Faculty

Faculty have primary responsibility for the student clinical evaluation. 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 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. Clinical evaluation is complex, with different students having different learning experiences (Walsh & Seldomridge, 2005). 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 an inaccurate or unfair clinical evaluation (Orchard, 1994). 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

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; Loving, 1993). 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. Self-assessments are further discussed later in this chapter as a component of self-evaluation and self-reflection.

Nursing staff and preceptors

Nursing staff may provide input to the evaluation process and tend to provide data from an informed perspective as a result of collaboration with students. 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 only provided directly to the student 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 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.

Peer evaluators

There is debate about the appropriateness of having student peers act as evaluators in the clinical setting. Student peers should only evaluate competencies and assignments that they are prepared to judge. There should be clear guidelines for peer review and the student levels of responsibility (McAllister & Osborne, 1997). Peer evaluation can help students develop collaborative skills, build communication abilities, and promote professional responsibility. A potential disadvantage is that peers may be biased in providing only favorable information about student colleagues or may have unrealistic expectations of their student colleagues. Providing students with this peer evaluation opportunity and then appropriately weighting the contribution can be a reasonable practice (Boehm & Bonnel, 2010).

Patients

Patients provide data from the product consumer viewpoint. Patient satisfaction is considered an important marker in quality health care and can be considered as part of student evaluation. Judgments about student performance are made from patients’ personal experiences and data should be weighted for their value. Patients often have positive comments to make about their students, which can be positive for the students to hear.

Anecdotal notes

Anecdotal or progress notes are objective written descriptions of observed student performance or behaviors. The format for these can vary from loosely structured “plus–minus” observation notes to structured lists of observations in relation to specified clinical objectives. These written notes initially serve as part of formative evaluation. As student performance records are documented over time, a pattern is established. This record or pattern of information pertaining to the student and specific clinical behaviors helps document the student’s performance pattern for both summative evaluation and recall during student–faculty conference sessions. Liberto, Roncher, and Shellenbarger (1999) noted the importance of determining which clinical incidents to assess and the need to identify both positive and negative student behaviors.

Checklists

Checklists are lists of items or performance indicators requiring dichotomous responses such as satisfactory–unsatisfactory or pass–fail (Table 27-2). Gronlund (2005) describes a checklist as an inventory of measurable performance dimensions or products with a place to record a simple “yes” or “no” judgment. These short, easy-to-complete tools are frequently used for evaluating clinical performance. Checklists, such as nursing skills check-off lists, are useful for evaluation of specific well-defined behaviors and are commonly used in the clinical simulated laboratory setting. Rating scales, described in the following paragraph, provide more detail than checklists concerning the quality of a student’s performance.

Rating scales and rubrics

Rating scales incorporate qualitative and quantitative judgments regarding the learner’s performance in the clinical setting (Box 27-2). A list of clinical behaviors or competencies is rated on a numerical scale such as a 5-point or 7-point scale with descriptors. These descriptors take the form of abstract labels (such as A, B, C, D, and E or 5, 4, 3, 2, and 1), frequency labels (e.g., always, usually, frequently, sometimes, and never), or qualitative labels (e.g., superior, above average, average, and below average). A rating scale provides the instructor with a convenient form on which to record judgments indicating the degree of student performance. This differs from a checklist in that it allows for more discrimination in judging behaviors as compared with dichotomous “yes” and “no” options. Mahara (1998) noted the benefit of more standardized assessments such as checklists and rating scales but faults these objective scales for failing to capture the complex clinical practice environment and clinical learning. Oermann (1997) emphasized the benefit of asking appropriate patient care questions along with clinical observations to gauge student critical thinking abilities.

Rubrics, a type of rating scale, help convey clinically related assignment expectations to students. They provide clear direction for graders and promote reliability among multiple graders. The detail provided in a rubric grid allows faculty to provide rapid and extensive feedback to students without extensive writing (Walvoord et al., 2010). Typical parts to a rubric include the task or assignment description and some type of scale, breakdown of assignment parts, and descriptor of each performance level (Stevens & Levi, 2005). Rubric examples exist for providing detailed feedback for clinical related assignments such as written clinical plans and conference participation. A web search by topic can provide samples for review.

Rubrics or checklists are beneficial in facilitating both the lab experience and the clinical grading for faculty and students. They promote clear communication as to expectations of best practice in completing skills. Providing skills checklists for students provides direction in their skill learning and practice. Students can use these tools for self-assessments and participate in peer assessments to promote learning. Rubrics can be used within learning management systems as well. These tools can be distributed to students, as well as be completed by faculty, and tracked or monitored over time (Bonnel & Smith, 2010).

Videotapes as source of observational data

Another method of recording observations of a student’s clinical performance is through videos. Videos, often completed in a simulated setting, can be used to record and evaluate specific performance behaviors relevant to diverse clinical settings. Advantages associated with videos include their valuable start, stop, and replay capabilities, which allow an observation to be reviewed numerous times. Videos can promote self-evaluation, allowing students to see themselves and evaluate their performance more objectively. Videos also give teachers and students the opportunity to review the performance and provide feedback in determining whether further practice is indicated. Use of videos can contribute to the learning and growth of an entire clinical group when knowledge and feedback are shared (Reilly & Oermann, 1992). Videos are particularly popular for evaluation in distance learning situations. Videos can also be used with rating scales, checklists, or anecdotal records to organize and report behaviors observed on the videos.

Documentation and patient progress notes

The value of electronic text-based communication in the changing health care system is evident. Writing cogent nursing and clinical progress notes is an important clinical skill. Reviewing student documentation provides faculty with an opportunity to evaluate students’ ability to process and record relevant data. Students’ skill in using health care terminology and documentation practices can be examined and critical thinking processes can be demonstrated in these notes (Higuchi & Donald, 2002). With the focus on electronic records as a tool in patient safety, orienting students to these tools and evaluating students’ skill in this area is essential (Bonnel & Smith, 2010).