title: Confident to seek help: the development of skill and judgement in nurse practitioners. A mixed methods study.
abstract: BACKGROUND
  Healthcare is undergoing a transformation in terms of traditional role and skill assignations of staff, with an attendant blurring of boundaries. Expert judgement is used in order to develop and assess learners as they prepare for these new roles.
  
  
  OBJECTIVE
  To determine factors related to the perceived usefulness of feedback, to find out how participants use expert judgement, to develop skill and to examine how the context of learning affects the development of judgement.
  
  
  METHODS
  Four NHS Health Board areas within Scotland.
  
  
  METHODS
  95 nurse practitioners who had successfully completed a specified course of skills based education between September 2008 and August 2010. 10 participants agreed to follow up interview.
  
  
  METHODS
  Survey and follow-up semi-structured interviews.
  
  
  METHODS
  Mixed methods. 20 item, internet based questionnaire (n = 85) and semi-structured interviews (n = 10), collected between September 2010 and February 2011.
  
  
  RESULTS
  Response rate was 55%-confidence level of 99%, this sample yields a confidence interval of 12.9%. The results demonstrate that the demonstration of skill and the perception of expertise of the supervisor are related to the perceived usefulness of feedback (p < 0.004). The participants use feedback as one strategy to develop skill and judgement, although the mining of the tacit knowledge of medical colleagues, reference to associated theory and peer support and learning strategies are also seen to be important. The development of judgement is restricted by the tightly controlled learning environment.
  
  
  CONCLUSIONS
  Identification of participants with the expertise of the supervisory group reveals a group who are highly aspirational and for whom the governance of learning leads the participants to be confident to seek help and not the confidence to identify learning needs. Learning is seen to be dominated by the context in which it is set and as the participants learn motor skills, they learn to fit in and manage a brittle working environment.
authors.affiliation: University of the West of Scotland, High Street, Paisley PA1 2BE, United Kingdom. diane.fotheringham@uws.ac.uk
authors.forename: Diane
authors.initials: D
authors.lastname: Fotheringham
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000193:education* / Q000592:standards*; D024802:Nurse's Role; D010865:Pilot Projects; D012606:Scotland; D011795:Surveys and Questionnaires
keywords: Judgement; Nurse practitioners; Professional identity; Self monitoring; Skill development; Social constructivism