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The test paper at the end of the training period should indicate whether in fact the course has been
effective and the objectives achieved, i.e. if she can apply it to her job. Unfortunately it will not indicate
whether she actually does apply it or not; this kind of testing is not feasible here.
A study of 64 completed student files (1 year's students) should give some indication as to the stage of
training at which community experience is most effective and what previous experience would seem most
beneficial. The weakest areas of our programme should be highlighted and it should be possible to assess the
influence of a good or poor impression of training e.g. a poor impression may sometimes act as a stimulus.
Pre-testing of questionnaires and instructions is important to ensure that they are acceptable and
understood before adopting them as a method of assessment. The final questionnaire was pre-tested, using
the first group of students who took part in the course in 1971 as they could not be included in this study.
Four completed the questionnaire in a group situation and eight by postal method. The former was the
faster method but owing to the difficulty of making these arrangements it would be too difficult to adopt
as a regular feature. The postal method was slower but, due to the efforts of the tutors, all questionnaires
were returned.
This pre-testing showed the need for some adjustments. Students were in some cases reluctant to
complete test papers and it is felt that in future some assurance must be given that the test papers will in no
way be used as part of their hospital assessment. Some of the wording was not understood and had to be
altered. I am not entirely happy about the use of test papers as a means of long term evaluation since if sent
by post they are not completed under examination conditions and it is doubtful whether if this method
were used as a routine a sufficient proportion of the students would voluntarily return completed test
papers. It would therefore be preferable if such an evaluation could form part of the State Final
Examination.
There are certain limitations in any scheme in that to be effective it must be simple to execute and
interpret as well as acceptable to the tutors, staff and students, together with being practicable within the
organisation structure. The Plan already outlined would seem at the moment to fulfil these requirements.
Effect on the service
Although the programme has been in action for one year I think it is still a little early to attempt to
answer whether the service has been changed in any way. The novelty of having the student nurse may not
as yet have worn off, producing a possible reaction. However, it is worth looking at the areas that may be
affected and in what way this might happen.
First, there is the effect on the client. This may vary according to the service they are receiving. Certain
nursing procedures e.g. lifting, bathing, may be more comfortable for the patient because the District Nurse
has help, whereas a client wishing to discuss a personal problem with the Health Visitor may be unwilling to
take the opportunity to do so because of the presence of a stranger. The client may benefit by some overall
improvement of procedure instituted as a result of direct feedback from the student who, after all, is an
informed and often critical observer. There may in fact be an overall improvement in the service to the
client, other than the inconvenience of having another stranger in their home.
Secondly, there is the effect on the staff. The main complaint is the feeling of strain imposed by
constantly having to explain one's actions, and in planning the work to fit in with the student's
requirements. There is a general feeling that the work is considerably slowed; however, looking at the
Health Visitors' returns which can be taken as a measure, it would seem that the actual number of home
visits remains constant and in some cases is probably higher. This of course gives no indication of the
quality of visiting, however it would seem inevitable that anyone demonstrating their work to an observer is
forced, perhaps unconsciously, to look at their job more closely and to think about its efficiency, quality
and usefulness, thereby automatically attempting to improve its standard.
Finally there is the effect on the administrative staff. There is considerable strain and many are the
headaches which result from the endless arranging and re-arranging of programmes, particularly where this
involves asking help from other departments and outside services. The constant renewal of contacts and
goodwill is essential and it is important here to consider at what level of management this is most useful to
other aspects of the work and not alone to the student programmes. The first line manager in her day to
day contact with other field disciplines would seem to be in a position to benefit most directly and in my
view this is the level at which programme arrangements should be placed.