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An efficient evaluation tool is essential when measuring the clinical performance of undergraduate nursing students. It is also important that this evaluation tool accurately assess the critical competencies that students must demonstrate in the clinical setting. The tool should be unambiguous, succinct, and adaptable to a wide variety of clinical experiences and faculty. As part of a curriculum improvement initiative for their baccalaureate nursing program, the nursing faculty teaching in a 4-year undergraduate program identified the need for the development of a new clinical performance evaluation tool for the evaluation of undergraduate nursing students in each clinical placement. The resultant tool more accurately appraised clinical capabilities by focusing on quality and safety in health care, and it permitted the evaluation of critical thinking skills and team communication.

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The onset of a myocardial infarction (MI) is frequently associated with distinct sensations that may shape the personal meaning of the MI illness experience. Although highly important, patients may have difficulty communicating the personal meaning of the MI illness experience because of lack of congruence between the clinician's and patient's frames of experience. The frame of experience defines the context and agenda for encounters from each participant's perspective. This secondary analysis of data explored MI patients' use of metaphorical language to convey aspects of their underlying frame of experience. Specifically, this paper addressed (a) the structural and linguistic features of metaphorical language used by patients to describe MI pain, (b) the content and structure of associated patient metaphors, and (c) the similarities and differences between the content of patient metaphors and descriptions of MI pain. Our findings confirm that even in encounters characterized by clinician imposition of an organizing framework upon the patient encounter, patients use metaphors to reveal their underlying frame of experience and aspects of the personal meaning of the MI illness experience. Furthermore, although non-metaphorical descriptions provide insights into the patients' cognitive understanding of events associated with the MI, metaphorical descriptions are particularly helpful in eliciting aspects of the affective response to the MI.

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