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
Objectives
Clinical Evaluation Tools
Tools for Evaluation: Assignments
Observation
Clinical Performance Rubric
Patient Assessment
Nursing Care Plans
Concept Maps
Clinical Evaluation Activity
Student Self-Evaluation
Student-Faculty Relationships
Summary
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Copyright 2008 by The Health Alliance of MidAmerica LLC
Reprinted with permission
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 Rubric
Patient Assessment Tool
Nursing Care Plan
Concept Care Map
1
Clinical Evaluation Tools
Opening
PPT 6-1
Introduce 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.
Objectives
PPT 6-2
Highlight 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 Evaluation
PPT 6-3
Briefly 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.
Copyright 2008 by The Health Alliance of MidAmerica LLC
Reprinted with permission
Clinical Evaluation Tools
2
Tools for Evaluation: Assignments
PPT 6-4
The 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.
Observation
PPT 6-5
Observation 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 situation
In 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 6-6
The 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.
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3
Why develop a clinical rubric?
PPT 6-7
First, 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 Scales
PPT 6-8
These 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.
Copyright 2008 by The Health Alliance of MidAmerica LLC
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4
Another example of a rating scale used at Keele
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 Management
PPT 6-9
The 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 Outcomes
PPT 6-10
The 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.
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5
Clinical Outcome 1.1a
Identifies disease processes, psychological and
sociocultural factors that affect the client's health
Satisfactory
The student defines/describes patient’s
primary medical diagnosis and/or
surgical intervention.
Needs
Improvement
The student defines patient’s medical
diagnosis or surgical intervention with
assistance of faculty.
Unsatisfactory
The student is unable to identify
patient’s primary medical diagnosis or
surgical procedure.
Clinical Outcome 1.1a Identifies disease processes,
psychological and sociocultural factors that affect the
client’s health: Example of a Rubric
PPT 6-11
The 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, subobjective 1a.
6-11
Satisfactory
Needs
Improvement
Unsatisfactory
The student defines/describes
patient’s primary medical
diagnosis and/or surgical
intervention.
The student defines patient
medical diagnosis or surgical
intervention with assistance of
faculty.
The student is unable to identify
patient’s primary medical
diagnosis or surgical procedure.
Patient Assessment
PPT 6-12
The 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 Assessment
PPT 6-13
The 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.
Copyright 2008 by The Health Alliance of MidAmerica LLC
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6
Nursing Care Plan
PPT 6-14
The 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 Disadvantages
PPT 6-15
The 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?
Copyright 2008 by The Health Alliance of MidAmerica LLC
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Concept Maps
PPT 6-16
A 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 Disadvantages
PPT 6-17
The 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 — Types
PPT 6-18
Students 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 Map
Show 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.
Copyright 2008 by The Health Alliance of MidAmerica LLC
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Clinical Evaluation Activity — Introduction
PPT 6-19
Divide 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
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Issues
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Concerns
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Likes and Dislikes
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What if?
Clinical Evaluation Activity — Debrief
PPT 6-20
After 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.
6-20
Student Self-Evaluation
PPT 6-21
Students 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?
Copyright 2008 by The Health Alliance of MidAmerica LLC
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Encourage your students to give details. If they do not
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 Relationships
PPT 6-22
According 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.
Copyright 2008 by The Health Alliance of MidAmerica LLC
Reprinted with permission
10
Summary
PPT 6-23
In 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
Copyright 2008 by The Health Alliance of MidAmerica LLC
Reprinted with permission
11