Perception of self-assessment (SA) in learning nursing clinical skills

Background: Nursing is a practice-based discipline. Self-assessment (SA) encourages students to critically analyze their theoretical knowledge and apply them to practical settings. The aim of the study was to explore their perception of SA before and after its introduction Methodology: Pre validated semi-structured interview based on blood drawing and intra venous (IV) drug administering procedures for 2 nd and 3 rd year students. Results: Before introducing SA, students had concerns regarding the influence of ego, and SA will not be reliable in assessing nursing skills. After exposure, they were more optimistic about the benefits, obtained insight into performance and reflective learning. Conclusion: Students’ exposure to SA created a more positive outlook towards learning clinical skills.


Introduction
Nursing education strives to make changes in all three learning domains: cognitive, psychomotor, and affective. Currently, nursing education is adopting the concept of studentcentred learning with an increasing trend of incorporating self-assessment in clinical settings (Sun et al., 2014). SA is a fundamental concept concerning professional development that is emphasized in contemporary health care. According to Habermas (2010), SA is a strategic pathway of becoming conscious of one's experiences learning through critical thinking and reflection.
In the practice of SA, students connect, rethink and analyse new experiences comparing with what they already know. However, adopting SA and reflection in nursing education are challenging because it depends on the learners' perspectives. Though the literature emphasizes the value of SA in nursing education, it is an under-researched area in Sri Lanka.

Objectives
To explore their perception of self-assessment before and after its introduction among undergraduate nursing students of the Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka.

Methodology
Ethics approval was obtained from the faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka. Research design A qualitative explorative design.

Study population
Undergraduates registered for the BSc nursing program at the University of Peradeniya, Sri Lanka (150 students).

Inclusion criteria
Undergraduates in the 2nd and 3rd academic years of the BSc Nursing program (75 students).

Sampling method Convenient purposive sampling method
Data collection was conducted based on three stages: conducting semi-structured interviews before and after the introduction of SA, and conducting focused group discussions after the introduction of SA. 27 students were interviewed before and after the introduction of SA .36 students participated in four discussion groups parallelly.

Process of the introduction of SA
Subsequently, pre validated scale and assessment criteria for blood drawing and IV drug administering procedure were introduced.
Interventions were carried out in medical and surgical wards at Teaching Hospital Kurunegala. Students were requested to complete the SA guide reflecting on their performance comparing their performances to the guide.

Data Analysis
Thematic analysis was conducted based on Braun and Clarke (2006).

Results
Perceptions of nursing undergraduate on SA before its introduction:

Discussion
Changes were identified in a more positive direction after the SA activity. Students revealed SA improved self-confidence and self-esteem and helped identify one's weaknesses to initiate self-directed learning through reflective practice and gained insight. Similarly, as reported by Schunk (1996), students followed three main steps: focus on self-observation, self-judgements, critical analysis, and self-reaction during SA.
After experiencing, students identified the correct process of incoparating SA based on a validated guideline combined with peer assessment which will enrich the learning process. Since students are not used to this practice, provision of training before commencement were requested. Four steps were suggested to improve validity as adopting an extended rubric, training to apply rubric into practice, combining with teacher feedback or peer feedback, and the need for the students to be motivated.

Conclusion
Changes were identified in a more positive direction after the SA activity. Students mentioned that they felt less dependent on the teacher and engaged in self-directed learning. Detailed guidelines with assessment criteria (rubric) should be developed by teachers and should be aligned with the lesson objectives of the given academic year.