Aims and objectives of the project
Nurses are required to make clinical decisions about patients' health and well-being, responding to changes in each patient's condition, which may occur within very small time-frames. The ability to make clinical judgements depends on both a sound theoretical background and good decisionmaking skills. Practice-based learning enables students to develop these skills at the same time as they acquire the necessary underpinning knowledge. The aim is to develop a tool that can be used in different modes for both formative and summative assessment. The tool will be piloted with a cohort of nursing students at the end of the Common Foundation Programme with the aim of incorporating the tool at the end of the Branch programmes in either Adult or Mental Health nursing.
Objectives
 To develop practice-based assessment strategies that are assessed independently of a mentor
 To develop a web-based interactive clinical-decision making tool to facilitate formative and summative assessment
 To pilot the assessment strategies with a cohort of student nurses

To use the findings to inform future assessment strategies
Explanation of how the proposal meets the criteria outlined in Section C
This proposal addresses the theme of eAssessment of practice-based learning using a web-based tool.
This approach lends itself to open learning as students can complete the assessment in their own time.
It also provides an alternative to mentor-led practice assessment, which can bring its own problems due to the tension between nurturing and judgement (Yorke (2005). It complements reflective writing as a method of assessing students’ evolving professional practice, that is to say their integration of theory and practice, which is so vital when preparing students for professional registration.
Individuals to be involved (name, title, brief relevant experience)
Dr Verina Waights
Dr Waights, Lecturer in Professional Health Care Education in HSC, carried out a pilot study regarding the development of students’ clinical decision-making skills with Yr 1 funding. She has also developed interactive activities and assets for a practice-based simulation tool that enables students to develop skills in a virtual environment. She is a main author of current practice-based courses and is leading the
Assessment Strategy Working Group. She has experience of developing interactive media for students in other settings and is a registered practitioner of the Higher Education Academy.
Ali Wyllie

Ali Wyllie is currently Lecturer in Learning and Teaching Technologies in HSC where she initiates developments in new media and works closely with course teams in the development of multiple media learning and teaching materials. She has been involved in the design, development and use of educational multimedia for the past seven years, and has developed multimedia for FELS, OUBS, Arts,
Social Science and HSC. Recently she led the development of a practice-based software simulation tool for pre-registration nursing students which enables them to develop skills in a virtual environment.
It is recognized that the successful development of critical thinking skills for academic purposes does not necessarily mean that these skills are used in decision-making in practice (Seymour et al 2003).
When in practice, nurses make decisions ‘on-their-feet’, often without time to seek out further information about the patient or the issues in question. Research has shown clinical decisions are strongly influenced by the context in which they are made (Bucknall 2000) and as the complexity of decision tasks increases, so context-specific knowledge determines the effectiveness of decisionmaking (Botti & Reeve 2003). This project, therefore, aims to assess students’ decision-making skills in a virtual environment, which is context driven and builds on work undertaken in a small pilot study -
Developing skills in clinical decision-making through work-based learning.
We will develop the assessment strategy by using a web-based tool to provide decision-making opportunities, building on Laurillard (2002) , who suggests that ‘ Traditional modes of assessment of knowledge are seen as inadequate because they fail to assess students‘ capability in the authentic activities of their discipline.
The maze concept allows for assessment to occur in context and over time.
The different contexts which can be created using both simple or complex media elements mean that this tool enables assessment at a distance and we believe the flexibility of this tool to illustrate those contexts provides an innovative approach to assessing clinical skills.
Outline of the methodology to be used
Developing case studies for assessment
T his project involves developing case studies to assess students’ abililty to make clinical decisions.
These case studies will have differing levels of complexity, beginning with straightforward cases and building up to cases that involve missing or conflicting clinical information. This approach has been shown to be effective in differentiating between novice and expert decision-makers (Botti & Reeve
2003). These case studies form the content of the web-based interactive tool and can be developed relatively simply, using mainly textual description, or with sufficient complexity to enable simulation of real-life clinical decisions. The initial case studies will be used for assessment of individual students but the approach can also be developed for group assessment, which could stimulate considerable active discussion and negotiation of meaning within the group, allowing different points of view and value perspectives to be expressed.
Developing the web-based interactive tool (clinical decision maze)
This interactive tool, based around the concept of a maze, provides a challenging framework for assessment. A `maze' refers to a problem-solving activity based on a clinical case study. The initial
(problematic) situation of the patient or client is described, and may include supporting information, such as data, graphs, images, very short audio-visual clips, followed by a clinical question that needs addressing. A list of possible actions to take in response to this question is given and the student selects one option. Each of these possible responses then leads to a description of the consequences of the action chosen, again with supporting information, followed by a further list of choices for subsequent action. Thus the maze progresses over time, with each choice determining the next context students ’ find themselves in, until some final state is reached. This final state may be a positive one or a
E-Assessment project March 2006

negative one, depending on the path taken, and students will submit a short report explaining the rationale for their actions at each stage in the maze. See attached (simplified) example.
Piloting the clinical decision maze
60 volunteer pre-registration nursing students, representative of the cohort completing the Common
Foundation Programme in 2005, will be divided into two groups, matched for age, gender, years as a
Health Care Assistant and previous educational qualifications. One group will be sent the clinical decision maze and the other will carry out the task using hard copies of the materials, with a facilitator presenting the next set of materials as students complete each stage of the task. The students will be asked to complete a questionnaire to obtain their perceptions of their developing clinical skills.
Collation of results and dissemination of data
The findings will be collated to give statistical data of the effectiveness of the tool. This information will be fed back to the Programme to inform future assessment strategies. The clinical decision maze could form an electronic TMA or part of an end-of-course project. Currently the reflective writing required from students is based around their own practice episodes. This approach would give the opportunity for students to interact with and reflect on the same case study, enabling a richer understanding of their developing skills.
The findings would also be published in two peer-reviewed journals, such as the Journal of Advanced
Nursing and the British Journal of Educational Technology. One pair of papers will be written after completion of the exercise at the first time point and another pair after the second time point.
Outline of the timescale involved
Time period
Months 1-3
Month 5
Months 2-6
Months 7-9
Months 10-
12
Activity
Develop and refine case studies for assessment at first time point
Personnel
Verina Waights
2AL/Practitioners one mental health and one adult branch
Design assets for maze Verina Waights
Develop first prototype of the maze
Pilot the clinical decision maze prototype at first time point
Ali Wyllie web-designer
Verina Waights
Ali Wyllie
Analyse data
Refine maze
Write papers for the journals/Inform
Programme
Verina Waights
Ali Wyllie
Verina Waights
Ali Wyllie
Contact details
E-Assessment project March 2006

v.waights@open.ac.uk
Tel: 01908 654785 a.j.wyllie@open.ac.uk
Tel: 01908 858943
References
Botti M & Reeve R (2003) Role of knowledge and abi lity in student nurse’ clinical decision-making.
Nursing and Health Sciences 5 39-49
Bucknell T (2003) The clinical landscape of critical care: nurses’ decision-making
Laurillard D (2004) Rethinking University Teaching: A framework for the effective use of learning technologies. 2 nd Edition. Routledge England p204.
Seymour B; Kinn S; & Sutherland N (2003) Valuing both critical and creative thinking in clinical practice: narrowing the research-practice gap. Journal of Advanced Nursing 42 p288-296
Yorke M (2005) A report prepared for the Practice-based Professional Learning CETL The Open
University.
Example Maze (simplified)
E-Assessment project March 2006

Dilemma 1
It’s time for Brian’s medicine, you can’t find the right medicine. What do you do?
Option 1
Ask your supervisor for help
Option 2
Use Paracetamol instead of Nurofen
Option 3
Tell him he’ll have to manage without
Your supervisor is away. What do you do?
Brian reacts badly to the
Paracetamol. What do you do?
Brian gets angry and starts attacking you. What do you do?
Option 1
Scream!
You are sacked
Option 2
Find another supervisor
Option 1
Call a doctor
Option 2
Make him vomit
He comes with you to
Brian
The Dr gives
Brian his paracetamol
He chokes and dies
Option 1
Call for security
Option 2
Run!
Guards come and secure him
You are sacked
E-Assessment project March 2006