Clinical Evaluation in Nursing Education Its Types, Criteria and Competencies

Criteria and Competencies of Clinical Evaluation Its Types

Concept of Clinical Evaluation,Clinical Evaluation Versus Grading,Norm and Criterion Referenced Clinical Evaluation,Formative and Summative Clinical Evaluation,Fairness in Clinical Evaluation,Base Clinical Evaluation on Predetermined Outcomes or Competencies,Develop a Supportive Learning,Student Stress in Clinical Practice

Concept of Clinical Evaluation

    Clinical evaluation is a process by which judgments are made about learners' competencies in practice. This practice may involve care of patients, families, and communities; other types of experiences in the clinical setting; simulated experiences; and performance of various skills. Most often, clinical evaluation involves observing performance and arriving at judgments about the student's competence. 

    Judgments influence the data collected, that is, the specific types of observations made to evaluate the student's performance, and the inferences and conclusions drawn from the data about the quality of that performance. Teachers may collect different data to evaluate the same outcomes, and when presented with a series of observations about a student's performance in clinical practice, there may be little consistency in their judgments about how well that student performed. 

    Clinical evaluation is not an objective process; it is subjective involving judgments by the teacher and others involved in the process.Assessment and the Educational Process, the teacher's values influence evaluation. This is most apparent in clinical evaluation, where our values influence the observations we make of students and the judgments we make about the quality of their performance. Thus, it is important for teachers to be aware of their own values that might bias their judgments of students.

    This is not to suggest that clinical evaluation can be value-free; The teacher's observations of performance and conclusions will always be influenced by her or his values. The key is to develop an awareness of these values so as to avoid their influencing clinical evaluation to a point of unfairness to the student. For example, if the teacher prefers students who initiate discussions and participate actively in conferences, this value should not influence judgments about students' competencies in other areas. 

    The teacher needs to be aware of this preference to avoid an unfair evaluation of other dimensions of the students' clinical performance. Or, if the teacher is used to the fast pace of most acute care settings, when working with beginning students or someone who “moves slowly,” the teacher should be cautious not to let this prior experience influence expectations of performance. Clinical educators should examine their own values, attitudes, and beliefs so that they are aware of them as they teach and assess students' performance in practice settings.

Clinical Evaluation Versus Grading

    Clinical evaluation is not the same as grading. In evaluation, the teacher makes observations of performance and collects other types of data, then compares this information to a set of standards to arrive at a judgment. From this assessment, a quantitative symbol or grade may be applied to reflect the evaluation data and judgments made about performance. The clinical grade, such as pass fail or A through F, is the symbol used to represent the evaluation. 

    Clinical performance may be evaluated and not graded, such as with formative evaluation or feedback to the learner, or it may be graded. Grades, however, should not be assigned without sufficient data about clinical performance.

Norm and Criterion Referenced Clinical Evaluation

    Clinical evaluation may be either norm referenced or criteria referenced, as described, Assessment and the Educational Process. In norm-referenced evaluation, the student's clinical performance is compared with that of other students, indicating that the performance is better than, worse than, or equivalent to that of others in the comparison group or that the student has more or less knowledge, skill , or ability than the other students. 

    Rating students' clinical competencies in relation to others in the clinical group for example, indicating that the student was “average” is a norm referenced interpretation. In contrast, criterion referenced clinical evaluation involves comparing the student's clinical performance with predetermined criteria, not to the performance of other students in the group. In this type of clinical evaluation, the criteria are known in advance and used as the basis for evaluation. 

    Indicating that the student has met the clinical outcomes or achieved the clinical competencies, regardless of how other students performed, represents a criterion-referenced interpretation.

Formative and Summative Clinical Evaluation

    Clinical evaluation may be formative or summative. Formative evaluation in clinical practice provides feedback to learners about their progress in meeting the outcomes of the clinical course or in developing the clinical competencies. The purposes of formative evaluation are to enable students to further develop their clinical knowledge, skills, and values; indicate areas in which learning and practice are needed; and provide a basis for suggesting additional instruction to improve performance. 

    With this type of evaluation, after identifying the learning needs, instruction is provided to move students forward in their learning. Formative evaluation, therefore, is diagnostic; it should not be graded (Brookhart & Nitko, 2019). For example, the clinical teacher or preceptor might observe a student perform wound care and give feedback on changes to make with the technique. The goal of this assessment is to improve subsequent performance, not to grade how well the student carried out the procedure. 

    Summative clinical evaluation, however, is designed for determining clinical grades because it summarizes competencies the student has developed in clinical practice. Summative evaluation is done at the end of a period of time, for example, at midterm or at the end of the clinical practicum, to assess the extent to which learners have achieved the clinical outcomes or competencies. Summative evaluation is not diagnostic; it summarizes the performance of students at a particular point in time. 

    For much of clinical practice in a nursing education program, summative evaluation comes too late for students to have an opportunity to improve performance. Any protocol for clinical evaluation should include extensive formative evaluation and periodic summative evaluation. Formative evaluation is essential to provide feedback to improve performance while practice experiences are still available.

Fairness in Clinical Evaluation

    Considering that clinical evaluation is not objective, the goal is to establish a fair evaluation system. Fairness requires that:

1. The clinical teacher identifies his or her own values, attitudes, beliefs, and biases that may influence the evaluation process.

2. Clinical evaluation is based on predetermined outcomes or competencies.

3. The teacher develops a supportive clinical learning environment.

Identify One's Own Values

    Teachers need to be aware of their personal values, attitudes, beliefs, and biases, which may influence the evaluation process. These can affect both the data collected about students and the judgments made about performance. In addition, students have their own set of values and attitudes that influence their self evaluations of performance and their responses to the teacher's evaluations and feedback. 

    Students' acceptance of the teacher's guidance in clinical practice and information provided to them for improving performance is affected by their past experiences in clinical courses with other faculty. Students may have had problems in prior clinical courses, receiving only negative feedback and limited support from the teacher, staff members, and others. 

    In situations in which student responses inhibit learning, the teacher may need to intervene to guide students to be more self-aware concerning the students' own values and the effect they are having on learning.

Base Clinical Evaluation on Predetermined Outcomes or Competencies

    Clinical evaluation should be based on preset outcomes or clinical competencies that are then used to guide the evaluation process. Without these, neither the teacher nor the student has any basis for evaluating clinical performance. What are the outcomes of the clinical course to be met or what competencies should the student achieve in this clinical practicum? These outcomes or competencies provide a framework for educators to use in observing performance and for arriving at judgments about achievement in clinical practice. 

    For example, if the competencies relate to developing communication skills, then the learning activities, whether in the patient care setting or as part of a simulation, should assist students in learning how to communicate. The teacher's observations and subsequent assessment should focus on communication behaviors, not on other competencies unrelated to the learning activities.

Develop a Supportive Learning

    Environment It is up to the teacher to develop a supportive learning environment in which students view the teacher as someone who will facilitate their learning and development of clinical competencies. Students need to be comfortable asking faculty and staff members questions and seeking their guidance rather than avoiding them in the clinical setting. A supportive environment is critical to effective assessment because students need to recognize that the teacher's feedback is intended to help them improve performance. 

    Developing a “climate” for learning is also important because clinical practice is stressful for students (Bagcivan, Cinar, Tosun, & Korkmaz, 2015; Bhurtun, Azimirad, Saaranen, & Turunen, 2019; Blomberg et al., 2014; Suresh, Matthews , & Coyne, 2013; Zieber & Williams, 2015). Many factors influence the development of this learning climate. 

    The clinical setting needs to provide experiences that foster student learning and development. Staff members need to be supportive of students; work collaboratively with each other, students, and the clinical teacher; and communicate effectively, both individually and as a team. Most of all, trust and respect must exist between the teacher and the students.

Student Stress in Clinical Practice

    There have been a number of studies in nursing education on student stress in the clinical setting. Some of the stresses students have identified are:

• The fear of making a mistake that would harm the patient
• Having insufficient knowledge and skills for patient care
• Changing patient conditions and uncertainty about how to respond
• Being unfamiliar with the staff, policies, and other aspects of the clinical setting
• Caring for difficult patients
• Having the teacher observes and evaluates clinical performance
• Interacting with the patient, the family, nursing staff, and other healthcare providers Learning in the clinical setting is a public experience.

    Students cannot hide their lack of understanding or skills as they might in class or in an online discussion. In clinical practice, the possibility exists for many people to observe the student's performance the teacher, patient, family members, peers, nursing staff, and other healthcare providers. 

    Being observed and evaluated by others is stressful for students in any healthcare field. The potential stress that students might experience in clinical practice reinforces the need for faculty members to be aware of the learning environment they set when working with students in a clinical course. 

    The student is a learner, not a nurse, although some educators, preceptors, and other providers expect students to perform at an expert level without giving them sufficient time to practice and refine their performance (Oermann, Shellenbarger, & Gaberson, 2018). Simulated experiences may be effective in reducing some of the anxieties students experience by allowing them to practice their skills, both cognitive and psychomotor, prior to care of patients.