Triangulation for the assessment of clinical nursing skills: A review of theory, use and methodology

Aim: To review the use and usefulness of the methodological strategy of triangulation in the assessment of skill in nursing curricula. Design: Systematic search of the literature relevant to the definition and assessment of skill, reliability and validity of assessment methods and triangulation of assessment strategies. Data sources: One hundred and twenty papers from nursing, medical, educational and social scientific databases, relevant websites and relevant books were reviewed. Forty papers were included based on their relevance to the theory and methodology of clinical skills assessment of health care professionals, particularly nurses. Papers concerning vocational skills assessment and the assessment of skill in school children were excluded. Results: There is a current imperative within the field of health care professional education to assess clinical skills and to quantify this assessment. However, clinical skill, as it relates to cognition, is poorly defined concept and may be viewed as a quality of the practitioner and, as such, is difficult to quantify. Very many methods of assessing clinical skill have been documented and there are inherent issues in ensuring both reliability and validity of these assessment strategies for clinical skill. This has led commentators to suggest that the process of triangulation should be employed. Conclusions: The paper fundamentally questions whether the concept of triangulation can be applied to skills assessment without dependable measures of reliability and validity of the tools of assessment and concludes that the process of applying multiple modes of assessment should not be confused with the process of triangulation. (C) 2009 Elsevier Ltd. All rights reserved.