| Quantitative studies included in the review |
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| 1. Ahn and Hyun-Young, Korea26 |
To implement two high-fidelity simulations to help nursing students integrate their cognitive and psychomotor skills to evaluate the students’ simulation experience using the Simulation Design Scale and learning outcomes.To analyze the correlation between students’ simulation experience and these learning outcomes. |
Quasi-experimental post-test design. |
Five nursing experts and 69 nursing students ANCOVA was used to compare the experimental and control groups, and correlation coefficient analysis was used to determine the correlation among them. |
Students rated guided reflection and fidelity highly in the designed simulations.Learning objectives were appropriate for third-year students Simulations led to higher self-confidence of students.Improved performance in course material may be achievable with the addition of rigorous simulation design. |
| 2. Oetker-Black et al., Tanzania27 |
To psychometrically evaluate the Clinical Skills Self-Efficacy Scale in a population of nursing students in Tanzania. |
Psychometric evaluation. |
287 nursing students enrolled in the preservice or in-service nursing programs at two schoolsItem analysis, reliability and validity were assessed.CSES included 12 items in a confidence scale designed to measure clinical skills self-efficacy expectations. |
Evidence of construct validity.Future research to focus on self-efficacy and the successful transferal of clinical skills learned in a simulated laboratory to the clinical setting. |
| 3. Teixeira et al., Brazil28 |
To compare the level of anxiety and performance of nursing students when performing a clinical simulation through the traditional method of assessment with the presence of an evaluator and a filmed assessment without the presence of an evaluator. |
Randomized control trial. |
20 nursing students were randomly assigned to one of two groups.The level of anxiety was assessed using the Zung test and performance was measured based on the number of correct answers. |
The final scores of the two groups correspond to mild anxiety.There was no difference between the groups. |
| 4. Alamri and Almazan, Saudi Arabia29 |
To examine the barriers to physical assessment skills among nursing students in a government university in the Arab Peninsula. |
A cross-sectional research survey. |
206 nursing students participated.A standardized questionnaire was used.Independent Samples t-test and paired t-test were used to analyze the data. |
Physical assessment is not often practiced in clinical settings.Barriers identified were reliance on others and technology, ward culture, lack of influence on patient care.Continuous exposure, increasing self-confidence and enhancing the quality of planning and promotion of the nursing students could help develop necessary skills. |
| 5. Alquwez et al., Saudi Arabia14 |
To assess the perceived patient safety competence during clinical training of Saudi nursing students. |
Descriptive, cross-sectional design. |
829 nursing students.Descriptive and inferential statistics were used to analyze the data. |
Students expressed positive perceptions toward their patient safety competencies.Significant differences in patient safety competence of nursing students between universities, gender, and year of study were recorded. |
| 6. Arbabshastan et al., Iran30 |
To determine the status of clinical competencies nurse practitioner students – self and instructor assessment. |
Analytical cross-sectional study. |
All senior nurse students (n = 50) from a bachelor degree program.The checklist contained 16 items with Yes and No options and a self-assessment form to be completed after each competency.Descriptive T-test was used to analyze data. |
The lowest scores of competencies were from communication and hygieneThe development of clinical competencies requires close mentorship from someone who can provide feedback to students. |
| 7. Daly et al., Australia16 |
To determine the extent of assessor variability in clinical skills assessments in an undergraduate nursing program. |
Prospective follow-up study design |
The results of students’ clinical skills assessments in three clinical units were extracted from an administrative database.Descriptive and inferential statistics were used to analyze data. |
Overseas-born students had lower pass grades than Australian-born students.Significant variability was seen in pass grades across units, campuses, and assessors.Students assessed by the most lenient assessors were over seven times more likely to pass than students assessed by the most stringent assessors. |
| 8. Gurkova et al., Slovakia31 |
To investigate the use and effectiveness of a valid and reliable rating scale for summative clinical evaluation of student performance. |
Descriptive cross-sectional study |
82 students participated in the study.Descriptive and inferential statistics.This evaluation was compared with the grade point for the students’ clinical performance obtained in the practical component of their final examinations. |
A valid and reliable tool may allow an objective evaluation of nursing student performance in clinical settings. The Nursing Student Clinical Performance Evaluation Scale is useful for summative evaluation of student performance. Teachers and clinical mentors can rate students’ performance over time and note patterns of performance. |
| 9. Iglesias-Parra et al., Spain32 |
To develop an evaluation system of clinical competencies for the practicum of nursing students based on the NIC. |
Psychometric validation study a cross-sectional study. |
Reliability and construct validity, as well as responsiveness, were tested by the evaluations performed by clinical mentors on 107 students over two consecutive years.12 faculty staff and 3 clinical lecturers participated in an expert consensus panel using a modified Delphi technique. |
A competency system for the nursing practicum, structured on the NIC, is a reliable method for assessing and evaluating clinical competencies. |
| 10. Kajander et al., Finland33 |
To assess the congruence between graduating nursing students’ self-assessment and their mentors’ assessments concerning nurse competence with a particular focus on nursing skills. |
Cross-sectional study |
Completed questionnaires were received from 60 students and 50 mentors.42 students—mentor pairs were matched for the sample of this study.Descriptive and inferential statistics were used in the data analysis. |
Students’ rated their performance higher than the mentors.No congruence assessments were found between students and mentors. |
| 11. Langari et al. Finland and the United Kingdom34 |
To examine and compare the self-assessment of patient safety competence between British and Finnish nursing students. |
Cross-sectional study. |
The PaSNEQ, 502 surveys to the final year nursing studentsThe data were analyzed with descriptive statistics and binary logistic regression. |
No separate module for patient safety was included in the curriculum. Both groups of students ranked their competence to prevent patient safety incidents (attitude) the highest and their competence to act after errors (skill) relatively low. |
| 12. Macia-Soler et al., Spain35 |
To determine the level of involvement of clinical nurses accredited by the Universitat Jaume I (Spain) as mentors of practice (Reference Nurses) in the evaluation of competence of nursing students. |
Cross-sectional study |
200 clinical nurses completed the CPAM tool. |
63% of CPAM were completed correctly, without reaching the quality threshold established (80%). Nurses’ performance on the CPAM tool was determined by their respective clinical units There are significant differences according to clinical units. Collaboration and training of clinical nurses was recommended. |
| 13. Murray et al., United Kingdom36 |
An evaluation of a NTS framework that could potentially be used to measure ward round skills of student nurses. |
Observation (cohort) study. |
Development of NTS frameworkRating of simulation using framework.Evaluating content validity of framework. |
The proposed NTS framework included seven categories which were rated as important and relevant to practice and could be used as a means of evaluating student nurse competencies in respect of many NTS required for a successful ward round. |
| 14. Numminen et al., Finland37 |
To evaluate whether educational outcomes of nurse education meet the requirements of nursing practice by exploring the correspondence between nurse educators’ and nurse managers’ assessments of novice nurses’ professional competence. |
A cross-sectional, comparative design using the Nurse Competence Scale. |
86 Nurse educators and 141 nurse managers.Descriptive and inferential statistics were used in the data analysis. |
Examiners who are educators rate novice nurses’ competence higher than examiners who are managers in all competence areas. Differences between educators’ and managers’ assessments scores were strongly associated with their age and work experience. |
| 15. Meskell et al., Ireland38 |
To explore electronic OSCE delivery and evaluate the benefits of using an electronic OSCE management system.To explore assessors’ perceptions of and attitudes to the computer-based package. |
A descriptive survey. |
An electronic software in the management of a four-station OSCE assessment with first-year nursing students over two consecutive years (n = 203).Assessors were trained in the use of the OSCE management software packageAssessors were invited to evaluate their experience. |
Electronic software facilitated the storage and analysis of overall group and individual results thereby offering considerable time savings.Submission of electronic forms was allowed only when fully completed thus removing the potential for missing data. Students were able to compare their performance with the class due to the timely feedback of the software. |
| 16. Oermann et al., United States of America39 |
To explore the feasibility of developing scenarios for high-stakes evaluation of students’ clinical performance. |
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Video recordings of students performing in standardized scenarios.Four outcomes were chosen for the evaluation of students’ clinical performance in a simulation based on the results of an expert panel think tank(a) assessment and intervention,(b) nursing judgment,(c) quality and safety, and(d) teamwork and collaborationCommunication was integrated across other areas. |
Most of the nursing students were able to competently perform most of the skills assessed on the CCEI. There was some inconsistency in the inter-rater agreement.Administering medications safely; managing technology and equipment; and performing procedures were items that generated the most inter-rater disagreement while patient safety recorded lower inter-rater disagreement.Checking the functionality of the equipment. |
| 17. Ossenberg et al., Australia40 |
To advance the assessment properties of a new instrument, the ANSAT, and investigate the acceptability of this instrument when applied to the evaluation of the professional competence of nursing students in authentic practice settings. |
Cross-section survey study |
A validation study of ANSAT was conducted by 23 clinical assessors from two universities, completing 220 instruments for nursing students.Data were analyzed using both descriptive and inferential statistics. |
The instrument is sensitive to different levels of performance across different year levels.The ANSAT has high internal consistency. With the addition of supportive behavioral cues, the ANSAT enables clarity, consistency, and collaboration in the workplace-based assessment. |
| 18. Solheim et al., Norway41 |
To develop and evaluate a new reflection and feedback tool for formative assessment. |
Descriptive design |
129 nursing students participated in the study. After high fidelity simulation, data were collected using a questionnaire with 19 closed-ended and 2 open-ended questions. |
The tool provided a structure for self-assessment and made visible items that are important to be aware of in clinical skills. The tool has the potential for enabling students to learn about reflection and developing skills for guiding others in practice after they have graduated. |
| Qualitative studies |
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| 19. Cassidy et al., United Kingdom42 |
To develop a theoretical explanation of how mentors experience borderline competency achievement of nursing students in clinical practice. |
Grounded theory study. |
Interviews and focus group discussions with Registered Nurse mentors and practice educators.Data were analyzed using open, axial, and selective coding consistent. |
There were conflicts regarding mentors’ assessment decision-making where students were on the borderline of achievement of competence in clinical practice.The need to prepare, support, and regulate nurses who assess the clinical competency of nursing students. |
| 20. Meier et al., United Kingdom22 |
To examine how the ISP was used to assess interpersonal skills in a university pre-registration nursing program. |
Realistic evaluation approach |
Interviews with clinical nursing mentors, practice education facilitators, and education champions. Documentary analysis of student assessment booklets was also done. |
The ISP tool is used for formative and summative assessment. It supports the overt assessment of interpersonal skills, support to mentors, and provides feedback and “feed-forward” to students. |
| 21. Ochylski et al., United States of America43 |
To demonstrate the use of a multidimensional evaluation method as applied to a new simulation-based remediation course to enhance the clinical skills of prelicensure nursing students. |
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Seven who participated in a variety of simulation scenarios and skill-building activities were interviewed on the last day using 12 open-ended questions. |
Student scores reflected positive skill performance 2 months after participating in the course. Some students expressed concern over a potential negative stigma among peers for needing and participating in a skills enhancement course. |
| 22. Tommasini et al. Belgium, Denmark, Greece, Norway, Poland, Portugal, and Italy44 |
To compare the clinical competence assessment processes and instruments adopted for nursing students during their clinical placement abroad. |
A case study design |
Tools for evaluating competences and written procedures were scrutinized through a content analysis method. Seven European countries participated in the study. |
Great variability emerged in the tools, with between five and 88 items included. Twelve different core competence categories were identified.Increased transparency in learning expectations and evaluation. |
| Mixed method |
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| 23. Burke et al., Ireland45 |
To explore Irish preceptors’ experience of using a competence tool to assess undergraduate nursing students’ clinical competence. |
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Six focus group interviews to explore preceptor's experience of using an assessment tool to assess clinical competence.A descriptive survey instrument was developed and administered to 843 preceptors to measure preceptor's attitudes to the local competence assessment tool. |
Preceptors had difficulty understanding the content of the tool as it was too academic. Challenges of using the assessment tool include difficulty understanding the content, negotiating complex repetitive language, time constraints and the need to facilitate qualitative commentary. |
| 24. Zasadny et al., Australia13 |
To develop a model in response to the inadequacies of existing tools to assess competence. |
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The ASAP tool was trialed in three public tertiary hospitals and four private hospitals. Quantitative and qualitative feedback was collected from students and clinical facilitators. |
The ASAP model can be used as a focused diagnostic tool, removal from PEP support tool, and a framework for documenting evidence.The ASAP model offers a comprehensive focused assessment of nursing students’ performance in practice. It supports both formative and summative feedback and can be used to accurately identify specific areas of practice deficiency requiring redirection and support for nursing students. |
| 25. Lai, Taiwan, China46 |
To implement an online video peer assessment system to scaffold their communication skills and examine the effects and validity of the peer assessment. |
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Expert evaluation scores showed that peer assessments led to significant improvement in students’ communication performance. |
Online peer assessment could be perceived as a valid assessment method for nursing communication skills training. Communication became more patient-centered gradually due to peer assessments. Peer assessment activities contributed to the improvement of the communication skills of students |
| Multimethod |
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| 26. Marquez-Henandez et al., Spain47 |
To design, develop, and implement a tool to evaluate the clinical skills of nursing students. |
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250 Nursing students were randomly placed in an experimental group and a control group.Descriptive analysis was conducted, the nonparametric Mann Whitney U test was used to compare the qualitative and quantitative variables. |
The web-based tool designed is an effective strategy to evaluate clinical skills. The need for innovative strategies that can determine the development and acquisition of the skills required for future nursing professional |
| 27. Imanipour and Jalili, Iran48 |
To develop a comprehensive assessment system for nursing students in their critical care rotation based on a programmatic approach |
-Expert review-Quantitative study |
38 nursing students in their critical care course.The learning objectives of the course were classified into three categories using an expert panel content validity and reliability of the assessment tools were established |
The new assessment system had high validity, reliability, and a positive impact on learning.A programmatic approach should be used for the effective evaluation of the clinical performance of nursing students in critical care settings. |
| 28. Wu et al., Singapore49 |
To develop and test psychometric properties of a holistic clinical assessment |
-Systematic review-Expert review-Student survey |
Synthesis of the literature, exploratory and confirmatory factor analysis, Content Validity Index |
HCAT was developed and validated through psychometric testing. The tool was internally consistent and reliable. |
