Development and testing of a competence assessment intrument for undergraduate nursing students

[摘要] English: Nursing roles and responsibilities in South Africa are evolving, demanding nursing practitioners to become more autonomous, responsible and accountable. Competent nursing practitioners who are able to apply their knowledge, skill and attitude in clinical practice are in great demand. Competence is therefore regarded as a prerequisite for nursing students entering the workforce as nurse practitioners. Competent student nurses demonstrate thinking processes such as critical thinking, clinical reasoning, sound clinical judgment and metacognition as they assess, diagnose and treat patients. In order for competent student nurses to apply these thinking processes the basis of foundational knowledge, conditional knowledge, functional knowledge and metacognitive knowledge need to be in place. At present there is no assessment instrument based on the thinking processes to assess the competence of student nurses in South Africa.The aim of this study was to develop a valid and reliable instrument to assess nursing students�?competence through their demonstration of clinical judgment and metacognition in clinical settingsA quantitative methodological study was done to prove the developed assessment instrument as reliable. Sixteen existing competence assessment instruments were accessed and analysed. Consequently a thematic analysis of nine of the existing competence assessment instruments delivered an assessment instrument comprised of 38 items, classified according to thinking processes. A panel of experts enhanced face and content validity of the developed assessment instrument before the instrument was implemented. Twenty respondents each assessed 15 second-year undergraduate nursing students who participated in a standardised patient simulation activity via video footage. A Cronbach Alpha coefficient test, Intraclass correlation coefficient (ICC) test and a Kendall‟s coefficient of concordance (W) test determined reliability of the developed assessment instrument.A Cronbach Alpha coefficient of .90 is indicative of good internal consistency and proves the developed assessment instrument as reliable. The ICC value of .85 indicates excellent inter-rater reliability as a continuum of all the respondents and further contributes to the reliability of the developed assessment instrument. However the W values of the developed assessment instrument were low and ranged between .04 and .40 per item. The low W values were attributed to the fact that some respondents were inconstant in assessing students, the fact that respondents could not validate the reasoning of students, and the large number of assessors (20) in comparison to other inter-rater studies that have three assessors at the most.The competence of student nurses needs to be assessed in order to determine if they can apply their knowledge and reasoning in clinical practice. The value of this research is that the developed assessment instrument may aid nurse educators or preceptors to identify the specific learning need of a student. Furthermore the developed assessment instrument will give an indication of the competence of student nurses. This knowledge will encourage nurse educators to build in and expand teaching strategies that develop thinking processes into their pedagogies.It is recommended that future research, such as an exploratory and confirmatory factor analysis, be done in order to determine the construct validity of the developed assessment instrument. This will significantly enhance the validity of the developed assessment instrument.

[发布机构] University of the Free State