instructor clinical evaluation tools

Clinical Evaluation Tools

Purpose

Time

Outline

Materials Needed

This session provides an overview of a variety of typical clinical evaluation tools that the new clinical educator may use for student evaluation. Through discussion and a small-group activity, participants are exposed to the major evaluation tools. Depending on when and where the participants attended nursing school, the concept map and other tools may be new to them. The hands-on activity in using a clinical performance rubric helps build participants’ skills and prepares them for their first clinical rotation with students. This session is the practical application of the previous session, Clinical Evaluation: Concepts and Processes (Tab 5).

60 minutes

ObjectivesClinical Evaluation ToolsTools for Evaluation: AssignmentsObservationClinical Performance RubricPatient AssessmentNursing Care PlansConcept Maps Clinical Evaluation ActivityStudent Self-EvaluationStudent-Faculty RelationshipsSummary

PowerPoint Slides 6-1 through 6-23 Examples of concept care maps that students have

created Clinical Evaluation Activity Handouts (Tab 6 of the

participant notebook, pages 8-13): Student Scenario and Clinical Evaluation RubricPatient Assessment ToolNursing Care PlanConcept Care Map

CLINICAL EVALUATION TOOLS 1By: Joric M. Magusara, RN, RPT


6-2

Objectives Discuss a variety of clinical evaluation tools. Discuss the development and use of a clinical performance

rubric. Discuss methods of providing feedback

to students. Compare the traditional nursing care plan with the concept

map. Discuss how to develop positive student-faculty

relationships. Practice using the performance rubric for a selected case

study.

6-3


Direct Observation Preceptor Observation Anecdotal Notes Clinical Performance Rubrics

OpeningPPT 6-1Introduce yourself and your role. Share some background information on your expertise with clinical evaluation. The purpose of this session is to review with you, the participants, the types of clinical evaluation tools that might be encountered when evaluating students in clinical practice. The decision as to which evaluation tools are to be used is often made by the full-time or permanent faculty in the clinical course. As adjunct clinical instructors, you are obligated to follow the evaluation methods established by the course faculty and offer suggestions for change when needed to the course faculty. More than likely, you will not use all of these methods in a semester. However, having an understanding of the various methods is important.

ObjectivesPPT 6-2Highlight the objectives for this session. Explain that after discussing the major evaluation methods and tools, participants will work in small groups to practice using a clinical performance rubric.

Tools for EvaluationPPT 6-3Briefly review with the participants the tools that the faculty member uses to evaluate students: direct observation, preceptor or staff observation, anecdotal notes, and clinical performance rubrics.



6-4

Tools for Evaluation: Assignments

Journaling/Reflection Papers Process Recordings Portfolios Patient Assessment Tools Nursing Care Plans Concept Maps Student Self-Evaluation

6-5

Observation

Observation GuidesChecklistsSimulation Lab

Direct Clinical ObservationAnecdotal NotesClinical RubricsPreceptor Observation

6-6

What is a clinical performancerubric? Predetermined behaviors/criteria Delineates safe and satisfactory student

performance Derived from course outcomes Describes different levels of quality such as:

SatisfactoryNeeds ImprovementUnsatisfactory

Tools for Evaluation: AssignmentsPPT 6-4The evaluation methods on this slide may be assigned to the students to assist faculty members in the evaluation process. These methods or tools help to evaluate students’ cognitive, affective, and psychomotor domains. These methods include: journals/reflection papers, process recordings, portfolios, patient assessment forms, nursing care plans, concept maps, medication profiles, and student self-evaluations.

ObservationPPT 6-5Observation is the main method faculty members use in the student evaluation process. Observation occurs in the skills lab using observation guides in the form of checklists during skill demonstrations. There is direct clinical observation in the clinical setting by the faculty member, the preceptor, or even the staff member.

After observing students, faculty members often keep anecdotal notes to remember specific information about their observations. According to O’Connor (2001), anecdotal notes should include a description of: Care the patient received What the student did or failed to do in providing care Any situational or environmental factors that

contributed to the observed situationIn addition to anecdotal notes, faculty may choose to use a clinical performance rubric to record student performance, which will be presented next.

What is a clinical performance rubric?PPT 6-6The clinical performance rubric is a listing of predetermined behaviors that faculty members want students to be able to consistently perform in a safe and satisfactory manner for students to achieve a passing score. The predetermined behaviors on the rubric should be derived from the clinical course learning outcomes. The rubric also delineates a quality rating to the performance of behaviors such as satisfactory, needs improvement, and unsatisfactory.

Why develop a clinical rubric?


6-7

Why develop a clinical rubric?

Provide new students with expected behaviors Provide students with a concrete view of

their performance Identification of poor levels of performance early Provide new faculty with examples of behaviors

6-8

Rubric Rating Scale Examples Clinical Competence

Rating Scale Independent Supervised Assisted Marginal Dependent Not Applicable Not Observed

Keele University ClinicalCriteria Outstanding Very good Good Average Poor Unacceptable Not Assessed

PPT 6-7First, the clinical performance rubric provides the brand new student with a list of behaviors faculty expect them to perform by the end of the first clinical course. For the new student, the rubric can help them better understand the nurses’ role and responsibilities.

Second, a copy of the rubric with faculty comments/feedback provides the student with a concrete view of their performance. The completed rubric also can be a guide for faculty when giving the student verbal feedback.

Third, the rubric helps faculty identify poor student performance early in the term so the student then has time to make improvements.

Fourth, the clinical rubric provides the new faculty member with examples of behaviors to be evaluated. It also provides a mechanism for assigning a letter grade to a clinical course by assigning a numerical value to each rating.

Rubric Rating ScalesPPT 6-8These are two examples of rubric rating scales that could be adapted. The Clinical Competence Rating Scale was adapted from Dr. Kathleen Bondy by Dr. Linda J. Scheetz (2000). According to Sheetz, this rating scale has been tested and has evidence of reliability and validity. It uses the ratings of independent, supervised, assisted, marginal, dependent, not applicable, and not observed. Chrisman (2007) has found that this rating scale is best used during skills demonstrations and possibly in a clinical capstone course.

According to Chrisman (2007), students had previous experience with the rubric verbalized appreciation when the faculty member used the “Not Applicable” and “Not Observed” categories versus the faculty member trying to judge a student’s behavior they could not have possibly observed.

Another example of a rating scale used at Keele


6-9

Faculty Guidelinesfor Clinical Rubric Management Give student a copy of the rubric Allow student to review and ask questions Checkmark the behaviors observed Write comments in space available Give student a copy of the rubric with feedback Review your comments with the student

6-10

Example of Clinical Outcomes1. Provide care for clients in a variety of settings based on the

relationship of the client, health, and environment.2. Demonstrate professional nursing knowledge, attitudes, and

behaviors in the delivery of person-oriented health care.3. Apply critical thinking skills when caring for clients in a variety of

settings.4. Employ effective communication with clients, health team

members, faculty, and peers.5. Implement therapeutic nursing interventions to meet

client needs.

University (Priest, 1998) includes the descriptors of outstanding, very good, good, average, poor, unacceptable, and not assessed.

Chrisman recommends that when using a clinical performance rubric you should use the clinical rating scale already in place by the institution where you work.

Faculty Guidelines for Clinical Rubric ManagementPPT 6-9The following guidelines were used by Chrisman when she implemented the clinical rubric.

First, each student received a copy of the rubric during clinical orientation. They were given time to review the behaviors and the layout of the rubric and were encouraged to ask questions. Of course, because this was their first clinical course, they really did not know what to ask initially.

Second, faculty should checkmark each behavior they observed and how they rated the quality of the student performance (satisfactory, needs improvement, or unsatisfactory). The faculty member then writes comments for every needs improvement and unsatisfactory rating. Positive comments about their satisfactory performance are always appreciated by the students.

Third, the faculty member should give the student a copy of the rubric with the feedback before the next clinical week. Faculty should then review their written comments with the student ASAP to answer student’s questions and to ensure the student is interpreting faculty comments as intended.

Example of Clinical OutcomesPPT 6-10The list on Page 3 of Tab 6 in the participant notebook is an example of clinical outcomes for a first clinical practice course. The focus of the first outcome is client, health, and environment. The second outcome focuses on nursing and the individual. The focus of the third outcome is critical thinking. The fourth is communication. The fifth is therapeutic nursing interventions. The learning outcomes of a specific course generally reflect the nursing program outcomes. Clinical Outcome 1.1a Identifies disease processes,


6-11

Clinical Outcome 1.1a Identifies disease processes, psychological and sociocultural factors that affect the client's health

The student is unable to identify patient’s primary medical diagnosis or surgical procedure.

Unsatisfactory

The student defines patient’s medical diagnosis or surgical intervention with assistance of faculty.

Needs Improvement

The student defines/describes patient’s primary medical diagnosis and/or surgical intervention.

Satisfactory

6-12

Patient Assessment

May accompany the nursing care planand/or concept map

Graded weekly

One assessment per assigned patient

Configuration may vary

6-13

Patient Assessment

Patient Demographics Chief Complaint History Current/Past Medical & Surgical Allergies and Current Medications IV Information Laboratory, Diagnostic Tests, and Procedures Physician Orders Pathophysiology Review

psychological and sociocultural factors that affect the client’s health: Example of a Rubric PPT 6-11The chart found on page 3 of the participant notebook (Tab 6) and on the slide is a sample of how the descriptors (satisfactory, needs improvement and unsatisfactory) are differentiated for a clinical course outcome 1, sub-objective 1a.

Satisfactory

The student defines/describes patient’s primary medical diagnosis and/or surgical intervention.

Needs Improvement

The student defines patient medical diagnosis or surgical intervention with assistance of faculty.

UnsatisfactoryThe student is unable to identify patient’s primary medical diagnosis or surgical procedure.

Patient AssessmentPPT 6-12The patient assessment form or tool is one of the most common evaluative methods used to evaluate student understanding, accuracy, and comprehensiveness. The assessment form usually is accompanied by a medication profile, a nursing care plan, or a concept care map. The patient assessment form is typically graded by the clinical faculty member with feedback. There is a place on the clinical performance rubric to indicate the quality of the student’s work. Typically, one assessment tool is required for each assigned patient.

Patient AssessmentPPT 6-13The patient assessment form often contains the following sections — patient demographics; chief complaint; history current/past medical and surgical; allergies and current medications; IV information; laboratory, diagnostic tests and procedures; physician orders; and pathophysiology review. How the patient assessment tool is configured depends on course faculty preference.

Nursing Care Plan


6-14

Nursing Care Plan

Application of nursing process Preparation for clinical experience Standardized format Key points for evaluation Formative evaluation Graded

6-15

Nursing Care Plans

Advantages Standard approach or format Thought to show critical thinking Helpful in learning to think like a nurse

Disadvantages Standardized care plans Use of critical thinking skills Linear approach Real nurses do not write care plans

PPT 6-14The nursing care plan (NCP) is the next most common method used to evaluate student understanding of the nursing process. The purpose of the NCP is to provide the student with a plan of care for one patient problem that is to be followed during the day. It is considered a working document that, at the end of the clinical week, should reflect changes to the plan as needed. A draft of the student’s NCP should be reviewed in the morning of the first clinical day of the week. This initial draft demonstrates student preparedness and knowledge. The format for the NCP is fairly standard and includes the nursing diagnosis, outcomes, interventions, rationale, and outcome evaluations. Remember, patient outcomes are behavioral changes that can be demonstrated and measured and must be achieved within a specified time frame. The key points of evaluation include the following. (a) The NCP is individualized for the patient. (b) The NCP includes all parts in an organized manner. (c) Rationales help to demonstrate knowledge of theory. (d) The student should reference the rationale as required by faculty. The NCP is typically part of formative evaluation and is graded by faculty with feedback. The clinical performance rubric does include the NCP in outcome #5.

Nursing Care Plans — Advantages and DisadvantagesPPT 6-15The advantages of the NCP are that it is a standardized approach to demonstrating understanding of the nursing process, it is a vehicle for demonstrating critical thinking and reasoning, and it helps the student learn how to think like a nurse. The disadvantages of the NCP are that there are standardized care plans available, which causes students to question the value of developing others. If standard NCPs are used, then does critical thinking really occur? The traditional linear NCP has been criticized by those who believe the nursing process does not reflect nursing practice. And, there also is the attitude that because “real nurses do not write care plans,” why should the students?

Concept Maps


6-16

Concept Maps

Diagrammatic strategy Demonstrates relationships Organizes data Used in place of nursing care plans Formative evaluation Graded

6-17

Concept Maps

Advantages Synthesis of knowledge Less writing Shows student understanding

Disadvantages Map may be large No two will be alike in format Attractiveness may influence

assessment

6-18

Concept Maps

Types of MapsPathophysiologic FocusNursing Care FocusCombination Pathophysiologic and Nursing

Care Focus

PPT 6-16A new and competing method of demonstrating understanding of the nursing process and student understanding of the “whole patient” is the concept care map. The concept map is a diagrammatic teaching strategy that helps students to demonstrate how the patient assessment tool is configured, depending on course faculty preference and the relationships between data. The concept care map shows a student’s ability to organize a large amount of data. It takes the place of a traditional NCP. It also is a part of student’s formative evaluative process and is graded with feedback.

Concept Maps — Advantages and DisadvantagesPPT 6-17The advantages of the concept care map are that it is a creative process that shows synthesis of information data and requires less writing. The disadvantages of the concept map are that it may be large and difficult to follow, no two maps will be the same, and attractiveness of the map may influence faculty evaluation of the students’ abilities.

Concept Maps — TypesPPT 6-18Students can use the concept map format to demonstrate understanding of the patient’s pathophysiologic processes, the nursing process, or they can use the format to demonstrate both the nursing process and the pathophysiology behind the patient outcomes and nursing interventions. The combined pathophysiologic and nursing care concept map provides the student with an opportunity to visualize and integrate theories with the nursing process (Daley, 1996; Irvine, 1995; Kathol, Geiger, & Hartig, 1996).

Concept Care MapShow examples of concept care maps that you have brought. Point out the resources listed in Tab 11 for participants who want additional information on concept care maps.

Clinical Evaluation Activity — Introduction


6-19

Clinical Evaluation Activity

Handouts Needed:Student ScenarioClinical Performance RubricPatient Assessment ToolNursing Care PlanConcept Care Map

6-21

Student Self-Evaluation

Clinical performance

Strengths

Areas of improvement

Strategies for improved performance

PPT 6-19Divide the participants into groups of two to four, depending on room configuration. Use the instructions on page 6 (Tab 6) of the participant notebook to introduce the activity to the participants. Go through the student scenario and explain to the participants that they are being asked to review the patient assessment tool, the nursing care plan, and the concept care map. Explain they are to use the portion of the clinical performance rubric to record their evaluation of the written work and add comments to the rubric for the student. Give them about 15-20 minutes for the small group to work and then move to the next slide to debrief this activity.

Clinical Evaluation Activity — DebriefPPT 6-20After the activity, offer the participants time to ask questions and bring up any issues, concerns, their likes and dislikes. Ask if they have any “what if” scenarios they would like to explore.

Student Self-EvaluationPPT 6-21Students are now being asked to evaluate their clinical performance weekly.

Sometimes, faculty members ask the students to evaluate themselves based on the clinical evaluation tool or the clinical performance rubric. At other times, faculty want the students to examine what they learned, what their strengths were, identify where they want to improve, and how they plan to improve.

Many students have difficulty with this activity. They often feel unsure because they don’t know what the faculty member wants to see written. They do not know how to provide rationale or supportive data when they say that they demonstrated understanding of the patient’s medical diagnosis and surgical procedure. Well, how did they do that? What supportive information can they offer? Encourage your students to give details. If they do not


6-20

Clinical Evaluation Activity Issues

Concerns

Likes and Dislikes

What if?

6-22

Student-Faculty Relationships

Positive relationships require:ConfidenceRespectRealistic clinical expectationsHonest and directApproachableCaring behaviorsSupport and encourage

Gaberson & Oermann, 1999

give details, send the evaluation back and indicate you are unable to evaluate what they have written and you need more information/examples are needed. According to Oermann and Gaberson (2006), students in the first clinical course may need assistance with identifying their strengths and areas needing improvement. Faculty need to assist students in the identification of strategies to improve their performance. The self-evaluation process is only for formative evaluation and is not graded, according to Oermann and Gaberson.

Student-Faculty RelationshipsPPT 6-22According to Gaberson and Oermann (1998), it is the job of the clinical faculty to foster positive relationships with their clinical students by displaying confidence in the students, showing them respect, keeping clinical expectations realistic (first clinical course behaviors versus the final clinical course behaviors), being honest and direct when giving feedback, staying approachable, displaying caring behaviors, and remaining supportive and encouraging about their potential for improvement and growth.

With problem students, you should step back and make sure you are not the problem. If you decide you might be part of the problem, be honest with the student and let them know what you will do to make changes and then guide them to understand their responsibilities in the change process. Make a commitment to help this student to become the best nurse during the time you have them. Of course, this may be difficult if you have very short clinical rotations.

If you are sure the student may have difficulty being successful no matter what you or the student does, evaluate them weekly using the rubric, and keep them informed. And, remember to document, document, and document. Document all student behavior that demonstrates unsatisfactory performance.

Summary


6-23

Summary: What was accomplished? Introduced a variety of clinical evaluation tools available to faculty. Discussed the development and use of a clinical performance

rubric. Reviewed guidelines for providing clinical feedback to students. Compared the traditional nursing care plan with the concept care

map. Discussed how to develop positive student-faculty relationships. Practiced using the clinical performance rubric based on a case

scenario.

PPT 6-23In conclusion, during this session we: Introduced various clinical evaluation tools available to

faculty Discussed the development and use of a clinical

performance rubric Reviewed guidelines for providing clinical feedback to

students Compared the traditional nursing care plan with the

concept care map Discussed how to develop positive student-faculty

relationships Practiced using the clinical performance rubric based

on a student scenario and paperwork examples

The overall goal of this session was to help familiarize you with the various methods of clinical evaluation and introduce the clinical performance rubric and the concept care map. New clinical faculty are not expected to be perfect at clinical evaluation, so it is important you keep in touch with the full-time or permanent course faculty, ask lots of questions and ask for guidance as you begin your journey of clinical evaluation. Remember, the student’s job is to learn, and the clinical faculty’s job is to be the student’s guide. Good luck to each of you.

FILE: G-CFA Instructor Tab 6 Clinical Eval Tools


instructor clinical evaluation tools

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