Validation of the tool assessment of clinical education (AssCE): A study using Delphi method and clinical experts

Experiences of Using a Digital Guidance and Assessment Tool (the Technology-Optimized Practice Process in Nursing Application) During Clinical Practice in a Nursing Home: Focus Group Study Among Nursing Students

BACKGROUND

Nursing students' learning during clinical practice is largely influenced by the quality of the guidance they receive from their nurse preceptors. Students that have attended placement in nursing home settings have called for more time with nurse preceptors and an opportunity for more help from the nurses for reflection and developing critical thinking skills. To strengthen students' guidance and assessment and enhance students' learning in the practice setting, it has also been recommended to improve the collaboration between faculties and nurse preceptors.

OBJECTIVE

This study explores first-year nursing students' experiences of using the Technology-Optimized Practice Process in Nursing (TOPP-N) application in 4 nursing homes in Norway. TOPP-N was developed to support guidance and assessment in clinical practice in nursing education.

METHODS

Four focus groups were conducted with 19 nursing students from 2 university campuses in Norway. The data collection and directed content analysis were based on DeLone and McLean's information system success model.

RESULTS

Some participants had difficulties learning to use the TOPP-N tool, particularly those who had not attended the 1-hour digital course. Furthermore, participants remarked that the content of the TOPP-N guidance module could be better adjusted to the current clinical placement, level of education, and individual achievements to be more usable. Despite this, most participants liked the TOPP-N application's concept. Using the TOPP-N mobile app for guidance and assessment was found to be very flexible. The frequency and ways of using the application varied among the participants. Most participants perceived that the use of TOPP-N facilitated awareness of learning objectives and enabled continuous reflection and feedback from nurse preceptors. However, the findings indicate that the TOPP-N application's perceived usefulness was highly dependent on the preparedness and use of the app among nurse preceptors (or absence thereof).

CONCLUSIONS

This study offers information about critical success factors perceived by nursing students related to the use of the TOPP-N application. To develop similar learning management systems that are usable and efficient, developers should focus on personalizing the content, clarifying procedures for use, and enhancing the training and motivation of users, that is, students, nurse preceptors, and educators.

Problematic situations related to social media use and competencies to prevent them: results of a Delphi study

A three-round Delphi method was used to study the problematic situations that adolescents may encounter when using the social media, and the competencies needed to address these situations. A panel of Finnish experts (N = 22) provided an open-ended list of problematic situations and competencies in 2020-2021. These were then evaluated and ranked according to their significance. The experts provided an information-rich list of both problematic situations and competencies. Finally, 16 problematic situations and 19 competencies were ranked in order of importance by the experts. The most important problematic situations were direct and indirect cyberbullying and sexual harassment. The most important competencies were the ability to act responsibly, knowing what kinds of activity are prohibited, and knowing whom to contact on exposure to cyberbullying or harassment. The findings can be used in developing policies, recommendations, and solutions aimed at counteracting the harmful effects of social media on wellbeing during adolescence.

Psychometric properties of a clinical assessment tool in the postgraduate midwifery programme, Botswana

BACKGROUND

 The psychometric properties of a clinical assessment tool used in the postgraduate midwifery programme in Botswana have not been evaluated. A lack of reliable and valid clinical assessment tools contributes to inconsistencies in clinical assessment in midwifery programmes.

OBJECTIVES

 This study aimed to evaluate the internal consistency and content validity of a clinical assessment tool used in the postgraduate midwifery programme in Botswana.

METHOD

 For internal consistency, we calculated the total-item correlation and Cronbach's alpha coefficient. For content validity, subject matter experts completed a checklist to evaluate the relevance and clarity of each competency in the clinical assessment tool. The checklist included questions with Likert-scale responses, indicating the level of agreement.

RESULTS

 The clinical assessment tool had a good reliability, with a Cronbach's alpha of 0.837. The corrected item total correlation values ranged from -0.043 to 0.880 and the Cronbach's alpha (if item deleted) ranged from 0.079 to 0.865. Overall content validity ratio was 0.95, and content validity index was 0.97. Item content validity indices ranged from 0.8 to 1.0. The overall scale content validity index was 0.97 and the scale content validity index using universal agreement was 0.75.

CONCLUSION

 The clinical assessment tool used in the postgraduate midwifery programme in Botswana has acceptable reliability. Most of the competencies included in the clinical assessment tool were relevant and clear. Certain competencies need to be reviewed to improve the reliability and validity of the clinical assessment tool.Contribution: The clinical assessment tool currently used in the postgraduate midwifery programme in Botswana had acceptable internal consistency reliability and validity.

A Technology-Supported Guidance Model to Increase the Flexibility, Quality, and Efficiency of Nursing Education in Clinical Practice in Norway: Development Study of the TOPP-N Application Prototype

BACKGROUND

The challenges of nursing shortage in the nursing profession and of limited nursing educational capacity in nursing education in clinical practice need to be addressed to ensure supply according to the demand of these professionals. In addition, communication problems among nursing students, nurse educators, and nurse preceptors; variations in the guidance competence of nurse preceptors; and limited overview from nurse educators on nursing students' clinical practice are common challenges reported in several research studies. These challenges affect the quality of nursing education in clinical practice, and even though these problems have been highlighted for several years, a recent study showed that these problems are increasing. Thus, an approach is required to ensure the quality of nursing education in clinical practice.

OBJECTIVE

We aimed to develop a guidance and assessment application to meet the challenges reported in clinical practice. The application intended to increase the flexibility, quality, and efficiency of nursing education in clinical practice. Furthermore, it intended to increase interactive communication that supports guidance and ensure structured evaluation of nursing students in clinical practice.

METHODS

This study employed a multidisciplinary user-participatory design. Overall, 23 stakeholders from the project team (ie, 5 researchers, 2 software developers, 1 pedagogical advisor, and 15 user representatives [4 educators, 6 preceptors, and 5 students]) participated in a user-centered development process that included workshops, intervention content development, and prototype testing.

RESULTS

This study resulted in the creation of the Technology-Optimized Practice Process in Nursing (TOPP-N) guidance and assessment application for use as a supportive tool for nursing students, nurse preceptors, and nurse educators in clinical practice. The development process included the application's name and logo, technical architecture, guidance and assessment module, and security and privacy.

CONCLUSIONS

This study offers insights into the development of an evidence-based technological tool to support nursing students, nurse preceptors, and nurse educators in clinical practice. Furthermore, the developed application has the potential to meet several challenges reported in nursing education in clinical practice. After a rigorous development process, we believe that the TOPP-N guidance and assessment application prototype is now ready to be tested in further intervention studies.

A Technology-Supported Guidance Model to Support the Development of Critical Thinking among Undergraduate Nursing Students in Clinical Practice: A Concurrent, Exploratory, Flexible, Multi-Method Feasibility Study (Preprint)

BACKGROUND

There is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP‑N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education.

OBJECTIVE

The main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention.

METHODS

This study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence.

RESULTS

Nursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention.

CONCLUSIONS

The use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP‑N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/31646.

Development and validation of the Mental Health Promotion Scale

PURPOSE

This study aimed to develop and validate a scale that assesses adults' mental health promotion abilities.

DESIGN AND METHODS

This study was conducted in Istanbul from October 2016 to May 2018. Three rounds of the Delphi method were conducted to develop the scale.

FINDINGS

After the third Delphi round, the experts reached a consensus on 93 scale items. Forty-six items were excluded from the scale based on exploratory factor analysis (EFA) results. In the last EFA of the 47-item scale, a 12-factor construct was found with an eigenvalue >1 that explained 64.3% of total variance. The overall Cronbach's alpha of the scale was .93.

PRACTICE IMPLICATIONS

This scale can be used to assess adults' mental health promotion abilities.

Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Protocol of an Exploratory, Flexible Mixed Methods Feasibility Study

Background

Critical thinking is an essential set of skills in nursing education, and nursing education therefore needs a sharper focus on effective ways to support the development of these skills, especially through the implementation of technological tools in nursing education.

Objective

The aim of this study protocol is to assess the feasibility of a technology-supported guidance model grounded in the metacognition theory for nursing students in clinical practice.

Methods

Both quantitative (research questionnaires) and qualitative (focus group interviews) approaches will be used to collect data for a feasibility study with an exploratory, flexible mixed methods design to test a newly developed intervention in clinical practice.

Results

The intervention development was completed in December 2020. The intervention will be tested in 3 independent nursing homes in Norway.

Conclusions

By determining the feasibility of a technology-supported guidance model for nursing students in clinical practice, the results will provide information on the acceptability of the intervention and the suitability of the outcome measures and data collection strategy. They will also identify the causes of dropout and obstacles to retention and adherence.

International Registered Report Identifier (IRRID)

DERR1-10.2196/31646

Psychometric Testing of a Theory-Based Measure to Evaluate Clinical Performance of Nursing Students

AIM

The aim of this study was to psychometrically test a clinical evaluation tool that measures instructors' gut feelings for placing students on a learning contract.

BACKGROUND

Evaluators feel unprepared or hesitant to fail students who do not meet professional and clinical expectations.

METHOD

A multiphase process was used to determine the reliability and validity of the Gut Feelings Scale. The first phase focused on item generation, the second phase focused on content validity and feedback from expert raters, and the third phase focused on psychometric evaluation to streamline the item pool and explore validity.

RESULTS

Correlations and descriptive statistics for each subscale were calculated. Reliability analyses revealed relatively strong estimates of internal consistency; specifically, the reliability estimates surpassed our criteria of >.70.

CONCLUSION

This pilot study established the validity and reliability of the scale and found it to be a reliable tool to guide instructors' evaluative decision-making.

Effect of TiO2 on the Sintering Behavior of Low-Grade Vanadiferous Titanomagnetite Ore

Low-grade vanadiferous titanomagnetite ore (LVTM) is as an important mineral resource for sintering ore manufacturing. Furthermore, TiO₂ has a significant effect on the sintering process of iron ore fines. The effects of TiO₂ on the metallurgical properties, microstructure, and mineral composition of LVTM sinter were investigated by sintering pot tests, X-ray diffraction (XRD), scanning electron microscopy (SEM), and mineral phase microanalysis. The results were as follows: as the TiO₂ content increased from 1.75% to 4.55%, the flame front speed and productivity decreased, while the reduction degradation index (RDI) and softening properties deteriorated. In addition, the tumbler index (TI) values reached a maximum at TiO₂ = 1.75%. In addition, with increasing TiO₂ content, an increase in the magnetite and perovskite phase, and a decrease in calcium ferrite and hematite were found with an increase in TiO₂ content. Thus, the lower the TiO₂ content, the better the quality of the sinter.

Validation of the Patient-Centred Care Competency Scale Instrument for Finnish Nurses

Patient-centredness in care is a core healthcare value and an effective healthcare delivery design requiring specific nurse competences. The aim of this study was to assess (1) the reliability, validity, and sensitivity of the Finnish version of the Patient-centred Care Competency (PCC) scale and (2) Finnish nurses' self-assessed level of patient-centred care competency. The PCC was translated to Finnish (PCC-Fin) before data collection and analyses: descriptive statistics; Cronbach's alpha coefficients; item analysis; exploratory and confirmatory factor analyses; inter-scale correlational analysis; and sensitivity. Cronbach's alpha coefficients were acceptable, high for the total scale, and satisfactory for the four sub-scales. Item analysis supported the internal homogeneity of the items-to-total and inter-items within the sub-scales. Explorative factor analysis suggested a three-factor solution, but the confirmatory factor analysis confirmed the four-factor structure (Tucker-Lewis index (TLI) 0.92, goodness-of-fit index (GFI) 0.99, root mean square error of approximation (RMSEA) 0.065, standardized root mean square residual (SRMR) 0.045) with 61.2% explained variance. Analysis of the secondary data detected no differences in nurses' self-evaluations of contextual competence, so the inter-scale correlations were high. The PCC-Fin was found to be a reliable and valid instrument for the measurement of nurses' patient-centred care competence. Rasch model analysis would provide some further information about the item level functioning within the instrument.

Dual use of instruments for assessing nursing students professional- and clinical competence

BACKGROUND

Changes in demographics and the development of health systems have a direct impact on patients' nursing needs and nurses' ability to meet them. Modern and forward-looking nursing education programmes that will help nursing students to develop their professional competence require useful tools for assessment and self-reflection that can be combined in theoretical and clinical education.

OBJECTIVES

To investigate the associations between the Nurse Professional Competence Scale - Short Form (NPC-SF), and the tool Assessment of Clinical Education (AssCE) tool, and to assess the graduating students´ professional competence based on their self-assessment.

DESIGN

A cross-sectional descriptive study design was used.

PARTICIPANTS AND SETTINGS

A total of 151 nursing students at a Swedish university college completed the NPC-SF and the AssCE (response rate 77%).

METHODS

In their final weeks of the nursing programme, students were invited to respond to two questionnaires: the NPC Scale - Short Form (35 items) and the AssCE tool (21 items).

RESULT

There are significant correlations between the nursing students' responses to the NPC-SF competence areas and the AssCE areas (r = 0.19-0.57). Students score in the NPC-SF were highest in Value-based Nursing Care and lowest in Development, Leadership and Organization of Nursing Care, and in the AssCE areas student scores were highest in Examination and treatment and Professional Approach and lowest in Management and Cooperation.

CONCLUSION

The NPC-SF and AssCE are valid and reliable instruments, showing a high level of correlation. Results imply that dual use could strengthen student-centred theoretical and clinical learning as well as professional competence development. Additional research is needed to assess student's competence development during the nursing program.

Integrating Peer Learning Activities and Problem-Based Learning in Clinical Nursing Education

INTRODUCTION

The implementation of nursing clinical learning in Indonesia has several challenges that require innovation in the learning method strategy. The method that has been used so far focuses on the hierarchical relationship between lecturers/preceptors and students, so that there are many shortcomings in learning outcomes. The application of the method of active learning with Peer Learning (PL) and Problem Based Learning (PBL) techniques has proven effective in classroom learning, but its rarely found in clinical learning.

OBJECTIVE

The purpose of this study was to determine the effectiveness of the PL and PBL towards the achievement of clinical learning in nursing students.

METHODS

The research method used a true experiment with a posttest only control group design, the sampling technique was taken by randomize control trial. An instrument for clinical learning achievement using AssCE.

RESULTS

The analysis was carried out as descriptive and bivariate. The results showed the mean in the experimental group was 7.059 and the control group was 6.325. Further statistical test results were obtained p-value = 0.001 (p < 0.05) which showed that the average score there were differences in clinical learning achievement development scores.

CONCLUSION

Clinical learning using peer learning and PBL methods can directly improve various aspects of student competency achievement.

Translation and further validation of a global rating scale for the assessment of clinical competence in prehospital emergency care

Global rating scales are useful to assess clinical competence at a general level based on specific word dimensions. The aim of this study was to translate and culturally adapt the Paramedic Global Rating Scale, and to contribute validity evidence and instrument usefulness in training results and clinical competence assessments of students undergoing training to become ambulance nurses and paramedics at Swedish and Finnish universities. The study included translation, expert review and inter-rater reliability (IRR) tests. The scale was translated and culturally adapted to clinical and educational settings in both countries. A content validity index (CVI) was calculated using eight experts. IRR tests were performed with five registered nurses working as university lecturers, and with six clinicians working as ambulance nurses. They individually rated the same simulated ambulance assignment. Based on the ratings IRR was calculated with intra-class correlation (ICC). The scale showed excellent CVI for items and scale. The ICC indicated substantial agreement in the group of lecturers and a high degree of agreement in the group of clinicians. This study provides validity evidence for a Swedish version of the scale, supporting its use in measuring clinical competence among students undergoing training to become ambulance nurses and paramedics.

Lecturers' reflection on the three-part assessment discussions with students and preceptors during clinical practice education: A repeated group discussion study

Assessment of students' learning and achievement requires active involvement of participating students, preceptors and lecturers. The lecturers have overall responsibility for both the content of the assessment and students' learning. The aim of the present study was to investigate lecturers' reflections on the mid-course discussion and final assessment that are part of nursing students' clinical practice education. The design was descriptive and had a qualitative approach. Repeated group discussions were undertaken with 14 lecturers at two university campuses in Norway. Five categories were identified: preparing for the three-part discussion, creating a collaborative atmosphere, facilitating student learning, verifying student learning, using the assessment tool to create the assessment discussion; one theme emerged: 'being able to see and justify students' learning processes'. Lecturers' reflections on both assessment discussions and students' learning proceeded from a clear pedagogical viewpoint.

Validation of the Change or Stop Testosterone-Lowering Medication (COSTLow) Scale Using the Delphi Method Among Clinical Experts

Guidelines for pharmacological treatment of patients with paraphilic disorders have been developed by a working group of the World Federation of Societies of Biological Psychiatry (Thibaut et al., 2010 ). With an increasing duration of experience and number of treated patients as well as aging patients, change of or withdrawal from testosterone-lowering medications (TLM) has become an important issue. The current study aimed to assess the quality of a structured professional judgment procedure that helps switching or discontinuing TLM in patients with paraphilic disorders. We used the Delphi method to estimate the quality of 10 factors originally proposed by the authors. A total of 30 experts participated in the first stage; 18 experts participated in the second stage. The experts' assessment resulted in an instrument of 15 factors that can be used to structure the process of changing or discontinuing TLM. These factors can be grouped into five broader categories: age and duration of treatment; therapeutic alliance; psychopathology and risk factors; motivation; and compliance and level of control. The developed COSTLow-R Scale provides an instrument that can be used to structure the process of changing or discontinuing TLM in patients with severe paraphilic disorders.

Assessment in clinical education: A comparison between a generic instrument and a course-specific criterion-based instrument

Assessment of students’ clinical performance and reasoning raises critical questions of whether learning outcomes have been reached and whether the aims of a course/education programme have been fulfilled. The aim of this study was to compare two assessment instruments in clinical education. A cross-sectional, comparative design was used. Nursing students and supervisors from five universities and university colleges in Sweden were included in the study. A sample of 435 students was used. Data were collected with study-specific questionnaires targeted for the two groups, nursing students and supervisors, and were analysed using cross-tabulation, chi-square with WinSTAT. Students perceived supervisors using the instrument Assessment of Clinical Education (AClEd) to be more aware of what to assess and they experienced more support from the ‘AClEd supervisors’ as compared to the supervisors using the second instrument, the Assessment form for Clinical education (AssCe). Furthermore, the AClEd assessment was perceived to be fairer compared to the AssCe assessment. The criterion-referenced assessment instrument AClEd was perceived, by both nursing students and supervisors, to give a clearer view of the learning outcome and the possibility of a fair and comprehensive assessment.

Nursing students' and preceptors' experience of assessment during clinical practice: A multilevel repeated-interview study of student-preceptor dyads

Nursing students' learning process during clinical practice is dependent on the quality of their assessment, and the feedback that is given, however an issue that is very little examined. The aim of this study was to investigate student-preceptor dyads and their experiences of mid-course discussions and final assessment. Data were collected through repeated semi-structured individual interviews with 13 dyads close in time to the assessment discussions, and were analyzed by searching for similarities and differences in their experiences. Both students and preceptors shared the view that the preparations before the discussions caused uncertainty, but they described different reasons. Both students and preceptors meant that the assessment tool was used in a structured way. The feedback mediated to students emphasized what was important to concentrate on in the next part or next period, but less about the individual students' progress. The student-preceptor dyads did not share the view of what content had been in focus in the discussions and there were variations in the details. Conclusions can be drawn that one of the crucial elements of an assessment discussion, to give students constructive feedback in relation to learning outcomes, was not fulfilled.