The paradox of an expected level: The assessment of nursing students during clinical practice - A qualitative study.

Aim: The aim of this study is to increase knowledge about the assessment of nursing students' clinical practice, particularly concerning how teachers and clinical supervisors identify and assess the expected level of competence in mid-term evaluations and students, teachers and supervisors' experiences of mid-term assessment. Assessment is important to assure the quality of students' clinical competence and studies show that further research on this topic is required.

Design: This study has an explorative qualitative design.

Methods: Thirty semi-structured interviews were conducted with nursing students, teachers and clinical supervisors along with 16 observations of mid-term assessments during clinical practice, as part of a bachelor's programme in nursing.

Results: Two main challenges concerning establishing an expected level of competence were identified from the analysis of the interviews and observations: 1) a general formulation of learning outcomes and 2) vague expectations of what is the expected level of achievements at different points in time. Both challenges were at institutional level. Furthermore, at performance level, certain patterns were identified related to these challenges, such as teachers and supervisors needing to concretise the general formulation of learning outcomes and their discretion to set the expected level. Additionally, non-verbal language during mid-term assessment seemed to affect how the assessment situation was perceived.

Conclusion: We suggest that the institutional guidelines need to be critically reviewed to include greater focus on clarifying what students are expected to achieve, as well as what constitutes the expected level. We have emphasised that discretion is a necessary premise to identify an expected level of clinical competence at mid-term assessment, in particular when there is lack of a clear standard and the assessment form is vague, but also when there is no clear definition of the expected level of competence at different points in time. The consequences are that the student feel insecure about how the assessment ought to be perceived, what level they are at in their learning process, and subsequently, their level in the process of developing necessary clinical competence.