The Assessment for Nursing Potential: Nursing Quality Scale
The study integrated the qualities of nursing students (N=227) with their aptitude and academic achievement in a tripartite model. A battery of tests called in the Assessment for Nursing Potential (ANP) composed of the (a) Nursing Quality Scale (NQS) with factors on caring, compassion, commitment and connectedness; (b) Achievement test; and (c) Aptitude test was used in the study. Using a three-wave longitudinal design, the NQS was first administered followed by the aptitude, then the achievement tests.
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The effects of the nursing qualities on achievement and aptitude were analyzed using Structural Equation Modeling (SEM). The first model indicates that nursing quality as a latent factor has no significant effects on both achievement and aptitude, obtaining a moderate goodness of fit (RMSEA=. 09). However, when the same model was tested including the effect of aptitude on achievement, it resulted to a better fit (RMSEA=. 06). In the second model, aptitude has a significant effect on achievement, p<. 05.
The model explains that attitudinal characteristics of nurses are independent of cognitive abilities such as their aptitude and achievement, and thus supports the belief that it is possible to integrate them in assessing nursing potential. Although effective nurses may possess the necessary characteristics such as caring, compassion, commitment, and connectedness, these quality traits do not affect their abilities. Considering the growing demand of Filipino nurses abroad, there is a great need for them to improve nursing quality by learning necessary competencies and characteristics to succeed in the profession.
Valanis (2000) argued that nurses need additional competencies in order to function effectively. The Joint Commission on the Accreditation of Healthcare Organization also states that nurses need to develop more competencies to perform well in their job functions. These competencies refer to knowledge, skills, behaviors as well as personal characteristics. Different studies on nursing quality focused on exploring trait on caring as a primary characteristic (e. g.
Blasdell & Hudgins-Brewer, 1999; Gunther & Thomas, 2006; Tise, 1988). On the other hand, most of the studies on the achievement of nurses focused on predicting their success using licensure examination scores as the criterion (e. g. Lam, 2000; Waterhouse & Beeman, 2003; Giddens & Gloeckner, 2005). The current literature on nursing characteristics and achievement were studied separately considering that there is a growing attention in describing the complexity of nurses’ characteristics as well as their changing roles.
The present study proposes to integrate both quality and abilities of nurses because providing services with care needs to be aligned with their ability to handle the technical aspects of their job. The study further tested a model showing the direction from qualities of nursing students (caring, compassion, commitment, and connectedness) directly affecting their aptitude and academic achievement. The model implies that there should be an integration of the knowledge, skills, and behaviors of nurses to optimize their potential for success in the nursing profession..
Nursing Quality Traits Nursing quality is defined as an experiential judgment emerging from the nurse-patient interaction. Most of the studies on nursing quality and traits focused on a single factor such as emphasizing on nursing care while neglecting other characteristics and components. The study by Mamauag and Magno (2005), however, elaborates varied nursing qualities extracted from factor analysis. The resulting framework of nursing qualities does not only emphasize the importance of caring but also other factors such as compassion, commitment, and connectedness.
In the said study, a scale composed of these four factors was constructed showing that caring, compassion, commitment, and connectedness have items that highly load for each factor. Using the Rasch model application, the items were further calibrated to generate a pool comprising those that have goodness of fit. These four characteristics are culturally relevant for Filipino nurses because they are described and defined in a collectivist orientation grounded on in-depth interviews among nursing students and practitioner-experts.
These factors of nursing quality are all directed towards others where caring means providing comfort, compassion is sympathetic consciousness of others, commitment is responsibility to others and to the profession, and connectedness is the nurse-patient bond. Valanis (2000) has a different model on nursing quality that entails the concern of developing nursing competencies rather than personal characteristics and qualities. She advocates that nurses must: (1) independently practice the profession and evaluate one’s own performance, (2) have the aptitude for elf-motivation and autonomy, (3) be able to identify gaps in knowledge and plan appropriate professional development activities, (4) be able to translate learning into practice, (5) assess patient needs, (6) elicit patient and family values, (7) provide patients with continuity of service, (8) synthesize knowledge and skills, (9) have a broad view of health, (10) assess potential contribution to technology, (11) be skilled in behavior change theory, (12) be able to differentiate nursing functions from those of other professions, and (13) exert leadership in ensuring nursing’s unique contribution to policy on the preventive and remedial aspects of illness. These 13 competencies proposed by Valanis calls for greater demand from nurses to recognize their growing role in the health care profession. These competencies entail aspects of abilities more than affective qualities.
Valanis contended a more crucial need for nurses to possess competencies rather than focus on the separate etymological concepts. Gunther and Thomas (2006) were able to extract the same nursing characteristics found in the study of Mamauag and Magno (2005). Using the qualitative research approach, Gunther and Thomas explored the experiences in caring for patients in contemporary hospitals among 46 nurses. Running themes identified were the following: (1) extraordinary care giving events, (2) incomprehensibility, (3) isolation experienced by nurses while giving care as well as profound moment of connection with patients, and (4) questioning what other things could have been done.
The study of Blasdell and Hudgins-Brewer (1999) used different measures to determine the personality characteristics and attributes that guidance counselors believe to be important for a career in nursing. It was found that “other orientation” subscale (includes traits such as compassion, kindness, sincerity, altruism, and concern for others) was ranked the most important followed by the academic achievement, conformity and lastly leadership. They also found out that leadership and academic achievement is significantly more important for BSN-prepared nurses (Bachelor of Science in Nursing) compared to those taking AND (Associate Degree in Nursing).
The study also recognized that academic achievement is the most important factor for a career in medicine than in nursing. It is also important to note in the study of Blasdell and Hudgins-Brewer that nursing students need to be compassionate, kind, obedient, and moderately academically able. This moderate achievement level is enough evidence pointing to the need for nurses to improve their cognitive abilities such as critical, thinking, achievement, and aptitude as advocated by Valanis (2000). Guidance counselors had realistic perceptions of nursing and identified personal and cognitive attributes of students that would promote success in nursing as investigated by Bolan and Grainger (2005).
This supports the earlier findings of Blasdell and Hudgins-Brewer (1999). However, Bolan and Grainger further argued that nurses involved in the recruitment of students need to ensure that guidance counselors have more accurate perceptions of the changing role of nurses, their opportunities for practice outside hospital settings, and the importance of problem-solving and leadership skills for nurses. Considering that high school guidance counselors can influence the career choices of students, it is also imperative that they be equipped with information on what characteristics will make successful, competent and caring nurse-practitioners. Nursing Achievement and Aptitude
Majority of studies in nursing shows that nursing achievement is moderately perceived as important. This concerns a great concern to improve the abilities of nurses such as their aptitude and academic achievement. The common measure of nursing achievement in published studies on nursing education can be found in the results of licensure examinations such as the NCLEX (National Council Licensure Examination). In the Philippine setting, the Philippine Regulation Commission also uses a test for the licensure of nurses, although there are no published studies using the said instrument. Three studies are published in reviews using the NCLEX as a measure of nursing achievement.
The study by Lamm and McCaniel (2000) used the State Board Test Pool Examination (SBTPE), Grade Point Average (GPA), parental education level, and age as predictors of the NCLEX. The purpose of the study was to identify which variables accurately predict the success of practical nursing students on the NCLEX-PN. The results indicate that among all predictors, the General Mental Ability (GMA-subscale of SBTPE) was the only significant predictor of the NCLEX-PN. A recent study by Waterhouse and Beeman (2003) was able to identify more significant predictors of the NCLEX such as scores in the Risk Appraisal Instrument (RAI), grades in the different nursing courses, and the nursing achievement test. In a more ecent study, Giddens and Gloekner (2005) investigated the relationship between critical thinking and the performance scores on the NCLEX. Their study showed that both measures of critical thinking (California Critical Thinking Test and California Critical Thinking Disposition Inventory) did not significantly predict the NCLEX scores. The study recognized the need to explore other dispositional variables in explaining nursing achievement scores. The studies on nursing achievement usually correlated other cognitive measures such as critical thinking, mental ability, grades, with demographic factors such as age, gender, and parents’ educational level.
Previous studies did not explore other dispositional factors such as nursing quality traits in predicting nursing achievement levels because these concurrent studies were driven by the factors explained by other previous studies. This poses a need to explore and use other kinds of disposition such as quality traits in explaining nursing achievement and aptitude. What is required is a mechanism to predict academic success for nursing students during the course of their studies (Hass, Nugent and Rule, 2004). In this way, educational resources can be honed to meet best the needs of the students and the profession/workforce. Not all pathways have a consistent entrance requirement and this confounds any attempt to predict academic and clinical achievement (Campbell and Dickson, 1996) particularly when nursing students arise from quite diverse backgrounds.
It was perceived by the authors that not enough was known about how these different pathways would impact on nurse academic and clinical achievement. Studies suggested that different psychological tests had been used to predict academic and clinical achievement. Blackman and Darmawan (2004) in their study that examined criteria used to predict achievement for medical students, explored the use of psychological assessment as a factor associated with of student success in graduating from medical schools, but these had proved to be unreliable particularly when such variables as the student’s personality, interest and attitudes (Aldrich, 1987) were considered. Other studies cited by Blackman et al. 2004) suggested that useful predictors for medical student success in the academic aspects of their studies included their achievement at high school and their past grade point average scores (Green, Peters and Webster, 1993; Hoschl and Kozeny, 1997; Shen and Comrey, 1997). The very purpose of the educational system is to develop and mold the minds of the young individuals to become responsible and rational adults who are well-prepared for life. Educational experiences guide and strengthen the foundation of one’s development towards achieving one’s goal in life, which is success (Guirra, 1998). For the students to attain this vision in life, they should have the much needed academic preparation, to be able to pass a licensure examination (Blankas, 2003). An entrance examination is conducted by educational institutions to determine whether prospective students are qualified to enter.
It is also used to determine the candidate’s preparation for a course of study (http://en. wikipedia. org). Nursing institutions always administer entrance examination to upgrade the professional standard, evaluate the intellectual capability of the applicant as well as some other personal and social aspects. Institutions that offer nursing course cannot just admit applicants who cannot show excellent academic performance to meet the challenging needs of the course (Bajet, 2001). Aptitude tests measure one or more clearly defined and relatively homogeneous segments of ability. They are often used to predict success in an occupation, training course, or educational endeavor (Gregory, 2004).
Research data show that individually administered aptitude tests have the following qualities: a) excellent predictors of future scholastic performance, b) provide ways of comparing an individual’s performance with that of others in the same situation, c) provide a profile of strengths and weaknesses, d) assess differences among individuals, e) uncover hidden talents in individuals, thus improving their educational opportunities, and f) serve as valuable tools for working with the handicaps (http://www. ericdigest. org). Achievement tests attempt to assess what a person has learned following a specific course of instruction. These tests have as their goal the endpoint evaluation of a student’s knowledge after a standard course of training (Kaplan & Sacuzzo, 2001). Moreover, an achievement test may also be used as a predictor of future learning.
In Blankas (2003), Robles as cited by Espiritu (2001), stated that a certification examination is conducted to provide license to graduates of a specific course for the professional practice. Licensing is a way of assuring that practitioners meet the minimum qualifications required for the proper practice in their area of training. Such test intends to measure certain domains in the training that the graduate has completed. If the test adequately assessed the particular domain that it intends to measure, its scores should be significantly related with other indices of the individual’s past training. Roble (1995), as cited by Bajet (2001), concluded that the board examination performance of Siliman University College of Nursing (SUCN) graduates is significantly related with their academic achievement.
Further, Martinez (1980), Gagajena (1975), and Refuerzo, (1989) also in Bajet (2001) pointed out that there exists a correlation between academic achievement of nursing graduates and their performance in the Nursing Board Examination. They also stated that academic achievement is a good predictor of performance in the Nursing Board Examination. Braga still in Bajet (2001), found out that there is a positive correlation between preentrance test and success in the nursing school and the state board examination. Further, Rubio in Esguerra (1993) stressed that there is a significant relationship between NCEE ratings and academic achievement, and NCEE ratings and performance in the Board Examination for Nurses. She also found out that academic achievement is a better predictor of success in the Nursing Board Examination than the NCEE ratings.
Her dissertation study on the other hand revealed that academic performance significantly relate with Nursing Licensure Examination performance. Martinez, et al. (1980) made An Analytical and Correlational Study of State Board Examination Rating and Academic Achievement of Nursing Students, and they deduced from the results of the study that there is a strong relationship between performance in the nursing state board examination and achievement in high school, pre-nursing and nursing proper. They further stated that academic achievement is a good predictor of performance in the Nursing Licensure Examination. Likewise Carreon’s (1983) study showed that there is a substantial positive correlation between college achievement and board examination performance.
In addition, Tolentino (2010) found that college academic performance, nursing aptitude test, dominance and perfectionism as components of personality test are factors significantly related to passing the Philippine Nursing Licensure Examination. The study focused on the predictors of Nursing Board Examination Performance which included the UNP-CAT, Nursing Aptitude Test and Academic Performance. This has a resemblance with the study conducted by Tolentino (2010) as she used academic performance, nursing aptitude test as factors related in passing the Nursing Licensure Examination. In addition, the studies conducted by Martinez (1980), Refuerzo (1989) and Roble (1995) correlated the academic achievement of the nursing graduates with their performance in the Nursing Board Examination.