Current Practice in Assessment of Undergraduate Nursing Student Clinical Skills - Assignment Example

Current Practice in Assessment of Undergraduate Nursing Clinical Skills Introduction The teaching-learning process in undergraduate nursing education must go beyond the limits of academic theoretical learning into the clinical learning environment. Therefore, assessment of students clinical performance is integral and essential to undergraduate nursing education since this allows a measure of progress in education, of abilities to practice, and of achievements of the students. Assessments not only provides a method of evaluation of learning, also it provides guidelines for teaching in order to examine whether teaching was able to achieve intended learning goals and outcomes as applicable to undergraduate nursing education. In this assignment, three current journal research articles will be critically reviewed with the focus on assessment clinical skills of undergraduate nursing students in clinical practice in order to discuss recommendations regarding student assessment (Eaton, 2001). Critical Review Kassean and Rajaram in their article, "Teaching and Assessing in Clinical Practice" present their findings from a structured teaching program designed for second year student nurses, where learning outcomes were evaluated in terms of knowledge, skill, and attitude. The recommendations regarding the assessment are closely related to the teaching program. When assessment is directed toward achievement of learning goals, it is important to provide a planned teaching program that includes specific aims and learning outcomes. The teachers need to be trained as mentors to supervise and support students to enhance learning in the clinical environment where adequate resources are available to facilitate learning. One hour formal teaching should be followed by an assessment to evaluate the extent of meeting the learning outcomes. The assessment process must include assessment of knowledge and skills. The assessment process must acknowledge the types of students and be aware that students may demonstrate desire to have more explanation for a skill, may seek more time to think and consolidate ideas, may wish to be more sure of the details in the skills , and may be immediately ready to practice. Thus the strategies would include questions, answers, and demonstrations with discussions on wrong answers until they are able to identify and learn from the mistakes. This highlights the importance of clear, specific, appropriate, and balanced feedbacks in the assessment process. This is an assessment strategy based on evidence, and this applies Knowles andragogical and pedagogical techniques, where students were encouraged to be active participants in order to maximize learning. It is clear from this study that most of the predesigned learning outcomes were met, and therefore, these are the strengths of these strategies. However, this does not include the provision for more practice to make the students more confident in practice, and evaluation of teaching in this study indicates more room for further improvement. Another weakness of this assessment strategy is that this is a designed assessment strategy for research purposes, which may not be entirely practically applicable in a real clinical scenario, where work pressure in the wards may compromise teaching and learning, hence assessment (Kassean and Rajaram, 2006). Pfeil in his article "Assessing the clinical skills performance of nursing students" records the development of assessment criteria for the clinical skills of nursing students within a problem-based learning environment. In this multi-stage study including validation through focus groups, it has been indicated that in the assessment, the students should be able to explain their actions and to demonstrate background knowledge. Therefore, a potential criteria would be to correctly employ learned skills in varying care situations aided by the background knowledge and/or related theory. The next criteria would be to examine whether the students performed the skills with maintenance of patient safety at all times. These criteria were based on research evidences, and hence these capture reality in clinical skills acquisitions. These were assessed based on focus group studies, and this validation adds to the strengths of these recommendations, which is evident from the results to demonstrate that learning objectives were met. However, the criteria of assessment of competence in skills through confidence level analysis may be dubious. This is apparent from the participants remarks that the assessment took place by asking the right kind of questions. The weakness however appeared when students felt themselves confident, but the supervisors disagreed. Although this is a weakness, the study design kept space for recognition of the mistakes and for improvement of skills and knowledge. Confidence level as indicated by anxiety can be a weak criterion due to the very specific interrelationship between anxiety and confidence, since with increasing anxiety confidence level may diminish. Moreover anxiety is a personal and subjective perception, and assessment criteria should be objective. Performing a new skill may evoke anxiety, and there appears to be little direct consequential relationship between skill performance and confidence level. Attainment of competence should be assessed through cognitive, psychomotor, and affective attributes, as indicated in this study, and they are applicable to nursing education since they are evidence based. The other strength in these assessments is that the criteria have been designed with piloting with practitioner inputs and are clear and comprehensive. The format of pass-fail decisions and provision of feedback through evaluation provide a structured way of monitoring the progress and measuring achievements and motivation, where the student can demonstrate competence by fulfilling all the criteria and feel a sense of achievement and motivation. Moreover, this also incorporates the concept of safety by ensuring safe skills performance (Pfeil, 2003). McNee et al. in their article on the teaching of clinical skills discuss the pre-registration training of clinical skills of the nurses and examine the assessment process through implementation of clinical skills laboratories to teach student nurses the requisite skills. The authors present the intrinsic flaws in ward-based practical assessments, which usually used to present an artificial situation. This led to continuous assessment systems to assess nursing students competence, but with flaws detected in them, the clinical skills laboratory concept was in vogue, but this also presented the problems of assessment in a simulated environment, which is a weakness. The strength in this recommendation is that teaching of clinical skills becomes easier with a transition from pure teaching of the psychomotor skills to holistic problem-based care scenarios. These have been recommended to be adjuncts of practice placements early in the preregistration program where students; confidence and competence can be boosted. These have proved benefits, the details of which are outside the scope of this discussion; however, it has been found that the very structure of it facilitates formative and summative assessments. In this framework, the students can achieve clinical skills of competence, and skills of nursing practice can be achieved and assessed. The recommendations that have been made are therefore, compulsory assessment of skills within a laboratory environment prior to practice placements and development of scenario-based clinical skills teaching rather than teaching separate psychomotor skills would be ideal. The second weakness of this assessment program is difficulty in obtaining necessary equipment in order to facilitate learning. Moreover, although this system provides facilitation for development and assessment of real practice in clinical placements with scopes for self-evaluation and without fear of harming clients, this self-confidence of the students in assessment process is accomplished at the cost of a labor-intensive system of application with the need for presence of a number of facilitators in the class room environment, which may not be feasible in practice due to lack of teachers (Mcnee, Clarke, and Davies, 2005). Conclusion Clinical teaching should prepare students to integrate previously acquired information to acquire professional and personal skills, attitudes, and behavior that are essential to enter health care practice. Assessment is legitimate in the clinical environment since it is an opportunity to integrate theory into practice (Eaton, 2001). It has been observed that specialized training is difficult to access, and with the lack of supervision, the students tend to acquire clinical skills through observations on the job and by working together with the senior colleagues. Huge workload in the wards precludes the students to have formal teaching on a regular basis. Therefore improvement of learning environment is supposed to be the most single important parameter to improve clinical skills and thus the assessment would fit to these. The recommendations from these articles can be implemented with some limitations as indicated, but a proactive approach from the teachers and learners both can solve a lot of problems. Reference List Eaton, A., (2001). Assessing Learning Needs. In Hinchliff, S. (eds.), The practitioner as teacher, Second Edition. London: Bailliere Tindall. pp. 115–160. Kassean, H.K. and Rajaram, R., (2006). Teaching and Assessing in Clinical Practice. Journal of Health Management; 8; 119-130. Mcnee, P., Clarke D., and Davies, J., (2005). The teaching of clinical skills in the context of children’s nursing: a UK survey. Journal of Child Health Care; 9; 208-223. Pfeil, M., (2003). Assessing the Clinical Skills Performance of Nursing Students. Journal of Child Health Care;7; 191-208. Read More