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World Medicine 2018: Preliminary investigation of continuous self-improvement and nursing student clinical performance - Dale M Hilty - Mount Carmel College of Nursing, USA

Dale M Hilty

Nurse educators need objective and relevant tools for measuring students’ clinical performance. The challenge is to combine sound historical initiatives with contemporary advances and develop assessment strategies that prepare students who are fit for award, fit for practice, and fit for purpose. Some reasons for assessing students’ clinical performance are:

• Protection of the public

• Predict future behaviour

• Measure achievement

• Assess competence

• Monitor students’ progress

• Motivate students

Robust instruments are required for assessing the practice component of course modules and ensuring that these needs are met. Hepworth (1989) noted that nursing skills can readily be demonstrated through the act of delivering nursing care, and that ‘observing the student in the clinical setting clearly has high ecological validity. Problems have been identified with the assessment of practice and with its documentation.

To ensure reliability and validity, assessment documentation should be open to independent re-examination, but the evidence base from which documentation has been developed is often inadequate (Phillips et al 1993). Derbyshire et al (1990) argued that: 'Clinical assessment can be irrelevant to and estranged from practice.’ Ross et al (1988) stated that one of the problems of measuring clinical competence was the limited number of clinical performance measures available`

Alongside the current worldwide change in wellbeing callings' instruction, understudy appraisal additionally should be changed with more accentuation on learning results and expertise preparing. Learning in clinical settings is less organized than preclinical learning, so there are specific difficulties to defeat in building up a compelling evaluation program for clinical settings. As a result of the unpredictability of the instructive destinations and the majority of the errands and abilities that clinical and nursing understudies must learn and perform during their clinical training, organizations have the obligation to give a far reaching and legitimate evaluation framework to exhibit satisfactory procurement of those targets

Assessing clinical performance of nursing students continues to be challenging. In nursing education, there are multiple complex clinical skills and tasks that nursing students encounter and have to be competent in them. As a result, it is difficult to assess students' ability to carry out all aspects of such tasks.

Clinical assessment of nursing students has traditionally been based on unstructured and empiric observation of students' performance by a clinical preceptor and has been permanently in doubt because it is subjective, thus running the risk of unfairness and observer bias In a study in Scotland, all nursing students believed that their clinical assessment was open to bias and that how they were assessed depended on the assessor's personality. Poor agreement between assessors and insufficient attention to psychomotor skills were some complaints of students regarding their assessment process The findings of some other studies have shown that most nursing students are dissatisfied with clinical performance assessment tools and methods with little confidence in their results

In the academic environment, Wooden’s competitive greatness can be linked to Continuous Self-Improvement (CSI). By focusing on individual growth and development, there are endless opportunities to expand our skills and abilities. Meyer’s 10-80-10 principle estimates that 10 percent are in relentless pursuit of improvement or CSI.

We have an example of a CSI nursing student functioning at an exceptional level of engagement, deeper learning processing of material from textbook readings and lecture presentations. Using an intrinsic reward system, they internalize content and concepts and continuously apply them in new, unique ways. These students appear to feel the satisfaction and receive the validation they are going to be excellent nurses. Not only do they understand the scientific and theoretical aspects of nursing, but they also demonstrate the art and caring nature of an excellent and compassionate nurse. Viewing performance on a continuum (4=Exceptional, 3=Exceeds Expectations, 2=Meets Expectations, 1=Improvement Needed/Unsatisfactory). A majority of nursing students (i.e., non-CSI) appear grouped in Meyer's 80 percent category who meets the requirements of their nursing program requirements.

They obtain their BSN degree, state licensure and are successfully employed RNs. The CSI students appear to regularly offer higher levels of patient care, demonstrate higher level of performance on their clinical paperwork (e.g., care plan, concept map, lab analysis, medical information). They more frequently demonstrate a big picture understanding by being able to reliably answer five questions: (1) What did I learn about the patient? (2) What concepts can I apply from my course’s theoretical component? (3) What connections can I find between a variety of variables? (4) What directed my care? (5) How and why did I perform the tasks? The nursing students were evaluated on a weekly basis regarding their clinical performance in providing patient care. Evaluations were based on seven operational behaviors.

Since the clinical careful course is a 16-week course, it had the option to gather week after week time periods the CSI (Meyer's 10% gauge) and non-CSI (Meyer's 80% gauge) understudies invested their energy in clinical setting destinations and practices. The assessment utilized three models: On irregular direct perception, the clinical assessment instrument and the electronic wellbeing record. Understudy execution on the seven practices gave a week after week conduct estimation. Utilizing SPSS 25 (autonomous t-test), a huge distinction was found between the CSI and the non-CSI understudies (p=0.001). Instances of one operational execution conduct: Non-CSI: Regarding the Electronic Health Record (EHR), understudy utilizes the rubric to decide the kind of clinical administrative work to finish just as to manage their training. CSI: Regarding the Electronic Health Record (EHR), understudy finishes clinical administrative work, talks with interdisciplinary medicinal services experts and their companions to convey quiet consideration.