Assessment of competence in clinical practice — a review of the literature

Abstract

Continuous practical assessments for those programmes leading to registration began to be introduced in the UK in the late 1970s and were generally hailed, certainly by educationalists, as being a much more valid, reliable and realistic method of assessment (Quinn 1989). However, now, with the increasing pressures on the role of the ward manager, the introduction of supernumerary status for learner nurses and shorter clinical placements, it could be argued that continuous practical assessment is in great danger of becoming no assessment at all. The extent to which experienced nurses are able to supervise and give the continued feedback on learners' progress that was considered such a significant improvement on the previous systems of assessments is questioned. On examination of the literature, consideration will be given to how experienced nurses measure and help others measure performance. The tools practitioners use to assist them in forming their judgements need to be examined. Are practitioners concerned with students' successful completion of tasks or do they rely on intuitive judgements in the complexity of the ‘real life’ situation? If intuitive judgements are involved, do they have any foundations, or are they concerned with mere random form completion and personality measures? In particular examination will be made of the various measurement tools available and different approaches to the assessment of competency in the ‘real world’ of nursing practice. Since the United Kingdom Central Council (UKCC) formally introduced the Nurses' Rules (Nurses, Midwives and Health Visitors Act 1979) in 1983, all courses throughout the UK, leading to registration had to begin to formally prepare students to work towards the achievement of the identified competencies. A ‘competent practitioner’ began to become the focus of assessment in nurse education (Quinn 1989). This begs the question of what is meant by the term competence and how it can be assessed, especially at different levels of development.