Enhancing Self-Assessment and Reflection in
Nursing Education: Insights from a Qualitative Study on Students’ Professional
Development in Clinical Practice
Ingrid Rachel Strand, Oslo Metropolitan University
Unni Knutstad, Oslo Metropolitan
University
Mette Sagbakken, Oslo Metropolitan
University
Authors’ Note
Ingrid Rachel Strand https://orcid.org/0000-0003-0775-5097
Unni Knutstad https://orcid.org/0000-0002-2162-7959
Mette Sagbakken https://orcid.org/0000-0003-0055-476X
The authors received no funding for this
research.
Correspondence concerning this article should be addressed to Ingrid Rachel Strand at ingfi@oslomet.no.
Abstract
This study emphasizes the pivotal role of
self-assessment in the professional development of nursing students,
illustrating how educators can facilitate this process. The findings indicate
that although clinical practice is essential for connecting theoretical
knowledge and practical skills, the incorporation of reflective practice and
structured guidance from professors and supervisors is equally important. The
data comprises 30 in-depth interviews with students, professors, and
supervisors. Analysis was conducted using Braun and Clarke’s thematic analysis
(2022). The study revealed that nursing students found self-assessment and
reflection on their professional growth during clinical placements to be
crucial for developing nursing skills. The results suggest that
students who prepared for the mid-term assessment gained more from the
assessment than their unprepared peers. Professors and supervisors often saw efficiency as a key nursing
competency for students. This highlights a mismatch between supervisors’ and
professors’ expectations and the time required for students to engage in
meaningful learning processes. However, to support students in self-assessment,
professors and supervisors facilitated learning by guiding them to recognize
educational opportunities and activities within the clinical setting.
Keywords: self-assessment, professional growth, nursing profession, nursing
students, clinical practice, qualitative research
Enhancing Self-assessment and Reflection in
Nursing Education: Insights from a Qualitative Study on Students’ Professional
Development in Clinical Practice
Clinical practice is
vital for nursing students to grasp the nursing profession and serves as a
fundamental element of nursing education worldwide. According to European Union
standards, a bachelor’s program in nursing requires that 50% of the total study
duration be dedicated to clinical placements. In the educational context,
learning outcomes for a bachelor’s program in nursing in Norway emphasize,
among other things, the students’ ability to self-assess (Regulation on
National Guidelines for Nursing Education, 2019). The nursing education program
plan at the university involved in this study includes assessing students'
general competence in their ability to “critically reflect on personal
professional development and engage in academic discussions with colleagues”
(OsloMet, 2024). This focus on self-assessment and reflective practice is
crucial for fostering a deeper understanding of clinical competencies and
preparing students to navigate complex healthcare environments effectively.
Thus, throughout their clinical placements, nursing students are
expected to engage in continuous self-assessment, allowing them to gain a
deeper understanding of their nursing skills, strengths, weaknesses, and values (Manning, p. 4,
2020). This self-assessment entails evaluating their skills, knowledge, and
attitude in comparison to the standards and competencies outlined in the course
they follow. Engaging in self-assessment enhances students’ awareness of their
learning process and identifies professional development needs (Taylor et al.,
2020). This reflective practice prompts students to contemplate their
experiences, thereby enriching their learning and nurturing the cultivation of
critical thinking skills. One essential part of self-assessment is being able
to reflect, as well as pursue feedback on their thoughts, to better set a focus
for future goals and professional development (Manning, 2020, p. 4). Metacognition
and reflective thinking are linked. Flavell (1979) defined metacognition as a
process of recognition, monitoring, feedback and adjusting factors affecting,
for example, learning strategies. A study conducted
in the Netherlands (de Vries et al., 2022) examined the
effects of a teacher professional development program focusing on assessment
for learning (AfL) for secondary math instructors in Belgium, Cyprus, Greece,
and the Netherlands. The study found that students’ ability to self-assess is
closely linked to their capacity for metacognition.
Research indicates that advanced nursing students’ self-assessment of
clinical competencies can reveal areas needing further education and
development (Taylor et al., 2020). However, previous
studies highlight that the ability to reflect and perform self-assessment
requires experience and substantial time spent in clinical practice (Taylor et
al., 2020), and this ability improves annually for baccalaureate nursing
students (Kajander-Unkuri et al., 2020). Additionally, studies show that
students often rate their competence higher than it may be, likely due to
insufficient training in self-assessment during their education (Gardulf et
al., 2016; Kajander-Unkuri et al., 2016; Kajander-Unkuri et al., 2020). Panadero`s
(2015) review on issues related to students’ self-assessment (SSA) identified five
key components: SSA typologies, accuracy, the role of expertise (professors and
clinical supervisors), the expectations of, and the varying effects of SSA on
different students. According to Panadero (2013, 2015), the accuracy with which
a student can self-assess their own work, or achievement, represents a form of
validity in SSA.
Another perspective on self-assessment suggests it may be ineffective
for students to demonstrate their strengths in clinical competencies (Baxter &
Norman, 2011). According to Kruger & Dunning (1999), low-performing students
often overestimate their clinical performance, while high-performing students
do the opposite. Known as the Dunning-Kruger effect, this bias occurs because
individuals with limited expertise often lack the metacognitive ability to
recognize their own incompetence. This concept underscores the significance of
self-awareness and accurate self-assessment across various domains, as those
lacking competence may be less likely to perceive their own limitations (Kruger
& Dunning, 1999). The support and involvement of supervisors in clinical
practice is crucial for fostering students’ critical reflection and
subsequently self-assessment, particularly during challenging periods of
clinical training (Alvsvåg & Førland, 2006, p. 37). In a meta-analysis of
46 studies, Baars et al. (2020) found that for students to make accurate
monitoring judgements about the association between their effort during
learning and their progress, the need for instruction is essential.
A systematic review on self-assessment in surgical training revealed
that time and age are crucial for more accurate self-evaluation, with factors
like stress negatively impacting the ability to assess one's clinical skills (Nayar
et al., 2019). A study from the Czech Republic, involving 274 final year
nursing students assessing their own competence, found that the majority (80.3
%) rated their competence as good or very good. Two key factors positively influenced
students’ self-assessment: prior work experience in health care and positive
experiences with their clinical supervisors. These factors significantly
contributed to students’ confidence in evaluating their own competence (Zeleníková et al., 2023).
Systematic self-reflection during the learning process can enhance
patient safety and care (Ambrose & Ker, 2014; Lucas, 2023; Strandbygaard et
al., 2013; Sweet et al., 2019). Pai (2015) conducted a longitudinal study in
Taiwan that found six months to be vital for nursing students to improve their
learning, nursing competence, and professional socialization. Based on Pai`s
findings, it is reasonable to assume that time is essential for students to
effectively self-assess their clinical performance and professional
development. However, previous research also indicates that the ability to
reflect and self-assess requires experience, which varies among nursing
students in undergraduate programs (Taylor et al., 2020).
When students lack clarity about
their path in the learning process, it becomes challenging for them to
effectively self-assess their clinical competence. For instance, nursing
students often struggle to grasp which learning activities are associated with
specific learning outcomes, partly due to the abstract language used in these
outcomes (Finstad et al., 2022). A Norwegian quantitative study with 1500
respondents revealed that supervisors in clinical practice have limited time to
familiarize themselves with student learning outcomes and to adequately
supervise students (Norwegian Nursing Association, 2018). As a result,
supervisors may also be unsure about the content of the learning outcomes. However, a
Finnish study suggests that learning activities, such as systematic reflections
and assessments, have a greater impact on guiding student learning than the
descriptions of intended learning outcomes (Hailikari et al., 2022). Additional
research recommendations include encouraging nursing programs to emphasize the
importance of self-assessment in identifying clinical competency levels (Taylor
et al., 2020). A barrier to fostering student self-assessment is the limited
understanding of the metacognitive mechanism that underpins it, especially how
students monitor and regulate their evaluative judgements. In the absence of
this knowledge, designing effective supports to develop students’ self-assessment
is not yet possible (Richey et al., 2025).
Ontological
and Epistemological Approach
This study is grounded in a social constructivist ontology and
views reality, including self-assessment and professional development,
as socially constructed and context-dependent. Ontology concerns the
nature of reality, and in this study approach, self-assessment is seen as
an emergent phenomenon, shaped by the interplay between individual
agencies and broader social and institutional structures. Thus, this study
highlights the importance of contexts, such as clinical placements, and
addresses divergent expectations—where students may need time for reflection,
while supervisors often prioritize efficiency.
Aligned with this ontological foundation,
the study adopts a constructivist epistemology, which explores how
knowledge about self-assessment and professional development is co-constructed.
Epistemology concerns how we come to know a certain reality, and in this
study, knowledge is recognized as a shared, collaborative
process shaped through dialogue, reflection, and experiences. This
philosophical stance guided the choice of methodology, focusing on subjective
experiences and co-constructed meanings through methods such as
semi-structured interviews and observations.
The Rationale of the Study
A
multi-database literature search specifically
found a lack of studies examining the perspectives of both students,
professors, and clinical supervisors, and how these educators facilitate
students’ ability to reflect on and evaluate their own progress. This gap
underlines the need to explore how self-assessment is shaped through social
interactions and institutional contexts.
Study Aim and Research Questions
This study aims to explore the experiences of
students, professors, and supervisors in reflecting on, assessing, and
supporting the students’ learning processes and adaptation to the nursing
profession during clinical practice. Specifically, the focus is on
understanding how students engage in self-assessment of their professional
development and how professors and supervisors facilitate this process. Based
on this, the study addresses the following research questions:
1. How do students self-assess their own
professional development?
2. In what ways do professors and supervisors
facilitate students’ ability to self-assess their professional development?
This
study is part of a larger qualitative research project with a hermeneutic
approach, focusing on the assessment of nursing students during clinical
practice. Rooted in a constructivist epistemology, the overall project includes
data from both observations and interviews. This specific study, however,
focuses on the analysis of data derived from 30 interviews.
Recruitment and Participants
It
was essential to include data reflecting the experiences of nursing students,
university professors, and clinical supervisors (registered nurses) to ensure
that all three key stakeholders involved in students' assessment during
clinical practice were represented.
Information about the study was sent to nursing professors and students
at one of the largest universities in Norway, via e-mail and through an oral
presentation at a faculty meeting. The professors taught in the bachelor’s
nursing programme at the university, representing all three years of the
programme. Both male and female professors were invited to participate. It was
essential that professors participating in the study were actively supervising
students in clinical practice during the following months. These professors
became gatekeepers to recruit nursing students as participants. Information
regarding the focus of the study was presented to students in a pre-clinical
setting. The study sample comprised 30 respondents:
The nursing professors included in the study consisted of two males and
nine females, aged between 57 and 70 years. They worked with students in
different clinical settings, including elderly care homes, medical, surgical,
psychiatric units, and home care services. The student participants included
four males and eleven females, aged between 25 and 59 years, all of whom were
in clinical practice within one of these settings. The students were enrolled
in the first, second or third year of the bachelor’s program in nursing.
Additionally, six female clinical supervisors, aged 25 to 59 years, agreed to
participate in the study. These supervisors were responsible for six of the 16
students who were interviewed.
Table 1
Participant
Characteristics.
|
Who |
# & Gender of Participants Interviewed |
Year of program in 1st/ 2nd/ 3rd yr |
Age range |
|
Professors |
9 (7F/2M) |
3/3/3 |
57-70 |
|
Students |
15 (11F/4M) |
4/3/8 |
20-58 |
|
Supervisors |
6 6F |
1/2/3 |
25-59 |
|
Total |
30 |
30 |
20-70 |
Note. F-female M-male
Setting
Some of the questions in the interview guide focused
on experiences with the mid-term assessment (MTA). The MTA takes place midway
through the students’ clinical placement, typically four to five weeks into
their rotation. The three participants in the MTA are the students, the
university professor, and the clinical supervisor. The assessment is centered
around a form outlining the learning outcomes specific to that clinical
placement, which the student completes in advance. The purpose of the MTA is to
assess whether the student has reached the expected learning outcomes and to
identify areas for improvement during the remainder of the placement. The interviews
were conducted after the MTA, either in a private room at the university or in
a clinical setting.
Data collection
Thirty in-depth interviews with students, professors and supervisors
were conducted. A semi-structured interview guide was used for the interviews.
The students were asked about their experiences of being assessed, including self-assessment
and its role in clinical practice, their relationship with
their supervisor, and their overall experiences related to being a student in
clinical practice. The professors and the supervisors were asked questions
regarding their experiences of supervising students in clinical practice, including
assessing students’ clinical practice and their role in facilitating students’
self-assessment. The interviews had a median duration of 45 minutes.
The interview guide was not derived from a
specific theoretical framework; rather, it was developed collaboratively by the
three researchers in conjunction with the broader research group. A pilot test
was conducted to evaluate the clarity and relevance of the questions, and the
guide was subsequently refined based on the pilot findings.
Table 2
Examples of Questions from the Final Interview Guide.
|
Examples of Questions from the Interview Guide |
|
|
To Student/s |
Can you tell a little about the expectations you had
for the mid-term assessment? |
|
To Student/s |
Can you tell how you prepared for the midterm
assessment? |
|
To Student/s |
Did you get help from a clinical supervisor during
practice or a professor from university (to prepare ahead of mid-term
assessment) |
|
To Student/s |
Who spoke during the evaluation? Is there anyone you
think should have spoken more/less |
|
To professor/s and Clinical Supervisor/s |
Can you describe a typical assessment situation, how
it takes place? |
|
To Professor/s and Clinical Supervisor/s |
What do you do beforehand (Midt-term assessment),
any follow-up work, the contact you have with both the student and the
Clinical supervisor/professor during practice? |
Ethical Considerations
In August 2017, the
Norwegian Centre for Research Data (now SIKT) approved the project (case number
54821). Permission to conduct interviews was also obtained from the programme
coordinators for years 1-3 of the University’s Bachelor of Nursing programme,
as well as from the department head. In addition, the directors and
departmental managers of the participating healthcare institutions and units approved
to conduct interviews. The purpose and specific objectives of the study were
clearly communicated, both verbally and in writing, to all participating
students, professors, and clinical supervisors. The researcher emphasized that
participation was voluntary and that they could withdraw at any time without negative
consequences. Written informed consent was obtained from all participants. All data were securely stored on an encrypted memory
stick, which was kept in a locked drawer in accordance with a risk and
vulnerability analysis.
Analysis
The six-step thematic analysis method developed by Braun and Clarke
(2006/2022) was used to analyze the data. As the interviews were transcribed, the
initial reading of the material took place. During the transcription process,
comments and preliminary codes were created, with a specific focus on
self-assessment and facilitators for self-assessment. All data were uploaded
into NVIVO, a qualitative analysis software, to assist in organizing the text.
During the second
reading, the data were manually reviewed line by line, and significant text
snippets related to various aspects of nursing students’ self-assessment in
clinical practice were coded in NVIVO. In the initial phase of analysis, an
inductive approach was employed, allowing themes to emerge directly from the
data. In the second phase, noteworthy excerpts were organized into new codes,
with particular attention to themes surrounding self-assessment and its
facilitation. During the third reading, the codes were further condensed and
refined, aligning them with the research questions. This phase involved an
iterative process of moving back and forth between excerpts, initial codes, and
the development of more focused, condensed codes.
During the
analysis process, themes related to students’ reflections and self-assessment
of their clinical competencies were identified and coded. Additionally, themes
concerning how professors and supervisors facilitated students’ understanding
of clinical competencies were also coded. Through further rounds of theme
condensation, three overarching themes emerged, guided by the research
question. These themes were: i) Students’ self-assessment and reflection on
their professional development, ii) Preparedness, and iii) The role of professors
and supervisors in facilitating students’ self-assessment. All three authors of
this article reached a consensus on the final themes as requested by Braun and
Clarke (2022).
The following section will elaborate on the
findings. Quotations will be cited using codes to identify the participants: students
will be labelled as ST1, ST2, professors as P1, P2 and clinical supervisors as CS1,
CS2.
Findings
Students’ Self-assessment of Professional Development
While students reflected
on their professional development within the nursing profession, they provided
various examples of how they had integrated and applied their theoretical knowledge.
These examples ranged from communication and interaction skills to specific
procedures like measuring blood pressure. As they shared their reflections,
they appeared surprised at their ability to manage different skills learned in
school and apply this knowledge in clinical practice. To illustrate this
ongoing reflection, a first-year student stated during an interview:
“Everything from heart rate and blood pressure to respiration. We have
practiced a lot of the concepts we went through in school here (in clinical
practice), and I feel like I have excellent control over them” (ST1). The student's
expression of having “excellent control” over these skills serves as a form of
self-assessment, highlighting their professional growth in clinical
competencies. Another example is the application of communication to clinical
abilities, as described by one student: “But now that you see the many
perspectives of communication, how to act around someone who has dementia, and
requires more time [...] it has become apparent” (ST2).
These findings
indicate that clinical practice provided students with valuable insights into
the nursing profession and various approaches to patient care, although these
were not always apparent in the initial weeks. This was particularly noted in
psychiatric units due to the lack of concrete tasks. Initially, the students viewed
supervisors and co-workers as merely sitting with residents in the living room.
However, they gradually realized that these professionals were actively
employing clinical observations, knowledge, and interaction skills, even when
they appeared to be ‘sitting still.’ This understanding was exemplified by a
second-year student during an interview:
“You feel like
you’re just sitting around doing nothing, so it took me a while to grasp what
they’re actually doing here […]. Simply watching how a resident seems today and
then discussing it. Then I reflected, ‘Oh yes, they have noticed, sure, right.’
... there is a lot more (of nursing skills/clinical competencies) than you
might imagine” (ST3).
Thus,
being able to understand the rationale behind activities, such as why and how
to interact with patients, or how to communicate with patients in settings like
a psychiatric ward or with individuals with dementia, was described as
essential to be able to reflect on relevant personal skills. As one student
stated:
“There is now greater clarity regarding communication
theories, including guidance on appropriate interaction with individuals with
dementia who may require additional time” (ST4).
In other words, understanding the reasoning behind patient interaction
and communication, particularly in complex settings like dementia care, was
seen as crucial for fostering self-reflection and personal skill development.
Preparedness for the MTA
Students who familiarized
themselves with the assessment form and were prepared in advance of the MTA demonstrated
a stronger understanding of self-assessment. In terms of preparations for the
mid-term evaluation, where students are expected to perform a self-assessment
of their professional development, there was considerable variation in their
preparatory activities and overall readiness. The findings revealed a spectrum
from students who were thoroughly prepared to those who were inadequately
prepared for the mid-term evaluation. Illustrating the lack of preparation, a
first-year student commented during an interview:
“I wasn't prepared at all... I just showed up” (ST5).
A student shared a similar perspective on not being adequately prepared:
“I hadn´t spoken with my clinical supervisor about the mid-term assessment
because I thought she could simply show up to the assessment and observe how it
unfolded. [...]. I approached the mid-term evaluation with an open mind and few
expectations” (ST6).
Conversely, some students reported being
well-prepared, as exemplified by one student's statement:
“I had generally noted every single learning outcome and what I had done
in relation to it, along with the theoretical aspects” (ST2).
This approach could help students connect learning
situations and activities to the learning outcomes in the ward, enabling them
to better self-assess whether they have achieved the expected outcomes.
Another student highlighted the use of theoretical knowledge as a method
of preparation for the mid-term evaluation, expressed during an interview:
“I had read extensively” (textbooks
related to the curriculum) (ST7). The student emphasized the value of
reading to be prepared, and thus also being able to respond to the learning
outcomes with a deeper and contextual understanding. Other students prepared
for the mid-term evaluation by engaging in discussions about their learning
experiences with their clinical supervisor. One student shared how she prepared
for her self-assessment to be demonstrated during the midterm evaluation: “Before the mid-term evaluation, the
supervisor and I discussed my views regarding my experiences with the others,
and when I was working independently, how it went, and my thoughts on it” (ST8).
Students were self-assessing their
perceived performance in relation to specific assessment criteria, as addressed
by another student:
“I summarized my perceived performance against the criteria established
beforehand. I felt confident about meeting these criteria and maintaining
control, which was subsequently confirmed as satisfactory” (ST9).
Some students considered how they might have been better prepared for
the mid-term assessment, which would assist in evaluating their professional
development. One student identified a potential area for improvement:
“Perhaps I should have read
more or engaged in further discussions with my nursing supervisor” (ST10).
Another student shared her thoughts while considering possible
improvements:
“I could perhaps have been even
more explicit about the nursing concepts (in the learning outcomes), as those
concepts eventually encompassed quite a lot” (ST11).
This statement reflects a student’s realization about the complexity and
breadth of nursing concepts embedded within the learning outcomes. It illustrates
the student’s awareness of the challenges in mastering comprehensive nursing
concepts and her commitment to enhancing her professional development.
To summarize, students’ preparedness for the mid-term assessment (MTA)
varied widely, ranging from thoroughly prepared to inadequately prepared. Those
who reviewed the assessment form and prepared in advance demonstrated stronger
self-assessment skills. Effective preparation strategies included mapping
clinical experiences to learning outcomes, extensive reading of relevant
theory, discussing progress with clinical supervisors, and summarizing
performance against predefined criteria. Some students arrived unprepared,
expecting to ‘see how it unfolds,’ while others later identified gaps, such as
needing more reading, discussion, or clearer articulation of nursing concepts.
Overall, readiness enhanced the quality of self-assessment and facilitated a
deeper, more contextual understanding of learning outcomes.
Professors and Supervisors’
Role in Facilitating Students’ Self-assessment
Some professors and
supervisors believed that encouraging students’ independence would enhance
their ability to connect learning outcomes with related clinical tasks, thereby
facilitating self-assessment. To cultivate this independence, students needed
opportunities to experience, reflect, and understand the connection between theoretical
knowledge and clinical practice. Professors saw it as their duty to assist
students in applying theoretical knowledge to clinical tasks pertinent to the
ward, guiding them in interpreting their knowledge during patient interactions
and enhancing professional development. One supervisor said during an
interview:
“It was quite productive
because when the teacher bases the evaluation on the student rather than a set
of standardized questions, I think it is more beneficial for the students in
terms of what they should focus on moving forward” (CS1).
Several supervisors highlighted the role of language as a key element in
bridging the gap between theoretical knowledge and practical application,
offering a clear connection. To ensure coherence for students, supervisors
stressed the importance of using everyday language, particularly for those
whose first language was not Norwegian. A supervisor emphasized this during an
interview:
“Maybe we just
have to use ordinary words” (CS2), referring to the general language in the
learning outcomes, and how a practical language could be more suitable for
clinical activities.
One supervisor gave a concrete example during an interview:
“Students knew a
lot about it (aesthetics), but they were not familiar with the word. Before understanding the content of the word
aesthetics (through teacher and supervisors’ explanation), they were completely
paralyzed and didn’t dare mention it” (CS3).
This example illustrates how the supervisor and teacher facilitated
students’ self-assessment of clinical competencies by providing practical
examples of words like aesthetics in clinical practice. Supervisors also
acknowledged the difficulty of translating theoretical concepts into practical
activities, drawing from their own experiences as students. One supervisor
highlighted this challenge during an interview:
“I understand as a student,
and I remember well as a student myself that…just decoding the concepts in the assessment
form is a process” (CS4).
The supervisor reflected on her prior experiences as a student,
including how to navigate the assessment form, informing her understanding of
the challenges students encounter when completing it. Professors reported that
clinical supervisors often described students as ‘intelligent,’ ‘skilled,’ and ‘fitting
in well’ when evaluating their professional development during the MTA.
Although professors understood the intended context of these remarks—typically
referring to effective communication with patients and colleagues—they regarded
such characterizations as insufficiently specific to support students’
self-assessment and achievement of learning outcomes. Interview data indicated
that professors facilitated greater precision by encouraging supervisors to specify
behaviours, provide concrete examples, and reference criteria when evaluations
were vague. Professors interpreted general remarks about students’ performances
such as ‘so effective,’ ‘it goes so smoothly,’ and ‘the student is so bright’—as
reflections of the students’ ability to assess their own skills. As one
professor explained:
“I have to
challenge the supervisor, (and ask) ‘what does that mean?” (P1).
An alternative approach for professors in facilitating students’
self-assessment of their professional development was through engaging in a
dialogue with the student during the mid-term assessment. This was highlighted
by a student in an interview:
“There weren't
many concrete questions; instead, it felt like a conversation around topics so
he could assess whether I had gained anything and learned from the situations I
had encountered” (S12).
This quote
underscores the importance of time and flexibility in the learning and
assessment process. Rather than adhering to a rigid format with specific
questions, the supervisor opted for a more conversational approach. This
flexibility allows for a deeper exploration of the students’ experiences and
understanding, fostering a more comprehensive assessment of their personal development.
Providing time during
mid-term assessments for students to reflect and self-assess their professional
development was therefore described as essential. The quote below reflects a student's perception of the balance of
contributions between themselves and the teacher during the assessment. By
expressing this interaction in percentages, the student indicates that they
feel they are taking a slightly larger role in their assessment:
The interviews also show the need for structured support
and clearly defined expectations to facilitate meaningful self-assessment and
active engagement in clinical practice. By setting clear expectations and
providing consistent feedback, teachers and supervisors seem to be better able
to make students take their clinical placements seriously and engage deeply in
their learning process, ultimately fostering the development of skilled and
reflective practitioners. However, such conditions were not always present. Some students emphasized how the lack of expectations
from the teacher and/or supervisor prevented students from entering a critical
self-assessment process, as exemplified by a student in the quote below:
“I suppose I would have taken this clinical placement
much more seriously (with higher expectations). Unfortunately, I haven’t
managed to take it very seriously” (ST14).
Similarly, another student emphasized how the
lack of expectations of theoretical knowledge was something that did not
encourage active preparedness:
“We asked whether there was anything we needed to read before the
mid-term evaluation, and he said, ‘No, no, we won’t be discussing anything like
that’” (ST15).
Overall, these quotes highlight the importance of setting
expectations that encourage students to engage with both the theoretical and
practical aspects of their education. By offering clear guidance and
emphasizing the relevance of theoretical knowledge, educators can support
students in becoming more active and prepared participants in their clinical
learning experiences, while also facilitating the assessment of their
professional development.
Discussion
This study explores nursing students’ self-assessment of their
professional development, from the perspectives of both students, professors,
and clinical supervisors. Further, the study also explores how these educators
facilitate students’ ability to self-assess their progress. As Baars et al. (2020)
and de Vries et al. (2022) underline, the students’ ability to self-assess
depends on their capacity for metacognition. When students are
well-prepared, they are better able to engage in metacognitive activities such
as planning, self-monitoring, and reflecting on their clinical performance
(Baars et al., 2020; de Vries et al., 2022). One dimension of self-assessment
was related to preparedness. Our findings show that preparation for mid-term
evaluations revealed a wide range of readiness among students, with some
feeling thoroughly prepared and others being inadequately prepared. Well-prepared
students reported a deeper understanding of learning outcomes during mid-term
assessment. Conversely, a lack of preparedness can hinder metacognitive
thinking, leaving students feeling unsupported and stressed. Accordingly,
fostering preparedness through clear guidance, time for reflection, and
structured assessment tools is essential in helping nursing students develop
both their practical skills and their metacognitive abilities.
In general, the findings
highlight the importance of nursing students’ self-assessment in the process of
developing their nursing skills. The findings also underscore the vital role of
clinical practice in bridging theoretical knowledge with practical skills. The
importance of integrating theoretical knowledge with practical application was
underscored, and students recognized the need for clear expectations and
structured support from professors and supervisors to facilitate meaningful
self-assessment.
Students were pleasantly surprised by their ability to apply
communication skills and clinical procedures in real-world settings. Through
reflective practice, they gained deeper insights into their growing proficiency
and understanding of various nursing competencies. This reflection not only
reinforced their theoretical knowledge but also highlighted their progression
in effectively bridging theoretical knowledge with practical patient care. Our
findings are in accordance with Manning (2020), who underscored the importance
of reflection during clinical practice and how self-assessment plays an
important role in identifying strengths and areas for improvement, ensuring
continuous learning, thus contributing to continuous professional development
and secure patient care. Further, continuous self-assessment enhances personal accountability
and ownership of decisions made in clinical practice.
Our study also
highlighted challenges, such as the lack of clear expectations from educators,
which hindered students’ ability to critically assess their progress. By
setting expectations and providing consistent feedback, educators can encourage
students to engage with both theoretical and practical aspects of their
education, ultimately fostering skilled and reflective practitioners. It is,
however, important to note that some students were capable of ensuring their
progress, without any expectations from their professors in assessment
situations, such as mid-term assessment, underlining the importance of taking responsibility
for their own professional development. As our findings indicated, another
study demonstrated that increased competence and experience in the skill or
knowledge being evaluated is a significant factor in
enhancing the accuracy of self-assessment (Panadero et al., 2015).
According to Kruger & Dunning (1999), those who are low-performing
students tend to overestimate their clinical performance, whereas
high-performing students tend to underestimate it. This phenomenon, known as
the Dunning-Kruger effect, arises because those with limited expertise often
lack the metacognitive ability to recognize their own shortcomings. However,
our findings do not provide a clear link between students’ performance levels
and their capacity to accurately evaluate themselves against the learning
outcomes. Instead, the issue seems to revolve around preparedness, thus
responsibility, and the extent to which supervisors and professors facilitated
the students’ professional development.
Thus, students should be provided with genuine opportunities to prepare,
develop, and practice their self-assessment skills (Kajander-Unkuri et al.,
2020). According to Taylor et al. (2020), the capacity for reflection and
self-assessment necessitates experience, which includes significant time
engaged in clinical practice. This ability is observed to enhance annually
among nursing bachelor students (Kajander-Unkuri et al., 2020). This is in
accordance with the findings in our study, where time was seen as essential to
be able to reflect
and thus gain a deeper understanding
of the different nursing tasks and related skills.
However, the students’ need for time often conflicts
with supervisors’ expectations for efficiency in tasks such as patient
communication or morning care, where efficacy is considered a key nursing
skill. This discrepancy between supervisors’ and professors’ expectations and
the students’ learning needs may potentially create a gap between learning and performing
concrete nursing tasks. According to Taylor et al. (2020), there is a necessity
for a transitional space between learning and working. To integrate the student
into this transitional space, the supervisor plays a crucial role by assisting
students in reflecting and critically evaluating their own or their co-workers'
clinical performances. Furthermore, engaging in self-assessment also helps the
students to identify their professional development needs. Our findings show that
professors and supervisors play a crucial role in facilitating students’
self-assessment by encouraging independence and providing opportunities to
connect theory with practice. Engaging students in dialogue during assessments further
promoted a deeper exploration of experiences and personal development. However, supervisors often
used vague expressions such as ‘so effective,’ ‘it goes so smoothly,’ ‘the
student is so bright,’ or ‘slides right into the environment’ when assessing
students. These ambiguous phrases made it difficult for students to critically
evaluate their professional development or measure their performance against
specific learning outcomes.
These findings align with a study by Zeleniková
et al. (2023), which highlights the critical role of supervision during
clinical practise as a key factor influencing students’ ability to evaluate
their own competencies. Similarly, other studies suggest that a contributing
factor to challenges in self-assessment may be the lack of systematic
integration of self-assessment practices within the formal education system
(Gardulf et al., 2016; Kajander-Unkuri et al., 2016; Kajander-Unkuri et al.,
2020).
These challenges in
self-assessment, compounded by the use of vague feedback, highlight the
critical role of professors and supervisors in creating a supportive learning
environment. One key finding in this study
is that when professors and supervisors fail to recognize the importance of
time and reflection, students may feel unsupported in their learning journey,
potentially prolonging their development due to a lack of guidance and feedback
on their clinical performance. Research indicates that stress adversely affects
learning (Nayar et al., 2019). Consequently, pressuring students to prioritize efficiency
over reflection can hinder learning, causing additional stress as they strive
to meet supervisors’ expectations. Providing students with adequate time for
reflection to self-assess their clinical competence not only strengthens their
professional development but also enhances patient safety and quality of care
(Ambrose & Ker, 2014; Strandbygaard et al., 2013; Sweet et al., 2019).
Conclusion
In conclusion, this study underscores the critical
role of self-assessment in nursing students’ professional development,
highlighting how educators can facilitate this process. The findings reveal
that while clinical practice is indispensable for bridging theoretical
knowledge with practical skills, the integration of reflective practice and
structured support from professors and supervisors is equally vital. Students’
abilities to apply communication skills and clinical procedures in real-world
settings were enhanced through reflection, reinforcing their theoretical
knowledge, and advancing their practical proficiency.
However, the study identifies challenges such as
inconsistent expectations from educators, which can impede students’ ability to
critically assess their progress. Educators need to establish clear
expectations and provide consistent feedback to promote effective
self-assessment. The variance in student preparedness for mid-term evaluations
further illustrates the need for genuine opportunities to develop
self-assessment skills. The research
also explores the Dunning-Kruger effect, where less experienced students may
overestimate their abilities, while high-performing students might
underestimate theirs. Despite this, no definitive link was found between
performance levels and self-assessment accuracy, suggesting that the focus
should be on preparedness and the role of educators in facilitating
professional growth. Insufficient preparation may impede metacognitive
processes, leading students to perceive inadequate support and heightened
stress.
Overall, this study advocates for a more
structured approach to self-assessment within nursing education, emphasizing
the critical role of educators in bridging the gap between theoretical learning
and practical application, as well as facilitating meaningful reflections on
clinical experiences.
Implications
This study highlights the importance of structured
self-assessment processes in nursing education to facilitate the development of
clinical competencies. Educators should prioritize creating clear expectations
and providing consistent feedback to help students effectively integrate
theoretical knowledge with practical application. By incorporating regular
opportunities for reflection and dialogue, both in the classroom and clinical
settings, educators can enhance students’ ability to critically assess their
progress. This approach not only aids in bridging the gap between theoretical
learning and practical application but also supports students in identifying
their professional development needs. Furthermore, balancing the demand for
efficiency with the need for reflective practice can mitigate stress and
improve learning outcomes, ultimately leading to better patient care.
Supervisors should recognize the importance of transitional spaces for learning
and working, where students can critically evaluate their clinical performance,
thereby fostering skilled, reflective practitioners who are well-prepared for
the complexities of patient care.
Limitations and Suggestions for Future
Research
Limitation
This study primarily relies on qualitative data from
one educational institution in Norway, which may limit the transferability of
the findings across different educational contexts and institutions.
Additionally, the study focuses on self-assessment processes within a specific
cultural and educational framework, potentially overlooking variations in
practices and expectations in other regions. The sample size and the diversity
of participants may also affect the breadth of insights, as they may not fully
capture the range of experiences encountered by nursing students globally. On
the other hand, self-assessment is a significant topic in many professions, and
the findings may therefore be beneficial for other educational programs.
Future Research
Further research should explore the impact of
structured self-assessment processes on long-term clinical competence and
professional development across diverse educational settings. Quantitative
studies could provide a broader understanding of how different self-assessment
approaches affect learning outcomes and patient care. Additionally, examining
the role of technology and digital tools in facilitating self-assessment and
reflection could offer innovative strategies for enhancing educational practices.
Research should also investigate the perspectives of educators and supervisors
on the challenges and benefits of integrating self-assessment into nursing
curricula, providing insights into effective implementation strategies across
various contexts.
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