Using the OSCE to measure clinical skills performance in nursing

A comparison of the nursing competence of graduates and diplomates from UK nursing programmes

This paper reviews the literature on nursing competence measurement and reports the results of a comparative quantitative study of the competencies of Project 2000 diplomates and BA (Hons) Adult Nursing graduates from two UK nursing programmes. The findings reveal that graduates appear to overcome any initial limitations and become more competent than the diplomates in certain areas. Attention to social awareness and participation is necessary in both pre-registration programmes, whilst greater attention could be given to graduates' leadership and management development. Diplomates need support in their professional development if they are to achieve the same level of competence as graduates during the first post-qualifying year. There are implications for the level of support afforded to qualifying nurses in their first staff positions; preceptorship programmes could be an important means of assisting newly qualified staff to gain confidence. More research on nurse competencies with larger samples drawn from programmes across the UK is needed.

The development of clinical competencies for use on a paediatric oncology nursing course using a nominal group technique

This paper outlines the development of a competency model to be used to assess clinical competence during a post-registration specialist course. A nominal group technique was used to gather data about the detailed practice of paediatric oncology nurses. The nominal group technique was chosen to achieve consultation and consensus with a professional group. The six steps from undertaking the nominal group technique to implementation are described in detail. Some reflections on the use of competency statements are offered.

Clinical competency: the right assessment tools?

Effective assessment of competency of student nurses in clinical practice is vital. Use of simulation rather than real life settings can be used to assess competency. Development of information technology and its use in teaching clinical skills offers opportunities for assessment. Clinical governance increases the need to scrutinize the assessment of practice. Ongoing assessment of clinical competency for qualified nurses is also important.

A perspective on clinical evaluation in nursing education

Clinical evaluation in nursing education is an important activity with potentially serious implications for students, teachers, and the recipients of nursing care. The evaluation of student learning in the clinical area has been the focus of much effort and energy as educators struggle with issues arising from the subjective nature of clinical evaluation and the role of clinical instructors as both teachers and evaluators. In this paper, the objectivity-subjectivity debate is reviewed and the limits of evaluation practices based solely in positivism are discussed. The teacher-evaluator and formative-summative distinction is viewed as a false dichotomy which enforces power differentials and impoverishes student learning. A case is built for clinical evaluation as a form of inquiry, the purpose being the discovery and verification of the process and product of the teaching and learning of nursing practice. Fourth generation evaluation is proposed as a basis for evaluation practices that address the unique and context-dependent nature of clinical practice, are capable of producing credible and dependable clinical evaluations, and are supportive of empowering teacher-student relationships.

Assessment of clinical skills: a new approach to an old problem

The changed nature of clinical placements, with shorter in-patient episodes and staff in clinical areas carrying increasingly high workloads, has prompted changes in the teaching learning and assessment of clinical skills. The 'Bart's Nursing OSCE' is an innovative approach to the assessment of clinical skills, through the medium of simulated professional practice. The antecedents of this educational development are discussed before detailed description of the Bart's Nursing OSCE. Discussion focuses upon: the rationale, authenticity, validity and reliability of the assessment; the roles of assessors and simulated patients; feedback to and from students and other stakeholders; the educational impact of the innovation; and management issues.

Developing and implementing an OSCE in dentistry

The processes of development, implementation and perceived usefulness of an objective structured clinical examination in restorative dentistry (OSCE(D)) are reported. An OSCE is a system of assessment. It consists of a set of standardised 'stations'. At each station, a student is tested on a specific clinical task. Each student moves from one station to the next so that by the end of the OSCE, every student has completed every station. The primary purpose of this OSCE was to provide feedback to 49 4th year students on their performance in the clinical areas of conservative dentistry, periodontology and prosthetics. Individual profiles were provided to students and the overall results discussed by staff. There were no significant differences in overall performance between genders or between students in the morning and afternoon examinations. There was a significant difference between performance in prosthetics and the other areas and there were some significant differences among the skill clusters of clinical knowledge, procedures, clinical reasoning, history-taking, techniques and communication. Students and staff perceived the OSCE(D) as a valuable tool for providing feedback. The development of the OSCE and the findings described in this paper will be of value to clinical staff who are developing OSCEs in all areas of dentistry.

An exploratory study of similarities and differences between senior students from different pre-registration nurse education courses

A triangulation design using two simulations, non-participant observation and a semi-structured interview to explore senior student nurse performance in South East England is described. A comparison of student nurse performance (registered general nurse [RGN] programme n = 34; registered nurse Project 2000 diploma programme n = 34; integrated degree programme n = 31) indicated many similarities but also some important differences in outcomes which included: a more systematic approach to information-seeking, better care-planning skills and higher quality nurse performance among integrated degree programme participants; use of a model and the immediate role of the nurse to guide information-seeking and better care-planning skills and weaknesses in clinical nurse performance among RGN programme participants; and weaknesses in the information-seeking, care-planning and clinical nurse performance among Project 2000 diploma participants. There were no significant differences between the clinical performance scores of the RGN and diploma programme participants. The interview data suggested that the integrated degree programme participants had a client focus in contrast to the professional focus of RGN and Project 2000 diploma participants. The findings, however, must be viewed within the context of an exploratory study of limited sample size. The research was funded by the English National Board for Nursing, Midwifery and Health Visiting.

Operationalisation of an observation instrument to explore nurse performance

This paper explores the operationalization of an observation instrument to explore actual situated behaviour in the clinical setting. Challenges encountered during this process and strategies employed to address these difficulties are discussed. This work formed part of a comparative study of outcomes of pre-registration nurse education programmes commissioned by the English National Board for Nursing, Health Visiting and Midwifery.

A relational view of learning: implications for nurse education

For about two decades, student learning in the context of professional and higher education, more generally, has been investigated by groups of researchers in countries such as Sweden, the UK, Australia and South Africa. The focus in many of these studies has been on the experience of students as they undertake complex, realistic tasks such as reading academic articles, listening to lectures, writing essays, solving problems and learning subject matter concepts. Central to this research is the adoption of a relational and holistic model of learning in which the relationships among all elements in the learning situation, including the student, the learning task, the teaching methods and assessment practices have been investigated. In particular, researchers from this line of inquiry have studied the relationship between the ways students go about learning in natural educational settings, referred to as approaches to learning, and what they learn. They have established that a full understanding of subject matter is reliant on students employing deep learning approaches which, in turn, depend on the perceived learning environment encouraging such learning. In this paper, the work of the relational theorists is described and the substantial and practical findings arising from this school of research are reported. Specific implications for the education of undergraduate nurses are also outlined.

Objectively assessing nursing practices: a curricular development

In preparation for the changing needs of undergraduate nursing students undertaking a Project 2000 degree, it was necessary to rethink the nursing skills programme. After studying the literature a nursing skills laboratory was designed which provided both an institutional and a domestic setting. A progressive programme was developed, to help the students learn nursing practices, which was based on the Objective Structured Clinical Evaluation (OSCE). A small pilot study was set up using second and third-year students from the traditional nursing studies degree. A number of stations were set up comprising various nursing scenarios. The students who were being assessed rotated through these. Other students acted as patients, examiners and some volunteered to be novices being taught by the more senior students. A set of marking criteria was drawn up for each station to enable each student to be assessed objectively. One of the stations was filmed to provide the students with personal feedback. By the end of the session the students had rotated through each of the stations and received the marked criteria as feedback. At the end of the session a focused group interview took place with all the students and the two lecturers involved in setting up the project. Students were positive and felt the process had potential for future development as a means of integration and consolidation of skills prior to clinical experience. The early introduction of filming to the programme was though to be of benefit by reducing stress levels through regular use. Students felt that the role of teaching the 'novice' helped them focus on their knowledge and performance. This process is resource intensive in human and non-human terms but enables small groups of students to learn in a realistic but safe, non-threatening environment and encourages them to take responsibility for their own learning.

Recent cognitive perspectives on learning--implications for nurse education

Nurse educators must keep abreast of contemporary learning theory so that their teaching reflects current ideas of best practice. In view of this, it is important to report on recent developments in the field of learning. Of particular significance is the fact that behaviouristic explanations of learning have largely been replaced with cognitive perspectives which emphasise the complexity of the learning process. Memory, learning, problem solving and expertise have all been investigated from a cognitive stance. The highlights of this work include, firstly, the portrayal of learning as an active, constructivist, cumulative and self-regulated process leading to the development of understanding and complex, skilled performance. Secondly, the highly important role played by knowledge in learning has been identified and described. Lastly, novice-expert differences in problem solving and academic and practical performance more generally, are well understood as a result of investigations of expertise in many domains. In this paper, these three significant perspectives from cognitive psychology will be examined and their implications for the education of undergraduate nurses described. Developments in the field of nursing that reflect or challenge a cognitive outlook are also identified.

Neglected conflicts in the discipline of nursing: perceptions of the importance and value of practical skill

The patient's body has moved out of focus in nursing. This has led to the diminishing importance of practical skill in the discipline of nursing. Patients, however, consider these skills to be a vital part of good nursing care. How can nursing as a practical discipline live with the long-standing conflicts that these disparate views create? It is time that theoretical discourse within the discipline paid attention to the patient's perception of good nursing care, and that efforts are made to investigate how nurses in the clinical setting develop and consolidate the practical skills needed for the patient's hygiene, comfort and medical treatment. In this paper the conflicts are delineated and conditions relevant to their development are discussed.

The Clinical Evaluation Tool: A Measure of the Quality of Clinical Performance of Baccalaureate Nursing Students

This article describes an approach to the evaluation of students' clinical performance. Specifically, the paper describes: (a) the history of the evaluation of clinical performance in nursing education; (b) the development of the Clinical Evaluation Tool (CET), an instrument designed to measure the clinical performance of nursing students across settings; and (c) the relationships between basic baccalaureate nursing students' scores on the CET and the following variables: age, college credits earned prior to entry to the program, grade point average at entry, college aptitude, and moral reasoning.

Competence versus performance: which is more important?

The extensive literature in the field of competence and performance is reviewed in this paper, which argues that there is much confusion between these different constructs. It concludes that since nurse pre-registration education is concerned with producing nurses who consistently provide care of a high quality, greater emphasis should be placed upon performance in the real-life clinical setting rather than upon competence.

Nurse Practitioner Education: Enhancing Performance Through the Use of the Objective Structured Clinical Assessment

An Objective Structured Clinical Assessment (OSCA) was implemented in a graduate nurse practitioner (NP) program to determine the effect that participation in this type of clinical simulation would have on the cognitive and clinical competency of students. Based on the analysis of data, participation in the OSCA simulations did not lead to significantly better cognitive or clinical performance. Support for the OSCA was shown, however, by NP students when subjectively evaluating their experiences. All students agreed or strongly agreed that OSCA participation was a valuable learning experience and that the feedback provided was beneficial to their clinical and cognitive performance.

Using the objective structured clinical examination in a psychiatry residency

Evaluation of psychiatric residents' clinical skills and knowledge is important to assure faculty that residents are achieving competence. Because psychiatric residents perform many activities without direct observation, it is necessary to construct techniques that allow careful objective evaluation of their performance. This article describes how one residency program developed an Objective Structured Clinical Examination (OSCE) to assess the clinical skills of its PGY-2 and PGY-4 psychiatric residents.

Assessment of competence in clinical practice--a review of the literature

Continuous practical assessments for those programmes leading to registration began to be introduced in the UK in the late 1970s and were generally hailed, certainly by educationalists, as being a much more valid, reliable and realistic method of assessment (Quinn 1989). However, now, with the increasing pressures on the role of the ward manager, the introduction of supernumerary status for learner nurses and shorter clinical placements, it could be argued that continuous practical assessment is in great danger of becoming no assessment at all. The extent to which experienced nurses are able to supervise and give the continued feedback on learners' progress that was considered such a significant improvement on the previous systems of assessments is questioned. On examination of the literature, consideration will be given to how experienced nurses measure and help others measure performance. The tools practitioners use to assist them in forming their judgements need to be examined. Are practitioners concerned with students' successful completion of tasks or do they rely on intuitive judgements in the complexity of the 'real life' situation? If intuitive judgements are involved, do they have any foundations, or are they concerned with mere random form completion and personality measures? In particular examination will be made of the various measurement tools available and different approaches to the assessment of competency in the 'real world' of nursing practice. Since the United Kingdom Central Council (UKCC) formally introduced the Nurses' Rules (Nurses, Midwives and Health Visitors Act 1979) in 1983, all courses throughout the UK, leading to registration had to begin to formally prepare students to work towards the achievement of the identified competencies.(ABSTRACT TRUNCATED AT 250 WORDS)