title: Development and psychometric testing of Holistic Clinical Assessment Tool (HCAT) for undergraduate nursing students.
abstract: BACKGROUND
  A major focus in nursing education is on the judgement of clinical performance, and it is a complex process due to the diverse nature of nursing practice. A holistic approach in assessment of competency is advocated. Difficulties in the development of valid and reliable assessment measures in nursing competency have resulted in the development of assessment instruments with an increase in face and content validity, but few studies have tested these instruments psychometrically. It is essential to develop a holistic assessment tool to meet the needs of the clinical education. The study aims to develop a Holistic Clinical Assessment Tool (HCAT) and test its psychometric properties.
  
  
  METHODS
  The HCAT was developed based on the systematic literature review and the findings of qualitative studies. An expert panel was invited to evaluate the content validity of the tool. A total of 130 final-year nursing undergraduate students were recruited to evaluate the psychometric properties (i.e. factor structure, internal consistency and test-retest reliability) of the tool.
  
  
  RESULTS
  The HCAT has good content validity with content validity index of .979. The exploratory factor analysis reveals a four-factor structure of the tool. The internal consistency and test-retest reliability of the HCAT are satisfactory with Cronbach alpha ranging from .789 to .965 and Intraclass Correlation Coefficient ranging from .881 to .979 for the four subscales and total scale.
  
  
  CONCLUSIONS
  HCAT has the potential to be used as a valid measure to evaluate clinical competence in nursing students, and provide specific and ongoing feedback to enhance the holistic clinical learning experience. In addition, HCAT functions as a tool for self-reflection, peer-assessment and guides preceptors in clinical teaching and assessment.
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore, 117597, Singapore. nurwux@nus.edu.sg.|School of Health and Welfare, Jönköping University, Jönköping, Sweden. nurwux@nus.edu.sg.
authors.forename: Xi Vivien
authors.initials: XV
authors.lastname: Wu
authors.affiliation: School of Health and Welfare, Jönköping University, Jönköping, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Enskär
authors.affiliation: Department of Education and Practice, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Lay Hoon
authors.initials: LH
authors.lastname: Pua
authors.affiliation: Nursing Education, National University Hospital, Singapore, Singapore.
authors.forename: Doreen Gek Noi
authors.initials: DG
authors.lastname: Heng
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore, 117597, Singapore.
authors.forename: Wenru
authors.initials: W
authors.lastname: Wang
keywords: Holistic clinical assessment tool; Psychometric testing; Tool development; Undergraduate nursing students