Mentor judgements and decision-making in the assessment of student nurse competence in practice: A mixed-methods study

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.

Nurse mentors' experiences with suitability assessments in clinical placement: A qualitative study

AIM

This study aims to explore mentors' experiences with assessing the suitability of nursing students in clinical placements in a context where suitability assessment is required by law.

BACKGROUND

It is the schools' responsibility to assess students, but mentors play an important role when students are in clinical placements. Clinical placements are typical arenas for assessing suitability.

DESIGN

An explorative qualitative study METHODS: Participants were 17 registered nurses with experience as mentors for nursing students in clinical placement. The participants represented somatic and surgical wards from three different hospitals in Norway. Individual, semi-structured interviews were conducted.

RESULTS

The analysis revealed a total of four themes: 1) the understanding of suitability, 2) experiencing borderline performance, 3) the heavy responsibility of doing the assessment and 4) the importance of support.

CONCLUSIONS

The mentors found it difficult to assess suitability. They reported having little or no knowledge about leading rules and guidelines. The mentors experienced support from their colleagues, something which lightened the burden of assessing the students. This study indicates that mentors need more information about suitability and suitability assessments.

REGISTRATION NUMBER

To be included in abstract after acceptance.

What are nurse practice assessors' priorities when assessing student mental health nurses? A qualitative content analysis

BACKGROUND

UK healthcare policy has observed over a decade of changes that has focussed on healthcare staffs' professional values as a marker for safe, high-quality care In 2018 the regulatory body for nursing and midwifery introduced several new proficiencies, with an emphasis on physical health assessment. However, a global debate has since surfaced regarding the generification of nurse education, which has been thought to have eroded field specific skills in mental health nursing.

AIM

To explore the priorities of practice assessors, articulated within the open comments written within online practice assessment documents.

METHODS

A qualitative study was conducted, with data collected from comments made within online practice assessment documents relating to the ongoing assessment of student mental health nurses at one UK University. 26 individual sets of assessor comments were collected. An inductive content analysis was used to explore the nature of qualitative feedback provided to student mental health nurses, generated by mental health practice assessors. The COREQ checklist was used for the reporting of the study.

RESULTS

Findings demonstrated that practice assessors were prioritising two core areas or broad-based skills categories: 'transactional' and 'transformational' competencies. Transactional competencies related to the practical application of specific tasks. Transformational competencies were commented on more frequently and placed emphasis on the students' personal attributes and characteristics, and how these contribute to 'good' mental health nursing practice.

CONCLUSION

Mental health nurses prioritise assessing student nurses in relation to their personal attributes, work ethic, and values that are congruent with humanist perceptions of mental health nursing.

Suitable, fit, competent and safe to practice nursing? Assessing nursing students' personal qualities in clinical placement-An integrative review

AIMS AND OBJECTIVES

This study aims to explore, describe, and synthesize the personal requirements student nurses are assessed in their clinical placement to be suitable, fit, competent, and safe for the nursing profession.

BACKGROUND

There are different terms and concepts used when describing what nursing students are assessed by regarding personal requirements needed to be eligible to enter the nursing profession. This is regulated and enforced mainly by different standards and guidelines.

DESIGN

An integrative review using Whittmore and Knafl's (2005) methodology.

METHODS

Searches were systematically conducted in CINAHL, Education Source, ERIC, Academic Source Elite, MEDLINE and EMBASE, NORART, SveMed+, and Bibliotek.dk. The PRISMA checklist for systematic reviews was used.

RESULTS

Eighteen studies were included in the review. The results present various factors student nurses are assessed by in clinical placements, which were categorized into three themes: attitude and personal characteristics, behavior, and basic knowledge. Assessing students is a complex and subjective endeavor, and decisions are based on a holistic assessment of several different aspects of the student's performance and behavior CONCLUSIONS: The personal requirements to be deemed suited for det nursing profession are complex and composed of several different components. Assessments are often based more on assessors' subjective standards and intuition than on the provided guidelines and standards. There is no universal understanding of which characteristics or qualities are considered necessary for a student to be deemed suited for the nursing profession.

RELEVANCE TO CLINICAL PRACTICE

This study points at challenges with the assessment of nursing students today as there are no clear standards or understanding of the requirements needed.

The assessment of undergraduate bachelor of nursing students in the collaborative clusters education model: A qualitative descriptive design

BACKGROUND

Worldwide, undergraduate Bachelor of Nursing students are required to complete experiential learning placements in health care settings as part of the curriculum. There are a variety of facilitation models that support student learning and assessment on clinical placement. As workforce pressures increase globally, innovative approaches to clinical facilitation are required. In the Collaborative Clusters Education Model of clinical facilitation, hospital-employed clinical facilitators work collaboratively within peer groups (clusters) to collectively participate in a process of facilitating student learning and conducting assessment and moderation of student performance. The assessment process in this collaborative clinical facilitation model is not well described.

AIM

To describe how the assessment of undergraduate nursing students is achieved in the Collaborative Clusters Education Model.

DESIGN

A qualitative descriptive approach was employed.

METHODS

In March 2021 individual and group interviews were conducted with seven clinical facilitators working in the Collaborative Clusters Education Model in one health service in southeast Queensland, Australia. Content analysis of transcribed interviews was performed.

RESULTS

Assessment was achieved through two processes, situational scoring and moderation. In the process of situational scoring, clinical facilitators balanced the students' perception of their role in assessment, accounted for the type of experiences available, considered multiple sources of evidence and used the Australian Nursing Standards Assessment Tool. In the process of moderation, clinical facilitators communicated with their cluster colleagues to determine a shared understanding of student history, considered data from multiple evidence sources and collaboratively evaluated the trustworthiness of student performance evaluation decisions.

CONCLUSIONS

In the Collaborative Clusters Education Model, the input of multiple assessors, working in a small team, ensured transparency in assessment processes. Furthermore, this transparency in assessment practices normalised on-going moderation, an in-built quality-check and, as such, an innovative component of assessment in the Collaborative Clusters Education Model. As nursing directors and managers seek to ameliorate the impact of nursing workforce pressures, this innovative model of collaborative assessment may serve as a valuable addition to nursing clinical assessment toolkits.

TWEETABLE ABSTRACT

The Collaborative Clusters Education Model of Clinical Facilitation enables transparency in assessment processes and normalises moderation.

Preceptors' considerations when entrusting professional activities to postgraduate nursing students: A qualitative study

BACKGROUND

Nurse-preceptors regularly struggle to evaluate students' readiness to take care of patients unsupervised, even with sophisticated workplace-based assessment tools. Preceptors' gut feelings are not always captured well, but are critical for judgement of readiness for learner entrustment with care tasks. Studies in medical education report features that clinicians consider important when trusting students with clinical responsibilities that might also apply in nursing.

OBJECTIVES

To unravel preceptors' considerations when entrusting professional activities to postgraduate nursing students. The findings may contribute to the improvement of workplace-based assessments and the training of preceptors.

METHODS

Thematic analysis of semi-structured interviews with sixteen nurse-preceptors from three postgraduate nursing specialisations in Dutch hospitals.

RESULTS

Three themes emerged: CONCLUSIONS: For preceptors of postgraduate nursing students, entrustment requires more than merely insight into objectively measurable competencies. Entrusting is accompanied by subjectivity related to what preceptors expected of students. These expectations are in line with suggested factors in the literature-capability, integrity, reliability, agency, and humility-considered before entrusting students with clinical responsibilities identified in medical training. Entrusting is also accompanied by what preceptors realise about their own role in entrustment decisions. Combining different information sources made assessment more transparent and the implicit more explicit.

In-situ simulation for nursing students' professional competence development in postanesthesia care: A quasi-experimental study

AIM

To evaluate the differences in professional competence development between nursing students in routine clinical practice and those who experienced four additional in-situ simulations.

BACKGROUND

The amount of clinical practice time available to nursing students is limited. Occasionally, clinical settings do not provide all of the content that nursing students are expected to acquire. In high-risk clinical scenarios, such as the postanesthesia care unit, clinical practice may not provide sufficient context for students to develop the professional competence.

DESIGN

This was a non-blinded, non-randomized, quasi-experimental study. The study was conducted in the postanesthesia care unit of a tertiary hospital in China between April 2021 and December 2022. Nursing students' self-assessed professional competence development and faculty-assessed clinical judgment were used as indicators.

METHODS

A total of 30 final year undergraduate nursing students were divided into two groups according to the time they arrived at the unit for their clinical practice. Nursing students in the control group followed the routine teaching protocol of the unit. Students in the simulation group received four additional in-situ simulations during the second and third weeks of their practice in addition to the routine program. Nursing students self-assessed their postanesthesia care unit professional competence at the end of the first and fourth weeks. At the end of the fourth week, the nursing students were evaluated on their clinical judgment.

RESULTS

Nursing students in both groups scored higher on the professional competence at the end of the fourth week than at the end of the first week and there was a trend of higher competence improvement in the simulation group than in the control group. For clinical judgment, nursing students in the simulation group scored higher than the control group.

CONCLUSIONS

In-situ simulation contributes to the development of professional competence and clinical judgment of nursing students during their clinical practice in the postanesthesia care unit.

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.

Advancing the process of mentorship among nursing deans: The Searching, Engaging, Trialing, and Shaping (S.E.T.S.) theory

The aim of this study is to identify processes, examine insights, and develop a theory on the concept of mentorship among deans of Nursing colleges in Region IV-A. Data collection was through semi-structured interviews using aide-memoire. Audio recording and note-taking were done for the data accuracy. Validation was utilized by performing re-interview and through observation to the same KI. Data analysis done was cool and warm, along with the execution of expert analysis, guided by the procedures and phases of Strauss and Corbin.¹ The mentor-mentee relationship resulted in 4 phases: Searching, Engaging, Trialing, and Shaping (S.E.T.S.), which details how mentorship exists and engenders the ideal working environment. These phases characterize the most definite relationship between the mentors and mentees, specifically the deans and their faculty members. This study further ignites desirable effects and outcomes holistically and to enhance more mentorship style and how a mentee will transcend positively.

What Academic Factors Influence Satisfaction With Clinical Practice in Nursing Students? Regressions vs. fsQCA

Clinical practices are considered one of the cornerstones in nurses' education. This study provides a framework to determine how factors in the academic environment, influence nursing student's satisfaction with their practices. A cross-sectional analytical study was conducted in a convenience sample of 574 nursing students at a private university in Valencia, during the 2016/2017 academic year, 79% (456) were women. Two statistical methodologies were used for data analysis: hierarchical regression models (HRM) and fuzzy sets qualitative comparative analysis (fsQCA). The HRM indicate that the students' mean score influences all dimensions of satisfaction. Furthermore, in the fsQCA, the type of service and center, as well as the type of management, the preference in the choice of the practice center and the number of students per period per clinical educator influence satisfaction with clinical practices. These results could be used to understand how academic factors influence nursing students' satisfaction with their clinical practices and to create intervention programmes that improve it. This will help prepare students to be the future nursing workforce.

The state of mixed methods research in nursing: A focused mapping review and synthesis

AIMS

To consider the scope and quality of mixed methods research in nursing.

DESIGN

Focused mapping review and synthesis (FMRS).

DATA SOURCES

Five purposively selected journals: International Journal of Nursing Studies, Journal of Nursing Scholarship, Journal of Advanced Nursing, Worldviews on Evidence-Based Nursing, and Journal of Mixed Methods Research.

REVIEW METHODS

In the target journals, titles and abstracts from papers published between 2015-2018 were searched for the words or derivative words 'mixed methods'. Additional keyword searches were undertaken using each journal's search tool. We included studies that investigated nursing and reported to use a mixed methods approach. Articles that met the inclusion criteria were read in full and information was extracted onto a predetermined pro forma. Findings across journals were then synthesized to illustrate the current state of mixed methods research in nursing.

RESULTS

We located 34 articles that reported on mixed methods research, conducted across 18 countries. Articles differed significantly both within and across journals in terms of conformity to a mixed methods approach. We assessed the studies for the quality of their reporting as regard the use of mixed methods. Nineteen studies were rated as satisfactory or good, with 15 rated as poorly described. Primarily, a poor rating was due to the absence of stating an underpinning methodological approach to the study and/or limited detail of a crucial integration phase.

CONCLUSIONS

Our FMRS revealed a paucity of published mixed methods research in the journals selected. When they are published, there are limitations in the detail given to the underpinning methodological approach and theoretical explanation.

Clustering clinical learning environment and mentoring perceptions of nursing and midwifery students: A cross-sectional study

AIMS

This study aimed to explore nursing and midwifery students' evaluation of the clinical learning environment and mentoring and to identify distinct student profiles relating to their perceptions.

DESIGN

This study employed a cross-sectional design.

SETTINGS

The study population included nursing and midwifery students in a university hospital in Finland.

PARTICIPANTS

All nursing and midwifery students who completed their clinical placement were invited to take part in the study in the academic year 2017-2018.

METHODS

The data (N = 2,609) were gathered through an online survey using the Clinical Learning Environment, Supervision and Nurse Teacher scale. The data were analysed using a K-mean cluster algorithm to identify nursing and midwifery students' profiles.

RESULTS

The findings from this study indicate four distinct profiles (A, B, C, & D) of nursing and midwifery students in relation to the clinical learning environment and mentoring. Profile A (N = 1,352) students evaluated their clinical learning environment and mentoring to the highest level (mean varied from 9.44-8.38); and Profile D (N = 151)- to the lowest (mean varied from 5.93-4.00).

CONCLUSION

The findings highlight that nursing and midwifery students evaluate their clinical learning environment and mentoring more highly when: they have a named mentor, student and mentor discuss learning goals, there is a final assessment in clinical learning, the mentor's guidance skills support student learning, the clinical learning supports the student's professional development and pre-clinical teaching in an educational institution supports learning in the clinical placement.

IMPACT

Clinical learning plays an important role in nurse and midwifery education. Mentoring of clinical practice was shown to have a great influence on students' perceptions of their success in clinical learning. We suggest that clinical practice should be strengthened by the building of collaboration between nursing teachers and registered nurses.

Standardized language systems for the design of high-fidelity simulation scenarios: A Delphi study

PURPOSE

This study aimed to identify which of the standardised Nursing Interventions Classification (NIC) activities should be used in the design of clinical cases with high fidelity simulation for educational preparation of undergraduate nursing students in non-technical skills.

DESIGN AND METHODS

A three-round Delphi study was carried out: the first round with taxonomy experts, the second round with academic and clinical lecturers with limited experience in the simulation-based learning methodology, and the third round with academic and clinical lecturers having at least two years of simulation experience. The NIC interventions were grouped into two levels of competence in accordance with the undergraduate nursing degree curriculum (1st- and 2nd-year students, the "novice" level; 3rd- and 4th-year students, the "advanced" level). The NIC allows the description of nurse student competencies in multiple clinical scenarios and throughout various contexts: theory, clinical practice and simulation.

FINDINGS

The experts identified 163 interventions in 8 areas as relevant and feasible, selecting 42 for the "novice" students, in Nursing Fundamentals (13) and Adult Nursing Care 1 (29), and 97 for the "advanced" students: Maternity Care and Child Health Nursing (18), Mental Health (13), Nursing Care of Older People (12), Community Health Nursing (20) and Adult Nursing Care 2 (34). In addition, 24 interventions were identified as cross-cutting, with training to be provided across all four years of the degree.

CONCLUSION

A total of 163 interventions of the NIC list were selected by experts as being both relevant and feasible to nursing undergraduate education. This creates the favourable framework to design high-fidelity scenarios for the training of non-technical skills according to the competences required and in line with the health care reality. Therefore, enabling an optimal combination of theoretical education by academic lecturers with practical training by clinical lecturers and staff nurses.

Developing a 'core of steel': the key attributes of effective practice assessors

BACKGROUND

the Nursing and Midwifery Council has emphasised that its recently introduced standards for student supervision and assessment aim to 'ensure that no one gets onto the register who shouldn't be there'. A key element in achieving this is the new practice assessor role, implemented to bolster practical assessment processes.

AIM

to identify the key personal characteristics of robust practice assessors who are prepared to fail underperforming students.

METHOD

a national study, using a grounded theory approach. Thirty-one nurses were interviewed about their experiences of failing students in practice-based assessments.

FINDINGS

robust practical assessors have a 'core of steel', characterised as having five key features: solidarity, tenacity, audacity, integrity and dependability.

CONCLUSION

organisations should base their selection of practice assessors on how strongly they exhibit these five characteristics. Designating all current mentors as new practice assessors, when it is known that often they are reluctant to fail, could perpetuate failure to fail.

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.

Gut feeling: A grounded theory study to identify clinical educators' reasoning processes in putting students on a learning contract

AIM

To develop a substantive theoretical explanation that makes sense of the decision-making process that clinical instructors use to place students on a learning contract.

BACKGROUND

Clinical instructors are challenged with the task of objectively evaluating students using subjective tools such as anecdotal notes, diaries, unstructured observations and verbal feedback from other nurses. Clinical instructors' assessment decisions have a considerable impact on a variety of key stakeholders, not least of all students.

DESIGN

Grounded theory method and its heuristic tools including the logic of constant comparison, continuous memoing and theoretical sampling to serve conceptualisation were used in the process of data collection and analysis.

METHODS

Seventeen individual semi-structured interviews with clinical instructors in one university in Western Canada were conducted between May 2016-May 2017. Data were analysed using open, axial and selective coding consistent with grounded theory methodology. The study was checked for the Standards for Reporting Qualitative Research (SRQR) criteria (See Appendix S1).

FINDINGS

Three subcategories, "brewing trouble," "unpacking thinking" and "benchmarking" led to the study's substantive theoretical explanation. "Gut feeling" demonstrates how clinical instructors reason in their decision-making process to place a student on a learning contract.

CONCLUSION

Placing a student on a learning contract is impacted by personal, professional and institutional variables that together shift the process of evaluation towards subjectivity, thus influencing students' competency. A system-level approach, focusing on positive change through implementing innovative assessment strategies, such as using a smart phone application, is needed to provide some degree of consistency and objectivity.

RELEVANCE TO CLINICAL PRACTICE

Making visible the objective assessments currently being done by clinical instructors has the potential to change organisational standards, which in turn impact patient and clinical outcomes.

Are mentors failing to fail underperforming student nurses? An integrative literature review

AIM:

this review aimed to identify and review primary research to address the question: 'Is there evidence that mentors are failing to fail underperforming student nurses?' Design: this was an integrative literature review.

METHODS:

online databases (Medline, Scopus, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)) were searched using specified inclusion and exclusion criteria to focus the review. Critical appraisal was undertaken and key findings, outcomes and emergent concepts were identified from each study. These were then collated and synthesised into themes.

RESULTS:

five articles met the criteria and review aim. Three main themes were identified. These were the mentors' relationship with the university, documentation when failing a student, and psychological and emotional impacts.

CONCLUSION:

the phenomenon of failing to fail continues to concern the nursing profession but there is limited primary research evidence to inform contemporary discussions in the UK regarding the management of this in practice.