Clinical Outcomes and Competencies in Nursing Education Introduction
The evaluation of clinical outcomes and competencies in nursing education is a crucial aspect of ensuring that nursing students are prepared for the demands of the profession. Effective clinical evaluation not only assesses students’ ability to apply theoretical knowledge in real-world settings but also provides feedback that facilitates their professional growth. This article explores the principles and practices of providing feedback as part of clinical evaluation, discusses the various ways to specify clinical outcomes and competencies, and examines the implications for nursing education.
Understanding Feedback in Clinical Evaluation
Definition and Importance of Feedback
Feedback in clinical evaluation is essential for guiding nursing students toward professional competence. According to Bonnel (2008), feedback is the communication of information from the teacher to the student based on assessment that enables the student to reflect on their performance, identify learning needs, and decide how to address them. Feedback can be verbal, through direct comments and observations, or visual, through demonstrations of correct procedures. Effective feedback helps students understand what they are doing well and what areas require improvement.
For feedback to be constructive, it must be specific and actionable. General comments such as “You need to improve your assessment skills” are less helpful than detailed feedback that identifies specific areas for improvement. For instance, instead of a broad statement, feedback should include precise observations about the student’s data collection and physical examination techniques.
The Role of Reflection
Bonnel (2008) emphasizes that for feedback to be effective, students must engage in reflection. This means not only receiving feedback but actively reflecting on it and incorporating it into their learning process. Reflection enables students to internalize feedback, understand their strengths and weaknesses, and develop strategies for improvement.
Brookhart and Nitko (2019) further assert that feedback should also identify underlying reasons for any shortcomings in performance. Sometimes, a lack of progress may be due to insufficient prerequisite knowledge or skills. Therefore, clinical teachers must assess students’ foundational knowledge and skills before providing advanced feedback.
Principles of Providing Feedback in Clinical Evaluation
1. Specificity and Precision
The first principle of effective feedback is specificity. Feedback must be precise and focused on specific aspects of performance. General comments do not provide actionable insights. Instead, feedback should address particular areas of strength and improvement. For example, rather than telling a student, “Your assessment needs work,” a more effective approach would be to detail which aspects of the assessment were lacking and suggest specific ways to improve.
2. Verbal and Visual Feedback
For skills that involve procedures, technology, or psychomotor tasks, both verbal and visual feedback are crucial. Verbal feedback involves explaining where errors occurred and how to correct them, while visual feedback might include demonstrations of the correct procedure. Research by Soderstrom and Bjork (2015) indicates that physically guiding students through tasks enhances their accuracy and learning. Immediate practice with guidance helps students apply feedback effectively.
3. Timeliness
Prompt feedback is essential for its effectiveness. According to Chickering and Gamson (1987), giving feedback immediately after performance helps students retain relevant information and make timely adjustments. Delayed feedback can reduce its impact, as both the student and teacher may forget specific details of the performance. This principle applies to all types of performance, whether cognitive skills, technical procedures, or attitudes.
4. Tailoring Feedback
Different students require varying amounts of feedback and reinforcement. Beginners may need frequent and detailed feedback, while more advanced students may only need periodic guidance. Feedback should be adapted to the individual needs of the student, and it should always be delivered in a private setting to ensure confidentiality and focus.
5. Diagnostic Feedback
Feedback should be diagnostic, meaning that it should help identify areas needing improvement and guide students toward solutions. Altmiller (2016) highlights the importance of framing feedback as an opportunity for growth and providing options for improvement. This cyclical process involves observation, assessment, feedback, and guided practice to enhance student competence.
The Five-Step Process for Providing Feedback
Gigante, Dell, and Sharkey (2011) propose a structured approach to feedback that includes the following steps:
- Identify Expectations: Clearly outline what is expected of students in the clinical practicum. This helps set clear goals and standards for performance.
- Set the Stage: Prepare students to receive feedback by explicitly stating that the feedback is intended to help them improve. This sets a positive tone for the feedback session.
- Encourage Self-Assessment: Begin by asking students to evaluate their own performance. This encourages reflective practice and helps students become more self-aware.
- Provide Specific Feedback: Describe observed behaviors and provide concrete examples of performance. Detail how students can improve and address specific areas of concern.
- Seek Student Input: Involve students in the feedback process by asking for their input. If performance issues persist, develop a written plan for improvement with clear consequences.
Specifying Clinical Outcomes and Competencies
Defining Clinical Outcomes
Clinical outcomes refer to the specific results or achievements expected from students’ clinical practice. These outcomes can be framed in terms of competencies that students should demonstrate. Outcomes should be clear, measurable, and directly related to the skills and knowledge required in clinical settings.
Exhibit 13.1 provides examples of clinical outcomes that might be used to develop specific competencies for a clinical course. Not all courses will have the same outcomes, and some may have unique competencies tailored to specific clinical specialties. For instance, communication skills may be a focus in all courses but may be tailored to different contexts, such as interacting with patients, families, or interdisciplinary teams.
Competencies in Clinical Practice
Competencies are the knowledge, skills, and attitudes that students need to develop to perform effectively in clinical settings. Competencies should be clearly defined and used to guide evaluation. Examples of specific competencies include conducting systematic assessments, evaluating the impact of health problems on families, and identifying resources for patient care.
For practicing nurses, competencies reflect the expected level of performance in patient care. These competencies are assessed during hiring and through ongoing evaluations, usually annually, to ensure that nurses maintain their skills and meet professional standards.
Challenges in Developing Clinical Outcomes and Competencies
Developing clinical outcomes and competencies involves balancing the number of outcomes with the practicalities of clinical teaching. Too many outcomes can overwhelm both students and teachers and make it difficult to collect sufficient data on student performance. Teachers should focus on realistic and useful outcomes that guide evaluation without being overly burdensome.
Conclusion
The evaluation of clinical outcomes and competencies is a critical aspect of nursing education that ensures students are prepared for professional practice. Effective feedback, based on the principles of specificity, timeliness, and diagnostic guidance, is essential for helping students develop their skills and knowledge. By specifying clear clinical outcomes and competencies, educators can provide meaningful evaluations that support students’ professional growth. Through structured feedback processes and well-defined competencies, nursing education can enhance the quality of clinical practice and contribute to the development of competent, confident practitioners.