An autoethnographic analysis: assessment practices on nursing students at the University of Namibia | BMC Medical Education

The reflective analysis was conducted following five themes using a pre-existing theme from the literature.

Theme 1: types of assessments in nursing education at UNAM

The reflective analysis revealed that formative and summative assessments are used in nursing education at the University of Namibia. Different methods of assessment used include tests, assignments, portfolios, case studies, and objective structured clinical examinations. All assessment methods are used following the policies and procedures of the institution. The assessments were also conducted at different intervals, such as before the process of teaching to diagnose or establish the schemata, to enable the lecturer to see what learners have learned before teaching takes place and after teaching has taken place. In nursing education, summative assessment is conducted through various activities that contribute to the continuous assessment mark, and sometimes it is through examinations that are written at the end of a module. Summative assessments do not contribute to student learning, but the focus is on grading determination. The lecturer should ensure the advantages and limitations of each assessment. Assessment is used to validate decisions and to enhance both teaching and learning among nursing students at levels 2 and 3, undergraduate students for the Bachelor of Nursing Science. Overall, assessment is taken as an integral part of the process of teaching and learning process.

Theme 2: national and institutional quality assessment for nursing students at UNAM

The assessment for nursing students in higher education institutions is guided by the regulatory body at the national level, such as the National Council of Higher Education (NCHE) and the Namibia Qualifications Authority (NQA). According to the Namibia Qualification Authority Act [17], all higher education institutions should ensure quality assurance and enhancement, and the accreditation and monitoring of teaching and learning. The Health Professional Council of Namibia (HPCN) set up standards to be followed in nursing training that include curriculum development, teaching and learning, and assessment through the Nursing Act, No 8 of 2004 [18]. Therefore, all nursing training programmes in Namibia are accredited by the HPCN after demonstrating that they have met the requirements for training nurses. The reflective discussion revealed that assessment practices for the nursing student align with the national and institutional regulatory frameworks.

The Quality Assurance and Management Policy for the University of Namibia ensures the delivery and maintenance of excellence in instruction, learning, acquisition, research, academic and administrative/support services, student welfare, governance, and community service [32]. The aim is to realise the vision, mission, values, and objectives, ensure the delivery and maintenance of excellence in instruction, learning, acquisition, research, academic and administrative/support services, student welfare, governance, and community service. A Centre for Quality Assurance and Management (CEQUAM) was formed by UNAM to develop the University’s quality assurance capabilities and improve and update academic and managerial activities. It is also to administer and facilitate the operations of UNAM’s Quality Assurance and Enhancement Policy and Procedures. A major objective of CEQUAM is to improve the quality standards of academic, research, community engagement, and support services activities within the University [32]. The study found that assessments were conducted according to the national and institutional legislative framework. In addition, the UNAM Assessment and Awards Policy follows the quality assurance protocols, such as internal and external moderation of assessment activities. These ensure that assessment practices align with the principles of quality assessment practices.

Assessments were conducted considering the Teaching and Learning policy, assessment policy, and quality improvement policy. All formative and summative assessments are internally moderated by an expert, and the decisions are made on modules for summative assessment for external moderation for quality purposes. Furthermore, conducting summative assessment enables the evaluation of the competency level of students in relation to outcomes of a unit/module and/or programme.

The researchers identified that assessment transformation and decolonisation imperatives have currently taken place at the institution. All principles of assessment, such as fair treatment of all students regardless of their background, are being practiced. In addition, as the nursing curriculum is based on standards set by the Nursing Council of Namibia, nurses have always attempted to decolonise the curriculum by incorporating different cultures and accommodating cultural beliefs in teaching, learning, and assessment, as well as providing holistic nursing care. However, the indigenous knowledge practices have not yet been incorporated into the nursing curriculum. This leads to the patient being scolded or harassed when visiting health facilities, when it is discovered that they have used alternative medication or worn traditional symbols of healing practices. This is caused by the nurses’ lack of knowledge and skills to understand and address the unique health needs of such patients and accommodate the indigenous practice because they were not oriented to it during the training. Therefore, advocates for the accommodation of indigenous knowledge practices in the curriculum and assessments. Furthermore, integration of indigenous knowledge into the curriculum would lead to lecturers considering including information on indigenous knowledge in the formative and summative assessments to assess the students’ knowledge and competencies.

Theme 3: assessment practices and approaches

The reflection found that different assessment approaches are used for different reasons. Both the assessment for learning and assessment of learning are utilised in the course of discussion. Assessment for learning is referred to as formative assessment, which is conducted throughout the teaching and learning process. It is also designed to inform instruction to provide data to revise planned instruction. Assessments are conducted based on the national and institutional regulations for quality purposes that include both formative and summative. Formative assessment is conducted on an on-going basis, aimed at assessing the students’ understanding, learning needs. Ongoing feedback is used by instructors to improve their teaching and for students to improve their learning during a lesson or unit. From this perspective, achievement in learning is often equated with the accumulation of skills and the memorisation of information in a given domain. Learning is demonstrated in the formation of habits that allow speedy performance. Students are given demonstrations to assess their competencies in the nursing procedures.

The researchers reflected on different theories used in the course. Cognitive theory is used during teaching by assessing students with problem-solving scenarios to stimulate their critical thinking skills. This results in competency in the diagnosis and management of patients. Constructivist theories of learning focus on how people construct meaning. They learn through making sense of the world by organising structures, concepts, and principles in the schema. Prior knowledge is regarded as a powerful determinant of a student’s capacity to learn new material. There is an emphasis on eliminating misunderstanding, and problem-solving is seen as the context for knowledge construction. Therefore, this theory is used by giving the learners topics and asking them to actively participate in discussions, especially in group discussions. This theory motivates teamwork and cooperation.

A behaviourist theory is often applied, especially in clinical teaching, by practicing repetitive teaching and learning. Mannequins are used to allow the students to learn and be able to make mistakes without harming the patients. Students are given enough time to demonstrate different procedures. The reflection recognises that nursing students learn differently; thus, the assessment practices should adhere to differentiated assessment tasks. This ensures inclusive and equitable assessment practices. Furthermore, the assessments are guided by Bloom’s Taxonomy levels as espoused in the National Qualification Framework, as lecturers’ knowledge and skills are updated through in-service education.

Theme 4: knowledge and disciplinary structures and assessment development

Bernstein’s [6] theory investigated the production and distribution of knowledge until it is recontextualised through textbooks and the planning of curriculum. Also, this includes how knowledge is reproduced through pedagogic practice. Bernstein’s [6] pedagogic device of knowledge structure is applied in the assessment for the course under discussion. Disciplinary knowledge structures are divided into two categories, namely hierarchical or horizontal [6]. A hierarchical knowledge structure consists of a coherent, explicit, and systematically principled structure, and the knowledge requirement is aligned in order. Hierarchical knowledge enables students to learn from the basic to the complex. This type of knowledge is applied to the course under discussion. The content of the module starts with the basics, with students assessed on the content before going on to the complex content. For example, the Midwifery module, which is spread over three years, lecturers assess students in the first year on the reproductive system before a normal pregnancy. This helps them to differentiate between nonpregnant and pregnant women.

In the second year of midwifery science, students learn and get assessed on the normal labour and normal puerperium. In the third year of study, they learn and are assessed on abnormal pregnancy and puerperium, as they already know the normal pregnancy and puerperium. Vertical knowledge structure is important because students’ knowledge is improved by learning and assessed on simple aspects before they are assessed on complex aspects. In addition, there is a prerequisite criterion, such as the expectation that the student should pass Midwifery Science one before registering for Midwifery Science two. Horizontal knowledge structure is also applied in assessment. The knowledge in nursing is structured differently. Therefore, the assessment practices should consider how the knowledge is structured in the nursing curriculum. Thus, assessment considers the scaffolding of students from one level to another.

Theme 5: quality assurance principles and processes on assessment

Assessment has been conducted according to the Quality Improvement Management Policy of UNAM [31]. Lecturers are appointed based on their qualifications and experience to ensure the continuous process of quality improvement. Leung et al. [25] argue that assessment should support and promote active learning. At UNAM, all academic staff are often trained on quality improvement processes in assessment. Adhering to the university’s quality improvement plan ensures that standards and criteria are based on the module objectives and learning outcomes. This enables the assessors not to assess students on things that are not in the course outline or outside the scope. Students’ performance may improve because the assessment criteria are made explicit from the beginning. This enables students to understand what is expected through formative or summative assessment.

Assessments such as tests are moderated internally by the subject’s experts, while all examinations are also moderated internally, with some also sent to external experts for moderation. Test scripts and examination scripts are also moderated. Quality assessment is also ensured with different assessment strategies such as portfolio, test, assignment, demonstration, peer assessment, observation, and student interviews. However, the most common assessment methods are tests, assignments, and a final written exam or practical examination, such as the Objective Structured Clinical Examination (OSCE).

Different types of assessment methods allow all students to demonstrate their knowledge, understanding, and skills. Feedback is provided to students on time after the assessment so that students can learn from their mistakes and improve their learning. Also, assessment tasks are set at the correct level of the Bloom taxonomy. Bloom [9] underscores the importance of balance in assessment that must be considered. This enables an assessment task to cover different objectives, which are aligned with cognitive (mind), psychomotor (body), and affective (heart) ways of knowing. The assessment conducted in the training of nurses at UNAM is inclusive of assessments that test the mind, that test the psychomotor skills, and the empathy-related skills.

The autoethnography revealed that assuring quality in assessment could be maintained through adherence to the policy standards. There is a continuous need to train academics on assessment practices. Also, quality assessment should be constructively aligned to the learning outcomes, the instructional activities. The principles of quality assessment should be assured through control measures such as internal and external moderation. Different strategies should be explored to ensure inclusive and equitable assessment of and for student learning that reflect holistic domains of learning and different levels of Bloom’s Taxonomy. Moreover, timely feedback is an important component of assessment, which promotes student learning.