A review of clinical competence assessment in nursing

Comparison of the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses: A cross-sectional-correlation study

INTRODUCTION

Nurses' sensitivity to moral issues, especially in emergency and intensive care units is essential for providing complex nursing care. Therefore, the present study aimed to determine the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses.

METHODS

The present multi-center cross-sectional correlational study was conducted in 2022 on 180 nurses in five emergency departments and four intensive care units of general hospitals affiliated to Semnan University of Medical sciences. The study tools include a demographic questionnaire, 25 item Lutzen Moral Sensitivity Questionnaire (MSQ), and a standardized Competency Inventory for Registered Nurses (CIRN). Data were analyzed by mean, standard deviation and MANOVA, Pearson's correlation coefficient test.

RESULTS

The two groups did not have significant differences in demographic characteristics (p < 0.05). Majority of two emergency department nurses (83.9%) and Intensive care nurses (81.8%) had a moderate level of moral sensitivity. Also, clinical competence of majority of emergency department nurses (73.3%) and Intensive care nurses (75.8%) were in moderate level. There was significant positive relationship between moral sensitivity with Clinical competence in emergency department nurses (p ≤ 0.01, r = 0.61). No significant relationship was observed between moral sensitivity and the clinical competence of intensive care nurses (p > 0.05, r = 0.15).

CONCLUSIONS

There is need for improving the level of knowledge of nurses about moral principles and increasing moral sensitivity which can expand the components of clinical competence, especially in intensive care units.

Clinical competency of nurses trained in competency-based versus objective-based education in the Democratic Republic of the Congo: a qualitative study

BACKGROUND

Designing competency-based education (CBE) programmes is a priority in global nursing education for better nursing care for the population. In the Democratic Republic of the Congo (DRC), object-based education (OBE) remains mainstream in pre-service nursing education programmes. Recently, the Ministry of Health developed a self-assessment tool and quantitatively compared the clinical competency of CBE- and OBE-trained nurses. This study aimed to qualitatively triangulate the results of self-evaluation by exploring perception of supervisors, incumbent CBE-, and OBE-trained nurses in comparison with the competence of the two types of nurses, and to identify influential factors or barriers to their competence in clinical settings.

METHODS

A qualitative descriptive approach with conventional content analysis was applied. Twenty interviews with clinical supervisors who oversaw both CBE- and OBE-trained nurses, 22 focus group discussions (FGDs) with CBE-trained nurses, and 21 FGDs with OBA-trained nurses currently working in health facilities were conducted. Participants of the FGDs were selected from the participants of the DRC self-assessment competency comparison study where there was no statistically significance between CBE- and OBE-trained nurses in the demographic characteristics. Data were analysed in terms of the competencies identified by the Ministry of Health.

RESULTS

The supervisors recognised that the CBE-trained nurses had stronger competencies in professional communication, making decisions about health problems, and engaging in professional development, but were weak in clinical skills. This study identified challenges for supervisors in assuring standardised care in health facilities with OBE- and CBE-trained nurses, as well as barriers for CBE-trained nurses as a minority in the workplace in demonstrating their competencies.

CONCLUSIONS

The study results support the Ministry of Health's policy to expand CBE in pre-service education programmes but reveal that its slow implementation impedes full utilisation of the acquired competencies at health facilities. Implementation could be accelerated by strengthening cooperation among the Ministry of Health's three human resource departments, and developing and implementing a well-planned, legally binding, long-term CBE reform strategy, including an approach to the Continuing Professional Development system.

Assessing the Competence of Nursing Students in Clinical Practice: The Clinical Preceptors' Perspective

Nursing students' integration of theoretical knowledge and practical abilities is facilitated by their practice of nursing skills in a clinical environment. A key role of preceptors is to assess the learning goals that nursing students must meet while participating in clinical practice. Consequently, the purpose of this study was to explore the current evidence in relation to competency assessment and assessment approaches, and the willingness of preceptors for assessing nursing students' competency in a clinical setting. The scoping review used the five-stage methodological framework that was developed by Arksey and O'Malley, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Relevant studies were searched by applying a comprehensive literature search strategy up to April 2024 across the following databases: CINAHL, OVID MEDLINE, EMBASE, and PUBMED. A total of 11,297 studies published between 2000 and April 2024 were revealed, and 38 were eligible for inclusion, which the research team categorised into three main themes: definitions of competence, tools for assessing competence and preceptors' and mentors' viewpoints in relation to the assessment of nursing students' competence. This review established that there are a multitude of quantitative instruments available to assess clinical competence; however, a lack of consistency among assessment instruments and approaches between countries and higher education institutions is prevalent. Existing research evidence suggests that the preceptors carried out the assessment process clinically and they found difficulties in documenting assessment. The assessing of nursing students' competency and the complexity of assessment is a concern for educators and mentors worldwide. The main concern centers around issues such as the interpretation of competence and complex measurement tools.

Perceived professional preparedness and identity among senior nursing students: a latent profile Analysis

BACKGROUND

Senior nursing students' perceptions of their professional preparedness help them for expectations of their future nursing role with more confidence, and professional identity may contribute to cultivating nursing students' perceptions of professional preparedness. In this study we applied latent profile analysis to identify the latent profiles of perceived professional preparedness among senior nursing students and to examine their identity and predictors.

METHODS

This was a cross-sectional descriptive study. A total of 319 senior nursing students from five universities in China were enrolled. Data were collected using the Perceived Professional Preparedness of Senior Nursing Students' Questionnaire and the Professional Identity Scale for Nursing Students.

RESULTS

Three latent profiles were identified and labeled as "low perceived professional preparedness" (n = 90, 28.2%), "low clinical competency-low EBP (Evidence-Based Practice)" (n = 190, 59.5%), and "high perceived professional preparedness" (n = 39, 12.2%). Place of residence, average clinical practicum hours per day, part-time experience, good relationships with classmates, and feeling nobility toward nursing due to COVID-19 significantly predicted profile membership. The average professional identity score was also statistically different across the three profiles (F = 54.69, p < 0.001).

CONCLUSIONS

Senior nursing students' perceptions of their professional preparedness were divided into three profiles, and out results show that promoting professional identity may effectively foster their perceived professional preparedness. This study therefore highlights the importance of targeted interventions by considering their distinct perceptions of professional preparedness patterns.

Methodological approaches and competence areas of nursing students in virtual reality simulation research - A scoping review

OBJECTIVES

To analyze methodological approaches (theoretical frameworks, study designs, methods) and competence areas of nursing students in research on virtual reality simulations (VRS) with a high level of immersion.

METHODS

A scoping review was performed. A systematic search of the literature was conducted on MEDLINE, CINAHL and ERIC databases on 30/11/22. In addition, a manual search was utilized. The extracted data relating to the research questions was descriptively analyzed and results were narratively summarized.

RESULTS

In total 23 studies were included in the review. Selected studies employed a wide range of theoretical frameworks and research designs. The studies aimed to develop competences both through complex interventions where team-based skills are required in acute situations, and they described basic nursing interventions where individual skills are required in non-acute nursing care.

CONCLUSIONS

A significant amount of the selected studies did not utilize a learning theory or an instructional design framework as a basis for their research. More knowledge was found on training specific skills compared to facilitating the attitudes and values of the participants. Therefore, there is a need for further research on whether nursing students' attitudes and values can be supported through VRS with a high level of immersion.

Psychometric Validation of the Nursing Professional Competence Scale Among Italian Nurses and Albanian Nursing Students

Background and Purpose: The main aim of this study has been the psychometric validation of an Italian translation of the Nurse Professional Competence Scale-Short Form (I-NPCS-SF), testing its validity and reliability. Methods: A multiphase design was used for the I-NPCS-SF translation and psychometric validation: (a) cultural and linguistic validation, (b) content and face validity, and (c) construct validity. Results: The I-NPCS-SF showed adequate linguistic translation, cultural adaptation, and content validity. Confirmatory factor analysis supported a four-factor structure of the I-NPCS-SF, in explaining data obtained from nurses and nursing students. Conclusions: The I-NPCS-SF demonstrated evidence of validity and reliability in measuring four professional competencies. Having an appropriate tool to be applied in the Italian context for professional competence self-assessment constitutes an essential step in measuring professional competencies.

Clinical Evaluation of Competence in Nursing Education: What Do We Know?

AIM

The purpose of this article was to examine the research literature to identify objective, replicable measurement of clinical competence in undergraduate nursing education.

BACKGROUND

Although a standardized licensure examination is used to determine minimal competence to practice, no consensus on the definition or components of competence exists in the research literature.

METHOD

A comprehensive search was conducted to locate studies that evaluated nursing students' general competence in the clinical setting. Twelve reports published from 2010 to 2021 were examined.

RESULTS

Measures to evaluate competence were varied and contained multiple concepts including attributes of knowledge, attitudes and behaviors, ethics and values, personal attributes, and cognitive or psychomotor skills. Most studies used researcher-created instruments.

CONCLUSION

Although essential to nursing education, competence in the clinical setting is not commonly defined or evaluated. The lack of standardized instruments has contributed to the use of varied methods and measures for evaluating competence in nursing education and research.

Comparison of the clinical competency of nurses trained in competency-based and object-based approaches in the Democratic Republic of the Congo: A cross-sectional study

In the Democratic Republic of the Congo (DRC), the object-based approach (OBA) still remains mainstream in the basic nursing education program, despite the intention of the Ministry of Public Health to expand the competency-based approach (CBA) nationwide. This study aimed to compare the clinical competency of nurses trained with CBA and OBA. A cross-sectional, mixed study was conducted. We developed a self-assessment questionnaire consisting of an individual demographic information, a clinical competency assessment scale and the General Self-efficacy Scale. Nurses trained with CBA or OBA and currently working in health facilities with two to five years of clinical experience were purposively selected from ten cities across nine provinces in the DRC. We also conducted key informant interviews with the clinical supervisors at health facilities. In a comparison of 160 nurses trained with CBA and 153 with OBA, 3 competency domains ("establishing professional communication", "making decisions about health problems", and "performing nursing interventions") of the 5 domains required for nurses had significantly higher scores in the CBA group. The key informant interviews supported these results while revealing various issues in the basic nursing education program. The results support the strategic direction of the Ministry of Public Health in the DRC to expand CBA. Collaboration among education institutions, health facilities, and administrative bodies is crucial for clinical nurses to fully engage their competencies for the population. Other low- and middle-income countries with scarce resources can refer to the developed and implemented competency assessment method applied in this study.

Instruments for measuring empowering patient education competence of nurses: Systematic review

AIM

This review aimed to identify validated self-reported instruments used to measure nurses' competence or attribute(s) of competence in empowering patient education, to describe their development and main content and critically appraise and summarize the quality of the instruments.

DESIGN

Systematic review.

DATA SOURCES

Electronic databases of PubMed, CINAHL and ERIC were searched from January 2000 to May 2022.

REVIEW METHODS

Data was extracted following predetermined inclusion criteria. With the support of the research group, two researchers performed data selection and appraised the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist (COSMIN).

RESULTS

A total of 19 studies reporting 11 instruments were included. The instruments measured varied attributes of competence and the contents were heterogenous reflecting the complex nature of both empowerment and competence as concepts. Overall, the reported psychometric properties of the instruments and methodological quality of the studies were at least adequate. However, there was variation in the testing of the instruments' psychometric properties and lack of evidence limited the evaluation of both the methodological quality of the studies and quality of instruments.

CONCLUSION

The psychometric properties of the existing instruments assessing nurses' competence in empowering patient education need to be tested further, and future instrument development should be built on a clearer definition of empowerment as well as on more rigorous testing and reporting. In addition, continued efforts to clarify and define both empowerment and competence on the conceptual level are needed.

IMPACT

Evidence on nurses' competence in empowering patient education and its valid and reliable assessment instruments is scarce. Existing instruments are heterogenous and are often missing proper testing of validity and reliability. These findings contribute to further research on developing and testing the instruments of competence in empowering patient education and strengthening nurses' empowering patient education competence in the clinical practice.

Changes in nursing students' self-reported professional competence in simulation-based education and clinical placement: A longitudinal study

BACKGROUND

A primary learning outcome for nursing students is to achieve the professional competence necessary to provide safe and high-quality care in complex and specialized health services. Simulation-based education (SBE) and clinical placement are two educational settings in which nursing students' professional competence can be facilitated as a learning outcome.

OBJECTIVES

The study objectives were to investigate changes in nursing students' self-reported professional competence in SBE and clinical placement and the transfer of this competence from SBE to clinical placement. We also aimed to investigate which competence areas were highest and lowest rated.

DESIGN

A quantitative longitudinal survey design was applied.

SETTINGS

The study took place from May 2019 to January 2020 in a simulation center at a Norwegian university and clinical placement in hospital units.

PARTICIPANTS

Bachelor nursing students (N = 38) in their second and third year of a four-year part-time Norwegian nursing bachelor's degree program.

METHODS

The Nurse Professional Scale Short Form (NPC Scale-SF) consisting of six competence areas was used to measure nursing students' self-reported professional competence across four time points. Paired sample t-test and descriptive statistics were used to analyse data.

RESULTS

For changes in the longitudinal perspective, students' self-reported professional competence increased significantly. In the transfer perspective, from SBE to clinical placement, four competence areas declined significantly. Value-based nursing care were scored highest, whilst Development, leadership, and organization of nursing care were scored lowest score at all time-points.

CONCLUSIONS

Findings indicate that nursing students' self-reported professional competence increased in the longitudinal perspective. Supporting students in transfer of professional competence should be addressed in SBE and clinical placement, whilst nursing education should be strengthened concerning development, leadership, and organization of nursing care.

Developing a professional competence framework for the master of nursing specialist degree program in China: A modified Delphi study

BACKGROUND

The urgency of ensuring adequate professional competence in clinical nursing practice is evident. However, there is little formal professional competence framework for the education of master's degree students in nursing specialist programs in China.

OBJECTIVE

To develop a professional competence framework for the Master of Nursing Specialist (MNS) degree program in China.

DESIGN

A modified Delphi study.

PARTICIPANTS

An expert panel discussion was held with 12 experts, and Delphi rounds were conducted with 24 experts.

METHODS

A literature review and an expert panel discussion were conducted to develop an initial competence framework. A two-round Delphi survey was employed to obtain a consensus on the framework through either an online or paper questionnaire. Descriptive statistics were used to analyze the data. The consensus threshold was set according to the mean (≥ 4.0), coefficient of variation (< 0.25), and consensus level of agreement (≥70 %).

RESULTS

A consensus on seven domains and 54 items of the professional framework for the MNS degree program was achieved. The framework domains included clinical practice (12 items), professional attitude (8 items), collaboration and communication (5 items), professional development (8 items), research (7 items), education (7 items), and administration (7 items).

CONCLUSION

The professional competence framework offers guidelines for MNS degree programs in China. Future research should focus on imbedding these competences in MNS degree programs to prepare qualified advanced practice nurses.

What really matters for patient safety: Correlation of nurse competence with international patient safety goals

Background

Optimal level of nurse competence is imperative for patient safety and quality of care. A research gap exists in empirical evidence for associating nurses’ competencies with patient safety.

Purpose

The primary purpose of this study was to measure the association between general ward nurses' competencies with international patient safety goals.

Method

Correlational research design was adopted. Stratified random sampling was used to recruit (n  =  182) nurses working in two JCIA accredited and non-JCIA hospitals. Data were collected using the Competency Inventory for Registered Nurses and International Patient Safety Goals. The research was approved by the Institutional review board and ethics committee.

Findings

The regression analysis showed enhancement of patient safety with an improvement in nurse competencies R2  =  0.238. Nurse competencies showed a moderate positive association with an overall patient safety such as critical thinking and research aptitude (r  =  0.420, P – Value < 0.001), teaching coaching (r  =  0.469, P- Value <0.01), professional development (r  =  0.436, P – Value < 0.001), legal and ethical practices (r  =  0.434, P –Value < 0.001), interpersonal relationships (r  =  0.430, P –Value < 0.001), Leadership (r  =  0.400, P –Value < 0.001), and Clinical Care (r  =  0.541, P –Value < 0.001). Moreover, experience and professional education show positive association with both, patient safety and nurses’ competencies.

Conclusion

Nurses’ clinical competencies are crucial to enhance patient safety. Personal and professional attributes affect the competencies of nurses and patient safety. Hospital management should take mandatory steps to ensure improving nurses’ competencies for better patient safety.

Developing the Heart Failure Specialist Nurse Competency Framework

The aim of this article is to outline the underpinning conceptual principles of advanced nursing and competency embedded in the Heart Failure Specialist Nurse Competency Framework, launched in January 2021. The authors refer to Benner's novice to expert pedagogy and explore how this provides a robust framework on which to assess the progress of the heart failure specialist nurse. Some key considerations are discussed, for example the importance of constructive feedback and feed-forward in the individual's learning cycle. Finally, plans for the future are discussed and the importance of evaluation in the authors' ongoing commitment to improving the learning experience.

Exploring the formal assessment discussions in clinical nursing education: An observational study

Introduction

According to EU standards, 50% of the bachelor education program in nursing should take place in clinical learning environments. Consequently, this calls for high quality supervision, where appropriate assessment strategies are vital to optimize students’ learning, growth, and professional development. Despite this, little is known about the formal assessment discussions taking place in clinical nursing education.

Objective

The aim of this study was to explore the characteristics of the formal assessment discussions taking place during first-year students’ clinical education in nursing homes.

Method

An exploratory qualitative study was performed. The data consist of passive participant observations of 24 assessment discussions (12 mid-term and 12 final assessments) with first-year nursing students (n=12), their assigned registered nurse mentors (n=12) and nurse educators (n=5). The study was conducted in three public nursing homes in a single Norwegian municipality. Data were subjected to thematic analysis. The findings were reported using the Standards for Reporting of Qualitative Research.

Results

Three themes were identified regarding the characteristics of the formal assessment discussions: (1) adverse variability in structuring, weighting of theoretical content and pedagogical approach; (2) limited three-part dialogue constrains feedback and reflection; and (3) restricted grounds for assessment leave the nurse educators with a dominant role.

Conclusion

These characteristic signal key areas of attention to improve formal assessment discussions to capitalize on unexploited learning opportunities.

Influence of emotional intelligence on the clinical ability of nursing interns: a structural equation model

Background

Internship is a critical period during which nursing students develop clinical skills and establish professional attitudes. Requirements for nursing interns are evolving with the development of medicine and the transformation of teaching models. The emotional intelligence (EI) of nursing students has an influence on their clinical performance. This study aimed to investigate the impact of EI on the clinical ability of nursing interns.

Methods

A cross-sectional observational study was designed to include nursing students interning in a tertiary hospital in Shanghai, China from April 1, 2019 to April 30, 2020 (N = 310). Chinese versions of the EI scale (EIS) and holistic clinical assessment tool (HCAT) were used to measure the EI and clinical ability of interns, respectively. Pearson’s correlation coefficient was utilized to determine the correlation between EI and clinical ability. Multiple linear regression analysis was performed to further explore the influence of EI on clinical ability, and the structural equation model (SEM) was used for multivariate path analysis.

Results

The mean EI and clinical ability scores of interns were 125.17 ± 14.98 and 97.91 ± 19.55, respectively, indicating an upper-moderate level in both aspects. EI scores were correlated positively with clinical ability ones (R = 0.534, p < 0.05). Multivariate path analysis showed that “managing emotions” and “facilitating thought” of EI branches have direct effects on clinical ability. Furthermore, the type of school, family financial state and the knowledge of EI indirectly influence clinical ability through their impact on “managing emotions” and “facilitating thought”.

Conclusions

EI is essential to enhancing the clinical ability of nursing students. EI training should focus on facilitating thought and managing emotions. It is also necessary for educators to consider the context of nursing students and the characteristics of schools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00933-y.

Effectiveness of pediatric learning modules in enhancing competencies among nurses in a specialized unit

The global shortage of highly competent nurses has forced healthcare organizations to adapt to various strategies, including rotating nurses to different units, impacting their competency levels. To equip nurses with the needed competencies, the researchers developed the pediatric learning modules and conducted this study to analyze their effectiveness. Researchers employed purposive and random sampling to identify study participants, and utilized a mixed-method design, including Solomon Four Group Design and a narrative approach. A researcher-made evaluation questionnaire, competency checklists, and guide questions for a written narrative were used to collect data. Descriptive statistics and factorial analysis of covariance were utilized for data analysis. The outcomes revealed that demographic variables have no effect on knowledge and competence (p > 0.05). It was also discovered that exposure to learning modules enhanced the competence levels of nurses who were inexperienced in the pediatric setting (F = 41.183, df = 1, p = 0.000). Furthermore, results revealed that enhancing knowledge and competencies is not wholly dependent on well-structured educational sessions and training modules, but is also influenced by other factors, including time allocation for module delivery, protected time to practice, and the opportunity to apply new skills in the clinical area.

Development of a high-risk neonatal infection control competency scale

The purpose of this study was to develop a scale to measure high-risk neonatal infection control competency among nurses in neonatal intensive care units (NICUs). The study participants included 251 nurses working in NICUs at seven hospitals in South Korea. The scale was designed to measure high-risk neonatal infection control competency in terms of performance (HirNICCS_P) and knowledge (HirNICCS_K), which were addressed by 42 and 54 items, respectively, and was initially subjected to content validity testing by a panel of experts in neonatal nursing. The items were divided into five factors: (1) basic care, (2) skin care, (3) feeding management, (4) medication and invasive procedures, and (5) environment management. After participant completion of the scale, construct validity was examined using exploratory and confirmatory factor analyses, and internal reliability tests were also performed. The total variance of validity was 53.7% for HirNICCS_P, and the Cronbach's alpha values for reliability were .95 for HirNICCS_P and .67 for HirNICCS_K based on a Kuder-Richardson-20 test. We concluded that this scale can be used to assess the performance and knowledge with regard to infection control competency among neonatal nurses and that its application can support strengthening of infection control education for nurses who score low on performance and knowledge competency.

Development of clinical competence - a longitudinal survey of nurse practitioner students

BACKGROUND

In order to achieve a sustainable standard of advanced clinical competence for nurse practitioners leading to a credible role, it is important to investigate the development of clinical competence among nurse practitioner students.

AIM

The aim of the present study is to analyse the development of nurse practitioner students' self-assessed clinical competence from the beginning of their education to after completion of their clinical studies.

DESIGN

The study involved the application of a longitudinal survey design adhering to STROBE guidelines.

METHODS

The participants consisted of 36 registered nurses from a nurse practitioner programme at a Norwegian university. The Professional Nurse Self-Assessment Scale II was used for data collection during the period August 2015 to May 2020.

RESULTS

The students developed their clinical competence the most for direct clinical practice. Our findings are inconclusive in terms of whether the students developed clinical competence regarding consultation, coaching and guidance, and collaboration. However, they do indicate a lack of development in some aspects of clinical leadership. The students with the lowest level of clinical competence developed their clinical competence regarding direct clinical practice significantly more than the students with the highest level of clinical competence. The differences between students with high and low levels of clinical competence were levelled out during their education. Thus, the students as a whole became a more homogenous group after completion of their clinical studies. Previous work experience in primary healthcare was a statistically significant, yet minor, predictor of the development of clinical competence.

CONCLUSION

Our findings indicate that the students developed their clinical competence for direct clinical practice in accordance with the intended learning outcomes of the university's Master's programme and international standards for nurse practitioners. It is imperative that the clinical field supports nurse practitioners by facilitating extended work-task fits that are appropriate to their newly developed clinical competence. We refrain from concluding with a recommendation that prior clinical work experience should be an entry requirement for nurse practitioner programmes. However, we recommend an evaluation of the nurse practitioner education programme with the aim of investigating whether the curriculum meets the academic standards of clinical leadership expected in advanced level of nursing.

Academic evaluation, management and satisfaction of clinical practicums among undergraduate students: software CliPrAS@UB

AIM/OBJECTIVE

To determine the development of competency acquisition, the satisfaction of the agents involved and recording incidents with a digital platform CliPrAS @UB on the Clinical Placements I and II courses in the second and third years of the Bachelor's Degree in Nursing.

BACKGROUND

The teaching of clinical practice subjects requires an analysis of the competence evolution, a management structure and an analysis of the satisfaction of the agents involved in the subject.

DESIGN

Prospective, analytical, observational cohort study.

METHODS

The study was carried out in a public university center in Barcelona with 387 students distributed in nine centers of the network of Health Institutions.

RESULTS

An increase of 2.32 points was observed in the competence dimensions of Professional Practice and with a reduction in the average score in the skills of care provision, therapeutic communication and professional development of more than 0.08 points. Regarding the seminars, a reduction of the average global score of 0.58 points was observed.

CONCLUSIONS

The use of the CliPrAS @ UB computer platform has improved the implementation of the mandatory documents, the recording of incidents and the overall satisfaction of the students.

See it, hear it, feel it: embodying a patient experience through immersive virtual reality

Purpose

The aim of the study was to explore aspects of learning in terms of gain in knowledge, confidence and empathy with immersive virtual reality (VR) from the patient perspective in undergraduate nursing students.

Design/methodology/approach

A pilot study integrating immersive VR experiences during clinical courses was facilitated based on the INACSL (2016) standards for simulation practices with a convenience sample of 165 nursing students in three levels of cohorts, using two different VR scenario simulations. Quantitative and qualitative data were collected through pre- and post-surveys.

Findings

Student participants embodied patients with chronic disease using immersive VR. Findings showed substantial gains in most measures of knowledge, confidence and empathy, with slightly less difference seen in lower level nursing students particularly with empathy and understanding.

Research limitations/implications

Embodiment through immersive VR scenarios was shown to increase learner development. The positive findings from the pilot study justified continuance of integration of immersive VR in nursing education, recommending further use and research.

Originality/value

Simulated learning for nursing has known benefits on knowledge and understanding. Immersive VR is gaining recognition within nursing education as a method to enhance cognitive and affective knowledge. This paper hopes to add insights on the impact of immersive VR for student learning and encourage discussion about the future for innovative immersive teaching and learning approaches for experiential learning.

The objective structured clinical examination as an assessment strategy for clinical competence in novice nursing practitioners in Taiwan

Background

The conventional written tests and professional assessment have limitation in fair judgement of clinical competence. Because the examiners may not have total objectivity and may lack standardization throughout the assessment process. We sought to design a valid method of competence assessment in medical and nursing specialties. This work was aimed to develop an Objective Structured Clinical Exam (OSCE) to evaluate novice nursing practitioners’ clinical competency, work stress, professional confidence, and career satisfaction.

Methods

A Quasi-experimental study (pre-post). Fifty-five novice nursing practitioners received the OSCE three-months following their graduation, which consisted of four stations: history taking, physical examination, problem-directed management, interpersonal communication, and the required techniques of related procedures. The examiners had to complete an assessment checklist, and the participants had to complete a pre-post questionnaire (modified from a Nursing Competency Questionnaire, a Stress scale, and Satisfaction with Learning scale).

Results

Among the novice nursing practitioners, 41 of them (74.5 %) passed the exam with a mean score of 61.38 ± 8.34. There was a significantly higher passing rate among nurses who were working in medical-surgical wards (85.7 %) and the intensive care unit-emergency department (77.8 %) compared to novice nursing practitioners working in other units. All the novice nursing practitioners at Station A had poor performance in assessing patients with a fever. OSCE performance was more associated with educational attainment and work unit, rather than the gender. Finally, the participants showed statistically significant increases in their clinical competency, confidence in their professional competence, satisfaction with the clinical practice, and decreased work stress after the OSCE.

Conclusions

We found that the OSCE process had a positive educational effect, in providing a meaningful and accurate assessment of the competence of novice nursing practitioners. An appropriate OSCE program is vital for novice nursing practitioners, educators, and administrators. The effective application of OSCEs can help novice nursing practitioners gain confidence in their clinical skills.

Development and validation of the nursing clinical assessment tool (NCAT): a psychometric research study

OBJECTIVES

The aim of this pilot psychometric study was to develop and assess the reliability, validity, and applicability of a nursing clinical assessment tool (NCAT) to assess students' clinical performance in the clinical training.

METHODS

Total of 325 forms were completed by 36 clinical raters for undergraduate nursing students who were selected using convenience sampling. International quality and safety education for nurses (QSEN) and Benson and Clark's (Benson, J., & Clark, F. (1982). A guide for instrument development and validation. The American Journal of Occupational Therapy, 36(12), 789-800) model guided the construction of the NCAT. Following literature review, a cross-cultural adaptation and psychometric testing were used.

RESULTS

This newly developed tool showed substantial overall internal consistency reliability (Cronbach's alpha = 0.74). Three factors (i.e. Care Provider, Leadership & Team Work and Professionalism and Ethical Considerations) were identified for construct validity using exploratory factor analysis (EFA).

CONCLUSIONS

This study suggests that the NCAT is a reliable, valid and applicable tool. It can be used in clinical and educational settings. Further testing of the tool in similar and different cultures is recommended.

Interassessor agreement of portfolio-based competency assessment for orthotists/prosthetists in Australia: a mixed method study

BACKGROUND

Internationally qualified orthotists/prosthetists who want to practice in Australia must pass a portfolio-based competency assessment. Testing the agreement between independent assessors is important to engender confidence in the assessment, and continually improve the processes.

OBJECTIVES

To quantify interassessor agreement for all 68 performance indicators in the Australian Orthotic Prosthetic Association's Entry Level Competency Standards and where there was significant disagreement between assessors, to explore the reasons why.

STUDY DESIGN

Mixed methods: explanatory sequential.

METHOD

Fifteen portfolios were assigned to independent assessors. Assessors determined whether the evidence presented met the requirements of each performance indicator. Interassessor agreement was calculated using Gwet's Agreement Coefficient 1 (AC1), and these data informed semistructured interviews to explore the reasons for disagreement.

RESULTS

Most performance indicators (87%) had moderate to substantial agreement (AC1 > 0.71), which could be attributed to a variety of factors including the use of a simple assessment rubric with supporting guidelines and assessor training to establish shared expectations. The remaining performance indicators (13%) had fair to slight agreement (AC1 ≤ 0.7). Interviews with assessors suggested that disagreement could be attributed to the complexity of some performance indicators, unconscious bias, and the appropriateness of the evidence presented.

CONCLUSIONS

Although most performance indicators in Australian Orthotic Prosthetic Association's Entry Level Competency Standard were associated with moderate to substantial interassessor agreement, there are opportunities to improve agreement by simplifying the wording of some performance indicators and revising guidelines to help applicants curate the most appropriate evidence for each performance indicator.

Piloting of a nursing and midwifery competence framework in the cultural context of a middle eastern country

Clinical competence amongst nurses and midwives is vital for the delivery of safe and consistent patient care. However, worldwide there is a lack of agreement on definitions and notions about what constitutes competence and how it can be determined in everyday clinical practice. This situation poses professional dilemmas in situations where competing dialogues exist. This is particularly evident in countries that employ nurses and midwives from diverse national backgrounds with differing professional and educational experiences. To address potential misunderstandings, ensure a consistent approach to the confirmation of clinical competency and assure patient safety, a strategic decision was taken by the nursing and midwifery leadership of the country's major healthcare organisation to develop an organisationally and culturally sensitive competence framework model. This article reports on the design, development and piloting of an educationally led framework model. The model, referred to as 'Q-PACE: Qatar's Practice, Appraisal, Competence and Education', links previously fragmented activities regarding confirmation of clinical competence of staff into a unified holistic process that provides assurance regarding the competence of new and existing employees.

Is nurses' clinical competence associated with their compassion satisfaction, burnout and secondary traumatic stress? A cross-sectional study

Aim

The current study aimed to investigate the relationship between clinical competence and subscale of professional quality of life (ProQOL).

Methods

This cross-sectional study was conducted from November 2018 to May 2019 on 291 nurses working in public hospitals in south Iran (Rafsanjan). The nurses were selected by convenience sampling method. Data were collected using the ProQOL questionnaire that included three subscales: compassion satisfaction, secondary traumatic stress and burnout and the Competency Inventory for Registered Nurse (CIRN) that measured clinical competence.

Results

A significant positive relationship was observed between compassion satisfaction and clinical competence. A significant negative association was found between compassion satisfaction and secondary traumatic stress/burnout and also between secondary traumatic stress and clinical competence. The results of regression analysis indicated that compassion satisfaction was the best predictor of secondary traumatic stress (R2 = 65%), burnout (R2 = 40%) and clinical competence (R2 = 12%). Moreover, secondary traumatic stress was found to be the best predictor of compassion satisfaction (R2 = 53%).

Evaluation of Nurse Practitioners' Professional Competence and Comparison of Assessments Using Multiple Methods: Self-Assessment, Peer Assessment, and Supervisor Assessment

PURPOSE

Nurse practitioners (NPs) are increasingly important in healthcare as they play a key role in leading advanced nursing practices. Assessing their professional competence is essential. The aim of this study was to evaluate NPs' professional competencies based on at a collaborative model around NP self and compare different methods of assessment.

METHODS

This is a cross-sectional study, and a purposive sample of 211 participants in the teaching hospital was used. Methods used were self-assessment (nurse practitioners), peer assessment (physicians and nurses) and supervisor assessment (head nurses).

RESULTS

The competence of nurse practitioners was rated as moderate (mean score = 3.45 of a possible 5; SD = 0.59). However, each method resulted in differences in competence for total scores and dimensions. The highest competence was in direct patient care (mean = 3.55, SD = 0.53), and the lowest score was in monitoring the quality of patient care (mean = 3.30, SD = 0.82). post hoc analysis shown that supervisor assessment rated professional competence significantly lower than the method of self-assessment and peer assessment (F = 10.07, p < .001).

CONCLUSION

NPs require an increased effort to continuous learning for enhancing professional competencies. Moreover, using multiple methods for assessment to obtain a more comprehensive and accurate evaluation of NPs' professional competence.

Design of a nursing objective structured clinical examination of a first-year clinical practice program

OBJECTIVE

The aim of the present study was to design a content-valid nursing objective structured clinical examination attending a first-year clinical nursing practice program.

METHOD

The examination was designed following a procedure based on the consensus of experts which was comprised of three phases: selection of the activities in which students should be competent according to the learning outcomes of the course, clinical case design, and integration of the clinical cases designed into the stations of the test.

RESULTS

Of the 44 surveys submitted for the design of the stations, 37 were answered, of which 31 respondents met the inclusion criteria of the panel of experts. The activities on which the experts reached the highest degrees of consensus were: basic physical assessment and monitoring of vital signs, assessment of hygiene and skin status, ability to develop care plans, management of safety principles in administration of medication and administration of oral medication. Based on the selected activities, the experts developed 20 clinical cases, from which a four-station nursing objective structured clinical examination was designed.

CONCLUSION

The structured methodology based on the design of experts enabled the design of a content-valid objective structured clinical examination appropriate for the evaluation of the learning outcomes achieved by the students attending a clinical practice program.

Anaesthesia nursing competence: Self-assessment of nursing students

BACKGROUND

The importance of competence assessment in anaesthesia nursing education has increased since nurse educators and anaesthesia care employers have identified the gap between nursing education and nursing practice. In order to ensure nursing students' preparedness for entry into anaesthesia nursing practice, it is necessary to measure whether nursing students have achieved the required competence to practice as anaesthesia care providers.

OBJECTIVES

To assess the anaesthesia nursing competence of nursing students and to describe factors related to their anaesthesia nursing competence. This study will provide new knowledge to support the curricula of nursing education and new nurses' practice in anaesthesia care.

DESIGN

Cross-sectional survey design.

METHODS

Data from a sample of Finnish nursing students (n = 205) were collected by using an on-line/paper and pencil survey (the Anaesthesia Nursing Competence Scale, 7 categories) in 2017. The assessment was based on self-assessment and used a Visual Analogue Scale (0-100). Descriptive statistics, a Pearson correlation coefficient, independent sample t-tests and a multivariable regression were used to analyse the data.

RESULTS

The self-assessed overall competence of graduating nursing students was 59 (range 43-73). Approximately half of the students reached an acceptable level (60≤) and half did not. The highest self-assessed category was collaboration within patient care, and the lowest was knowledge of anaesthesia patient care. The number of credits, anaesthesia courses, and experience of clinical practice in anaesthesia nursing were significantly related to anaesthesia nursing competence.

CONCLUSIONS

Competence development in the knowledge of anaesthesia patient care should be considered in general nursing education. Student nurses' competence could be developed by providing more opportunities for theoretical studies and clinical practice in anaesthesia nursing. A specialised post-registration education in anaesthesia nursing might be one solution to overcome the limitations in the competence that general nursing education is not fully able to cover for anaesthesia nursing.

New graduate nurses' clinical competence: A mixed methods systematic review

AIM

To appraise and synthesize evidence of empirical studies reporting assessment of new graduate nurses' clinical competence in clinical settings.

DESIGN

Mixed methods systematic review.

DATA SOURCES

The search strategy included keywords relevant to: new graduate nurse; clinical competence; and competence assessment. The searched literature databases included CINAHL, MEDLINE, Embase, PsycINFO and Web of Science. The search was limited to full-text papers in English or French, published between 2010 -September 2019.

REVIEW METHODS

Inclusion criteria were: 1) empirical studies; 2) detailed method and complete results sections; 3) competence assessment in clinical settings; and 4) new graduate nurses (≤24 months). Two independent reviewers screened eligible papers, extracted data and used the Mixed Methods Appraisal Tool framework for quality appraisal. Divergences were solved through discussion.

RESULTS

About 42 papers were included in this review: quantitative (N = 31), qualitative (N = 7) and mixed methods (N = 4). Findings suggest that new graduate nurses exhibit a good or adequate level of competence. Longitudinal studies show a significant increase in competence from 0-6 months, but findings are inconsistent from 6-12 months.

CONCLUSION

There are a multitude of quantitative tools available to measure clinical competence. This suggests a need for a review of their rigor.

IMPACT

No recent reviews comprehensively synthesized the findings from new graduate nurses' clinical competence. This review has found that new graduate nurses' competence has been mostly assessed as good, despite the expectation that they should be more competent. Longitudinal studies did not always show a significant increase in competence. These findings can help nurse educators in providing more support to new graduate nurses throughout the transition period or design improved transition programme. This review also identified quantitative tools and qualitative methods that can be used for competence assessment.

Perceived professional preparedness of senior nursing students' questionnaire: Development and psychometric evaluation

BACKGROUND

Nursing students' perceptions of their professional preparedness help them perform their independent nursing role with self-confidence.

OBJECTIVES

To develop and psychometric testing of an instrument, the "Perceived Professional Preparedness of senior Nursing Students" questionnaire.

DESIGN

Mixed-method exploratory study.

METHODS

We conducted this study in two phases: (1) development of initial questionnaire through interview and literature review; (2) evaluation of psychometric properties of the instrument to introduce a reliable, valid tool.

SETTINGS AND PARTICIPANTS

We assessed qualitative and quantitative face validity of initial questionnaire by administering it to 10 nursing students. Then, a panel of 10 nursing specialists determined the Content Validity Index. After modifying items, we assessed the construct validity of the 45-item questionnaire. A sample of 159 senior nursing students completed the questionnaire, and we conducted exploratory and confirmatory factor analysis using this data. To assess the test-retest reliability, 30 students completed the instrument twice with a two-week time interval.

RESULTS

The Content Validity Index with the modified Kappa coefficient was calculated as ≥0.72, which is considered satisfactory. In exploratory factor analysis using the maximum likelihood method and varimax rotation, we extracted 19 items in four factors. This structure included 61.91% of the total variance. The factors were clinical competency, evidence-based practice, framework-oriented performance, and patient-centered care. Cronbach's alpha coefficient and McDonald's omega values higher than 0.70 and inter-class correlation coefficient above 0.90 for all factors confirmed reliability. Confirmatory factor analysis indicated a suitable fitting of the final developed model.

CONCLUSION

The developed questionnaire is a valid, reliable tool to assess the perceived preparedness of senior nursing students for transition to the clinical setting. Further psychometric testing for this questionnaire on larger populations and in different contexts is suggested.

Factors Related to the Clinical Competence of Registered Nurses: Systematic Review and Meta-Analysis

PURPOSE

To determine the factors associated with the clinical competence of registered nurses.

METHODS

Systematic review and meta-analysis was used. The search strategy was limited to 10 years, ranging from January 2009 to December 2019, in Science Direct, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Google Scholar. A meta-analysis was performed using R Studio with the metafor package (Boston, MA, USA; https://rstudio.com/products/rstudio/older-versions/).

RESULTS

A total of 22 studies were included, representing 33,961 nurses. There were 28 factors associated with clinical competence. Of those, 13 factors were significantly supported and included for meta-analysis, grouped into (a) individual-related factors, (b) job satisfaction, (c) bullying, (d) burnout, and (d) specific knowledge. The effect size of those factors ranged from -0.14 to 0.50.

CONCLUSIONS

Among individual-related factors, salary has the largest effect size on competence and is considered important. Clinical competence is positively affected by job satisfaction, but negatively influenced by bullying and burnout. Although specific knowledge has a large effect size, it does not significantly affect the clinical competence of registered nurses.

CLINICAL RELEVANCE

It is critical to understand factors related to the clinical competence of registered nurses to maintain quality care and patient outcomes in clinical settings. The findings serve as data to help nurse managers find effective ways to improve the knowledge, skill, attitudes, and performance of registered nurses.

Measurement properties of scales assessing new graduate nurses' clinical competence: A systematic review of psychometric properties

BACKGROUND

New graduate nurses' competence is a concern for all healthcare organizations. Previous reports show heterogeneous levels of competency amongst them. As a positive association between competency and quality of care in clinical settings has been suggested, it is essential for researchers and clinicians to select valid, reliable, and responsive scales to assess new nurses' competence. However, a systematic evaluation of the measurement properties of scales measuring new nurses' competence had yet to be published.

OBJECTIVE

To analyse, evaluate and synthesize the measurement properties of scales used to assess new nurses' clinical competence.

DESIGN

A systematic psychometric review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methods.

DATA SOURCES

The search strategy included a combination of keywords and thesaurus terms related to new graduate nurses, clinical competence, and competence assessment. Five databases were searched: Embase, CINAHL, MEDLINE, PsycINFO and Web of Science. The search was limited to full-text papers published in English or French, from 2010 to 2019.

REVIEW METHODS

Two independent reviewers screened eligible papers, extracted data related to validity, reliability, and responsiveness of each scale, and evaluated the quality of their measurement properties as well as risk of bias in their psychometric evaluation. Divergences were solved through discussion.

RESULTS

Ten scales were included: eight original scales, one culturally adapted and one modified. Of these scales, eight were developed or adapted in the 2010s decade and the other two scales were developed earlier. Most scales are divided into 6 to 8 subscales and use an adjectival scale with either 4, 5 or 7 points. The content validity study of all scales in this review was deemed to be doubtful or inadequate quality. Reliability was almost exclusively assessed by calculating the internal consistency with Cronbach's alpha coefficient which gives no information on equivalence or stability of the measure. Responsiveness was never properly assessed in the reviewed studies.

CONCLUSIONS

There is little evidence on the measurement properties for each scale regarding their validity and reliability; responsiveness was not assessed for any scale. Every scale evaluated in this review had different characteristics (length, subscales, response options). Therefore, selection of the most appropriate scale depends on the context and purpose of the assessment. Prospero registration number: CRD42018109711 Tweetable Abstract: Systematic review of scales measuring new nurses' competence: we must do better and conduct more validity/reliability testing of existing scales.

Developing and Evaluating the Psychometric Properties of the Pediatric Nursing Competency Scale for Nursing Students

Aim

This study aims to develop and evaluate the psychometric properties of the Pediatric Nursing Competency Scale for nursing students.

Methods

This study was conducted with 318 nursing students, including third-year students enrolled in a pediatric nursing course and fourth-year students completing a pediatric nursing internship. Factor analysis, Cronbach’s alpha, item-total score analysis, and known-groups comparison were used to assess the research data. In total, 16 items were eliminated from the scale on the basis of experts’ recommendations.

Results

The scale consisted of 39 items and 8 sub-scales. The 8 sub-scales exhibited 66.4% of the total variance. Both exploratory factor analysis and confirmatory factor analysis (CFA) revealed that all factor loads were greater than 0.40. The CFA also revealed that all of the fit indices were greater than 0.85, and the root mean square error of approximation was less than 0.08. Cronbach’s alpha was 0.96 for the entire scale, and greater than 0.80 for all sub-scales.

Conclusion

The Pediatric Nursing Competency Scale for nursing students was found to be valid and reliable.

Performance competence of pregraduate nursing students and hospital nurses: A comparison study

AIMS AND OBJECTIVES

To compare and contrast the competence in clinical performance between pregraduate nursing students and hospital nurses. The study also explored the most difficult technical skills for the participants to perform.

BACKGROUND

Assessment, communication and critical thinking are competencies that help in providing safe and appropriate care for patients. Yet, self-perceived competence was mostly measured while performance competence that reflected nurses' performance in real cases has seldom been explored in literature.

DESIGN

A cross-sectional design was applied. The study adhered to the STROBE guidelines to improve reporting quality.

METHOD

Fifty-two nurses and 50 nursing students completed the Computerized Model of Performance-Based Measurement system, which measures performance competence including the steps of critical thinking, conflict resolutions and common clinical technical problems. Six case scenarios containing 107 test questions were completed.

RESULTS

Only 53.85% of nurses and 20.0% of students achieved a satisfactory level of performance competence. They showed low scores on the steps of critical thinking: "collecting data from on-site physical assessment," "processing information," "recognising/prioritising problems" and "arranging a course of action for patient care," as well as solving common technical problems and conflicts. The three most difficult skills to perform were CPR, reading EKGs and venipuncture/starting intravenous lines.

CONCLUSIONS

The study captured the participants' weaknesses in the critical thinking process and the nursing skills that were difficult to perform. These skills are imperative to nursing care and need to be strengthened in school and in-service education. The academic curriculum and course design for students as well as training programmes for nurses need to be reviewed to address the challenges to be faced in a clinical setting.

RELEVANCE TO CLINICAL PRACTICE

Teaching-learning strategies that focus on enhancing critical thinking and performing difficult skills need to be designed and implemented both in practice and in school.

Development and psychometric testing of the 10-item satisfaction with Nursing Skill Examination: Objective Structured Clinical Assessment scale

The Objective Structured Clinical Examination (OSCE) or Assessment (OSCA) has traditionally been used in disciplines such as medicine and nursing, to assess students' competence to perform clinical skills safely in a simulated hospital environment. Despite its accepted use, a validated and reliable tool has yet to be developed and tested to assess students' perception of and satisfaction with this mode of assessment. This study developed and tested the psychometric properties of a brief Objective Structured Clinical Examination tool for assessing student perception that could have transferability across health education settings. The study used a cross-sectional survey design. Final year students (n = 727) enrolled in an undergraduate nursing program in Western Sydney completed the 10-item Satisfaction with Nursing Skill Examination: Objective Structured Clinical Assessment (SINE-OSCA) Scale in 2017. Exploratory factor analysis uncovered a one-component structure with component loading that ranged from 0.45 to 0.86. Cronbach's alpha of the SINE-OSCA was 0.91. Socio-demographic group comparisons revealed that respondents who were: i) male (p = 0.003); ii) non-native-born (p < 0.001); iii) non-English-speaking (p < 0.001); and iv) International (p = 0.001), reported higher satisfaction with clinical assessments, as measured by the SINE-OSCA scale. The SINE-OSCA scale demonstrates validity and reliability in identifying students who may have difficulty with this mode of clinical skill assessment.

The Nature of Nursing Competency in Simulation of Adult Medical-Surgical Nursing: Exploratory Factor Analysis

BACKGROUND AND PURPOSE

Educators, employers, and regulatory agencies face substantive challenges in evaluating nursing competency. Evidence on what competency is and how to measure it can mitigate the challenges.

METHODS

Participants (N = 67) completed three high-fidelity simulation tests. Each video-recorded test was scored by three raters using a 41-item instrument. Exploratory factor analysis was used to define the latent structure of the instrument.

RESULTS

A five-factor solution accounted for 56% of the variance, minimized negative loadings, and minimized the number of cross-loadings. The factors were minimally correlated (each r < .30).

CONCLUSIONS

The factors, Vigilant Action, Role Nuances, Precision, Procedural Skills, and Risk Reduction, represent integrated dimensions of competency that can be linked to specific tasks underlying safe practice.

Developing an integrated approach to the assessment of student nurse competence using the Total Client Care (TCC) assessment tool

The aim of this study was to evaluate the validity and reliability of an integrated assessment of competence using the Total Client Care (TCC) assessment tool within an undergraduate Nursing course. The Total Client Care Assessment Tool aims to assess multiple competencies in an integrated way thereby mirroring the way in which registered nurses are expected to practice. TCC is a tool designed to assess the student's ability to provide holistic care to a client over a specified period of time. TCC measures the student's performance around four constructs, these are: Communication, Planning and Responding, Care Delivery and Assessing and Evaluating. G-theory analysis revealed satisfactory levels of global reliability on single use G co-efficient 0.90 although this dropped to 0.76 when used on eight occasions to assess the same students over a two-year period. Analysis of variance revealed that students and assessment occasions accounted for most of the variance. The TCC assessment tool is useful as it provides data about the student's performance when providing actual care. When used as part of a wider system of assessment involving triangulation of evidence from a number of sources the tool can support mentor judgements about the achievement of competence.

Newly graduated nurses' clinical competencies and need for further training in acute care hospitals

AIM

To assess self-reported clinical competence and the need for further training among newly graduated registered nurses (NGRNs) working in Swedish acute care hospital settings.

BACKGROUND

NGRNs are expected to take full responsibility for patients' nursing care in an increasingly complex clinical context, and professional nurses' clinical competence is critical in providing high-quality and safe nursing care.

DESIGN

A cross-sectional design.

METHODS

Data were collected using the 50-item ProffNurse SAS II. A total of 85 NGRNs who had recently commenced working with direct patient care at three hospitals in central Sweden participated in the study. The response rate was 69%. The STROBE cross-sectional reporting guidelines were used.

RESULTS

The NGRNs assessed their clinical competence as being highest in areas relating to team collaboration and ethics and lowest in areas relating to professional development and direct clinical practice. The need for further training was greatest in areas such as direct clinical practice and patient safety and lowest in areas such as team collaborating and ethics.

CONCLUSION

The use of instruments to identify NGRNs' self-assessed clinical competence is of value when designing and evaluating introductory programmes for NGRNs taking on positions in acute care hospital settings. The availability of experienced nurses from whom NGRNs can gain clinical competence and learn from is of importance, both from the perspective of the NGRNs themselves and patient safety.

RELEVANCE TO CLINICAL PRACTICE

An understanding of NGRNs' clinical competence and their need for further training may assist in both planning and organising nursing programmes and in making clinical policy decisions when designing introduction programmes in acute care settings.

The usefulness and acceptance of the OSCE in nursing schools

This qualitative study explores the usefulness and acceptance attributed by students and faculty members to an Objective Structured Clinical Evaluation (OSCE) administered to nursing undergraduates in Catalonia (Spain) for 10 years. Seventy undergraduate nursing students and twelve faculty members participated in the study. The data collection techniques included an open-ended questionnaire, a student focus group, and individualized faculty interviews. The students experienced the OSCE positively as a learning event that offered an opportunity for feedback that could help them master the required competencies. The OSCE increased students' responsibility by presenting them with a set of challenges that they had to tackle individually. Moreover, it reaffirmed their confidence in situations that closely resembled professional practice. Faculty members valued the ability of the OSCE to integrate and assess competencies, its objectivity, and the indirect information it provided on the effectiveness of the curriculum. The educational impact attributed to the OSCE and its acceptance among faculty and students suggest that it would be useful to re-implement it in the Bachelor's of Nursing in Catalan universities. Our findings may be of use to other nursing programs considering how to assess competency-based education, especially in the context of the European Higher Education Area.

The self-assessment of clinical competence and the need for further training: A cross-sectional survey of advanced practice nursing students

AIMS AND OBJECTIVES

(a) To describe and analyse advanced practice nursing students' self-assessment of their clinical competence and need for further training and (b) to analyse the possible predictive variables in their self-assessment.

BACKGROUND

The self-assessment of clinical competence in nursing education is important for identifying professional development and educational needs to improve patient care.

DESIGN

A cross-sectional survey following STROBE guidelines was used.

METHODS

Ninety-nine students from three universities/university colleges in Norway participated in the study, and data were collected using a revised version of the Professional Nurse Self-Assessment Scale II. Descriptive, correlation and regression analyses were performed.

RESULTS

The students gave the highest self-assessment ratings for their clinical competence in taking full responsibility and for their need for further training in medication effects and interactions. Although the students gave themselves low ratings for the use of electronic devices, they assessed their need for further training in this area as average. Clinical work experience as a registered nurse and previous higher education level were not significant predictors of clinical competence nor the need for further training.

CONCLUSION

The findings indicate that self-assessment is appropriate for students in advanced practice nursing programmes. This study implies that programmes in advanced practice nursing need to familiarise students with the possibilities of information technology. It questions the entry requirement that stipulates that prospective students must have several years of clinical work experience as registered nurses before entering advanced practice nursing programmes. These programmes need to communicate that competencies other than direct clinical practice are also needed for students' future roles.

RELEVANCE TO CLINICAL PRACTICE

The study contributes to the exploration of how students self-assess own clinical competence and need for further training in advanced practice nursing programmes. Further research should evaluate the development of clinical competence.

Exploration of Factors Influencing Nurse Competence Through Nursing Profile Analysis

BACKGROUND

Nurse competence is a combination of knowledge, performance, skills, and attitudes that are required in fulfilling one's role as a nurse. So far, few comprehensive studies have explored the influencing factors of nurse competence.

METHOD

The competence levels of 160 RNs in a Chinese hospital were evaluated using a questionnaire method, and the relationship between competence results and nursing characteristics was analyzed.

RESULTS

The competence of participating nurses was at a medium level. Among all the characteristics, education and staffing levels were two main factors influencing nurse competence.

CONCLUSION

Quantity of nurses and quality of nursing service are two main issues facing the modern nursing system. The findings from this study provide useful information and suggestions on how to improve nurse competence to nurse industry personnel, including nurses, nursing employers, educators, and students. [J Contin Educ Nurs. 2019;50(12):572-580.].

The State of the Science on Clinical Evaluation in Nursing Education

AIM

The purpose was to synthesize the published evidence to present the state of the science in clinical evaluation research in nursing education.

BACKGROUND

Clinical evaluation is key to ensuring nursing students' clinical competence, application of knowledge, and critical thinking, all of which are important to patient safety and quality nursing care.

METHOD

Cooper's research synthesis method was used.

RESULTS

A comprehensive literature search resulted in 250 documents, of which 88 met study criteria. Topics were exhaustive but not mutually exclusive and included competence, instrumentation, congruence, teaching methods, objective structured clinical evaluation, faculty/preceptor issues with clinical evaluation, essential clinical behaviors, topic-based evaluation, decision-making about clinical grade, and clinical reasoning.

CONCLUSION

Nursing education science is in its infancy in many areas. Two areas most in need of future research are the need to accurately define and efficiently measure competence in the clinical area and the need for reliable and valid instrumentation.

Assessment of nursing students' competence in clinical practice: A systematic review of reviews

BACKGROUND

The assessment of nursing students' nursing competence is a matter of concern worldwide and the complexity of assessing students' clinical competence has challenged educators for decades. It has been recognized that there is inconsistency among assessment methods and tools between countries and institutions.

OBJECTIVE

To identify the current best evidence on the assessment of nursing students' competence in clinical practice.

DESIGN

Systematic review of reviews.

DATA SOURCES

The electronic databases CINAHL, PubMed, Eric, Medic and the JBI Database of Systematic Reviews and Implementation Reports were searched in autumn 2018.

REVIEW METHODS

Two researchers independently assessed the eligibility of the studies by title, abstract and full-text, and then assessed the methodological quality of the included studies. Analysis of study findings was conducted using the thematic synthesis approach.

RESULTS

Six reviews were included following critical appraisal. Assessment tools used to assess students' nursing competence commonly focus on the domains of professional attributes, ethical practices, communication and interpersonal relationships, nursing processes, critical thinking and reason. Clinical learning environments and mentoring provide important support structures and guide the learning of students. The availability of assessment tools and criteria along with providing individualized feedback and time for reflection strengthen the objectivity and reliability of assessment.

CONCLUSIONS

There continues to be a need to develop consistent and systematic approaches in assessment, and to use reliable and valid instruments in assessment. Mentors find assessment of students' competence to be particularly challenging and emphasize the importance of clear assessment criteria, support from nurse educators and further education on assessment. Further development in feedback practices and providing students with opportunities for reflection are important in supporting the continuous learning process of students.

Development of a nursing-specific Mini-CEX and evaluation of the core competencies of new nurses in postgraduate year training programs in Taiwan

BACKGROUND

Modern nursing requires a broad set of academic and practical skills, and an effective nurse must integrate these skills in a wide range of healthcare contexts. Cultivation of core competencies has recently become a key issue globally in the development of nursing education. To assess the performance of new nurses, this study developed a nursing-specific Mini-Clinical Evaluation Exercise (Mini-CEX) to evaluate the effect of postgraduate year (PGY) nurse training programs in Taiwan.

METHODS

A nursing-specific Mini-CEX was developed based on the required core competencies of nurses. Reliability and validity were confirmed in evaluator workshops carried out prior to the administration of the pilot test and final test. Thirty-two PYG trainees were recruited with a supervisor-to-trainee ratio of 1:1.94. Data were collected from February to June 2012 and analyzed using the Kruskal-Wallis test.

RESULTS

The 32 PGY trainees scored highest in the "nursing professionalism" dimension and the lowest in the "physical examination" dimension. The overall competency score was satisfactory. The trainee nurses with 19-24 months of experience scored higher than the other two groups in overall performance.

CONCLUSION

The results of this research indicate the feasibility of using our Mini-CEX tool to evaluate the competencies of PGY trainees.

Explaining the inhibitory characteristics of clinical instructors in the process of developing clinical competence of nursing students: a qualitative study

BACKGROUND

Different inhibitory factors may play a role in the process of developing the students' clinical competence; among them, some of the characteristics of clinical instructors can be considered as the most important factors.

PURPOSE

The aim of this study was to determine the inhibitory characteristics of instructors in the process of developing clinical competence in nursing students.

METHODS

This qualitative study was conducted using the conventional content analysis. Seventeen senior nursing students were selected by purposive sampling method. Individual semistructured interviews were used to collect data. After recording and implementing the interviews, the content analysis was used to extract the concepts.

RESULTS

According to participants' experiences, the three themes, i.e. "autocracy," "low clinical competence," and "self-confidence weakness" were extracted as inhibitory features of clinical instructor in the process of developing the clinical competence of nursing students.

CONCLUSION

The findings of this study illustrate the characteristics of a clinical instructor, which play an important role in reducing the clinical development and lack of clinical competence development among students.

Psychometric Evaluation of a Tool for Assessment of Clinical Development in Newly Licensed Registered Nurses

BACKGROUND AND PURPOSE

For effective evaluation of clinical development, established psychometric properties of reliability and validity are essential. The Clinical Development Assessment (CDA) tool was developed within a 12-month pediatric nurse residency program. Benner's novice-to-expert model framed the development of the CDA.

METHODS

Data from 129 nurse residents and their preceptors were used to evaluate internal consistency reliability and face, content, and construct validity. Nine elements were assigned a six-point Likert scale scored as (a) unsafe, (b) novice, (c) advanced beginner, (d) competent, (e) proficient, and (f) expert.

RESULTS

Moderately strong reliability was found. Using exploratory factor analysis, a single factor accounted for 68% of the variance in clinical development. Face and content validity were confirmed.

CONCLUSIONS

This study identified a brief, valid, and reliable tool to evaluate clinical development in newly licensed registered nurses.