Evaluation of an undergraduate nursing entrustable professional activities framework: An exploratory qualitative research

BACKGROUND

Entrustable professional activities (EPA) are mainly used in graduate medical education and professional development and have not been widely implemented in nursing undergraduate settings. Nursing EPAs were therefore developed by the Alice Lee Centre of Nursing to translate theoretical nursing competencies into clinical practice and as forms of standardized clinical assessment tools. Feedback from various stakeholders is required to further refine the framework.

OBJECTIVES

To explore the perceptions and experiences of using the new EPA framework in nursing students and hospital and university clinical instructors.

DESIGN

An exploratory qualitative study using focus group interviews.

PARTICIPANTS

Seven year-one nursing undergraduates, 12 year-two undergraduates, seven university clinical instructors, and 18 hospital clinical instructors participated in this study.

METHODS

The students formed five groups, while the clinical instructors formed seven groups, each consisting of three to four participants. Semi-structured interviews were conducted to explore stakeholders' experiences and perceptions of the EPA assessment framework. Thematic analysis was used to analyze the data.

RESULTS

Despite initial mixed reactions of confusion and relief, many students and clinical instructors commended the comprehensive and structured EPA framework and its emphasis on holistic patient-centered care. EPAs also allow flexible assessment methods, encourage critical thinking among students, and promote team-based care and peer teaching. However, the assessment using a two-dimensional matrix with multiple competencies for the EPAs, subjective assessment criteria, the lack of standardization using checklists, subjective assessment criteria, and the lack of, manpower, and time may potentially affect the accuracy of the clinical assessments. The effectiveness of the EPA framework was also dependent on the quality of feedback, students' intrinsic motivations, and learning environments. The refinement of EPAs and entrustment levels, a physical checklist, and an incorporation of EPAs into school curricula were recommended to improve practitioners' learning experiences.

CONCLUSIONS

The use of EPAs in nursing education continues to be a novel and evolving process. There remains a need for a further refinement of the EPA framework to tailor to instructors' expectations and students' capabilities.

[Development and Psychometric Testing of the Clinical Nursing Competency Scale for Clinical Preceptor Use (CNCS-CP)]

PURPOSE

The purpose of this study was to develop and establish the psychometric properties of a clinical nursing competency evaluation tool to be utilized by clinical preceptors.

METHODS

The initial items were identified through in-depth literature review and field interviews based on a hybrid model. Content validation of the items was evaluated through three rounds of content validity testing. Participants were 34 clinical preceptors and 443 nursing students participating in clinical practice. Data were analyzed using exploratory and confirmatory factor analysis, convergence and discriminant validity, internal consistency and inter-rater reliability.

RESULTS

The final scale consisted of 23 items and four factors, fundamental nursing skills performance, critical thinking skills based on the nursing process, basic nursing knowledge, and professional attitude; these factor explained 69.7% of the total variance. The analysis with multi-trait/multi-item matrix correlation coefficients yielded 100.0% and 95.7 % convergence and discriminant validity, respectively. Cronbach's alpha for the total items was .95. The four subscale model tested by confirmatory factor analysis was satisfactory. Inter-rater reliability ranged from .912 to .967.

CONCLUSION

This scale was found to be a reliable and valid instrument that clinical preceptors can apply for evaluating the clinical nursing competency of nursing students in clinical settings.

The Meaning of Grades: Stories of Undergraduate, Master's, and Doctoral Nursing Students

BACKGROUND

Although the literature is replete with information about grades, there is a lack of empirical evidence about the meaning of grades to nursing students.

PURPOSE

This study sought to understand the meaning of grades for nursing students at all educational levels.

METHOD

Using Heideggerian hermeneutic phenomenology, 46 nursing students from 14 schools were asked to tell about a time that stood out to them when they were graded. They then reflected on their story and described what this experience meant to them.

RESULTS

Data analysis revealed several themes. The main theme was "needing an A." It was discussed by students at every level of nursing education.

CONCLUSIONS

Students not only needed to get an A, but also they needed to get an A in every course they took, causing stress and disappointment when they were unable to achieve these grades. It seemed that what they were learning was not as important as the grade they received.