The development of a framework for assessing clinical competence of nursing students in Ghana: a multimethod study

Abstract

Introduction: Assessment is defined as the process of gathering and evaluating the information on what students know, understand, and can do in order to make an informed decision about the next steps in the educational process. The current clinical competence assessment system in Ghana, although nationalised and centralised, was no longer standardised due to ad hoc changes that have been made over the last decade. As a result, students complained that they were not uniformly evaluated, resulting in an unfair and unreliable system. Competent students may fail while not so competent students may pass due to the discrepancies in the assessment system. The development of an evidence-based framework to guide the assessment of clinical competence in Ghana is expected to assist in standardising and improving clinical competence quality. The study intends to identify how nursing students' clinical competence in Ghana can best be assessed to standardise the assessment system to improve the quality of the clinical competency assessment system that will lead to improved patient safety and quality of care in Ghana. Aim: The study aimed to develop a framework to assess nursing students' clinical competence in Ghana with the intention to standardise and improve the quality of clinical assessments. Methodology: a multimethod study in four phases; a scoping review, situational analysis, framework development, and expert review were used in the study. The study was conducted in Nursing Education Institutions in Ghana. Findings: 1150 articles were obtained in five search engines, and 28 published articles were accepted for the scoping review, with themes such as clinical competencies assessed, other areas assessed, quality of assessment system, strengths and weaknesses of assessment, testing assessment systems, examiner-related factor, supporting students during an assessment, scoring performance and quality improvement of an assessment system. A situational analysis in three sections; firstly, a qualitative document analysis of four documents on clinical competence assessment were analysed. The analysis showed that most v of the information covered clinical competency teaching but rarely on how the assessment was designed and administered. Themes that emerged from the key informant interviews were structure, process, outcome and recommendations. Themes from the focus group discussion of nursing students were the examination system, clinical competency assessment process, competency assessment outcome, and proposals for quality improvement. Results from phases one and two were used to develop the draft framework and guided by The World Bank framework for building an effective assessment system. The draft framework was made up of five constructs: policies guiding the clinical competency examination, proposed content of the examination, system alignment of a competency examination, expectations and standards of nursing students and quality improvement of a clinical competency examination. At the fourth phase, the draft framework was evaluated for clinical utility. Nursing experts evaluated the draft framework as relevant, context-specified, and feasible in assessing nursing students' clinical competence in Ghana. Conclusions: A framework for assessing nursing students' clinical competence in Ghana is expected to create a uniform assessment system for all students and improve the quality of the assessment system, leading to well-trained nurses who will provide quality service to patients in Ghana beyond.