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.
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