Summative Evaluation In Nursing Education Evaluating outcomes in nursing education, particularly through summative assessments, is crucial for determining the effectiveness of educational interventions and ensuring that learning objectives are met. Summative assessments serve as a means to evaluate long-term changes in behavior, skills, or knowledge that result from education. This article will explore the scope and outcomes of summative assessments in nursing education, highlighting how they are measured, the implications for practice, and the distinctions between outcome and impact evaluations.

Outcomes of Summative Assessment

The primary purpose of outcome evaluation, often referred to as summative evaluation, is to measure the results of teaching efforts after the educational intervention has been completed. Unlike process evaluations, which monitor the learning experience as it occurs, outcome evaluations focus on the end results.

Summative assessments answer questions such as:

• Was the teaching method appropriate for the learners?
• Did the learners acquire the intended knowledge or skills?
• Were the behavioral objectives met?
• Did the learner apply the skills or knowledge in practice, such as a patient using a learned skill at home or a nurse applying new techniques in a clinical setting?

These evaluations aim to assess whether the learners have achieved the long-term goals established at the beginning of the educational program. Summative assessments provide crucial feedback on whether teaching interventions led to meaningful and lasting changes in behavior, knowledge, or practice.

Scope and Outcomes of Evaluation in Nursing Education

Summative assessments have a broad scope, encompassing the long-term effects of educational interventions. As Abruzzese (1992) notes, outcome evaluations differ from content evaluations by focusing on changes that persist after the learning experience has ended. The outcomes measured in summative assessments can include the adoption of new processes, habitual use of new techniques, or the integration of new values and attitudes.

The scope of outcome evaluations typically involves assessing whether learners can apply the acquired knowledge or skills in real-world situations. For example, a patient’s demonstration of a new skill prior to discharge might suffice for content evaluation, but outcome evaluation would measure the patient’s ability to perform the skill correctly and independently in their home environment after discharge.

Similarly, nurses who acquire new skills in a workshop or lab setting may be tested immediately for knowledge retention, but outcome evaluations would assess whether they successfully apply those skills on the clinical floor after returning to practice. Abruzzese (1992) suggests collecting outcome data several months after the educational intervention to determine whether the changes have been sustained over time.

Measuring Outcomes in Summative Assessments

To effectively measure outcomes, summative assessments require a structured approach that often includes the collection of baseline data, followed by post-intervention measurements. The resources required for conducting outcome evaluations are more significant than those needed for process or content evaluations. These include:

• Knowledge of baseline data collection: Establishing what learners knew or could do before the educational intervention is crucial for measuring progress.
• Expertise in measurement strategies: Summative assessments often require more sophisticated tools and techniques to ensure data validity and reliability.
• Time and personnel: Conducting long-term follow-ups, such as phone interviews or clinical observations, requires additional personnel and time.

Outcome evaluations often serve as the point where evidence-based practice (EBP) and real-world application intersect. For example, if a nursing team observes non-compliance among heart failure patients, they might frame a PICO question (Population, Intervention, Comparison, Outcome) to guide their evaluation of a new patient education intervention aimed at improving medication adherence.

Example of Summative Outcome Evaluation

In Ferrara, Ramponi, and Cline’s (2016) study, an outcome evaluation was conducted two months after an educational intervention in an emergency department aimed at improving staff knowledge and attitudes regarding family presence during resuscitation. The evaluation found that family presence during resuscitation increased from 23% to 87.5% after staff received the education, demonstrating a significant change in behavior.

Another example of outcome evaluation comes from Sumner et al. (2012), where nurses who completed an arrhythmia course were tested 4 weeks and 3 months after the intervention. Although content evaluation showed immediate improvement in knowledge, the outcome evaluation revealed no significant changes in arrhythmia identification skills after 3 months. This illustrates that while short-term knowledge gains may be measurable, long-term retention and application of skills require further evaluation.

Impact Evaluation

While outcome evaluations focus on the direct results of an educational intervention, impact evaluations extend further by examining the broader effects on the institution or community. The purpose of impact evaluation is to assess the long-term value of an educational program, answering questions such as:

• What effect does an educational program have on staff turnover or patient outcomes?
• Does the program justify the resources invested?

The scope of impact evaluation is typically more extensive and long-term than that of outcome evaluations. It looks beyond immediate learning outcomes to measure whether those outcomes contribute to larger organizational or societal goals. For instance, while an outcome evaluation may measure whether nurses demonstrate proper body mechanics post-training, an impact evaluation would examine whether the training reduces back injuries among healthcare workers over time.

Impact evaluations are resource-intensive, often requiring external funding, trained personnel, and sophisticated data collection methods. Ching, Forte, Aitchison, and Earle (2015), for example, conducted an impact evaluation of an interprofessional education program for diabetes management, finding that patient health outcomes improved significantly up to 15 months post-intervention.

Total Program Evaluation

The RSA model (Abruzzese, 1992) provides a framework for total program evaluation, which seeks to measure the extent to which all educational activities within a program meet established goals. Unlike process, content, or outcome evaluations, total program evaluation looks at the cumulative effects of educational interventions over a longer period.

Total program evaluations address broader questions such as:

• Did the entire program meet its educational objectives?
• To what extent did educational activities contribute to the organization’s overall goals?

This form of evaluation is complex and resource-intensive, often requiring multi-year data collection and extensive personnel resources. For example, Du Hamel et al. (2011) conducted a multi-year evaluation of a nursing certification review course, collecting data on knowledge retention, certification pass rates, and clinical application of skills over time.

Conclusion

Summative assessments in nursing education play a vital role in measuring the long-term effectiveness of educational interventions. By focusing on outcome evaluations, nurse educators can assess whether the skills and knowledge acquired during education translate into real-world application and practice. Summative assessments also provide valuable insights for improving educational programs and ensuring that they meet the broader goals of the institution.

Outcome evaluations are distinct from impact evaluations in that they focus on immediate changes resulting from education, while impact evaluations examine the broader, long-term effects on organizations or communities. Both types of evaluations are essential for determining the value of educational programs, though they differ in scope and resource requirements.

In conclusion, whether evaluating immediate learning outcomes or long-term organizational impact, summative assessments are an indispensable tool for improving nursing education and ensuring the ongoing professional development of healthcare providers.