DEVELOPMENT AND VALIDATION OF A STRUCTURED CLINICAL ASSESSMENT TOOL FOR ASSESSING STUDENT NURSES’ CLINICAL COMPETENCE
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.