Despite a 40-year history of researching and developing an instrument for measurement of clinical competence in nursing, there are none that are universally accepted for this purpose. This article presents a critical review of the research, which has been carried out to explore the measurement of nurses' clinical performance. To search the literature in a systematic manner, the criteria stipulated by the Cochrane Research Database were applied. The review showed that assessment tools have been developed using a variety of different methods and several instruments were found to have been developed but nothing that is universally accepted. However, the authors found that the pathway for instrument generation suggested by Smith and Kendall (1963) offers a robust approach to the generation of such a tool regardless of the practice setting. Other methods identified in this literature review also offer interested researchers an opportunity to explore the current role of the nurse, as well as the possibility of developing tools for assessing the performance of students at various stages in their education and nurses at various times after qualification.
"Commentary and research on competency frameworks in nursing has, quite predictably, increased exponentially in recent years. Within this broad body of work, numbers of authors have pointed to a looseness of definition of competence and competency (Cowan et al 2005; Robb et al 2002: Reeves et al 2009; Watson et al 2002). Indeed, while the intent of nursing professional bodies generally has been to institute generic competencies derived from national standards, the translation of competencies in practice has resulted in a myriad of definitions and descriptors (Chiarella et al 2008). "
[Show abstract][Hide abstract] ABSTRACT: WINDSOR C, DOUGLAS C and HARVEY T. Nursing Inquiry 2012; 19: 213–222 Nursing and competencies — a natural fit: the politics of skill/competency formation in nursing
The last two decades have seen a significant restructuring of work across Australia and other industrialised economies, a critical part of which has been the appearance of competency based education and assessment. The competency movement is about creating a more flexible and mobile labour force to increase productivity and it does so by redefining work as a set of transferable or ‘soft’ generic skills that is transportable and is the possession of the individual. This article sought to develop an analysis of competency based clinical assessment of nursing students across a bachelor of nursing degree course. This involved an examination of a total of 406 clinical assessment tools that covered the years 1992–2009 and the three years of a bachelor degree. Data analysis generated three analytical findings: the existence of a hierarchy of competencies that prioritises soft skills over intellectual and technical skills; the appearance of skills as personal qualities or individual attributes; and the absence of context in assessment. The article argues that the convergence in nursing of soft skills and the professionalisation project reform has seen the former give legitimacy to the enduring invisibility and devaluation of nursing work.
[Show abstract][Hide abstract] ABSTRACT: Nurses play a crucial role in patient-care. Therefore, assessing nurses' clinical competence is essential to achieve qualified and safe care. The aim of this study was to determine and compare the competence assessments made by head nurses and practicing nurses in a university hospital in Iran in 2009.
A cross-sectional survey was conducted to make comparisons of both self-assessment of nurse competence as well as assessment made by their respective head nurses working in a university hospital setting in Iran. The instrument employed for data collection was Nurse Competence Scale (NCS), whose reliability and validity have been previously confirmed. The clinical competence of the nurses in 73 skills under 7 categories was determined based on a Visual Analogue Scale (VAS) (0 to 100). They were also asked to indicate the extent to which their competence was actually used in clinical practice on a four-point scale of Likert. The data was analyzed through descriptive and inferential statistics.
Comparison of self-assessment (87.03 ± 10.03) and the assessment done by head nurses (80.15 ± 15.54) showed a significant difference but no precise differences were found between the assessment methods for the frequency of using these competencies.
The results of this study indicated no consensus between the nurses owns assessment and their head nurse assessment. Therefore, it is necessary to use a combination of nurses' competence assessment methods in order to reach a more valid and precise conclusion.
Iranian journal of nursing and midwifery research 03/2011; 16(3):227-34.
"There is little empirical nursing research into factors that influence the reliability and validity of assessment tools (Watson et al., 2002). Problems of objectivity, validity and reliability are experienced during the assessment of clinical competence in the nursing profession (Robb et al., 2002). Even when an agreement has been reach defining competence, and the performance required to demonstrate it, the assessment requires some form of measurement. "
[Show abstract][Hide abstract] ABSTRACT: This research evolved out of the need to examine the validity and inter-rater reliability of a set of performance-based scoring rubrics designed to measure competencies within the operating suite.
Both holistic and analytical rubrics were developed aligned to the ACORN Standard [Australian College of Operating Room Nurses Standard NR4, 2004. ACORN Competency Standards for Perioperative Nurses: Standard NR4: The Instrument Nurse in the Perioperative Environment. Australian College of Operating Room Nurses Ltd, Adelaide] and underpinned by the Dreyfus model (1981). Three video clips that captured varying performance of nurses performing as instrument nurses in the operating suite were recorded and used as prompts by expert raters, who judged the performance using the rubrics.
The study found that the holistic rubrics led to more consistent judgments than the analytical rubrics, yet the latter provided more diagnostic information for intervention purposes. Despite less consistency, the Analytical Observation Form had sufficient construct validity to satisfy the requirements of criterion referencing as determined by the Item Separation Index (Rasch, 1960), including high internal consistency and greater inter-rater reliability when average ratings were used.
The study was an empirical investigation of the use of concomitant Analytical and Holistic Rubrics to determine various levels of performance in the operating suite including inter-rater reliability. The methodology chosen was theoretically sound and sufficiently flexible to be used to develop other competencies within the operating suite.
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