Evaluation Instruments and Barriers In Nursing What are Evaluation Instruments?
In nursing education, evaluation instruments refer to the tools used to measure specific outcomes of an educational program, whether it’s assessing learner knowledge, skills, or attitudes. When selecting, revising, or constructing evaluation instruments, nurse educators must consider several key factors. If possible, it is always preferable to use existing evaluation tools rather than developing new ones. Developing new instruments requires a significant amount of expertise, time, and resources. The testing process for new instruments, which includes establishing reliability and validity, can take several months or even years (Osborne, Elsworth, & Whitfield, 2007).
To begin selecting an instrument, nurse educators should conduct a literature review to identify existing tools that have been used in similar evaluations. Journals and studies that focus on nursing education often contain validated instruments that can be adapted. Instruments that have been tested multiple times are usually preferable, as they are more likely to have undergone thorough testing for reliability and validity.
Instruments for Reliability and Validity of Instruments
The reliability and validity of an evaluation instrument are critical to its usefulness. Reliability refers to the instrument’s consistency in producing the same results under the same conditions, while validity ensures that the instrument measures what it is supposed to measure. Once potential instruments have been identified, they must be carefully critiqued to determine their appropriateness for the specific evaluation planned.
First, the instrument must measure the exact performance that is being evaluated, and it must align with the operational definitions outlined for the evaluation. For instance, if the goal is to assess participants’ satisfaction with a nursing education program based on specific components (e.g., educator responsiveness, relevance of content), the instrument must directly measure these components.
Second, the instrument must have documented evidence of its reliability and validity, particularly with individuals similar to those participating in the evaluation. For example, an instrument designed for young orthopedic patients may not be appropriate for older adults with different needs and characteristics. Additionally, the instrument must be suitable for the participants’ reading level, cognitive abilities, and other relevant characteristics, such as visual acuity if the instrument is a questionnaire.
Furthermore, nurse educators may sometimes need to modify an existing instrument or create an entirely new one. This is especially true for cognitive tests, which need to match the content covered during the educational program. A test blueprint, which outlines the areas of instructional content to be evaluated, can help ensure the test is comprehensive and relevant.
Several validated instruments exist for evaluating a wide range of factors in nursing education, such as patient and healthcare provider characteristics, including perceptions, attitudes, and communication skills. For instance, Monsivais and Reynolds (2003) describe tools to evaluate the effectiveness of patient education materials, while Shoemaker, Wolf, and Brach (2013) developed the Patient Education Materials Assessment Tool (PEMAT), which assesses the clarity and actionability of print and audiovisual materials.
Barriers to Evaluation in Nursing Education
Despite the importance of evaluation in nursing education, it is often neglected or viewed as an afterthought. Several barriers contribute to this, but they are not insurmountable. Barriers to evaluation can be grouped into three categories:
- Lack of Clarity
- Lack of Ability
- Fear of Punishment or Loss of Self-Esteem
Lack of Clarity
Evaluation becomes difficult when the focus is unclear or when the purpose is not well-defined. Many evaluations are conducted to assess the quality of an educational program, but without clearly defined measures of “quality,” the evaluation is unlikely to be meaningful. Questions such as “What constitutes quality?” or “Who determines the evidence of quality?” need to be answered before an evaluation can be effectively conducted.
To overcome the barrier of lack of clarity, nurse educators should focus on the five components of evaluation: audience, purpose, questions, scope, and resources. By clearly identifying these components, educators can avoid confusion and ensure that the evaluation is properly targeted. For example, knowing the primary audience for the evaluation results helps define the focus of the evaluation. The audience’s perspective will shape how concepts such as “quality” are defined and measured. Additionally, a clearly stated purpose helps direct the evaluation process and sets clear goals, such as assessing a patient’s ability to take their medication independently.
Lack of Ability
Lack of ability often stems from insufficient knowledge, confidence, or resources needed to carry out the evaluation process. Educators may not have the necessary training or experience to conduct evaluations effectively. This challenge can be addressed by enlisting the help of individuals with expertise in evaluation techniques. Experts can offer consultation, assist with data collection, or help develop appropriate tools.
Educators can also seek collaboration or perform a literature review to enhance their knowledge of evaluation techniques. For example, Lahl, Modic, and Siedlecki (2013) developed a tool to evaluate pediatric nurses’ perceptions of their role as patient educators. However, external experts were needed to determine the reliability and validity of the tool. Similarly, nurses interviewed by Kelo, Martikainen, and Eriksson (2013) expressed a need for further professional education on teaching and multi-method evaluation techniques.
Fear of Punishment or Loss of Self-Esteem
One of the most significant barriers to evaluation is the fear that an evaluation will be used as a judgment of personal worth or competence. Both learners and educators may fear that their performance will be judged harshly or that less-than-perfect results will lead to criticism or loss of esteem. This fear is particularly common when evaluations are used as punitive measures, such as when quality assurance monitoring leads to negative consequences.
To overcome this barrier, educators should emphasize that the evaluation is focused on the learning process, not on personal judgment. For instance, in process evaluations, the goal is to enhance learning, and the focus should remain on improving the learning experience rather than assigning blame for perceived failures.
Encouragement and constructive feedback are critical in reducing the fear associated with evaluations. By highlighting achievements and encouraging continued effort, educators can create a supportive environment that promotes learning. Additionally, ensuring that individuals understand the purpose of the evaluation and reassuring them that their privacy will be protected can alleviate concerns. It is also essential to obtain informed consent when collecting data to ensure ethical conduct and respect for the learners’ rights.
Conclusion
Instruments used in evaluation are critical to assessing the outcomes of nursing education, whether for student learning, patient education, or staff development. Evaluators must ensure that instruments are reliable, valid, and appropriate for the population being evaluated. Barriers to conducting evaluations, such as lack of clarity, lack of ability, and fear of punishment or loss of self-esteem, are common but can be addressed through careful planning, collaboration with experts, and clear communication about the purpose and focus of the evaluation. By overcoming these barriers, nursing educators can implement more effective evaluations, ultimately leading to improved educational outcomes and better patient care.