The validity and reliability of clinical judgement and decision-making skills assessment in nursing: A systematic literature review

Objectives: To appraise the validity and reliability of approaches to assessing the clinical decision-making skills of nurses, and use findings to inform the assessment of students as they transition to newly qualified nurses. Design: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to conduct the review. Data sources: Medline, CINAHL and the British Nursing Index were searched from inception to November 2019. Review methods: Studies were grouped according to their assessment approach following a competency framework with findings presented as a narrative synthesis. Results: 38 articles were included in the review which assessed clinical decision-making in a variety of settings; clinical practice, simulation, written examinations and self-assessment. Multi-level rubric and checklist approaches demonstrated good validity and reliability in practice and simulation settings, and the former was effective at differentiating between students at different stages of their training. Written, case study examinations were also effective at assessing clinical decision-making, although an optimum structure for their presentation was not possible to discern. Students tended to score themselves more highly than faculty staff when undertaking rubric-based self-assessments. Conclusions: Findings suggest that the best approach to assess clinical decision -making for final year students is to use several low-stakes, snap-shot summative assessments in practice environments, which are marked using a multi-level observational rubric. To assure reliability, it is recommended that a small team of expert practice assessors undergo regular training and peer review, have protected time to complete their assessor role and are appropriately supported.

Automated summary

The study evaluated the validity and reliability of approaches to assessing clinical decision-making skills of nurses, finding that multi-level rubric and checklist approaches were effective in practice and simulation settings. Written and case study examinations were also effective, but students tended to rate themselves higher in self-assessment. The best approach for final year students was recommended to be multiple low-stakes assessments in practice environments using a multi-level observational rubric, with expert practice assessors undergoing regular training and peer review for reliability.