Evaluation of Clinical Competencies In Nursing Education
What are Clinical Competencies to Evaluate
Evaluation
is an informed approach that uses a systematic, rigorous procedure to examine
the worth of an entity such as a program, process, procedure, individual, or
other element requiring an appraisal. Evaluation of clinical competencies in
nursing is the application of a process, which may use one or multiple
strategies to provide both formative and summative measures of the clinical
capabilities of pre-licensure , graduate students, or a licensed nurse in
clinical practice.
Implementation of Evaluation Methods for Clinical Competencies
Evaluation
methods for the appraisal of clinical competencies are used throughout the
pre-licensure educational process. Judgments are made regarding a student’s
performance in the clinical setting during and at the conclusion of each
clinical course. Determination of the student’s ability to provide professional
competent client-centered care is the central objective of the appraisal.
Clinical evaluation is a decisive element in the educational process and has
significant implications for students and public safety. Evaluation of clinical
competency is equally important for graduate students preparing for advanced
practice.
Competent advanced practice requires that the graduate student has
succeeded in acquiring new skills, possesses the procedural knowledge and
psycho-motor ability to execute them, and possesses the schematic knowledge that
directs when and why to implement specific patient care measures. Determination
of clinical competency provides assurance that the graduate-advanced practice
nurse is prepared for entry into practice (Cook, Marienau , Wildgust , Gerbast
, & Watkins 2013; Phelen , O Connell, Murphy, McLoughlin , & Long,
2014).
Impact of Best Clinical Evaluation
Competency
in nursing is the ability to perform a skill or carry out an activity to a
prescribed standard that has been instituted to ensure safety and prevent harm.
Evaluation of clinical competencies is concerned with what individuals can do
in addition to what they know (Garrett, MacPhee , & Jackson, 2013 The
translation of knowledge into the practice of nursing by the student engaged
indirect patient care is the target of the evaluation.
The process of clinical
evaluation is a two tier sequence conducted on multiple occasions during the
course of the educational process in nursing, formative evaluation of clinical
competency involves observation of the student’s performance, identification of
strengths and/ or weaknesses, and the provision of feedback regarding the
student’s progress on achieving the objectives. Time is allotted to learn a
skill, practice a skill, and incorporate constructive feedback into the
successful execution of the skill. The observations for formative evaluations
are documented by the faculty as narrative notes or on a rating scale and may
include assignments submitted by students regarding their clinical
experience.
Formative evaluation is generally not graded, but rather is used to
evaluate patterns of clinical performance and continuous learning efforts as
well as interval accomplishments.The
summative evaluation of clinical competence is directed at validating the
acquisition of a skill or set of skills at the end of an instructional unit or
level in the program. A grade is issued that indicates if the clinical
competency has been achieved. Summative evaluations are often documented on a
clinical evaluation tool, a numerically ranked score that denotes a successful
or a failed attempt to acquire the designated competencies.
The dominant
strategy for evaluating clinical performance in all nursing programs is faculty
observation of the student’s interactions. A clinical evaluation tool was
identified by 98% of nursing faculty as the instrument used to record the
summative observations and rank the performance of students ( Oermann ,
Yarbrough, And, Saewert , & Charasika , 2009).
Faculty in undergraduate
nursing programs have developed instruments for clinical evaluation using
elements from the Essentials of Baccalaureate Education for Professional
Nursing Practice (American Association of Colleges of Nursing [AACNI 2008),
which identifies the expected student outcome for baccalaureate-level
education. Other indicators reported by faculty that are employed to complement
their direct observations of a student’s clinical performance are activities
demonstrated during clinical post-conference such as case study analysis,
values clarification exercises, and presentations on relevant clinical topics (
Cermann et al. 2009 ) .
Individuals
who are in an advanced practice graduate program are prepared for a role in
direct patient care. Core competencies for advanced practice specialties are
determined by each specialty’s professional organizations. Clinical evaluation
instruments used for the systematic appraisal of graduate student’s clinical
competencies in the advanced practice programs have been developed using the
Essentials of Master’s Education for Advanced Practice Nursing Education (AACN,
1996), the Essentials of Doctoral Education for Advanced Practice Nursing
Education (AACN , 2006), and the respective specialties’ accreditation council
standards.
The use of a clinical evaluation instrument for the determination of
an individual’s ability to competently practice is contingent on the properties
of the instrument. The items in the instrument must be consistent with the
desired outcome competency. Students at each level must be clear regarding what
the successful demonstration of a particular skill includes. Trustworthiness of
the tool to contain the necessary items for evaluation is indispensable if the
instrument is to be a valid indicator of clinical competencies. The score on
the instrument used for evaluation should be a true representation of the
observed behavior.
The instrument must also perform in a reliable manner; thus,
the same results can be obtained when the tool is used by different faculty and
with different students (Collins & Callahan, 2014; Courtney Pratt,
Fitzgerald, Ford, Johnson, & Wills, 2013).Other
measures identified in the literature to evaluate clinical competency include
the Objective Structure Clinical Examination (OSCE). The instrument affords the
opportunity to generate an unbiased objective review of performance in a
controlled setting, not in an actual patient care setting A key value of OSCE
is that it can be used for review and practice of skills that are of a highly
critical nature, yet are used infrequently; for example, disaster readiness (
Rushforth , 2007).
Inappropriate Measures and Method
There
is a lack of information on the properties of the instruments used for the
evaluation of clinical competency. Validity and reliability assessment of
existing instruments are needed to guarantee confidence that the scores
calculated using the clinical evaluation tool are a true representation of the
observed behavior. Faculty observations are a cornerstone for the evaluation of
clinical competency. The criteria to demonstrate skills at all levels must be
clearly communicated, and efforts to minimize bias must be incorporated into
the evaluation process.
American Association of Colleges of Nursing (1996).
Essentials of master’s education for professional nursing practice. Washington,
DC: Author.American
Association of Colleges of Nursing (2006) Essentials of doctoral education for
professional nursing practice. Washington, DC: Author. American Association of
Colleges of Nursing. (2008). Essentials of baccalaureate education for
professional nursing practice.