Original researchEvaluating a nursing erasmus exchange experience: Reflections on the use and value of the Nominal Group Technique for evaluation
Introduction
The Nominal Group Technique is an evaluative methodology which emerged from the work of Van de Ven and Delbecque (1971) for addressing group decision making processes. It is further described as an evaluative methodology which is semi quantitative and qualitative. It has been used in healthcare education for generating ideas to develop curricula and find solutions to issues in programme delivery (Perry and Linsley, 2006, Varga-Atkins et al., 2011, Lennon et al., 2012). Techniques to evaluate nursing experiences vary and in the main can be retrospective and identify objectives or competencies achieved. Reactions to experiences can be captured but more often the transformative nature of experience is not explored. Nursing education and preparation has evolved significantly over the last decade requiring nurses to widen and deepen their knowledge and awareness of health needs within a changing Europe and globally. Even nursing in the United Kingdom (UK) requires the same awareness. Papadopoulos, 2011, Papadopoulos. et al., 2016 argues nurses must use culturally appropriate and acceptable nursing/healthcare interventions which take into consideration both the patients’ and the carers' cultural backgrounds as well as beliefs, behaviours and values and the context in which care is given in a ‘culturally competent’ manner. This is challenging to measure, define and plan for. Unsurprisingly, over the last decade there is an appetite for, and increase in, nurse exchanges to experience nursing in another country or culture which is often afforded through the Erasmus study abroad exchange scheme. This may be likely to increase as students demand more from their programmes especially if they have to invest highly in their education. Even with the uncertainties of Brexit exchanges may still be a feature and so understanding the benefits to nursing students of exchanges is still needed.
Nursing education in the United Kingdom (UK) like many countries is underpinned by European Union directives (2013/55/EU and 2005/36/EU) as well as local professional body (Collins and Hewer, 2014). Nursing education does vary across European countries (located in universities or colleges) but as Lahtinen et al. (2014) report more significant similarities exist as opposed to differences in nursing education between the 45 (of the 47) different European Higher Education Area (EHEA, 2015) member countries. Clinical learning environments are recognised as complex social environments which are more complex in differing cultures and contexts and highly influence students’ learning. Furthermore supervisory systems also vary across Europe (Salminen et al., 2010) to add to the complexity. Thus understanding of these is required to effectively prepare and support students engaging with placements in Europe. Overall this provides challenges within nursing education but also offers opportunities for nursing students to become aware of the wider health and nursing issues beyond their home environment. The focus of this paper is not the experiences per se but how to best capture and develop experiences through a specific process: Nominal Group Technique.
Section snippets
Evaluation of clinical experiences - which approach?
Evaluation of student placement in the United Kingdom (UK) is an important element of good practice on all programmes (Nursing and Midwifery Council (NMC), 2010, Quality Assurance Agency (QAA), 2012). Much work has been done looking at dimensions of effective placements and satisfaction with specific tools addressing this (Saarikoski et al., 2008, Warne et al., 2010, Papastavrou et al., 2010, Gameel et al., 2015). However these are undertaken with ‘native’ students in their own country and such
Traditional Nominal Group Technique method
The ‘traditional’ approach comprises four (or possibly five) stages commencing with silent generation of ideas; round-robin feedback; discussion of each idea and further clarification and evaluation, preliminary voting and individual ranking of responses then refining the ranked items and perhaps actions to take forward. Crucially this needs to be initiated with an effective and clear question which ought to be sufficiently open-ended for participants to connect with and offer their opinions.
Method (modified NGT)
The adopted process followed the main stages as outlined above but was modified slightly to achieve the purpose of evaluating two aspects (key questions) and timed to allow discussion at the later stage. One of the programme team facilitated but did not participate or guide the process. The students were consulted and indicated they were happy to have a member of the team present and their role was clearly outlined acknowledging this was not research but evaluation. Since dissemination was
Application of nursing exchange evaluation and reorientation
NGT technique was chosen for this evaluation because of the key aspects outlined earlier. This method was used for three successive years (2013/14, 2014/15 and 2015/16). During each there were modifications mainly in the level of instructions given (facilitation) and the allocation of sufficient time to each stage until the described process was reached. In total with instructions and setting up this took approximately 2 h. It had not been formally evaluated and the programme team decided it
Discussion of the approach
Scrutiny of the NGT point to a number of attractive and persuasive components: it requires minimal preparation, it is efficient (considering time and outputs), it is collaborative and provides almost instantaneous results. The generation of such abundant data could also be daunting even small numbers of participants can have much to offer and managing all this could be challenging. The other view is that such a breadth of opinions and experiences or comments provides a very rich feedback from
Limitations
Previous experience using NGT for non-nursing students returning from placement in China (Bell and Cunningham, 2006) meant a ‘neutral’ person facilitating enabled a more balanced evaluation and safe environment (Tuffrey-Wijne et al., 2007). The programme team as facilitator may have influenced this and the extent of this is unknown. Critics indicate convenience sampling limits generalisability (Harvey and Holmes, 2012) one could argue they are a heterogenous group since they all elected to do
Conclusion
As an evaluation process it led to more detailed insights than other written or online tools alone. The benefits of such a ‘de-briefing’ and the opportunity to meet peers with whom they have shared a significant experience to exchange views are clear. This event served as an important ‘reflection’ and re-orientation to the UK which is often overlooked in such experiences (Greatrex-White, 2007, Cowan, 2007). Whilst there are benefits (speed, collated results, low cost) there are limitations
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