Content Validation of a Quality and Safety Education for Nurses (QSEN)-Based Clinical Evaluation Instrument

The literature indicates that students view clinical performance evaluation as less objective than classroom evaluation and as such, it can serve as a source of contention between students and faculty. Evaluation of clinical competency in prelicensure nursing education is a high stakes assessment, therefore it requires the use of a valid method of measurement. This presentation will describe the development of a clinical evaluation instrument based on the Quality and Safety Education for Nurses (QSEN) competencies and the process of establishing content validation for its items using the content validity index. The QSEN competencies identify the knowledge, skills, and attitudes needed by nurses to meet the demands of the health care environment, emphasizing patient-centered care, collaboration with other members of the health care team, evidence-based practice, continuous quality improvement, safety, and the integrated use of informatics. Establishing content validation for a clinical evaluation instrument based on these competencies is essential because while many educators use QSEN as a framework for developing teaching strategies that integrate quality improvement and patient safety concepts into student learning, there is little evaluative data regarding the efficacy of this practice.

The QSEN-Based Clinical Evaluation Instrument was developed by the researcher to standardize and clarify expectations of clinical performance for medical-surgical nursing students. Once developed, six expert nurse educators were recruited as reviewers; three doctorally prepared and well versed in QSEN, one masters prepared with expertise in simulation, and two masters prepared adjunct faculty members that had no knowledge of QSEN but were aware of the concepts because they held full time practice positions in acute care centers. The six experts were ask to rate and provide comments to refine the items. Two rounds of reviews yielded a 42 item instrument where each item had a content validity index of .83 or higher indicating the item was content valid and appropriate for the final version of the clinical evaluation. The scale content validity index was computed using two methods; scale content validity index/universal agreement was 1.0; scale content validity index/average was .979. The high level of agreement among the 6 expert reviewers supports that the content is relevant and appropriate for inclusion in a QSEN-based clinical evaluation instrument designed to define and evaluate prelicensure student clinical performance.

Using the QSEN competencies as a framework to measure clinical performance evaluation provides a clear structure for objective analysis of student competency in the clinical setting and works to organize the expectations for clinical practice into coherent categories so that students can more accurately identify areas of strength and weakness. Despite the varying knowledge level of the QSEN competencies by the expert nurse educator reviewers, the high level of agreement for the relevance of the items suggest that the QSEN competencies provide a relevant framework for clinical practice evaluation and that the items included in the QSEN Based Clinical Evaluation Instrument provide valid measures for both contemporary nursing education and practice. Future work will include adapting and leveling this clinical evaluation for other clinical nursing courses and establishing content validation for those instruments as well.