Journal of Nursing Education

BRIEFS 

Diagnostic Evaluation and Grading in Nursing Laboratory Courses

Mary J Wilhite, EdD, RN

Abstract

Introduction

The nature of clinical laboratory courses imposes restrictions on how faculty members grade student achievement. In many schools, faculty have sidestepped problems associated with letter grades by adopting a pass-fail system for clinical laboratory courses or the clinical portion of integrated courses. Many students do not like the pass-fail system, especially those who tend to perform well in clinical situations.

Reilly (1978) described evaluation as a judgmental process and grading as a quantitative process. She said that although evaluation may occur independently of grading, grading is always dependent on evaluation. The purpose of this article is to discuss ways faculty can evaluate student performance before assigning final letter grades and without resorting to "the numbers game."

Diagnostic Evaluation

Diagnostic evaluation is evaluation by teachers that provides learners with information that identifies strengths and areas of concern. Evaluation is concerned with the learner's self-development (Reilly, 1978). Fbr example, interpersonal process recordings (IPR) may be assigned for several reasons, including providing a method for monitoring one-to-one encounters between student and client; providing practice for the student in identifying communication/interaction phenomena; or providing a basis for the teacher to assist students in modifing inappropriate or inadequate interpersonal behavior with clients. The IPR is not graded, but it does provide new data for "diagnosing" areas of concern.

Another example of diagnostic evaluation relates to daily nursing care plans submitted by students during the clinical pre-conference. The care plan should contain all the components of the nursing process, but may focus on only one or two nursing diagnoses. No grade need be assigned, but on the basis of the daily plan of care the teacher may recognize that a student is ill-prepared and needs further help before giving nursing care.

Teacher comments on any written assignment should reflect the nature of the assignment. If, on an IPR, the student only named the kind of phenomena observed, the teacher might comment:

You have correctly identified the type of communication in this interaction. It would be appropriate to speculate on why you and your client limited your interaction to "social chitchat." Was it by design; for example, were you attempting to relieve a tense situation? Or were you aware of the limited nature of your interaction?

The teacher's comment goes beyond pointing out an error or deficiency. It guides the student toward a line of thought and can be the focus of a later conference with the teacher.

Most students seem to need a reference point for ungraded but diagnostically evaluated work. "Good" written on a paper is tod subjective, though, and may be misinterpreted. One student may be elated because she perceives she is doing "A" work, although the teacher may have meant, "Compared with previous work submitted by this student, the work is adequate, and she may make it through the course." Another student may be upset because she did not get an "excellent." The teacher may have meant, however, that she enjoys reading this student's work because she is always so well prepared. In the first instance, the student would probably benefit more from a comment that indicates that the work submitted has improved and is satisfactory; in the latter instance, the teacher might be justified in writing exactly what she meant.

Diagnostic evaluation is probably most helpful both to students and faculty when accompanied by regular and frequent conferences. Some students like and benefit by group conferences, where two or three students meet with the teacher to review the week's laboratory experiences, receive help with the nursing process, go over nursing diagnoses, and make plans for the next week's assignments. Other students…

Introduction

The nature of clinical laboratory courses imposes restrictions on how faculty members grade student achievement. In many schools, faculty have sidestepped problems associated with letter grades by adopting a pass-fail system for clinical laboratory courses or the clinical portion of integrated courses. Many students do not like the pass-fail system, especially those who tend to perform well in clinical situations.

Reilly (1978) described evaluation as a judgmental process and grading as a quantitative process. She said that although evaluation may occur independently of grading, grading is always dependent on evaluation. The purpose of this article is to discuss ways faculty can evaluate student performance before assigning final letter grades and without resorting to "the numbers game."

Diagnostic Evaluation

Diagnostic evaluation is evaluation by teachers that provides learners with information that identifies strengths and areas of concern. Evaluation is concerned with the learner's self-development (Reilly, 1978). Fbr example, interpersonal process recordings (IPR) may be assigned for several reasons, including providing a method for monitoring one-to-one encounters between student and client; providing practice for the student in identifying communication/interaction phenomena; or providing a basis for the teacher to assist students in modifing inappropriate or inadequate interpersonal behavior with clients. The IPR is not graded, but it does provide new data for "diagnosing" areas of concern.

Another example of diagnostic evaluation relates to daily nursing care plans submitted by students during the clinical pre-conference. The care plan should contain all the components of the nursing process, but may focus on only one or two nursing diagnoses. No grade need be assigned, but on the basis of the daily plan of care the teacher may recognize that a student is ill-prepared and needs further help before giving nursing care.

Teacher comments on any written assignment should reflect the nature of the assignment. If, on an IPR, the student only named the kind of phenomena observed, the teacher might comment:

You have correctly identified the type of communication in this interaction. It would be appropriate to speculate on why you and your client limited your interaction to "social chitchat." Was it by design; for example, were you attempting to relieve a tense situation? Or were you aware of the limited nature of your interaction?

The teacher's comment goes beyond pointing out an error or deficiency. It guides the student toward a line of thought and can be the focus of a later conference with the teacher.

Most students seem to need a reference point for ungraded but diagnostically evaluated work. "Good" written on a paper is tod subjective, though, and may be misinterpreted. One student may be elated because she perceives she is doing "A" work, although the teacher may have meant, "Compared with previous work submitted by this student, the work is adequate, and she may make it through the course." Another student may be upset because she did not get an "excellent." The teacher may have meant, however, that she enjoys reading this student's work because she is always so well prepared. In the first instance, the student would probably benefit more from a comment that indicates that the work submitted has improved and is satisfactory; in the latter instance, the teacher might be justified in writing exactly what she meant.

Diagnostic evaluation is probably most helpful both to students and faculty when accompanied by regular and frequent conferences. Some students like and benefit by group conferences, where two or three students meet with the teacher to review the week's laboratory experiences, receive help with the nursing process, go over nursing diagnoses, and make plans for the next week's assignments. Other students sometimes prefer and need individual conferences with their teachers. The length of time rarely needs to exceed 30 minutes per student or group, and if written evaluation comments have been precise and helpful (and returned to the student before the conference), students may need only occasional individual conferences.

All written comments and conferences need to be timely. A student who learns that a nursing diagnosis is inappropriate a week after a client goes home has no opportunity to reassess or otherwise "correct" the diagnosis. It is extremely important to provide positive as well as negative feedback before the next clinical experience. Students almost always perform at higher levels of competency in clinical situations when they know they are doing at least some things correctly. Even very good students become discouraged and possibly lax when teacher feedback is delayed, absent, or always negative.

Teachers must be prepared at all times to discuss grades, even when no graded material has been submitted by students. Students worry about whether they are "doing all right," especially during the first 2 or 3 weeks of laboratory courses. The teacher must give realistic reassurance during this time. The following dialogue is not uncommon:

Student: How am I doing?

Faculty: Oh, fine.

Student: Do you think I'll make an A?

Faculty: Oh, it's too early to determine that!

Student: Well, what do I have to do to be sure to make an A?

This is the critical point. There are as many ways to answer this question as there are teachers. One way is:

Faculty: If I had to record a grade for you on the basis of the five days you have been in this clinical setting, Td probably record a B (or C or A).

Teachers must convince students that diagnostic evaluations are not used to determine laboratory grades. The only sure way to do this is to have well-defined grading criteria.

Grading

Grading is evaluation by teachers that leads to a letter or numerical grade that is recorded and used for purposes of determining academic standing. Nursing laboratory courses often are graded dichotomously: pass or fail. With specific criteria, however, laboratory courses may be graded on a continuum, eg, A, B, C, D, F.

The starting point for grading nursing laboratory courses is the set of course objectives: to earn a grade of C the student has to complete the objectives in the laboratory setting as outlined in the laboratory guidelines, unit objectives, or clinical objectives (or combinations of these). To earn a higher grade, a student must demonstrate superior ability in, for example, application of the nursing process:

To earn a C, the student is required to:

* Complete course objectives, unit objectives, and/or clinical objectives.

* Implement the nursing process in the clinical setting in a safe manner.

To earn a B, the student is required to:

* Meet criteria of C student.

* Demonstrate greater precision in analysis of data.

* Include relevant research-based citations in rationale for nursing diagnoses and nursing interventions,

* Include appropriate alternative proposals for nursing interventions.

* Demonstrate greater than average skill in evaluating outcomes of nursing interventions.

To earn an A1 the student is required to:

* Meet criteria of C and B students.

* Demonstrate consistently superior analytic ability.

* In situations where choices between two or more "correct" nursing interventions can be made, demonstrate superior judgment.

Students who earn a D may be borderline in their academic and/or clinical understanding of nursing process, or may fail to complete objectives. The grade of F ordinarily is reserved for students who are unsafe, whose academic understanding of the nursing process is blatantly inadequate, or who fail to complete numerous objectives.

Lest any reader think that the author has been much too general in citing criteria, it should be added that each ambiguous term can and should be operationally defined. The way in which "consistently superior analytic ability" is defined depends on the program's objectives, conceptual or organizing framework, and the faculty's specific expectations for junior or senior nursing students. As much as the author believes it is possible for the whole nursing profession to come to some agreements, this is not one of the things on which a million nurses probably will agree. Even so, a faculty usually can, with some travail, reach an agreement on this and other definitions in language that students can understand.

A paper-and-pencil examination may properly be a part of a laboratory course grade. If used, the examination should relate to the laboratory setting in which students have had their nursing experiences, for example, an acute care setting. Also, it should measure students' understanding of nursing process (and other relevant concepts from the program's conceptual or organizing framework) within the context of the course, unit, and/or clinical objectives.

Some paper-and-pencil examinations may be at the "knowledge" level, for example, related to procedures that must be safely completed. By testing students' knowledge about procedures unique to a specific clinical setting, the teacher has data on which to base grades and to decide if students are ready to implement nursing interventions that include a procedure. An example of this is administration of medications, such as specific drugs for psychiatric patients, or medications unique to labor-delivery nursing units.

Clinical courses can be partially or wholly graded using on-campus simulations. There are numerous reasons why the simulation examination is preferable to on-site supervised clinical examinations, including it is easier to control the situation; it is more "fair" because every student has the same test; or the simulation can test a broader range of knowledge and skill without endangering clients. There are at least as many reasons why simulation is not desirable, including the human element is missing; some students are intimidated by a simulated test; or the situation is too subjective.

Grading, regardless of what is graded, is subjective. An "objective" paper-andpencil examination is subjective in content. The only factor that is objective about some multiple-choice items is that once a "correct" answer is decided, the faculty member is obliged to grant students credit for a correct response when that answer is chosen.

As professionals with advanced clinical preparation, faculty are in a position to make expert decisions about the quality of students' nursing practice in clinical settings. With well-defined criteria - broad enough to allow flexibility, but specific enough to ensure safety - nursing faculty can do much to reward above-average and superior students by recognizing their achievements beyond the pass level.

Reference

  • Reilly, D.E. (1978). Evaluation: Theory and strategies. In D.E. Reilly (Ed.), leaching and evaluating the affective domain in nursing programa (pp. 49-64). Thorofare, NJ: Charles B. Slack.

10.3928/0148-4834-19900101-11

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