Students Evaluation of an Observed Structured Clinical Evaluation (OSCE) in Community Health Nursing Clinical Practice

Mrs. Smita Sunil Gawade

Sadhu Vaswani College of Nursing 10-10/1, Koregaon Park Road, Pune-411001

*Corresponding Author Email: smita23282@gmail.com

ABSTRACT:

Innovation in community health nursing practices required skill full competent nurse in order to provide comprehensive care for promotion of health and prevention of illness in the public health sector. The speed innovation in nursing practice is not at a fast enough speed to accommodate the enormous global challenges facing nursing's future. Innovation in evaluation method will improve quality of nursing practices which will be help full to achieve professional competency. Objective structured clinical examination (OSCE) is a multi-system examination using real or simulated patients to evaluate clinical skills, attitudes and cognitive abilities. It demonstrated reliability and validity for assessing clinical performance. It is a powerful innovative tool in the evaluation of clinical competence in nursing and that it may also be an effective facilitator for learning to perform clinical skills in nursing to achieve professional competency. So this study was conducted to assess student's evaluation of an Observed Structured clinical evaluation (OSCE) examination in community health nursing practices in a selected college of nursing of Pune city. A descriptive exploratory design and Non-probability convenience sampling technique was used. Sample size was 25. Students have evaluated structure, content, organization, quality, validity and reliability of an OSCE with the use of a modified Pierre et al. (2004) OSCE evaluation questionnaire tool. Findings shows that OSCE is a fair examination method (100%) and 80% of them felt that it provides a true measure of essential clinical skills without biasness which minimized their chances of failing. Most of them (80%) also agreed that the assessment process with checklist helped to identify weaknesses and gaps in their competencies. (60%) of them found that OSCE is fearless and not stress full. This study finding shows that student’s acceptability of an OSCE as an effective tool to assess student's clinical competency level. Students evaluated that OSCE is fair and transparent, valid, fearless, stress less process to assess clinical competencies of nursing students through formative and summative evaluation in community health nursing practices. OSCE can be evaluated as a standardized method clinical skill evaluation which can be used in a combination with traditional (current) method. So that expected competency level of nursing student in community health nursing clinical practice will be achieved.

KEYWORDS: Observed Structured clinical evaluation, community health nursing practices, community health nursing, student's evaluation.

INTRODUCTION:

Objective structured clinical examination (OSCE) is a multi-system examination using real or simulated patients to evaluate clinical skills, attitudes and cognitive abilities. It demonstrated reliability and validity for assessing clinical performance. In the 1970s by Dr. Ronald Harden, the OSCE has gotten momentum for clinical assessment to evaluate the nursing student's clinical competencies¹. Objective Structured Clinical Examination (OSCE) is now established as one of the most valid, reliable and effective tests to measure cognitive, interpersonal communication, and psychomotor².

The objective structured clinical examination, or the OSCE for short, is an approach to the assessment of clinical competence in which the components of competence are assessed in a planned or structured way with attention being paid to the objectivity of the examination. The OSCE is a performance assessment and is concerned with what students can do rather than with what they know³.

OSCE can objectively assess important aspects of clinical experiences, such as problem solving ability, physical examination skill, technical skill, and interpersonal skill, decision making ability and nursing management skills⁴.

The student is assessed at a series of stations with one or two aspects of competence being tested at each station. the examination can be described as a 'focused' examination with each station focusing on one or two aspects of competence¹.

Many study outcomes concluded that the OSCE was recommended as a beneficial and effective tool for evaluating nursing students' clinical performance. There is a traditional tool for assessing nursing students has basically consisted of a written exam (essay type, multiple choice, and short-answer type questions), practical exam (viva and case presentation, practical exam- procedure) Currently, community health nursing- theory and procedures are taught in the class by using lecture and demonstration methods to the large group of nursing students. The acquisition of critical thinking abilities and problem solving skills are difficult to manage which may lead to mal practice in community setting thus affects family health services. Traditionally Student’s clinical competency in a community health nursing practices are assessed directly in the community setup without assessing student’s skill with the help of structured checklist. In witch teachers conduct the assessment of the student performance and give summative evaluation. So it is a challenge to have an assessment tool to assess student’s clinical competencies in a comprehensive manner especially with the increased number of students.

However, this method has exhibited a lot of criticism over the years because of their inability to evaluate the top levels of the pyramid of competency.

MATERIAL AND METHOD:

1. Research Approach: Quantitative

2. Research Design: A descriptive exploratory

3. Study Setting: The study will be conducted in selected college of Nursing,Pune

4. Sampling Technique: Non-probability convenience sample of nursing students who completed their community health nursing examination.

5. Sample size: 25

6. Variables of the study:

Dependent- Student's evaluation:

Independent- Observed Structured Clinical Examination (OSCE),

7. Tool:

Students evaluation about an OSCE is evaluated with the total 25 modified Pierre et al. (2004) OSCE evaluation questionnaire which consist 3 sections. first section consists of 13 questions to evaluate an OSCE, second section consist of 8 questions to evaluate quality of performance testing and students perception of validity and reliability is evaluated with 4 questions.

8. Ethical considerations:

Ethical committee approval is obtained from the Sadhu Vaswani College of Nursing. Students who have experienced community health nursing examination, were informed about the present study and verbal consent is obtained. Teachers are informed about an OSCE and verbal consent is obtained.

9. Preparation for the OSCE:

Three OSCE stations were arranged in the clinical skills lab, which includes first station for Checking of height and weight (5 min), second station for measurement of Blood Pressure (5min), third station for developing a health education plan for change in lifestyle for client with hypertension (5min).

Administration of OSCE:

The OSCE stations were ready with the instruction sheet. Observational checklist was prepared for each nursing procedure. All the student made compulsory to attend all the stations. Each OSCE station was supervised by teacher who are trained for OSCE stations and its checklist.

Collecting students feed back:

Data was collected with the use of a modified Pierre et al. (2004) OSCE evaluation questionnaire tool was distributed to all students after completion of their OSCE. Students were asked to evaluate the structure, content, organization, quality, validity and reliability of the OSCE.

RESULTS:

OSCE evaluation:

Twenty five students responded to the questionnaire

The majority of students agreed that the OSCE was fair (100%) and covered a wide range of knowledge and clinical skill (80%). Most of them (80%) also agreed that the assessment process with checklist helped to identify weaknesses and gaps in their competencies. (Table 1).

Table 1 OSCE evaluation

Sr.no	Question	Agree	%	Neutral	%	Disagree	%
1	Exam was fair	25	100	0	0	0	0
2	Wide knowledge are covered	20	80	3	12	2	8
3	Needed more time at stations	12	48	11	44	2	8
4	Exams well administered	25	100	0	0	0	0
5	Exams very stressful	0	0	10	40	15	60
6	Exams well structured and sequenced	20	80	5	20	0	0
7	Exam minimized chance of failing	15	60	10	40		0
8	OSCE less stressful than other exam	20	80	5	20	0	0
9	Exam was fearless	10	40	15	60	0	0
10	Highlighted areas of weakness	20	80	5	20		0
11	Student aware about required information	25	100	0	0		0
12	Wide range of clinical skills covered	20	80	5	20		0
13	Students performance is evaluated with the checklist	20	80	5	20		0

Quality of performance testing:

Table 2 Quality of performance testing N= 25

Sr. no	Question	Not at all	%	Neutral	%	To great extent	%
1	Fully aware of nature of exam			15	60	10	40
2	Tasks reflected those taught			6	24	19	76
3	Time at each station was adequate	2	8	5	20	18	72
4	Setting and context at each station felt real (authentic)			10	40	15	60
5	Instructions were clear			5	20	20	80
6	Tasks asked to perform were fair					25	100
7	Sequence of stations logical and appropriate				5	20	80
8	Exam provided opportunities to learn				5	20	80

Student perception of validity and reliability

Table 3 Student perception of validity and reliability

Sr.no	Question	Not at all	%	Neutral	%	To great extent	%
1	OSCE exam scores provide true measure of essential clinical skills in community	2	8	6	24	17	68
2	OSCE scores are standardized			6	24	19	76
3	OSCE practical and useful experience			5	20	20	80
4	Personality, ethnicity and gender will not affect OSCE scores			5	20	20	80

(80%) found that OSCE practical is an useful experience and OSCE score will not affect by personality, ethnicity and gender that mean there is no bias. (76%) observed that OSCE scores are standardized. (68%) felt that OSCE exam scores provide true measure of essential clinical skills in community health nursing practices.

DISCUSSION:

Students evaluated that OSCE is fair and transparent, valid, fearless, stress less process to assess clinical competencies of nursing students through formative and summative evaluation in community health nursing practices. They expressed that there is minimum chances of failing and the result were a true reflection of their clinical skills.

OSCE may be a powerful innovative tool in the evaluation of clinical competence in nursing and that it may also be an effective facilitator for learning to perform clinical skills in nursing⁵.

In current nursing education system, student- centered approach can be effectively implement with greater student participation in quality assurance exercises⁶.

This study findings shows that students acceptability of an OSCE as a effective tool to assess student's clinical competency level. OSCE will be evaluated as a standardized method clinical skill evaluation which can be used in a combination with traditional (current) method. So that expected competency level of nursing student in community health nursing clinical practice will be achieved. Thus OSCE will be applied in all nursing clinical examination.

REFERENCES:

1. Harden, R., M. Stevenson, W.Downie and G. Wilson, 1975. Assessment of clinical competence using objective structured examination. British Medical Journal, 1(5955): 447-451

2. Austin, Z., C. O'Byrne, J. Pugs ley and L. Munoz, 2003. Development and validation processes for an Objective Structional Clinical Examination (OSCE) for entry -to-practice certification in pharmacy: the Canadian experience. American Journal of Pharmaceutical Education, 67(3):1-8.

3. Patricia Katowa-Mukwato, Lonia Mwape, Marjorie Kabinga-Makukula, Implementation of Objective Structured Clinical Examination for Assessing Nursing Students’ Clinical Competencies: Lessons and Implications; 2013. Vol.4, No.10A, 48-53, Published Online October 2013 in Scientific Research.

4. Merrick H, Nowacek G, Boyer J, Robertson J (2000). Comparison of theobjective structured clinical examination with the performance of third year medical students in surgery. Am. J. Surg. 179:286-288

5. Russell B Pierre., Andrea Wierenga., Michelle Barton:Student evaluation of an OSCE in paediatrics at the University of the West Indies, Jamaica, BMC Medical Education2004

6. Rob mcsherry, Ffnmrcsi, Mary douglas: Innovation in nursing practice, a means to tackling the global challenges facing nurses, midwives and nurse leaders and managers in the future

7. Amaal M. Al-Zeftawy, Samia E. Khaton., Student Evaluation of an OSCE in Community Health Nursing Clinical Course at Faculty of Nursing Tanta University: IOSR Journal of Nursing and Health Science, Volume 5, Issue 4 Ver. III (Jul. -Aug. 2016), PP 68-76. www.iosrjournals.org

Received on 30.01.2018 Modified on 18.02.2018

Asian J. Nursing Education and Research. 2018; 8(2): 278-281.

DOI: 10.5958/2349-2996.2018.00054.X