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Clinical Evaluation Tools

Purpose

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 readies them for their first

clinical rotation with students. This session is the

practical application of the prior session, Clinical

Evaluation: Concepts and Processes (Tab 5).

Time 60 minutes

Outline Objectives


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

Materials Needed PowerPoint Slides 6-1 through 6-27

Examples of concept care maps that students have

created

Clinical Evaluation Activity Handouts (Tab 6 of the

participant notebook, pages 10-20

Student Scenario and Clinical Evaluation Rubric




Opening

PPT 6-1

Introduce yourself, your role, and share some

background information on your expertise with clinical

evaluation.

State: The purpose of this session is to review with you

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, but having an understanding of

the variety of methods is important.

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.

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.

6-3


Direct Observation

Preceptor Observation

Anecdotal Notes

Clinical Performance Rubrics

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.



6-4


Journaling/Reflection Papers

Process Recordings

Portfolios

Patient Assessment Tools

Nursing Care Plans

Concept Maps



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.

6-5

Observation

Observation Guides

• Checklists

• Simulation Lab

Direct Clinical Observation

• Anecdotal Notes

• Clinical Rubrics

• Preceptor Observation

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 (2015),

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.

6-6

What is a clinical performance

rubric?

Predetermined behaviors/criteria

Delineates safe and satisfactory student performance

Derived from course outcomes

Describes different levels of quality such as:

• Satisfactory

• Needs Improvement

• Unsatisfactory

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 in order 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.



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

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 or

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 as

well as provides a mechanism for assigning a letter

grade to a clinical course by assigning a numerical value

to each rating.

6-8

Rubric Rating Scale Examples

Clinical Competence Rating Scale

• Independent

• Supervised

• Assisted

• Marginal

• Dependent

• Not Applicable

• Not Observed

Keele University Clinical Criteria

• Outstanding

• Very good

• Good

• Average

• Poor

• Unacceptable

• Not Assessed

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, and uses the ratings of

Independent, Supervised, Assisted, Marginal,

Dependent, Not Applicable, and Not Observed. This

rating scale is best used during skills demonstrations

and possibly in a clinical capstone course.

Students who have had experience with the rubric being

offered during this session verbalized appreciation when

the faculty member used the Not Applicable and Not

Observed categories versus the faculty member trying to

judge a student behavior they could not have possibly

observed.

Another example of a rating scale used at Keele

University (Priest, 1998) includes the descriptors:

Outstanding, Very Good, Good, Average, Poor,



Unacceptable, and Not Assessed.

When using a clinical performance rubric, use the

clinical rating scale already in use by the institution

where you work.

6-9

Faculty Guidelines

for 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

Faculty Guidelines for Clinical Rubric Management

PPT 6-9

The following guidelines were used when implementing

the clinical rubric as follows:

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, since this was

their first clinical course they really did not know

exactly 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 wrote

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 prior to the next

clinical week. Faculty should then review their written

comments with the student ASAP to answer student

questions and to make sure the student is interpreting

faculty comments as the faculty member intended.

6-10

Example of Clinical Outcomes

1. 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.

Example of Clinical Outcomes PPT 6-10

Page 3 of Tab 6 in the participant notebook lists the

clinical outcomes from a 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.



6-11

Clinical Outcome 1.1a

Identifies disease processes, psychological and

sociocultural factors that affect the client's health

SatisfactoryThe 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.

UnsatisfactoryThe 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, 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.

Unsatisfactory

The student is unable to identify

patient’s primary medical

diagnosis or surgical procedure.

6-12

Patient Assessment

May accompany the nursing care plan and/or concept map

Graded weekly

One assessment per assigned patient

Configuration may vary

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.



6-13

Patient Assessment

Patient Demographics

Chief Complaint

History Current/Past Medical and Surgical

Allergies and Current Medications

IV Information

Laboratory, Diagnostic Tests, and Procedures

Physician Orders

Pathophysiology Review

Patient Assessment PPT 6-13

The patient assessment form or tool often contains the

following sections:

Patient Demographics; Chief Complaint; History

Current/Past Medical & Surgical; Allergies and Current

Medications; IV Information; Laboratory, Diagnostic

Tests, and Procedures; Physician Orders, &

Pathophysiology Review. How the patient assessment

tool is configured depends on course faculty preference.

6-14

Nursing Care Plan

Application of nursing process

Preparation for clinical experience

Standardized format

Key points for evaluation

Formative evaluation

Graded

Nursing Care Plan PPT 6-14

The nursing care plan (NCP) is the next most common

evaluative method used to evaluate student

understanding of the nursing process. The purpose of

the nursing care plan 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 AM 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.



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

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, does

critical thinking really occur? The traditional linear

NCP has been criticized by those who feel the nursing

process does not reflect nursing practice. And then

there is the attitude that ‘real nurses do not write care

plans,’ therefore why should the students.

6-16

Concept Maps

Diagrammatic strategy

Demonstrates relationships

Organizes data

Used in place of nursing care plans

Formative evaluation

Graded

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 students’ ability to

organize a large amount of data. It takes the place of a

traditional NCP. It is also a part of students’ formative

evaluative process and is graded with feedback.

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

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.



6-18

Concept Maps

Types of Maps

• Pathophysiologic Focus

• Nursing Care Focus

• Combination Pathophysiologic and Nursing Care Focus

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, 1999; Irvine, 1995; Kathol,

Geiger, & Hartig, 1996).

Concept Care Map

Show examples of concept care maps that you have

brought with you. Point out the resources listed in

Tab 11 for participants who want additional information

on concept care maps.

Tips for Concept Mapping

Both theory driven and an evidence-based teaching/learning strategy

Integral part of learning how to think like a nurse

Demonstrate how to construct a concept map

Use concept map to keep notes throughout shift

Assessment tool of student learning

Collaborative learning and critical thinking

6-19

(Torre, Durning, & Daley, 2013)

Tips for Concept Mapping

PPT 6-19

Here are six tips about concept mapping for faculty use

and student learning.

6-20

(Torre, Durning, & Daley, 2013)

Concept Map Example PPT 6-20

This figure can be used to teach students about the logic

of the concept map and how all parts are connected.



Concept Map Configurations

6-21 (Noonan, 2011)

Concept Map Configurations PPT 6-21

Concept maps can take on several configurations

depending on the purpose of the map.

6-22

Spinal Cord

Compression

Admission

Info

Assessment

Findings

4/17

#5

Risk for

Powerlessness

#2

Self-care

Deficits

#3

Risk of

Impaired

Skin

Integrity

#1

Impaired

Physical

Mobility

#4

Disturbed

Body

Image

Pathological

Effects

Meds for

Compression

Meds for

Constipation

Pathological

Effects

Sample Student Concept Map Framework

PPT 6-22

This is a basic framework of a concept map prepared by

a student. See the handout.

6-23


Handouts Needed:

• Student Scenario

• Clinical Performance Rubric

• Patient Assessment Tool

• Nursing Care Plan

• Concept Care Map

Clinical Evaluation Activity — Introduction PPT 6-23

Divide the participants into groups of 2 to 4 persons

depending on room configuration. Use the instructions

on page 7 (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.



6-24


Issues

Concerns

Likes and Dislikes

What if…?

Clinical Evaluation Activity — Debrief

PPT 6-24

After the activity, offer the participants time to ask

questions, bring up any issues, concerns, their likes and

dislikes, and ask if they have any what if scenarios they

would like to explore.

6-25


Clinical performance

Strengths

Areas of improvement

Strategies for improved performance

Student Self-Evaluation PPT 6-25

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 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, and if you do not get them to,

then send the evaluation back and indicate that you are

unable to evaluate what they have written and that you

need more information/examples. According to

Oermann and Gaberson (2014), 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.



6-26


Positive relationships require:

• Confidence

• Respect

• Realistic clinical expectations

• Honest and direct

• Approachable

• Caring behaviors

• Support and encourage

Gaberson & Oermann, 2015


PPT 6-26

According to Gaberson and Oermann (2014), 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 vs.

the final clinical course behaviors), being honest with

them and direct when giving feedback, staying

approachable, displaying caring behaviors, and

remaining supportive and encouraging about 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 they can in 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.

6-27

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.

Summary PPT 6-27

In conclusion, during this session we:

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 student scenario and paperwork examples



The overall goal of this session was to help familiarize

you with the variety of methods of clinical evaluation

and to introduce you to 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 their 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 Evaluation Tools

clinical evaluation tools instructor... · clinical evaluation tools purpose ... clinical rotation...

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