Methods: A NLN-funded research synthesis was conducted to identify published research and dissertations on clinical evaluation of nursing students. Cooper’s (2010) method of conducting a research synthesis was used to guide the study. Search methods included literature searches of nursing, educational, and health sciences databases; dissertation abstracts; review of table of contents of 7 leading nursing education journals from 2005-2015; and review of the reference lists of 6 review articles on clinical evaluation (e.g. Cant, McKenna, & Cooper, 2013). The full search resulted in 177 articles, of which 77 met the study criteria related to research on clinical evaluation of nursing students. From these, a total of 30 studies focused on clinical evaluation of competence, which was defined as the measurement or evaluation of competence in general or in a specific area. Data analyses included creation of a matrix for comparison of study data and narrative synthesis of study data.
Results: The 30 studies were published between the years 1988-2015 and used quantitative (n = 26), qualitative (n = 1), and mixed methods (n = 3). The studies were conducted in eight different countries including Australia, Finland, Ireland, Sweden, Taiwan, Turkey, the United Kingdom, and the Unites States, providing information useful for evaluating diverse populations of students in various clinical settings including international venues.
The majority of the studies aimed to measure global competence at the end of a nursing program. Studies frequently measured student progress over time with pre and post-measures administered before and after an entire program, semester, clinical rotation, or specific event, such as a summer precepted experience. Seven studies focused on competence in a specific area including medication calculation (Macdonald, Weeks, & Mosely, 2013), vaccinations (Nikula, Puukka, & Leino-Kilpi, 2012), critical thinking (Pitt, Powis, Levett-Jones, & Hunter, 2015), psychiatric nursing skills (Glass & Ward, 2008), culturally specific care (Jeffreys & Dogan, 2013), and interpersonal communication (Klakovich & Cruz, 2006).
Most of the studies (n = 21) used researcher-developed instruments, and some also conducted psychometric testing of the study instrument (e.g. Hsu & Hsieh, 2013). Data for analyses included student-self reports (Kajander-Unkuri et al., 2014), faculty or preceptor evaluations of student performance (Cassidy et al., 2012). Many studies examined comparisons among these types of evaluations, while others compared either specific exam scores or grades in didactic courses with the clinical measures. A majority of the studies used descriptive, correlational, or comparative methods, and were classified as levels 4 or 6 according to Melnyk and Fineout-Overhalt’s (2011) levels of evidence.
Conclusion: Clinical evaluation in nursing education has been an ongoing area of educational research for decades and includes evaluation of competence in specific skills or nursing practice specialty areas, and in general competence. Despite the use of standardized licensing exams for entry into practice in many countries globally, a review of the research literature reveals clinical evaluation of competence lacks standardization of measures or methods, and a lack of replication of studies and instrument testing to build the science of nursing education related to evaluation of clinical competence. The common use of student self-evaluation and researcher-created measures is problematic for determining reliability and validity of instruments and comparison of findings across studies. The use of predominately descriptive research decreases the ability to use the research findings as evidence to guide nursing faculty in clinical evaluation methods. Imperative areas for future research and practice are the need to accurately and efficiently measure competence in the clinical area, the need for reliable and valid instruments, and the elevation of nursing research rigor in clinical evaluation of competence to include quasi-experimental and experimental research methods.