Where Is the Grade Coming from? Problems and Challenges in Evaluating the Clinical Performance of Nursing Students

Abstract

Evaluating the clinical performance of nursing students effectively and fairly is a challenge which continues to confront nurse education and there is evidence of both faculty and student concerns. This paper reports part findings of a hermeneutic phenomenological study which explored the clinical learning experience of Malawian undergraduate student nurses. The study took place at a University Nursing College in Malawi, using a purposive sample of thirty student nurse participants. Conversational interviews were conducted to obtain participants' accounts of their clinical learning experience and a framework developed by modifying Colaizzi's procedural steps guided the phenomenological analysis. Several issues emerged from this study, but for this paper the assessment issues which the study revealed were discussed. It revealed concerns of unfairness and lack of objectivity during the evaluation of the clinical performance of nursing students. It also revealed that interpersonal relationships significantly influenced the evaluation process. Consequently, nursing students become preoccupied with building relationships with qualified nurses knowing the impact of such relationships on the clinical grade. The findings reveal that students employ various strategies in order to obtain good grades and this illustrates students' overall preoccupation with "making the grade". It is argued that the evaluation of the clinical performance of nursing students is a vital component of nursing education and it must be conducted in a manner that enables nurse educators to effectively determine the clinical proficiency of nursing students.

Sources of Stress among Undergraduate Nursing Students during Clinical Practice: A Malawian Perspective

“…Data analysis was guided by a framework which was developed through modification of Colaizzi's [8] procedural steps for phenomenological analysis. The reasons for the modifications could be located from [5] [6].…”

“…The study used hermeneutic phenomenology to explore the clinical learning experience of undergraduate nursing students in Malawi. However, a detailed description of the research design is not presented in this paper but can be located in detail in [5] [6].…”

Learning in the traditional-faculty supervised teaching Model: PART 1-The nursing students’ perspective

“…Students in this study like others in previous studies [68] queried the validity of the grades they received from their CIs as they felt the CI had not observed them perform a procedure or spent enough time with them to know their weaknesses and strengths. It is acknowledged that in the traditional model of teaching, due to the number of students that the CIs have to supervise, they can only sample limited student behaviour, which may result in an unfair or inaccurate clinical evaluation.…”

“…(p.446) However, evidence from the literature reveals that typically clinical evaluation tools have not been tested for reliability or validity. [67,68] Amicucci [66] suggests that nursing programs need to create clinical evaluation tool that are course specific and with clearly defined expected behaviours and skills that need to be achieved. Other scholars have suggested the clinical evaluation tool should be reviewed at the very beginning of each clinical placement to ensure that the evaluation criteria will be known to both students and the CIs or faculty.…”

“…These findings corroborate similar evidence from the previous studies. [32,37,[66][67][68][69] For example, Killam and Heerschap [37] found students perceived the clinical evaluation process as subjective and complex and difficult to comprehend. Bourbonnais et al [67] also reported concerns of inconsistency in the clinical evaluation process by teachers within the same year.…”