The palliative care quiz for nursing (PCQN): the development of an ...

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Palliative aire quizTable 2 Rank order of itemsmissed by group (lowernumbers indicate mostfrequently missed items)ItemRank orderGenencstudentsPost-RNstudentsRegisterednursesRegisteredpracUcal nursesWdfP1234567891011121314197811125101418115324185101711320161941526116125171031920146112712068171321918153145410 1750 30 5515201289161761387189127181714131619994102016131511have at their hfuids a method of measuring the leammgneeds of providers of care, providing instruction to learners,and determining the outcomes of educational programmesaimed at increasing knowledge of palliativecare practiceThe process used m the development of the PCQN wasparticipatory, consultative and comprehensive in natureand involved those most knowledgeable about palliativecare nursing at all phases of development Such a processmay have utility for other settings and content areas hyincreasing the likelihood that knowledge assessment toolsreflect the content area to he tested Prominent features ofthis process are (a) the convenmg of an advisory committeeto provide direction at all phases of development,(h) a wide process of consultation beyond the advisorygroup, (c) the development of a conceptual framework,(d) determination of format, (e) the development of a poolof Items, (f ) pre-testing of items, (g) piloting of the items,and (h) further testing of itemsThe palliative care quiz for nursing is a 20-item true,false and don't know test of knowledge that takes approximately20 minutes to admmister and is quickly and easilyscored It was developed with several purposes m mmdFirst, it was mtended to measure knowledge of palliativecare nursing Respondents varied m their responses to thePCQN according to level of education and expenenceThose with higher levels of education and more years ofexpenence achieved the highest scores m response to thePCQN In addition, those with specialized trammg in palliativecare achieved higher scores than those without suchtraimng These findings provide evidence of the validityof the PCQN as a measure of knowledgeSecondly, the PCQN was developed to stimulate discussionabout palliative care nursing Though admittedlysubjective, assessment of the quiz for stimulating groupdiscussion, at least among nurses and students of nursing,was positive The PCQN was administered to genenc students,post-RN students, registered nurses and registeredpractical nurses Participants responded favourahly totaking the quiz and were acutely interested m thecorrect answers Although not quantified, their verhatimresponses regarding the usefulness of the quiz suggest thatthe PCQN IS thought-provoking and eye-openmg Furthertesting, however, is required to determine whether use ofthe quiz prior to a penod of instruction would result ingreater willingness to contnhute to discussion and a generedheightened receptivity to the instruction that followsThirdly, the PCQN was intended to identify misconceptionsahout palliative care nursing Although there weredifferences among groups with respect to misconceptions,there were also notahle similanties One such example liesm the similanty among groups with respect to the misconceptionthat palliative care is not compatible with the provisionof aggressive treatment This was the second mostfrequent misconception among registered nurses andpost-RN students, the third among genenc students andthe fifth among registered practical nurses The qiuz can,therefore, serve as an educational needs assessment tool© 1996 Blackwell Science Ltd, Journal of Advanced Nursing, 23, 126-137 133
M M Ross et alby providmg data about the level of knowledge alreadypossessed by potential participants and allow educators tofocus instruction on the issues of greatest needThis finding also suggests that educational programmesin palliative care should be targeted for specific audienceswith specific leammg needs Nevertheless, given the similantiesm misconceptions across groups, there is a needfor all levels of nurses to upgrade their level of knowledgeof the concepts of palliative care and their application mclmical practice The PCQN can be useful m identifyingand correcting their misconceptions about palliative carenursmgFinally, the quiz can also be used as a tool for instructionitself or as the primary focus for a period of instructionwithout any pre- or post-testing In this way, the PCQNcan be used to encourage students to be active participantsm their learning by stimulating discussion of issues relatedto palliative care nursmgLimitationsDespite Its potential use, the PCQN has several limitationsIt IS not designed to provide a comprehensive assessmentof knowledge of palliative care or palliative care nursingBrevify and simplicify of administration and scoringmakes the quiz useful for many educators but limits itsvalue vnth respect to the comprehensive assessment ofhigher levels of knowledge associated with expertise inpalliative care practice Therefore, it is not appropriate forthe assessment of knowledge levels of expert practitionersRather, the quiz focuses on the basic type of informationrequired for entry to practice that would normally be foundm introductory courses, workshops and programmesThe predictive validify of the quiz has not been assessedand therefore it is not known to what degree knowledgeas measured hy the PCQN is related to actual behaviourFurther research should examine this issue as well as theissue of whether the quiz is useful for assessing change inknowledge resulting from instruction In addition, thesample with whom the quiz was developed was not fullyrepresentative of the broad range of nursmg personnel withwhom the qmz might eventually be used Pilot testing witha more representative sample of registered nurses,registered practical nurses and other categones of nursmgpersonnel, would be wise to assure that the reading levelsand content associated with the PCQN are appropnateAlthough the psychometnc properties of the PCQNcould be improved by elimmating some of the items,especially those with an item difficulfy of over 0 80 forregistered nurses, a decision was made to retain theseItems m order to add to the edumetnc properties of thequiz The quiz is designed to yield measurements that aredirectly interpretable m terms of specific performancestandards (Glaser & Mitko 1971) The specified performancestandard m this case is the abilify to answer all 20items correctly Given this standard, it is not crucial thatall Items have a high discnmmatory power or high itemto total correlation An mdividual who can answer theitem correctly has more information than an mdividualwho cannotOther edumetnc properties include the abilify to identifymisconceptions and to stimulate discussion about palliativecare nursmg These properties would not have beenimproved by attending too stnngently to the entena ofitem difficulty and item discrimination Such entena,while eentral to the psyehometnc properties of a test, arenot necessanly central to its edumetnc properties Thus,by retaining items that have not attained optimal psychometncproperties for one group of respondents, but thatare conceptually important, it is expected that the edumetncproperties of the quiz are enhancedConclusionIn conclusion, the palliative care quiz for nursmg appearsto be a promising tool with utility for assessing knowledge,stimulating discussion and identifying misconceptionsThe quiz can be used for assessing learning needs and maybe useful as a teachmg tool and for contnbutmg to theevaluation of educational programmes related to the provisionof palliative care The development of the palliativecare quiz for nursmg helps to fill the gap m instrumentationavailable for teaching and research initiatives aimedat improving the qualify of education received by healthcare providers and ultimately the qualify of palliative carereceived by those who are dying and their familiesAcknowledgementsThe Ottawa Carleton Regional Palliative Care Associationprovided the major funding for this project KnollPharmaceutics, the Victonan Order of Nurses (OttawaCarleton Branch), the Ottawa Carleton Regional CancerCentre and the Riverside Hospitid provided additionalfundmg A Community Researcher Award from theNational Health and Research Development Programmeand a Mimstry of Health of Ontano Career Scientist Awardto Dr Margaret M Ross also provided assistance withthe conduct of the study and the preparation of thismanuscriptReferencesBenner P (1984) From Novice to Expert Excellence and Powerin Clinical Nursing Practice Addison-Wesley, Menlo Park,GaliformaBenoliel J Q (1985) Loss and terminal illness Nursing Climes ofNorth Amenca 20(2), 439-448Gourtenay B G & Weideman G (1985) The effects of a 'don't know'134 © 1996 BlackweU Science Ltd, Journal of Advanced Nursmg, 23, 126—137
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