Observations as a Clinical Evaluation Method in Nursing Education

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Observations as a Clinical Evaluation Method in
Nursing Education

• Dr. Belal Hijji, RN, PhD
• 22/05/2011

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Learning Outcomes

• At the end of this presentation, participants
  will be able to
• Discuss the value of observation in clinical
  evaluation.
• Identify some of the threats to the reliability
  of observations.
• Identify the advantages of using anecdotal notes
  and checklists in assessment of performance.
• Describe how to use anecdotal notes and
  checklists as methods of recording observations
  about students performance.

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Observations
For as long as people have been interested in
studying the social and natural world around
them, observation has served as the bedrock
source of human knowledge.
(Adler and Adler, 1994, p. 377) Observing
students is a main strategy for evaluating
performance in clinical practice, simulation, and
learning laboratories. (Oermann and Gaberson,
2009)
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Threats to Validity and Reliability of
Observations

• Observations of students may be influenced by the
  teachers values, attitudes, and biases.
• Different teachers may focus attention on
  different aspects of performance. For example,
  during an IV medication administration, a teacher
  may focus mainly on the technique used for its
  administration, while another may focus on asking
  questions about the purpose of the medication,
  and observing how the student interacts with the
  patient.
• Incorrect judgments could be made about students
  performance, such as inferring that a student is
  inattentive during conference when in fact s(h)e
  is thinking about the comments made by others.

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• The level of students performance may vary
  between observations. This also applies to
  teachers and nurses.
• All observed behaviors should be shared with the
  students.

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Recording Observations

• Recording observations of students in clinical
  settings, simulation, and learning laboratories
  could be carried out through anecdotal notes,
  checklists, and rating scales. Anecdotal notes
  and checklists will be the focus of this
  presentation.

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Anecdotal Notes

• Teachers may not remember the observations made
  of each student for each clinical activity.
  Anecdotal notes are helpful in remembering what
  they observed and the context in which the
  performance occurred.
• The elements of effective anecdotal notes are
  presented below.

Figure 1. Key elements of effective anecdotal
notes
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• Anecdotal notes are narrative descriptions of
  observations made about students performance.

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Figure 2. Poorly written anecdotal note
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Figure 3. Well-written anecdotal note
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• Anecdotal notes should be recorded as close to
  the time of the observation as possible.
• Anecdotal notes should be shared with students as
  frequently as possible otherwise they are not
  effective for feedback.

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Checklists

• A checklist is a list of specific behaviors to be
  observed with a place for marking whether or not
  they were applied during the performance (Slide
  12).
• Nurse educators use or develop checklists that
  often list the steps a student should follow when
  performing a nursing procedure or demonstrating a
  skill.
• Checklists facilitate the teachers observation
  of procedures and students behaviors and
  learning new skills, and checklists also provide
  a way for learners to assess their own
  performance.
• Checklists enable learners to review and evaluate
  their performance prior to assessment by the
  teacher.

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A Checklist for IV Injection of Medication
Step Activity Applied Not applied
1 Checks physicians order
2 Checks medication administration record
3 Adheres to rights of medication admin.
4 Assembles appropriate equipment
5 Checks compatibility with existing IV if present
6 Explains procedure to patient
7 Positions patient appropriately
8 Checks patency of IV line
9 Administers medication at proper rate
10 Monitors patient response
11 Flushes tubing as necessary
12 Documents IV medication correctly
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Checklists (Continued)

• It is favorable that a checklist include errors
  in performance that are commonly made. For
  example, Hijji et al.s (2010) observational
  study on nurses observed practice of blood
  transfusion (n 49) included the following 3
  errors in practice

Practice Performed N Did not perform N
Covered blood with blanket/ linen 7 14 42 86
Performed remote checks at nurses station 30 61 19 39
Initiated the transfusion more than 30 minutes after blood collection 21 43 28 57
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• Regardless of the method being used, educators
  should record observable and objective NOT
  subjective data, and should have the knowledge of
  how to develop valid and reliable methods to
  assess students performance. For example, in a
  previous experience of the Presentor in a Middle
  Eastern university, nurse educators included the
  following multivariable item in their assessment
  of students performance on establishing a
  sterile field
• Professional development, communication skills,
  attendance, and punctuality.
• on a scale of 1 2 3 4 5 6 7

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References

• Adler, P. and Adler, P. (1994). Observational
  techniques. In N. Denzin and Y. Lincoln (eds.)
  Handbook of Qualitative Research. London Sage.
  pp. 377-392.
• Hijji, B., Parahoo, K., Hossain, M., Barr, O.
  and Murray, S. (2010). Nurses practice of blood
  transfusion in the United Arab Emirates an
  observational study. Journal of Clinical Nursing.
  19, 33473357.
• Oermann, M. Gaberson, K. (2008). Evaluation
  and Testing in Nursing Education. 3rd edition.
  New York Springer.
• Nitko, A. J., Brookhart, S. M. (2007).
  Educational assessment of students (5th ed.).
  Upper Saddle River, NJ Pearson Education.

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Thank You Very Much
Any Questions?