Nursing Education and Clinical Performance Evaluation, General Issues and Preceptors
Clinical Performance Evaluation, General Issues in Evaluating Clinical Performance, Using the Team: Participants in Evaluating Faculty, Students Self Evaluation and Nursing Staff and Preceptors in Nursing Education.
Clinical Performance Evaluation in Nursing Education
In times of profound change in health care, evaluating students’ attainment of clinical knowledge, skills, and abilities remains constant. From patient safety to student confidence as clinicians, conducting careful clinical performance evaluations for each student is essential.
As students and healthcare teams come together to establish a culture of safety and quality patient care, using best practices in evaluation of clinical performance is imperative. Providing fair and reasonable clinical evaluation is one of the most important and challenging aspects of the faculty role.
Faculty must discern whether students can think critically within the clinical setting, maintain a professional demeanor, interact appropriately with patients, prioritize problems, have basic knowledge of clinical procedures, and complete care procedures correctly.
All the while, faculty need to minimize student anxiety within the complex health care setting so that student clinical performance and not extraneous factors, such as anxiety or fatigue, are being observed. Evaluation of clinical performance provides data from which faculty can judge the extent to which students have acquired specified learning outcomes.
General Issues in Evaluating Clinical Performance in Nursing Education
When clinical performance is evaluated, students’ skills are judged as they relate to an established standard of patient care. Acceptable clinical performance involves behavior, knowledge, and attitudes that students gradually develop in a variety of settings. A review of literature about clinical evaluation has identified challenges in obtaining this full picture.
For example, the concept of clinical judgment, or evaluating students’ thinking and problem-solving ability, is consistently noted as both important and challenging. In a survey of clinical faculty, researchers found that, although clinical faculty are intent on gaining a holistic student evaluation, much time is spent on task completion and observing task skills (Ironside, McNelis, & Ebright, 2014).
The literature also describes the need for models to evaluate clinical judgment and problem solving. Tanner (2006) describes a model of clinical judgment, incorporating components such as student reflection in action and reflection on action.
The critical decision model, adapted to incorporate both observation and questioning, related to students’ clinical situation awareness, cues for action, and pattern recognition has also been described (McNelis, Ironside, Zvonar, & Ebright, 2014). Incorporating additional evaluation approaches, such as writing, active learning cases, and simulation, in later sections, can help gain a comprehensive evaluation.
The ultimate outcome for clinical performance evaluation is safe, quality patient care. Clinical performance evaluation provides information to the student about performance and provides data that may be used for individual student development, assigning grades, and making decisions about the curriculum.
Students have the right to a reliable and valid evaluation that assesses achievement of competencies required to take on the role of novice nurse. Good practice includes multidimensional evaluation with diverse evaluation methods completed over time, seeking student growth and progress.
All evaluation should respect students’ dignity and self-esteem. In addition to the concepts of assessment and evaluation, grading is considered part of a systems approach that includes integrating evaluation as the final component of learning (Walvoord, Anderson, & Angelo, 2010).
Before assessing and evaluating clinical performance, faculty must consider several issues. These issues include who will be participants in the evaluation, evaluation timing, and evaluation access and privacy.
Using the Team: Participants in Evaluating Faculty in Nursing Education
Clinical evaluation is complex. Although faculty have primary responsibility for the student clinical evaluation, gaining multiple individuals’ perspectives or a team approach enhances the evaluation as designated others contribute. Faculty are knowledgeable about the purpose of the evaluation and the objectives that will be used to judge each student’s performance.
This clarity of purpose provides direction for the selection of evaluation tools and processes. Initial faculty challenges in completing clinical evaluations include factors such as faculty value systems, the number of students supervised, and reasonable clinical opportunities for students. Faculty need to be aware of their own value systems to avoid biasing the evaluation process.
When faculty are supervising a group of students in the delivery of safe and appropriate nursing care, faculty can only sample student behaviors. Limited sampling of behaviors or individual biases may result in inaccurate or unfair clinical evaluation. Because of these limitations, faculty use a variety of evaluation methods to capture the broader picture of student competence.
Faculty strive to identify equitable assignments and can consider evaluation input from other sources with potential adjunct evaluators, including students, nursing staff and preceptors, peer evaluators, and patients.
Students Self Evaluation in Nursing Education
Completion of self-assessments by students provides not only data, as part of the evaluation process, but also a learning experience for the students (Bonnel, 2008). Student self-evaluation provides a starting point for reviewing, comparing, and discussing evaluative data with faculty.
Initial student involvement in self-assessment tends to facilitate student behavior changes and provides a positive environment for learning and improvement. Participation in their own evaluation also empowers students to make choices and identify their strengths.
Nursing Staff and Preceptors in Nursing Education
New models for clinical education, including dedicated units with entire patient care staff engaged in educating students, dedicated preceptors, and academies to support clinical teaching, emphasize the need to focus on engaging preceptors as part of the clinical evaluation team.
Nursing staff and other designated preceptors often provide input to the evaluation process and tend to provide data from an informed perspective because of collaboration with students. Even with newer clinical evaluation models, these team members often have limited experience with clinical evaluation.
Nursing literature indicates that clinical preceptors consistently report wanting more knowledge about conducting clinical evaluation and giving feedback. There is also a need for addressing the issue of faculty and preceptor interrater reliability. Preceptors indicate the need for faculty support, especially when students are unprepared for clinical (Dahlke, Baumbusch, Affleck, & Kwon, 2012; McClure & Black, 2013).
Nursing staff should understand their role in student evaluation, with staff expectations in the evaluation process clearly articulated. This includes determining whether staff feedback should be provided directly to the student only or shared with faculty as well.
One of the disadvantages of including nursing personnel in the evaluation process is that expectations in the clinical area may differ from course performance objectives. Sharing course objectives, expectations of students, and clinical evaluation forms with staff promotes an evaluation partnership. Although evaluation is time consuming for busy nurses, this may be part of a nurse’s career development or joint appointment responsibilities.
Preceptors have a specified role in modeling and facilitating clinical education for students, especially for advanced nursing students. Typically, preceptors serve a more formal role in evaluation, such as an adjunct faculty role, and provide evaluative data as part of a faculty team.
If staff nurses and nurse preceptors provide data for the evaluation process, they should be oriented to the nursing school’s evaluation plan. Roles should be clarified, indicating whether staff will be asked to provide occasional comments, to report only incidents or concerns, or to complete a specific evaluation form.
Hrobsky and Kersbergen (2002) describe the use of a clinical map to assist preceptors in identifying student strengths and weaknesses. Seldomridge and Walsh (2006) note the importance of adequately preparing adjunct evaluators for their role, teaching these individuals to provide good feedback with tools such as rubrics to promote consistency and specifying clinical activities to evaluate.