title: Impact of a practice-based feedback intervention on student performance during clinical placements in acute-care health settings: A quasi-experimental study of the REMARK programme
Creators: name: Ossenberg, Christine
Publisher: name: Griffith University
Year: 2021
Subjects: subject: Attributes
subject: Clinical learning environment
subject: Clinical placement
subject: Feedback
subject: Normalisation process theory
subject: Nurses
subject: Nursing student
subject: Socio-constructive learning
subject: Work-integrated learning
subject: Workplace-based assessment
subject: Workplace performance

description: Feedback is frequently heralded as having a powerful influence on learning. However, feedback is not always the panacea it is presented as, with dissatisfaction of feedback widely reported. As a formative process, feedback expands a learner’s knowledge, skill, and comprehension of a general or specific content area—reinforcing good practice, eliciting change, and motivating learners to improve. In the context of this thesis, feedback is described as a dynamic, dialogic process through which the learner uses evidence to construct knowledge about their practice and/or self and therefore, a driver for change. Both the learner and learning partner are active participants in the process and recognise the importance of the sociocultural contexts and interactions in which feedback is constructed and learning the principal goal. Encouraging dialogue, shared understanding, and co-construction of feedback between learners and learning partners enhances feedback literacy. Sustainable feedback processes that involve both learners and learning partners can ultimately maximise learning outcomes and optimise selfregulation. Normalisation process theory (NPT) is a middle-range sociological theory of action which aids in explaining how the work of a new practice is normalised (i.e., embedded and sustained) in everyday life. It is centred around four principal constructs: coherence, cognitive participation, collective action, and reflexive monitoring. NPT was used prospectively in this study. Confluence between NPT and tenets of socio-constructivist learning approaches provided strong theoretical underpinnings for this study. The aim of this work was to determine: What impact does a work-based educational programme drawing on the principles of effective feedback have on:i. student performance during clinical placements as measured by a validated assessment tool used nationally—the Australian Nursing Standards Assessment Tool (ANSAT); ii. student, buddy nurse, and clinical facilitator (CF) engagement with the feedback process as measured by a feedback perception survey called the Quality Feedback Inventory (QFI); and iii. student, buddy nurse, and CF adoption of best practice feedback principles as measured by the NoMAD1 instrument for the nuRse fEedback iMplementAtion framewoRK (REMARK) study? A non-equivalent, quasi-experimental design was used to examine the impact of implementing an educational intervention to improve feedback on student performance during clinical placements in acute healthcare settings. The four-week intervention included a range of strategies based on best practice principles of effective feedback and situated learning. Normalisation process theory was used to underpin the design, delivery, and evaluation of the intervention. Student performance was measured using standardised assessment processes of the participating university at three time points: baseline (pre-test), mid-placement (post-test 1), and end-placement (post-test 2). Student performance at each time point was measured using the ANSAT. A newly developed instrument, the QFI, was used to gauge participants’ engagement with feedback during clinical placements. Participants’ level of adoption of the intervention was measured using the NoMAD instrument for the REMARK study. Data from these surveys were collected from all participants at the completion of the clinical placement period. Study participants consisted of final year nursing students (n = 214), buddy nurses (n = 145), and clinical facilitators (n = 41) during periods of clinical placements at the control and intervention sites. Results indicated that students participating in the REMARK programme had statistically higher ANSAT scores than students in the control group (p= 0.003). Statistical modelling was adjusted for the variables of student group (i.e., control/intervention), placement setting, and assessment time point. Analysis revealed that only assessment time point had an impact on students’ ANSAT scores; student group and placement setting did not.Differences between buddy nurses’ and CFs’ engagement with feedback were observed, with CFs reporting higher engagement than buddy nurses at a statistically significantlevel. Overall, CFs in both the control and intervention groups reported significantly higher levels of engagement with the feedback attributes compared with buddy nurses in the control (p &lt; .001) and intervention (p = .002) groups. Interestingly, students in the control group reported a statistically higher level of engagement (p &lt; .001) with feedback attributes than those students in the intervention group. Evidence of adoption of the REMARK programme was greatest in CFs followed by students. Buddy nurses demonstrated the lowest level of adoption of the REMARK programme. This programme of research makes a pivotal contribution to understanding and applying concepts of dialogic feedback within the dynamic clinical learning environment, particularly drawing attention to the impact feedback can have on improving student performance during clinical placement. Concomitantly, this research identified differing levels of buddy nurse and CF engagement with feedback, clearly highlighting the critical importance that preparation to supervise student learning in the clinical learning environment has for both roles. Of note is the contribution normalisation process normalisation process theory can make in supporting the design, delivery, and evaluation of education programmes that address these differences. Furthermore, this work illuminates lingering deficiencies in our knowledge and practice of dialogic feedback, as well as targeted recommendations for the higher education sector and healthcare facilities to consider in moving this issue forward. Notwithstanding, the understandings elicited through this work have the potential to empower students to engage with sustainable feedback practices that are responsive to their learning goals, thereby developing their professional practice and provision of safe and effective patient care.