Evaluation of an undergraduate nursing entrustable professional activities framework: An exploratory qualitative research

Background: Entrustable professional activities (EPA) are mainly used in graduate medical education and professional development and have not been widely implemented in nursing undergraduate settings. Nursing EPAs were therefore developed by the Alice Lee Centre of Nursing to translate theoretical nursing competencies into clinical practice and as forms of standardized clinical assessment tools. Feedback from various stakeholders is required to further refine the framework. Objectives: To explore the perceptions and experiences of using the new EPA framework in nursing students and hospital and university clinical instructors. Design: An exploratory qualitative study using focus group interviews. Participants: Seven year-one nursing undergraduates, 12 year-two undergraduates, seven university clinical instructors, and 18 hospital clinical instructors participated in this study. Methods: The students formed five groups, while the clinical instructors formed seven groups, each consisting of three to four participants. Semi-structured interviews were conducted to explore stakeholders' experiences and perceptions of the EPA assessment framework. Thematic analysis was used to analyze the data. Results: Despite initial mixed reactions of confusion and relief, many students and clinical instructors commended the comprehensive and structured EPA framework and its emphasis on holistic patient-centered care. EPAs also allow flexible assessment methods, encourage critical thinking among students, and promote team-based care and peer teaching. However, the assessment using a two-dimensional matrix with multiple competencies for the EPAs, subjective assessment criteria, the lack of standardization using checklists, subjective assessment criteria, and the lack of, manpower, and time may potentially affect the accuracy of the clinical assessments. The effectiveness of the EPA framework was also dependent on the quality of feedback, students' intrinsic motivations, and learning environments. The refinement of EPAs and entrustment levels, a physical checklist, and an incorporation of EPAs into school curricula were recommended to improve practitioners' learning experiences. Conclusions: The use of EPAs in nursing education continues to be a novel and evolving process. There remains a need for a further refinement of the EPA framework to tailor to instructors' expectations and students' capabilities.