Development and content validation of a comprehensive nursing care assessment rubric (CNAR) in simulation

Background: Simulation is a staple of nursing education, yet assessment often relies on scenario-specific checklists. While useful for beginners, checklists can foster a task-oriented approach that fragments care and increases faculty workload due to the need for constant tool development. There is a critical need for a standardized instrument that evaluates not only physical skills but also the integration of safety, communication, and clinical judgment across diverse adult medical-surgical scenarios. Purpose: This study aimed to develop and establish the content validity of the Comprehensive Nursing Care Assessment Rubric (CNAR), a standardized, process-oriented tool designed to assess comprehensive nursing care competencies, specifically targeting physical assessment and clinical judgment, in simulation-based learning environments. Methods: A methodological research design was employed. Phase 1 involved constructing a 54-item rubric based on established clinical guidelines and nursing competency frameworks. Phase 2 involved rigorous content validation by a panel of 5 expert nursing academics. Experts rated item relevance on a 4-point Likert scale and provided qualitative feedback. Item-level (I-CVI) and Scale-level (S-CVI/Ave) Content Validity Indices were calculated. Results: The rubric demonstrated exceptional content validity, achieving an overall S-CVI/Ave of 0.99. Qualitative thematic analysis using Braun and Clarke’s framework led to substantive revisions, including refining the history-taking process for medication safety, expanding symptom assessment parameters, and incorporating physiological integrity. Crucially, the domain of clinical judgment was validated as a core component of the assessment. Conclusion: The CNAR is a content-valid instrument. Focusing on universal nursing competencies rather than case-specific tasks, it provides educators with a sustainable and standardized approach to evaluating student performance.