Development and validation of the nursing clinical assessment tool (NCAT): a psychometric research study

Iman Al Hashmi; Loai Mohammad Abu Sharour; Judie Arulappan; Lourance Al Hadid; Karabi Nandy

doi:10.1515/ijnes-2020-0091

Article

Development and validation of the nursing clinical assessment tool (NCAT): a psychometric research study

Iman Al Hashmi , Loai Mohammad Abu Sharour , Judie Arulappan , Lourance Al Hadid and Karabi Nandy

Published/Copyright: June 3, 2021

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From the journal International Journal of Nursing Education Scholarship Volume 18 Issue 1

Abstract

Objectives

The aim of this pilot psychometric study was to develop and assess the reliability, validity, and applicability of a nursing clinical assessment tool (NCAT) to assess students’ clinical performance in the clinical training.

Methods

Total of 325 forms were completed by 36 clinical raters for undergraduate nursing students who were selected using convenience sampling. International quality and safety education for nurses (QSEN) and Benson and Clark’s model guided the construction of the NCAT. Following literature review, a cross-cultural adaptation and psychometric testing were used.

Results

This newly developed tool showed substantial overall internal consistency reliability (Cronbach’s alpha = 0.74). Three factors (i.e. Care Provider, Leadership & Team Work and Professionalism and Ethical Considerations) were identified for construct validity using exploratory factor analysis (EFA).

Conclusions

This study suggests that the NCAT is a reliable, valid and applicable tool. It can be used in clinical and educational settings. Further testing of the tool in similar and different cultures is recommended.

Keywords: clinical competence; educational measurement; nursing; student

Corresponding author: Iman Al Hashmi, PhD, Assistant Professor, College of Nursing, Sultan Qaboos University, Al kodh 66, 123 Muscat, Oman, E-mail: eiman@squ.edu.om

Funding source: Dean’s Fund, College of Nursing, Sultan Qaboos University

Acknowledgments

The author is very thankful to all the associated personnel in any reference that contributed in/for the purpose of this research including Dr. Omar Al Rawajfah, Dean of College of Nursing at Sultan Qaboos University, and Mr. Sathish kumar Jayapal, statistician, Ministry of Health, Sultanate of Oman.

Research funding: The research was funded by Dean’s fund, College of Nursing, Sultan Qaboos University.
Author contributions: Dr. Iman Al Hashmi conceived, and planned the study intervention. Dr. Iman wrote the study abstract, methods, contributed to the introduction section, and edited the whole manuscript. Dr. Loai Abu Sharour wrote the discussion and conclusion section. Dr. Judie contributed to the conception of the idea, data collection and wrote the introduction part. Dr. Karabi Nandy wrote the results section, contributed to data analysis and interpretation of data. Dr. Lourance Al Hadid reviewed the whole manuscript and provided editorial support. All authors revised the manuscript and provided critical feedback. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: No author of this paper has a conflict of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included in this manuscript.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The local Institutional Review Board ethically approved the study.

Appendix

Nursing clinical assessment tool

Rating scale	Descriptor	Characteristics
3	Excellent performance	The student demonstrates: High level of ethical and professional nursing attitude Ability to answer all questions with current, EBP knowledge Outstanding performance of holistic nursing care High level of effective communication and collaboration at different levels High level of critical thinking
2	Good performance	The student demonstrates: Medium level of ethical and professional nursing attitude Ability to answer the majority of the questions with current, EBP knowledge Good performance of main aspects of nursing care Medium level of effective communication and collaboration at different levels Medium level of critical thinking
1	Fair performance	The student demonstrates: Low level of ethical and professional nursing attitude Ability to answer some questions with current, EBP knowledge Acceptable performance of some aspects of nursing care Low level of effective communication and collaboration at different levels Low level of critical thinking
0	Poor performance	The student demonstrates: Very low ethical and professional nursing attitude Ability to answer none of the questions Very low level of performance of nursing care Very low level of effective communication and collaboration at different levels Very low level of critical thinking

Scoring instructions

Nursing clinical assessment tool compose of three subscales that are the Care Provider (8 items), Leadership & Team Work (5 items) and Professionalism and Ethical Considerations (2 item).
Each item in the subscales may not be applicable for all nursing skills.
First, in scoring, the items are evaluated individually in a 0–3 scale, with 0=poor performance, 1=fair performance, 2=good performance and 3=excellent performance. The highest total score is 45 and the lowest total score is zero.
Second, the total score for each subscale is the calculated sum scores of the relevant items.
For item number sixteen, the scoring is based on the safety measures performed by the student. If the student missed performing any of the applicable and relevant items, then the student will be scored as unsafe and s/he will fail the whole exam.

Competency-based scoring

Competency	Relevant items	Score
SLO1: Ethical and Professional nursing	2, 14, 15	9
SLO2: Safe and Quality nursing care	16	Pass or fail
SLO3: Evidence-based, holistic and Culturally Sensitive care	1, 3, 5, 8	12
SLO4: Leadership, Management and Advancement of care	9, 11, 12	9
SLO5: Effective communication skills	1, 6, 7, 13	12
SLO6: Critical thinking	4	3
SLO7: Collaboration and teamwork	10	3

Item no.	Criterion	Score
Item no.	Criterion	0	1	2	3	NA
Care provider
	Shows caring attitude (gentle, mindful, shows empathy)
	Consents to perform procedure
	Assesses patient for the procedure
	Ensures appropriate diagnostics for the procedure
	Explains pre an post procedure information for client
	Demonstrates clear and simple communication (no medical jargon)
	Shows active listening (e.g. responding, feedback)
	Performs post-assessment/post-care for the performed procedure
Leadership and team work
	Utilizes hospital resources efficiently
	Asks for assistance to perform the procedure if needed
	Performs skill in accordance to hospital; policy/protocol
	Completes procedure in a timely manner
	Documents procedure and related findings appropriately
Professionalism and ethical considerations
	Removes patient clothes with consent
	Covers unnecessary exposed body parts during procedure
Performs safe nursing Practice*		Pass		Fail
	Verifies order. Identifies patient correctly. Adheres to infection prevention guidelines. Performs critical elements of the nursing skill correctly. Maintains safe environment (e.g., Bed level down/Side rails up, sharp objects, etc.).

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Received: 2020-08-24

Accepted: 2021-04-29

Published Online: 2021-06-03

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Articles in the same Issue

https://doi.org/10.1515/ijnes-2020-0091

Keywords for this article

clinical competence; educational measurement; nursing; student