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Effects on performance scores between those Baccalaureate nursing students receiving videotaped performance… Collins, Angela Janet 1977

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THE  EFFECTS ON PERFORMANCE SCORES BETWEEN THOSE BACCALAUREATE NURSING STUDENTS RECEIVING VIDEOTAPED PERFORMANCE FEEDBACK AND THOSE STUDENTS RECEIVING TEACHER FEEDBACK, WHILE PERFORMING A SPECIFIED PSYCHOMOTOR SKILL  by  ANGELA JANET COLLINS B.N., M c G i l l U n i v e r s i t y , 1970  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE  REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING  i n the School of Nursing  We accept t h i s t h e s i s as conforming t o the r e q u i r e d  standard  THE UNIVERSITY OF BRITISH COLUMBIA June 1977 (g) Angela Janet  Collins  In p r e s e n t i n g t h i s  thesis  in p a r t i a l  f u l f i l m e n t o f the requirements f o r  an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, the L i b r a r y s h a l l I  f u r t h e r agree  for  freely available  that permission  r e f e r e n c e and study.  f o r e x t e n s i v e copying o f  this  representatives. thesis  It  this  thesis  is understood that copying o r p u b l i c a t i o n  f o r f i n a n c i a l gain s h a l l  written permission.  Department of  NURSING  The U n i v e r s i t y o f B r i t i s h  Columbia  2075 Wesbrook Place Vancouver, Canada V6T 1W5  Date  for  that  s c h o l a r l y purposes may be granted by the Head o f my Department o r  by h i s of  make i t  I agree  ^2^^ Zl? /?77  not be allowed without my  ABSTRACT The purpose of t h i s study was t o e x p l o r e the q u e s t i o n : does t h e use o f a videotaped r e c o r d i n g o f a n u r s i n g student's performance o f a psychomotor s k i l l , w i t h subsequent review by the student, enhance t h a t student's performance?  In order t o  answer t h i s q u e s t i o n , a q u a s i - e x p e r i m e n t a l study was c a r r i e d out. The psychomotor s k i l l s e l e c t e d f o r t e s t i n g was t h a t o f t r a n s f e r r i n g a c l i e n t from a bed t o a w h e e l c h a i r . study, s u b j e c t s had completed Sixteen f i r s t  P r i o r t o the  a l e a r n i n g module on the s k i l l .  year b a c c a l a u r e a t e n u r s i n g students were randomly  p l a c e d i n t o an experimental o r comparison group.  Following  t h i s , the i n v e s t i g a t o r taught the s p e c i f i e d s k i l l  employing  the t e a c h i n g techniques of demonstration  and d i s c u s s i o n .  A v i d e o t a p e was made of a l l s u b j e c t s performing the skill  t o p r o v i d e a data base and determine  sample homogeneity.  The two groups then r e c e i v e d t h e i r r e s p e c t i v e feedback  treatments.  E i g h t students i n the experimental group r e c e i v e d a v i d e o t a p e o f t h e i r performance, along w i t h a performance c h e c k - l i s t t o a s s i s t them i n the review o f t h e i r v i d e o t a p e s .  E i g h t students i n the  comparison group r e c e i v e d teacher feedback performance.  during t h e i r  skill  The teacher was guided by the same performance  c h e c k - l i s t used by the experimental group s u b j e c t s . After  a p e r i o d o f e l e v e n o r twelve days, depending on  the group, the experimental and comparison groups r e t u r n e d f o r a f i n a l v i d e o t a p e d t e s t performance.  ii  Seven s u b j e c t s i n each  group completed the t e s t performance.  A q u e s t i o n n a i r e was  completed by the f o u r t e e n s u b j e c t s a t t h i s time.  T h i s was an  attempt t o gather data on s e l e c t e d c h a r a c t e r i s t i c s o f the l e a r n e r , b e l i e v e d t o a f f e c t psychomotor s k i l l l e a r n i n g . Students  d i d not view the data base or f i n a l t e s t  formance v i d e o t a p e s .  per-  One r a t e r scored these performances u s i n g  the performance c h e c k - l i s t .  The scores were compared t o d e t e r -  mine s i m i l a r i t i e s and d i f f e r e n c e s between the videotaped feedback and t e a c h e r feedback groups.  The q u e s t i o n n a i r e  responses were t a b u l a t e d and i n t e r p r e t e d w i t h i n the a n a l y s i s of  the score  results.  When t h e g a i n scores between t h e data base and f i n a l t e s t performances were compared, no s i g n i f i c a n t d i f f e r e n c e s were found between the experimental  and comparison groups.  A n a l y s i s o f the data base mean scores r e v e a l e d t h a t no s i g n i f i c a n t d i f f e r e n c e s e x i s t e d between the groups.  This indicated  sample homogeneity before the feedback treatments  were g i v e n .  Gain s c o r e s w i t h i n each group d i d not show s i g n i f i c a n t d i f f e r e n c e s . With the l a c k o f s i g n i f i c a n t d i f f e r e n c e s i n the g a i n scores between groups, i t was concluded  t h a t videotaped  formance feedback was as e f f e c t i v e as teacher  per-  feedback.  82 pages  TABLE OF CONTENTS Page ABSTRACT  i i  LIST OF TABLES  v i i  ACKNOWLEDGEMENTS  viii  Chapter I  INTRODUCTION  1  The Problem  II  2  Statement o f the Problem  2  S i g n i f i c a n c e o f t h e Problem . . . .  2  Scope o f the Study  6  D e f i n i t i o n o f Terms  6  Assumptions  8  Hypothesis  8  REVIEW OF THE LITERATURE L e a r n i n g Theory  III  9 9  Psychomotor S k i l l L e a r n i n g  11  Videotape i n E d u c a t i o n  13  Videotape i n E d u c a t i n g Nursing Students  16  Discussion  20  METHODOLOGY  23  D e s c r i p t i o n of the Study  23  Overview  23  The V a r i a b l e s  24  iv  Chapter  Page The Design  24  Sample S e l e c t i o n  25  The S e t t i n g  25  The Sample  26  Data Gathering  Instruments  The Performance C h e c k - L i s t  26 . . .  The Q u e s t i o n n a i r e  IV  V  26 29  Implementation  29  Method o f Data A n a l y s i s  35  ANALYSIS OF THE DATA  37  Discussion of the Findings  45  L i m i t a t i o n s o f the Study  49  SUMMARY, CONCLUSIONS AND IMPLICATIONS FOR FURTHER RESEARCH  50  Summary  50  Conclusions  52  I m p l i c a t i o n s f o r F u r t h e r Research . .  53  LITERATURE CITED  55  APPENDIX  60  APPENDIX A.  The Performance C h e c k - L i s t . . . .  61  APPENDIX B.  The Performance C h e c k - L i s t : F i r s t Draft  64  I n t e r r a t e r R e l i a b i l i t y f o r the Performance C h e c k - L i s t . . . .  67  APPENDIX C.  v  Chapter APPENDIX D.  Page Intra-rater  Reliability  f o r the  Performance C h e c k - L i s t  70  APPENDIX E.  The Q u e s t i o n n a i r e  72  APPENDIX F. APPENDIX G.  Consent t o P a r t i c i p a t e Raw Scores Obtained by Experimental and Comparison Groups on the Data Base Performance  75  APPENDIX H.  APPENDIX I .  77  Raw Scores Obtained by Experimental and Comparison Groups on the T e s t Performance Rater T e s t - R e t e s t R e l i a b i l i t y  vi  79 . . .  81  LIST OF TABLES Table 1.  2.  3.  4.  5. 6.  7.  8.  9.  10.  Page Summary o f Data Base Scores, T e s t Performance Scores and Gain Scores Obtained by Experimental and Comparison Groups . . . .  38  Comparison o f Gain Scores Obtained by the Experimental and Comparison Groups Between the Data Base Performances and T e s t Performances  39  Comparison Scores Obtained by t h e Experimental and Comparison Groups on the Data Base Performance  40  P a i r e d Comparisons w i t h t h e Experimental and Comparison Groups Between Data Base Performance Scores and T e s t Performance Scores  40  Summary o f Data C o l l e c t e d on t h e Questionnaire  41  Performance Scores and Rank O r d e r i n g of Obtained Scores i n Determining I n t e r r a t e r Reliability  67  The C o r r e l a t i o n C o e f f i c i e n t s Obtained by D i f f e r e n t R a t e r s , Between t h e F i r s t and Second O b s e r v a t i o n s , i n Determining I n t r a rater R e l i a b i l i t y  70  Raw Scores Obtained by Experimental and Comparison Groups on the Data Base Performance  77  Raw Scores Obtained by Experimental and Comparison Groups on the T e s t Performance  79  The C o r r e l a t i o n C o e f f i c i e n t o f Student Performance Scores Obtained by the Rater .  81  vii  ACKNOWLEDGEMENTS I wish t o express my thanks t o my committee, Ray Thompson and Sarah Hannaway, f o r t h e i r continued guidance and support throughout t h i s endeavor. i s a l s o extended  Appreciation  t o t h e many people who a s s i s t e d  f i r s t year f a c u l t y  f o r t h e i r arrangements,  interest,  me:  t o the  t o my f r i e n d s and  c o l l e a g u e s f o r t h e i r support and e x p e r t i s e , and t o Jack Yensen f o r h i s h e l p w i t h the s t a t i s t i c a l who p a r t i c i p a t e d  components.  i n the study I am e s p e c i a l l y  To the students grateful, for  without t h e i r enthusiasm and c o - o p e r a t i o n t h i s study would not have been  possible.  viii  CHAPTER I INTRODUCTION I n t e g r a l i n the f u n c t i o n o f n u r s i n g i s s k i l l i n c a r r y i n g out psychomotor a c t i v i t i e s .  Emphasis has r e c e n t l y  been p l a c e d on the c o g n i t i v e and a f f e c t i v e s k i l l s , wider scope, depth and autonomy t o n u r s i n g .  giving a  However, i t r e -  mains e s s e n t i a l t h a t the nurse m a i n t a i n a high l e v e l o f e x p e r t i s e i n performing quality c l i e n t care.  psychmotor s k i l l s  so as t o ensure  The q u e s t i o n then becomes:  how does the  nurse a c q u i r e t h i s e x p e r t i s e ? T h i s w r i t e r was i n t e r e s t e d i n the area o f psychomotor l e a r n i n g , p a r t i c u l a r l y on the feedback component o f l e a r n i n g . If  the assumption i s made t h a t knowledge o f performance a f f e c t s  the r a t e of l e a r n i n g (Ammons 1956, p. 283), then the q u e s t i o n i s asked: for  what methods o f p r o v i d i n g feedback a r e e f f e c t i v e  the learner? Furthermore, t h e r e was a l s o a concern with t h e i n c r e a s i n g  a c c o u n t a b i l i t y p l a c e d on teachers and students f o r t h e l e a r n i n g process  and f o r p r o v i d i n g q u a l i t y c l i e n t As a r e s u l t o f these expressed  care.  concerns r e g a r d i n g  a c c o u n t a b i l i t y and t h e psychomotor s k i l l performance o f n u r s i n g s t u d e n t s , a search f o r methods t o enhance s k i l l undertaken.  l e a r n i n g was  T h e o r i e s on l e a r n i n g and psychomotor s k i l l  acqui-  s i t i o n p r o v i d e d the framework f o r the subsequent development of  the l i t e r a t u r e search.  The concept  o f feedback, e v i d e n t i n  these t h e o r i e s , became the c e n t r a l theme.  1  2  D i r e c t i o n was  g i v e n f o r pursuing the focus o f  this  study from examining the l i t e r a t u r e encompassing the f i e l d s of  l e a r n i n g theory, g e n e r a l e d u c a t i o n , n u r s i n g and  education.  medical  The use of videotape, as a means t o p r o v i d e f e e d -  back to n u r s i n g s t u d e n t s , became i n c o r p o r a t e d i n t o the s e a r c h . Based upon the f i n d i n g s i n the l i t e r a t u r e , a q u a s i experimental  study was  designed  t o address  the f o l l o w i n g ques-  tion. The  Problem  Statement of the Problem The  s p e c i f i c problem i n v e s t i g a t e d i n t h i s study  be s t a t e d i n the form o f a q u e s t i o n .  may  Does the use of a v i d e o -  taped r e c o r d i n g of a n u r s i n g student's performance of a psychomotor s k i l l , w i t h subsequent review by the student, enhance t h a t student's  performance? S i g n i f i c a n c e o f the Problem  The mechanisms of psychomotor s k i l l  l e a r n i n g are complex  and o n l y i n r e c e n t years has a concerted e f f o r t been taken t o r e s e a r c h t h i s area. 1972,  pp.  1-2)  Urbach  ( N a t i o n a l S p e c i a l Media I n s t i t u t e s  s t a t e s t h a t educators,  i n g e n e r a l , have not  de-  voted a t t e n t i o n t o the psychomotor domain but r a t h e r , have looked a t man  as an i n t e l l e c t u a l b e i n g .  Urbach p o i n t s out,  however, t h a t the psychomotor component of man r a t e d from the a f f e c t i v e  and c o g n i t i v e domains.  cannot be  sepa-  3  The b a s i c p r i n c i p l e s and techniques o f psychomotor s k i l l s i n n u r s i n g are l e a r n e d as a student.  In a s c h o o l of  n u r s i n g , students come w i t h a v a r i e t y o f l i f e  experiences,  which i n c l u d e d i f f e r i n g a b i l i t i e s t o perform motor s k i l l s . Singer  ( N a t i o n a l S p e c i a l Media I n s t i t u t e s 1972,  c i t e d seventeen  the s k i l l  cetera.  12-42) has  l e a r n e r c h a r a c t e r i s t i c s which can a f f e c t psycho-  motor s k i l l l e a r n i n g . * as how  pp.  These are compounded by such t h i n g s  i s taught, amount and type of p r a c t i c e e t  P r a c t i c e time may  be l i m i t e d by the c o n s t r a i n t s of  the n u r s i n g programme, and o p p o r t u n i t i e s f o r p r a c t i c e may be r e a d i l y a v a i l a b l e i n the c l i n i c a l s e t t i n g . many f a c t o r s a f f e c t i n g psychomotor s k i l l may  o r may  not  Because of the  l e a r n i n g , the  graduate  not be comfortable w i t h h e r * * l e v e l of a b i l i t y i n  performing psychomotor s k i l l s . How ability?  i s the n u r s i n g student assessed f o r psychomotor  The s c h o o l may  provide s p e c i f i c tests f o r students,  upon e n t e r i n g the programme.*** U s u a l l y , the student i s observed o n l y when p r a c t i c i n g a newly learned s k i l l .  I t i s often d i f f i -  c u l t f o r the t e a c h e r t o d i s c e r n between the d i f f i c u l t i e s student has always possessed and the new  situation.  the  those which e x i s t because of  I t i s not suggested  t h a t r a d i c a l means of  •See pages 11-12. **Since the m a j o r i t y of nurses are female, the feminine gender w i l l be used h e n c e f o r t h . T h i s i s not to negate the presence of men i n n u r s i n g . ***For i n s t a n c e , those designed by Dr. Joseph E. H i l l , Community C o l l e g e , Boomfield H i l l s , Michigan.  Oakland  4  assessment f o r psychomotor a b i l i t y be i n s t i t u t e d , but r a t h e r , a l t e r n a t e means of a s s i s t i n g students i n t h e i r l e a r n i n g o f n u r s i n g s k i l l s i n t h e psychomotor domain. Through the process o f feedback,  i t i s anticipated  t h a t the student w i l l become aware o f c o r r e c t and i n c o r r e c t actions.  When l e a r n i n g a n u r s i n g psychomotor s k i l l ,  v e n t i o n a l method c a l l s to t h e student.  the con-  f o r the t e a c h e r t o g i v e v e r b a l  feedback  I t i s t h i s w r i t e r ' s b e l i e f that verbal feed-  back may be e f f e c t i v e f o r the student who has an awareness o f her psychomotor a b i l i t i e s , b u t what about those who do not? I f a student t h i n k s she i s performing an a c t i o n c o r r e c t l y , when i n f a c t she i s n o t , a r e t h e r e more e f f e c t i v e means f o r the student t o p e r c e i v e the e r r o r ? I t i s g e n e r a l l y b e l i e v e d , by educators, t h a t the student has a r e s p o n s i b i l i t y f o r her own l e a r n i n g .  Therefore,  i t would seem a p p r o p r i a t e t o p r o v i d e the student w i t h some o b j e c t i v e means o f a s s e s s i n g her motor s k i l l performance and l e a r n i n g needs, so t h a t h e r involvement  i s elicited.  Video-  t a p i n g the student c a r r y i n g o u t a psychomotor s k i l l , w i t h subsequent  review by the student, would be one p o s s i b l e means. S e v e r a l s t u d i e s t o i n v e s t i g a t e videotaped feedback  been undertaken, and n u r s i n g .  with a v a r i e t y of s k i l l s , i n education,  With the e x c e p t i o n o f a study by Q u i r i n g  n u r s i n g e d u c a t i o n has attempted  have medicine  (1972),  l i t t l e i n r e l a t i o n t o the use  of videotaped performance feedback  i n psychomotor s k i l l  Q u i r i n g was not i n v e s t i g a t i n g videotaped feedback  learning.  p e r se, b u t  5  r a t h e r , the e f f e c t s of t i m i n g i n An important is  feedback.  f a c e t , i n the t e a c h i n g o f n u r s i n g today  accountability. As n u r s i n g t e a c h e r s ... Ewel w i l l be h e l d accountable more and more f o r our a c t i o n s . We must answer t o the student, t o s o c i e t y , t o our p r o f e s s i o n , t o the i n s t i t u t i o n o f f e r i n g the program, and t o o u r s e l v e s ( R e i l l y 197 5 p. 2).  The  teacher assumes r e s p o n s i b i l i t y f o r the l e a r n e r and  q u a l i t y of n u r s i n g c a r e p r o v i d e d t o the c l i e n t .  The  the  teacher  i s u l t i m a t e l y r e s p o n s i b l e f o r producing a s a f e p r a c t i t i o n e r . With the c u r r e n t concern i n regards t o a c t u a l or p o t e n t i a l i n f l a t i o n , t e a c h e r s are becoming more accountable f o r c o s t containment, w h i l e c o n t i n u i n g t o p r o v i d e a high l e v e l of e d u c a t i o n to students.  The U n i v e r s i t i e s C o u n c i l of B r i t i s h  r e c e n t l y expressed  the  Columbia  concern  ... t h a t u n i v e r s i t i e s may not be d i r e c t i n g s u f f i c i e n t a t t e n t i o n t o the areas o f t e a c h i n g methods and use of a u d i o - v i s u a l and computerized media f o r i n s t r u c t i o n . "New, automated methods w i l l never s u b s t i t u t e f o r seminars, student r e s e a r c h and experimentation and g i v e and take w i t h s t i m u l a t i n g t e a c h e r s , but much can be done t o take advantage of c u r r e n t and emerging technology without l o s i n g other v a l u e s , . . . " (The Vancouver Sun, February 26, 1977, p. 37). As mentioned p r e v i o u s l y , the student i s r e s p o n s i b l e f o r becoming i n v o l v e d i n the l e a r n i n g p r o c e s s . accountable f o r her behaviour  She i s a l s o  i n giving c l i e n t care.  student's a c c o u n t a b i l i t y p r i m a r i l y r e f l e c t s s a f e t y and  The comfort  f o r the c l i e n t . A c c o u n t a b i l i t y behooves n u r s i n g educators t o continue t h e i r s e a r c h f o r more e f f e c t i v e t e a c h i n g methods t o a s s i s t  the  6  student i n d e v e l o p i n g c o n f i d e n c e and a b i l i t y i n the performance of n u r s i n g  skills.  To r e c a p i t u l a t e , to a c c o u n t a b i l i t y  this writer's  prime concerns  relate  and e x c e l l e n c e i n the psychomotor s k i l l  per-  formance of n u r s i n g s t u d e n t s . Scope of the Study The  scope of the study i s l i m i t e d by the  following  factors: 1.  Sample s i z e  ( o r i g i n a l N=16;  through a t t r i t i o n N=14).  2.  U n c o n t r o l l e d extraneous  variables  subject c h a r a c t e r i s t i c s  and p r a c t i c e  such as  individual  of the  skill.  3.  Laboratory s e t t i n g as opposed t o a c l i n i c a l  setting.  4.  Sample c h a r a c t e r i s t i c o f b a c c a l a u r e a t e n u r s i n g s t u d e n t s . D e f i n i t i o n of Terms  1.  Performance s c o r e s :  The n u m e r i c a l s c o r e s o b t a i n e d , by  u s i n g a performance c h e c k - l i s t , d u r i n g the i n i t i a l  and  f i n a l t e s t performances of s t u d e n t s . 2.  Nursing s t u d e n t s : who  were l e a r n i n g  Those f i r s t to transfer  year b a c c a l a u r e a t e students c l i e n t s f o r the f i r s t  time  and were i n the same c l a s s . 3.  Videotaped  performance feedback:  student c a r r y i n g  out the psychomotor s k i l l  the student f o l l o w i n g review by her.  A videotape of the and g i v e n t o  the performance, f o r i n d i v i d u a l  I n s t r u c t o r feedback:  The t r a d i t i o n a l method of v e r b a l  comments, g i v e n by the teacher, i n p o i n t i n g out c o r r e c t and i n c o r r e c t a c t i o n s t o the student, d u r i n g the  skill  performance. Psychomotor s k i l l :  "A motor s k i l l r e f e r s t o a muscular  movement o r motion of the body r e q u i r e d f o r the s u c c e s s ful  e x e c u t i o n of a d e s i r e d a c t (Same as  skill). of  S p e c i f i c c r i t e r i a are s e t f o r the  performance"  t u t e s 1972, Skill  perceptual-motor  p.  (Singer:  acceptability  N a t i o n a l S p e c i a l Media  Insti-  12).  s e l e c t e d f o r t h i s study:  A p i v o t t r a n s f e r of a  " c l i e n t " from a bed t o a w h e e l c h a i r , namely:  With the  " c l i e n t " s i t t i n g on the edge o f the bed, without  her  s l i p p e r s on, the student: - p l a c e s the s l i p p e r s on t h e " c l i e n t ' s "  feet  - a s s i s t s the " c l i e n t " t o a s t a n d i n g p o s i t i o n - p i v o t s the " c l i e n t " towards the w h e e l c h a i r - lowers the " c l i e n t " "Client":  i n t o the w h e e l c h a i r  A person t r a i n e d t o assume the r o l e of a 75  year o l d female c l i e n t w i t h the f o l l o w i n g l i m i t a t i o n s : - injured r i g h t leg (painful) - no weight b e a r i n g on r i g h t l e g - unsteady of  one  on l e f t  l e g , but can stand w i t h  support  person.  Data base v i d e o t a p e :  A videotape of both the comparison  and the experimental groups,  taken d u r i n g t h e i r  first  performance of the psychomotor s k i l l and p r i o r t o v i d e o -  8  taped performance feedback o r t e a c h e r feedback s e s s i o n s . T e s t performance v i d e o t a p e :  A v i d e o t a p e o f both the  comparison and experimental groups, taken d u r i n g t h e f i n a l performance o f the psychomotor  skill.  Assumptions Both c o g n i t i v e and a f f e c t i v e domains a r e i n v o l v e d i n a student p e r f o r m i n g ... (Urbach:  the s p e c i f i e d  psychomotor  skill  N a t i o n a l S p e c i a l Media I n s t i t u t e s 1972, p. 2 ) .  Knowledge o f performance a f f e c t s r a t e o f l e a r n i n g ... (Ammons 1956, p. 283). The Hypothesis h y p o t h e s i s f o r t h i s study was p u t f o r t h t h a t : Those b a c c a l a u r e a t e n u r s i n g students r e c e i v i n g v i d e o t a p e d performance feedback, f o r a s p e c i f i e d psychomotor s k i l l , w i l l o b t a i n h i g h e r s c o r e s on a performance checkl i s t than those students r e c e i v i n g t e a c h e r feedback f o r the same s k i l l .  CHAPTER I I REVIEW OF THE D i r e c t i o n was  LITERATURE  g i v e n f o r pursuing the focus of t h i s  study by examining the l i t e r a t u r e encompassing the f i e l d s of l e a r n i n g theory, g e n e r a l e d u c a t i o n , n u r s i n g and m e d i c a l education.  T h e o r i e s of l e a r n i n g and psychomotor s k i l l  p r o v i d e d the framework upon which t o b u i l d the To i n v e s t i g a t e whether videotape may 1  i n psychomotor l e a r n i n g , i t s use i n the f i e l d sought.  acquisition  inquiry.  be of a s s i s t a n c e of education  A more c r i t i c a l a n a l y s i s of the l i t e r a t u r e  explored  the use of videotape i n educating the n u r s i n g student, c u l a r l y as feedback f o r psychomotor s k i l l  was  learning.  parti-  Applicable  s t u d i e s from o t h e r h e a l t h p r o f e s s i o n s have supplemented  those  from n u r s i n g . L e a r n i n g Theory L e a r n i n g t h e o r i s t s have proposed a wide range of t h e o r i e s in  an attempt to e x p l a i n the phenomenon of l e a r n i n g .  1974, liefs.  pp.  (Snelbecker  389-493) summarizes some of these commonly h e l d be-  Such t h e o r i e s as operant c o n d i t i o n i n g and  behavior  m o d i f i c a t i o n , c o g n i t i v e c o n s t r u c t approaches, t a s k a n a l y s i s t h e o r i e s and humanistic psychology explored. of  One  a p p l i e d to l e a r n i n g , were  common thread can be found i n e a c h — e v a l u a t i o n  l e a r n i n g progress and r e i n f o r c e m e n t , t o g i v e the l e a r n e r  feedback on h i s performance. knowledge o f r e s u l t s .  Feedback i s a l s o r e f e r r e d t o as  The concept of feedback was 9  c e n t r a l to  10  the subsequent development of t h i s  review.  By the l a t e 1930's, a c o n s i d e r a b l e number o f s t u d i e s had been conducted which showed t h a t knowledge of r e s u l t s was an e f f e c t i v e v a r i a b l e : t h a t l i t t l e improvement o c c u r r e d without knowledge of r e s u l t s , t h a t the i n t r o d u c t i o n of knowledge of r e s u l t s r e s u l t e d i n improvement and t h a t w i t h drawal o f r e s u l t s was f o l l o w e d by a d e t e r i o r a t i o n of performance ( I r i o n : B i l o d e a u 1966, p. 30). L a t e r r e s e a r c h would seem t o be based upon these  as-  sumptions but has attempted t o e x p l o r e types of feedback  and  manipulate time v a r i a b l e s . For i n s t a n c e , Newman and others  (1974) found no  over-  a l l d i f f e r e n c e i n performance, r e g a r d l e s s of the t i m i n g of feedback.  Supporting  w i t h n u r s i n g students and delayed  this finding, Quiring*s  (1972) study  showed no d i f f e r e n c e s between immediate  (24 hours) feedback.  Tuckman and o t h e r s  (1969), found t h a t v e r b a l feedback,  which evoked d i s c r e p a n c i e s between observed  behavior  and  t e a c h e r s ' s e l f p e r c e p t i o n , promoted teachers t o change t h e i r behavior. An i n t e r e s t i n g o b s e r v a t i o n was p r a c t i c e s e s s i o n s , when Parker of  made d u r i n g  students  (1974) i n v e s t i g a t e d the  value  u s i n g e r r o r s i n t e a c h i n g a complex n u r s i n g procedure.  students p r a c t i c e d the s k i l l ,  no feedback was  s t r u c t o r s and students expressed feedback was  given.  While  Both i n -  d i s c o m f o r t when c o r r e c t i v e  lacking.  In summary, feedback t o students, r e g a r d i n g r e s u l t s of t h e i r performance, would appear t o be a s i g n i f i c a n t aspect their learning.  of  The means by which feedback i s g i v e n i n d i c a t e s  11  a need f o r f u r t h e r r e s e a r c h . Psychomotor S k i l l The  Learning  psychomotor domain i s concerned w i t h  r e a c t i o n time and muscular c o n t r o l (Urbach:  co-ordination,  National Special  Media I n s t i t u t e s 1972, p. 1 ) . A motor s k i l l r e f e r s t o muscular movement or motion o f the body r e q u i r e d f o r the successf u l execution o f a d e s i r e d a c t (Same as perceptual-motor s k i l l ) . S p e c i f i c c r i t e r i a a r e s e t f o r the a c c e p t a b i l i t y of performance (Singer: N a t i o n a l S p e c i a l Media I n s t i t u t e s 1972, p. 12). Singer  ( N a t i o n a l S p e c i a l Media I n s t i t u t e s 197 2, pp.  12-42) summarized the g e n e r a l r e s e a r c h psychomotor domain.  f i n d i n g s about the  He i n c l u d e s t h e o r i e s and d e f i n i t i o n s  which g i v e d i r e c t i o n t o the examination o f psychomotor s k i l l learning. Motor s k i l l s range from f i n e movements t o gross movements, minimal c o r t i c a l a c t i v i t y t o c o - o r d i n a t i o n o f c o g n i t i v e processes,  and v a r y i n g degrees o f p e r c e p t u a l  involvement.  Beyond e m p i r i c a l o b s e r v a t i o n s and scanty r e s e a r c h evidence, i t becomes d i f f i c u l t t o s p e c i f y those a b i l i t i e s a s s o c i a t e d with task p r o f i c i e n c y (Singer: N a t i o n a l S p e c i a l Media I n s t i t u t e s 1972, p. 23). Singer  s p e c i f i e d seventeen c h a r a c t e r i s t i c s t o c o n s i d e r  when l o o k i n g a t the nature of the l e a r n e r . marized as f o l l o w s : periences; ality;  (1) body b u i l d ;  (3) p r i o r s p e c i f i c s k i l l s ;  These can be sum-  (2) e a r l y childhood ex(4) aspects  (5) some g e n e r a l motor a b i l i t i e s ;  o f person- ^  (6) i n i t i a l l e v e l s of  task p r o f i c i e n c y ; (7) p h y s i c a l measures (e.g. s t r e n g t h ,  flexi-  12  bility,  endurance);  balance, speed); and  verbal  emotions; (16)  sex  cues); (13)  (8) motor measures (e.g.  (9) sense a c u i t y (10)  (e.g. k i n e s t h e t i c ,  perception;  (11)  l e v e l of a s p i r a t i o n ;  differences;  and  (17)  S p e c i a l Media I n s t i t u t e s 1972,  visual  intelligence;  (14)  attitudes;  aging process pp.  co-ordination,  (12)  (15)  (Singer:  fears; National  21-25).  In a d d i t i o n t o l e a r n e r v a r i a b l e s , S i n g e r c i t e s o t h e r v a r i a b l e s which a f f e c t psychomotor s k i l l conditions  can be manipulated, such as how  s i t u a t i o n i s presented, the c o n d i t i o n s occurs and  learning.  s p e c i f i c learning  under which p r a c t i c e  the-type of p r a c t i c e allowed.  ternal conditions,  the  External  In each of the  ex-  the concept of feedback, or knowledge of  r e s u l t s , i s mentioned as being c r i t i c a l  to l e a r n i n g  a  skill.  I t seems t h a t  feedback, e s p e c i a l l y v i s u a l feedback which i s  immediate and  accurate, increases  a c t t o occur.  the p r o b a b i l i t y of a  desired  I t f u r t h e r serves t o m o t i v a t e , r e i n f o r c e  and  d i r e c t behavior. Fleishman ( N a t i o n a l pp.  57-82) has  motor a b i l i t y  S p e c i a l Media I n s t i t u t e s  1972,  done e x t e n s i v e r e s e a r c h i n i d e n t i f y i n g psychofactors.  Abxlity  . . . r e f e r s t o a more g e n e r a l t r a i t of the i n d i v i d u a l which has been i n f e r r e d from the c o r r e l a t i o n s obtained among performance of i n d i v i d u a l s on c e r t a i n kinds of t a s k s (Fleishman: N a t i o n a l S p e c i a l Media I n s t i t u t e s 1972, p. 58). Skill  " . . . r e f e r s t o the  l e v e i of p r o f i c i e n c y on a s p e c i f i c  task or l i m i t e d group o f t a s k s " Media I n s t i t u t e s 1972,  p.  58).  (Fleishman:  National  Special  13  Most of the r e s e a r c h i n psychomotor s k i l l  learning  has been i n the f i e l d of e d u c a t i o n , both at the t h e o r e t i c a l and a p p l i c a t i o n l e v e l s .  N u r s i n g has undertaken very  study i n v o l v i n g the psychomotor domain. term  "manual s k i l l s " has not denoted  Perhaps  little  the o f t used  the more complex motor  and sensory f u n c t i o n i n g , thereby r e l e g a t i n g psychomotor to  a " l e s s e r p o s i t i o n " than a f f e c t i v e and c o g n i t i v e  skills  skills.  Whyte (1974) wrote a s e r i e s of a r t i c l e s on n u r s i n g s k i l l s , emphasizing t h a t they are not j u s t manual or p h y s i c a l , but r a t h e r sensory-motor,  r e q u i r i n g i n p u t of the s e n s a t i o n s  and output of movements.  She a l s o d i s c u s s e d the  of  knowledge o f r e s u l t s , t r a n s f e r of s k i l l s and m o t i v a t i o n . Gudmundsen  how  (1975) reviews l e a r n i n g theory and  the l e a r n i n g of n u r s i n g psychomotor s k i l l s can be  f i e d and how tor  importance  mastery can be promoted.  a n a l y s i s of the s k i l l ,  o v e r l e a r n i n g f o r mastery,  asks simpli-  She suggests t h a t  fac-  leading to terminal objectives, accommodates s e l f - p a c i n g ,  and  self-  i n s t r u c t i o n and s e l f - d i r e c t e d l e a r n i n g r e i n f o r c e m e n t . Videotape i n E d u c a t i o n While v a r i o u s media have been used, with i n c r e a s i n g frequency, concern has been expressed r e g a r d i n g the l a c k of r e s e a r c h t o support which media are b e s t used under which conditions. Allen  (1973), Campeau (1974) and Molstad  l i n e t h e i r concerns.  (1974), out-  Campeau reviewed l i t e r a t u r e from 19 66-  14  1971,  r e l a t e d t o the use  of a u d i o v i s u a l media t o t e a c h a d u l t s .  From the v a s t amount of l i t e r a t u r e p u b l i s h e d , d i s a p p o i n t i n g l y few No  s t u d i e s which met  she  her p r e s e t  s t u d i e s u s i n g v i d e o t a p e f e l l w i t h i n the  found criteria.  criteria.  Most of t h i s non-experimental l i t e r a t u r e c o n s i s t e d of surveys, t e s t i m o n i a l s , h i s t o r i c a l and d e s c r i p t i v e assessments, r e p o r t s of i n f o r m a l e v a l u a t i o n s — a l l of which d i d not even attempt t o d e a l w i t h or assess the i n s t r u c t i o n a l e f f e c t i v e n e s s of a u d i o v i s u a l media (Campeau 1974, p. 10). Molstad  (1974, p. 389) , i n h i s s e l e c t i v e review o f  media e f f e c t i v e n e s s a l s o found: These data u s u a l l y c o n s i s t of u t i l i z a t i o n s t a t i s t i c s , teacher t e s t i m o n i a l s or q u e s t i o n n a i r e s and media a t t i t u d e responses, and student documentation of use and preferences. He p o i n t s out  that research  has  o f t e n been l a c k i n g because of  the d i f f i c u l t y i n c o n t r o l l i n g v a r i a b l e s such as the nature of the l e a r n e r , l e a r n i n g s t i m u l i and  "...  their inter-  a c t i o n s , and what s p e c i f i c l e a r n i n g r e s u l t s are achieved (Molstad 1974,  p.  389).  With these comments i n mind, s p e c i f i c s t u d i e s r e p o r t s on the use being on  ..."  of v i d e o t a p e were examined, the  and  emphasis  feedback. C o n f l i c t i n g reports  i n the  l i t e r a t u r e regarding  the  e f f e c t i v e n e s s of s e l f - v i e w i n g , v i a v i d e o t a p e or f i l m , prompted Solomon and  McDonald  (1970) to examine the t o p i c .  n o t i c e d t h a t where the s u b j e c t ' s s u b j e c t knew what was  behavior was  expected of him.  The  They  changed,  two  carried  had the out  a study t o see what happened when d e s i r e d behaviors were not  15  known.  Changes o c c u r r e d which "...were c l e a r l y r e l a t e d t o  the s u b j e c t s ' p r e d i s p o s i t i o n " 285).  No c o n t r o l group was  (Solomon and McDonald 1970,  used and the authors s t a t e t h a t  s e l f - v i e w i n g cannot be regarded as feedback f o r behavior  as no  standard  existed.  P e r r o t t and Duthie Teeple  p.  (1970), DeBacy (1970) and Robb and  (1969) a l s o q u e s t i o n whether the s u b j e c t p e r c e i v e s  h i m s e l f a c c u r a t e l y by viewing h i s performance on v i d e o t a p e . The f a c t t h a t the students d i d not a l t e r t h e i r views i n d i c a t e d perhaps t h a t a s e l f viewing may cause a p s y c h o l o g i c a l b l o c k f o r d e t e c t i n g e r r o r s , t h a t t h e r e i s a l a c k of i n t e r e s t i n viewing f o r e r r o r s i n performance, or both (Robb and Teeple 1969, p. 82). T h i s q u e s t i o n bears f u r t h e r i n v e s t i g a t i o n because of the i m p l i c a t i o n s i t has on u s i n g videotape f o r s e l f - v i e w i n g purposes. Some o f the s t u d i e s reviewed  have used o t h e r t o o l s  w i t h v i d e o t a p e , such as b e h a v i o r c r i t e r i a  (Wragg 1970-71),  s e l f - a n a l y s i s or teacher comment (Breen 1970).  Breen found  a n x i e t y tended t o be reduced i n subsequent performances  and  t h a t videotape alone does not seem t o be a good s u b s t i t u t e f o r teacher comment. In t e s t i n g s c h o o l c h i l d r e n ' s psychomotor s k i l l by v a r i o u s feedback  techniques, Hurley  arrived at interesting conclusions. student r a t e d h i s own  learning  (1971) and Meers (1972)  Hurley found t h a t when a  performance w i t h the a i d of a  checksheet  and videotape r e p l a y , he reached a h i g h e r l e v e l of performance than by viewing the videotape a l o n e , u s i n g the alone or not r e c e i v i n g any feedback.  checksheet  Meers added a f o u r t h  16  dimension,  t h a t of a videotape p l u s a p a n e l of judges.  He  found t h i s the most e f f e c t i v e . Robb and Teeple  (1969), DeBacy (1970) and Armstrong  (1971) have i n v e s t i g a t e d the e f f e c t s of videotaped in  a sports s k i l l .  Armstrong found t h a t i n s t a n t v i s u a l f e e d -  back, as compared t o l e c t u r e - d e m o n s t r a t i o n , d i d not cantly a f f e c t learning tennis s k i l l s . i n c r e a s e d , however.  She  signifi-  found m o t i v a t i o n  DeBacey's hypothesis t h a t "...viewing  o n e s e l f performing a s p o r t s k i l l w i l l reduce between s e l f - a s s e s s e d s k i l l (1970, p.  feedback  any  and a c t u a l s k i l l " ,  differences  was  supported  31).  Mental r e t a r d a t e s are another group who t e s t e d w i t h videotaped feedback (Park 1973).  have been  f o r psychomotor s k i l l  I t i s q u e s t i o n a b l e as t o whether the  learning  findings  from t h i s p o p u l a t i o n can be g e n e r a l i z e d t o those of normal intelligence. With the v a r i e d and not always c o n c l u s i v e data in  found  the p r e c e d i n g s t u d i e s , t h i s author agrees w i t h Molstad  (1974)  and Campeau (1974) t h a t more s c i e n t i f i c r e s e a r c h i s needed. Videotape In  i n E d u c a t i n g Nursing  Students  s e a r c h i n g the n u r s i n g l i t e r a t u r e ,  i t became obvious  t h a t l i t t l e r e s e a r c h had been done i n t e s t i n g media e f f e c t i v e ness, e s p e c i a l l y w i t h t e l e v i s i o n and v i d e o t a p e .  Many of the  r e p o r t s are s i m i l a r t o those found i n e d u c a t i o n — e x p r e s s i o n s of o p i n i o n , q u e s t i o n n a i r e s , one group t e s t i n g .  I t seems much  weight i s p l a c e d on o p i n i o n , as supported by the number of  17  a r t i c l e s of t h i s k i n d (Beyers, Diekelmann and Thompson Brooks 1976,  Davis and Eaton  1974,  Koch 1975,  1972,  Malo-Juvera  1973,  O ' N e i l l 1974). The terms t e l e v i s i o n and videotape are o f t e n used synonymously and a t o t h e r times d i f f e r e n t l y . of t h i s review, no d i f f e r e n t i a t i o n was  For the  made.  T e l e v i s i o n i n n u r s i n g education appeared as the 1950's and e a r l y 1960's ( P h i l l i p s 1956, Scholder 1957,  D i l l e y 1961,  purposes  Okamoto 1962).  as f a r back  M u l l e r and  I t was  primarily  used t o t e a c h content and examples of p a t i e n t s i t u a t i o n s not always a v a i l a b l e t o the s t u d e n t s . S t u d i e s t o i n v e s t i g a t e whether t e l e v i s i o n i s an e f f e c t i v e means f o r t e a c h i n g n u r s i n g have supported the of e d u c a t i o n r e s e a r c h (Westley and Hornback 1964,  findings  VanMondfrans,  Sorenson and Reed 1972). Major reviews of l i t e r a l l y hundreds of comparative e f f e c t i v e n e s s s t u d i e s concluded t h a t , i n g e n e r a l , no s i g n i f i c a n t d i f f e r e n c e s were found when i n s t r u t i o n a l t e l e v i s i o n was compared w i t h f a c e - t o - f a c e , l i v e i n s t r u c t i o n (Campeau 1974, p. 20). Perhaps the most comprehensive r e s e a r c h study  investi-  g a t i n g the use o f t e l e v i s i o n i n t e a c h i n g n u r s i n g s t u d e n t s ,  was  c a r r i e d out from 1962-1964 a t the Bronx Community C o l l e g e and M o n t e f i o r e H o s p i t a l i n New was  shown t h a t one  York  ( G r i f f i n and o t h e r s 1965).  i n s t r u c t o r u s i n g t e l e v i s i o n can teach  students as e f f e c t i v e l y as ten by c o n v e n t i o n a l methods.  It  fifteen Positive  f e e l i n g s about the use of t e l e v i s i o n were expressed by p a t i e n t s , h o s p i t a l s t a f f , teachers and  students.  Students can be exposed t o viewing p a t i e n t s i t u a t i o n s , otherwise u n a v a i l a b l e t o them, through t e l e v i s i o n  (Allen  1975,  18  Hinsvark 1968,  M u l l e r and Scholder 1957,  Okamoto 1962).  Allen  (1975) o b t a i n e d i n c o n c l u s i v e r e s u l t s i n her study of u s i n g videotape t o teach n u r s i n g s i t u a t i o n s .  By her own  admission,  many problems became apparent d u r i n g the course of the r e s e a r c h . The t o p i c o f f e r s the o p p o r t u n i t y f o r repeated r e s e a r c h . Videotape,  as a feedback  t o o l , has p r i m a r i l y been  u t i l i z e d t o teach a f f e c t i v e s k i l l s i n n u r s i n g w i t h p r a c t i c i n g nurses more than w i t h students e n r o l l e d i n n u r s i n g e d u c a t i o n programmes  ( S u l l i v a n and others,, 1975,  Carpenter and K r o t h  1976,  Muecke 1970). A v a r i e t y o f a r t i c l e s can be found e x t o l l i n g the use of videotape f o r feedback Malo-Juvera  1973,  purposes  (Brody 1971,  Davis  1974,  Muecke 1970).  Regler and Anderson (1971) t e s t e d a s m a l l group o f twenty-one h e a l t h educators to determine unfocused  feedback  produced  whether focused or  changes i n s e l f - p e r c e p t i o n .  found focused f e e d b a c k — s t o p p i n g  the tape a t i n t e r v a l s  They and  g i v i n g d i r e c t i o n t o s p e c i f i c c u e s — h a d s h o r t term r e s u l t s o n l y , w h i l e unfocused  feedback  showed none.  The authors  concluded  t h a t v i d e o alone i s not s u f f i c i e n t t o change b e h a v i o r and t h a t there i s a need f o r "...repeated, focused t o produce l a s t i n g changes."  self-confrontations  (Rezler and Anderson 1971,  p.  63).  A study by Q u i r i n g (1972) i n v e s t i g a t e d the e f f e c t s of immediate or delayed videotaped feedback psychomotor s k i l l l e a r n i n g . between types of feedback. or i n t i m i n g o f feedback  as r e l a t e d t o complex  She found no s i g n i f i c a n t  differences  No d i f f e r e n c e s i n performance scores  e x i s t e d between students w i t h a h i g h  19  grade p o i n t average  and a low one.  C r i t i c a l thinking  d i d not i n t e r a c t s i g n i f i c a n t l y w i t h feedback the students w i t h higher c r i t i c a l t h i n k i n g performance  scores.  performance  scores than the c o n t r o l group.  ability  t i m i n g , although achieved h i g h e r  Both experimental groups a t t a i n e d h i g h e r T h i s supported  the  hypothesis t h a t the a u t o t u t o r i a l approach would be more e f f e c t i v e than the c o n v e n t i o n a l d i s c u s s i o n - d e m o n s t r a t i o n . U n f o r t u n a t e l y , the study by Q u i r i n g i s the o n l y one found by t h i s i n v e s t i g a t o r which has researched videotaped feedback w i t h n u r s i n g students performing a psychomotor  skill.  In her study, Q u i r i n g (1972, p. 333) made the assumption  that  v i d e o t a p e feedback  enhances psychomotor performance.  This  q u e s t i o n has not been i n v e s t i g a t e d s p e c i f i c a l l y w i t h n u r s i n g students. S e v e r a l s t u d i e s were found i n the m e d i c a l j o u r n a l s although none of them gave enough content t o adequately assess the r e s u l t s .  Two  Goldman  such s t u d i e s were reviewed. (1969) i n v e s t i g a t e d the use of c r i t i c a l  of videotaped performance repair.  i n c a r r y i n g out an i n g u i n a l h e r n i a  Teams of f i r s t and f o u r t h year s u r g i c a l r e s i d e n t s were  p l a c e d i n one of t h r e e groups.  A l l were videotaped performing  the r e p a i r and then Team A reviewed the tape with an  investi-  g a t o r , Team B reviewed the tape alone and Team C d i d not the tape. later.  The procedure and v i d e o t a p i n g was  C r i t e r i a f o r e v a l u a t i o n were exposure  motions and progress of the o p e r a t i o n . t h a t exposure Team C.  review  see  repeated two weeks time, i n a p p r o p r i a t e  The r e s u l t s  indicated  time decreased f o r Team A and B and i n c r e a s e d f o r  I n a p p r o p r i a t e motions decreased from 96 t o 12 f o r  20  Team A, Team B from 65 t o 9, w h i l e Team C i n c r e a s e d .  No  s i g n i f i c a n t d i f f e r e n c e s i n the progress of the o p e r a t i o n were noted. Ravin  (1974) c a r r i e d out a s i m i l a r study w i t h  fifteen  a n e s t h e s i a students i n t e a c h i n g them a n e s t h e s i a techniques. Ravin found the d i f f e r e n c e s between the groups reviewing the tape w i t h the i n v e s t i g a t o r and those reviewing the tape alone, were not s i g n i f i c a n t .  Nor were d i f f e r e n c e s apparent between  the group reviewing the videotape alone and those who see the tape.  A s i g n i f i c a n t d i f f e r e n c e was  d i d not  found between the  group w i t h the i n v e s t i g a t o r and the group who  d i d not  review  the tape. Discussion The  l i t e r a t u r e review analyzed s e l e c t e d s t u d i e s p e r t i -  nent t o the i n v e s t i g a t i o n of psychomotor s k i l l tape as a feedback students. for  learning, video-  t o o l and the a p p l i c a t i o n of both t o n u r s i n g  An assessment of the c o n c l u s i o n s w i l l g i v e d i r e c t i o n  f u r t h e r r e s e a r c h , based upon i d e n t i f i e d problems. Over the y e a r s , r e s e a r c h has shown t h a t feedback i s  a component necessary f o r e f f e c t i v e l e a r n i n g . r e c o g n i z e d as a b a s i c assumption  f o r t e a c h i n g and  However, the t i m i n g and type of feedback conclusive results. to  determine  T h i s can  learning.  g i v e n has shown i n -  More r e s e a r c h i s i n d i c a t e d i n an  the i d e a l  be  attempt  circumstances.  A l s o w e l l documented, i s the t h e o r e t i c a l base of psycho motor s k i l l  l e a r n i n g , although the i n t r i c a t e mechanisms are not  21  f u l l y understood.  I t would seem t h a t s t u d i e s i n a p p l i c a t i o n of  the theory are needed.  Because of the many v a r i a b l e s  the behavior of i n d i v i d u a l s i n complex s k i l l  learning  identified, situations  has not been e x t e n s i v e l y e x p l o r e d . In  both education and n u r s i n g , t e l e v i s i o n has been  demonstrated t o be as e f f e c t i v e a t e a c h i n g method as f a c e - t o face c o n t a c t .  I t has been asked whether an i n d i v i d u a l a c c u r a -  t e l y p e r c e i v e s h i m s e l f on v i d e o t a p e . q u e s t i o n may himself. to  determine  Research  s p e c i f i c to t h i s  means t o a s s i s t the person i n viewing  Does l e a r n i n g a n u r s i n g s k i l l  encourage the student  focus more c r i t i c a l l y on her performance than l e a r n i n g a  sports s k i l l , f o r instance? Other areas where more r e s e a r c h would be u s e f u l  concern  the ways i n which v i d e o t a p e can be used i n t e a c h i n g n u r s i n g . few s t u d i e s have e x p l o r e d u s i n g videotape t o teach content and s i t u a t i o n s f o r a n a l y s i s .  A  procedures,  However, many of these  s t u d i e s are not r e c e n t or c o n t a i n m e t h o d o l o g i c a l problems. A l s o , most o f the n u r s i n g s t u d i e s have been w i t h p r a c t i c i n g nurses.  Can  these f i n d i n g s be g e n e r a l i z e d t o n u r s i n g students  l e a r n i n g the s k i l l  f o r the f i r s t  time?  As p r e v i o u s l y c i t e d , psychomotor s k i l l n u r s i n g has b a r e l y been touched  upon.  How  learning i n  t o account  for indi-  v i d u a l v a r i a b l e s when l e a r n i n g a psychomotor s k i l l has been looked a t i n r e l a t i o n t o academic and t h i n k i n g a b i l i t i e s . has not been s t u d i e d as t o how and s i t u a t i o n a l v a r i a b l e s  It  p r e v i o u s psychomotor l e a r n i n g  ( c l i e n t , student, environment) a f f e c t  the l e a r n i n g of a n u r s i n g psychomotor  skill.  22  Research d e s c r i b i n g the use o f videotape feedback f o r n u r s i n g psychomotor s k i l l  i n giving  l e a r n i n g i s almost  non-existent. T h i s l i t e r a t u r e review has i n c l u d e d a wide range o f s t u d i e s f o r two reasons.  One has been t o p r o v i d e a t h e o r e t i c a l  base upon which t o operate.  The other has been t o i n d i c a t e  sources which have r e c e i v e d adequate o r inadequate Based upon the review  research.  t h i s author has i d e n t i f i e d  three  broad problem areas which r e q u i r e f u r t h e r e x p l o r a t i o n through sound r e s e a r c h . 1. Psychomotor s k i l l  learning i n nursing.  2. Means f o r p r o v i d i n g feedback t o n u r s i n g students  l e a r n i n g a psychomotor  3. The scope of u s i n g videotape feedback t o n u r s i n g  skill.  i n providing  students.  From these t h r e e areas i t was proposed t h a t r e s e a r c h be c a r r i e d out t o i n v e s t i g a t e the g e n e r a l q u e s t i o n :  i s video-  tape an e f f e c t i v e means of p r o v i d i n g feedback t o n u r s i n g students  l e a r n i n g a psychomotor  skill?  CHAPTER I I I METHODOLOGY D e s c r i p t i o n of the Study Overview The purpose of t h i s study was of  v i d e o t a p e d performance feedback,  feedback,  to i n v e s t i g a t e the use  as compared t o teacher  w i t h n u r s i n g students performing a s p e c i f i e d psycho-  motor s k i l l .  The r e s e a r c h study was  deemed p e r t i n e n t as  i n d i c a t e d by the l a c k o f r e s e a r c h i n the area of psychomotor l e a r n i n g i n n u r s i n g and the i n c r e a s i n g a c c o u n t a b i l i t y p l a c e d on teachers and  students.  A q u a s i - e x p e r i m e n t a l comparative with f i r s t motor s k i l l  year b a c c a l a u r e a t e n u r s i n g s t u d e n t s . s e l e c t e d f o r the study was  c l i e n t from a bed t o a w h e e l c h a i r . was  a second  The  out  psycho-  t h a t of t r a n s f e r r i n g a  A demonstration  of the  skill  video-  The students c a r r i e d out the  skill  time; the experimental group were videotaped w h i l e  the comparison group were g i v e n feedback guided by a performance c h e c k - l i s t . mental group was  of  carried  g i v e n to a l l s u b j e c t s , a f t e r which each s u b j e c t was  taped performing the s k i l l .  for  study was  by a t e a c h e r , who  was  Each member of the e x p e r i -  g i v e n her videotape and a performance c h e c k - l i s t ,  review d u r i n g the next week.  A f t e r a s p e c i f i e d time p e r i o d  e l e v e n or twelve days, a l l s u b j e c t s r e t u r n e d f o r a t e s t  performance of the s k i l l .  Performances on the f i r s t  videotape  were scored t o p r o v i d e a data base and d e t e r m i n a t i o n of sample  23  24  homogeneity.  The g a i n scores between the d a t a base performance  and t e s t performance were computed t o t e s t the h y p o t h e s i s . S u b j e c t s d i d not view the data base o r t e s t performance  video-  tapes. The V a r i a b l e s 1. Dependent v a r i a b l e ;  The s c o r e s o b t a i n e d , u s i n g a performance  c h e c k - l i s t , d u r i n g the f i n a l t e s t performance o f students p e r forming a s p e c i f i e d psychomotor s k i l l ,  f o l l o w i n g videotaped  feedback or t e a c h e r feedback. 2. Independent v a r i a b l e :  The method o f performance  feedback—  videotaped o r t e a c h e r — g i v e n t o the s t u d e n t . The Design The p r e t e s t - p o s t t e s t c o n t r o l group d e s i g n was used t o c a r r y out t h i s study (Campbell and Stanley,1966, pp. Group 1 R (experimental)  0±  X±  0  2  Group 11 R (comparison)  0  X  0  4  S u b j e c t s were randomly or comparison groups.  3  2  13-22).  (R) p l a c e d i n t o e x p e r i m e n t a l  Both groups were scored on t h e i r  (data base) performances  (0^ and O3).  initial  Videotaped feedback  (X^)  was g i v e n to the e x p e r i m e n t a l group, w h i l e t e a c h e r feedback (X ) was g i v e n t o the comparison group. 2  were scored  (O^ and 0^) f o r both groups.  Final test  performances  The term "comparison  group" was used r a t h e r than " c o n t r o l group" as the p a r t i c i p a n t s  25  r e c e i v e d a form of feedback. In  t e s t i n g psychomotor  skill  l e a r n i n g , the number o f  c h a r a c t e r i s t i c s encountered, without means of c o n t r o l , would seem t o pose the q u e s t i o n , "how t h i s reason, i t was  and what to p r e t e s t ? "  For  o r i g i n a l l y i n t e n d e d t h a t a p r e t e s t not be  g i v e n and t h a t a p o s t t e s t - o n l y c o n t r o l group d e s i g n be used. However, i t was d e c i d e d t h a t by having a d a t a base of performance scores p r i o r t o the feedback treatments, i n i t i a l  differences  between groups i n the performance o f the s p e c i f i e d s k i l l be determined.  I t was not f e a s i b l e t o p l a c e s u b j e c t s i n t o each  group a e c o r d i n g t o scores s i n c e they were not a v a i l a b l e a l l t e s t i n g was  completed.  Random placement of s u b j e c t s  comparison and experimental groups was to  could  d i s t r i b u t e the e f f e c t s of l e a r n e r  until into  a l s o seen as a mechanism  characteristics.  Sample S e l e c t i o n The In controlled.  Setting  a h o s p i t a l s e t t i n g , many v a r i a b l e s cannot be Environmental and c l i e n t v a r i a b l e s are  A l s o c l i e n t s a f e t y would be o f concern.  fully  examples.  An a d d i t i o n a l v a r i a b l e  which cannot be e a s i l y measured i s student a n x i e t y which  may  be i n c r e a s e d when i n the c l i n i c a l s e t t i n g w i t h c l i e n t s . For s e t t i n g was  the above reasons, a s c h o o l o f n u r s i n g  laboratory  s e l e c t e d i n an attempt to decrease the number of  extraneous v a r i a b l e s . study were new  The l a b o r a t o r y f a c i l i t i e s used i n the  t o the s t u d e n t s , which may  have i n t r o d u c e d other  26  variables.  However, i t was f e l t t h a t a l a b o r a t o r y s e t t i n g  would p r o v i d e some means o f c o n t r o l f o r a l l s u b j e c t s . The s k i l l  t e s t e d was p a r t o f the students u s u a l l a b o r a -  t o r y experience d u r i n g the time o f the study. The  Sample  Sixteen f i r s t - y e a r baccalaureate nursing students, i n the same c l a s s , p a r t i c i p a t e d i n the study.  The sample con-  s i s t e d o f f i f t e e n females and one male. The t o t a l c l a s s o f students had been d i v i d e d i n t o two l a b o r a t o r y groups, r e c e i v i n g t h e i r l e a r n i n g experiences on c o n s e c u t i v e days.  W i t h i n each h a l f of the c l a s s , f o u r groups  existed. The  sample was s e l e c t e d immediately  being implemented.  p r i o r t o the study  The teacher i n charge o f each group o f  students asked f o r two students t o v o l u n t e e r f o r t h e study. S i t u a t i o n a l circumstances d i c t a t e d t h a t the sample c o n s i s t o f students who v o l u n t e e r e d . Each p a r t i c i p a n t was randomly p l a c e d i n t o the e x p e r i mental or comparison group.  T h e r e f o r e , on each day there were  f o u r s u b j e c t s i n the experimental group and f o u r i n the comparison group, f o r a t o t a l o f e i g h t students i n each group. Data Gathering  Instruments  The Performance C h e c k - L i s t A c h e c k - o f f o b s e r v a t i o n sheet c o n s i s t i n g o f d e s i r e d behaviours f o r t h e psychomotor s k i l l  selected —  transferring a  27  " c l i e n t " from a bed t o a w h e e l c h a i r ™ was study.  designed  for this  (See Appendix A ) . The instrument was  used  i n four ways.  Firstly,  i t was  used t o score the performances of both groups i n the data base videotape. to  The experimental group was  s e l f - e v a l u a t e themselves  The teacher who  g i v e n a copy of the t o o l  a g a i n s t t h e i r performance v i d e o t a p e .  gave the feedback  to the comparison group a l s o  had a copy of the t o o l as a guide.  L a s t l y , the t o o l was  used  r a t e the t e s t performances o f both the experimental and son  to  compari-  groups. References  on p r i n c i p l e s of body mechanics and the t e c h -  niques of t r a n s f e r r i n g c l i e n t s were c o n s u l t e d i n order to i s o l a t e p e r t i n e n t behaviours r e q u i r e d t o c a r r y out the (Fuerst, Wolff and W e i t z e l 1974, J a e c k e l s 1973,  skill.  pp. 268-278, Krueger  pp. 31-32, Lewis 1976,  pp.  and  60-68 and pp.  A l l of the items c o n t a i n e d i n the t o o l were o b s e r v a b l e  252-253). behaviours  and deemed e s s e n t i a l by the i n v e s t i g a t o r and a p a n e l of t h r e e teachers of n u r s i n g so t h a t the t e s t r e s u l t s were amenable to s t a t i s t i c a l analysis.  A simple s c o r i n g method of 1  present) or 0 (behaviour performed or  omitted) was  i n c o r r e c t l y , not  (behaviour completed,  decided upon.  The t o o l was  t e s t e d f o r content v a l i d i t y ,  and i n t r a - r a t e r r e l i a b i l i t y .  A p r e l i m i n a r y item a n a l y s i s  c a r r i e d out by t h r e e r a t e r s u s i n g the twenty-three on s i x performances.  interrater was  items scored  However, the spread of disagreement  noted  between the t h r e e r a t e r s made i t d i f f i c u l t t o remove o f f e n d i n g items.  I t was  t h e r e f o r e decided t o r e t a i n a l l items on  the  28  performance  check-list.  To e s t a b l i s h  content v a l i d i t y , a p a n e l of t h r e e nurse  educators, f a m i l i a r w i t h t e a c h i n g the s k i l l , were asked t o r e view the performance c h e c k - l i s t items were d e l e t e d and f o r one by adding a phrase.  f o r content.  As a r e s u l t ,  item the i n t e n t was  clarified  The two d e l e t e d items were r e l a t e d  p e r t a i n e d t o a d j u s t i n g the bed t o the c o r r e c t  height.  and I t was  f e l t t h a t the bed h e i g h t should have been adjusted p r i o r s i t t i n g the c l i e n t on the edge of the bed; measured i n t h i s study.  Interrater  draft  The remaining items on the  t o o l were seen, by the p a n e l , as a p p r o p r i a t e c r i t e r i a i n c l u s i v e of the behaviours  to  the l a t t e r not being  (See Appendix B f o r the f i r s t  of the performance c h e c k - l i s t ) .  two  and  expected.  r e l i a b i l i t y was  t e s t e d by t h r e e n u r s i n g  teachers s i m u l t a n e o u s l y viewing a videotape of s i x performances of the designated s k i l l . p l a y i n g the s k i l l .  Four nurses were videotaped  role-  Each nurse gave a d i f f e r e n t performance i n  order t o e l i c i t a range of s c o r e s .  The r a t e r s were allowed  to view the v i d e o t a p e s u n t i l they f e l t c o n f i d e n t i n t h e i r scoring. The 373-374) was  c o e f f i c i e n t of concordance W used to determine  the t h r e e r a t e r s  0.92.  above the 0.01  W measures the  scores between a l l p a i r s  The c o e f f i c i e n t of concordance was T h i s was  pp.  i n t e r r a t e r r e l i a b i l i t y between  (see Table 6, Appendix C ) .  degree of agreement of ranked raters.  (Ferguson 1976,  found t o be  of V/ -  accepted as being a s i g n i f i c a n t c o r r e l a t i o n level.  well  29  To t e s t f o r i n t r a - r a t e r r e l i a b i l i t y , viewed the same tape one-week l a t e r . s h i p between the f i r s t and  the t h r e e r a t e r s  To measure the  relation-  second scores f o r each r a t e r d u r i n g  the s i x performances, c o r r e l a t i o n c o e f f i c i e n t s were determined. (See Table 7, Appendix D). r = 0.86,  r = 0.94  and  r e q u i r e d a t the 0.05 test.  The  t h r e e c o e f f i c i e n t s were:  r = 0.99.  A c r i t i c a l v a l u e of 0.81  was  l e v e l of s i g n i f i c a n c e , u s i n g a t w o - t a i l e d  T h e r e f o r e , i n t r a - r a t e r r e l i a b i l i t y was The  accepted.  Questionnaire  In a d d i t i o n t o the performance c h e c k - l i s t a q u e s t i o n n a i r e was of  designed.(See Appendix E ) . t h i s q u e s t i o n n a i r e was  The major o b j e c t i v e f o r the  use  t o c o l l e c t d a t a i n r e l a t i o n t o the  seventeen c h a r a c t e r i s t i c s o f the l e a r n e r c i t e d by Singer a l S p e c i a l Media I n s t i t u t e s 1972,  pp.  21-25).  I t was  (Nation-  recognized  t h a t o n l y a few of the c h a r a c t e r i s t i c s were assessed, but  they  were seen as the major f a c t o r s a f f e c t i n g the s k i l l of t r a n s f e r ring a client.  As w e l l as p r o v i d i n g some d e s c r i p t i v e data about  the sample, the q u e s t i o n n a i r e was to  anticipated to give  the f i n d i n g s of the r e s e a r c h study.  I t was  support  also f e l t that  d i r e c t i o n f o r f u r t h e r study would emerge from the data  collected  on the q u e s t i o n n a i r e . Implementation During  the r e s e a r c h study, both the experimental  comparison groups underwent the f o l l o w i n g a c t i v i t i e s : 1. Random placement i n t o e i t h e r group.  and  30  2. Videotape o f i n i t i a l performance.  I n d i v i d u a l s c o r e s and  group scores were t a b u l a t e d t o p r o v i d e a d a t a base (0^ and O^).  Students d i d not view the tape.  3. Feedback  treatment.  (a) Experimental group: student was  Videotaped  feedback  (X^).  The  asked t o review her tape, u s i n g the t e s t  performance c h e c k - l i s t as a guide i n her (b) C o n t r o l group:  Teacher  feedback  (X^).  self-evaluation. A t e a c h e r , using  the performance c h e c k - l i s t gave the " u s u a l " p o i n t e r s i n g u i d i n g a student through a new answered but no demonstration  skill.  Questions were  given.  4. Videotape of f i n a l performance e l e v e n or twelve days l a t e r (depending  on the group).  the s t u d e n t s .  T h i s v i d e o t a p e was  The q u e s t i o n n a i r e was  Performance scores were computed  (0  not viewed by  completed 2  and  at t h i s  time.  0^).  E x p l a n a t i o n of each of the above a c t i v i t i e s f o l l o w s . The  study was  e x p l a i n e d t o the s u b j e c t s i n terms of the  i n v e s t i g a t o r ' s i n t e r e s t i n determining e f f e c t i v e ways o f h e l p i n g students l e a r n n u r s i n g s k i l l s .  The approximate time commitment  asked of the students was  (about two  A consent  form was  given  hours).  signed by a l l p a r t i c i p a n t s , p r i o r t o  the study, i n d i c a t i n g t h e i r p e r m i s s i o n t o be p a r t of the and t o have the r e s u l t s made known.(See Appendix F ) .  study  I t was  c l e a r l y s t a t e d t h a t o n l y the r e s e a r c h e r , her t h e s i s committee members and her a s s i s t a n t s would have access t o the v i d e o t a p e s . I t was  a l s o emphasized t h a t the i n d i v i d u a l performance s c o r e s  would not be r e l e a s e d or i d e n t i f i e d t o any persons.  Further,  31  performance scores i n t h i s study would not be used f o r e v a l u a t i o n purposes w i t h i n the s c h o o l .  The e d u c a t i o n a l  institution,  i n which the study was c a r r i e d out, r e q u i r e d an a d d i t i o n a l consent t o be signed by the p a r t i c i p a n t s g i v i n g p e r m i s s i o n f o r v i d e o t a p e t o be used. Videotape was used t o r e c o r d the i n i t i a l and f i n a l p e r formances f o r two reasons.  One was  a v a i l a b l e f o r a p e r i o d of time. speed a t which the psychomotor to  t o have the raw d a t a  The o t h e r p e r t a i n e d t o the s k i l l was performed i n r e l a t i o n  the l a r g e number o f c r i t i c a l elements i n v o l v e d i n the s k i l l .  I t would have been d i f f i c u l t t o a c c u r a t e l y score the performance i f o n l y one v i e w i n g was  available.  T h e r e f o r e , by u s i n g v i d e o -  tape, the r a t e r c o u l d review the tapes as o f t e n as necessary when s c o r i n g each performance. The s u b j e c t s were a s s i g n e d a random number  (Kendall  1962, pp. 177-183), which became t h e i r code number throughout the  study.  Each student was  asked t o draw a number from a box  to determine e x p e r i m e n t a l or comparison group d e s i g n a t i o n . T h i s procedure was used t o e s t a b l i s h a random placement the  into  groups. The i n i t i a l v i d e o t a p e o f the student's performance  was  an attempt t o c a p t u r e a p r e - e x p e r i m e n t a l data base t o de-  termine the degree o f homogeneity between the two groups. was  a n t i c i p a t e d t h a t the scores would be s i m i l a r because of  the  randomization.  T h i s r e a s o n i n g was  It  s u b s t a n t i a t e d by the  s t a t i s t i c a l a n a l y s i s of the s c o r e s , which i n d i c a t e d no s i g n i f i cant score d i f f e r e n c e s e x i s t e d between the groups.  A summary  32  of the a n a l y s i s  i s found i n Chapter IV, p. 39.  Knowledge o f  the o r i g i n a l scores allowed f o r computation o f i n t r a - g r o u p and  i n t e r - g r o u p changes between the d a t a base performance and  t e s t performance. P r i o r t o the t a p i n g , the i n v e s t i g a t o r persons  instructed  four  (not students o r teachers i n the study agency) t o move  i n the same way and e x h i b i t the same l i m i t a t i o n s as the " c l i e n t " i n the s i t u a t i o n .  The same two persons p a r t i c i p a t e d  d u r i n g the  i n i t i a l performance t e s t i n g and the feedback treatments. o t h e r persons r o l e - p l a y e d performance.  t h e " c l i e n t " d u r i n g the f i n a l  Two test  I t was f e l t t h a t random order of student t e s t i n g  would decrease the p o s s i b i l i t y o f advantages i n performance due t o the d i f f e r e n c e s  which may e x i s t between  "clients".  In order t o l i m i t the amount o f time i n v o l v e d  f o r the  students, the i n i t i a l and f i n a l t e s t performances were c a r r i e d out u s i n g two v i d e o cameras i n two d i f f e r e n t rooms. gator and another person, i n s t r u c t e d  The i n v e s t !  t o use the same f i l m i n g  p a t t e r n s , c a r r i e d o u t t h e e n t i r e v i d e o t a p i n g i n the study. Using two v i d e o cameras n e c e s s i t a t e d for  each  having the two " c l i e n t s "  session. Because o f the e x i s t i n g circumstances i n the study  field,  the i n v e s t i g a t o r  taught the s k i l l o f t r a n s f e r r i n g a  c l i e n t , from t h e s i t t i n g p o s i t i o n on the edge o f a bed, i n t o a wheelchair. and  Teaching s t r a t e g i e s  discussion  employed were demonstration  i n which p r i n c i p l e s u n d e r l y i n g body mechanics  were i n c o r p o r a t e d .  P r i o r t o i n s t r u c t i o n , the students had  completed a l e a r n i n g module on the s k i l l .  33  Immediately  f o l l o w i n g the demonstration, the s u b j e c t s  were v i d e o t a p e d , i n random o r d e r , f o r t h e i r i n i t i a l performance.  Random o r d e r i n g was  (data base)  an attempt t o c o n t r o l f o r  maturation between the demonstration of the s k i l l and the s t u dents' performance. knowing who  was  The o r d e r i n g a l s o prevented the r a t e r from  i n the experimental arid comparison  groups.  The  f o l l o w i n g s i t u a t i o n and d i r e c t i o n s were shown t o each student, upon e n t e r i n g the room; CLIENT SITUATION DATA: -  75 year o l d female injured r i g h t leg (painful) no weight b e a r i n g on r i g h t l e g unsteady on l e f t l e g , but can stand with support of one person - s i t t i n g on edge of bed ready t o get up, except f o r p u t t i n g on s l i p p e r s  TASK: - t r a n s f e r c l i e n t t o w h e e l c h a i r I n a d v e r t e n t l y , f o u r students were not shown the s i t u a t i o n d u r i n g the i n i t i a l performance,  on the f i r s t day.  However,  s i n c e they had so r e c e n t l y seen the demonstration of t r a n s f e r r i n g a c l i e n t , a l l f o u r s u b j e c t s proceeded without h e s i t a t i o n . N e i t h e r the " c l i e n t " nor the camera o p e r a t o r noted any obvious d i f f e r e n c e s between those students who and those who  r e c e i v e d the d i r e c t i o n s  d i d not.  A f t e r the i n i t i a l performance,  the e x p e r i m e n t a l and  comparison groups underwent t h e i r r e s p e c t i v e feedback s i m u l t a n e o u s l y , i n d i f f e r e n t rooms.  treatments  The experimental group  was  asked to perform the t r a n s f e r s k i l l a g a i n , u s i n g the same situation.  They were informed t h a t they would be v i d e o t a p e d .  34  Upon completion of the t r a n s f e r , each student was g i v e n an i n d i v i d u a l copy of t h e i r v i d e o t a p e d performance and i n s t r u c t e d to  review the tape d u r i n g the next week, a t her convenience.  These students were g i v e n the performance c h e c k - l i s t (without the  marking i n s t r u c t i o n s ) , t o a s s i s t them i n t h e i r  evaluation. the  self-  The i n v e s t i g a t o r was r e s p o n s i b l e f o r v i d e o t a p i n g  e x p e r i m e n t a l group and g i v i n g the i n s t r u c t i o n s t o the s t u -  dents f o r the use o f t h e v i d e o t a p e . Meanwhile, the comparison group was a l s o asked t o r e p e a t the  transfer s k i l l .  Each s t u d e n t was g i v e n v e r b a l feedback, by  a t e a c h e r , d u r i n g the performance. the  T h i s feedback c o n s i s t e d of  g e n e r a l " p o i n t e r s " , c o r r e c t i o n s e t c e t e r a , a c c o r d i n g t o the  performance c h e c k - l i s t , i n the u s u a l manner o f h e l p i n g students l e a r n a new s k i l l .  The t e a c h e r had a l s o a c t e d as t h e o t h e r  video-camera o p e r a t o r . The s t u d e n t s , i n both groups, were asked not t o d i s c u s s w i t h anyone, what each had been requested t o do i n the study. They were a l s o i n s t r u c t e d t h a t p r a c t i c e of t h e s k i l l was a l l o w e d , as t h i s s k i l l was p a r t of t h e i r n u r s i n g  programme.  A time common f o r a l l s t u d e n t s , was agreed upon f o r the f i n a l t e s t performance.  A s c h o o l term break and c o n f l i c t s i n  c l a s s schedules d i c t a t e d t h e a v a i l a b l e time f o r t e s t i n g .  The  end r e s u l t gave one group f i v e s c h o o l days and the o t h e r group f o u r s c h o o l days, e x c l u s i v e o f the day of t e s t i n g , between t h e initial  and f i n a l t e s t performances.  T h i s amounted t o a t o t a l  l a p s e of e l e v e n o r twelve days, depending on the group. For  the f i n a l t e s t performance, students drew a number  35  for  random order of t e s t i n g , t o c o n t r o l f o r f a c t o r s such as  f a t i g u e and f o r the reasons g i v e n i n the i n i t i a l  testing.  Two  video-cameras were used, along w i t h two " c l i e n t s " , l o c a t e d i n d i f f e r e n t rooms.  The students were shown t h e same " c l i e n t  s i t u a t i o n " and asked t o perform  the same s k i l l .  Due t o a t t r i -  t i o n , o n l y f o u r t e e n s u b j e c t s p a r t i c i p a t e d i n the f i n a l  test  performance. F o l l o w i n g t h e videotaped performance, each student was asked  t o complete the q u e s t i o n n a i r e . The  initial  performance v i d e o t a p e s and f i n a l t e s t per-  formance v i d e o t a p e s were not seen by the students. of  Both s e t s  videotapes were scored by an e x t e r n a l r a t e r who had no  knowledge o f which students were i n the experimental o r comparison groups.  The r a t e r had had p r e v i o u s experience w i t h the  i n v e s t i g a t o r i n viewing and r a t i n g the v i d e o t a p e s used f o r t e s t i n g the performance c h e c k - l i s t t o o l . f a m i l i a r w i t h the performance c h e c k - l i s t .  The r a t e r was a l s o Since i t was the  student's performance being r a t e d and not the a b i l i t y of the r a t e r , t h e r a t e r was allowed t o view the videotapes as o f t e n as she f e l t  necessary. Method of Data A n a l y s i s The n u l l hypothesis formulated f o r t e s t i n g can be s t a t e d  as f o l l o w s : There w i l l be no d i f f e r e n c e i n scores on a performance c h e c k - l i s t between those b a c c a l a u r e a t e n u r s i n g students r e c e i v i n g videotaped performance _ feedback, f o r a s p e c i f i e d psychomotor s k i l l , and those students r e c e i v i n g teacher feedback f o r the same s k i l l .  36  A 0.05  alpha l e v e l of s i g n i f i c a n c e was  specified  determine c r i t i c a l r e g i o n s f o r r e j e c t i o n of the n u l l Campbell and S t a n l e y f o r the d e s i g n used i n t h i s  (1966, p. 23)  to  hypothesis.  state that,  study  The most w i d e l y used a c c e p t a b l e t e s t i s t o compute f o r each group p r e t e s t - p o s t t e s t g a i n scores and t o compute a t between experimental and c o n t r o l groups on these gain scores. T h e r e f o r e , a o n e - t a i l e d t t e s t was  employed to t e s t  the h y p o t h e s i s . The data base videotape s c o r e s were computed to d e t e r mine sample homogeneity. was  A t t e s t f o r independent samples  used to t e s t t h a t the two  same p o p u l a t i o n Model 10, p.  samples  (Hewlett-Packard  (groups)  belonged  C a l c u l a t o r , 9810  to the  A S t a t Pac,  241).  To determine i n t r a - g r o u p g a i n s c o r e d i f f e r e n c e s , a t t e s t f o r dependent samples was 1970,  pp.  c a r r i e d out  (Glass and  Stanley  297-298).  The q u e s t i o n n a i r e was of responses  t o each q u e s t i o n .  analyzed i n terms of  frequency  The responses were l a t e r  porated i n t o the i n t e r p r e t a t i o n of the s t a t i s t i c a l  incor-  analysis.  CHAPTER IV ANALYSIS OF THE DATA T h i s study was undertaken  t o answer the q u e s t i o n :  does the use o f a videotaped r e c o r d i n g o f a n u r s i n g student performing a psychomotor s k i l l , w i t h subsequent review by t h e student, enhance t h a t student's performance?  One n u l l hypo-  t h e s i s was t e s t e d t o answer t h i s q u e s t i o n . The a n a l y s i s o f the data i s presented i n r e l a t i o n t o the h y p o t h e s i s , w i t h a d d i t i o n a l f i n d i n g s from the data base performance s c o r e s and the questionnaire. ., A d i s c u s s i o n o f 1  the f i n d i n g s and l i m i t a t i o n s o f the study w i l l attempt the r e s u l t s i n p e r s p e c t i v e . A n a l y s i s o f the Data F i n d i n g s i n R e l a t i o n t o t h e Hypothesis The h y p o t h e s i s t e s t e d was t h a t There w i l l be no d i f f e r e n c e i n scores on a performance c h e c k - l i s t between those baccal a u r e a t e n u r s i n g students r e c e i v i n g videotaped performance feedback, f o r a s p e c i f i e d psychomotor s k i l l , and those students r e c e i v i n g teacher feedback f o r the same s k i l l .  37  to place  38  The g a i n scores between the data base and f i n a l  test  performance scores f o r the experimental group and comparison group were computed.  The summary of t h i s data i s shown i n  T a b l e 1. TABLE 1 SUMMARY OF DATA BASE SCORES, TEST PERFORMANCE SCORES AND GAIN SCORES OBTAINED BY EXPERIMENTAL AND COMPARISON GROUPS  Group  Experimental  Comparison  Data Base Scores  Test Scores  17  23  6  19  19  0  16  23  7  23  23  0  15  17  2  19  17  -2  19  16  -3  15  15  0  17  21  4  14  23  9  22  22  0  23  20  -3  22  23  1  16  21  5  Gain Scores  39  A o n e - t a i l e d t t e s t was used t o compare t h e g a i n s c o r e s between t h e two groups.  The f i n d i n g was t = 0.41  which i s not s i g n i f i c a n t a t the 0.05 l e v e l . thesis  was not r e j e c t e d .  The n u l l hypo-  Table 2 summarizes t h e r e s u l t s . TABLE 2  - COMPARISON OF GAIN SCORES OBTAINED BY THE EXPERIMENTAL AND COMPARISON GROUPS BETWEEN THE DATA BASE PERFORMANCES AND TEST PERFORMANCES  Group  N  X  S.D.  df  t  Experimental  7  1.43  3. 82  12  0.41*  Comparison  7  2.29  3.99  *not s i g n i f i c a n t a t the 0.05 l e v e l .  40  F i n d i n g s i n R e l a t i o n t o the Data Base Performance Scores The performances i n the d a t a base v i d e o t a p e were r a t e d and a s c o r e computed f o r each s u b j e c t (N=16).  A two-tailed t  t e s t f o r independent groups was used t o compare the mean scores of the experimental and comparison groups. v a l u e o f t = 0.38 was n o t s i g n i f i c a n t freedom a t the 0.05 l e v e l .  The r e s u l t i n g  f o r f o u r t e e n degrees o f  T h e r e f o r e , t h e experimental and  comparison groups were c o n s i d e r e d t o have been drawn from the same p o p u l a t i o n .  T a b l e 8, Appendix G l i s t s the raw scores  f o r each group, w h i l e Table 3 summarizes  the r e s u l t s .  TABLE 3 COMPARISON SCORES OBTAINED BY THE EXPERIMENTAL AND COMPARISON GROUPS ON THE DATA BASE PERFORMANCE  Group  N  X  S.D.  df  t  Experimental  8  18.88  2.95  14  0.38*  Comparison  8  18.25  3.54  *not s i g n i f i c a n t a t the 0.05 l e v e l .  41  F i n d i n g s i n R e l a t i o n t o Intra-Group Scores Within each o f t h e e x p e r i m e n t a l and comparison groups, i n t r a - g r o u p g a i n scores between the data base performance scores and t e s t performance scores were compared.  A paired  comparison o n e - t a i l e d t t e s t r e s u l t e d i n the v a l u e s t a b u l a t e d i n T a b l e 4. TABLE 4 PAIRED COMPARISONS WITHIN THE EXPERIMENTAL AND COMPARISON GROUPS BETWEEN DATA BASE PERFORMANCE SCORES AND TEST PERFORMANCE SCORES  Group  N  df  t  Experimental  7  6  -0.989*  0.3611  Comparison  7  6  -1.516*  0.1802  *not s i g n i f i c a n t a t the 0.05 l e v e l .  Probability  42  F i n d i n g s i n R e l a t i o n t o the Q u e s t i o n n a i r e The r e s u l t s of t h e q u e s t i o n n a i r e have been t a b u l a t e d by n o t i n g the number of responses t o each item. j e c t s completed  the q u e s t i o n n a i r e .  Fourteen sub-  The data i s summarized i n  T a b l e 5 a c c o r d i n g t o each q u e s t i o n . TABLE 5 SUMMARY OF DATA COLLECTED ON THE QUESTIONNAIRE  Number of Responses Experimental Comparison Group Group  Question  Total  1. Age range: 17 - 20 years  6  5  11  21 - 24 years  1  2  3  25 - 28 years  0  0  0  29-32  0  0  0  0  0  0  yes  3  3  6  no  4  4  8  yes  1  4  5  no  6  3  9  0  0  0  years  33 and over 2. Do you c o n s i d e r y o u r s e l f actively involved i n a p h y s i c a l f i t n e s s programme?  Actively involved i n sports?  3. How would you r a t e your g e n e r a l muscle tone? Poor  43  TABLE 5 - Continued  Question  Number of Responses Experimental Comparison Group Group  Below average  Total N=14  1  1  Average  7  2  9  Above average  0  3  3  Excellent  0  1  1  Poor  0  0  0  Below average  2  1  3  Average  3  2  5  Above average  2  3  5  Excellent  0  1  1  Poor  0  0  0  Below average  1  1  2  Average  5  6  11  Above average  1  0  1  Excellent  0  0  0  6  6  12  4. How would you r a t e your g e n e r a l muscle s t r e n g t h ?  5. How would you r a t e y o u r s e l f i n performing n u r s i n g s k i l l s ( i . e . "motor s k i l l s " ) ?  6. In comparing y o u r s e l f t o your c l a s s m a t e s , do you f i n d t h a t performing a n u r s i n g s k i l l takes you Longer than the average time Average time  44  TABLE 5 -  Continued  Number of Responses [Experimental Comparison Group Group  Question Less than average 7. Which do you f i n d to do:  Total N=14  time  easier  (a) L e a r n i n g something which r e q u i r e s " f i n e " movement of the hands or body (b) L e a r n i n g something which i n v o l v e s "gross" body movement (c) I f i n d no d i f f e r e n c e i n l e a r n i n g (a) or (b) 8. Have you had any experience in transferring clients?  If  yes  1  0  1  no  6  7  13  yes, i n what c a p a c i t y ? *  9. How much time have you spent practicing this s k i l l since you f i r s t d i d i t l a s t week? with a  classmate  yes  1  no  6  (twice)  2-once 3^1-twice' 4  4 10  • c a p a c i t y w i l l not be recorded i n o r d e r t o p r o t e c t anonymity of s u b j e c t .  Discussion The  of the  n u l l h y p o t h e s i s was  of s i g n i f i c a n c e . differences  The  existed  Findings not  rejected  have c o n t r i b u t e d  d i s c u s s i o n which f o l l o w s f a c t o r s which may differences  level  f o r students r e c e i v i n g videotaped performance i n Table 2, page 3 9  f i n d i n g supports those r e p o r t e d i n the  f a c t o r s may  0.05  r e s u l t s i n d i c a t e d t h a t no s i g n i f i c a n t  feedback or teacher feedback, as i n d i c a t e d This  at the  has  Several  to the r e s u l t s i n t h i s study. attempted t o propose a few  have accounted f o r the  between groups, and  the comparison group.  literature.  f o r the  The  of these  l a c k of s i g n i f i c a n t l a r g e r g a i n scores of  Since the q u e s t i o n n a i r e was  intended  to  f a c i l i t a t e i n t e r p r e t a t i o n of the f i n d i n g s , the r e s u l t s have been i n c o r p o r a t e d That two cannot be six  throughout t h i s  s u b j e c t s were unable to r e t u r n  ignored.  points  The  for testing  experimental group s u b j e c t  had  scored  h i g h e r than the comparison group p a r t i c i p a n t .  wide d i f f e r e n c e c o u l d on  discussion.  have c o n s i d e r a b l y  This  a f f e c t e d the g a i n scores  the f i n a l t e s t i n g depending upon the performance of each of  these p a r t i c i p a n t s . The a f f e c t e d by was  r = 0.61,  a t the  0.05  scores).  v a l u e of t on the g a i n scores c o u l d low  rater r e l i a b i l i t y .  which i s not  The  have been  correlation coefficient  s i g n i f i c a n t for a two-tailed  l e v e l of s i g n i f i c a n c e • ( S e e  T a b l e 10,  I f the r e l i a b i l i t y score of the  Appendix I f o r  r a t e r had  p r i o r to her r a t i n g of the t e s t performances, t h i s would have i n c r e a s e d  test  been a v a i l a b l e investigator  the r a t e r ' s t r a i n i n g i n regards t o  scoring  46  the v i d e o t a p e d performances. to  T h i s was not accomplished due  t h e time c o n s t r a i n t s imposed upon the i n v e s t i g a t o r . The teacher feedback was g i v e n a t the time the student  was performing t h e s k i l l .  The v i d e o t a p e d feedback was n o t  c o n t r o l l e d f o r t i m i n g , hence i t v a r i e d from student t o student over a p e r i o d o f eleven t o twelve days.  Although i t has been  suggested i n the l i t e r a t u r e t h a t t i m i n g of feedback i s not s i g n i f i c a n t , i t may have been an i n f l u e n c i n g f a c t o r i n t h i s study s i n c e the time p e r i o d was g r e a t e r than 24 hours. While w a i t i n g f o r t e s t i n g , p a r t i c i p a n t s i n the e x p e r i mental and comparison  groups were n o t separated.  Due t o the  f a c i l i t i e s a v a i l a b l e , they were seated t o g e t h e r i n the same ante room.  Both groups had been i n s t r u c t e d not t o d i s c u s s  what each was doing i n the study, but because  the groups were  t o g e t h e r i t was i m p o s s i b l e t o "hide" v i d e o t a p e s g i v e n t o the experimental group  from members o f the comparison  group.  This  exposure t o the f a c t that some had v i d e o t a p e s and some d i d n o t have v i d e o t a p e s may have cued both groups t h a t they were " d i f f e r e n t " from each o t h e r .  T h i s c o u l d have i n c r e a s e d both groups'  focus on the s k i l l . Using v o l u n t e e r s u b j e c t s f o r the sample c o u l d have i n f l u e n c e d the r e s u l t s .  Apart from the data base s c o r e s , which  suggest sample homogeneity, i t i s not known whether the v o l u n t e e r sample i s r e p r e s e n t a t i v e o f the f i r s t  year bacca-  laureate nursing population. P r a c t i c e of the s k i l l must be argued as a major f a c t o r in  c o n t r i b u t i n g t o the s l i g h t l y higher mean g a i n score o f the  47  comparison group  (Table 2, p. 39).  R e s u l t s from the q u e s t i o n -  n a i r e i n d i c a t e t h a t t h r e e o f the f o u r s u b j e c t s who  practiced  between the data base performance and t e s t performance were i n the  comparison group.  performance s c o r e s . the  A l l t h r e e showed p o s i t i v e g a i n s i n t h e i r However, the one person who  practiced i n  experimental group showed a decrease i n her s c o r e .  f o u r s u b j e c t s who  p r a c t i c e d were from the second day o f  t e s t i n g and feedback s e s s i o n s .  While t h i s may  The initial  have been by  chance, i € i s q u e s t i o n e d i f group awareness could have i n f l u e n c e d p r a c t i c e time. Some data from the q u e s t i o n n a i r e was of c o n s i d e r a b l e interest.  E q u a l numbers o f s u b j e c t s i n both groups, namely  four persons, were i n v o l v e d i n a p h y s i c a l f i t n e s s programme. However, four of- the f i v e who  s a i d "yes" t o b e i n g a c t i v e i n  s p o r t s were i n the comparison group.  I t was noted t h a t f o u r  students i n the comparison group, compared t o none i n the e x p e r i mental group, r a t e d themselves above average or e x c e l l e n t i n muscle tone.  With muscle s t r e n g t h , two experimental s u b j e c t s  r a t e d themselves above average. were the same as f o r "tone". dents who  The comparison group r a t i n g s  L a s t l y , three of the f o u r respon-  found i t e a s i e r t o l e a r n something w i t h gross body  movements, were i n the comparison group.  While no f i r m c o n c l u -  s i o n s can be made, the s u g g e s t i o n i s put f o r t h t h a t the comparison group s u b j e c t s showed more of the l e a r n e r c h a r a c t e r i s t i c s c i t e d by Singer and reviewed on pp. 11-12) which may  (as  have f a c i l i -  t a t e d l e a r n i n g the s e l e c t e d s k i l l f o r t e s t i n g , than d i d the experimental group.  Furthermore, w h i l e i n i t i a l performance of  43 a s k i l l may  not e l i c i t  d i f f e r e n c e s , perhaps the above c h a r a c t e r -  i s t i c s a s s i s t a student t o l e a r n the s k i l l  at a f a s t e r  rate.  However, s i n c e t h e r e were no s i g n i f i c a n t d i f f e r e n c e s between groups on t h e i r g a i n s c o r e s , t h i s i d e a cannot be supported. Teacher feedback a l s o may have accounted f o r the h i g h e r g a i n scores i n the comparison group. Although the i n v e s t i g a t o r endeavored t o t e a c h the i n the same manner on both days, d i f f e r e n c e s may  skill  have been  i n t r o d u c e d i n a d v e r t e n t l y , p a r t i c u l a r l y to the second group as a r e s u l t o f " p r a c t i c e " on the f i r s t  day.  For t h i s reason, the  experimental and comparison group s u b j e c t s were d i s t r i b u t e d on both days r a t h e r than each group on a separate day.  I t was  hoped t h a t t e a c h e r v a r i a b l e s would be e q u a l l y d i s p e r s e d between groups. As the i n i t i a l v i d e o t a p i n g f o r the data base immediately f o l l o w e d the demonstration of the s k i l l , a time l a p s e t o " f o r g e t " .  s u b j e c t s d i d not have  T h i s c o u l d have a f f e c t e d the mean  scores on the d a t a base performance f o r both groups, s i n c e no s i g n i f i c a n t d i f f e r e n c e s were noted i n the s c o r e s . Although the " c l i e n t s " had a l l been i n s t r u c t e d t o behave in  the same manner, i n d i v i d u a l d i f f e r e n c e s were i n e v i t a b l e .  Random o r d e r i n g o f s u b j e c t s f o r each performance was expected to decrease the p o s s i b l e d i f f e r e n c e e x i s t i n g between groups due to  "client"  variables.  I n d i v i d u a l s u b j e c t a n x i e t y must be acknowledged p o s s i b l e f a c t o r i n f l u e n c i n g the performance s c o r e s .  The  as a final  t e s t performance was c a r r i e d out l a t e i n the a f t e r n o o n and consequently s e v e r a l s u b j e c t s were concerned about o t h e r commitments  w i t h time c o n s t r a i n t s . of those  T h i s may  have a f f e c t e d the performance  subjects. The  p r e c e d i n g d i s c u s s i o n has c i t e d a few p l a u s i b l e  i n f l u e n c e s on the r e s u l t s of t h i s study.  While no  significant  d i f f e r e n c e s i n g a i n scores e x i s t e d between the experimental comparison groups, the comparison group d i d achieve  a higher  mean g a i n s c o r e . L i m i t a t i o n s of the Study G e n e r a l i z a t i o n s of the r e s u l t s from t h i s study l i m i t e d by the f o l l o w i n g f a c t o r s : 1. A n u r s i n g l a b o r a t o r y s e t t i n g . 2. F i r s t year b a c c a l a u r e a t e  nursing  students.  3. Small sample s i z e . 4. Sample s e l e c t i o n method of u s i n g  volunteers.  are  and  CHAPTER V SUMMARY, CONCLUSIONS AND  RESEARCH IMPLICATIONS  Summary The purpose of t h i s study was of  videotaped performance feedback,  feedback,  use  as compared t o teacher  with n u r s i n g students performing a s p e c i f i e d psycho-  motor s k i l l . of  t o i n v e s t i g a t e the  One  s p e c i f i c q u e s t i o n was  explored.  Does the  use  a videotaped r e c o r d i n g of a n u r s i n g student's performance of  a psychomotor s k i l l , w i t h subsequent review by the student, enhance t h a t student's performance? To answer t h i s q u e s t i o n , a q u a s i - e x p e r i m e n t a l was  study  designed t o t e s t the n u l l hypothesis t h a t : There w i l l be no d i f f e r e n c e i n s c o r e s on a performance c h e c k - l i s t between those baccal a u r e a t e n u r s i n g students r e c e i v i n g videotaped performance feedback, f o r a s p e c i f i e d psychomotor s k i l l , and those students r e c e i v i n g teacher feedback "for the same s k i l l . A sample of s i x t e e n students was  s e l e c t e d on a v o l u n -  t e e r b a s i s from the f i r s t year of a b a c c a l a u r e a t e n u r s i n g programme.  A f t e r random placement of students i n t o the e x p e r i -  mental and comparison groups, of  the s e l e c t e d psychomotor  t r a n s f e r r i n g a " c l i e n t " from a bed t o a w h e e l c h a i r  taught by the  was  investigator.  A v i d e o t a p e was  made of a l l s u b j e c t s performing  s k i l l to p r o v i d e a data base. videotape.  skill  The  back treatments.  the  S u b j e c t s d i d not view t h i s  two groups then r e c e i v e d t h e i r r e s p e c t i v e f e e d E i g h t students i n the experimental group 50  51  r e c e i v e d a v i d e o t a p e of t h e i r performance i n c a r r y i n g out the s k i l l , w h i l e e i g h t students i n the comparison group r e c e i v e d teacher feedback d u r i n g t h e i r s k i l l  performance.  A performance c h e c k - l i s t had been developed and  was  g i v e n t o the experimental group t o a s s i s t them i n review o f t h e i r v i d e o t a p e d performance.  I t was  a l s o used by the t e a c h e r  to guide her i n g i v i n g feedback t o the comparison group. A f t e r a p e r i o d o f e l e v e n or twelve days, depending on the  group, the e x p e r i m e n t a l and comparison groups r e t u r n e d f o r  a f i n a l v i d e o t a p e d t e s t performance. group completed the t e s t performance. t h i s videotape.  A q u e s t i o n n a i r e was  Seven students i n each Students d i d not view completed by the f o u r t e e n  s u b j e c t s a f t e r each had been v i d e o t a p e d f o r the t e s t performance. One r a t e r scored the v i d e o t a p e d data base performances and f i n a l t e s t performances. the  These scores were used t o compare  e f f e c t s o f the videotaped feedback and teacher feedback.  S p e c i f i c a l l y , the g a i n scores were compared t o determine the e x i s t e n c e of s i g n i f i c a n t d i f f e r e n c e s between the two groups. Intra-group s c o r e s , and data base mean scores between groups were a l s o computed.  The q u e s t i o n n a i r e responses were t a b u l a t e d  and i n t e r p r e t e d w i t h i n the a n a l y s i s of the score r e s u l t s . The d a t a was thesis.  analyzed i n r e l a t i o n t o the one n u l l hypo-  The h y p o t h e s i s was not r e j e c t e d , i n d i c a t i n g t h a t the  method o f g i v i n g f e e d b a c k — e i t h e r v i d e o t a p e d or t e a c h e r — d o e s not  a f f e c t the performance s c o r e s of n u r s i n g students performing  a s p e c i f i e d psychomotor  skill.  F u r t h e r data a n a l y s i s i n d i c a t e d t h a t no  significant  52  d i f f e r e n c e s e x i s t e d between the experimental and  comparison  groups on the data base mean s c o r e s or w i t h i n each group's gain scores.  I t was  d e s i r a b l e t h a t no s i g n i f i c a n t  differences  e x i s t i n the data base s c o r e s as t h i s supports sample homogeneity. Conclusions T h i s study found t h a t the type of or  feedback—videotaped  t e a c h e r — d i d not s i g n i f i c a n t l y a f f e c t the f i n a l performance  scores of f o u r t e e n n u r s i n g students performing a s p e c i f i e d psychomotor  skill.  T h i s f i n d i n g g i v e s d i r e c t i o n f o r the use o f these methods i n t e a c h i n g n u r s i n g psychomotor s k i l l s . been argued  not t o negate the v a l u e of teacher  T h i s method has been shown t o be as e f f e c t i v e as  videotaped feedback  and t h e r e f o r e should continue t o be  However, t h i s i n v e s t i g a t o r has c i t e d as important  i n the t e a c h i n g - l e a r n i n g p r o c e s s .  not more e f f e c t i v e than teacher feedback,  i t was  as e f f e c t i v e .  used.  accountability I t has been  demonstrated by t h i s study t h a t , although videotaped was  i t had  t h a t more e f f e c t i v e means of t e a c h i n g psychomotor  s k i l l s were needed, t h i s was feedback.  While  two  feedback  as had been hoped,  T h e r e f o r e , when teacher and  student  dis-  cuss each of t h e i r r e s p o n s i b i l i t i e s i n the t e a c h i n g - l e a r n i n g p r o c e s s , videotaped feedback If  should be given as an  alternative.  a student f e e l s t h a t a videotape of her performance i s a  u s e f u l l e a r n i n g t o o l , then i t should be a v a i l a b l e . the teacher may her own  Similarly,  f e e l i t more v a l u a b l e f o r the student to review  performance p r i o r t o teacher i n p u t .  I t would be  53  p r e f e r a b l e i f mutual agreement was reached on u s i n g v i d e o t a p e so t h a t i t s e f f e c t i v e n e s s c o u l d be r e a l i z e d . Implications f o r Further  Research  Since the many l e a r n e r c h a r a c t e r i s t i c s  ( c i t e d by S i n g e r :  N a t i o n a l S p e c i a l Media I n s t i t u t e s 1972, pp. 21-25) i n psychomotor s k i l l l e a r n i n g have not been e x p l o r e d withnnursing dents, i t i s s t r o n g l y recommended t h a t r e s e a r c h be to do so.  stu-  undertaken  I t would appear t h a t these c h a r a c t e r i s t i c s  influence  the student's l e a r n i n g i n such a way t h a t other p a r t s o f the l e a r n i n g p r o c e s s , such as feedback, c h a r a c t e r i s t i c s can be accounted l e a r n i n g methods w i l l  are a f f e c t e d .  U n t i l the  f o r , research into teaching-  always be s u b j e c t t o u n c o n t r o l l e d l e a r n e r  variables. F u r t h e r study i s needed i n d e t e r m i n i n g students* perc e p t i o n of viewing t h e i r videotaped performance.  Is t h e i r  p e r c e p t i o n a c c u r a t e o r are they s e l e c t i v e i n t h e i r T h i s was n o t accounted  f o r i n t h i s study.  viewing?  I f i t was found  that  s e l e c t i v e viewing o c c u r r e d , the need f o r teacher feedback, a t l e a s t i n the i n i t i a l performance, It  would be i n d i c a t e d .  i s recommended t h a t a study employing  three  feedback  treatments o f v i d e o t a p e review with a c h e c k - l i s t , teacher f e e d back, and v i d e o t a p e review w i t h a t e a c h e r , be c a r r i e d out w i t h n u r s i n g s t u d e n t s . l e a r n i n g psychomotor s k i l l s .  T h i s i s needed  to  support evidence found i n the l i t e r a t u r e t h a t teacher review  of  the v i d e o t a p e w i t h the student i s the more e f f e c t i v e means  of  g i v i n g feedback.  I f so, then the c r i t i c a l elements w i t h i n  54  the s i t u a t i o n mentioned above should  be i s o l a t e d and  i n t o l e a r n i n g s t r a t e g i e s to be u t i l i z e d by  the l e a r n e r  which do not n e c e s s i t a t e the presence of the I t was  and  teacher.  not i d e n t i f i e d , i n t h i s study, what e f f e c t s the  performance c h e c k - l i s t had videotape.  developed  on the students reviewing  their  own  T h i s r e l a t i o n s h i p c o u l d be grounds f o r f u r t h e r  investigation. A d d i t i o n a l s t u d i e s i n r e l a t i o n t o t i m i n g of for  psychomotor s k i l l  feedback  l e a r n i n g i n n u r s i n g would p o s s i b l y  give  d i r e c t i o n i n the s e l e c t i o n of the most a p p r o p r i a t e jtimes  to  g i v e feedback. It the one  i s s t r o n g l y recommended t h a t a s i m i l a r study t o  c a r r i e d out by t h i s i n v e s t i g a t o r be undertaken.  w i t h s e v e r a l s t u d i e s found i n the l i t e r a t u r e on feedback w i t h psychomotor s k i l l l i m i t e d by s m a l l sample s i z e . of t h i s study w i t h a l a r g e r N  -  As  exploring  l e a r n i n g , t h i s one  too, i s  I t i s suggested t h a t r e p l i c a t i o n (of a t l e a s t f o r t y ) may  g i v e more  c o n c l u s i v e evidence on the use of videotaped feedback compared to teacher  feedback.  By e l i m i n a t i n g some of the m e t h o d o l o g i c a l  problems encountered i n t h i s study, f u r t h e r s t u d i e s may elicit  more c o n c l u s i v e r e s u l t s .  well  55  LITERATURE CITED A l l e n , Moyra. 1972. 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Supp.  Wragg, E.C. 1970-1971. The i n f l u e n c e of feedback on t e a c h e r s ' performance. E d u c a t i o n a l Research. 13: 218-221.  )  APPENDIX  c  60  APPENDIX A THE PERFORMANCE CHECK-LIST  61  62  OBSERVATION  SHEET - T r a n s f e r r e d a C l i e n t From a Bed t o a Wheelchair  Code Number INSTRUCTIONS:  Date P l a c e a (\/) mark under "yes" i f a c t c a r r i e d out a c c o r d i n g t o c r i t e r i a o r "no" i f a c t (a) done i n c o r r e c t l y , (b) not completed, o r (c) omitted. CRITERIA  YES  1. P l a c e s wheelchair p a r a l l e l t o bed, i n c l o s e proximity to c l i e n t 2. Locks the wheels 3. In a s q u a t t i n g p o s i t i o n , r a i s e s f o o t pedals 4. P l a c e s s l i p p e r s on c l i e n t ' s  feet  5. Knees bent, back s t r a i g h t d u r i n g #4 6. With f e e t comfortably  apart, faces  client  7. I n s t r u c t s c l i e n t t o p l a c e h i s / h e r hands on nurse's shoulders (or around neck) 8. P l a c e s hands under a x i l l a e  (or around waist)  9. F l e x e s knees and h i p s 10. Keeps back s t r a i g h t 11. Supports c l i e n t ' s knees w i t h own, p r i o r t o standing c l i e n t up 12. A s s i s t s c l i e n t t o standing p o s i t i o n w h i l e : (a) Keeping back s t r a i g h t (b) Keeping knees f l e x e d , as necessary  NO  63  CRITERIA  YES NO  (c) M a i n t a i n i n g base o f support (d) C o u n t e r a c t i n g c l i e n t ' s weight w i t h own 13. P i v o t s c l i e n t towards wheelchair 14. Supports c l i e n t ' s knees (or f e e t ) w i t h own, p r i o r t o lowering c l i e n t i n t o wheelchair 15. Lowers c l i e n t i n t o wheelchair w h i l e : (a) Keeping back s t r a i g h t (b) Bending  knees  (c) M a i n t a i n i n g base o f support (d) C o u n t e r a c t i n g c l i e n t ' s weight w i t h own 16. I n a s q u a t t i n g p o s i t i o n , p l a c e s f o o t under c l i e n t ' s f e e t  rests  17. M a i n t a i n s smoothness o f movement throughout procedure (may have one j e r k y movement) TOTALS  TOTAL PERFORMANCE SCORE: ( t o t a l number o f "yes" marks) P o s s i b l e t o t a l : 23  APPENDIX B THE PERFORMANCE CHECK-LIST: FIRST DRAFT  i  /  64  65  OBSERVATION  SHEET - T r a n s f e r r i n g a C l i e n t From a Bed t o a Wheelchair  Code Number INSTRUCTIONS:  Date P l a c e a ( ,/) mark under "yes" i f a c t c a r r i e d out a c c o r d i n g t o c r i t e r i a o r "no" i f a c t (a) done i n c o r r e c t l y , (b) not completed, or (c) omitted. CRITERIA  YES NO  1. P l a c e s w h e e l c h a i r p a r a l l e l t o bed, i n c l o s e proximity to c l i e n t 2. Locks the wheels 3. In a s q u a t t i n g p o s i t i o n , r a i s e s f o o t pedals 4. P l a c e s s l i p p e r s on c l i e n t ' s  feet  5. Knees bent, back s t r a i g h t d u r i n g #4 -  6. A d j u s t s h e i g h t o f bed so t h a t f e e t o f c l i e n t touch the f l o o r 7. Knees bent, back s t r a i g h t d u r i n g #6 8. With f e e t comfortably  apart, faces  client  9. I n s t r u c t s c l i e n t t o p l a c e h i s / h e r hands on nurse's shoulders (or around neck) 10. P l a c e s hands under a x i l l a e  (or around  11. F l e x e s knees and h i p s 12. Keeps back s t r a i g h t 13. Supports c l i e n t ' s knees w i t h own  waist)  66  CRITERIA  YES  14. A s s i s t s c l i e n t t o standing p o s i t i o n w h i l e : (a) Keeping back s t r a i g h t (b) Keeping knees f l e x e d , as necessary (c) M a i n t a i n i n g base o f support (d) C o u n t e r a c t i n g c l i e n t ' s weight with own 15. P i v o t s c l i e n t towards w h e e l c h a i r 16. Supports c l i e n t ' s knees (or f e e t ) w i t h own, p r i o r t o lowering c l i e n t i n t o c h a i r . 17. Lowers c l i e n t i n t o w h e e l c h a i r w h i l e : (a) Keeping back s t r a i g h t (b) Bending  knees  (c) M a i n t a i n i n g base o f support (d) C o u n t e r a c t i n g c l i e n t ' s weight w i t h own 18. In a s q u a t t i n g p o s i t i o n , p l a c e s f o o t r e s t s under c l i e n t ' s f e e t 19. M a i n t a i n s smoothness o f movement throughout procedure (may have one j e r k y movement) Totals TOTAL PERFORMANCE SCORE: ( t o t a l number o f "yes" marks) P o s s i b l e t o t a l : 25  NO  APPENDIX C INTERRATER RELIABILITY FOR THE PERFORMANCE CHECK-LIST  67  68  TABLE 6 PERFORMANCE SCORES AND RANK ORDERING OF OBTAINED SCORES IN DETERMINING INTERRATER RELIABILITY COEFFICIENT OF CONCORDANCE  Tape Number  A Score  Rank  Rater B Rank Score  W  Score  C  Rank  Mean of Ranks  1  21  2  21  2  19  2-5  2  17  3  !9  3  14  4  10  3  14  4.5  • 16  4  19  2.5  11  4  6  6  2  6  6  6  18  5  23  1  23  1  23  1  3  6  14  4.5  12  5  12  5  14.5  6.5  Sum of the Ranks  63  Mean Rank T o t a l  10.5  Vl = 0.9206* *p>0.01 s i g n i f i c a n c e  level  69  Coefficient  o f Concordance  W  =  W  Formula:  12S M (N -N) 2  Where:  3  S = sum o f the squares o f d e v i a t i o n s about the mean rank t o t a l M = the number o f judges N = the number o f performances  1. Mean rank t o t a l = 6_3  =  10.5  6 2. Sum o f squares o f d e v i a t i o n s about t h i s mean: S = (6.5-10.5) (18-10.5)  2  2  + (10-10.5) + (3-10.5)  2  2  + (11-10.5)  + (14.5-10.5)  2  2  + = 145  3. M = 3 N = 6 4. W = 12 x 145 2 3_ 3  ( 6  6 )  =  1740 1890  =  0.9206  A v a l u e o f S = 122.8 r e q u i r e d f o r the 0.01 l e v e l o f s i g n i f i c a n c e (Kendall 1962, p. 188).  APPENDIX D (  INTRA-RATER RELIABILITY FOR THE PERFORMANCE CHECK-LIST  '70  71  TABLE 7 THE CORRELATION COEFFICIENTS OBTAINED BY DIFFERENT RATERS, BETWEEN THE FIRST AND SECOND OBSERVATIONS, IN DETERMINING INTRA-RATER RELIABILITY*  Rater  Observation  A  1  Tape Number 3 4  1  2  ,91  ,74  .61  5  6  .26 1.0  .61  0.86*  1  2 B  C  1.0  .87  .87  .13  1.0  .30  1  .91  . 83  .70  .10 1.0  .55  2  .91  .78  .87  .13  1.0  .35  1  .83  .61  .83  .26  1.0  .52  2  .91  .61  .87  .17 1.0  .52  0.94*  0.99*  •Scores were s t a n d a r d i z e d because of m i s s i n g data on two tapes on the f i r s t s c o r i n g (by one r a t e r ) . * * S i g n i f i c a n t a t the 0.05 l e v e l . df = 4 C o r r e l a t i o n C o e f f i c i e n t Formula used: r  xy  =s  Sxy SxSy  i  APPENDIX E THE QUESTIONNAIRE  7,2  73  Questionnaire Code Number Direction^ complete the f o l l o w i n g q u e s t i o n s by p l a c i n g a check ( • ) b e s i d e the a p p r o p r i a t e answer o r g i v i n g your comments, where asked. p  l  e  a  s  e  1. Age range: 17 - 20 y e a r s 2 1 - 2 4 years 25 - 28 y e a r s 2 9 - 3 2 years 33 and over 2. Do you c o n s i d e r y o u r s e l f a c t i v e l y i n v o l v e d i n a p h y s i c a l f i t n e s s programme? Yes No A c t i v e l y involved i n sports? Yes No 3. How would you r a t e your g e n e r a l muscle tone? Poor Below average Average Above average Excellent 4. How  would you r a t e your g e n e r a l muscle s t r e n g t h ? Poor Below average Average Above average Excellent  5. How would you r a t e y o u r s e l f i n performing n u r s i n g ( i . e . "motor" s k i l l s ) ? Poor Below average Average Above average Excellent 6. In comparing y o u r s e l f t o your classmates, do you t h a t performing a n u r s i n g motor s k i l l takes you Longer than the average time Average time Less than average time \  skills  find  74  7. Which do you f i n d e a s i e r t o do: (a) L e a r n i n g something which i n v o l v e s "gross" body movement (b) Learning something which r e q u i r e s " f i n e " movement of the hands or body or (c) I f i n d no d i f f e r e n c e i n l e a r n i n g (a) or (b) 8. Have you had any p r e v i o u s experience i n t r a n s f e r r i n g clients? Yes No If  yes i n what c a p a c i t y ?  9. How much time have you spent p r a c t i c i n g t h i s s k i l l s i n c e you f i r s t d i d i t l a s t week? With a classmate  \  APPENDIX F CONSENT TO PARTICIPATE  75  Research Study t o be Conducted  by Angela J . C o l l i n s , B.N., R.N.  CONSENT TO PARTICIPATE  I,  ' (participant)  , agree t o p a r t i c i p a t e i n t h i s  r e s e a r c h study upon the f o l l o w i n g c o n d i t i o n s .  I understand  t h a t my name w i l l n o t be used; t h a t I w i l l be i d e n t i f i e d by a number, t o p r o t e c t my anonymity.  F u r t h e r , my  performance  d u r i n g t h i s r e s e a r c h study w i l l not be used t o e v a l u a t e me i n my s c h o o l programme. Videotapes taken d u r i n g the study w i l l be seen o n l y by t h e r e s e a r c h e r , her a s s i s t a n t s and h e r t h e s i s committee members.  The v i d e o t a p e s w i l l not be used f o r any purpose  w i t h i n the s c h o o l programme.  After a prescribed length of  time, the v i d e o t a p e s w i l l be e r a s e d . Code numbers w i l l be used on t h e q u e s t i o n n a i r e and the i n f o r m a t i o n c o n t a i n e d w i l l be summarized as a group  result.  R e s u l t s o f the study w i l l be a v a i l a b l e t o i n t e r e s t e d persons and through t h e t h e s i s and a b s t r a c t p u b l i c a t i o n s . A l l i n f o r m a t i o n p e r t a i n i n g t o i n d i v i d u a l s w i l l be preceded by code numbers d i f f e r e n t from those used d u r i n g the study. I understand t h a t I have the r i g h t t o withdraw from t h e study a t any time. Signed: Date:  Researcher:  APPENDIX G RAW SCORES OBTAINED BY EXPERIMENTAL AND COMPARISON GROUPS ON THE DATA BASE PERFORMANCE  78  TABLE 8 RAW SCORES OBTAINED BY EXPERIMENTAL AND COMPARISON GROUPS ON THE DATA BASE PERFORMANCE  Experimental Group Scores  Comparison Group Scores  17  15  19  17  16  14  23  22  15  23  23  17  19  22  19  16  APPENDIX H RAW SCORES OBTAINED BY EXPERIMENTAL AND COMPARISON GROUPS ON THE TEST PERFORMANCE  79  80  TABLE 9 RAW SCORES OBTAINED BY EXPERIMENTAL AND COMPARISON GROUPS ON THE TEST PERFORMANCE  Experimental Group Scores  Comparison Group Scores  23  15  19  21  23  23  23  22  17  20  17  23  16  21  X 19.71  X 20.71  S.D. 3.20  S.D. 2.75  APPENDIX I RATER TEST-RETEST RELIABILITY  81  82  TABLE 10 THE CORRELATION COEFFICIENT OF STUDENT PERFORMANCE SCORES OBTAINED BY THE RATER  Scores F i r s t Rating  Scores Second Rating  22  23  19  21  15  20  16  19  19  20  17  21  23  20  15  16  X 18.25  X 20.00  S.D. 3.06  S.D. 2.00  r = 0.61* *p < 0.05 s i g n i f i c a n c e df = 6  level  

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