offering best support through questioning

My recent musing has been around the subject of questioning for assessment.

Hand (2006) suggests that questions elicit evidence of competence that is not observable, by evoking a verbal response from the learner. It’s a valuable way of determining the level of knowledge a learner has, and identifying their understanding of events and interventions. Questioning rounds out the assessment picture, allowing for a more holistic and integrated review of learner competence.

Obviously questioning is important in the whole process of assessment, but I have had a wavering commitment to it. If you tracked on a chart my questioning history, the line would start high, indicating lots of questions being asked, before dropping down as the number of questions reduced, and right now the line is on the rise again as I recognise the need to incorporate questioning into a well rounded assessment plan.

Thinking back over my questioning history in this way is helpful. When I started this job I asked a lot of questions – I wanted to know what the graduates knew and what they thought about their practice. I wanted to identify knowledge deficits in order to help them develop a learning plan.

Understandably the graduates were uncomfortable with being questioned. They felt that since they had already qualified to be a registered nurse they no longer needed this level of scrutiny. I also began to feel uncomfortable – my position is one of clinical support and somehow giving the graduate the third degree in questioning didn’t seem appropriate support.

I stopped asking so many questions, but my evaluation of the graduates’ progress decreased. Thinking back to my last blog, I’ve come to realise that if my task is to monitor the quality and quantity of learning that has taken place in order to develop appropriate learning plans (which it is!), I simply cannot do that without asking questions. In order to offer the best clinical support, I must practice questioning.

Now I have come full circle, and I am gradually getting back into the groove of questioning, though I still find myself easily put off by the attitude of the graduates and the busyness of their day. I have to push through these obstructions and do what must be done not what feels good!

An incident the other day highlighted the issues here – the importance of questioning and the pressure not to question.

A graduate was working in a room with four patients, and one patient had two intercostal chest tubes (ICT). From experience, every graduate stumbles over the same issues with intercostal tubes every time, so I sidled up to this particular graduate and asked how they were going with the ICTs. They said they’d been looking after them for a few shifts now, and were OK with all that needed to be done. Since the graduate was obviously in the middle of a busy moment, I advised them that I would return soon and we could go through the ICT together.
Later I returned and pulled out the ICT observation chart and asked the graduate to explain what each observation meant. When we came to ‘air leak’ they started talking about checking the tubing for air leaks and noted that there had been a hissing coming from the suction connections the previous day. I then asked them if ‘air leak’ could refer to anything other than the tubing and when they didn’t know I took the opportunity to educate them correctly about ICTs and air leaks. This task was made more difficult because someone else had already ‘educated’ them about the ICT, so when I came along informing them that the original education was incorrect, they were somewhat dubious.

We continued to discuss ICTs, correct observation recording and other relevant protocols and the graduate continued on with their day. I walked away from the conversation suddenly very aware of the value of questioning. If I had merely looked at the completed observation chart, or taken the graduate’s word for it I might have missed the learning needs they had.

I’ve come away from this experience with a greater appreciation for the role of questioning in supporting the graduates. Now my task is to look at ways I can ease back into more thorough questioning - ‘How are you going today?’ and ‘Can I help you with anything?’ don’t really count!

I want to be the best Clinical Support Nurse I can, and questioning will help me better assess and provide support on the wards.