A model for a national clinical final examination in the Swedish bachelor programme in nursing

Instruments used in graduating nursing students' exit exams: an integrative review

IMPACT STATEMENT

This review provides a comprehensive analysis of undergraduate nursing students' exit examinations and indicates that more clinical evaluation methods should be developed to ensure adequate competence.

Clusters of competence: Relationship between self-reported professional competence and achievement on a national examination among graduating nursing students

AIMS

To identify clusters based on graduating nursing students' self-reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students' perceptions of overall quality of the nursing programme, and students' general self-efficacy (GSE).

DESIGN

A cross-sectional study combining survey data and results from a national examination.

METHODS

Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the GSE scale, and results from the National Clinical Final Examination. A two-step cluster analysis was used to identify competence profiles, followed by comparative analyses between clusters.

RESULTS

Three clusters were identified illustrating students' different competence profiles. Students in Clusters 1 and 2 passed the examination, but differed in their self-assessments of competence, rating themselves under and above the overall median value, respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher.

CONCLUSION

The study illustrates how nursing students' self-assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self-evaluation is a key learning outcome and is, in the long run, essential to patient safety.

IMPACT

The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their GSE lower than other students. The findings illuminate the need for student-centred strategies in nursing education, including elements of self-assessment in relation to examination to make the students more aware of their clinical competence.

Undergraduate nursing student perceptions of directed self-guidance in a learning laboratory: An educational strategy to enhance confidence and workplace readiness

A self-directed learning laboratory (SDL Lab) was established in which undergraduate nursing students were provided access to experienced nurses in a simulated ward environment to enhance preparedness for clinical practice. The aim of this study was to explore perspectives of final year, undergraduate student nurses about the SDL Lab and directed self-guidance, with particular focus on the impact on learning and preparedness for professional practice. The study was framed within a qualitative descriptive approach using semi-structured, digitally recorded face-to-face interviews. The purposive sample included undergraduate students enrolled in their final year of a Bachelor of Nursing program, who had accessed the SDL Lab on at least two occasions. Thematic analysis was used. Twelve students participated. Three main themes were identified: 1) A safe environment that fosters effective learning; 2) Directed self-guidance strengthens confidence and competence during workplace experiences; 3) Enhancing accessibility and realism will improve learning. Reports of increased confidence in performing nursing skills was found in this study. Evaluation of the SDL Lab found that this alternative teaching strategy was favourable, and students appreciated the safe learning environment. Future research might explore measurement of the effect of directed self-guidance in an SDL facility on competence and confidence.

Implementation and student evaluation of clinical final examination in nursing education

BACKGROUND

Clinical examinations have a distinct focus, the overall aim being to demonstrate through action whether nursing students have acquired the knowledge and skills necessary to be safe and accountable practitioners. This complexity of knowledge cannot be assessed using single examinations, thus there is a need to develop multiple assessment approaches.

OBJECTIVES

To describe the process of developing valid clinical examinations for nursing students at the end of the final semester and to evaluate students' perceptions of these examination formats.

OUTLINE OF THE DEVELOPMENTAL PROCESS

Based on earlier research, overall goals for the degree of Bachelor of Science in Nursing and guided by both task-related and relational aspects of nursing, two clinical final examinations were developed and tested. One was a standardized test of performance in vitro using Objective Structured Clinical Examination (OSCE) based on five specific areas in which newly graduated nurses had shown deficiencies. The other was a test of performance in real conditions, in vivo, using Bedside Observation Examination (BOE) assessing nurse-patient relation, entirely based on patients' needs.

NURSING STUDENTS' EVALUATION

Three classes of students (n=203) were asked to participate and answer a study-specific questionnaire. The students highly valued the two examinations and perceived that the knowledge and skills tested were relevant to nurses' work. They found the examinations stressful, but at the same time meaningful, and felt they could do themselves full justice through this form of examination.

RECOMMENDATIONS

The assessment test should be chosen depending on the preferred outcome. The OSCE, with its high degree of standardization, is appropriate to use to assess task-related aspects of nursing (show how), while the BOE, with its low degree of standardization, is suitable in real settings and has the potential to capture the relational aspects of nursing (does).