A review of clinical competence assessment in nursing

Summary

Aims

To investigate trends in the evaluation of clinical competence in nursing students and newly qualified nurses over the last 10 years.

Design

A literature review following PRISMA guidelines.

Methods

The following databases were searched: Cochrane, Medline and CINAHL using the terms competenc*, nurs*and assess*, evaluat*, measure*, from January 2001–March 2010. Strict inclusion and exclusion criteria were applied.

Results

Twenty three papers were included and these mainly considered the following topics: instrument development and testing; approaches to testing competence; assessment and related factors. A holistic concept of competence is gaining popularity, and consensus around definitions is emerging. Some methods and instruments to measure competence are under systematic development and testing for reliability and validity with large samples and rigorous statistical method. Wider national and international cooperation is evident in competence-based assessment.

Conclusions

Competence-based education is evident, but this does not mean that issues related to competence definition have been resolved. Larger and more international cooperation is required to reach common agreement and validity in competence-based education and assessment.

Introduction

Watson et al. (2002) published a systematic review of clinical competence assessment in nursing from 1980 to 2000 and argued that the definition of competence was obscure, the measurement of competence was unsystematic and the reliability and validity of measurement tools or strategies was seldom reported. They found that a significant amount of literatures came from outside nursing. The present paper seeks to examine the situation 10 years on.

Nearly 10 years later, after Watson et al.'s (2002) review, the definition of competence lacks consensus, remains obscure and contradictory (Cowan et al., 2007, Axley, 2008, Scott Tilley, 2008, Cassidy, 2009, Valloze, 2009) especially, the differentiation between competence and competency (Cowan et al., 2007). However, there is some evidence of progress.

Scott Tilley, 2008, Axley, 2008, Valloze, 2009 used the process of Walker and Avant, 1995, Walker and Avant, 2004 to study the concept of competence and demonstrated different model cases, borderline cases and contrary cases to help clarify the meaning of competence. A holistic competence was accepted by other researchers and statutory bodies (Percival, 2004, Meretoja et al., 2004, Australian Nursing and Midwifery Council (ANMC), 2005, Black et al., 2008). In the UK, Cowan et al. (2007) advocated applying a holistic conception of competence including knowledge, skills, performance, attitudes and values and claimed that the use of a holistic concept could enable people to accept this concept and to develop more precise competence standards and assessment instruments.

Besides academic debate, the regulatory bodies have also tried to unify the definition of the concept and the framework of nursing clinical competence to reach national or international consensus. In the UK, the Nursing & Midwifery Council (NMC) used the term competence referring to “the overarching set of knowledge, skills and attitudes required to practice safely and effectively without direct supervision” (NMC, 2010, p. 145), In Australia, in the National Competency Standards for the Registered Nurse (2005, p. 8), competence was defined as “a combination of skills, knowledge, attitudes, values and abilities that underpin effective and/or superior performance in a professional/occupational area”. In Canada, competence was defined as “the ability of the registered nurse to integrate and apply the knowledge, skills, judgments and personal attributes required to practice safely and ethically in a designated role and setting” by 10 nursing regulatory bodies cooperatively (Black et al., 2008, p. 173).

Although the concept of clinical competence in nursing is not universally defined, as before 2000, progress towards consensus and clarity of the concept is emerging. However, the above literature is based on collaboration and consensus seeking in the design of systems for the assessment of competence and tends not to be concerned with providing evidence.