DEFINITION
Clinical evaluation is a process in which an instructor evaluates a nursing student’s per- formance in the clinical area using specifi c criteria. The clinical area is where students must demonstrate acquired knowledge and apply that knowledge when caring for patients. Clinical evaluation is challenging and complex because it encompasses the three domains of learning: cognitive, affective, and psychomotor (Bradshaw & Lowenstein, 2011).
The goal for each student during the clinical
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The outcome of a clinical evaluation is dependent on the instructor’s ability to know and respond to the students’ learning needs, goals, strengths, limited knowledge, and limited clinical experiences. Knowing the student as an individual minimizes assumptions and biases by faculty, mak- ing the evaluation more reliable and valid (Gillespie, 2002).
RECOMMENDATIONS
Nursing faculty involved in the clinical edu- cation of nursing students has a responsi- bility to reduce inconsistencies in expected learning outcomes that are evaluated in the clinical setting. Consistent standards must be created and aligned with evidence- based teaching to assess and evaluate levels of clinical competency in the nursing pro- gram (Oermann, 2008). Research studies are needed to examine new methods of clinical evaluation that will include consistent stan- dards while fostering professional growth and meeting the challenges of changes in the delivery of health care.
Billings, D. M., & Halstead, J. A. (2011).
Teaching in nursing: A guide for fac- ulty (4th ed.). St. Louis, MO: Elsevier Saunders.
Bonnel, W., Gomez, D. A., Lobodzinski, S.,
& West, C. D. H. (2005). Clinical perfor- mance evaluation. In D. M. Billings & J.
A. Halstead (Eds.), Teaching in nursing: A guide for faculty (2nd ed., pp. 521–542). St.
Louis, MO: Elsevier Saunders.
Bradshaw, M. J., & Lowenstein, A. J. (Eds.).
(2011). Innovative teaching strategies in nurs- ing and related health professions (5th ed.).
Boston, MA: Jones and Bartlett.
Gallant, M., MacDonald, J. A., & Smith Higuchi, K. A. (2006). A remediation pro- cess for nursing students at risk for clini- cal failure. Nurse Educator, 31, 223–227.
Gillespie, M. (2002). Student-teacher connec- tion in clinical nursing education. Journal of Advanced Nursing, 37(6), 566–576.
Kuiper, R. A., & Pesut, D. J. (2004). Promoting cognitive and metacognitive refl ective can be documented weekly by the instruc-
tor on a student experience form with an additional area for students to express their perceptions of the clinical experience. As a result, students are continually learning and growing as professionals while being infl u- enced positively by mentoring of the clini- cal instructor (Bonnel, Gomez, Lobodzinski,
& West, 2005). Summative evaluation is the fi nal judgment of whether the student has demonstrated the required learning objec- tives and determined to be a safe and com- petent practitioner (Gallant, MacDonald, &
Smith Higuchi, 2006).
SYNOPSIS
Clinical evaluation of nursing students is a complex process. Clinical competence includes safety, application of knowledge, proper performance of nursing skills, and demonstration of a positive and profes- sional attitude. The student nurse must be effi cient in analyzing complex patient situ- ations, solving problems, and communi- cating effectively with patients and other health care professionals. Furthermore, instructors provide evidence of leadership and sensitivity to the cultural and spiri- tual needs of patients (Mitchell, Bennett,
& Manfrin-Ledet, 2006). It is important to develop a valid and reliable clinical evalua- tion tool to establish and convey to students what objectives must be achieved to be suc- cessful (Gallant et al., 2006).
Clinical instructors use a wide range of evaluation strategies in the clinical setting to keep decisions about clinical evaluation trustworthy and fair. Strategies may include written assignments, skill testing, refl ective journals, simulations, student presentations, and peer review. Observation in various clinical situations is the most popular strat- egy used by faculty in nursing programs (Oermann, Saewert, Charasika, & Yarbrough, 2009). Evaluating a student can be fi lled with fl aws relating to inconsistencies with the cri- teria and subjectivity by the faculty.
An effective and expert clinical teacher will guide a student’s clinical performance.
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competent client-centered care is the central objective of the appraisal. Clinical evaluation is a decisive element in the educational pro- cess and has signifi cant implications for stu- dents and public safety. Evaluation of clinical competency is equally important for gradu- ate students preparing for advanced prac- tice. Competent advanced practice requires that the graduate student has succeeded in acquiring new skills, possesses the proce- dural knowledge and psychomotor ability to execute them, and possesses the schematic knowledge that directs when and why to implement specifi c patient care measures.
Determination of clinical competency pro- vides assurance that the graduate-advanced practice nurse is prepared for entry into practice (Cook, Marienau, Wildgust, Gerbasi,
& Watkins 2013; Phelen, O Connell, Murphy, McLoughlin, & Long, 2014).
SYNOPSIS
Competency in nursing is the ability to per- form a skill or carry out an activity to a pre- scribed standard that has been instituted to ensure safety and prevent harm. Evaluation of clinical competencies is concerned with what individuals can do in addition to what they know (Garrett, MacPhee, & Jackson, 2013).
The translation of knowledge into the prac- tice of nursing by the student-engaged indi- rect patient care is the target of the evaluation.
The process of clinical evaluation is a two-tier sequence conducted on multiple occasions during the course of the educational process in nursing. Formative evaluation of clinical com- petency involves observation of the student’s performance, identifi cation of strengths and/
or weaknesses, and the provision of feedback regarding the student’s progress on achieving the objectives. Time is allotted to learn a skill, practice a skill, and incorporate constructive feedback into the successful execution of the skill. The observations for formative evalua- tions are documented by the faculty as narra- tive notes or on a rating scale and may include assignments submitted by students regarding their clinical experience. Formative evaluation is generally not graded, but rather is used to reasoning skills in nursing practice:
Self-regulated learning theory. Journal of Advanced Nursing, 45(4), 381–391.
Mitchell, D. L., Bennett, M. J., & Manfrin- Ledet, L. (2006). Spiritual development of nursing students: Developing competen- cies to provide spiritual care to patients at the end of life. Journal of Nursing Education, 45, 365–370.
Oermann, M. H. (2008). Annual review of nurs- ing education: Clinical nursing education (Vol.
6). New York, NY: Springer Publishing.
Oermann, M. H., Saewert, K. J., Charasika, M.,
& Yarbrough, S. S. (2009). Assessment and grading practices in schools of nursing:
National survey fi ndings Part 1. Nursing Education Perspectives, 30(5), 274–278.
Debra O’Shaughnessy Mary T. Quinn Griffi n
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VALUATION: C
LINICALC
OMPETENCIESDEFINITION
Evaluation is an informed approach that uses a systematic, rigorous procedure to examine the worth of an entity such as a program, pro- cess, procedure, individual, or other element requiring an appraisal. Evaluation of clinical competencies in nursing is the application of a process, which may use one or multiple strategies to provide both formative and summative measures of the clinical capabili- ties of pre-licensure, graduate students, or a licensed nurse in clinical practice.
APPLICATION
Evaluation methods for the appraisal of clini- cal competencies are used throughout the pre- licensure educational process. Judgments are made regarding a student’s performance in the clinical setting during and at the conclu- sion of each clinical course. Determination of the student’s ability to provide professional
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The use of a clinical evaluation instru- ment for the determination of an individual’s ability to competently practice is contingent on the properties of the instrument. The items in the instrument must be consis- tent with the desired outcome competency.
Students at each level must be clear regard- ing what the successful demonstration of a particular skill includes. Trustworthiness of the tool to contain the necessary items for evaluation is indispensable if the instrument is to be a valid indicator of clinical compe- tencies. The score on the instrument used for evaluation should be a true representation of the observed behavior. The instrument must also perform in a reliable manner; thus, the same results can be obtained when the tool is used by different faculty and with dif- ferent students (Collins & Callahan, 2014;
Courtney-Pratt, Fitzgerald, Ford, Johnson, &
Wills, 2013).
Other measures identifi ed in the litera- ture to evaluate clinical competency include the Objective Structure Clinical Examination (OSCE). The instrument affords the oppor- tunity to generate an unbiased objective review of performance in a controlled set- ting, not in an actual patient care setting.
A key value of OSCE is that it can be used for review and practice of skills that are of a highly critical nature, yet are used infre- quently; for example, disaster readiness (Rushforth, 2007).
RECOMMENDATIONS
There is a lack of information on the prop- erties of the instruments used for the eval- uation of clinical competency. Validity and reliability assessment of existing instru- ments are needed to guarantee confidence that the scores calculated using the clinical evaluation tool are a true representation of the observed behavior. Faculty observa- tions are a cornerstone for the evaluation of clinical competency. The criteria to dem- onstrate skills at all levels must be clearly communicated, and efforts to minimize bias must be incorporated into the evalu- ation process.
evaluate patterns of clinical performance and continuous learning efforts as well as interval accomplishments.
The summative evaluation of clinical com- petency is directed at validating the acquisition of a skill or set of skills at the end of an instruc- tional unit or level in the program. A grade is issued that indicates if the clinical competency has been achieved. Summative evaluations are often documented on a clinical evaluation tool, a numerically ranked score that denotes a successful or a failed attempt to acquire the designated competencies. The dominant strat- egy for evaluating clinical performance in all nursing programs is faculty observation of the student’s interactions. A clinical evaluation tool was identifi ed by 98% of nursing faculty as the instrument used to record the summa- tive observations and rank the performance of students (Oermann, Yarbrough, Ard, Saewert,
& Charasika, 2009). Faculty in undergradu- ate nursing programs have developed instru- ments for clinical evaluation using elements from the Essentials of Baccalaureate Education for Professional Nursing Practice (American Association of Colleges of Nursing [AACN], 2008), which identifi es the expected student outcome for baccalaureate-level education.
Other indicators reported by faculty that are employed to complement their direct observa- tions of a student’s clinical performance are activities demonstrated during clinical post- conference such as case study analysis, values clarifi cation exercises, and presentations on relevant clinical topics (Oermann et al., 2009).
Individuals who are in an advanced practice graduate program are prepared for a role in direct patient care. Core competencies for advanced practice specialties are deter- mined by each specialty’s professional organi- zations. Clinical evaluation instruments used for the systematic appraisal of graduate stu- dent’s clinical competencies in the advanced practice programs have been developed using the Essentials of Master’s Education for Advanced Practice Nursing Education (AACN, 1996), the Essentials of Doctoral Education for Advanced Practice Nursing Education (AACN, 2006), and the respective specialties’ accredi- tation council standards.
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