Literature review exploring issues of service user and carer involvement in the assessment of students’ practice.

Executive Summary This literature review focuses on exploring issues of service users and carer involvement in the assessment of students‟ practice. Recommendations are made to inform the development of a National Approach to Practice Assessment for the pre-registration Nursing and Midwifery programmes in Scotland. Objectives of the Literature Review  Undertake a literature / evidence review that focuses on exploring issues of service user and carer involvement in the assessment of students‟ practice.  Make recommendations based on the above review to inform the National Approach Working Group in formulating guidance to Higher Education Institutions around service user and carer involvement in the assessment of students‟ practice. Literature review Literature was collected following a systematic search and spanned across 17 lay and professional groups. In total a 212 articles were reviewed following application of exclusion criteria. Sixty six papers were finally selected as fully meeting the inclusion criteria. Of these there was a varied and wide ranging use of research methods as well as guidelines / tools and more descriptive / opinion based articles. The most common were descriptive / opinion based, followed by guidelines and tools thus underlining the often reported dearth of evidence based literature in the area of the involvement of service users and carers in the assessment of students‟ practice. Findings from the literature review Following a brief overview of the contextual background, definition of terms and an outline of the continuum of involvement, the findings from the literature review addressed the following areas: The challenges and barriers to the involvement of service users and carers focusing on the hierarchies within Higher Education; the use of superiority as a barrier; and using excuses as a barrier. This is followed by a discussion related to assessment methodologies including assessment methods and processes; issues related to reliability, quality and the context of assessment. The next section addresses the impact of involvement on students, service users and carers which includes an exploration of the benefits of service user and carer involvement in the assessment of students‟ practice; and the reactions and views of service users, students and staff. Finally the implications for training and support are explored. Conclusions and recommendations There are a number of recommendations and advice offered in the literature. Only those specific to the involvement of service users and carers in the assessment of students‟ practice are presented here. The culture in which service users and carers are involved in the assessment process must be commensurate with the aims and purpose of such participation. This therefore requires involvement of all those involved (including practice placement personnel), agreement and dissemination of the vision or purpose; two-way communication; setting of ground rules including the ability to challenge the use of jargon and the provision of a supportive environment where service users and carers feel safe to share any concerns or anxieties that they may have (Tew et al. 2004; Basset et al. 2006; Duxbury & Ramsdale 2007; Masters & Forrest unpublished). Training and support is fundamental to the success of service user and carer involvement. Levin (2004); Speers (2008) and Masters & Forrest (unpublished) recommend ensuring that the involvement of service users and carers in the assessment of students‟ is not seen to be coercive but rather an opt in or opt out process. Anghel & Ramon (2009) emphasise the need for support not just for service users and carers but also academic and practice staff. A number of authors recommend the development and use of protocols and guidance in order to provide structure for all those involved (Shennan 1998; Edwards 2003; Speers 2008; Anghel & Ramon 2009; Branfield 2009; Stickley et al. 2010) which should hopefully help with consistency in the assessment process. Levin (2004) suggests that any assessment tool should start from the service users‟ perspective as opposed to using „trigger questions‟ related to competencies. Stickley et al. (in press) discuss the development of a service user designed assessment tool (SUSA© – Service User Student Assessment) which over a number of weeks evolved into containing four categories: attitude; communication skills; personal awareness and knowledge. A Likert scale is consistently used to elicit responses and there is sufficient room for individual comment. The tool also contains a glossary of terms for the service user / carer. In terms of the processes involved, recommendations are multifaceted:  Consider the terminology used – Stickley et al. (2010) and (in press) suggest referring to service user and carer „assessment‟ of students‟ practice as reviewing rather than assessing. The rationale for this is that the term reviewer addresses students‟ complaints of feeling disempowered and thus the feedback is less likely to be rejected outright. Literature Review: Involvement of Service Users & Carers in the Assessment of Students‟ Practice Page 7  Provide service users and carers with written information that they can read it and retain for future information. Information should include the “reason for seeking feedback; how it will be used and how long any forms or recordings will be kept” (Edwards 2003: 347). Speers (2008) adds that confidentiality in terms of the feedback should also be addressed.  Service user / carer feedback should be used to enhance the learning experience (Levin 2004).  Service user / carer feedback should be mandatory in all practice assessments (Levin 2004)  The selection of the service user / carer from which feedback will be elicited should be a joint process between the mentor / practice teacher and the student. It should not be the student‟s selection alone (Levin 2004; Masters & Forrest unpublished).  Stickley et al. (in press) advise using informal processes (such as witness statements, reflective writing and other portfolio items) to elicit service user / carer feedback. They warn that using more formal mechanisms will require planned training in forming and giving feedback. Furthermore they suggest that using a more formalised procedure may need mentor involvement to aid the feedback process. In conclusion, the consensus within the literature is to involve service users and carers in the formative feedback (or review) of students in the practice setting. The use of protocols and structured easily understood and implemented tools are recommended as is the inclusive and appropriate level of engagement training for all stakeholders involved in the process. Both Masters & Forrest (unpublished) and Stickley et al. (in press) identify that further research is required into the manner in which feedback is obtained from service users and carers and how it is then used to inform and enhance the learning process.