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Dunemn, Kathleen

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Current evaluation of clinical competency in nurse-midwifery education programs lacks clarity and consistency and is often a subjective process using a variety of assessment strategies. Recognizing that no single assessment strategy can provide all the information required to assess something as complex as clinical performance, the objective structured clinical examination (OSCE), when viewed alongside other forms of assessment, might be considered a valuable strategy for enhancing the assessment of nurse-midwifery student clinical competence and confidence. The main objective of this dissertation was to assess and compare self-reported confidence and anxiety levels of graduate nurse-midwifery students pre- and post-OSCE. This exploratory quantitative research study was designed to explore student self-confidence and anxiety with OSCEs in the development of clinical decision-making through the use of the Nursing Anxiety and Self-confidence with Clinical Decision-Making (NASC-CDM; White, 2014) questionnaire that has not been used previously in the graduate nurse-midwifery population. Ten graduate second-year nurse-midwifery students in both the Doctor of Nursing Practice (DNP) and Master of Science in Nursing (MN) programs of study participated; the setting was at a northwest United States public university. Participants completed a total of four OSCEs between February and April of 2021. Measures included the NASC-CDM (White, 2014); this 27-item questionnaire was completed by students pre and post OSCE. In addition, the NASC-CDM (White, 2014) was assessed for both validity and reliability for use in this study’s population and setting. Three content experts found the NASC-CDM valid for use in this study’s population. Cronbach’s alpha found the reliability of the NASC-CDM at a= 0.94 for self-confidence and a= 0.94 for anxiety. Using paired t-testing, statistically significant differences occurred pre and post OSCE for both self-confidence p < .000 and anxiety p < .001. The three dimensions of clinical decision-making were all statistically significant: dimension one at p < .000 for self-confidence and p < .023 for anxiety, dimension two at p < .008 for self-confidence and p < .005 for anxiety, and dimension three at p < .000 for self-confidence and anxiety. No statistical significance was found in comparisons of program of study, online vs. face-to-face OSCEs, or differences in self-confidence or anxiety over time. In this study, student self-confidence increased and anxiety decreased during OSCEs with the potential to positively affect strong confident clinical decisions in future clinical practicums and practice.


objective structured clinical examination; nurse-midwifery and nursing clinical education; student self-confidence and anxiety; clinical decision-making


119 pages

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