Clinical Practices

Clinical Practices
For the needs of the patients, families, and the health care consumers, and health care practice current assessment practices should be maintained by using evidence –based practices. Health care professionals are expected to demonstrate competent practice within the society. Determining sufficient of clinical assessments and the evaluation of the nursing students has redesigned a large amount of nursing school curriculum to remain relevant. Assessing students educational outcomes based on current clinical practices can be more challenging than just relaying on typical classroom theory in which the evaluation of cognitive knowledge can be tested. Within the clinical setting, students are required to reach a particular level of competency in areas of knowledge, psychomotor, and safety. The clinical performance measurements and determining the how to grade the clinical course has caused debate and concern among nursing educators for years (McCarthy & Murphy, 2010). The purpose of this paper is to examine current assessment practices through current research : reflective journaling (self-evaluation), competency-based performance assessment, and faculty/agency personnel observation/communication that are designed accurately to document competency within the framework of accelerating and fluctuating needs in education and practice.

There are numerous requirements that have been established by national agencies and association to perform competence-nursing practice in the health care system. By having the students understand what the importance of his or her role on what they can and cannot do. The use of competency-based performance assessment has been used to determine what practices will be assessed and to allow where there may be a need for skill correction or finding knowledge deficits. A competency- based assessment is outcome oriented the purpose is to evaluate a student’s skill in the clinical setting. Competency-based assessments can be adapted to a specific clinical course specialty. Hand states (2006), “the competency-based assessment holds value in providing a cost effective valuable tool in assessing students ”(p .50 ) . Walsh (2008) performed a research study in which there was a structured clinical assessment and evaluation done during the first year of the nursing students. From the analytical review of the article it was found that there is much of a consensus from other literature that supports for the educator to provide a valid and reliable assessment of the students affective and psychomotor elements, student cognition, and competence. Another suggested assessment tool clinical assessment practicing is allowing students to perform self-assessments. A research study performed by Wan, Lui, Wai Tong, Lee, Lai Wah, and Lee, (2012) for promoting self reflections in the clinical practice helped student nurses to be able to manage clinical situation better. Their study used the Johns’ Structured Reflection Model to develop a program on how to utilizes the skill of reflecting. Self-assessments are a common form of assessments used in clinical practices. Self-assessment is suggested to be used as an initial starting point to allow other forms of clinical assessments.

The subjectivity of a self-assessment can come with time-constraints and provided light on negative experiences (Wan, Lui, Wai Tong, Lee, Lai Wah, & Lee, (2012). The question is how effective can self- assessment be in clinical practice because students may need extra assisted ion reflecting in a purposeful and meaningful way. For student performing self-assessments this is done with reflective journaling. From the research analysis There are indications that show when student use reflective journaling that clinical reflection skills and significantly improve but only a limited amount of students became critical reflectors (Cleary, Horsfall , & Hunt, 2013). Faculty/Agency personnel can obtain information in the clinical assessment of student through formal evaluations. By having input meaningful and from different sources can add to the student learning experience. Assessing students through observation are not given enough credibility. Faculty and agency staff collects observational data from students while performing in the clinical setting, through real-time events and stimulation. Most students are aware that the faculty/ personnel are observing and providing constructive criticism and feedback during evaluation. The research study by Oranye, Ahmad, Ahmad, and Bakar (2012), utilized faculty observations are unstructured in nature and are spontaneous without consideration or direct focus. Recording of the data collected can be done by using anecdotal notes of clinical observation and later deciphered through to add more specify to what data was collected (Oranye, Ahmad, Ahmad, & Bakar, 2012).

There was also an assessment tool used in the observational study to evaluate the skills of the nursing student in the bachelor’s program. The assessment tool that was provided to the instructors and students was the evaluation tool of the objective structured clinical skills examination (OSCE) and the clinical instructors were able to provide observation feed back along with observational notes for grading (Walsh, 2008). Halcomb and Peters (2009) state, “ The evaluations of students who are in the clinical setting is one of the most challenging responsibilities an instructor has”(p.62). The evaluation of students is the process of obtaining and collecting data, interpreting data that is received , and making formative judgments and conclusions about what the data means. From analyzing the research articles previously stated I would recommend using a combination of assessment practices in the clinical setting based on each student learning style and from the objectives of the nursing course. From this recommendation it should be ensured that whichever assessment tool that was chosen to be used was reliable and valid.

From analyzed learning that techniques used are becoming more common in the evaluation as assessment of students clinical practices and skills in the medical professions. From the study it is recommended that the competency assessment tool wording should provide clear specific requirements for knowledge, demonstrating skill, and attitude. These assessments are done on the national and international levels that are workable strategies that can promoter for greater skill development within an assessment competency framework. All of these approach’s would make the assessment od student clinical practices more helpful to the clinical faculty, staff nurses, and preceptors to determine how safe and effective the nursing student will be in practice. The clinical instructor, the clinical stimulation instructor, and the healthcare organization in which the student is participating in the clinical setting perform the clinical evaluation. Evaluation of students from the current assessment practices of reflective journaling, competency-based assessment and concept mapping can be a complicated task. The evaluation of students can become somewhat problematic because the evaluation at some point involves the direct observation of students who are actively in engaging the clinical setting. The clinical setting is an unpredictable environment because it is in real-time and not in a controlled classroom setting (McCarthy & Murphy, 2008).

To ensure there is proper evaluation the school should provide the evaluator with clear objectives for the evaluation of the clinical setting. The evaluation has to observe the students while he or she is carrying out his or her assignment and the evaluation can be done on how well the student communicates with the patient and family, the comfort level of the student and the patient, the students skill level for procedures within his or her level of practice (Neuman, Pardue, Gray, Gray, Hobbins, Edelstein, & Herrman, 2009). Also how well student can provide responses through Socratic questioning in the clinical setting. Students play a role in the clinical assessment and evaluation process. Students at the initial start of the course are to understand the clinical objectives for the course as well as what specific evaluation assessment will be utilized by the clinical faculty and preceptors.

The students are also and evaluator themselves by providing important feed back to the instructors, school, and organization on how effective the clinical sites and availability to assist the students needs to fulfill the course objectives (Cassidy, Butler, Quillinan, Egan, Namara, Tuohy, & Tierney, 2012). Clinical assessment practices are a direct mechanism to help protect patients. Several methods that were analysis of the research articles provided indication that assessments used in the clinical setting do not all follow strict guidelines standardized in all nursing schools or organizations. Nonetheless, from the analysis from current research that formative and authentic assessments methods are encouraged to evaluate the clinical course. Not only do clinical faculty/instructors play a distinguished role in the clinical assessment but also students have to be aware of his or her role to ensure that there is a balanced view and clinical judgments can be made to ensure that the students are safe to practice.

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