Both quantitative and qualitative measures were employed to gather data to answer the research questions. They are as follows.
Demographic forms. Participants completed one of the two researcher developed
demographic tools used to describe the population under study. The New Graduate Nurse Demographic Tool (Appendix E) was color coded green and was completed by nurses with up to 18 months experience. The blue Experienced Nurse Demographic Tool (Appendix F) was designed for completion by the nurse with more than 18 months of experience.
Basic Knowledge Assessment Test (BKAT). The BKAT is a copyrighted tool
designed by Toth and Ritchey (1984). Permission to use and photocopy the tool has been obtained from Dr. Toth, with the stipulation that no parts of the tool may be converted to an electronic format (Appendix G). All seven versions of the BKAT have been cognitive written examinations that take approximately 45-60 minutes to complete. The test questions range in difficulty from recall of basic information to the application of basic knowledge in practice scenarios, and cover the cognitive, psychomotor and affective domains of learning. The BKAT was developed over a two-year period and released in 1984 as a criterion referenced measure to determine attainment of minimal requirements to safely work in the critical care setting. The goal of the original BKAT was to ascertain what comprises basic critical care knowledge and to develop a tool to quantify that knowledge (Toth & Ritchey, 1984). The researchers based their tool on the standards of
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care developed by the American Association of Critical Care Nurses (AACN). Those standards were designed to define safe clinical practice and to guide critical care orientation programs. However, Toth and Richie (1984) reported a dichotomy between what educators and employers expected as minimal competencies. Therefore the tool was developed based on a thorough review of the literature as well as input from staff and head nurses working in critical care units, critical care physicians, and a panel of critical care education experts.
The BKAT has been updated to reflect current practice in critical care nursing and in 2006 the BKAT 7th version was released. It is a 100 question multiple-choice and fill- in-the-blank pencil and paper test that measures basic critical care nursing knowledge. Assessment areas include the following body systems: cardiovascular, pulmonary, neurological, gastrointestinal, endocrine, and renal. Two additional categories include hemodynamic monitoring lines as well as infection control, burn care, hypothermia, and spiritual care. Psychosocial aspects of care are infused throughout the test.
Construct validity of the BKAT was supported through the use of pre-established group differences comparing scores between newly graduated nurses and experienced critical nurses. The experienced nurses had a mean score of 82.3 and reliability of 0.90 while the newly graduated nurses‟ mean score was 74.8 with a reliability of 0.89. Reliability for BKAT- 7 was established by testing 298 critical care experienced nurses from 26 states and was found to range from 0.88 – 0.90. Repeat reliability testing has not been reported however throughout the previous six versions of the tool reliability is consistently reported above 0.80
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Semi-structured interview. Researchers use phenomenological methodology to
elicit and interpret the meanings of phenomena as they are described by a specific group. Phenomenology is rooted in German philosophy and is defined as “…an individual‟s perceptions of his or her presence in the world at the moment when things, truths, or values are constituted” (Morse & Richards, 2002, p. 44). This definition imparts philosophical underpinnings for the assumptions of this approach. Phenomenological researchers believe that the perceptions of those studied present evidence of the real world reflecting how the world is actually lived by those experiencing it, not how it is thought to be by those not experiencing the phenomenon. This approach states that people are conscious within their worlds and understanding is gained only when examined from the perspective or context of those being questioned. Phenomenology allows the researcher to understand the experience as it is known by the participant.
Within the umbrella of phenomenology lie several methodologies based on differing philosophical underpinnings (Munhall, 2001). Hermaneutic phenomenology, a philosophical and methodological approach used to reveal the essence of an experience of phenomena, is an interpretive and inductive form of research. The goal of hermeneutic phenomenology is ontological and therefore strives to reach beyond narrative description to understanding or interpretation. Through this methodology, an understanding of what is “real” occurs and therefore can be interpreted and analyzed based upon the researcher‟s knowledge and experience in the field (Laverty, 2003).
The NGNs who participate in individual interviews were asked the following primary research question:
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Think back to a recent patient situation that was very challenging for you- one in which you were challenged in making clinical judgments or decisions about how to proceed with your care. Please share that experience with me.
If during the course of the story the NGN did not provide the information sought, the primary research question was augmented with the following questions for detail expansion or clarification.
1. Tell me about what was concerning to you. a. What was your gut telling you?
2. Tell me how you proceeded with this patient‟s care.
a. What cues did you use to help fine tune your approach?
3. How did you evaluate the outcomes of the plan of care that you chose?
4. As you think back what do you notice differently now? What stands out to you?