Clinical evaluation of student nurses: syllabus needs for nursing instructors

Vivian Wood

This paper outlines a project carried out to assess nursing instructors needs for instruction in clinical evaluation. One of the frustrating tasks for the nursing instructor is that of evaluating the student nurses clinical experience. Often problems result from inadequate clinical evaluation. What course preparation have the nursing instructors had in this aspect of teaching? What should be included in the current curriculum for nurse educators, given the demands for accountability to students, patients and educational institutions? The findings suggest that many nursing instructors have inadequate backgrounds in clinical evaluation of student nurses. Hence, the existing course Evaluation in which had a clinical evaluation component lasting seven Nursing Education, weeks, was significantly altered to reflect the needs of the nursing instructors as revealed by the survey.

Clinical nurse will exist, subjective. in

evaluation educators. is based because These nurse in clinical between

is a stubborn As human problems long observation manifest on observation,

as

problem for clinical problems is at best

students Palmer shifted using

with made the general

the

clinical

evaluation advance of evaluation attention

process. when such she from as

a significant nursing categories

performance

educators

student

complaints, evaluation student problems. and the

themselves contradictory and frequent difficulties of times many the nursing precision

conscientiousness, knowledge and orgamsation, to specifying clinical objectives, and criteria .cr outstanding, formances. scale acceptable Palmer also (Palmer and unsatisfactory a nurses perrating clinintroduced 1962 1. for skills that while for testing student they are laboratory She also

reporting meetings instructor

to discuss

The

for evaluation formulated

of the student guidelines

and uniformity of gaining perception has been documented

ical performance Rines (Rines nurses learning.

(Wood 1972). Nevertheless, progress has been made in the development of clinical evaluation tools for clinical Much decades has to teachers. been assist written both nurse in the past two and educators

1963). She emphasised should not be evaluated She in was one nursing testing and

of the first education. acceptable

to introduce

criterion-referenced experience

V Wood BScN MM, Professor of Nursing, University of Western Ontario, Canada Manuscript accepted April 1986 For simplicity she is used when referring to nurses and tutors.

pioneered satisfactory grades as the only ones evaluation. Rines popular Rambo concepts Nursing

unsatisfactory for clinical

and Wood (1982) extended and introduced the very Skills for Clinical Practice

208

1100k5
(A~lell

for
:

nursing 19661 for clinical these in problems 1960s.

instructors. the evaluation product.

Fivars critiral and offered

and it

dents

sit for their Upon the Nurse)

registered

nurse

c~xaminations of c-ompletion then :tnd practice their Of

adopted

incident

following programme. examinations, (Registered as a registered

successful

completion successfitl may

tel,hnicjue .\lthough irtlpro\

;IS a succrsslul emcnts

commercial educators clinical become

araduatc after

use RN

introduced evaluation, apparent 1970s there the and nurses. The

many other toward was a form of shift using

her name

nurse.

u11~o1vtd pt~oliteration c-ltttical

rl~e encl of the r\aluation

In the

of articles behavioural process reflected

discussing objectives changes was clinical ob,jectives, examinations.

Nursing instructor
The nursing 3 instructor graduarc who is a of regi.stcrrti :I student college also nurse, in of exhealth eourst clinical usualIy programme, hospital-based nursing. for periencr agencies. development, evaluation Campbell in the with UK classroom, a ward of 1985). classroom in the She ba~alaureate nurses schools clinical for and

of student

I cI tlrfi ning
111~ nursing fi .nnev\~ork ecluc.atton. L\ ith siudrnt I\ eighting 1hr ;ilier ht ill IL~li)re computer these remain

as the essential recent

conceptual in nursing carried the Yet out use of and even 1977). an contracts,

instructs

or community instructor and teaching hospital is and also the student

Experimentation self-evaluations, of bchavioural for perfi~rniance obvious \ \Vood to clinical advances, 1982, the

The nursing

i\ responsible

or community responsible classroom nurses diftirs

evaluations many Woolley survey may

c linical

problems results,

! ~\ood
from

2-z
that

lhis sy-stem

proceeding

t,uamirration

of the terminology

be helpful.

where the tutor is c~ontinrtl and thr clinical experience sister or clinical instructor.

to the rests

DEFINITION

OF TERMS

Clinical evaluation
In evaluating dent nurse, The the clinical about csxperience must the students and, collection. clinical lvork, decisions are abvu
(along

Baccalaureate education
Nurses jletetl ,ocial j)crirncr hospitals scrvict> Irom with a baccalaureate based courses student the The with firr the degrees nursing in the nurse community student nurse with have comand exin other university as well education Clinical takes place and graduates a Bachelor

of a stumake perfbrfin on is based she eAuatiotr with used irk a

the nursing nursing clinical and the clinical from for

instructor

series mance. her grade. other

of drcisions

instructor experience data final

is responsible

j)rogramme, sciences

biological

the students responsible lhrse data

as nursing.

observ-ation:,

: wards),
a,gcncics. Science nurse

evaluations

course

the four-year

programme degree. examination

retention nursrs.

or promotion

t si utlcnt

rjf Nursing rrgistercd

She also sits for her immediately.

Education for the Registered Nurse diploma

In this programme, the student or college. years the student also The nurse be used. nurse is enrolChnical in stuother led itr a hospital \ary horn experience hospitals for programmes is gained and These

CLINICAL EVALUATION STUDENT NURSES

Clinical structors achieving but it important. evaluation with can be many objectivity; Explicit has diflicultics.

OF
nursin,q jartic-ularfy is very records irrin real ;LI.(

presented

two to three (wards!. mav

in length.

this diffreultv Good documentation

Community

overcome.

\crrvic e agencies

(~II be de-

2 10

NURSE EDUCATION

TODAY

veloped when and Such picture area have the Every

by the use of anecdotal properly written, provide increase of student a

records the

which,

reliability evaluation. complete clinical should policy out process to both of be middiscuss peruntil

GENERAL DISCUSSION
Data the on educational 197 respondents, nurse 10.2 the per a diploma background 17 per in nursing cent. cent Those Registered accounted A small the reveal had who that only had accounwith for 69 per proportion degree. the specifor nurse In the with this of a re-

objectivity records (West of student nursing This

clinical relatively

performance 1980). education easily policy of failure student clinical should and has be

in the

& Choi-Lao

registered ceived ted cent In and fied for of

diploma.

programme understandable should and the held and progress. spell the right Thus, to clinical on record

education

a complete, consequence Every of her strengths be given All conferences

nurses

for grading. appeal. informed term student should formance. signed should sed with to the student

baccalaureate (3.8 per cent), a monograph qualifications

preparation respondents. held outlining

a Master

of Science

responsibilities instructor,

of the nursing Association minimum degree

weaknesses should and Final and (Poteet kept

warnings

Registered that nursing Nurses survey 1).

Nurses the instructor Association

of Ontario

for unsatisfactory warnings

requirements in nursing these per while provinces

be in writing, evaluations be discus1981). shown of and the of

to be a registered of Ontario meet 41.6

by the student, graduates.

a baccalaureate

(Registered (Table from reper

clinical should & Pollok has

1978). criteria were

also be in writing the student the the and

72.8 per rent

Although improve, similar nursing as part clinical Nursing ation ation. several tors major cluded current evaluation

state-of-the-art practice Clinical In view troublesome of these quest

has continued not continues

Geographically, three cent western the from western were presented of Canadian parable (Health sample bution, basis extent language The Table The relatively 2. majority young The to did in the eastern not

cent

provinces eastern Ontario. provinces, and nurse

32 per and were

cent 26.4

progress. school. evaluation course of nursing This have survey received questions.

evaluation

to be difficult

in all types problems to improve of the Faculty Ontario, the formal in clinical nursing in What should evaluation the prepar-

In 1982, 30.6 per cent in the comcent were The in Ontario 1982). from this distriTo some by in were over fell per the group 39.2 per

instructors 30 per cent Statistics stray a on

of a continuing

component in Western to ascertain instructors attempted How many nurses? content instruction What

were

a survey evaluinstrucclinical are be their in-

Manpower seriously although

was undertaken

province-to-province occurred. can be is explained differences. described

to find answers

significant these and geographic

differences variations course

availability

of student

distribution of the faculty with largest only group, age group. 21.8 36645 per age

concerns? in courses educational

on clinical needs?

to meet nurse who

responding 16.8 per The group. cent next Thus, 35.5 per cent, cent and 25.9

To address educators from had naire. were attended Relevant obtained. programmes

these questions 197 six Canadian provinces seven continuing a nine-item

45 years. between 31-35 cent fell

the 25-30 constituted in the

education question-

answered

statistics and category counts Qualitative analysis included

largest group, those between

57.3 per cent, was made up of 25 and 35 years of age. These, having the (see Table had 23.8 one per

content analysis and themes and the development and use of nominal scales, categories and frequency been sequently tabulations. on modified. The 30 questionnaires and had subpre-tested volunteers

one can assume, represented those least experience in clinical teaching 3). Of year those or less answering, of teaching 52.3 per

cent

experience,

-9 years subject 1111 )\t hcquvntl>taught

t 33.6

per

cent)

while

NURSING INSTRUCTORS CONCERNS ABOUT CLINICAL EVALUATION OF STUDENT NURSES

FYhat practicr cantly The are the currrnt Ijasic student problems. has dilficultit~s nurse and .\lthou,qh t)rcn still must the of clinical improved, underlying ot thr evaluation problem: in a clinical threatrn zignifiremain. be done 1%~. rvcrturncorn--

pt~rfi)rlllance-hasrd settiq.

evaluation changin,g over

Percentage Registered Registered Registered Registered Total Table 2 Geographic Nurse Nurse, 1 year University Diploma Nurse, Baccalaureate Preparation Nurse, Masters Level Preparation 17 10.2 69 3.8 100

by an individual of patients

circumstances the tasks of both

the fi-tqurnt and

consistrnq instructor

plicatc The

:und studellt.

l)asic issues arr: is Ixlscd on ttirrcr exhibits otxrrinhrrrnt

Clinic~al evaluation \xtion. Since process, student. Human evaluation thr cliiiical
iind

observation is ;I setting contend illncssra.

bias and subjectivity. ltrfi~rm~lncc~-t~~is(~d is (1iti(,iLI to the Lvitll a multitude 01 stll(lt.nts accommodatt. that sirnula

distribution

of sample National distribution of inStructofs (percentage) 30.8 39.2 30 100

M ho must of the instructor student bascxl total nurse to clients. the clinical what and shr the
on

of personalities Brcausr nursing taneously individual inevitably nurse\ six \vrrk

Table 3 Age distribution Age-range 2530 3135 36-45 over 45 Total Table 4 Clinical teaching Percentage 35.5 21.8 25.9 16.8 100

number must

Provinces Western provinces Eastern provinces Ontario Total

Percentage 41.6 32.0 26.4 100

in her group.
a

her assessment ot an nurses txprricnc-t is samplr ot the student in the uml this

rsprricncc Ljuring

, Mardi.
she prrsonin tht to to CY),

The student ad,justing nrl, and applying classroom real-lift,. It is impossible drvisr prrienves
The

is 0t)scrvrd stafi and cnviromnent. has brt*n simulated riursiq

o\.ct 3 li)ur to period. other Ir:jrnirq is

period.

She is &I I,rborn tory instructor, learning

I!W

lor thr student survey1 evaluation

completely for tech

cornparablr

(\Vootl
their 7htv ihv

participalits rrspollse clinical \vcrc can 5. i\s nurse

\z ttx askrtl of studrnt two

in an nurses: rnajoi and but

responsibilities Percentage

open-endrd regarding in the not Iahlr studrnt c.linic.ally 380 rrsponsrs

to indicate obtains-d. br sren. lv,qal \vas

Ntxt

(oncrrns arc shown

Medical, surgical nursing Fundamentals of nursing Maternal, child, paediatrics Psychiatric Communiky nursing Biological sciences and other Total

33.6 31.2 17.4 6.0 0.5 11.3 100

arras

of concern

were lvho

implkations academic~all~ in

s01111cl.

fi~ccluc~rkc)~ 1va5

concrrn about the acquisitiotr about various clinical e\~;duation

t )I knowledgt~ tools. (;radillg

2 12

NURSE

EDUCATIOX

TODAY

Table 5 Matters of concern to participants content of clinical evaluations

by nursing
regarding

instructors. they had

Fifty-eight no previous

per

cent

in-

dicated

that

course

work

Percentage
Content Legal implications Student academically sound but not clinically Knowledge about variety of clinical tools Grading methods Knowledge of various evaluation strategies Rater subjectivity Levels of clinical evaluation Marginal student Student self-evaluation Evaluation while student is learning Length of time spent in the clinical area Number of incidents necessary Reliability, validity of clinical tools Assessment of communicative and affective behaviors Selection of patient assignments Working relations with faculty Studentfaculty ratio No questions of responses 16.7 13.0 9.4 5.5 5.2 5.2 4.9 4.9 2.7 2.7 2.6 2.4 2.0
1.7

in clinical evaluation, 26 per cent clinical evaluation was presented their undergraduate stated whether and education yes. concerns the they nursing had per cent workshop queried in either cent ground, structors measurement indicated attended nursing had taken

stated that briefly in and 16 a non-credit

courses, school.

in a university they

When in

a course only lack

evaluation Given

or the equivalent, 2.5 per of backinthis

or psychology, expressed

by nursing

are not surprising.

1.0 1.0 1.0 2.7

A MODEL FOR TEACHING CLINICAL EVALUATION

The nurse past decade and has enriched our knowledge, student many prepared develop skills not but bias; Ontario offered ten for in the secnurse course. two-hour with classstanThe the with understanding clinical skills are and of their of a in evaluating Nevertheless, inadequately They must own evaluation be reduced. Western is course

experience.

methods, strategies ivity of the Finally, of clinical ation while time spent of incidents failing nursing and (Wood sures early years, grades Many are were

the and levels other

variety problems specific about student student of clinical

of with

clinical evaluator

evaluation subjectnext. evaluthe or new and prestoday 15 their Delineation came and validity

nursing only also only At Faculty aspiring Nursing offered Masters tion Each session. evaluation room. dardised second nursr This on experience

instructors evaluation. observational

for clinical

concerns. evaluation reliability nurse area,

an awareness then the of

potential

concern tools, the

can subjectivity University Nursing nursing Education for nurse in Nursing clinical is one the first third testing

self-evaluation, is learning, and for

in the clinical needed nurses in were These

the number passing not of the

instructors: is one educators Science evaluation part class course unit and meets unit concerns nursing education

Evaluation of the Program. of student for a in itself enrolled in The

to justify issues As

courses

student evident & that

on the minds are nursing articles, are in the over demanded be the challenged

instructors. Campbell stated nursing stressful nurses dismissal appeals In

recent 1985). in their

literature the

Whelan facing the

of a 26 week is concerned

Meisenhelder are far more 1970s. student and student

week The The

instructors than have have

1960s or the past that justified. clinical appeals

of nursing

Increasingly

education.

decisions instances

unit focuses clinic-al second unit

on the evaluation is always

of student
one.

expericncc. a popular

evaluations.

several

were successful because presented to validate the proved inadequate (Whelan 1982). From tion, the responses

the documentation instructors position 1979, Meisenhelder open-ended ques-

Classroom attention first focuses on the standards by which students are evaluated. These standards are captured in the objectives of the course and the behaviours which can be reasonably expected her particular stage of the student of learning. The nurse at concepts

to the

one can sense

the frustrations

experienced

and purposes 01 learning Iundam~~ntal of \rudent Uitr (.olllynt tlrl. nwlx rlt.ilt\ clilli(.;tl Mrrc CL.Iluatloll IO\\ ~1 I)\ (~1,1111ating Ir,trniliy. stt UC101~ aiicl

ofevaluation theory. The importance of and

are discussed unit of direct the survey

in terms the

emphasises setting. the

Table 6 Evaluation Unit

in nursing education Time 9 weeks Content Critical role of evaluation in nursing: formative, and summative evaluation Historical role, critical issues, Analysis of: legal issues, contracts. grading, simulation, computers in clinical evaluation, peer and self-evaluation, cllnical performance examinations Critlcal analysis of nursing tests used for selection, achievement, placement and practice

observation course man); of the of is folixsucs in inclinical Stu-

behaviour completion
N'~IS

in the clinical

rc\iscd

now embraces b) the participants.

Evaluation of the student nurse in the classroom Evaluation of the student nurse during clinical rotation

docxunellted tool.
;I

110 lo~lger- required No\\ ~ historical in nursing of the perfbrmance that nurses arc the student arc Gould

to de\,elop dr\.elopment education crucial and affect

9 weeks

r\,alllation c.linicaI I,c,qal

a11c1

discussion issues

nursing

student situations

in the educational examined nursing law courts contracts nurses during

clinical

1Milk1
instructors are also and the of in sclfof
Nursing education and standardised tests 8 weeks

1CW
stlldicrl. mt~thotls clillic.al Cy- Iklane\ c.linicxl llll,

Chsrs
CIinical

involvinCy waluation

\I-1lic.h ha\ t rcwhrd of gxling rxpericllw 1982. cwminations

Il';q:c

prescntcd 1978). 18783. and Prcr

(Schoolcraft Simulations practised and examin(Gustafsori structure.

are used clinical

cl<LssrcJcml

Content included after expressed needs IS summarised in Table 5.

CX .~111al ioii,
:11i1)115

and

performance rvaluation the at)ove

.irt

f~~llowed

1)~ ;I critical

examination

1111. rewarch II>IOi.

iu clinical
oullirirs

i;il~lt~ 6

References

CONCLUSIONS
t:\ tll I hotlgh I.1 aluatioll
I~LIIW

research have

and

education

in clinical man) withhverc in is of for their prothe educoriof revealed

wntinurd WC rrquired

to improve, to perform survev The in singlr to

to

lllstructors
nrtds and

01it atltyuatr
~n:rn!-

prrparation. inadequacies. a course :I rrsponding

jnstructors

The

results course

1iw1111 in \ursiilg litnitc(I

rc\king Fducation. test in

E:valuation the need Continuing The during and that the

such

c,\istilr(l Y nursing

increase

t .rpabilitirs
c~tlucxtioll Ilti~ratioli 01 c,lirlicxl ilr5tru~.tora
.<I11 !w

in c,linical Mwrkshops 01 wccllrnt

evaluation. arr nredrd. research advances stratrgies demands the basic

) )ISI tlrcxdr,

th

recent

in a variety on the nursing prrparation

evaluatiolt makes

t ,~rion;~l accountability
included in iliatructot-a.

it imperative

iiursit12

14

NURSE

EDUCATION

TODAY

Lines A R 1963 Evaluating student progress in learning the practice of nursing. Nursing Education Monograph No 5, Teachers College, Columbia University, New York choolcraft V, Delaney C 1982 Contract grading in clinical evaluation. Journal of Nursing Education 21 (i): 614 Vest L M. Choi-Lao A T H 1980 A new aDDroach to anecdotal recording. In S Kooperstein Mikn (ed), Teaching tomorrows nurse: a nurse educator reader, Nursing Resources Inc, Wakelield, Massachusetts Vhelan W L 1979 Academic litigation as educational consumerism. National League for Nursing, New York

Wood V 1972 Evaluation of student nurse clinical performance: A problem that wont go away. International Nursing Review 19(4): 336-343 Wood V 1982 Evaluation of student nurse clinical performance A continuing problem. International Nursing Review 29111: 11-18 Woolley i S 1977 The long and tortured history of clin evaluation, Nursing Outlook 25(5): 308-315