Anjus Evaluation in Clinical Practice

8/2/2019 Anjus Evaluation in Clinical Practice

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EVALUATION OF CLINICAL PRACTICE IN NURSING

INTRODUCTION

Evaluation of the learners clinical practice is critical element in professional educational program.

Teachers in a professional program such as nursing, medical, etc must concern themselves not only withevaluating the students mastery of behavioral objectives as demonstrated by usual academic procedures

but must also assess the students competency in actual practice. Professionals practice their and are held

accountable for the quality of practice. Thus the development of practice competencies in critical

dimension of any professional program and must a matter of continuous evaluation.

Clinical practice may be viewed as the way or medium through which a professional

practitioner ministers to his/her client. Thus clinical practice may be conceptualized as the way the nurse

utilizes a particular constellation of abilities to meet the health needs of the client.

Nurse teachers must develop a concept of clinical practice in terms of nature of actions

involved, the client served, and the relationship of the nurse to the clients and their problems. The concept

of the teacher holds determines the expectations, the evaluation strategies, and the reward system

associated with clinical practice.

Since the nursing process is the methodology of practice, the major focal point in evaluating

clinical practice is the learners competency in using the process. Identification of nursing actions implicit

in the process serves as the basis for evaluation. The nursing actions are behavioral objectives.

Evaluations of learners practice skill occur in an environment with built-threats and pressures.

Not only does the supervisory process, by its nature, generate anxieties but the process takes place in an

environment that makes the learner particularly vulnerable. The developmental process that changes of

behavior takes place in full view of patients, colleagues, and other health workers. Care must be taken that

game playing is not resorted to as a means of lessening threats in clinical field.

PURPOSES OF CLINICAL EVALUATION

1.To assess quality and standard of clinical performance of students, e.g. Is performance satisfactory or

unsatisfactory?

2. To reinforce excellent and good performance, and help those students whose work is just at acceptable

level?

3. To identify performance deficiencies, and areas of unsatisfactory performances; to inform student or

help her to identify her shortcomings, and to correct poor work habits before they become entrenched; to

decide whether student needs further training, supervision or guidance.

4. To establish a basis for guiding and counseling students.


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GOALS TO BE ACHIEVED

*To determine whether the student has sufficient knowledge for the established level of clinical

practice.

*To provide feedback to encourage or discourage certain behavior.

*To determine the level of clinical performance of the student.

*To provide a record for the promotion, demotion and dismissal of professional in clinical

practice.

ASPECTS TO BE OBSERVED IN EVALUATION

1. Evaluation must appraise the behavior of the student, as the education brings certainly change in

behavior.

2. Evaluation must involve, more than a single appraisal at any time to determine whether change hastaken place or not, appraisal at an early point and at later points is needed to identify the changes that may

be occurring

PRINCIPLES OF CLINICAL EVALUATION

Clinical evaluation methods and techniques need to be:

*OBJECTIVE

*RELIABLE

*VALID

*ACCEPTABLE

*FEASIBLE

Objective: Evaluation should be based on facts, observed behaviors and adequate sampling of student

behaviors.

Reliable: Method used is consistent, stable, e.g. There is close agreement about students performance

when two instructions arrive at the same conclusion.

Valid: Evaluation measures what it is intended to measure, e.g. .interpersonal skills or technical skills.

Acceptable: Current thinking suggests that methods used should be acceptable not only to the clinical

instructors and supervisors but also for to students whose performance is being evaluated; students should

be familiar with expected performance standards.

Feasible: Methods should be realistic, practical and not too costly; a first class evaluation tool may have

to be discarded if it is too costly in terms of time and money.


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TYPES OF CLINICAL EVALUATION

1. THE FORMATIVE EVALUATION: The assessments are made during the teaching learning

process to monitor the progress of students and provide feedback to the students. It examines incidents

and events related to student learning. To identify and overcome the weakness.

2THE SUMMATIVE EVALUATION: It is the final assessment of student achievement after a

designated period of time, at the end of course or training programme .It surveys the pattern of behavior

noted in a group of events and incidents. The educator summarizes the past events.

PLANNING OF CLINICAL EVALUATION

*Define the learning objective.

*Specify the standard performance.

*Select appropriate method for evaluation.

*Enough samples of behavior must be recorded for summative evaluation.

*The recording of evaluation process should be deliberate and ongoing, reliability, and practicability.

CLASSIFICATION OF CLINICAL EVALUATION

Many different types of clinical evaluation methods have been developed. The evaluation of

is based primarily on direct observation and evidenced of quantity or quality of work done. Non one

procedure is suitable totality of practice. Strategies chosen should reflect the particular behavioral

objectives to be evaluated, the needs of the learner, and character of the practice setting. For clinical

evaluation, the quantitative techniques are to measure the clinical practice. The selected qualities

techniques or procedures suitable for clinical practice evaluation included the following.

I )OBSERVATIONAL TECHNIQUES

1. CHECKLISTS2. RATING SCALE3. ANECDOTAL SCALE4. CRITICAL INCIDENT TECHNIQUE.

II )WRITTEN COMMUNICATION SKILLS

1.NURSES NOTES

2.PROBLEM ORIENTED RECORDS

3.NURSING CARE STUDIES

4.PROCESS RECORDING


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III) ORAL COMMUNICATION METHODS

1. NURSING PATIENT CARE CONFERENCES

2 TEAM CONFERANCES

1. OBSERVATIONAL TECHINQUES.

One the evaluative procedures of the practice dimensions of the student learning used most often is the

observation of the student behavior during nursing practices. An observation technique generally implies

the use of a particular observational tool such as rating scale, checklist, etc. However the process of

observing and recording an individuals behavior is what is meant by phrase observation technique.

THE ADVANTAGES OF OBSERVATION are as the follows

1. Frequent observation of a students work and work habits can provide a continuous check on his

progress.

2. The errors or problems, as they arise can be immediately directed and corrective action taken quickly.

3. Observational techniques are not so time consuming as meaning for the student as are achievement

tests.

4. Observational data provide teachers with valuable teachers with valuable supplementary information,

much of which could not be obtained in any other way.

Observational is the most direct, timely and inexpensive means of clinical performance evaluation. It is

the task of the observer to organize observation, so that the data will be collected systematically and will

organize observations that the data will be collected systematically and will be comparable among

different observers.

An observation is used as a method of evaluation. It should be used as be valid. The following

suggestions help make valid observations:

1. Plan in advance what is to be observed?

2. The observer must be cognizant of sampling errors. There should be frequent ,short observations

distributed over a period of several weeks and at different times of the day.

3. Coordinate the observations with your teaching .Otherwise, there is real great danger that invalid

observations will result

4. Record and summarize the observation immediately after it has occurred. More important, however, is

the fact that when pupils know they are being observed, their resultant behavior may be typical.

5. Make no interpretations concerning the behavior until later on. Otherwise, it may interfere with the

objectivity of gathering observation data.

6. Prepare some sort of list, guide a form to help, make the observation process objective and systematic.


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TYPES OF OBSERVATION TOOLS

A) CHECKLIST

A checklist consists of a listing of steps, activities, or behavior which the observer records when an

incident occurs. A checklist enables the observer to note only whether or characteristic is present. A major

limitation of the checklist is that it doesnt indicate quality of the checklist is limits to procedure,activities, functions and specific tasks. Only a limited component of overall clinical performance can be

evaluated by checklist.

There are some advantages of checklist, as given or detailed below:

1. They are adaptable to most subject matters areas.

2. They are useful in evaluating those learning activities that involve a procedure process and some

aspects of personal social adjustment.

3. They are most useful for evaluating those learning activities that involve a procedure process that canbe subdivided into a series of clear distinct, separate actions.

4. When properly prepared, they constrain the observer to direct his attention to clearly specified traits or

characteristics.

5. They allow interindividual comparisons to be made on a common set of traits or characteristics.

6. They provide simple methods to record observations.

7. They objectively evaluate traits or characteristics.

CONSTRUCTION OF CHECKLISITS

While constructing the checklist the following points to be kept in mind

1. Express each item in clear, simple language.

2. Avoid lifting statements verbatim from the text

3Avoid negative statements wherever possible.

4Make sure that each item is clearly yes or no, true or false and the like.

5 Review the items independently.

UTILIZATION OF CHECKLISTS

While the checklist, evaluator should keep in mind the following:

1Use of checklist only when you are interested in ascertaining whether a particular trait or characteristic is

present or absent.


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2 Use only carefully prepared checklist for more complex kind of trait.

3 Clearly specify the traits or characteristics of behavior , to be observed .

4 Observe only one student at a time and confine your observations to the points specified in the

checklist.

5 Have separate checklists for each student, individual observations can be recorded on a master

6 The observer must be trained how to observe, what be trained how to observe, what to observe and how

to record the observed behavior .To make a valid judgments he should omit recording those behaviors for

which he has sufficient information.

Checklists require the observer to judge whether certain behavior of student and clinical practice has

taken place. For example, a checklist could be used in observing the activities of a nursing student taking

blood pressure and giving an injection. Some actions must be performed in certain sequence if a given

task is be done competently. Most laboratory procedures and some physical examations fall into this

category.

ANECDOTAL RECORD

An anecdotal record is running description of actual examples of behavior of a student as observed by

teachers and the counselor. It is followed by his comments. These are descriptive accounts of episodes or

occurrences in the daily life of the student.(Brown and Martin).Thus an anecdotal record is a report of

significant episode in the life of a student.

Anecdotal record is are cord of some significant item of conduct ,a record of an episode in the life of the

student , a word picture of the student in action,a word snapshot at the moment of the incident, any

narration of events in which may be significant about his personality.-Randall.

Anecdotal record ,as the name implies, involves setting down an anecdote concerning some aspects of

student behavior which implies ,involves setting down an anecdote concerning some aspects of students

behavior which seems significant to the observer.

CHARACTERISTICS OF THE ANECDOTAL RECORDS

These are records of specific incidents factual description of important and meaningful event or behavior

of students on informal occasions. Each event or behavior is described shortly after it occurs.

The characteristics as given below;

1. Anecdotal records should contain factual descriptions of what happened, when it happened, and underwhat circumstances the behavior occurred.

2. The interpretations and recommended action should be noted separately from the descriptions.

3. Each anecdotal record should contain a record of a single incident.


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4. The incident recorded should be that is considered to be significant to the students growth and

development of example.

ANECDOTES

1. Kum.Ganga is seen in library, sitting in a corner, preparing nursing careplan of cardiovascular diseases.

DATE ON 12.3.2008

2. Ganga is found to be only girl responding to the teachers question on cardiovascular nursing.

3. Ganga was caught reading a book Medical and Surgical Nursing during Community Health

Nursingclinicas and was asked to leave the room.

Interpretation: Gaga should be encouraged to do more in medical surgical nursing and also not to neglect

Community Health Nursing and other subjects.

4. Any significant behavior, be it in the classroom, in the school or college, or outside the college, i.e in

the clinical areas should be recorded.

5The exact behavior of the student should be recorded; inferences, guesses, or assumptions must be

avoided, unless it signifies.

6The facts presented in all the anecdotes must be arranged so that they may be studied in relation to one

another.

7The record should be regarded as confidentiality should not fall into irresponsible hands.

8Words and phrases are employed that are definable in terms of things rather than other words, concrete

statements are preferred to abstract ones.

Anecdotal record is a brief account of a critical incident. Anecdotal records of critical incidents that occurduring a students clinical experience are quite useful provided focus is on incidents that reflect effective

behaviors and ineffective behaviors.

The first part of an anecdotal record should be factual, simple and clear

*Name of the student

*Unit/ward/departments

*Date and time

*Brief report of what happened.

2. The second part of the anecdotal record may include additional comments, analysis and conclusions

based on interpretations and judgments.

The first part answers:

*Who was involved?


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*Where did it take place?

*When did it occur?

*What happened?

The second part answers

*How and why the behaviors occurred.

Follow ABC rule in writing anecdotal records.

A. Accuracy.

B .Brevity

C .Clarity

Descriptive reports: The instructor writes a brief report on student nurses performance over a given

period.

Instructor decides what to include in a report and she may quite inconsistent unless she is guided by some

kind of a structure.

ANECDOTAL NOTES

Anecdotal notes are frequently used in nursing education for recording data about the students practice

and reliability. An anecdotal note is a recorded description of the behavior and activities of the learner

during a particular performance of short duration.

When behavioral objectives are identified for clinical practice, nurse teachers should make decision as to

how each is to be evaluated. All students will be evaluated on the same behavioral objectives by the same

number of notes. This system also objectives by the same number of notes. This system also helps the

faculty to be realistic about the number of notes it is possible to collect in any clinical practice period.

Anecdotal notes are valuable to record longitudinal data about the students progress in developing

practice competency.


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BEHAVIOUROBJECTIVE EVALUATION

1.Assumes responsibilities for explaining procedures to a school agechild before beginning a task

2. Auscultation technique accurately

In two out of three observationsrudent explains the recorded in

anecdotal notes the student

explains the procedure.Criteria for evaluation

1.Explanation precedes the startof the procedure2.Explanation is in the language

understandable to the child

3. Explanation is accurate.

4.child is encouraged to askquestions and express concerns5. Questions are answered

accurately and sensitively

Criteria for evaluation

1.Identifies the proper land mark

2.Uses stethoscope properly

3.Distinguishes sounds correctly

4.Carries out procedure within areasonable time frame

CRITICAL INCIDENT TECHNIQUE

Behavioral O bjective ON

1.Shares on assessment of patient needs

With colleagues in nursing teamy Two critical incidents from

team conferences.

Criteria for evaluation1.Identify

a. Learner behaviorwhich assisted team

members inunderstanding patients

needs.

b. Learners behaviors whichinterfered with the team

members understanding ofpatients needs.


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The concept of critical incident differs from that of an anecdote .Fivers and Gonsells define a critical

incident as one that makes significant difference in the outcome of an activity. It may be the positive

factors that contribute towards the cusses of the behavior or it may be negative factors that interfere with

the completion of the assignment.

The critical incident technique is effective for formative evaluation; it enables the learner and the

teacher to assess the learners behaviors in relation to their impact on the outcome of action. It can alsobe

used in summative evaluation, provided several critical incidents are used to judge the students

mastery of behavior under consideration.

RATING SCALE

Rating means the judgmental of one by another. Rating is, in essence, direct observation .A rating scale

is a method by which we systematize the expression of opinion concerning a trait. These ratings are done

by the parents, teachers, a broad of interviewers and judges and by the self as well. These ratings scale

given an idea of personality of the individual .For example, the important aspects known as attitude orstyle is a part of all interactions between nurses and other which includes patients relatives, friends,

village leader, administrator, managers and fellow members of health team etc. To evaluate such aspects

rating scales are more likely to provide a better record than checklist. Rating scales provide systematic

procedure for obtaining ,recording, and reporting the observers judgment .That may be filled out while

the observation is made ,immediately after the observation is made, or as often in the case, long after the

observation.

ADVANTAGES OF RATING SCALE.

1. Technically, rating scale is standard device for recording quantitative and qualitative judgments about

observed performance.

2. They evaluate procedures such as playing an instrument, operating an equipment or machine. Working

in laboratory, demonstrating the nursing procedures, typing, cooking, oral reading, acting in play .,etc.

3. They help the teachers to rate their students periodically on various characteristics such as punctuality,

honesty, enthusiasm, cheerfulness, cooperativeness, considerations of others and other personality traits

In general, rating scales with behaviorally expressed items are more helpful than those with items

expressed as a list of traits; the behaviors are less ambiguous.

4. They can also be used by a student to rate himself.

5. They can also be used with a large number of students.

6. They tend to be very adaptable and flexible.

7. They can be efficient and economical in the use of a teachers time

8 They can be comprehensive in the amount of information recorded


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9 They can help to reduce the subjectivity and unreliability that are usually associated with observations

method.

DISVANTAGES OF RATING SCALES

Rating scales have certain limitations that must considered when certain limitations that must be

considered when a evaluator is determining their use within a perform.

1 There is a lack of uniformity with which terms are interpreted by evaluators. This is a particularly true

with used to designate various intervals in the rating continuum. An operational definition that includes

illustrations of acceptable behaviors for each interval can facilitate reliability.

2 There is a lack of uniformity with which terms are interpreted by evaluators .This is a particularly true

with which terms are interpreted by evaluators. This is particularly true with used to designate various

intervals in the rating continuum. An operational definition that includes illustrations of acceptable

behaviors for each interval can facilitate reliability.

3 There are common sources of errors in rating scale. All of these sources affect the validity of rating.

Errors may be due to:

1. Ambiguity

2Personality of the rater: Halo effect; personal bias; logical error.

3Attitude of the rater

4 Opportunity for adequate observation.

They represent descriptive data of clinical performance that suggest areas of strength and weaknesses.

Used with different color markings for each evaluation period this scale helps to present of the

Students developmental process. In this use of the scale, teachers must define the data base

They will use and strategies for obtaining the data, so that markings on the scale will reflect

The students total learning experiences.

TYPES OF THE RATING SCALE

Numerical rating scales: This is one of the simplest types of rating scales. The rater simply

Marks a number that indicates the extent to which a characteristic or trait is present. The trait is

Presented is a statement and values from 1 to 5, are assigned to each trait that is rated.

Typically a common key is used throughout, the key providing a verbal description.

Direction: Encircle the appropriate number showing the extent to which the pupil exhibits his

Skills: In the questioning.


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Key: 5 outstanding, 4 above, 3 average, 2 below average,1 unsatisfactory.

Skill

1. Questions were specific 12345

2. Questions were revelent to topic discussed.12345

3. Questions were grammatically corrected 12345

Graphing rating scale: As in the cases of the numerical rating scale, the rate is required to

Assign some value to a specific trait. This time however, instead of using predetermined scale

Values, the ratings are made in a graphic form-a position anywhere along a continuum

EXAM OF GRAPHIC OFRATING SCALE

1. Where the illustrations used interesting?

Too little ,little, adequate, much, too much,

1,2,3,4,5.

2.How attentive were you in the class

1,2,3,4,5

Very attentive, inattentive, ,attentive very attentive

3. Did the speech show good organization?

1,2,3,4,5

Very attentive, _,average, ,very good

Advantage: If a number of traits are rated on the same page with a common set of categories ,a

behavioral profile can be constructed.

Descriptive graphic rating scale: This type of scale is generally the most desirable type of the scale to use.

EXAMPLE OF DESCRIPTIVE GRAPHIC TYPE OFRATING SCALE

DIRECTIONS: As shown above for the graphic rating scale.1.While preparing a blackboard summaryhow was the penmanships?

Legible, beautiful, uniform size and Normally readable good looking, fluent motion, Illegible, badlooking tends to draw outlines slant.


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Such specific descriptions contribute to a greater objectivity of the rating process. The description also

helps to clarify and further define a particular dimension.

RankingIn the ranking procedure, the rater ,instead of assigning a numerical value to each to each

student with regard to a characteristic, ranks a given set of individuals from high to low on the

characteristic this is rated. To ensure that the pupils are validity ranked, rank from both extremes towards

the middle. This simplifies the task of the teacher. The ranking procedure becomes very cumbersome

when large number of students or characteristics per student are to be calculated.

WRITTEN COMMUNICATION METHODS AS CLINICAL EVALUATION

Nurses communicate among themselves and among practioners of their discipline through the written

media. Various forms of written communication serve as significant evaluation strategies .In this type of

evaluation, one is concerned with two dimensions, skill in communicating and quality of the substance

communicated .The usual methods are as follows:

1 .NURSES NOTES

2. PROBLEM ORIENTED RECORD

3 .NURSING CARE STUDIES

4PROCESS RECORDING

1. NURSES NOTES

The ability to report and record nursing actions is identified as critical behavior in most nursing programs,

yet the medium for the most of the recording and reporting, the patients chart has seldom been used in a

systematic evaluation protocol of learner practice competence. The learner has been expected to write in

the nurses notes .But the evaluative data about the students clinical practice performance seldom reflect

his/her skill in recording and the quality of the substance recorded.

The significance of the patients chart is becoming increasingly apparent as the movement to demand

accountability for quality healthcare gains momentu .Phaneauf has devised a nursing audit protocol for

ascertaining quality nursing care based on the use of patient charts the source of data. The chart is a

communication instrument essential to the safety of the patient and the management of his care. It serves

as the major means of communication between the various professionals involved in the care. It provides

legal documentation of the care provided. Recording is the part of one of the seven major functions of

nursing.

2 PROBLEM ORIENTED RECORDS

A problem oriented record is perceived as systematic record keeping centered around the patients health

problems. It consists of the four major components

1. Data base-all appropriate information about patient for assessing his conditions.


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2. Problem list-listing the conditions, systems or circumstances identified from the data base, which have

implications for the patients health. Each problem is unmerged in meta.

3. Initial plans-diagnostic and therapeutic orders for each problem listed. Plans are keyed to each problem.

4. Progress notes

a) Narrative note-an expository comment relative of each problem.

b) Flows sheets- graphic forms to record repetitive and serial data.

c) Discharge summary follow-up organized around each problem.

This approach to record keeping is integrative, as all professionals involved in the patients care

participate in developing and maintaining the record. Recording is also the integrative rather than

segregate, as in the usual form of patients charts which contain nurses notes, doctors notes, laboratory

reports etc. The focus is the patient and his problems; his totality is maintained.

Since, the report of actions and the thoughts behind the actions are a vital part of the record, Problemoriented records are valuable learning experience of the nursing learner.

As with any written communication, not only the quality of the substance the student includes in the

record, but also the communicating the massage considered in assessing the students competency with

problem oriented recording.

NURSING CARE STUDIES

The nursing care study is a familiar evaluation strategy in nursing education programs, although the form

and intent may vary considerably. Schweer defines a nursing carestudy as problem solving activity

whereby the student under takes the comprehensive assessment of a particular patients problems leading

to planning, implementing, and evaluating of nursing care measures.

The students written description of actions implicit in meeting patient needs enables evaluator to

determine ability not only in cognitive and effective domains for each step of the process but the ability to

establish meaningful relationships among steps of the process. Skills in communication concern the

degree to which the nurse conveys the message to the reader. This skill encompass clarity of

terminology and composition, concisiveness of the message, and logic in ordering elements of the

message.

The data gathered for this recording competency may include several longitudinal studies in which the

students recording of a patient are analyzed over a period of time, or it may represent a certain number of

recordings of patients at a particular interval in the learning experience. The design used depends upon

the objective of the experience.

PROCESS RECORDING

A procedure that has an any systematic scheme for formative evaluation is the nursing process recording

.Shweer defines the process recording as the verbatim serial reproduction of the verbal and non verbal


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communications between two individuals for the purpose of assessing interactions on the continuum

leading towards mutual understanding and relationships.

Process recording is amenable to any interaction of the learner with another individuals, such as the

learner and the client, the learner and client, the learner and the health team members, and between the

learner and learner .The most frequent use for the process recording is the nurse patient relationships .The

main four components in process recording are

1. CLIENT COMMUNICATION

2. NURSE COMMUNICATION

3. NURSES INTERPRETATION OF PATIENT COMMUNICATION.

4. IMPLICATIONS OF THE COMMUNICATION FORNURSING ACTION.

Client communication includes a verbatim report of all verbal and nonverbal behaviors of the client .The

nurse communication include verbatim verbal and nonverbal behaviors of the nurse, inclusive of

conscious feelings and actions. A process recording is best used in conjunction with individual conference

approach, so that the teacher and the learner can evaluate the total interaction as well as each of its

component parts. It is carried out during the learning process and provides for the diagnosis and remedial

measures.

The total procedure is a time-consuming one and therefore the quantity per learning experience needs to

be kept within reasonable limits. The behavioral objective must be sharply defined so that the student

focuses the interaction. The report should be written immediately after the interaction occurs, while the

event is vivid in the learners memory. The teachers evaluation and the conferences should be kept in

short time (at the most one week) after the event, so the learner can use the assessment in his development

of interpersonal relationship skills.

ILLUSTRATION OF EVALUATION PROCESS RECORDING

1

1

BEHVIORAL

OBJECTIVES

Encourages thepatient to express hisfears and concerns

about his impending

surgery.

EVALUATION PROCEDURES

Process recording of nurse patient

interactionCRITERIA OREVALUATION1. Identification of patient verbal and non

verbal cues.

2. Identification of own verbal andnonverbal cues.3. Appropriateness of interpretation of

patient behaviors.4. Relevancy of implications for nursing

action to cues exhibited in the

communications.

Process recording ,when used with the individual conferences ,enables the learner to gain skill in

analyzing the interaction in terms of the elements, As the skill is developed to a competency level, The

learner becomes adept at recognizing inconsistencies and misunderstandings ,in a communication .This


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evaluative process is particularly effective in assisting the learner to identify his/her own patterns of

behavior in interaction and thus to become self evaluative about his/her own interpersonal relationship

skills.

ORAL COMMUNICATION METHODS AS CLINICAL EVALUATION

Nurses communicate not only through written media ,but they must be also to convey their ideas and

thinking through the spoken words .The ability is of particular importance when presenting information or

sharing in the decision making process with interprofessional colleagues. The usual methods are:

1. Nursing care conferences

2. Team conferences

1.NURSING PATIENT CARE CONFERENCES

Nursing care conferences taken various forms, but in general, they are problem solving group discussions

about some facet of clinical practice. In one format, the student represents a patient situation to peer group

for critical analysis of the plan or action or implications. The peers evaluate the actions, raise relevant

questions and propose alternatives as appropriates. In some instances, the conferences may precede by

nursing rounds in which participants have the opportunity to observe the patients whose nursing care will

be discussed.

Regardless of the format, when group conferences are used, in the evaluation scheme ,the teachers is

concerned not only with quality of substances and skill in the use of communication technique (a s with

the written communication methods) , but also with learners ability to use the group process. Nursing for

the most part involves groups, and it is the essential that the behaviors relevant to individual participation

in group process be identified and evaluated. The conference provides an excellent medium for formative

evaluation of the student in his development in the skills in the group work.

The nursing care conference is a valuable evaluation strategy and may be used as either formative or a

summative evaluation procedure.


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BEHAVIORAL OBVECTIVES EVALUATION PROCEDURE

Collaborate with nursing team

members in managerial decisions

for a patient.

Team conference

Presentation to nursing team of a patient situation

necessitating decisions for a plan for management.

Criteria for evaluation.1. Collects data from other team members.2. Reports own observations.

3. Shares with group in establishing relationships amongdata.

4. Shares with group in establishing relationships among

data.5. Provides for all members to contribute ideas tocontribute ideas relative to goals for care.

6 .Leads groups to consensus of the goals.

7. Listens to members suggestions for implementationstrategies.

8. Develops plan of care for patient relevant to needs onthe basis of group consensus.

MULTIPLE APPROACHES TO CLINICAL EVALUATION

One of the greatest dangers in clinical evaluation is the tendency of the teacher to get into a rut with

evaluation procedures and use the same process in each evaluation period with every student. As the

approach becomes routinized, practice evaluation becomes an end in itself, divorced from the excitement

of learning.

It will be noted that five evaluation strategies for the single behavioral objective are suggested. Theteachers can vary the strategies with different groups of students, so that he/she is not confined to one

method and thus runs the risk of becoming bored and automatic in preparation of evaluation reports.

The suggestion of five methods is especially important now ever in enabling the teacher to individualize

evaluation procedures. Different methods may be used with different students, according to their needs

and the situation in which they are practicing. Another dimension of this individuality relates to the

evaluation strategy for summative evaluation.

Although ,educators profess a belief in individualized learning ,they generally require all the students to

march to the same drummer as far as evaluation is concerned .A teacher who adopts a mastery of

learning approach doesnt conclude that a student is incapable of meeting the objective on the basis of hisperformance on one evaluation strategy.


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Behavioral objectives Evaluation methods

Conducts purposeful interview. 1. Observation by the evaluator.

2.Tape recording

3.Videotaping

4.Clinical conferenceCriteria for evaluation

1.Clear definition

2.Questions related to purpose3. Questions stated to elicit responses.

4.Responses of patient consistent with scope

5.Patient cues acknowledge6. Nurses evaluation of interview in terms of principlesof principles of interviewing.

CRITERIA FOR DEVELOPING TOOLS FOR ASSESSING CLINICAL

PERFORMANCE:

Systematic study of the following four questions by nurse experts within a school of nursing will helpful

to the way to consensus in identification of the criteria.

1. What are the functions of the group to be evaluated? E.g. if nursing students are to be evaluated, the

faculty members should reach agreement of clinical performance they expect of students at various stages

in the program.

2. What qualities (traits, abilities, or skills) that are observable and measurable, are essential to the

effective functions of the group? Each quality selected for evaluation should be important for effective

performance of functions and should be distinctly different from each of other qualities chose

d from an average student, skilled student and so on. Rating scale can be a 3-point, 5-point, or 7-point

rating scale, e,g. dependability and reliability have similar connotations .If it is agreed that the quality

implied in these should be evaluated ,the terms of the behavior which is observable.

3. What criteria or standards are to be used in defining level of performance in relation to each qualities to

be evaluated?, i.e. what each of the qualities or skill encom-posses, it would be helpful to write briefly

statements incorporating an operational definition of this quality, which will describe what experts

consider to be satisfactory an outstanding and an unsatisfactory performance of the skill.

4. What specific activities or behavior, appropriate to the functions of the qualities to be evaluated at

varying levels of performances?

Specific activities pertaining to skill or behavior patterns that are observable and measurable should be

clearly listed out in the performance evaluation tool, e.g. rating scale.


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RATING SCALE:

A rating scale is a standardized method of recording, interpretation of behavior, with this technique

students/individuals rated on scale from low to high with respect to a particular trait. The accuracy of the

rating also depends on the extent to which the teacher understand precisely what is being rated.

Types ofRating Scales:

scales are as follows:

1. Descriptive rating scale.

2. Graphic rating scale.

3. Rank order method.

4. Forced choice.

Rating scales are used in nursing education for rating of skill in performance and for rating of

personality traits. Ideally a rating scale for performance should evolve from decisions made based on the

criteria agreed upon by nurse experts and put in writing in relation to these criteria. Scales used for rating

skill in performance describe behavior typical of each educational level and coding is given to quantify

the behavior. The rating scale should contain descriptions of performance and behavior that are expect

ale.

Direct observation the principal tool of performance evaluation, observation, the principal tool of

performance evaluation ,is an inherently subjective technique, and the only to the extent that subjectivity

of direct observation is reduced can be the reliability and validity of performance evaluation increased.

Therefore, solution to the problem of unsatisfactory evaluation is not the development of new rating

scales but finding a means of increasing ,to the greatest extent possible, the qualities(traits, abilities or

skills)that are observable and measurable are, therefore measurable are, therefore ,essential to effective

evaluation of clinical performance.

CLINICAL EVALUATION PROCESS

Clinical evaluation is a systematic process that can be considered as having three consecutive phases (1)

Preparation, (2) Clinical activity phases and the final data interpretation and feedback. Role ofFaculty

Evaluator during the evaluation process

PHASES1: PREPRATION

Determine objectives and competencies

Identify evaluation methods and tools

Choose clinical site

Orient students to the evaluation plan


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Focus on objectivity inn evaluation

PHASES2:CLINICAL ACTIVITY

Orient students and staff to the student role

Provide students clinical opportunities

Ensure patient safety

Observe and collect evaluation data

Provide student feedback to enhance learning

Document findings, maintain privacy of records.

Contract with students regarding any deficiencies

PHASE3: FINAL DATA INTERPRETATION AND PRESENTATION

Interpret data in fair , reasonable, and consistent manner

Assign grade

Provide summative evaluation conference (ensure privacy and respect confidentiality)

Additional discussion of selected points in each phase follows.

1.PREPARATION PHASE

Choosing the clinical setting and patient assignment as a part of the evaluation process.

Faculty are responsible for providing each student with ample opportunities to achieve course objectives

and must give careful attention to choosing a clinical site that will give careful attention to choosing a

clinical site that will give students these opportunities.

Safe delivery of care with the welfare and the safety of the patients as the first priority Before the clinical

experience begins, the faculty must develop a criteria for what is considered unsafe or inappropriate

behavior and what consequences will occur if such behavior is observed.

The faculty must be prepared to remove a student from the clinical setting if the student does not meet the

minimal level of safety. Communication between faculty and the students before the clinical experience

begins is essential. Students have the right to know the standard used for safe practice and evaluation.

Students should also be given an orientation to the clinical facility and the policies and the procedures that

will apply to the clinical experience. Unit orientation, as well as the orientation to evaluation methods, are

important in decreasing the of

Students and faculty are essential visitors in an established system, and the status of the student comfort

and the support in the clinical environment should be considered in evaluation as well, here the

importance of positive clinical learning environment for student learning.


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DETERMINING THE STANDARDS AND MEASUREMENT TOOLS

Student performance expectations should meet the following criteria

(1)Reasonable, (2) consistent and applied equally, (3)established and communicated before

implementation.

Faculties have the responsibility for choosing appropriate methods and tools of evaluation of the learners

clinical performance. These tools should be document performance expectation revelent to the course

objectives and be practical and time efficient.

The concepts of interratter reliability(whether results can be replicated by other raters) and content

validity (whether a tools measure what is desired) at minimum should be considered in selection of a

specific clinical evaluation instrument.

2. CLINICAL ACTIVITY PHASE

In both obtaining and analyzing clinical evaluation data, faculty needs to make professional judgment

about the performance of students. Because of the subjective nature of evaluation, there may be concern

that evaluation is based.

SAMPLE OF STUDENT EVALUATION OF CLINICAL SETTING

Name of Agency

Specific Unit

Direction

Print the name of the instructor and the name of the agency, the specific unit where you had your clinical

experience, and the days of the weeks you were assigned.

Please respond to the following statements with the rating that best your opinion.

A. Strongly agree

B. Agree

C .Disagree

D. Strongly disagree

Please qualify any rating of C or D with comments or suggestions. The agency personnel have asked thatyou make comments because this is what they can make improvements or know what is positive. Your

ratings and written comments will be used to determine clinical placement for future students and Amy be

shared with individuals in the setting but only in summary form.

Application of course material

1. The staff facilitated my ability to meet clinical objectives.


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2. I was able to meet the objectives of this course in this setting.

Population/patients

3. Patients presented clinical problems appropriate to then objectives for this course.

4. Culturally diverse patients (e.g. cultural, social, and economic) were available in the setting.

HEALTH PROFESSIONALS

5. Nurse Managers, staff nurses and support staff were accepting of students and student learning.

6. Nurse Managers, staff nurses, and support staff were available to answer the questions and provide

assistance.

7. The nursing staff were positive role models.

8. Nurses demonstrated professional relationships with other health care professionals.

PHYSICAL ENVIORNMENT

9. The setting was conductive to working with the patients and other health members.

10. Space was available for conferences with faculty and other students.

OVERALL IMPRESSION OF SETTING

11. I have a positive impression of the quality of care provided in this setting.

12. I would recommend this setting for future students taking this course.

13. Add statements specific to the clinical setting not already covered.

How could your clinical experience have been improved in this clinical setting?

Please use the separate sheet to make comments and suggestions.

To prevent biased judgment, faculty needs to be aware of the factors that can influence decision making

and must actively use strategies to prevent biases. Strategies that can help support trustworthiness of the

clinical evaluation data include the following:

1. Have specified objectives or competencies on which to base the evaluation.

2. Use multiple strategies and combined methods of evaluation for compiling data.

3. Include both qualitative and quantitative measures.

4. Determine a practical sampling plan and evaluate it over time.

5 .Provide clear directions for tools to promote consistency between rates in collection and interpretation

of data.


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6. Train faculty in use of specific clinical evaluation tools and approaches for consistency and fairness in

grading.

7. Be aware of common errors such as halo effect (assuming that positive behaviors in one evaluated

competency will be similar in others).

8. Incorporate teacher self-assessment of values, beliefs or biases that might affect the evaluation process.

3FINAL DATA INTERPRETATION AND PRESENTATION

i)Clinical Evaluation Conference: The findings of the clinical evaluation are usually shared with the

student individually at the end of the clinical experience or course. The timely feedback of the earier

formative evaluation should provide students with information sufficient to prepare them for this

evaluation. A students self evaluation is often submitted before the evaluation conference and discussed

at this time.

Evaluation results are commonly reported in both written and oral forms. Often, the primary evaluation

tool is presented to show student improvement and specifically recall incidents. The faculty should be

explained, giving specific incidents in which student had difficulties, excelled, performed adequately, or

improved. In addition, the faculty member needs to summarize the conference and the end on a positive

note.

The environment in which the evaluation conference takes place should be comfortable for the student,

and the privacy should be maintained. An hour during which the student is responsible for patient care or

directly after a during the clinical experience is not the most conducive time for conference. An

appointment during office hours away from clinical site provides a more comfortable and private setting

for student to listen to constructive criticism or encouraging comments.

ii) STUDENT RESPONSE: The students response to the faculty evaluation typically reflects the fairness

with which the results were determined. A student will perceive the results as fair if his or her own

appraisal is congruent with that of the faculty. A student self evaluation should be submitted before the

conference helps the faculty time to prepare a response. However, the best way to ensure congruent

results is for faculty to provide the student with a sufficient number of formative evaluations and time to

reflect on his or her own performance. Faculty need to be sensitive to the students needs, emphasizing

the students strengths, as well as weakness, and encouraging goals and aspiration.

iii) WORKING WITH STUDENTS WITH: Questionable Performance Supporting At-Risk Students:

Developing a positive learning environment is the basic step promoting positive supportive student s need

to learning relationships. Students have a right to expect respect. Pointing out areas in which students

need to improve and specific ways to achieve clinical goals promote positive learning environment and

minimizes potential legal risks.

Summarizes the following key points, which although relevant to evaluation, have a particular merit in

evaluating a student with questionable clinical performance behaviors.

1.E nsure that the criteria for student success .(i.e, the written course objectives or competency

statements) are clear to all parties.


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2. If a student is at risk, objectively document a pattern of marginal or failing behavior.

3. Report poor performance to student as formative evaluation and provide students with opportunities for

remedial work.

4. Use strategies such as clinical probation for supporting the risk student. Student clinical contract can

be used to document these plans for improvement. The written student contract should clarify student andfaculty expectations and what student behaviors need to occur for passing status to be achieved.

Follow written procedure form school handbooks. Anecdotal records should be written objectively and

used to document a pattern of behaviors.Faling behaviors need to be indentified in writing, and a contract

for corrections should be signed by the member of faculty and the student. An annotated record of each

counseling session and student evaluation should be signed by both of the student and the faculty member

and maintained by the faculty member.

iv)UNSATISFACTORY PERFORMANCE :It should be noted that when a student given a failing grade,

faculty must be aware of the standards to meet , that grades must not be arbitrary or capricious, and that

faculty must be able to explain how the grades are determined related the program or the course ofobjective. When a fair judgment is made that a students performance is unsatisfactory or failing,

strategies should be used to avert interpersonal or legal problems. As soon as the decisions made,

communication with student is essential. Documentation from formative evaluation conferences and

student contracts can provide support for the decision. Published school policies and procedures should

be followed, including documentation that decisions were made carefully and deliberately. Support from

the university or college is essential when performance is determined to be unsatisfactory, and the

administration should be notified of impending problems early in the grading process.

Final evaluations that result in unsatisfactory or failing performance require special tact and concern.

Faculty need to share specific findings that resulted in a student not meeting the expected clinical

objectives. Student contracts not fulfilled need to be identified. Students need time to process theinformation and should not feel rushed. Faculty need to listen attentively, with a strong show of concern

and support, to the students perceptions. The student may need time to reflect and return for another

conference after adjusting to the facts.

V) STUDENT REACTIONS: The failing student may react in variety of ways. Caring faculty will

recognize these behaviors and provide empathetic support. Students may respond with denial, providing

their own perception of how a specified incident did or did not occur and offering excuses. Faculty need

to steer the conversation to the students not meeting the objectives and provide support for the students

emotional needs. A student may attempt to bargain for passing grade. Faculty can be prepared to provide

information about options the student has. As the reality of the loss is recognized, the student may

respond with depression, confusion, lack of motivation, indecision, and tears. Faculty should provide

support, listen attentively, and generally convey caring behaviors; in some cases faculty may also need to

recommend professional counseling. The student may come in terms with the outcome and begin to make

plans for the future. Assistance from the faculty about options is often sought by the student. How well

the student adapts to the final evaluation typically depends on how well she or she has been prepared for

the results.


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The student may respond with anger. The student may become demanding or accusing and may have the

potential to become violent. In this case, faculty needs to take steps to ensure their own safety and that of

the student. Faculty should not take the anger personally but guidance about feelings and focus on the

anger as a part of loss. Students recommended handling anger with a professional deep breath.

Additionally, an established grievance policy should be available. Both utilizing students and faculty

share responsibility for knowing about and appropriately utilizing such policy. Students have a right to

respond to charges against them.

I) DISMISSING AN UNSAFE STUDENT FROM CLINICAL PRATICE: Behaviors unsafe for patient

care such as lack of preparation, violence, and substance abuse need to be addressed. It should be noted

the importance of a broad and through policy that allows for safe and appropriate actions to protect the

patient and the student. School policies and procedures need to be followed .Clear policies help prevent

arbitrary or capricious responses to an incident. Summarizes key points related to the students who is

unsafe to clear for patients, noting the faculty have an obligation to ensure that all students are returned to

an area of safety as well. The student unprepared to care for an assigned clinical practice should include a

review of relevant policies and clarification of professional students behaviors.

After the final student conference, the student and faculty need to evaluate the entire experience as a

whole. The clinical site is evaluated on how well it is met the learning and the practice needs of the

students. Was the philosophy of the staff congruent with that of the faculty and students? Where the

students are given the opportunity to meet all the objectives? As these questions are answered, the

preparation phase of evaluation begins again. A continuous quality improvement process for clinical

evaluation should be considered, with attention given to the structure (appropriate evaluation tools with

appropriate clinical environment and patient care opportunities), process (appropriate plans for sampling

and evaluating clinical behaviors and for sharing feedback and results of evaluation), and outcome

(satisfactory evaluative outcome indicating safe competent graduates).

ASSESSING CLINICAL PERFORMANCE

Education is a major process, the chief goal of which is to bring changes in human behavior .Nursing has

a practical component which is integral to its educational process. A major focus of education today is

the responsibility of the educational institutions to produce graduates who can perform in real life

situations because education in nursing without application is meaningless.

There are four stages that can be identified in the development of any educational

Program, i.e. formulation of objectives, selection of learning activities, organizations of learning

experiences and evaluation. Evaluation involves judging the worth of an experiences, ideas or process.

Evaluation is the process of determining the degree of changes in the behavior of students because the

overall aim of educational objectives is to produce certain desirable changes in behavior pattern of the

student.Evaluation is the process of determining to what extent the educational objectives are being

realized.

The progress of the students can be assessed / determined by measuring the change in

their behavior. This is measured by comparing the behavior of students before beginning of any


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experience and its completion, the following possibilities might be there:1.Objectives might be

inappropriate ,unclear and unachievable.

2. Learning experiences might not be relevant to the objectives.

3. The organization of learning experiences may not be appropriates.

4. The evaluation methods may be faulty.

Evaluating students clinical performance is one of the challenging responsibilities a nursing

instructor can have. When observing for students performance if the instructor looks certain behaviors

she considers important for successful performance and if these are absent she may give the student

unsatisfactory report about her performance, thus bringing in subjectivity into the evaluation. In view of

the complex nature of nursing practice a variety of tools is needed to evaluate clinical performance.

Further these tools must possess a high degree of objectivity, validity, reliability and practicability in

order to appraise the quality of students clinical performance. While developing such tools we should

identify the objectives and situation as given below:

IDENTIFICATION AND DEFINING OF OBJECTIVES:

While selecting and defining objectives, consideration must be given to the levels of students abilities,

the length of experience and adequacy of facilities under which experiences occurs. For evaluation to be

effective and consistent all who are involved in the process of evaluation, must have not only a clear out

understanding of the instructional objectives that are defined in terms of observable students behavior but

also an adequate preparation in technique and skill in evaluation.

IDENTIFICATION OF SITUATIONS:

The next step in the task of evaluation is to identify and arrange situations or learning an experience in

which student has an opportunity to display the specific behavior to be evaluated.

The techniques /tools used for evaluation are means for collecting evidence about students

development in desired directions. These tools therefore should be valid, reliable, objective, and

practicable.

A variety of tools and techniques can be used to assess students performance in the clinical

area. Some of these which are commonly used are anecdotes checklist, rating scale, nursing care plans,

nursing records, conferences, etc. Most of these involve direct observation is especially vulnerable, to

subjective to make observation in various situation. The instructor must make a special effort to view and

record the situation as it is in its actuality. Anecdotal records and checklist are quite helpful in this.

The rating scale helps to ascribe quantitative and qualitative value to students performance.

It must be subjected to the tests of validity, realibility and usability to determine its value. The final step

in the task of evaluation is to administer tool that has been developed and appraise its validity, reliability

and practibility.


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CONCLUSION

A teacher who adopts a mastery of learning approach does not conclude that a student is incapable of

meeting the objective on the basis of his performance on one evaluation strategy. A mastery of learning

teacher would select another evaluation procedure before drawing such a conclusion. The suggestion here

is that teachers recognize the complex nature of practice complex nature of practice and accordingly

diversity their evaluation strategies so that the learner and teacher engage in a developmental rather than a

controlling process.

BIBLIOGRAPHY

1.Basvanthappa B.T, Nursing Education, Second Edition 2009, Published by Jaypee

Brothers, Medical Publishers (P) Ltd, Page no:701-743.

2.Ezhilarasu Punitha, Indian Journal of continuining nursing education, Volume 09 (1)

January June 2008. Page no.2-3.

3.Neeraja K.P, Text book of nursing education, first edition:2003, Published by Jaypee

Brothers (p) Ltd, Page no:231-250.

4. Shankaranarayan B. Sindhu B., Learning and Teaching Nursing, Second Edition

Published by Brain fill Calicut, Page no:101,162-172.

5.Lynne E. Young Barbara L. Paterson, Teaching Nursing, developing a student centered

Student centered learning environment, Published by Lippincott Wilkins copyright

2007, Page no.12,32,165,585.

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