ABSTRACT
Assessment
of clinical performance contributes to academic qualifications that incorporate
professional awards. The administrators of Nursing Schools are facing the
problem of subjectivity in practical examination of student nurses. This is
evident in examination situations in which the examiner assigns any task of
choice to the student and scores the student based on his/her perception of the
student’s competence in performing the task. By this, some students are exposed
to more difficult tasks than others and subjective scoring, all depending on
the inclination of the examiner. In response to this problem, the study
developed and validated a Structured Clinical Assessment Tool (SCAT) that will
make it possible for all the students to be examined on the same tasks for any
examination episode and judged on the same premise. Instrumentation research
design was used. One hundred and thirty seven student nurses from three Schools
of Nursing in the South East Zone of Nigeria formed the sample for the study.
Prior to developing the tool, a competency assessment framework was developed
based on the nursing process model with the five steps of the process being the
core competencies and sub skills identified for each of the core competencies.
The appropriateness of the sub-skills was verified using 52 nurse educators.
The care sub-skills were pooled to form the model for SCAT. The model consists
of twelve activity stations which are examination points where students perform
specified nursing tasks and are scored using a predetermined standard.
Initially 48 items (four per station) and their scoring guide were generated
and four experienced nurse educator/managers were used to verify their
appropriateness. Thirty six items survived the validation exercise using average
congruency percentage. Data collected were analysed using alpha coefficient,
t-test and analysis of variance. The results of the analysis confirmed the
validity of the 36 items and showed that the items were able to discriminate
between the high and low achievers. The high reliability index (0.84-0.99) for
most of the procedure station items and moderate reliability index (0.69-0.78)
for others confirm that the instrument has a good inter-scorer consistency and
therefore is reliable. Based on these findings, the SCAT is a tool that has the
potentials for reducing the subjectivity that is inherent in clinical
assessments that are based on observation and is therefore recommended for
assessing clinical competence of student nurses.
CHAPTER ONE
INTRODUCTION
Background
to the Study
Effective administration requires rational decision making
which will lead to the selection of the way to reach the anticipated goal. The
educational administrator in trying to achieve the ultimate goal of improving
learning and learning opportunities to ensure competent products is faced with
the responsibility to make decision on such issues as selecting appropriate
curriculum, selecting appropriate teaching methods, and selecting appropriate
methods for assessing the student’s progress. If appropriate decisions are made
on these issues, appropriate educational policies will be made and the goals of
education will be met.
However if inappropriate
decisions are made, particularly on methods of assessing students, the society
will be exposed to the danger of incompetent practice. This is so because
learners who have not acquired the necessary knowledge and skills for competent
practice may be certified to be qualified to practice and may not give quality
and safe care.
Generally the school curriculum
is organized to expose students to subjects that provide opportunity for them
to acquire the knowledge and skills that should help them practice. Sometimes
students who have passed written examination and certified fit to practice fail
to do so.
Considering the legal and
financial implications of employee performance and safe practice in a rapidly
changing environment, a major concern of an educational administrator of an
institution should be to produce manpower that is competent. It is therefore
important in assessing students for certification to practice, in this case, in
a health care institution, to generate appropriate data that will help in
making decision on whether they are able to perform tasks that the knowledge
they have acquired should help them to accomplish. This can be done if an
appropriate assessment tool is in place.
Stressing the importance of
assessing what nursing care providers can do, not what they know, Del Bueno (1990)
cited situations in which people who had performed excellently well in
examination had difficulty performing a procedure or recognizing warning signs
in patients experiencing difficulty. This kind of situation is unacceptable and informed the reforms in nursing education which led to calls
for assessment of clinical performance to contribute to academic qualifications
that incorporate professional awards. In response to this call, training
institutions have developed clinical assessment tools. However, Redfern,
Norman, Calman, Watson & Murrels, (2002) expressed some concern about the
psychometric quality of the tools that are available and the ability of the
tools to distinguish between different levels of practice. They analyzed some
tools of assessing competence to practice in nursing, while Norman, Watson,
Murrels, Calman, and Redfern (2002) tested selected nursing and midwifery
competence assessment tools for reliability and validity. Both team of
researchers concluded that a multi-method approach which enhances validity and
ensures comprehensive assessment is needed for clinical competence assessment
for nursing and midwifery.
In order to ensure such a tool,
Lenburg (2006) created a constellation of ten basic concepts and suggested that
they should be adapted for developing and implementing objective performance
examination. They include:
Concept
of examination Dimensions of practice Required critical elements
Objectivity
of the assessment process
Sampling
critical skills for the testing period Level of acceptability
Comparability
in extent, difficulty and requirements Consistency in implementation
Flexibility
in actual clinical environment Systematized conditions.
These
concepts are very useful to the development of accurate assessment instruments.
Thus far in the nursing context in Nigeria, such tool does not exist. The
administrators of nursing schools are facing the problem of subjectivity in
practical examination of student nurses. This is evident in situations where
students are given different tasks to perform during clinical examination and
awarded grades based on the tasks they perform. By this some students are
exposed to more difficult tasks than others, all depending on the inclination of
the examiner and yet judged on the same maximum score. This is unfair. It is
therefore necessary to develop an assessment tool that will examine the
students on the same tasks for a particular examination episode.
In order to accomplish this,
consideration should be given to the concepts proposed by Lenburg (2006) which
were mentioned earlier. To achieve objectivity in an assessment process two components
must be considered. First the content (skills and critical elements) for the particular
assessment should be specified in writing and second, there should be a
consensual agreement of everyone directly involved in any aspects of the
examination process. When individual examiners begin to digress from the
established standards and protocols, objectivity erodes back into subjectivity
and inconsistency. This regression destroys the process and the purpose.
To prevent this from occurring,
the educational administrator should ensure that the content of the examination
is specified by the list of the dimensions of practice, that is, the skills and
competencies and their required critical elements that determine the extent and
conditions of competence.
The use of a conceptual
framework to systematically guide the assessment process increases the
likelihood that concepts and variables universally salient to nursing and
health care practice will be identified and explicated (Waltz, Strickland &
Lenz, 2005).
Concepts of interest to nurses
and other health professionals are usually difficult to operationalise, that is
to render measurable. This is partly because nurses and other health
professionals deal with a multiplicity of complex variables in diverse
settings, employing a myriad of roles as they collaborate with a variety of
others to attain their own and others goals. Hence, the dilemma that they are
apt to encounter in measuring concepts is two fold; first; the significant
variables to be measured must, by any means, be isolated, and second, very
ambiguous and abstract notions must be reduced to a set of concrete behavioural
indicators. It is therefore the responsibility of the educational administrator
who knows the goals that are intended and that selected the content that should
help in the achievement of the goal to select the variables that must be
measured and to reduce them to concrete behavioural indicators of competence.
These should be incorporated into a protocol that will guide the assessor.
Protocols ensure that each test
episode for a given group is comparable in extent, difficulty and requirements.
Protocol also ensures that the process is implemented consistently, regardless
of who administers the examination or when it was conducted. When
performance examinations are administered in actual clinical environment, not
simulation, the concept of flexibility is essential as each client is
different. The responsible educational administrator, who prepares students for
professional practice is therefore challenged to develop appropriate
competency-based assessment tools for use in the assessment of students’
clinical competence.
Competency-based assessment
tool focuses on measuring the actual performance of what a person can do rather
than what the person knows. It is based on criterion-referenced assessment
methods where the learner’s performance is assessed against a set of criteria
provided so that both the learner and assessor are clear on what performance is
required. Competency-based assessment technique addresses psychomotor,
cognitive and affective domains of learning and its goal is to assess
performance for the effective application of knowledge and skill in practice
setting. The competencies can be generic to clinical practice in any setting,
specific to a clinical specialty, basic or advanced (Benner, 1982; Gurvis &
Grey, 1995).
Criterion-referenced measures
are particularly useful in the clinical area when the concern is the
measurement of process and outcome variables as applies in nursing. A
criterion-referenced measure of process according to Waltz, Strickland &
Lenz (2005), requires that one identifies standards or the client care
intervention and compares the subjects’ clinical performance with the standard
of performance which is the predetermined target behaviour. When all these are
taken into consideration in developing a clinical assessment tool, the tool is
bound to be authentic.
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Item Type: Project Material | Size: 151 pages | Chapters: 1-5
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