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Clinical Evaluation Made Easy

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Ruby Wertz

on 5 August 2013

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Transcript of Clinical Evaluation Made Easy

Evaluation Strategies
Faculty
Observation

Written
Clinical
Paperwork

Student’s
Self-Evaluation
and
Self-Reflection

Clinical
Simulations

Student’s
Clinical Performance Evaluation

Student’s
Verbal
Presentation

Course
Evaluation
Tool and
Rubrics

March 15, 2013
Ruby Wertz, MSHA, BSN, RN
Clinical Evaluation Made Easy:
Putting the Pieces Together
Student’s
Clinical Performance Evaluation

Discuss effective clinical evaluation strategies

Describe the difference between formative and summative evaluations

Discuss legal and ethical issues related to clinical evaluations
Learning Objectives
Formative
Evaluation
Summative
Evaluation
The Clinical Evaluation Process
Provides data used to judge if specified learning outcomes
were achieved during the clinical practicum

Subjective because involves making a judgment about
performance based on observation and other evaluation
strategies

Significant responsibility of nursing faculty
The Clinical Evaluation Process
Provides feedback during the clinical practicum about progress in meeting clinical outcomes or developing clinical competencies

Allows development of clinical knowledge, skills, and attitudes to meet specified learning outcomes
Provide safe, quality nursing care!

Identifies areas in which further learning is needed to improve subsequent performance

Promotes self-awareness and encourages self-directed learning
Formative Evaluation
Summarizes clinical outcomes achieved or competencies developed in the clinical setting

Done at end of the clinical practicum to assess the extent of achievement of the specified learning outcomes

Summarizes the performance using the clinical evaluation tool

Usually designed for determining a grade
Summative Evaluation
Most important paper
Guides evaluation process
Provides framework in observing performance and making judgments
Clinical learning activities selected based on outcomes/objectives or competencies

Clearly defines student performance expectations
Preset outcomes/objectives or competencies
Based on course and level of student

Developed based on accreditation standards of school of nursing, state board of nursing regulations, and Quality and Safety Education for Nurses (QSEN) competencies
Course Evaluation Tool
Rating scales (referred to as an evaluation tool or instrument)
Provide means of recording judgment about observed performance

Has two parts: competencies, behaviors or outcomes to be demonstrated and a scale for rating the performance

Most useful for summative evaluation performance

Improves objectivity and consistency

Rubrics
Closely related to rating scales because they convey assignment expectations to students

Allows for quick and detailed feedback without extensive writing
Rating Scales and Rubrics
Student Interviews
Clinical instructor asks questions and student answers

Assess student knowledge, clarify misconceptions, and
promote critical thinking/ clinical reasoning

Clinical Conferences
Integrate theory and practice based on student’s clinical
experience

Discussion of experiences with all students encourages problem solving
and develops critical thinking/clinical reasoning skills

Allows for peer feedback and reflection

Faculty can evaluate multiple students performance at once
Verbal Communication
Performance is compared to clinical competency expectations identified in course outcomes/objectives

Faculty observe and analyze student performance

Feedback is provided regarding performance

Additional instruction is provided as needed

Observe in various situations and multiple times
Observations
Anecdotal Notes
Narrative description of observed student behaviors
Objectively written
Can include judgment of how well performed
Record as close to observation as possible
Key elements: date, student, setting of observation, student actions, faculty signature
Legal document, but not in student file
Need to maintain confidentiality of notes
Should be reviewed with student- may even sign

Document both positive and negative behaviors

Identify pattern of behavior over period of time
Observations
Charting
Important clinical competency
Use of technology and written communication

Evaluate student’s ability to process and record relevant data

Written Assignments (Concept Map, Care Plan, etc.)
Evaluates problem solving, critical thinking/clinical reasoning

Shows documentation that student can relate theory
content to clinical practice
Nursing process

Helps support clinical observations
Clinical Paperwork
Can be a simple role play or a high-fidelity simulation

Can focus on a specific clinical objective and evaluate the behavioral, technical and cognitive skills performed during the simulation

Creates safe environment for student learning

Students assess a situation, analyze the data, make decisions about problems and prioritize actions, implement the interventions and evaluate the outcome
Students make independent decisions and gain problem-solving skills

Can practice skills without restriction of opportunities available in the clinical setting

Enhances learning of theory content and development of skills by allowing for repeat performance and debriefing
Simulations
Students reflect on what they have learned

Students assess their progress related to the clinical course outcomes or objectives and competencies
Identify strengths and weaknesses
Set goals for improvement in the areas indicated

Students may not have developed the skill of self-reflection and self-evaluation and see their level of performance differently than instructor

Important skill to develop because will need to assess competency as a nurse

Journal or Log
Describe clinical experiences
Share thoughts and feelings
Review progress
Self-Evaluation and Self-Reflection
Instructor values, beliefs and biases influence evaluation process
Affects data collected and the judgment made
Personal influences and perceptions are unable to be discarded during evaluation process

Need to recognize biases to create fair evaluation of the student’s performance

Maintain professional relationship with students

Student’s values and beliefs influence their self-assessment and response to instructor’s feedback, which can create more instructor bias
Instructor Bias
Legal and Ethical Issues
Unsafe
Clinical
Practice
Regulations
and Policies
Learning
Contracts
Frequent
Feedback
Due Process
Instructor Bias
Fair and Objective Evaluation
Checklists
Useful for evaluation of specific well-defined behaviors

List of behaviors/activities to be observed and mark off whether present or not during performance

Common for nursing skills check-off

Allows for students to assess their own learning
Observations
Instructor values, beliefs and biases influence evaluation process
Affects data collected and the judgment made
Personal influences and perceptions are unable to be discarded during evaluation process

Need to recognize biases to create fair evaluation of the student’s performance

Maintain professional relationship with students

Student’s values and beliefs influence their self-assessment and response to instructor’s feedback, which can create more instructor bias
Instructor Bias
Standards
American Association of Colleges of Nursing (AACN): Commission of Collegiate Nursing Education (CCNE) Accreditation

National League for Nursing Accrediting Commission, Inc. (NLNAC)

Regulations/Scope of Practice
National Council for State Boards of Nursing (NCSBN)
Nevada State Board of Nursing

American Nurses Association
Scope and Standards of Practice for Nursing Professional Development and Code of Ethics

Grading and Grievance Policies
University/College and School of Nursing
Contract with students
Regulations and Policies
Students are informed of standards that performance will be judged

Students receive timely feedback

Students have opportunity to correct behavior that does not meet standard(s)

Public versus private
14th Amendment of the United States Constitution
Cannot deprive of life, liberty or property without due process of law

Contract Law or Discrimination
Policies create a contract when tuition paid

Burden of proof that academic due process was denied is on student
Due Process
Frequently communicate with student about performance!!

Five principles for effective feedback
Precise and specific
For skills or use of technology, provide both verbal and visual feedback
Give at time of learning or as close to it as possible
Students need different amounts of feedback and positive reinforcement
Should identify areas of weakness and guide the students to performance improvement
Frequent Feedback
Documentation of pattern of marginal or failing behavior(s) related to course outcomes, objectives, or clinical competencies and the plan for improvement

Clarifies faculty and student expectations of behavior necessary to successfully pass the course

Discuss with student in a conference and develop the improvement plan together
Student and faculty sign contract
Student receives a copy
Original placed in student file

Update the clinical learning contract as often as necessary
Learning Contracts
Action or behavior that has the potential to cause harm to a patient is unsafe practice

Students are held to same standard of care as a registered nurse

Denying access to clinical learning activities due to unsafe practice is appropriate for faculty
Protecting the right of patients to safe, competent care

Removal of student from clinical setting must be accompanied with an assignment to help correct the deficient knowledge, skill or attitude identified as unsafe

Result in course failure or termination from program?
Unsafe Clinical Practice
Examples of unsafe clinical practice themes:
Integrity and Honesty
Interprofessional Interactions
Knowledge and Skill Incompetence/Safety
Unprofessional Image/Accountability

Students are liable for own actions, including negligent acts
They need to performing within scope of practice and seek guidance when uncertain what to do

Clinical faculty are not liable for negligent act(s) of student if they:
Select appropriate learning activities based on course outcomes
Determine if student has prerequisite knowledge, skills, and attitudes necessary to complete assignment
Provide competent guidance to student
Unsafe Clinical Practice
E
C
Questions ???
C
U
S
S
Student’s
Clinical Performance Evaluation
Bonnel, W. (2009). Chapter 26: Clinical performance evaluation. In D.M. Billings and J.A. Halstead (Ed.) Teaching in Nursing, A Guide for Faculty (pp. 449-466). St. Louis, Missouri: Saunders.

Case, B. and Oermann, M. H. (2005). Chapter 7: Teaching in a clinical setting. In L. Caputi and L Englemann (Eds.) Teaching Nursing: The Art and Science (pp. 126-177). Glen Ellyn, Illinois: College of DuPage Press.

Hall, M.A., Daly, B.J., and Madigan, E. A. (2010). Use of anecdotal notes by clinical nursing faculty: a descriptive study. Journal of Nursing Education, 49(3), 156-159.

Holaday, S. D. and Buckley, K. M. (2008). Chapter 7: A standardized clinical evaluation tool-kit: improving nursing education and practice in clinical nursing education. In M. H. Oermann Annual Review of Nursing Education, Clinical Education in Nursing (pp. 123-149). New York, NY : Springer Publishing Company.

Ignatavicius, D. and Caputi, L. (2005). Chapter 8: Evaluating student in the clinical setting. In L. Caputi and L Englemann (Eds.) Teaching Nursing: The Art and Science (pp. 178-195). Glen Ellyn, Illinois: College of DuPage Press.

Kilam, L.A., Luhanga, F., and Bakker, D. (2011). Characteristics of unsafe undergraduate nursing students in clinical practice: an integrative literature review. Journal of Nursing Education, 50(8), 437-446.

Oermann, M.H. & Gaberson, K.B. (2007). Chapter 6: Ethical and legal issues in clinical teaching. In Evaluation and Testing in Nursing Education (2nd ed.). New York: Springer Publishing Company.

Oermann, M.H. & Gaberson, K.B. (2007). Chapter 16: clinical evaluation and grading. In Evaluation and Testing in Nursing Education (2nd ed.). New York: Springer Publishing Company.

Oermann, M.H. & Gaberson, K.B. (2009). Chapter 12: Clinical evaluation and Chapter 13: Clinical evaluation method. In Evaluation and Testing in Nursing Education (pp. 245-321). New York: Springer Publishing Company.
.
Oermann, M.H., Saewert, K.J., Charasika, M., and Yarbrough, S.S. (2009). Assessment and grading practices in schools of nursing: national survey findings part I. Nursing Education Perspectives, 30(5), 274-278.

Oermann, M.H., Yarbrough, K.J., S.S., Saewert, Ard, N., and Charasika, M. (2009). Clinical evaluation and grading practices in schools of nursing: national survey findings part II. Nursing Education Perspectives, 30 (6), 352-357.
References
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