Implementing a clinical competency assessment model that promotes critical reflection and ensures nursing graduates' readiness for professional practice

Aim: This paper describes the design, implementation and evaluation of the Structured Observation and Assessment of Practice (SOAP), a model used to assess third year undergraduate nursing students' clinical competence.

Background: Competence is a complex concept that is difficult to define and measure. The assessment of nursing students' clinical competence has confronted universities with problems of validity, reliability, subjectivity and bias for many years. This presents particular problems in nursing as patient outcomes may be compromised by incompetent practice. Too often assessments of nursing students' competence comprise brief assessments of psychomotor skills, vague global assessment of generic skills/attributes or assessments undertaken in simulated laboratory settings rather than the real world of practice.

Methods: The Structured Observation and Assessment of Practice (SOAP), is a full day holistic practice-driven clinical competence assessment approach that motivates nursing students' learning, promotes critical reflection and confirms graduates' readiness for professional practice. This model was introduced in 2004 and since then 1031 students have been assessed. Quantitative and qualitative data has been collected via an anonymous online evaluation.

Results: Survey results have been statistically analysed using The Statistical Package for the Social Sciences (SPSS) (Version 13) with exploratory factor analysis employed to ascertain construct validity. This paper will report on the four components that showed acceptable factor loadings and that together accounted for 77.65 per cent of the variance: perceived learning outcomes, consistency with general clinical performance, quality of assessors, and anxiety/stress impact.

Conclusion: The results of the SOAP approach supports the premise that quality clinical assessment requires nursing students' exposure to complex challenges undertaken in authentic clinical contexts, observed by registered nurses who are trained as assessors and have a strong educational and clinical background.