Clinical Evaluation Instrument Research Articles

Assessing the reliability of a novel cancer-specific multi-attribute utility instrument (FACT-8D) and comparing its validity to EQ-5D-5L in colorectal cancer patients.

To examine the test-retest reliability of the Functional Assessment of Cancer Therapy - 8 Dimension (FACT-8D) for the first time, and to conduct a head-to-head comparison of the distribution properties and validity between the FACT-8D and EQ-5D-5L in Colorectal Cancer (CRC) Patients. We conducted a longitudinal study on Chinese CRC patients, employing Functional Assessment of Cancer Therapy-General (FACT-G) and EQ-5D-5L at baseline, and FACT-G during follow-up (2-7 days from baseline). Utility scores for FACT-8D were derived from all available value sets (Australia, Canada and USA), while EQ-5D-5L scores were obtained from corresponding value sets for various countries. We assessed convergent validity using pairwise polychoric correlations between the FACT-8D and EQ-5D-5L; known-groups validity by discriminating participants' clinical characteristics, and effect size (ES) was tested; test-retest reliability for FACT-8D using kappa and weighted Kappa for choice consistency, and intraclass correlation coefficient (ICC) and Bland-Altman method for utility consistency. Among the 287 patients with CRC at baseline, 131 were included in the retest analysis. The utility scores of FACT-8D were highly positively correlated with EQ-5D-5L across various country value sets (r = 0.65-0.77), and most of the dimensions of FACT-8D and EQ-5D-5L were positively correlated. EQ-5D-5L failed to discriminate known-groups in cancer stage across all value sets, whereas both were significant in FACT-8D (ES = 0.35-0.48, ES = 0.38-0.52). FACT-8D showed good test-retest reliability (Cohen's weighted Kappa = 0.494-0.722, ICC = 0.748-0.786). The FACT-8D can be used as a valid and reliable instrument for clinical evaluation of patients with CRC, outperforming EQ-5D-5L in differentiating clinical subgroups and showing promise for cancer practice and research.

Assessing Smartphone Addiction among Mexican Students: Insights, Implications, and Interventions in the Era of Mobile Learning and Virtual Environments

This study conducted a new adaptation of the short version of the Smartphone Addiction Scale (SAS-SV) for the Mexican population. The scale exhibited excellent internal consistency (α = .88), with one factor explaining 54.8% of the variance. 286 students aged 15 to 35 years of age from central and southeast Mexico revealed a prevalence of 30% excessive users (18% men, 12% women). They used smartphones primarily for communication, social media, entertainment, productivity, and browsing the Internet. No gender differences were found; however, a significant association with age emerged (rho = .221, p < .001). Withdrawal (72.7% women) and tolerance (80.8% men) were common symptoms of addiction, while ignorance of consequences was less frequent (33.3% women, 30.8% men). The prevalence of potential excessive use of smartphones was close to the average identified in the reviewed studies. The results revealed a substantial risk of addiction to smartphones, particularly among men. Finally, the successful adaptation of the scale offers a valuable instrument for future study and clinical evaluation. These findings can guide targeted interventions and educational programs tailored to different groups. Additionally, recognition of common symptoms of addiction allows individuals to identify and address potential problems at an early stage. However, more study is needed to validate the findings and explore additional contributing factors in the Mexican context.

The effects of the SNAPPS model on clinical learning experiences for Physician Assistant students

The current study was created to pilot an approach to clinical experiential learning for Physician Assistant (PA) students by teaching students the six-step clinical teaching model: (1) Summarize the case, (2) Narrow the differential diagnosis, (3) Analyze the differential diagnosis (what key patient findings support or lack support for each), (4) Probe the preceptor (ask for clarification of topics about which the learner feels unsure), (5) Plan management (with preceptor input) and (6) Select a care-related issue for self-directed learning; abbreviated to SNAPPS. SNAPPS is known to be learner-led and has been shown in research to be effective in increasing insights into clinical reasoning and encouraging timely feedback to medical students. The research question asked what effect SNAPPS training may have on PA student ratings of (1) learning climate, (2) control of session, (3) communication of goals, (4) promotion of understanding and retention, (5) evaluation, (6) feedback and (7) global assessment on a survey instrument following clinical learning experience. In a Solomon-four group design, PA students from an Atlanta-based PA program completed the validated PA Clinical Rotation Evaluation (PACRE) instrument before and/or after a SNAPPS training or case-based education module. An analysis of variance showed the effects of group designation on the domains of Control of Session (F(3, 9) = 9.084, p= .004), Communication (F(3, 9) = 7.527, p=.008) and Evaluation (F(3, 9) = 5.626, p= .019) was statistically significant for differences in PACRE scores. It was noted that the case-based groups scored clinical rotation higher on the instrument than the SNAPPS groups, highlighting the potential effect that SNAPPS groups may have reflected more critically on their learning experience.

The Obsessive-Compulsive Inventory-Revised (OCI-R): Translation and Validation of the European Portuguese Version.

The Obsessive-Compulsive Inventory-Revised has been developed to evaluate the severity of obsessive-compulsive symptoms in both clinical and non-clinical individuals. The aim of this study was to evaluate the psychometric properties of the Portuguese version. This questionnaire was applied to 90 people with obsessive-compulsive disorder and 246 without a known mental illness. In addition to this clinical evaluation instrument, participants completed other clinical assessment scales that helped characterize the two study groups. Given the objective of this study, to evaluate the structure by six factors, a confirmatory factor analysis was performed [patient group: χ2(120, n = 90) = 205.779, p < 0.01; CFI = 0.916; GFI = 0.814; RMSEA = 0.0890. χ2(120, n = 246) = 224.762, p < 0.01; CFI = 0.938; GFI = 0.904; RMSEA = 0.060]. To assess the internal consistency of the scale, Cronbach's alpha was determined (patient group: α = 0.913; control group: α = 0.888). Convergent validity was tested by determining the Spearman correlation between the scores obtained in the Obsessive-Compulsive Inventory-Revised and Y-BOCS in the patient group (r = 0.651; p < 0.01). Obsessive-Compulsive Inventory-Revised has proved to be a consistent, valid, and reliable instrument with good psychometric properties to determine the severity of obsessive-compulsive symptoms in the Portuguese population.

Correlation of the functional scores with the beighton score, radiological measurements, and clinical assessment in patients diagnosed with flexible pes planus

To evaluate the relationship between radiological and clinical evaluation instruments used in children with flexible pes planus (FPP) with quality of life and functional scores. The study group consisted of sixteen children with FPP (mean age: 9.8 1.1 years). The patients were examined in detail using static pedobarography with the Win-Track system. A physical examination was also undertaken using the Foot Posture Index-6 (FPI-6). The four angles were measured on foot radiographs. For functional evaluation, the Pediatric Outcomes Data Collection Instrument (PODCI) score was employed. A single experienced rehabilitation specialist performed Beighton scoring. No correlation was found between the FPI-6 clinical rating scale and Beighton scores, radiographic data, and pedobarographic evaluation. The PODCI and Beighton scores, on the other hand, had a negative connection (P=0.000, r=-0.781). The radiological, clinical, and pedobarographic values were not correlated with the PODCI functional score. In the management of patients with FPP, the commonly used FPI-6, radiographic and pedobarographic measurements were not correlated with the PODCI functional score. However, children with extensive joint laxity are more likely to have functional limitations. Therefore, it is important to evaluate children with FPP in terms of common joint laxity before treatment planning.

Accuracy of risk factors for nursing diagnosis risk of infection in people with AIDS

To evaluate the accuracy of risk factors for infection that add up to the nursing diagnosis risk of infection in people with AIDS who are hospitalized. Accuracy study with case-control design carried out with a total of 208 people living with AIDS and hospitalized between 2010 and 2016. The cases comprised people living with HIV, hospitalized and who developed infection related to health care and controls to those who did not develop it. Secondary data from medical records and research forms were used to respond to the data collection instrument for sociodemographic, clinical evaluation and investigation of the presence or absence of risk factors. The accuracy of clinical diagnostic indicators was measured through specificity, sensitivity and predictive values. The risk factor that showed the greatest sensitivity and specificity was chronic illness, while the invasive procedure and the change in the integrity of the skin had the highest positive predictive value. Accurate diagnoses allow nurses to build a nursing intervention plan aimed at the needs of this population.

Content Validation of the Quality and Safety Framed Clinical Evaluation for Nurse Practitioner Students.

Clinical performance evaluation is a high-stakes assessment that requires a valid and reliable instrument. There appear to be no identified clinical evaluation instruments developed for nurse practitioner (NP) students that have undergone content validation. This study describes the process to develop, validate, and pilot a clinical evaluation instrument for NP students framed in the Quality and Safety Education of Nurses Competencies for advanced practice. Six expert nurse educators were recruited for the purpose of rating items for relevance for inclusion in the Quality and Safety Framed Clinical Evaluation Instrument for NP Students using the content validity index. The instrument was pilot tested in a primary care clinical course. Two rounds of review yielded a 34-item content validated instrument. Evidence suggests that the Quality and Safety Framed Clinical Evaluation for NP Students is a valid and reliable instrument to evaluate the clinical performance of NP students.

Dimensionality and psychometric analysis of DLQI in a Brazilian population

BackgroundThe Dermatology Life Quality Index (DLQI) is the most commonly used instrument for clinical evaluation of the impact on health-related quality of life (HRQOL) in dermatological research protocols. The DLQI’s classical psychometric properties have been considered adequate in validation studies from several countries. However, the structure of the DLQI is a matter of discussion, especially concerning the dimensionality and informative properties of its questions according to the item response theory (IRT).MethodsPooled data from studies in Brazil that utilized the DLQI to assess HRQOL in 14 dermatoses were reanalyzed. Classical psychometrical analysis, dimensionality assessment through parallel analysis and IRT (Samejima’s ordinal model) analysis were performed.ResultsThe sample consisted of 1286 patients with a mean age of 47 years (SD = 16), and the proportion of women was 59% (765). The DLQI scores ranged from 0 to 29, with a median (p25–p75) of 5 (2–11). All items indicated significant correlations with the total DLQI score (rho > 0.54). The Cronbach’s alpha result was 0.90 (CI 95% 0.89–0.91). Parallel analysis indicated a unidimensional factor structure. According to IRT analysis, items q6 (sports) and q7 (work/study) exhibited insufficient fit to the model (p < 0.01), while the items that indicated the best discrimination and information functions were q2 (embarrassment), q3 (shopping/gardening), q4 (clothing) and q5 (social/leisure). The ordination of the scores was confirmed for all items. Most items revealed non-uniform behavior according to sex, age and type of disease.ConclusionsThe DLQI exhibits adequate psychometric reliability and a unidimensional structure for assessing HRQOL in Brazilian dermatological patients. The DLQI’s performance varies in the assessment of HRQOL in heterogeneous samples.

Development and Implementation of a Clinical Dental Faculty Evaluation Instrument.

The aim of this study was to develop and test the reliability of an instrument to evaluate the quality of clinical teaching among dental school faculty. Fourth-year dental students' perspectives on effective clinical teaching were first collected in focus group meetings. An 11-item questionnaire to assess seven domains of clinical teaching was developed based on the collected student perspectives and a medical model. All 374 third- and fourth-year dental students at one U.S. dental school in 2015 were invited to evaluate four clinical instructors whom they felt were strong role models and four clinical instructors whom they felt would benefit from constructive criticism. The survey was completed by 139 students (37.2% response rate); they evaluated 96 dental instructors. The results showed that the survey demonstrated strong internal reliability, with Cronbach's alpha values of >0.95 for each of the seven domains. In addition, there was significant agreement between groups: the interclass correlation (ICC) ranged from 0.97 to 0.99. These results suggest that the clinical faculty evaluation instrument developed in this study is a reliable method that can be used to evaluate dental faculty members. This system can be a valuable guide for clinical faculty members and administrators in assessing and improving clinical teaching effectiveness.

GC-PROM: validation of a patient-reported outcomes measure for Chinese patients with gastric cancer

BackgroundThere is increasing recognition that PROs are important in the estimation of the burden of long-term survival among patients with gastric cancer. The study aimed to develop a disease-specific instrument to assess patient-reported outcomes for Chinese patients with gastric cancer.MethodFollowing the FDA’s draft guidance for patient-reported outcome, conceptual framework and item pool were defined based on relevant existing work. A draft scale was formed after revising some items based on feedback from experts and Chinese patients with gastric cancer. The pre-survey and formal survey were conducted in eight different hospitals in Shanxi Province, and two item-selection process based on classical test theory and item response theory. Finally, the patient-reported outcomes measure for Chinese patients with gastric cancer (GC-PROM) was validated in terms of reliability, validity, and feasibility. The minimal clinically important difference was determined by distribution-based method.ResultsThe final GC-PROM consisted of 38 items, 13 subdomains, and 4 domains. Reliability was verified by Cronbach’s alpha coefficient for four domains and 13 subdomains respectively. The validity results showed that the multidimensional scale fulfilled expectations. In the formal survey, the completion rate was 96.16%, and the average filling time was less than half an hour. The values of the minimal clinically important difference were 4.14, 3.41, 3.37, and 3.28 in the four domains.ConclusionsThe GC-PROM had good reliability, validity, and feasibility and thus can be considered an effective clinical evaluation instrument for Chinese patients with gastric cancer.

Content Validation of Quality and Safety Education for Nurses Prelicensure Clinical Evaluation Instruments.

Clinical evaluation is a high-stakes assessment that requires valid and reliable instruments that are understandable to faculty and students. This article describes the development of Quality and Safety Education for Nurses (QSEN)-based clinical evaluation instruments to measure competency in prelicensure clinical courses. The goal was to establish content validation for the items included on each and appropriately level requisite behaviors to demonstrate increasing progression in clinical performance expectation from fundamentals to senior nursing clinical courses. Based on their area of expertise, nurse educators were recruited into panels of 5 to 7 members each to review and rate items for relevance for each course-specific clinical evaluation instrument using the Content Validity Index. Two rounds of rigorous review yielded 6 content-validated instruments. The QSEN-based clinical evaluation instruments provide standardized language framed in quality and safety that demonstrate evolving sophistication, complexity, and expectation in student clinical performance.

Interrater Reliability and Usability of a Nurse Anesthesia Clinical Evaluation Instrument.

No Student Registered Nurse Anesthetist (SRNA) clinical evaluation instrument (CEI) has undergone interrater reliability or usability testing, to the authors' knowledge. This project determined the interrater reliability and usability of a new SRNA CEI. This was a prospective, mixed qualitative and quantitative, fully crossed observational design with a usability survey. SRNAs' recorded performance during simulation was evaluated by participants, who also completed a usability survey. Interrater reliability is high, intraclass correlation coefficient = .982, 95% CI [.884, .960], indicating strong agreement of SRNA clinical performance among participants (n = 10). Internal consistency is excellent (Cronbach's α = .943), indicating the CEI is constructed appropriately and participants found it easy to use. This CEI may advance the aim of impartiality in the evaluation of SRNA clinical performance through an instrument that is reliable, with good construct, and ease of use. [J Nurs Educ. 2018;57(7):446-449.].

Validation of a clinical rotation evaluation for physician assistant students

BackgroundWe conducted a prospective validation study to develop a physician assistant (PA) clinical rotation evaluation (PACRE) instrument. The specific aims of this study were to 1) develop a tool to evaluate PA clinical rotations, and 2) explore associations between validated rotation evaluation scores and characteristics of the students and rotations.MethodsThe PACRE was administered to rotating PA students at our institution in 2016. Factor analysis, internal consistency reliability, and associations between PACRE scores and student or rotation characteristics were determined.ResultsOf 206 PACRE instruments sent, 124 were returned (60.2% response). Factor analysis supported a unidimensional model with a mean (SD) score of 4.31 (0.57) on a 5-point scale. Internal consistency reliability was excellent (Cronbach α=0.95). PACRE scores were associated with students’ gender (P = .01) and rotation specialty (P = .006) and correlated with students’ perception of being prepared (r = 0.32; P < .001) and value of the rotation (r = 0.57; P < .001).ConclusionsThis is the first validated instrument to evaluate PA rotation experiences. Application of the PACRE questionnaire could inform rotation directors about ways to improve clinical experiences. The findings of this study suggest that PA students must be adequately prepared to have a successful experience on their rotations. PA programs should consider offering transition courses like those offered in many medical schools to prepare their students for clinical experiences. Future research should explore whether additional rotation characteristics and educational outcomes are associated with PACRE scores.

Validation of the Boston Carpal Tunnel Questionnaire in Russia

International scales and questionnaires have become widespread in Russian neurology. Validation is a procedure of top priority necessary before applying this kind of diagnostic instrument in Russian-speaking population. In this article, validation of the Boston Carpal Tunnel Questionnaire (BCTQ) intended for patients with this disease is described. Use of validated Russian version would allow to objectively evaluate severity of clinical manifestations of carpal tunnel syndrome and follow patient dynamics. We present the official BCTQ version recommended for use in Russia, as well as data that showed high sensitivity and reliability of this instrument for clinical evaluation of carpal tunnel syndrome.

Assessment of the Reliability and Validity of a Clinical Evaluation Instrument in Physical Therapy Education

Introduction. Competency-based education is a proven, effective strategy for developing skilled health care practitioners. The purpose of this study was to reassess the validity and reliability of the Emory University Internship Clinical Evaluation (EUICE) instrument by reassessment of the component behaviors of the curricular competencies (provision of patient care, interpersonal communications, the teaching–learning process and administration) developed by the faculty of the Emory University Division of Physical Therapy. Five aims were investigated. The first three assessed content validity by evaluating respondent ratings of the essentialness of the component behaviors to the definition of the related competency, the exhaustiveness of the component behaviors per competency, and the measurability/observability of the component behaviors in the clinical setting. The fourth aim assessed the construct validity of the EUICE by examining whether the component behaviors were reducible to the four competencies in the EUICE. The fifth aim was to determine whether the EUICE has internal consistency. Methods. A nationally representative clinical educator participant pool consisted of Directors of Clinical Education (DCEs)/Academic Coordinators of Clinical Education (ACCEs), along with Center Coordinators of Clinical Education (CCCEs) and clinical instructors (CIs) affiliated with the Emory Doctor of Physical Therapy (DPT) program. A total of 637 respondents (121 DCEs/ACCEs; 186 CCCEs; 330 CIs) completed a survey about the competencies and requisite component behaviors needed to practice as an entry-level physical therapist. The survey contained 50 items representative of the component behaviors in the EUICE. Descriptive statistics, principal component analysis (PCA), and Cronbach's alpha were used to assess content and construct validity and reliability of the component behaviors in the EUICE. Of the 50 survey items, 46 were included in the PCA and reliability analysis. Results. There was agreement among educators on the essentialness, exhaustiveness, and measurability/observability of each component behavior. Principal component analysis yielded four factors corresponding to the four curricular competencies and explaining a total of 38.47% of the variance of the entire set of component behaviors. Each component behavior loaded onto one of the four factors representing the EUICE competencies. The clustering of items revealed by the PCA was consistent with the assignment of component behaviors to the competencies in the EUICE, thereby supporting construct validity. Cronbach's alphas were all above 0.7, suggesting good internal consistencies and that each subscale is reliable. Discussion and Conclusion. In this study, we confirmed content validity, demonstrated construct validity, and established internal consistency of the component behaviors of the competencies in provision of patient care, interpersonal communications, the teaching–learning process and administration. Therefore, results support the use of the EUICE as a valid competency-based instrument by which to evaluate whether a student demonstrates competency in the clinical setting.

The PU-PROM: A patient-reported outcome measure for peptic ulcer disease.

ObjectivePatient‐reported outcome measure (PROM) conceived to enable description of treatment‐related effects, from the patient perspective, bring the potential to improve in clinical research, and to provide patients with accurate information. Therefore, the aim of this study was to develop a patient‐centred peptic ulcer patient‐reported outcome measure (PU‐PROM) and evaluate its reliability, validity, differential item functioning (DIF) and feasibility.MethodTo develop a conceptual framework and item pool for the PU‐PROM, we performed a literature review and consulted other measures created in China and other countries. Beyond that, we interviewed 10 patients with peptic ulcers, and consulted six key experts to ensure that all germane parameters were included. In the first item selection phase, classical test theory and item response theory were used to select and adjust items to shape the preliminary measure completed by 130 patients and 50 controls. In the next phase, the measure was evaluated used the same methods with 492 patients and 124 controls. Finally, we used the same population in the second item reselection to assess the reliability, validity, DIF and feasibility of the final measure.ResultsThe final peptic ulcer PRO measure comprised four domains (physiology, psychology, society and treatment), with 11 subdomains, and 54 items. The Cronbach's α coefficient of each subdomain for the measure was >0.800. Confirmatory factory analysis indicated that the construct validity fulfilled expectations. Model fit indices, such as RMR, RMSEA, NFI, NNFI, CFI and IFI, showed acceptable fit. The measure showed a good response rate.ConclusionsThe peptic ulcer PRO measure had good reliability, validity, DIF and feasibility, and can be used as a clinical research evaluation instrument with patients with peptic ulcers to assess their condition focus on treatment. This measure may also be applied in other health areas, especially in clinical trials of new drugs, and may be helpful in clinical decision making.

Chinese translation and validation of the Oxford Knee Scale for patients with knee osteoarthritis.

Background:Oxford Knee Scale (OKS) is a commonly used instrument to assess the symptoms and functional status in people with knee osteoarthritis. However, a Chinese version of this scale is not yet available.Objective:The objective of this study was to translate the OKS into Chinese and validate the Chinese version of OKS.Methods:The Chinese OKS was translated from the original English version following the recommendations of the International Society for Pharmacoeconomics and Outcomes Research. One hundred Chinese reading patients with knee osteoarthritis were recruited from local hospitals and physiotherapy clinics. Psychometric properties were evaluated in terms of test–retest reliability and internal consistency. Convergent validity was examined by Spearman rank correlation coefficient tests by comparing its score with the validated Chinese version of the Western Ontario and McMaster Universities Osteoarthritis Index and Health Outcome Survey Short Form-36.Results:Chinese OKS demonstrated excellent reliability (intraclass correlation coefficient = 0.88). Cronbach α of individual questions was > 0.7. Strong correlation was found between the Chinese OKS and the Western Ontario and McMaster Universities Osteoarthritis Index (ρ > 0.553, p < 0.001). Fairly strong negative correlation was also found between Chinese OKS and Health Outcome Survey Short Form-36 (ρ = −0.273 to −0.666, p < 0.05).Conclusion:The Chinese translated version of OKS is a reliable and valid instrument for clinical evaluation in Chinese reading patients with knee osteoarthritis.

Using the INACSL Simulation™ Design Standard for Novice Learners

BackgroundThe International Nursing Association for Clinical Simulation and Learning (INACSL) has released Standards of Best Practice™ for simulation. The purpose of this paper is to discuss the use of the INACSL Simulation Design Standard (SDS) to create a novice simulation experience for sophomore nursing students. MethodThis pilot study was conducted with sophomore nursing students over several semesters (n = 143) in a foundational nursing course to prepare students for fundamental respiratory concepts. Expert certified healthcare simulation educators facilitated and debriefed each simulation-based experiences (SBE). The Creighton Clinical Evaluation Instrument (C-CEI©) was used to provide feedback to students. Students also completed a post Simulation Perspective Survey after each experience. ResultsEighty percent of the students believed that the simulations were a valuable learning experience and helped to stimulate critical thinking. The SDS was an effective method providing clear guidelines for designing SBE for novice nursing students. ConclusionsThe SDS provides a clear format for designing SBE for novice nursing students. This article provides a concrete example on the implementation of the SDS framework in SBE, promoting the integration of best practice in simulation.

Competence evaluation processes for nursing students abroad: Findings from an international case study

BackgroundAssessing clinical competence in nursing students abroad is a challenge, and requires both methods and instruments capable of capturing the multidimensional nature of the clinical competences acquired. ObjectivesThe aim of the study was to compare the clinical competence assessment processes and instruments adopted for nursing students during their clinical placement abroad. DesignA case study design was adopted in 2015. Setting and ParticipantsA purposeful sample of eight nursing programmes located in seven countries (Belgium, Denmark, Greece, Norway, Poland, Portugal and Italy) were approached. MethodsTools as instruments for evaluating competences developed in clinical training by international nursing students, and written procedures aimed at guiding the evaluation process, were scrutinised through a content analysis method. FindingsAll clinical competence evaluation procedures and instruments used in the nursing programmes involved were provided in English. A final evaluation of the competences was expected by all nursing programmes at the end of the clinical placement, while only four provided an intermediate evaluation. Great variability emerged in the tools, with between five and 88 items included. Through content analysis, 196 items emerged, classified into 12 different core competence categories, the majority were categorised as ‘Technical skills’ (=60), ‘Self-learning and critical thinking’ (=27) and ‘Nursing care process’ (=25) competences. Little emphasis was given in the tools to competences involving ‘Self-adaptation’, ‘Inter-professional skills’, ‘Clinical documentation’, ‘Managing nursing care’, ‘Patient communication’, and ‘Theory and practice integration’. ConclusionsInstitutions signing Bilateral Agreements should agree upon the competences expected from students during their clinical education abroad. The tools used in the process, as well as the role expected by the student, should also be agreed upon. Intercultural competences should be further addressed in the process of evaluation, in addition to adaptation to different settings. There is also a need to establish those competences achievable or not in the host country, aiming at increasing transparency in learning expectations and evaluation.

Content Validation of a Quality and Safety Education for Nurses-Based Clinical Evaluation Instrument.

Quality and Safety Education for Nurses (QSEN) has been prominent in nursing education for 10 years. Since its inception, faculty have used the QSEN competencies as a framework for developing teaching strategies and tools, but there are few findings available to support this practice. This article describes the process of developing a QSEN-based clinical evaluation instrument for a prelicensure nursing program and establishing content validation for its items using the content validity index.