Implementation and student evaluation of clinical final examination in nursing education

Clinical examinations have a distinct focus, the overall aim being to demonstrate through action whether nursing students have acquired the knowledge and skills necessary to be safe and accountable practitioners. This complexity of knowledge cannot be assessed using single examinations, thus there is a need to develop multiple assessment approaches.

To describe the process of developing valid clinical examinations for nursing students at the end of the final semester and to evaluate students' perceptions of these examination formats.

Based on earlier research, overall goals for the degree of Bachelor of Science in Nursing and guided by both task-related and relational aspects of nursing, two clinical final examinations were developed and tested. One was a standardized test of performance in vitro using Objective Structured Clinical Examination (OSCE) based on five specific areas in which newly graduated nurses had shown deficiencies. The other was a test of performance in real conditions, in vivo, using Bedside Observation Examination (BOE) assessing nurse-patient relation, entirely based on patients' needs.

Three classes of students (n=203) were asked to participate and answer a study-specific questionnaire. The students highly valued the two examinations and perceived that the knowledge and skills tested were relevant to nurses' work. They found the examinations stressful, but at the same time meaningful, and felt they could do themselves full justice through this form of examination.

The assessment test should be chosen depending on the preferred outcome. The OSCE, with its high degree of standardization, is appropriate to use to assess task-related aspects of nursing (show how), while the BOE, with its low degree of standardization, is suitable in real settings and has the potential to capture the relational aspects of nursing (does).