The scientific and reasonable assessment content will play a positive role in promoting teaching. The content of traditional basic nursing skill practice assessment focused on individual single assessment, emphasized the unity of skill operation steps and procedures, and was lack of horizontal connection between various operations, resulting in students’ insufficient understanding of the complexity of clinical operations, which is not conducive to cultivating students’ overall nursing awareness and flexible response ability [1] . For these reasons, the course assessment content has been changed from the original individual skill assessment to a combination of individual skill assessment, virtual simulation single assessment, and team skill comprehensive assessment, using case studies as the carrier for assessment. The team skill assessment items are 2. The assessment content was designed based on clinical practice and clinical cases, emphasizing the combination of theory and practice, and the combination of foundation and clinical practice, emphasizing the cultivation of students’ comprehensive qualities and abilities [8] .

The assessment method was changed from individual skills assessment at the end of the term to a combination of individual skills assessment at the midterm and virtual simulation assessment and team skills assessment at the end of the term. The assessment team was a group of 2 people. Based on the clinical case given, the team discussed and determined the 2 nursing operations needed to solve the patient’s problem, and discussed, organized, and designed operation name, items required for operation and operation steps. Each person was randomly assessed for one operation, and then gave the appropriate nursing care to the patient in the case. The details are shown in Table 1.

In the past teaching, the final examination accounted for 100%, in which the single operation examination accounted for 90%, and the student attendance accounted for 10%. After the reform, the mid-term assessment (30% for single operation assessment, 15% for practical reports, and 5% for student attendance) and the final assessment (10% for virtual simulation operation assessment, 20% for team operation assessment, and 20% for comprehensive team assessment) each accounted for 50%. The details are shown in Table 1.

The method of combining summative evaluation (final operational assessment, attendance) with formative evaluation (mid-term operational assessment, attendance) and summative evaluation (team operational assessment, virtual simulation

operational assessment, practical report, comprehensive evaluation) has replaced the summative evaluation (final operational assessment, attendance); In the comprehensive skills assessment of the team, a combination of individual assessment and comprehensive assessment is adopted. The mid-term individual assessment includes the refinement, standardization, and standardization of operating steps and procedures. The comprehensive assessment includes nine items: quality requirements, team awareness, first aid awareness, organizational and coordination ability, and humanistic care. Please refer to Table 1 for details.

After the practical assessment, a self-made questionnaire was used to know the students’ satisfaction with the assessment content, assessment ratio, assessment method, and evaluation method. There were also open-ended questions to know students’ opinions about the course assessment. The questionnaire was tested by three nursing education experts and pre surveyed by 20 students. The reliability and validity of the questionnaire were retested with a reliability of 0.83 and a content validity of 0.87.

The total score of students is divided into five grades: Grade A (90 - 100 points, excellent), Grade B (80 - 89 points, good), Grade C (70 - 79 points, fair), Grade D (60 - 69 points, passing), and Grade E (less than 60 points, failing).

The study results show that students’ satisfaction with the assessment reform is 86.84%, and the students’ scores are all above 80 points. It indicates that students have a supportive attitude towards the examination reform, and the students’ performance has improved significantly. 89.47% of the students think that the content of examination after the reform is more reasonable and comprehensive. On the one hand, the regular assessment is a kind of supervision for students, which is conducive to consolidating their knowledge and skills. In addition, virtual simulation assessment is added to the final assessment, which is rich in content, vivid and intuitive, stimulates the visual, tactile and auditory senses, and enhances students’ learning interest, practical ability and independent learning ability [9] , and students feel that this method is closer to the actual clinical situation and easy to integrate in learning and assessment, but they may worry about the high deduction of points for their own operation to hurt patients, which also reflects that virtual simulation practice helps to cultivate students’ injury-friendly concept and safety awareness [10] , shortening the transformation process from student to nurse, from classroom to clinical transformation process [11] . The study shows that the assessment reform was recognized by most students and promoted the learning effect, which is worth extending to other course assessments.

Building a diversified and developmental evaluation system based on comprehensive quality assessment [12] is the current development trend. This study shows that students’ satisfaction with the assessment and evaluation methods is 88.15% on average, because the traditional examination methods focused excessively on the standardization and proficiency of skill operations, mainly measured by the assessment results of single operational skills, and used traditional summative evaluation methods, which made students less motivated to learn. The reformed assessment mode, however, adjusted the assessment ratio and adopted the assessment and evaluation methods combining clinical cases and virtual simulation, individual single and team synthesis, the process evaluation and summative evaluation, and the evaluation criteria were closely integrated with the clinic, avoiding the phenomenon of disconnection between assessment and clinic [13] . In the team comprehensive assessment, students realized that the level of one person’s performance was not only closely related to themselves, but also related to the immediate interests of team members, and was motivated to study harder and more actively. In addition, the diversified evaluation method reduced the pressure and randomness of the final examination, and comprehensively and objectively tested the comprehensive quality and ability of students in terms of knowledge, operational ability, attitude, and behavior.