of mental health difficulty or toprovide intervention in mild cases. Since appropriate referralsuggests prior identification of early warning signs in youngpeople, these responses may indicate a lack of clarity in thequestionnaire itself. However, they may equally reflect thestructure of the pre-registration programme, whereby 50%of the programme is practice placement based withstudents encountering a heterogeneous and wide range ofexperiences whilst actively seeking exposure to otherbranches. Respondents may feel that such exposureprovides a significant supplement to the rather limitedtheoretical component of learning in relation to CAMHS.

Subject Teaching – Content

There was a consensus of agreement that all seven RCNidentified areas of knowledge & skill should be included inthe Children’s Nursing curriculum. The areas of knowledgemost strongly and consistently highlighted were:

• Theories of psychological development

• Communicating with Children & Young People

• Promoting mental wellbeing

Interestingly the first two areas are already explicitlyidentified in module learning outcomes.

The two areas that showed least concordance wereknowledge of particular mental health disorders andassessment & diagnosis of mental health disorders. Theseresponses may well relate back to the issue of whether ornot CAMHS is regarded as a legitimate subject area in a pre-registration Children’s Nursing programme, which onreflection may not be an ‘all or nothing’ proposition. Themore accurate question to have asked might be ‘Whichareas of the discipline of child and adolescent mental healthshould be included in pre-registration Children’s Nursingprogrammes?’ Participants were also invited to list any otherareas of knowledge or skill they felt students needed in thissubject and what prior knowledge they thought studentsneeded to enable their understanding of the subject.Responses are summarised below in Figures 1 & 2.

By far the most commonly listed additional area ofknowledge and skill that needs to be included was skills inassessment. Five participants listed knowledge of childdevelopment as a required area of prior knowledge. Oneparticipant felt that no prior knowledge aside from student’slife experiences was needed to enable their understandingof the subject.

Figure 1.Other Areas of Knowledge & Skill re: CAMHS thatshould be included in the Pre-reg. Children’s Nursing Programmes• Practical skills of assessment & communication• Roles & responsibilities of Children’s Nurses• CAMHS service availability, structure & how to refer• Role of community support services & mechanisms• Address psychological development and the signs &

symptoms of mental health difficulties more overtly• Involving young people in the care of their

psychological health• Promoting independence in children & young people• Managing the challenges of working with adolescents

Figure 2.

Prior knowledge needed to facilitate students’understanding of the subject of CAMHS• ‘Normal’ child development• Attachment theory• Family structures/Parenting styles• Therapeutic Relationships• Principles of health promotion & holistic care• Incidence, prevalence & patterns of child & adolescent

mental health• Self awareness/ examination of own attitudes & beliefs

relating to issues of mental health, stigma & labelling

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Subject Teaching – Delivery

Participants were asked to decide which of four modes ofteaching would be most effective in CAMHS. There was a100% positive response to three out of four strategiesproposed - teaching by staff with CAMHS expertise,interdisciplinary team teaching and skills workshops –making it difficult to identify if any one method would bepreferred. The fourth strategy deploying Problem BasedLearning (PBL) produced the most mixed response with onerespondent disagreeing that it would be an effectivestrategy and only three of the rest strongly agreeing(compared with five strongly agreeing with use of the othermethods). Qualitative responses help to illuminate thefundamental issue surrounding the use of PBL. Somerespondents reflected on concerns they had over the level of expertise and knowledge in the subject area that existedin the Children’s Nursing Team and the impact this wouldhave on students’ learning experience within a PBL model.Possible strategies were suggested to overcome thisdeficiency including co-teaching and facilitating (childlecturer & a CAMHS lecturer), inclusion of a practitionerwith CAMHS expertise within the Children’s Nursing Teamand the use of fixed resource sessions delivered by CAMHSpractitioners to support the use of PBL. One participantsuggested the delivery of workshops for the Children’sNursing lecturers to help raise their awareness andknowledge of the subject of CAMHS thereby promoting itsinclusion and integration across all teaching and learningactivities. Other suggestions fell into two categories,structural or organisational strategies and classroomteaching methods as summarised in Figure 3

Documentary AnalysisThe documentary analysis of programme and modulelearning outcomes revealed that no learning outcomes wereidentified in either the Degree or Diploma programmes thatcould be readily associated with the subject of CAMHSalthough there were aspects of the indicative syllabus thatrelated to this subject area. Within the diploma programmethere is no explicit syllabus content related to child andadolescent mental health, although there are broad learningoutcomes pertaining to issues such as child development,communication and children’s rights which cross theboundaries of all disciplines and learning outcomes relatingto the care of the whole child, which could be said toimplicitly include mental health.

Student FeedbackStudents were asked to provide written anonymousfeedback on a CAMHS workshop I had delivered within thediploma programme, immediately after the session ended,identifying three positive and three negative aspects of thesession. A total of 22 students provided feedback. Both the positive and negative feedback fell into two main themes – teaching and learning strategies and content.

17 (77%) of the 22 students commented on their positiveexperience of the small & large group work used within theworkshop and a further five statements particularlyhighlighted the case study activity as helpful to theirlearning. Statements identifying negative aspects of theteaching & learning strategies all related to logisticalproblems experienced within that particular session.

With regard to content of the workshop 19 (86%)statements were received identifying the content asrelevant, interesting or as having provoked thought orenhanced understanding. Feedback regarding negativeaspects of the content all (n=8) referred to feeling that theyrequired more sessions or information on this subject or that

Figure 3.Suggested Teaching & Learning Strategies for Improvingthe Delivery of the subject of CAMHS

Structural/Organisational:• A formal & structured process across the programme

making the required content in each module explicit • Shared learning across children’s and mental health

branch• Co-teaching (Child & Mental health Lecturer’s)• Use of a short assignment or reflection to strengthen

the link with ‘Exposure to other Branches’ practice doc-umentation

• A Team of experts to deliver the content across theprogrammes

• Inclusion of a CAMHS practitioner in the Children’sNursing team

• CAMHS workshops for Children’s Nursing Lecturers

Classroom Strategies:• Experiential Learning/Role Play • Use of video’s to assist recognition of cues,

signs & symptoms, for enhancing assessment & communication skills

• Use of PBL if accompanied by fixed resources taught by experts

• Young Minds or Service User groups to deliver teaching

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they needed more time to cover theissues addressed. Three responsesnarrowed this down further statingthat they felt they particularly neededmore skills based sessions oncommunicating with children & theirfamilies regarding their emotionalhealth. Four students stated that theyfelt there were no negative aspects tothe workshop.

DiscussionThere is a clear consensus within datacollected from all stakeholders that thesubject of child and adolescent mentalhealth is an essential aspect ofChildren’s Nursing training and that itshould be addressed within the pre-registration programmes.Furthermore, current practice withinthe School of Nursing does notadequately address this subject,leading to uncertainty about whetherstudents at the end of the programme have acquired thecompetencies described withinnational practice frameworks.

The outcomes of this research suggesta fundamental issue regarding theextent to which the subject of CAMHSshould be taught at pre-registration asopposed to post-registration levels ofstudy. The comment of oneparticipant quoted below mirrorsresearch recommendations thatstudents should be exposed to crossdisciplinary experience at all academiclevels (CFIDR, 2004):

…coverage in pre-registration trainingis important to stop this subject beingtaught in isolation and to helpstudents develop a career path oncequalified…

However, other aspects of the surveyresults point to some content areaspotentially being more suitable forpost-registration training.

Current practice can best be describedas multi-disciplinary rather than inter-disciplinary which reflects widerpractice within the University ofSalford (Caruana & Oakey, 2004).Nonetheless, rather than validating myoriginal assumption that the subject ofCAMHS is only taught as a few ‘bolton’ sessions within particular modules,the results suggest that, extraneous tothese modules, aspects of child &adolescent mental health areaddressed implicitly in a number ofways. Finding ways to link up theseaspects across modules and overtlysignpost them for students could beone achievable strategy for building oncurrent practice as there is evidence tosuggest that a series of small changesis more successful in moving towardsinterdisciplinary practice than one ‘bigbang’ (PIPE Project, 2003).

Whilst participant responses indicate astrong willingness and openness toadopt teaching and learning strategiesthat promote interdisciplinarity,implementing the strategies proposedby the participants may be potentiallyimpeded by organisational structures,such as the boundaries of disciplineteams and practitioner roles andresponsibilities within these andsystems for recording workload. Forexample, all teaching activity that Icurrently engage in with the Children’sTeam is not recorded within myworkload balance and so is effectively‘extra’ work.

“In attempting to balance the strengthof disciplines and the pursuit of inter-disciplinary research, educationand training, many institutions areimpeded by traditions and policiesthat govern hiring and resourceallocation.” (CFIDR, 2004)

However at an interpersonal level ithas been my experience that even theprocess of engaging in this study hassignificantly increased the level of

dialogue and discussion that I havehad with the Children’s Teamregarding this issue.

One assumption I identified at theoutset of this project that has beensupported was that any teachingactivities to do with CAMHS currentlytaking place are not constructivelyaligned with the wider programme ormodule learning outcomes orassessment strategies. In fact theycannot be aligned to address thelearning objectives nor evidenced inassessment because existing objectivesand assessment strategies do notreflect the subject area. Questionnaireresults confirm this with an extremelyhigh level of consensus and this wasmirrored also in my meeting with theTeam’s professional lead. Future actionstrategies will reflect this focusing onattempts to develop a more co-ordinated and integrated view.

One of the criticisms of inter-disciplinary teaching is that it can lead to newer students feelingconfused and frustrated due toapparently competing perspectivesbeing taught together and a perceivedlack of cohesiveness (Caviglia-Harris &Hatley, 2004). If this is the case then aprogressive move towards teachingfrom an interdisciplinary perspectiveover the duration of the programmemay be more palatable for students.One taxonomy and model for buildingcurriculum objectives, which may assistin linking the concepts of constructivealignment and interdisciplinaritytogether is Biggs’ (1999) SOLOTaxonomy. The SOLO taxonomy isunderpinned by a cumulative model oflearning that has within it a numbersof milestones or transitions. The firstthree transitions are described as‘unistructural’, ‘multistructural’ and‘relational’ (Biggs, 1999). The nature of these stages can be paralleled witha progression from uni-disciplinary tomulti-disciplinary to interdisciplinarymodes of teaching & learning. A very

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putative model for implementing thiswithin the pre-registration programme,developed from a reflectiveconversation with a collaborator fromthe Children’s Team, might then be:

Figure 4 – Potential Adaptation/Applicationof SOLO Taxonomy to Design for DeliveringSubject of CAMHS within Pre-registrationChildren’s Nursing Programme

Reflection, evaluation andfuture actionThe literature suggests thatmultidisciplinarity is reasonably easy toachieve as most practitioners are goodat advocating for their own area ofexpertise (Rogers, 2004), whereas thehall mark of interdisciplinarity is thepractitioner’s capacity to facilitatecritical appraisal of the underpinningsof their own discipline and to

challenge its theoretical basis (Caviglia-Harris & Hatley, 2004). Thishas been a critical point of reflectionfor me as this project has progressed.Retrospectively, clearly the startingpoint of this study was my desire toadvocate for the greaterunderstanding of my subject area, andmy strongly held belief in itsimportance. The rigidity of thisposition I feel has been challengedthrough the course of the study andmay be beginning to shift slightly.However on reflection I think that itwill always be a difficult tension forpractitioners in more ‘marginal’disciplines to reconcile and manageeffectively in isolation.

At the end of this first cycle of actionresearch validity and reliability havebeen compromised to a degree bytime constraints and ethicalconsiderations regarding direct humanenquiry. These two factors have limited the size of the sample and ithas not been possible to engagestudents as key stakeholders in a livecollaborative process.

One of the core underlying principlesof an action research methodology isthe active seeking of validation of anyclaims made through rigorousjustification (Merton & Cooper, 2000).

Having anticipated that this would bea difficulty within the given timeframeI planned to try to ‘check’ theconclusions against existing literaturein the field (Wilding, 2003). Thisstrategy has been significantly lesssuccessful than hoped. A systematicelectronic and hand search of allUniversity of Salford held nursing andnursing related journals, regarding thisarea of enquiry did not yield anyresults, other than literature citing theimportance of CAMHS training for allhealthcare professionals working withchildren without discussion or thoughtas to how this might be achieved(Macdonald & Bower, 2000).

Constraining factors mean that at thecurrent time results of the study haveonly been analysed and interpreted bythe researcher who identified, at thestarting point, that they wereimmersed in the subject and wouldbring a very biased viewpoint to bearon all outcomes. In view of theselimitations future action has beenidentified as follows:

• To disseminate this report to allparticipants forconsultation/amendment

• Once final draft has been agreed, inconsultation with participants, todisseminate report to widerChildren’s and Mental Health teamfor comment/feedback

• Following meeting with Children’sNursing professional lead, to mapout a potential scheme of work forincluding CAMHS content across theprogramme, based on studyfindings, particularly in relation toimplementing the new nursingcurriculum.

• To identify with the Child Nursingteam ways of reviewing the modulelearning outcomes and assessmentstrategies

• To explore strategies forcollaborating with students to gaintheir feedback insight into this issue.

General conclusionsChild and adolescent mental health,like most ‘real world’ patient definedsubjects in health and social care, doesnot lie along a single discipline line. As such it requires a systematicinterdisciplinary approach that runsfrom pre-registration undergraduatetraining right through to clinicalpractice. Despite the mental health ofchildren becoming a prioritised issuewithin healthcare practice arenas, itwould appear that there is a paucity of literature and research regarding thebest way to integrate this subjectknowledge into the teaching of themore traditional or dominantdisciplines of Child and Mental Health.

Year 1- Unidisciplinary

Common Foundation/core skills within own discipline

Year 3 – Interdisciplinary

Co-teaching based on relating 2 disciplines to a central

issue/problemE.g. care of the chronically

ill child

Year 2 – Multidisciplinary

Fundamental building blocks ofCAMHS taught by CAMHS

practitioners. Content and T and Lsrategy constructively aligned tomodule outcomes in partnership

with Children’s team

19


Preliminary outcomes from this smallscale study indicate that for this to bea successful and meaningful learningexperience for students which informstheir professional practice and clientcare in the workplace, strategies forimplementation of teaching andlearning activity need to be groundedin principles of effective curriculumdesign and delivery. That is, those‘marginal’ subjects such as CAMHSneed to be embedded in the widermodule and programme learningobjectives and assessment strategiesand delivered through teaching &learning strategies that areconstructively aligned.

Whilst it may be difficult for academicpractitioners teaching their ownspecialised field to truly ‘give upsomething’ of their discipline andprofessional identity inter-disciplinaritymay evolve from continuing processesof overt dialogue and reflectioncoupled with increased opportunitiesfor co-teaching across disciplines(Caviglia-Harris & Hartley, 2004; Jones, 2003).

ReferencesAudit Commission (1999) Children inMind London: Audit Commission

Biggs (1999) Teaching for QualityLearning at University: What thestudent does. Buckingham:SRHE/OUP

CARN (2004) The collaborative actionresearch network: an outlinestatement.http://www.did.stu.mmu.ac.uk/carnAccessed 31.05.05

Caruana & Oakey (2004) Negotiatingthe Boundaries of ‘Discipline’:Interdisciplinarity, Multi-disciplinarity and Curriculum DesignUniversity of Salford,http://www.edu.salford.ac.ukAccessed 12.05.05

Caviglia-Harris & Hatley (2004)Interdisciplinary Teaching: analysingconsensus and conflict inenvironmental studies InternationalJournal of Sustainability in HigherEducation, 5(4), 395-403

Committee on Facilitating Inter-disciplinary Research (2004)Facilitating Inter-disciplinaryResearch. Washington D.C.: TheNational Academic Press

Crano & Brewer (2002) Principles andMethods of Social Research(e-Book). Mahwah: N. J. LawrenceErlbaum Associates Inc.

De Koning & Martin (Eds.) (1996)Participatory Research in Health:Issues & Experiences. London: Zed Books

DOH (2004) National ServiceFramework for Children, YoungPeople & Maternity Services: Child& Adolescent Mental Health(Standard 9) London: HMSO

Hopkins (1985) A Teachers Guide toClassroom Research Milton Keynes:Open University Press

Hutchinson (2004) Survey Research,In Foundations in Research:Methods of Inquiry in Education andthe Social Sciences (e-Book) Eds. DeMarrais & Lapan. Mahwah: N.J.

Lawrence Erlbaum Associates Inc

Jacobs (1989) The growing need forinterdisciplinary curriculum content. InJacobs (Ed.), InterdisciplinaryCurriculum: design andimplementation Alexandria, VA:ASCD.

Johnston (2003) Teaching &Researching Critical Academic Writing:scrutiny of an action research processEducational Action Research, 11(3),365-385

Jones (2004) The Post RegistrationEducation & Training Needs ofNurses Working with Children &Young People with Mental HealthProblems in the UK. RCN ResearchReports. London: Royal College ofNursing

Jones (2003) Impact of Inter-professional Education on Collaborative Practice. HigherEducation Academy,http://www.health.heacademy.ac.ukAccessed 25.05.05

Macdonald & Brewer (2000) Child andAdolescent Mental Health and PrimaryHealthcare: current status and futuredirections. Current Opinion inPsychiatry, 13(4), 369-373

Marton & Cooper (2000) ActionResearch in Health Care (e-Book).Malden: Blackwell Science

McNiff (2002) Action Research:Principles and Practice (e-Book)London: Routledge

Meltzer H (2000) The mental health of children and adolescents inGreat Britain London: HMSOwww.statistics.gov.uk Accessed14.04.05

Meyer (2000) Using QualitativeMethods in Health Related ActionResearch. In: Qualitative Researchin Healthcare Eds. Pope & Mays

Norton (2001) Researching YourTeaching: The Case for ActionResearch. Psychology Learning &Teaching, 1(1), 21-27

PIPE Project (2003) Promoting

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Inter-professional Education: acollaborative project across 6 HEI’sin Oxfordshire, Buckinghamshireand Thames Valley. Higher EducationAcademy,http://www.health.heacademy.ac.ukAccessed 25.05.05

Prosser M, & Trigwell K, (1999)Understanding Learning &Teaching: the experience in highereducation. Buckingham: SRHE/OUP

Ramsden P (2003) Learning to Teachin Higher Education (E-Book). NewYork: Taylor & Francis

Rogers, Scaife and Rizzo (2004) Isn’tMulti-disciplinarity enough? Whendo we really need inter-disciplinarity?http://www.sv.cict.fr/coctos/pjs/TheoreticalApproaches/AnnexPaper2.htm Citedin Caruana & Oakey (2004)Negotiating the Boundaries of‘Discipline’: Interdisciplinarity,Multi-disciplinarity and CurriculumDesign University of Salford,http://www.edu.salford.ac.ukAccessed 12.05.05

Thomas (2000) “Bums on Seats” or“Listening to Voices”: evaluatingwidening participation initiatives usingparticipatory action research. Studiesin Continuing Education, 22(1), 95-113

UoS Research Governance & EthicsCommittee (2004) Ethics ApprovalForm for Post Graduates.http://www.rgc.salford.ac.uk/resoffice/pgrformsept04.doc Accessed 01.01.05

University of Salford (2004) TheStrategic Framework: Building theEnterprising University 2004-2005http://www.planning.salford.ac.uk/information/StrategicFramework.pdfAccessed 01.05.05

University of Salford (2002) Learningand Teaching Strategyhttp://www.tal.salford.ac.uk/documents/learnteach.doc

Wenger E (1998) Communities ofPractice: learning, meaning &identity (E-book) Cambridge:Cambridge University Press

Wilding (2003) Meaning andMethod: Using metaphors inqualitative research. In: QualitativeEducational Research in Action.(Ed.) O’Donoghue & Punch. London: Taylor & Francis Limited

21

Innovative Learning in Action: Snapshots

Assessment in the Diploma in NursingProgramme with Advanced Standing:

Patchwork Text Possibilities

Jean [email protected] School of Nursing

AbstractThis paper is based on an actionresearch project completed for thePostgraduate Certificate in HigherEducation Practice and Research andforms part of an ongoing project.The study sets out to examine lecturers’ opinions of the suitability of Patchwork Text (PT) as a form ofassessment. This area was chosenbecause of the interest of theresearcher in this area and because ofopinions expressed regarding the present poster assessment for studentnurses in the first year of studytowards their Diploma in Nursing.Action research was the most appropriate methodology to obtainmaximum, in depth information in therelatively short time available. Twostrategies were used to obtain thedata: a focus group using a deliberatesample of lecturers and, at the suggestion of my academic supervisor,the results of an email survey of lecturers in the Teaching and LearningResearch Network. The email surveywas analysed using quantitative techniques and the data from thefocus group was analysed using thematic networks. The resultsrevealed an interest in PT locally and internationally and indicated that PTas a form of assessment was feasible,but that more groundwork was needed. It was concluded that Post-graduate students would be the mostappropriate target for a pilot group inthe future.

IntroductionPatchwork Text (PT) is a form ofassessment that is divided into aseries of small discrete sections whichare linked, but only finalised whenthey are “stitched” together. The patchwork is composed of piecesof writing linked to aims and

outcomes of a module which are thendiscussed in small groups. A reflexivecommentary on the Patchwork Textsis then completed by the student,handed in and marked, (Winter, Buck,Sobiechowska 1999:64-66). The BaseGroup of approximately fifteen student nurses would be an appropriate size for this type ofassessment. The Texts could be usedto develop different types of knowledge necessary to underpinNursing Practice e.g. theories of nursing, nursing models, health promotion and ethical practice, with areflexive commentary regarding howthese areas affected practice. It isproposed that PT leads to deeperrather than surface learning, enhancing writing, communicationskills and critical thinking, along withtransferable, key skills, (Akister, Illes,Maisch, Ovens, Parker, Rees, Smith &Winter 2003 University of Salford2004). Others have noted that thisform of assessment helped weakerstudents develop their own ideaswhile in turn learning from others inthe group during the discussion sessions, (Smith & Winter 2003,Winter 2003).

BackgroundIn the Diploma and BSc programmefor Pre-Registration Student Nurses,students are asked to consider targetareas from the material in theDepartment of Health’s White Paper“Saving Lives - Our Healthier Nation”(SLOHN) published and presented toParliament in 1999, (DoH 1999). Thisset out how the government proposed to save lives of those peopleunder 75 at risk of developing chronichealth problems. The paper indicatedthat this should be achieved in twoways, by promoting healthier lifestylesand by the reduction of inequalities in health.

The government proposed that individuals start to take greaterresponsibility for their own health

and that campaigns should concentrate on the least healthy, linking maintenance of the individual’sown health and prevention of chronicdisease with personal responsibility.The main targets were to reducedeaths caused by Cancer, CoronaryHeart Disease & Cerebro-VascularAccident (Stroke), Accidents andMental Illness. The government alsoproposed to tackle health inequalitiesby the introduction of social reforms.There is to be a review of how nearthe population is to the targets proposed in 1999 in 2005 (DoH 1999).

Historically Nurses have been involvedin promoting Public Health, althoughthis was largely paternalistic and followed the medical model. Therewere massive Public HealthCampaigns to eradicate infectious diseases such as Polio, Diphtheria andTB, with the Measles Mumps andRubella vaccination scheme being oneof the most recent. As the majorinfectious diseases declinedGovernment began to realise the highcost of treating diseases that wereviewed as being preventable bylifestyle changes. A paradigm shiftoccurred from trying to treat andmaintain the health of those peoplewith these conditions to the prevention of the problems. Therewas also a shift in responsibility forhealth from the state to the individual, transferring the responsibility for the prevention ofdisease to the individual, culminatingin SLOHN, (DoH 1999). This shiftaltered how some areas of StudentNurse Education were viewed. Ratherthan Nurse Education following amedical model, which described thedevelopment and treatment of disease, they were taught about thehealth – ill health continuum, the promotion of health and preventionof some avoidable and chronic diseases, (NMC 2005). Governmentinitiatives have since expanded on

22


SLOHN, which have involved nurses infurther changes in practice, (DoH2003, DoH 2004).

To emphasise the integral role ofhealth promotion in Nursing, studentsare asked to produce a poster andpresentation depicting an aspect of ahealthy lifestyle, linked to one of theconditions in SLOHN (DoH 1999) – aformative assessment in the firstsemester in the first year of a threeyear programme. Health promotionis advocated by the Nursing andMidwifery Council (NMC 2005) andtherefore sits within the design of thecurriculum for the Student Nurse Pre-Registration programme. Thematerial needed to produce theposter is easily retrieved, readilyaccessible and aids the early development of Key Skills, (Universityof Salford 2004). With the advent ofwidening participation in Universityeducation this type of project isachievable by those who have nottaken “A” Levels or been involved inHigher Education before. These factsappear to advocate the use of thistype of formative assessment; however, anecdotally several lecturershave explained that there are problems with this approach.Because this assessment is formative,a small number of students do nottake this assignment seriously and donot contribute to the work involved.There is little sanction availablebecause the assessment is formative.

Ramsden (2000) has variouslydescribed assessment as:Getting to know our students and thequality of their learning.

A way of teaching more effectivelythrough understanding exactly whatstudents know and do not know.

Showing respect for students as partners on a road to understanding(Ramsden 2000: 82, 181-3)Ramsdens’ (2000)

‘14 Rules for better assessment’include linking assessment with learning, setting tasks that are intrinsic to real problems whereverpossible and grading those assessments to encourage effort. This Ramsden (2000) proposes, fosters a deeper approach to learning, while allowing personaldevelopment – facilitating learners totake responsibility for their own learning. The present assessmentwhile addressing some of these issuesignores the remainder. In an attemptto address the problems discussedabove the researcher set out toexplore the suitability of PT as amethod of assessment in the Diplomain Nursing programme using anaction research approach. This wasbased on ongoing work carried outfor the Post Graduate Certificate inHigher Education Practice andResearch at the University of Salford.

The motives for this research projectwere considered and examined usingthe principles outlined for actionresearch by Robson, (Robson 1993).The code of ethics is explained byRobson (1993) who defines ethics as“rules of conduct for research” –what ought to be done. There is aconsensus that the participant shouldnot be harmed, that they should befully informed and consent to theresearch and that both the participantand researcher may withdraw, (RCN2004, Robson 1993). These principlesgave a logical framework to formulate thoughts and ideas bothprior to commencing and during thestudy. There was no monetary benefit to participants by them takingpart in this study, but it was anticipated that it would contributeto pedagogy by raising awareness ofan innovative form of assessmentwhich will also develop students,(Illes, 2003, Winter, Buck &Sobiechowska, 1999). Collaborators’informed consent was obtained anddocumented before participation. Allrecorded audiotapes and transcripts

were kept in secure storage. No participant identifiable material wasused. The researcher worked underthe rules of data protection.

MethodologyThis study used an action researchapproach, the data rich “swampyground” described by Schön (1987).The intention of action research wasoriginally designed to study social situations and this methodology hasbeen widely adopted in the healthcare sciences. It is described as being …

…undertaken by participants in socialsituations to improve their practicesand their understanding of them…Bowling (2002::410)

The choice of action research as atool for ‘new lecturers’ is supportedby Staniforth and Harland (2003)

Action research provides a genuineopportunity for newly appointed academics to validate and contesttheir tacit knowledge, challengeideas and values, and gain supportfor their immediate needs.Staniforth & Harland (2003)

In education, theorists have increasingly pointed to reflection inand on practice as a meaningful wayof improving teaching and learning(Biggs1999:6, 2000, Schön 1987:26).Four steps are indicated, reflection,defining a problem, implementing achange and then monitoring theeffects of that change. This cycle isthen repeated – similar to an actionresearch approach. Action researchand change management differ;change management may involveopinions of stakeholders, however, inaction research, collaborators play anintegral part in the design of theresearch project and their continuinginput is essential. In Higher Education,the stakeholders and potential collaborators are not just students,

23


but fellow lecturers, support staff andschools and the University as a whole.Indeed some changes in educationhave had global effects, ProblemBased Learning for example, (Ousey 2003).

Action research requires a strong personal conviction that somethingcould be done in a better way,(Cohen, Manion & Morrison,2000:21). The stimulus that triggersresearch can also come from listeningto others’ views and opinions, including those of the student,(Bowling 2002). Concerns expressedby others regarding the PosterAssessment and curiosity about thesuitability of Patchwork Text as a formof assessment was the trigger for thisstudy. The process of action researchwas the most appropriate method toexamine this topic in this contextwhere opinions, attitudes and inputfrom participants were being soughtand where it was essential that discussion, and therefore data, aregenerated in a non-threatening environment, (Bowling 2000). Thiswould have been impossible withstandard, pre-coded questions used ina questionnaire. Capturing collaborators opinions, knowledgeand attitudes was vital because oftheir wealth of knowledge and experience in differing roles bothwithin and outside higher education,enabling them to address theresearch from different perspectives.Often, observing participants bodylanguage when interacting in a focusgroup for example, can reveal feelingssuch as interest or frustration at thetopic under discussion (Bowling 2000).

Time scales did not allow for a largestudy involving staff and studentstherefore this cycle of research shouldbe regarded as a pilot study. It wasimperative that participants wereinvolved in the design of this study,(Bowling 2002). Views were soughtfrom the researchers’ academic

mentor and study supervisor to establish the course of the study.Following these discussions it wasdecided to use a focus group. Focusgroups are described as producing:

...organised discussion with a selectedgroup of individuals to gaininformation about their views andexperience of a topic.(Gibbs 1999)

What is referred to as a mini focusgroup comprising of four lecturers,was used to explore opinions andthoughts on PT, (Gibbs2003). Themain features of a focus group areinteraction of the collaborators andthe ability they give the moderator toelicit the ‘why’ and the ‘what’ of adiscussion. Lecturers were recruitedbecause, like people tend to disclosemore to people who resemble them,(CHED 2003). They were also the bestpeople to look at a relatively newform of assessment. Their insight andknowledge produced rich data. Theresearcher acted as moderator for thefocus group. The role of moderatordiffers from that of a facilitator; afacilitator fosters progress to a specific goal and is a mediator or co-ordinator, whereas a moderator isa person who assists in the conductof scholastic debate, (OED 2005). Therole of moderator in the focus groupwas to promote debate and probe fordetail. Issues of confidentiality anddata protection were raised with collaborators at the start of the focusgroup and ground rules established.

A question guide for the focus groupwas devised using points raised asconcerns with the present assessmentin relation to the suitability of PT. Themajority of collaborators, when firstapproached, had not heard or readabout PT before and therefore“understanding” was included asquestion. Other questions wereincluded at the suggestion of the various collaborators. The list of questions was altered to a topic

check list at the suggestion of a collaborator and academic supervisor,in order that topics could be exploredfrom different aspects without therestriction of one question. Furtherdiscussion resulted in a checklist oftopics decided upon by the researcherand collaborator, (Table 1). The check-list enabled the researcher toensure all areas of interest were covered without imposing a preconceived agenda on the discussion while allowing interestingbut unpredicted lines of enquiry to bepursued. Similarly, the order that thetopics were dealt with was not specified, (Gomm et al 2000,Bowling, 2000 Parahoo, 1997). Focus groups do have limitations inthis instance, because the findings donot allow generalisability because ofthe small numbers of participantsinvolved and also because of the differing level of experience represented in the group. Other limitations may include difficulty inassembling a group or representativesample, and may discourage the lessconfident and articulate from expressing their views. The role ofmoderator in encouraging those lessarticulate to express their views isespecially important in this latterpoint, (Gibbs 2003, Bowling 2000,Gomm et al 2000).

24


Table 1: Topic List for the Focus Group on Patchwork Text

If this pilot study indicated that PT would be anappropriate form of assessment for the student nurseprogrammes, further cycles of the action research processwould need to be carried out in line with the participantsideas and suggestions so that the impact on theprogramme as a whole and any implications for the Schoolof Nursing and the University could be examined. Timelimits for this study and time constraints in obtaining theappropriate ethical approval if student nurses and HealthCare Trust premises were used have limited the enquiry tothe opinions of four lecturers in the School of Nursing.At the general suggestion of lecturers in the EducationDevelopment Unit (EDU), when discussing action research,information and opinions were also sought from theLearning & Teaching Research Network (LTRN) via theirdiscussion board.

The email survey broadened the collection of data byrequesting any information regarding knowledge and/orexperience of the LRTN members’ use of PT, the responsewas included in the results of this project at the suggestionof the researchers academic supervisor (Table 2). It wasproposed that this information might give an indication ofinterest and understanding of this form of assessment andhas been used as triangulation of background knowledgeof Patchwork Text; in order to enhance the validity offindings, (Bowling 2002). An email survey was usedbecause it could target individuals, was unobtrusive andrespondents could elect to reply or not, (Bowling2002:195). The target population were people who hadan interest in educational research and because of this itwas presumed that they were the most likely people tohave read about or used this type of assessment.

A small purposive sample of four lecturers was identifiedfor the focus group. Purposive sampling was used toobtain a variety of views, the participants were readilyapproachable and had previously been interested in theresearcher’s thoughts regarding Patchwork Text, (Bowling,2002). Following conversations regarding assessment,deeper learning and transferable skills with colleagues, tenlecturers were approached and four were able to take partin the focus group. Three experienced lecturers hadvarying experiences within the school delivering the pre,post-graduate and specialist nursing programmes; one ofthe lecturers also had an interest in examination, thefourth member had approximately 12 months experienceas a lecturer in the School of Nursing with wide, high levelexperience in Nursing Practice. This ‘mix’ was at thesuggestion of one of the lecturers who was approachedand consented to take part. It was proposed that thiswould stimulate debate within the group whilst drawing inthe considerable experience of lecturers who had workedwith the present assessment for some time. The inclusionof the ‘new’ lecturer should give opinions less influencedby tradition in the school. The size of this sample is non-representative of the School of Nursing, but because ofthe range of experience of the collaborators, it wasthought that enough data would be generated for thisstudy and to initiate other cycles in the action researchprocess identified by the collaborators.

Understanding

Understanding of Patchwork Text

Relevance

Contribution of Patchwork Text to the development of:Key Skills

Deeper learning

Reflective practice

Barriers

Are there any barriers to the introduction of PatchworkText as a form of assessment?

In the Diploma in Nursing Programme

From LecturersFrom students

The Future

Do collaborators have any suggestions regarding:The use of Patchwork Text as a form of assessment

The drafting of an alternative assessment based onPatchwork Text

How Patchwork Text might be incorporated into the Diploma in Nursing Programme

How this project can be taken forwardIf Patchwork Text is unsuitable what are collaborators suggestions for an alternative

What next?

25


Number Comment on reply to researchers’ email n= %

5 Did not reply n=5 31.25

1 Aware of Patchwork Text n=1 6.25

1 Had heard of Patchwork Text but described something different n=1 6.25

9 Replied they did not know about Patchwork Text n=9 56.25

Results

Learning & Teaching Research Network e-mailSixteen people were indicated as having opened the researchers email distributed to the LTRN mailing list regardingPatchwork Text, eleven people replied. The results of this preliminary email survey are displayed in Table 2. The majorityof people who replied (62.5%) did not know about this form of assessment. An email to a lecturer in Australia alsoexpressed interest, but stated that they did not have experience of PT

Table 2. Replies received from researchers email asking members of the LTRN if they were aware of, or had used Patchwork Text.

Focus GroupThis section will consider the analysis of the data from the focus group and what implications these may suggest. Any analysis has two useful functions, one is description, summarising the results from the data generated, the other is inference, suggesting what may be concluded from the data, (Bowling 2002). Loosely structured interviews producelarge quantities of data on which some structure needs to be placed, (Glomm 2000:253). The data for this study wasanalysed using the techniques advocated by Attride-Sterling (2001). Attride-Sterling (2001), proposes the use of thematic networks as a systematic way of data analysis that is easily followed by others, enabling them to repeat thestudy and analysis if necessary. This model was used because it provides an easily illustrated diagram of ‘Global’ or mainthemes that emerge (Figure 1). Themes attempt to find a limited set of ideas which are pertinent to the research andconstitute a foundation for the data which collaborators have supplied, (Gomm, Needham & Bullman (2000:253).Thematic networks aim to find themes in text at varying levels which can then be illustrated in simple web-like diagrams,similar to the diagrams used in concept mapping, taking the reader from text to interpretation in a systematic way, (Attride-Sterling 2001, Williams 2004). The central or global theme is supported by organising themes which are in turnsupported by basic themes.

Figure 1. Structure of a Thematic Network, (from Attride–Sterling 2001)

Basic Theme

Basic Theme

Basic Theme Basic Theme

Basic Theme

Basic Theme

Global ThemeOrganising

ThemeOrganising

Theme

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Basic themes are organised with thoseof a similar nature which support anorganising theme. Global themessummarise and make sense of theclusters of organising themes. Once athematic network has been constructed it serves as an illustrativetool in the interpretation of the textwhich allows others to follow theresearcher’s analysis.

The text of the transcripts of thefocus group was examined for repeated codes. Themes were identified and recorded, (Table 3).The text was revisited three days laterto ensure no themes were disregarded (Bowling 2000). Inter-reliability can be enhanced byusing a panel of judges to code asample of transcripts. This was notpossible because of time constraints,but a summary of the transcript wassent to collaborators and their viewssought and comments includedbefore final organising of the themes,(Gomm et al 2000).Following further analysis the themesderived from the text were arrangedin groups and were used as basicthemes. The basic themes were tosupport the organising themes of thethematic network. The central orglobal theme encompassed the concepts of the organising themesand represents the “core” of the concept for this particular set of data.Using this analytical tool, five thematic networks were developed (Figures 2-6)

Table 3. Global Themes

Global Theme 1- Understanding (Figure 2)The themes indicated that there was a general understanding of PatchworkText. However discussion indicatedthat PT would not be any better atidentifying weak students or encouraging brighter students thanthe present system. This was in contrast to work done previously thathad found that PT did identify weakerstudents and encourage the moreable, (Akister, Illes, Maisch, Ovens,Parker, Rees, Smith & Winter 2003University of Salford 2004). One person mentioned that it was becoming harder to identify weak students with the present curriculumbecause: “there are so many differentlecturers involved with them (students)”. Discussion followedabout group dynamics betweenweaker and stronger students regarding the possibility that weakerstudents were strategic learners; howconflict between weaker and strongerstudents could alienate the two typesof student within a group.

The group felt that PT would generatestudent interest because lectures,workshops and seminars would belinked with a separate discussionregarding the Patch assigned to thatsection of the module and becausethere would be a link to the finalassignment. Two focus group members felt that familiar techniquessuch as quizzes, journals, newspaperarticles and questionnaires (6:20)could be used within the discussionsessions and would help with the‘stitching’ (of the patches), (4:14,5:13). Group discussion in PT was feltby one member of the focus group tobe an incentive to students to goaway and find ways to cover deficitsin knowledge, and would give students ongoing feedback on their learning.

Global Theme 2 – Timing of theIntroduction of PT into the nursing curriculum (Figure 3)The group gave considerable time todiscussing the most appropriate timefor PT to be introduced into the curriculum, deciding that a pilotgroup for post-graduate studentswould be the optimum arena.Discussion on the use of PT as a formof assessment revolved around theexams process and if impendingchanges in the way scripts weremarked would accommodate PT. Itwas decided that PT would have minimal effect on the exams process.PT it was proposed would give a systematic feedback to students ontheir progress, but there was concernabout the perceived amount of workthat PT would produce for lecturers.One collaborator felt passionatelyabout the need to develop the teaching and learning of critical think-ing and reflection and felt that PTwould be a useful vehicle for this. Therest of the group were much lessinterested and this silenced the collaborator on this subject. In orderto facilitate the introduction of PT intoa curriculum the group indicated thatit was essential that sound preparation and training was availableto all personnel involved includingstudents. None of the collaboratorsstated that they thought that PT wasnot an appropriate strategy, but wereconcerned that ‘we get it right’.

Global Theme 3 – Assessment (Figure 4)The use of PT as a form of assessment was viewed positively bythe group. This was supported by twocontributing themes, the ExamProcess within the school andSupporting Factors for PT. The supporting factors included the factthat PT assessment could be designedto reflect progression in skills andknowledge, (8: 3-8, 9:29 -30).Control of a PT assessment wasthought to be important, (9: 9-11) bythree collaborators.

Global Themes1. Understanding

2. Timing of the introduction of PT to the nursing curriculum

3. Assessment

4. Critical thinking & Critical reflection

5. Proposals for the Introduction of Patchwork Text

27


It was pointed out that new forms ofmarking assignments would probablybe used in the future, includingmachine reading (12:15-18). Thisposes the question: Can a machineidentify and assign a level to criticalthinking and reflection? However itwas felt by collaborators that thesummative assessment of PT, whichwould include the ‘stitching’ of thevarious patches, would lend itself tothis. It was proposed that if thegroundwork was done thoroughly PTwould not disrupt the exam system orthe work of the Exams Office in theschool, (10:31-32).

Global Theme 4 -Critical thinking & reflection (Figure 5)Two contributing themes developedthis global theme, Reflective Practiceand Teaching Critical Thinking andReflection. Guidelines for NurseEducation specify the need for Nursesto develop the skills of critical thinkingand reflection, (NMC 2005). This wasechoed in the discussion, (3:5-13),along with comparisons with the ‘old’Nursing curriculum. There was discussion about the level of studentability to involve themselves in reflection and critical thinking in thedifferent levels of students - Diploma,BSc and Post-registration, (6:8-32). It was thought that in some areasthere might be a lack of emphasis inteaching reflection and critical thinking, (7:31-32, 9:31-2, 10:1-2).Two collaborators implied that themore able students can emerge ascritical thinkers despite the curriculum, (10:4-6). Another collaborator explained that we wantstudents to look at evidence and thatwe, as lecturers also need to do thisin order to promote reflective practiceand critical thinking, (8: 22-23).Present methods of teaching andlearning such as Problem BasedLearning (PBL) would readily lendthemselves to teaching, learning andassessment using PT, (9:22-23)although the group was cautioned

regarding the difference between PBLand PT, with PBL being a teaching andlearning strategy and, in this context,PT being used for assessment, (9:29 -30).

Global Theme 5 – Proposals for thepreparation for the Introductionof Patchwork Text (Figure 6)This theme had two main factors, the preparation of the lecturers whowanted to introduce PT and thepreparation of all the lecturersinvolved in the delivery and support of PT.

All collaborators supported the proposal that it would be necessary to pilot PT if it were to be introduced,(7:7-8, 15-16), and that alot of fundamental work would haveto be done, especially regarding the teaching of critical thinking, (7:28-29,8:1) both with those who introducePT and the lecturers involved in delivering PT. The need to providesound evidence and to invest stronglyin staff development and training wasseen as crucial in the successful introduction of PT, (8:11-19).

At this stage the hour allocated andagreed as part of the ground rules forthe focus group was complete andthe discussion regarding PT ended.

Conclusion and recommendationsThere was agreement that the currentPoster assessment had faults; two collaborators had discussed these inthe last few days. The majority of thecollaborators thought that the introduction of PT was feasible, butthere was considerable debate aboutwhen and with which students itshould be introduced. One collaborator felt strongly that PTshould be intrinsic to the wholeNursing curriculum because of its usein developing critical thinking, but didnot pursue this. This was an interesting insight into group dynamics and participants’ perceived

hierarchies. The remaining collaborators decided post-graduatecourses would be better, mainlybecause of the smaller numbers ofstudents involved. The researcher wasunprepared for the fact that themajority of the collaborators did notthink that PT would enhance deeperlearning and critical thinking or identify and help weaker students,contrary to evidence found in the literature search.

Pedagogic theory regarding howassessment should be linked withlearning, where possible, using realproblems, would be met by PT. PTwould also give students freedom tolink with practice situations, makinglearning more productive for them.The researcher acknowledges her biasin making this statement. However,saturation was not reached with onefocus group, (CHED 2003, Bowling2002). These together with the factthat more questions were raised thananswered indicate the need for further cycles of this research.

It is recommended that two furthercycles of action research are started,enquiring:1. What training and information

would be needed to implement PTin the School of Nursing in a pilotgroup of postgraduate students

2. How can PT be developed for usein a pilot group of postgraduate students.

It is proposed to discuss plans forthese cycles with collaborators andlecturers who have led other innovations in the School of Nursing.

28


Concept of Patchwork Text difficultto understand

Will excite interest in studentsPost-registration

Students most appropriate

Contributing theme

Possible exciting development

Global Theme – 1

Understanding of Patchwork Text

Exciting interest in lecturers

Influence of ‘old’ Nursing CurriculumConcern regarding ‘new fashion’ &

feedback

Contributing theme

Wariness about introduction

Figure 2 Global Theme 1 - Understanding

29


Broader Clinical experience in post-graduate students

Time students spend in UniversityUse PT throughout Nursing

Education

Contributing ThemeIntroduce PT in Pre-registration

education

Global ThemeTiming of Introduction of PT

Introduce in 3rd year of pre-registration Nursing Education

High numbers of pre-registration students Influence of ‘old’

Nursing Curriculum

Post-grad students should havedeveloped some reflective skills

Contributing ThemeIntroduce PT in Post-graduate studies

Pilot group x 1& re-examine

Introduce from 1st year pre-registration Nursing Education

Figure 3. Global Theme 2 – Timing of Introduction of Patchwork Text

30


Inclusion of Summative assessment is PT important

PT is a form of continuous assessment

The need for good planning prior tointroduction of PT

Contributing Theme

Supporting factors for PT & Examprocess

Global Theme

Positive view of PT as an Assessment

Importance of feedback to studentsregarding their progress

PT should not be peer assessedPT should not cause Exams Officeextra work

Contributing Theme

Exam Process

PT would lend itself to new methods of marking including

machine reading

PT should illustrate student

progression

Debate about level of student learning & best time to

introduce PT

Figure 4. Global Theme 3 – Positive View of Patchwork Text as an Assessment Global Theme 3 – Positive View of Patchwork Text as an Assessment

31


Figure 4. Global Theme 3 – PositiveView of Patchwork Text as anAssessment Global Theme 3 –

Positive View of Patchwork Text asan Assessment

Level of students’ preparation for practice

Need to teach students critical thinking

Contributing themeTeaching critical thinking

& reflection

Global Theme

Essential to prepare nurses fit forpurpose and fit for practice

(NMC 2005)

Need to teach reflective practice

Possible deficit in teaching criticalpractice

Need to develop critical thinking instudents

Contributing ThemeNeed to develop reflective practitioners (NMC 2005)

Some students skilled at reflection & critical thinking

Figure 5. Global Theme 4 – Critical Thinking & Reflection

32


Training for lecturers who teachusing PT

Theoretical underpinning

Contributing ThemeWork to be done by those who

introduce PT

Global Theme

Proposals for preparation for theintroduction of PT

Thorough groundwork – with allwho will be involved with

introduction of PT

Training for the lecturers who introduce PT

Contributing Theme

Need for TrainingPreparation of students who

will use PT

Figure 6. Global Theme 5 – Proposals for the Introduction of Patchwork Text

33


ReferencesAkister, J., Illes, K., Maisch, M., McKenzie, J., Ovens, P.,Rees, B., Smith, L., Winter, R., (2003) Learning from thePatchwork Text Process- A Retrospective Discussion.Innovations in Education and Teaching International,http://www.docuserver.ingentasalect.com 23.02.05

Angelo, T., Cross, P., (1993) Classroom AssessmentTechniques, 2nd ed., Jossey-Bass, San Francisco, CA.Dearing Report (1997),http://www.leeds.ac.uk/educol/ncihe/sr 01.02.05

Attride-Sterling, J., (2001) Thematic Networks: an analytical tool for qualitative research. QualitativeResearch, volume 1 (3) 385-405. Sage Publications,London. Supplied by the British Library.

Barratt, H., (2004) One fifth of undergraduates drop out,Student BMJ,http://www.studentbmj.com/back_issues/0202/news/6.html 07.10.04

Beauchamp, T.L., Childress, J.F. (2001) Principles inBiomedical Ethics, 3rd edition, Oxford University Press,New York.

Bowling, A., (2002) Research Methods in Health, 2nd edition, Open University Press, Buckinghamshire.

CHED (2003) Focus Group Research, Centre for HigherEducation Development, Coventry University,http://www.coventry.ac.uk/legacy/ched/research/fogrweb.htm

Coate, K., Barnett, R., Williams, G., (2001) RelationshipBetween Teaching & Research in Higher Education inEngland, Higher Education Quarterly, 55:2; 158-174.

Cohen, L., Manion, L., Morrison, K. (2000), ResearchMethods in Education, Routledge, London.

DoH (2004) Choosing Health: making healthier choiceseasier. London. http://www.doh.gov.uk (26.03.05)

DoH (2003) The Essence of Care: patient focussed benchmarking for clinical governance. ModernisationAgency. London. http://www.gov.uk (26.03.05)

DoH (1999) Saving Lives: our Healthier Nation, Department of Health, London.

Gibbs, A., (2003) Social Research Update, Issue 19, pp1-7,University of Surrey,http://www.soc.surrey.ac.uk/sru/SRU19.html

Gomm, R., Needham, G., Bullman, A. (2000) eds.Evaluating Research in Health and Social Care,Sage, London.

Hattie, J., Marsh, H.W., (1996) The Relationship BetweenResearch & Teaching: A Meta-Analysis, Review ofEducational Research 66: 4; 505-542, in Coate, K.,Barnett, R., Williams, G., (2001) Relationship BetweenTeaching & Research in Higher Education in England,Higher Education Quarterly, 55:2;158-174.

Hunt, L., (1997) The Power of Gossip: Story telling toEnhance Work Practice, Sixth Women in LeadershipConference Proceedings 1997, Freemantle, Western Australia.

Illes, K., (2003) The Patchwork Text and BusinessEducation: Rethinking the importance of PersonalReflection & Co-operative Cultures. Innovation inEducation & Teaching International.http://www.tandf.co.uk/journals 23.02.05

Labonte, R., Feather, J., (1996) Handbook on using storiesin health promotion practice. Ottawa: Health Canada inHunt, L., (1997) The Power of Gossip: Story telling toEnhance Work Practice, Sixth Women in LeadershipConference Proceedings 1997, Freemantle, Western Australia

McKenzie, J., (2003), The Student as an Active Agent ina Disciplinary Structure: Introducing the PatchworkText in Teaching Sociology.http://www.docserver.ingenta-select.com 23.02.05

NMC (2005) Standards of Proficiency for pre-registrationnursing education, Nursing & Midwifery Council,http://www.nmcuk.org/nmc/main/publications/StandardsofProficiency.pdf

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Ovens, P., (2003) A Patchwork Text Approach toAssessment in Teacher Education. Teaching in HigherEducation, 8:4: 545-562. http://www.docserver.ingenta-select.com 23.02.05

Parahoo, K., (1997) Nursing Research: Principles, Process & Issues, McMillan, London.

Ramsden, P., (2000) Learning to Teach in HigherEducation, Routledge, London

RCN (2004) Informed Consent in health and socialcare research: RCN Guidance for nurses. (Draft) RoyalCollege of Nursing Research Society. http://www.rcn-org.uk/guidance 23.02.04

Robson, C. (1993) Real World Research – A Resourcefor Social Scientists and Practitioner Researchers,Blackwell, Oxford.

Smith, L., Winter, R., (2003) Applied Epistemology forCommunity Nurses: Evaluating the Impact of PatchworkText. Innovations in Education and TeachingInternational, http://www.docuserver.ingentasalect.com23.02.05

Staniforth, D., Harland, T., (2003) Reflection on Practice:collaborative research for new academics. EducationalAction Research, 11: 1; 79-91.. Travers, M., (2001) Qualitative Research Through CaseStudies – Introducing Qualitative Methods, Sage,London

Warnock, M. (1978) Ethics Since 1900, 3rd Edition,Oxford University Press, Oxford

Williams, M., (2004) Concept mapping – strategy forassessment. Nursing Standard, 19:9; 33-38.

Winter, R., (2003) Contextualising the Patchwork Text:Addressing Problems of Coursework Assessment in HigherEducation. Innovations in Education and TeachingInternational, http://www.docuserver.ingentasalect.com23.02.05

Winter, R., (1999) The Patchwork Text: a coursework format for education as critical understanding, Teaching in Higher Education, 4, 485- 499.

Winter, R., Buck, A., Sobiechowska, P. (1999) The‘Patchwork Text’ Shaping meaning through the explorationof diversity, in Professional Experience and theInvestigative Imagination – The Art of reflective writing, Chapter 6 pp64-106, Routledge, London.

University of Salford (2004) Key Skills Overview,http://www.edu.salford.ac.uk/keyskills/ 10.12.04

Yorke, M., (2000) A Cloistered Virtue? PedagogicalResearch & Policy in the UK, Improving Education, 106-126, http://www.ingentaselect.com 19.01.05

AcknowledgementsI would like to thank my collaborators, academic mentorand research supervisor for their input and support for this project.

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35


Encouraging a Deep Approach to Learningamong Students of Prosthetics and Orthotics

Martin [email protected] of Health Care Professions

AbstractThis paper reports findings of actionresearch analysing current approachesto learning of students on theBiomechanics 1 module of the BSc(Hons) Prosthetics and Orthoticsdegree, with the aim of encouraginga deep approach to learning amongthem. Using Biggs’ (1999) factors thatencourage a deep approach to learning as the framework, I designedand implemented a questionnaire forthe students to voluntarily complete.The results indicate that, althoughstudents are relatively motivated, theyhave concerns regarding gaps in theirprevious knowledge and exhibit apreference for working practicallyrather than at a conceptual level. This indicates that, in terms of myfuture teaching, I need to focus onaligning module aims, learning outcomes and assessment, and alsoto review the syllabus, the learningenvironment and the teaching/learning activities that I use in orderto encourage the students to adopt a deep approach.

RationaleMy research relates to theBiomechanics 1 module that I teachas part of the BSc (Hons) Prostheticsand Orthotics (P&O) programme. Ihave taught this module for the firsttime this year. Whilst some aspects ofthe teaching have gone well, (evidenced by positive feedback fromthe students on course materials, presentation of information etc.), Istill feel that students are not engaging with the subject as well as Ihad hoped. As a result they are having a less than optimal learningexperience. My objective for the project is therefore to “encourage adeep approach to learning among

students on the Biomechanics 1 module of the BSc (Hons) P&O programme”. This incorporatesanalysing my students’ currentapproach to learning, which will provide a basis for ascertaining what I can do to enhance theteaching/learning experience for boththem and me. Firstly, however, Iwould like to establish what is meantby a “deep approach” to learning.

The notion of both deep and surfaceapproaches to learning arose following an investigation by Marton& Saljo (1976). Having asked studentsto read a text on which they wouldbe asked questions, these authors discovered that students responded intwo different ways. The first groupfocussed on the questions they mightbe asked and “skated along the surface of the text taking a surfaceapproach”. The second group set outto understand the meaning of thetext taking a “deep approach”. Thesenotions of different approaches tolearning were adopted and developedby others, including Entwistle (1997),who identified a further “strategicapproach” to learning. Entwistle(1997) summarised these approachesas outlined in the following adapted section:

Deep approach – Transforming by• Intention to understand ideas

for yourself.• Relating ideas to previous

knowledge and experience.• Looking for patterns and

underlying principles.• Checking evidence and relating it

to conclusions.• Examining logic and argument

cautiously and critically.• Becoming actively interested in the

course content.

Surface approach – Reproducing by• Intention to cope with

course requirements.• Studying without reflecting on

either purpose or strategy.• Treating the course as unrelated

bits of knowledge.• Memorising facts and

procedures routinely.• Finding difficulty in making sense

of new ideas presented.• Feeling undue pressure and worry

about work.

Strategic approach – Organising by• Intention to achieve the highest

possible grades.• Putting consistent effort

into studying.• Finding the right conditions and

materials for studying.• Managing time and

effort effectively.• Being alert to assessment

requirements and criteria.• Gearing work to the perceived

preference of lecturers.

Building on the work of Marton &Saljo (1976), authors such asEntwistle (1997), Biggs (1999) andRamsden (2003) examined factorsthat encouraged students to adoptone or other of the three approaches.Biggs (1999) identified that these factors are present in both studentsand the teaching environment. Thefactors that encouraged students to adopt a deep approach aredetailed below:

From the students’ side:• An intention to engage the task

meaningfully and appropriately;such an intention may arise fromintrinsic curiosity or from a determination to do well.

• Appropriate background knowledge; the ability to focus at a high conceptual level, workingfrom first principles, requires a well

36


structured knowledge base.• A genuine preference and ability for

working conceptually rather thanwith unrelated detail.

In the teaching environment:• Teaching in such a way as to bring

out the structure of the topic orsubject explicitly.

• Teaching to elicit a positive responsefrom students, e.g. by questioningor presenting problems, rather thanteaching to expound information.

• Teaching by building on what students already know.

• Confronting and eradicating students’ misconceptions.

• Assessing for structure rather thanfor independent facts.

• Teaching and assessing in such away that encourages a positiveworking atmosphere so studentscan make mistakes and learn from them.

• Emphasising depth of learningrather than breadth of coverage.

• In general, and most importantly,using teaching and assessmentmethods that support the explicitaims and objectives of the course;this is known as practicing whatyou preach.

I have chosen a research topic thataims to establish which approach tolearning the students in my class aretaking, as generally I am keen to tryto find the combination ofteacher/student behaviour that produces an optimal environment forstudent learning. More specifically, Ibelieve that, instead of a deepapproach to learning, many of myBiomechanics students are displayingcharacteristics of a surface or strategicapproach. This belief is based oninformal student feedback and relatesto three distinct issues:

1) My subject is mathematically basedand a number of students have informally reported feeling some trepidation about approaching it, dueto poor experiences with quantitative

subjects in the past. As a result, Ibelieve they lack confidence in dealing with numbers and, at leastpartly, avoid doing so wherever possible. I therefore wish to establishwhether this is the case generally andwhether the majority of students seethe course and its assessment assomething they “have to getthrough” in order to continue withthe programme.

2) Linked closely to the above point,my students do not appear to havethe level of background knowledge inmathematics on which I was hopingto build, and this has caused difficulties in the class. I thereforewanted to find out whether the students on the programme hadmuch opportunity to build up asound knowledge base of basicmaths and if my current teachingmethods are exploiting that base ofknowledge sufficiently.

3) The nature and balance of topicswithin the BSc (Hons) P&O programme means that it tends toattract students who are often moreinterested in the patient care andpractical, manufacturing aspects ofthe subject than they are with thebiomechanical theory behind gait patterns and the manufacture of artificial limbs. I believe they thereforestruggle to understand the relevanceof this largely theoretical subject(Biomechanics), in the context ofwhat is, after all, a vocational degree.I therefore wanted to establishwhether the students understand therelevance of Biomechanics within theoverall BSc (Hons) P&O programme.

If my students do lack motivation,have gaps in their basic mathematicsknowledge and struggle to deal withthe theoretical aspects of the subject,this contrasts poorly with what Biggs(1999) identifies as student factorsthat encourage the adoption of adeep approach to learning. Although,as Ramsden (2003) points out that

one cannot instruct a student in theuse of deep approaches, my finalconcern is that the way I am teachingthe subject may exacerbate the students’ shallow or strategicapproaches. As “the first step inimproving teaching is to avoid thosefactors that encourage a surfaceapproach” (Biggs 1999), I am keen toestablish whether my concerns basedon this informal feedback are correct,and if so, to look at what I can do torectify the situation.

The implications of a deep approachto learning go much further than justmy classroom. According to Light &Cox (2001), although research hasnot made much of the relationship,“we would expect deep transformingcategories of learning to be moreclosely associated with abilities to perform than the surface of reproducing categories.” Ramsden(2003) notes that “what studentslearn is indeed closely associated withhow they go about learning it”, so ifwe wish to produce healthcare professionals who are highly competent from the start of theircareers to the end, we must givesome thought to the way in whichthey are taught.

The increased diversity and range ofability of students is also of relevancein terms of my personal practice. It isincreasingly difficult to pitch teachingat a level where those students withthe least background knowledge cankeep up and the students with themost do not feel bored. Increaseddiversity also means that studentsmay be less traditionally “academic”than in the past. As Biggs (1999)says, “Good teaching is getting moststudents to use the higher cognitiveprocesses that the more academicstudents use spontaneously”, whichmay only be achieved if students areencouraged to take a deep approach.This is set against the background ofa national framework of teachingstandards, which requires graduates

37


to have more general learning skills,such as “learning how to learn” and“critical analysis” (Dearing Report1997).

Of course, the process of encouraginga deep approach to learning is mademuch easier if it is part of the departmental culture, and management decisions are made inline with what Ramsden (2003) calls“collegial commitment to teachingand improving student learning”. Thishelps to provide an enabling teachingenvironment that encourages a student focussed approach to learning. I am fortunate, because theculture of my department is supportive, and should I identify reasonable resource needs from mystudy, then I am likely to be successfulin achieving them.

Research design“Action research can be described asa family of research methodologiesthat pursue action (or change) andresearch (or understanding) at thesame time” (Southern CrossUniversity). However, before I couldstart to make changes to my teaching, my first step was to clarify what the current situation vis-a-vis mystudents’ learning approaches actuallywas. This formed the first step in theaction research process and isdescribed below.

Having reviewed a number of different research tools, I decided thatan anonymous and voluntary questionnaire, which could be distributed to the students in my current Biomechanics class, would bethe most appropriate method for theaction research process. Inviting thestudents (in writing) to fill in a questionnaire required ethicalapproval, which was obtained fromthe Associate Dean of Research within the School of Health CareProfessions, to ensure that the students were not exposed to a

situation that may be detrimental totheir future studies.

Although the choice of questionnaireas a research tool had a number ofdisadvantages, such as a lack of qualitative depth and resulting superficiality, it meant that respondents could remain anonymous. This possibly gave me amore accurate response to my questions, and meant I could alsosample the entire population ratherthan focussing in on a small samplegroup. In addition, it was a time efficient method of collecting information (unfortunately thetimescales associated with the projectleft no opportunity to pre-test or pilotthe questionnaire). Using a questionnaire gave me the opportunity to explain, in writing toeach of the potential respondents,relevant information regarding theproject, including what the projectwas about, the potential benefits ofthe research and what would happento the results once they had been collected.

When designing the questionnaireitself, I attempted to adhere to thebasic rules outlined in Moore (1987),which include using simple words andkeeping sentences short. I began byasking students to respond to threeclassification categories relating togender, age and geographical background before moving on to nineattitudinal statements where studentswere asked to respond using anumerical rating scale. This scaleranged from 1 to 5, where 1 indicates“strongly agree” and 5 indicates“strongly disagree”. Students werethen given the opportunity to addany additional comments.

The choice of attitudinal statementsreflected the aims of the project asoutlined above. Also incorporatedinto the nine attitudinal statementswere three relating to current teaching practices and how useful

students found them. Whether it was appropriate to incorporate these threestatements into the questionnaire

will be reviewed in the next section.

FindingsThe questionnaire was distributed andcollected after a lecture to a total of30 students, 22 (73%) responded. Asthe number of questionnaires was relatively small descriptive rather thanstatistical analysis of the data wasdeemed appropriate. There were 11male and 11 female students. Thestudents were in one of two ageranges:

• 7 male students under 21, 4 malestudents aged between 21 and 34

• 4 female students under 21, 7female students aged between 21and 34

I chose to classify the students inthese ways to see if there were anydifferences between male and femalestudents’ approaches to learning. Iwas also keen to establish whetherage had an impact on the approachto learning. Meyer & Scrivener (1994)suggest that school leavers attendinguniversity for the first time “…find itmore difficult to organise their time;the subject appears fragmented without an overall structure, and theyare overwhelmed with the amount ofwork that needs to be core. Attemptsto understand (deep approach) areundermined, and their perception ofthe course content is superficial”.

Looking at the group of statementsthat relate to how students perceivethe “relevance of Biomechanics toP&O”, it can be seen that students doseem to understand “whyBiomechanics is included in the P&Oprogramme” (mean=1.8). Scores arealso relatively good for statementsrelating to the use of the “principlesof Biomechanics in my future career”(mean=2.0) and that a “knowledgeof Biomechanics is essential for practising prosthetists/orthotists”(mean= 2.2).

It is interesting to note that, on average, male students perceiveBiomechanics to be more relevant tothe overall programme (malemean=1.5, female mean=2.1), believethey will use “the principles ofBiomechanics in their future career”(male mean=1.5, female mean=2.5),and believe the “knowledge ofBiomechanics is essential for practising prosthetists/orthotists”(male mean=2.0, female mean=2.4).One possible explanation for this maybe that the female students were

attracted to, and have a preferencefor, the other aspects of the programme, such as manufacturingor patient care.

Moving on to the group of statements regarding students’ “confidence in maths and groupworking”, the overall results showedthat the students were reasonably“confident about working with numbers” (mean=2.6), but did notfeel they had a “strong mathematicalbackground” (mean=3.0). The scoreon this item was the lowest mean inthe questionnaire, showing the students disagreed with this statement the most. It is worth notingthat I decided to ask students abouttheir own view of their mathematicalbackground rather than simplyreviewing their “A” level results, as Ifelt it was their own perception ofstrength that was important.

In general, female students reportedfeeling less “confident about workingwith numbers” (female mean=2.8,male mean=2.4), and felt they had a

weaker “mathematical background”(female mean=3.4, male mean=2.7).This was particularly notable forfemale students under the age of 21(mean=3.5). Confidence increasedwith age for the female students anddecreased with age for the males.Male students under the age of 21were the most confident of all thegroups (2.6). In general, female students find group working moreuseful than their male peers (femalemean=2.8, male mean=2.9). This maybe a result of different preferredlearning styles between males andfemales, but this goes beyond thescope of my particular study.

The final group of statements withinthe questionnaire related to “learningand teaching method”. My aim herewas to try and establish whether students felt more comfortable withthe theoretical and conceptualaspects of the course or its practicalapplication. The overall resultsshowed that, in general, students did find “solving practical problemshelps me to understand

38


Theme

To do with:Confidence in maths and

working in groups

To do with:Relevance of Biomechanics

To do with:Learning and teaching method

Statement

I feel confident about working with numbers

I have a strong mathematical background

I find working in a group to solve biomechanical problems useful

It is clear to me why Biomechanics isincluded in the P&O programme

I will use at least some of the principlesof Biomechanics in my future career

Knowledge of Biomechanics is essentialfor practising prosthetists / orthotistsSolving practical problems helps me

to understand BiomechanicsI find worked examples of

biomechanical problems useful to refer to

Short class tests, which do not contribute to my final grade, are helpful

2.6 2.4 2.8

3.0 2.7 3.4

2.9 2.9 2.8

1.8 1.5 2.1

2.0 1.5 2.5

2.2 2.0 2.4

1.8 1.6 2.3

2.0 1.6 2.0

2.0 1.6 2.3

Mean Male mean Female mean

39


Biomechanics” (mean=2.0) and“worked examples of biomechanicalproblems” are “useful to refer to”(mean=1.8). The students also foundnon-assessed class tests useful(mean=2.0). Male students indicatethat they find these methods moreuseful than female students. There isalso a difference between female students under the age of 21 andthose between 21 and 34, with theolder female students finding thesetechniques more useful than theiryounger peers.

Interestingly, the majority of qualitative responses were concernedwith the type of teaching methodsused. Here the emphasis was on thepractical application of the theory.The suggestions include “starting off”students on biomechanical problemsto prevent them getting stuck right atthe start, and making the teachingmore practically relevant by usinganatomical models and clinical situations.

Limitations of the studyIn general, I was happy with the waythat the research process worked. Thequestionnaire provided an effectiveand speedy way of gathering studentopinions that encouraged students toanswer as truthfully as possible. Itwould have been useful to have additional qualitative information(e.g. from discussion groups), however, this would have compromised the anonymity of thestudents and subsequently the resultsof the survey. It would also haveraised ethical questions regardingwhether students should be put inthe situation of publicly commentingon a teacher’s performance beforework had been graded.

Were I to run the questionnaire again,I would amend the final three statements. For example, instead ofasking students if they want moretests in class I would include a list of

possible teaching techniques and askthe students to rank their preferences. Alternatively, I may investigate incorporating questionsfrom a pre-existing questionnaire,such as the Oxford Centre for StaffDevelopment’s questionnaire forimproving student learning.

ConclusionsReviewing the results the followingconclusions may be drawn from the study:

• Students generally understandclearly why Biomechanics is included in the curriculum of theBSc (Hons) P&O programme, andgenerally believe that the knowledge they gain from it isessential for their future careers andwill be utilised by them. Female students were, however, less likelythan male students to perceive thesubject as useful and relevant.

• Students are reasonably confidentabout their ability to work withnumbers. In general, younger malestudents are more confident thantheir peers.

• In general, students do not feelthey have a strong mathematicalbackground.

• Overall, students do not seem tofind working in a group to solveproblems particularly useful.However, this does not seem to belinked to a lack of confidence inworking with numbers, as femalestudents, who were least confident,reported finding this techniquemore useful than did male students.

• In general, students find the application of theory to practical situations a useful learning tool.

What next?“At its simplest, action researchinvolves setting something up andrunning it to see what happens”(Moore 1987). “To be properlyregarded as action research a projectwould need to contain a continuous

thread of objective valuation and amechanism whereby the results of thevaluation and the lessons learned during the project can be fed backinto the process” (Moore 1987).

Taking Moore’s (1987) definition ofaction research into account, the nextstage is to take the results of theresearch and try to incorporate theminto my teaching for the next groupof students joining the programme in2005. This is particularly importantfor me personally, as my teachingcommitments will be expanded and I would like the opportunity to develop my teaching materials in linewith revisions based on the results ofthis research.

The questions that I need to addressrelate back to Biggs’ (1999) factorsfor encouraging a deep approach tolearning within the teaching environment and aligning differentteaching and learning methods withthe aim of promoting that approach.In my specific context, this would mean:• Establishing a way of bringing out

the explicit structure ofBiomechanics.

• Reviewing the way in which I runteaching sessions with the aim ofencouraging more explicit responsesfrom students.

• Developing methods of establishingwhat students already know, sothat the course can utilise and buildupon this knowledge.

• Developing methods for uncoveringand eradicating student misconceptions.

• Revising the assessment process tofocus more on structure than repetition of facts.

• Encouraging a positive workingenvironment where students feelable to make mistakes and learnfrom them.

• Establishing explicit aims and objectives for the Biomechanics 1module and ensuring that I teachand assess in alignment with them.

My course of action is now to applywhat I have learned from this projectto the design of the Biomechanics 1module for the next academic year,and to develop ways of monitoringhow successful I have been in encouraging the students to avoidtaking a surface or superficialapproach to the subject.

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Department of Education (1997),Report of national committee ofinquiry into higher education(Dearing Report), Norwich:Department of Education.

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Notes



Innovative Learning in ActionEditorial Board

Viv CaruanaEditorEducation Development Co-ordinator(Learning and Teaching Practice)Education Development Unit

Geoff CoveHead of Education Development Unit

Jane HanstockPro-Vice ChancellorTeaching and Learning

Dorothy OakeyHead of Staff and Curriculum Development Education Development Unit

Carole RobertsDean of the Faculty of Business & Informatics

Nicola CoatesResearch Development Officer Education Development Unit

This journal is now available on-line at:www.edu.salford.ac.uk/scd/ltprac/05

Education Development UnitUniversity of SalfordSalford, Greater ManchesterM5 4WTUnited Kingdom

T +44 (0)161 295 2331

F +44 (0)161 295 2332

www.edu.salford.ac.uk

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