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Holistic clinical assessment for undergraduate nursing students
Jönköping University, School of Health and Welfare.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A major focus in nursing education is on the judgement of clinical performance, and it is a complex process due to the diverse nature of nursing practice. Difficulties in the development of valid and reliable assessment measures in nursing competency continue to pose a challenge in nursing education. A holistic approach in the assessment of competency comprises knowledge, skills and professional attitudes, wherein the notion of competency incorporates professional judgement and management skills in the clinical situation. Therefore, the thesis aims to develop a holistic clinical assessment tool with a reasonable level of validity and reliability to meet the needs of clinical education.

The conceptual framework underlying this research is formed by establishing a theoretical connection between the practice of learning, and of pedagogy and assessment. This research consists of five studies. In Study I, a systematic review was conducted to explore the current assessment practices and tools for nursing undergraduates. In Studies II, III and IV, a qualitative approach with focus group discussions was adopted to explore the views of final-year undergraduate nursing students, preceptors, clinical nurse leaders and academics on the clinical assessment. Based on the multiple perspectives, it therefore addresses concerns in clinical assessment. In Study V, a holistic clinical assessment tool was developed, for which a psychometric testing was conducted.

The systematic review indicated that limited studies adequately evaluate the psychometric properties of the assessment instrument. The qualitative studies have raised an awareness of professional and educational issues in relation to clinical assessment. Workload, time, availability of resources, adequate preparation of preceptors, and availability of valid and reliable clinical assessment tools were deemed to influence the quality of students’ clinical learning and assessment. In addition, the presence of support systems and formal educational programs for preceptors influenced their preparation and self-confidence. Nursing leaderships in hospitals and educational institutions have a joint responsibility in shaping the holistic clinical learning environment and making holistic clinical assessment for students. The involvement of all stakeholders in the development of a valid and reliable assessment tool for clinical competency is also essential to the process. The Holistic Clinical Assessment Tool (HCAT) was developed by the author based on the systematic review, qualitative findings and the core competencies of registered nurse from the professional nursing boards. The HCAT consists of 4 domains and 36 assessment items. Furthermore, testing of the psychometric properties indicated that the HCAT has satisfactory content validity, construct validity, internal consistency and test-retest reliability.

In conclusion, the HCAT is meritorious in that it carries the potential to be used as a valid measure to evaluate clinical competency in nursing students, and provide specific and ongoing feedback to enhance the students’ holistic clinical learning experience. The HCAT not only functions as a tool for self-reflection for the students, but also guides the preceptors in clinical teaching and assessment. In addition, the HCAT can be used for peer-assessment and feedback. It is imperative that the clinical and academic institutions establish various levels of ongoing support for both students and preceptors in the process of clinical assessment.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2016. , 99 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 69
Keyword [en]
Clinical assessment; transition to practice; clinical nursing education; clinical guidance; feedback; undergraduate nursing student; nurse preceptor; clinical nurse leader, academic, holistic clinical assessment tool; tool development; psychometric testing
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-29937ISBN: 978-91-85835-68-3 (print)OAI: oai:DiVA.org:hj-29937DiVA: diva2:929154
Public defence
2016-06-09, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2016-05-17 Created: 2016-05-17 Last updated: 2016-05-18Bibliographically approved
List of papers
1. A systematic review of clinical assessment for undergraduate nursing students
Open this publication in new window or tab >>A systematic review of clinical assessment for undergraduate nursing students
2015 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 35, no 2, 347-359 p.Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Consolidated clinical practicum prepares pre-registration nursing students to function as beginning practitioners. The clinical competencies of final-year nursing students provide a key indication of professional standards of practice and patient safety. Thus, clinical assessment of nursing students is a crucial issue for educators and administrators.

OBJECTIVE: The aim of this systematic review was to explore the clinical competency assessment for undergraduate nursing students.

DATA SOURCES: PubMed, CINAHL, ScienceDirect, Web of Science, and EBSCO were systematically searched from January 2000 to December 2013.

METHODS: The systematic review was in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Published quantitative and qualitative studies that examined clinical assessment practices and tools used in clinical nursing education were retrieved. Quality assessment, data extraction, and analysis were completed on all included studies.

RESULTS: This review screened 2073 titles, abstracts and full-text records, resulting in 33 included studies. Two reviewers assessed the quality of the included studies. Fourteen quantitative and qualitative studies were identified for this evaluation. The evidence was ordered into emergent themes; the overarching themes were current practices in clinical assessment, issues of learning and assessment, development of assessment tools, and reliability and validity of assessment tools.

CONCLUSION: There is a need to develop a holistic clinical assessment tool with reasonable level of validity and reliability. Clinical assessment is a robust activity and requires collaboration between clinical partners and academia to enhance the clinical experiences of students, the professional development of preceptors, and the clinical credibility of academics.

National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-25358 (URN)10.1016/j.nedt.2014.11.016 (DOI)000349500600010 ()25497138 (PubMedID)2-s2.0-84921388172 (Scopus ID)HHJCHILDIS (Local ID)HHJCHILDIS (Archive number)HHJCHILDIS (OAI)
Available from: 2014-12-18 Created: 2014-12-18 Last updated: 2017-12-05Bibliographically approved
2. Undergraduate nursing students' perspectives on clinical assessment at transition to practice
Open this publication in new window or tab >>Undergraduate nursing students' perspectives on clinical assessment at transition to practice
Show others...
2015 (English)In: Contemporary Nurse: health care across the lifespan, ISSN 1037-6178, E-ISSN 1839-3535, Vol. 51, no 2-3, 272-285 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Assessment of clinical competence requires explicitly defined standards meeting the national standards of the nursing profession. This is a complex process because of the diverse nature of nursing practice.

OBJECTIVES: To explore the perceptions of final-year undergraduate nursing students regarding clinical assessment at transition to practice.

METHODS: An exploratory qualitative approach was adopted. Twenty-four students participated in three focus group discussions. Thematic analysis was conducted.

FINDINGS: Five themes emerged: the need for a valid and reliable clinical assessment tool, the need for a flexible style of reflection and specific feedback, the dynamic clinical learning environment, students' efforts in learning and assessment, and the unclear support system for preceptors.

CONCLUSIONS: Workload, time, resource availability, adequate preparation of preceptors, and the provision of valid and reliable clinical assessment tools were deemed to influence the quality of students' clinical learning and assessment. Nursing leadership in hospitals and educational institutions has a joint responsibility in shaping the clinical learning environment and providing clinical assessments for the students.

Keyword
clinical assessment; clinical nursing education; transition to practice; undergraduate nursing students
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-29933 (URN)10.1080/10376178.2016.1163232 (DOI)000375908400013 ()26956057 (PubMedID)HHJCHILDIS (Local ID)HHJCHILDIS (Archive number)HHJCHILDIS (OAI)
Available from: 2016-05-17 Created: 2016-05-17 Last updated: 2017-11-30Bibliographically approved
3. The perspectives of preceptors regarding clinical assessment for undergraduate nursing students
Open this publication in new window or tab >>The perspectives of preceptors regarding clinical assessment for undergraduate nursing students
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2016 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 63, no 3, 473-481 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To explore the perspectives of preceptors about clinical assessment for undergraduate nursing students in transition to practice.

BACKGROUND: The assessment of clinical competence is a complex process due to the diverse nature of nursing practice. As such, nurse preceptors play a crucial role in clinical assessment for nursing students. Although preceptors may enjoy the process of clinical teaching and assessment, they face challenges that need to be addressed to facilitate students' clinical learning and assessment.

METHODS: An exploratory qualitative approach was adopted. A purposive sample of 17 preceptors from two tertiary hospitals in Singapore was recruited to participate in three focus group discussions from March to July 2014.

FINDINGS: Five themes emerged from the data analysis: the need for a valid and reliable clinical assessment tool; meaningful reflection and feedback; varied methods in clinical assessment; high level of commitment and struggles with dual roles and the need to enhance the support system for preceptors.

CONCLUSIONS: There is no doubt that a valid and reliable clinical assessment tool can serve as a guide for preceptors to enhance their clarity in assessment and feedback. It is essential for all stakeholders to be involved in the development of the clinical assessment tool. Workload, time, support system and formal educational programmes for preceptors influenced their preparation and self-confidence.

IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: The themes that emerged from the focus group discussions could assist in the development of a more reliable and valid clinical assessment tool to evaluate the clinical competence of nursing students in transition to practice. Clinical and educational institutions could collaborate closely to develop an educational programme and a preceptorship handbook, focusing on pedagogical contents for clinical education and assessment.

Keyword
Clinical Assessment; Clinical Guidance; Clinical Nursing Education; Feedback; Nurse Preceptors; Nursing Education
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-29934 (URN)10.1111/inr.12272 (DOI)27100137 (PubMedID)2-s2.0-84983386771 (Scopus ID)HHJCHILDIS (Local ID)HHJCHILDIS (Archive number)HHJCHILDIS (OAI)
External cooperation:
Available from: 2016-05-17 Created: 2016-05-17 Last updated: 2017-11-30Bibliographically approved
4. Clinical nurse leaders’ and academics’ perspectives on clinical assessment of final-year nursing students: a qualitative study
Open this publication in new window or tab >>Clinical nurse leaders’ and academics’ perspectives on clinical assessment of final-year nursing students: a qualitative study
Show others...
2017 (English)In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 19, no 3, 287-293 p.Article in journal (Refereed) Published
Abstract [en]

The nature of nursing practice is diverse; therefore, clinical assessment is a complex process. This study explores the perceptions of clinical nurse leaders and academics on clinical assessment for undergraduate nursing education during transition to practice. An explorative qualitative approach was applied. Eight nurse managers, six clinical nurse educators, and eight academics from two tertiary hospitals and a university in Singapore participated in four focus group discussions. Thematic analysis was conducted. Four overriding themes were revealed: the need for a valid and reliable clinical assessment tool, preceptors' competency in clinical assessment, challenges encountered by the students in clinical assessment, and the need for close academic and clinical collaboration to support preceptors and students. Closer academic-clinical partnership is recommended to review the clinical education curriculum. Clinical and educational institutions need to work closely to design a learning program to enhance preceptors' competence in clinical pedagogy and assessment. Furthermore, a stress management program could build students' resiliency in coping with unfamiliar clinical environments. Ongoing support needs to be provided for both preceptors and students to enrich the preceptorship and learning experiences.

Keyword
academics; clinical assessment; clinical nurse leaders; clinical nursing education; nurse preceptors; undergraduate nursing students
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-29935 (URN)10.1111/nhs.12342 (DOI)000409188300003 ()28371304 (PubMedID)2-s2.0-85016968526 (Scopus ID)HHJCHILDIS (Local ID)HHJCHILDIS (Archive number)HHJCHILDIS (OAI)
Note

Included in thesis in its submitted form

Available from: 2016-05-17 Created: 2016-05-17 Last updated: 2017-09-29Bibliographically approved
5. Development and psychometric testing of Holistic Clinical Assessment Tool (HCAT) for undergraduate nursing students
Open this publication in new window or tab >>Development and psychometric testing of Holistic Clinical Assessment Tool (HCAT) for undergraduate nursing students
Show others...
2016 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, 1-9 p., 248Article in journal (Refereed) Published
Abstract [en]

Background:A major focus in nursing education is on the judgement of clinical performance, and it is a complexprocess due to the diverse nature of nursing practice. A holistic approach in assessment of competency is advocated.Difficulties in the development of valid and reliable assessment measures in nursing competency have resulted in thedevelopment of assessment instruments with an increase in face and content validity, but few studies have testedthese instruments psychometrically. It is essential to develop a holistic assessment tool to meet the needs of the clinicaleducation. The study aims to develop a Holistic Clinical Assessment Tool (HCAT) and test its psychometric properties.

Methods:The HCAT was developed based on the systematic literature review and the findings of qualitative studies.An expert panel was invited to evaluate the content validity of the tool. A total of 130 final-year nursing undergraduatestudents were recruited to evaluate the psychometric properties (i.e. factor structure, internal consistency and test-retestreliability) of the tool.

Results:The HCAT has good content validity with content validity index of .979. The exploratory factor analysis revealsa four-factor structure of the tool. The internal consistency and test-retest reliability of the HCAT are satisfactory withCronbach alpha ranging from .789 to .965 and Intraclass Correlation Coefficient ranging from .881 to .979 for the foursubscales and total scale.

Conclusions:HCAT has the potential to be used as a valid measure to evaluate clinical competence in nursingstudents, and provide specific and ongoing feedback to enhance the holistic clinical learning experience. In addition,HCAT functions as a tool for self-reflection, peer-assessment and guides preceptors in clinical teaching and assessment.

Keyword
Holistic clinical assessment tool, Psychometric testing, Tool development, Undergraduate nursing students
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-29936 (URN)10.1186/s12909-016-0768-0 (DOI)000384493700004 ()27658587 (PubMedID)2-s2.0-84995390536 (Scopus ID)HHJCHILDIS (Local ID)HHJCHILDIS (Archive number)HHJCHILDIS (OAI)
Available from: 2016-05-17 Created: 2016-05-17 Last updated: 2017-11-30Bibliographically approved

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