Graduation Date

Spring 5-10-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Dr. Katie Bravo

Second Advisor

Dr. Lynnette Leeseberg Stamler

Abstract

Clinical evaluation tools play a crucial role in assessing nursing students' competencies, ensuring they develop the necessary knowledge, skills, and attitudes required for safe patient care. Current clinical evaluation tools (CETs) are seen as subjective, with ambiguous evaluation language, leading faculty to rely on personal factors for their evaluation standards and causing students to feel a sense of bias in the evaluation process. The overall purpose of this dissertation was to gain a deeper understanding of competency-based CETs and how a student is assessed as having achieved clinical competency. This was initially accomplished by conducting an integrative review to assess currently used CETs, focusing on the inclusion of psychometric analysis. Next, a comparison and contrast of the concepts of competency and competence was completed using a concept analysis approach, examining the concepts’ interconnectedness. Finally, an inductive, thematic mixed methods study was conducted to determine the psychometric analysis of an adapted CET, along with faculty interviews to foster a deeper understanding of decision-making associated with student clinical competency achievement. The major findings from the integrative review indicated inconsistencies in all aspects of clinical evaluation, such as what is competency vs. competence, which competencies to evaluate, who should complete the CET, how often a student should be evaluated, and which psychometric properties should be assessed. The comparison of the concepts of competency and competence provided clear delineations of these concepts, highlighting their deeply intertwined nature. Major findings from this iv dissertation's psychometric analysis revealed positive inter-rater reliability; however, the statistics were limited due to the researcher's decision to maintain the original format of the CET. From the interviews with faculty, four themes impacting their decision-making were identified: 1) utilization of guidelines, 2) personal experiences and expectations, 3) prevention of biases, and 4) uncertainty. This dissertation has implications for future research and educational practice. Understanding the factors faculty use to determine student clinical competency plays a key role in the development and adaptation of CETs. Further research is needed to develop and implement the adapted CET and to understand the phenomenon of decision-making associated with student clinical competency achievement.

Comments

2025 Copyright, the authors

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