Nursing students’ development, transfer and assessment of professional competence and clinical judgment skills: A quantitative study

Abstract

Background: Nurses with professional competence and clinical judgment skills are important to achieve person-centred healthcare and patient safety in healthcare services. Professional competence and clinical judgment skills are therefore desirable learning outcomes in nursing education. Simulation-based education and clinical placement are used as pedagogical approaches in the simulation setting and clinical setting to accomplish this. Debriefing is an important component of simulation-based education. Research on the effectiveness of debriefing methods is limited although it is recognized as important for students’ learning. Nursing students’ development of professional competence and clinical judgment skills in a longitudinal perspective across learning arenas is of interest to understand the learning progression. Research addressing this is limited. Nursing students’ find it challenging to transfer learning from the simulation setting to the more complex and unpredictable situations in the clinical setting. There is lack of research investigating nursing students’ transfer of professional competence and clinical judgment skills from the simulation setting to the clinical setting. Assessment of nursing students’ professional competence and clinical judgment skills can be used in the simulation and clinical settings to promote learning, evaluate learning outcomes, or conduct research. More research is needed investigating students’ self-assessment of clinical judgment skills in different learning arenas. Aim: The overall aim of this PhD project was: 1) to develop knowledge concerning nursing students’ development and assessment of professional competence and clinical judgment skills in the simulation setting and the clinical setting, and 2) to develop knowledge concerning nursing students’ transfer of professional competence and clinical judgment skills from the simulation setting to the clinical setting. Methods: The aims were addressed through a quasi-experimental study (Paper I), a longitudinal study (Paper II), and a comparative study (Paper III). The quasi-experimental study was conducted to investigate the effect of the PEARLS debriefing on nursing students’ professional competence and clinical judgment skills when compared to a standard debriefing. Data was obtained from two groups of nursing students (N=106) through self-reporting questionnaires consisting of the instruments NPC Scale-SF and LCJR-N. Data was collected at three timepoints: pre-test, post-test 1 and post-test 2. Linear regression and paired samples t-tests were used to investigate the effect of PEARLS between and within groups. The longitudinal study was conducted to investigate the change in nursing students’ professional competence across the simulation and clinical settings. Nursing students’ transfer of professional competence from the simulation setting to the clinical setting and their level of professional competence were also investigated. Data for the longitudinal study was collected from nursing students (N=38) at four points through self-reporting questionnaires including the instrument NPC Scale-SF. A paired samples t-test was used to investigate the change in and transfer of professional competence. Descriptive statistics were used to investigate nursing students’ level of professional competence. The comparative study (Paper III) was conducted to compare nursing students’ self-assessment of clinical judgment skills to an experienced evaluator’s assessment of the same students in the simulation and clinical settings. The presence of the Dunning-Kruger effect was also investigated. Data were obtained from nursing students (N=23) and one evaluator at two timepoints using the instrument LCJR-N. Scores were compared using a t-test, the intraclass correlation coefficient, Pearson’s correlation coefficient, and Bland-Altman plots. Linear regression and a scatter plot were used to investigate the presence of the Dunning-Kruger effect. Main results: No significant differences in the development of nursing students’ selfreported professional competence or clinical judgment skills were found between the students who received PEARLS debriefing and those who received the standard debriefing in the quasi-experimental study (Paper I). Professional competence and clinical judgment skills increased significantly for students who received PEARLS debriefing but not among those who received the standard debriefing. Students’ selfreported professional competence and clinical judgment skills developed in non-linear patterns in that it increased in the simulation setting but decreased when they entered the clinical setting (Paper I and II). Students’ self-reported professional competence increased significantly from before simulation-based education to the end of clinical placement in the longitudinal study (Paper II). Regarding the transfer process, findings from the quasi-experimental study (Paper I) and the longitudinal study (Paper II) showed that professional competence declined significantly in several areas when students entered clinical placement after simulation-based education. Value-based nursing care received the highest score while Development, leadership, and organization of nursing care was scored lowest at all timepoints in both the quasi-experimental study (Paper I) and the longitudinal study (Paper II). Findings in the comparative study (Paper III) showed an inconsistency between student self-assessment and evaluator assessment in both the simulation setting and the clinical setting. Students overestimated their clinical judgment skills compared to the evaluator’s assessment. Differences between students’ scores and the evaluator’s scores were larger when the evaluator’s scores were low, indicating the presence of the Dunning-Kruger effect. Conclusion: There is support for implementation of the PEARLS debriefing in simulationbased education to promote the development of professional competence and clinical judgment skills among nursing students. It is necessary for faculty to receive the training and resources necessary when implementing PEARLS. Results indicate that nursing students’ self-reported professional competence increased in a longitudinal perspective, although the development of competence related to Development, leadership, and organization of nursing care should be strengthened in nursing education. How to best support nursing students in transferring professional competence and clinical judgment skills to the clinical setting should be addressed in nursing education. Moreover, it is vital to acknowledge that student self-assessment of clinical judgment skills alone may not be a reliable predictor of a student’s clinical judgment skills in education or research. Additionally, students with a lower level of clinical judgment skills in this PhD project were less likely to be aware of it. For future practice and research, a combination of student self-assessment and evaluator assessment is recommended to provide a more realistic view of students’ clinical judgment skills.