Issues of validity and reliability in clinical competence assessment in critical care post graduate education: The students perspective

AIMS: This paper reports an evaluation of the student experience of using a clinical competence assessment tool (CCAT) in postgraduate critical care nursing education. The focus is on the perceptions of students in relation to the validity, reliability and usability of the assessment tool. The domains of competence assessed are based on five domains outlined by An Bord Altranais (2000). They are: professional/ethical practice, interpersonal relationships, practical and technical skills, utilising a holistic approach to care, clinical decision making and critical thinking skills and organisation and management of care. The assessment process encompasses three clinical assessments and clinical competence is measured using the developmental process of novice, advanced beginner, and competent as described by Benner (1984). Students are asked to reflect on their own learning needs prior to each assessment. The assessment includes a discussion on the knowledge that underpins practice thereby showing the integration of theoretical and practical knowledge. METHODS: A Clinical Competence Assessment Tool Evaluation Questionnaire was administered to all students who recently completed a Graduate Diploma in Nursing Studies (Critical Care) at a specific third level institution. RESULTS: The evaluation of the CCAT as a mode of competence assessment in postgraduate critical care nursing education was generally positive from the students' perspective. Some students considered the holistic nature of the CCAT document to be a limitation, suggesting that their level of competency could have been better addressed with a tool that was more oriented toward critical care rather than being so 'broad' in nature. Overall respondents considered that the CCAT helped them to identify learning needs and found the use of the tool to be a positive experience and easy to use although some respondents considered that the wording of some of the sub-domains and indicators was difficult to interpret. CONCLUSION: Competence assessment is about ensuring the delivery of safe and competent patient care. In order to determine competence a valid and reliable tool is needed. This small scale study presents the views of post registration critical care nursing students on using a competence assessment tool. The findings of this study cannot be generalised, however they do provide insight for educators and students using competence assessment tools in programmes preparing registered nurses for specialist nursing practice. The use of a holistic assessment process needs further explanation. Students need to be encouraged to move away from the reductionist approach, which is focussed on tasks and move towards a broader understanding of competent practice.