Date of Award
8-1-2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Nursing
First Advisor
Kristina Thomas Dreifuerst
Second Advisor
Dora Clayton-Jones
Third Advisor
Amy Newman
Abstract
Nursing education programs are faced with urgent demands to transition to competency-based education (CBE) to address the limitations of the nursing workforce. The AACN (2021) has developed the Essentials, or the core competencies for graduating entry- and advanced-level nurses to inform CBE. A concept analysis of Foundational Competence was developed by this researcher offers a refined perspective on the definition (McDermott & Dreifuerst, 2022). Foundational Competence is the competence of nursing student graduates at the end of an education program at the time of transition to practice. Assessment of competence has been identified as the biggest challenge facing CBE operationalization, in part due to the lack of competence assessment instruments. Therefore, the purpose of this study was to design, test, and implement a modified version of the Creighton Competency Assessment Instrument (CCEI). This study used a multi-method, observational, and descriptive design. First, the instrument was modified to reflect nurse practitioner (NP) practice (CCEI-NP), followed by content and construct validity testing. Construct validity was conducted to evaluate the ability of the CCEI-NP items to assess competencies defined in the Essentials. Second, clinical preceptors assessed NP students in patient encounters in simulation and traditional ambulatory clinical settings using the instrument. Third, follow-up interviews with preceptors were conducted regarding the instrument and assessment process. The findings of this study demonstrated the CCEI-NP has strong content and construct validity and high degrees of interrater reliability. The CCEI-NP is feasibly usable for the purpose of NP student assessment of competence. NP students had a passing CCEI-NP score of >80% demonstrating competence in 80% (n = 8) of student assessments conducted. This study contributes an instrument for the assessment of competence that has strong validity and reliability evidence, aligns with the Essentials, represents Foundational Competence, which is an updated, holistic, and pragmatic description of competence specific to the nursing discipline, and is feasible and usable for the purpose of NP student assessment. While further testing of the CCEI-NP is warranted, this work contributes to the discipline in a significant and meaningful way by moving the operationalization of CBE in nursing education one step further.