To pass or to fail? Understanding the factors considered by faculty in the clinical evaluation of nursing students

Clinical assessor's experiences of assessing undergraduate nursing and midwifery students who underperform on clinical placement: A qualitative systematic review and meta-summary

AIM

To summarise the qualitative evidence exploring the clinical assessor's experience of assessing undergraduate nursing and midwifery students who underperform on clinical placement.

DESIGN

A qualitative systematic review and meta-summary was undertaken.

DATA SOURCE

Database searches included CINAHL Plus with full text; Academic Search Complete; MEDLINE; PsycARTICLES; PsychINFO; Social Sciences Full text; SocINDEX with Full Text; ERIC; Pubmed; Scopus and Web of Science.

REVIEW METHOD

Included studies were appraised using the CASP (Critical Appraisal Skills Programme) tool. A meta-summary was conducted using Sandelowski & Barroso's method.

RESULTS

The review included 18 studies reported across 25 papers. Eight themes and 37 thematic sentences were created from 403 extracted findings.

CONCLUSION

The management of underperformance on clinical placement by undergraduate nursing and midwifery students presents a challenge for those nurses and midwives, working on the frontline of patient care, who also take on the role of clinical assessor. Addressing these challenges is essential to support the assessor and the student. Sharing of the decision making with a colleague when there is evidence of underperformance could address many of the difficulties experienced by the clinical assessor.

Suitable, fit, competent and safe to practice nursing? Assessing nursing students' personal qualities in clinical placement-An integrative review

AIMS AND OBJECTIVES

This study aims to explore, describe, and synthesize the personal requirements student nurses are assessed in their clinical placement to be suitable, fit, competent, and safe for the nursing profession.

BACKGROUND

There are different terms and concepts used when describing what nursing students are assessed by regarding personal requirements needed to be eligible to enter the nursing profession. This is regulated and enforced mainly by different standards and guidelines.

DESIGN

An integrative review using Whittmore and Knafl's (2005) methodology.

METHODS

Searches were systematically conducted in CINAHL, Education Source, ERIC, Academic Source Elite, MEDLINE and EMBASE, NORART, SveMed+, and Bibliotek.dk. The PRISMA checklist for systematic reviews was used.

RESULTS

Eighteen studies were included in the review. The results present various factors student nurses are assessed by in clinical placements, which were categorized into three themes: attitude and personal characteristics, behavior, and basic knowledge. Assessing students is a complex and subjective endeavor, and decisions are based on a holistic assessment of several different aspects of the student's performance and behavior CONCLUSIONS: The personal requirements to be deemed suited for det nursing profession are complex and composed of several different components. Assessments are often based more on assessors' subjective standards and intuition than on the provided guidelines and standards. There is no universal understanding of which characteristics or qualities are considered necessary for a student to be deemed suited for the nursing profession.

RELEVANCE TO CLINICAL PRACTICE

This study points at challenges with the assessment of nursing students today as there are no clear standards or understanding of the requirements needed.

Identifying self-presentation components among nursing students with unsafe clinical practice: a qualitative study

BACKGROUND

Maintaining patient safety is a practical standard that is a priority in nursing education. One of the main roles of clinical instructors is to evaluate students and identify if students exhibit unsafe clinical practice early to support their remediation. This study was conducted to identify self-presentation components among nursing students with unsafe clinical practice.

METHODS

This qualitative study was conducted with 18 faculty members, nursing students, and supervisors of medical centers. Data collection was done through purposive sampling and semi-structured interviews. Data analysis was done using conventional qualitative content analysis using MAXQDA10 software.

RESULTS

One main category labelled self-presentation emerged from the data along with three subcategories of defensive/protective behaviors, assertive behaviors, and aggressive behaviors.

CONCLUSION

In various clinical situations, students use defensive, assertive, and aggressive tactics to maintain their professional identity and present a positive image of themselves when they make a mistake or predict that they will be evaluated on their performance. Therefore, it seems that the first vital step to preventing unsafe behaviors and reporting medical errors is to create appropriate structures for identification, learning, guidance, and evaluation based on progress and fostering a growth mindset among students and clinical educators.

Failure to fail - Factors affecting faculty decisions to pass underperforming nursing students in the clinical setting: A quantitative study

AIM

The purpose of the study was to explore the relationship between face-implicating factors and faculty's likelihood of failing students in the clinical setting who do not meet passing criteria.

BACKGROUND

Clinical nursing faculty members struggle to assign failing grades to underperforming students in the clinical setting; this is known as failure to fail. Qualitative literature has revealed common factors for failure to fail; however, quantitative studies are required to determine the extent to which those factors affect faculty's decision-making process.

DESIGN

A quantitative, descriptive design was used.

METHODS

Snowball sampling was used to recruit participants from CCNE- and ACEN-accredited nursing programs to complete an online survey. There were 353 responses to the survey (a 30% return rate) and 327 usable responses. Eligibility criteria included pre-licensure nursing faculty members who had taught in the clinical setting within the past three years. The tool used for the study was adapted from Dibble's (2014) tool, which explored face-implicating factors' impact on the transmission of bad news.

RESULTS

Respondents who did not commit failure to fail (F2FN) disagreed more strongly with every survey item than those who committed failure to fail (F2FY). The differences in mean scores were compared and 64% of those differences were statistically significant (p < 0.05). Respondents who did not commit failure to fail were less affected by the face-implicating factors than those who committed failure to fail.

CONCLUSIONS

the null hypothesis was rejected; a direct connection was found between face-implicating factors and faculty's likelihood of passing students in the clinical setting who do not meet passing criteria.

Managing at risk nursing students: The clinical instructor experience

BACKGROUND

Clinical nursing instructors are responsible for providing optimal learning experiences and evaluating student performance, while maintaining patient safety in acute care settings. Our undergraduate Bachelor of Science in nursing program in Canada recently experienced an unusually high number of students who failed a compulsory medical surgical clinical course. Due to these high numbers, additional dedicated clinical groups were arranged for those students who were repeating.

METHOD

Seven clinical instructors participated in a focus group to share their experiences of managing students at risk. Thematic analysis was conducted on the interview data.

RESULTS

The results revealed four themes: (a) supporting student learning while ensuring patient safety, (b) balancing responsibilities and professional obligations (c) feeling physically and emotionally drained (d) experiencing self-doubt in making decisions (e) seeking and finding support.

CONCLUSION

The complexity of supervising at risk for failure nursing students in the clinical setting has an impact on instructors, patients, the educational institution and other students. Findings from this study offer a deeper understanding of the personal and professional impact on instructors when managing at risk nursing students and suggests ideas for future research, including examining the student perspective.

Psychometric Testing of a Theory-Based Measure to Evaluate Clinical Performance of Nursing Students

AIM

The aim of this study was to psychometrically test a clinical evaluation tool that measures instructors' gut feelings for placing students on a learning contract.

BACKGROUND

Evaluators feel unprepared or hesitant to fail students who do not meet professional and clinical expectations.

METHOD

A multiphase process was used to determine the reliability and validity of the Gut Feelings Scale. The first phase focused on item generation, the second phase focused on content validity and feedback from expert raters, and the third phase focused on psychometric evaluation to streamline the item pool and explore validity.

RESULTS

Correlations and descriptive statistics for each subscale were calculated. Reliability analyses revealed relatively strong estimates of internal consistency; specifically, the reliability estimates surpassed our criteria of >.70.

CONCLUSION

This pilot study established the validity and reliability of the scale and found it to be a reliable tool to guide instructors' evaluative decision-making.

Critical Incident Techniques and Reflection in Nursing and Health Professions Education: Systematic Narrative Review

BACKGROUND

The terms critical incident technique and reflection are widely used but often not fully explained, resulting in ambiguity.

PURPOSE

The aims of this review were to map and describe existing approaches to recording or using critical incidents and reflection in nursing and health professions literature over the last decade; identify challenges, facilitating factors, strengths, and weaknesses; and discuss relevance for nursing education.

METHODS

A systematic narrative review was undertaken. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature were searched using MeSH terms, returning 223 articles (2006-2017). After exclusions, 41 were reviewed.

RESULTS

Articles were categorized into 3 areas: descriptions of the development of an original tool or model, critical incidents or reflection on events used as a learning tool, and personal reflections on critical incidents.

CONCLUSIONS

Benefits have been identified in all areas. More attention is needed to the pedagogy of reflection and the role of educators in reflection.

Developing a consensus-based scoring rubric to enhance practice-based assessment of student nurses' clinical competence: A Delphi study

BACKGROUND

Concerns about reliability and validity of practice-based assessment of professional competencies are frequently reported in the literature. Difficulty in understanding competency statements or distinguishing different achievement levels has been found to be a major factor.

OBJECTIVES

To develop a consensus-based scoring rubric based on stakeholders' interpretations of level descriptors for student nurses' professional values competencies.

DESIGN

Two rounds of Classic e-Delphi.

SETTINGS

This study was conducted in a London based university using Bristol Online Survey website as a host.

PARTICIPANTS

100 stakeholders with vested interests in undergraduate pre-registration nurse education were purposefully invited to participate.

METHOD

Round one collected free-text interpretations of the United Kingdom Nursing and Midwifery Council professional values competency statements. Round two used a Likert scale questionnaire to measure the level of agreement to the level descriptor statements generated through round one. Responses were analysed through content analysis in round one and consensus measure in round two. A threshold of 70% agreement to determine consensus was set in advance.

RESULTS

In round one, 47 participants provided their interpretations of the competency statements. In round two, 51 participants completed the questionnaire. All 24 items achieved a strong consensus with 86%-100% of participants agreeing or strongly agreeing with the statements.

CONCLUSIONS

A Delphi study was successfully used to develop a consensus-based scoring rubric with clearly stated descriptors for professional values competency statements. This scoring rubric holds the potential to enhance practice-based assessment across all healthcare professional disciplines.

Moving forward: Barriers and enablers to failure to fail - A mixed methods meta-integration

BACKGROUND

Many academics and clinicians who assess nursing students as part of their work-integrated learning experiences encounter difficulties with awarding a failing grade to students who do not meet fitness for practice standards.

OBJECTIVES

The aim of this study was to explore and further our understanding of assessors' experiences of failure-to-fail of nursing students within work-integrated learning.

DESIGN

This aim was achieved through an exploratory, sequential, mixed methods research project.

METHODS

Guided by Invitational Theory, this programme of work included an integrated systematic review, one-on-one and focus group interviews, and finished with a survey.

RESULTS

The results of each of the phases of this mixed methods study were integrated to provide a greater understanding of the enablers and barriers for assessors managing poor performing students to ameliorate failure to fail. Enablers identified included: assessor supports, programme flexibility, and organisational culture. The barriers included grade inflation, in appropriate student responses, organisational processes and workload.

CONCLUSIONS

This comprehensive integration of a mixed methods study provides new and deeper understanding of the phenomenon of failure to fail. It provides clear recommendations for practical application by tertiary and clinical facilities to enhance the enablers and minimise the barriers to failure where it is warranted.

Nursing fundamentals - supporting clinical competency online during the COVID-19 pandemic

During the Spring of 2020, due to the COVID-19 pandemic, many schools of nursing were challenged to change their educational delivery methods from a face-to-face to an online format. This article discusses educational strategies utilized to support clinical competency using an online format for a fundamentals of nursing clinical course. Discussions of regulatory considerations, faculty planning, and teaching pedagogy utilized during this transition are presented. The authors also discuss future implications and suggestions for attaining learning objectives for a clinical course using an online format.

Dealing with the aftermath of student failure: Strategies for nurse educators

Although nurse educators may prefer to avert student failure, they need to handle the situation competently when failure occurs. Thus, faculty should know how to inform the student and administration of course failure, process their own emotions, and learn from the experience. However, many nurse educators lack confidence in dealing with the consequences of assigning a failing grade. This manuscript aims to provide foundational knowledge on managing student failure after it happens. Planning the timing, setting, and conversation can ease this challenging process. Despite faculty attempts to present the information compassionately, students may react aggressively. Consequently, faculty should develop a strategy to maintain safety. In addition, faculty may find it daunting to notify administrators of a student's failure, but preparing objective data based on missed course outcomes can promote administrator support of the decision. This factual rationale for the course failure also assists the faculty during a potential student appeal. Following the initial conversations with the student and administration, faculty should plan a time of respite to recover from the conflicting emotions that typically results from assigning a failing grade. Additionally, individual reflection and discussion with a mentor will help the educator to process the experience and grow professionally.

Who is failing who? A survey exploration of the barriers & enablers to accurate decision making when nursing students' competence is below required standards

Healthcare practice supports the achievement of programme learning outcomes for nursing students internationally. Within this context the issue of reluctance to fail nursing students, when warranted, is extensively examined within the literature with few definitive solutions emerging. Little is known about the perceived barriers that exacerbate this reluctance, or about factors that might enable and support nurses to fail students. To address this issue our study employed a non-experimental cohort study of nurses (n = 365) from two large teaching hospitals in the Republic of Ireland (ROI). Preceptors in this study clearly enjoyed their role with students, and received positive feedback from students. However, findings suggest that preceptors require more support from colleagues in providing comprehensive evidence in assessment. They also require additional training for providing negative feedback to students. A collaborative approach to competence assessment is recommended, whereby the professional burden can be borne by the team, and where students can engage in a holistic, reflective, learning experience that will ultimately improve their competence.

Developing a 'core of steel': the key attributes of effective practice assessors

BACKGROUND

the Nursing and Midwifery Council has emphasised that its recently introduced standards for student supervision and assessment aim to 'ensure that no one gets onto the register who shouldn't be there'. A key element in achieving this is the new practice assessor role, implemented to bolster practical assessment processes.

AIM

to identify the key personal characteristics of robust practice assessors who are prepared to fail underperforming students.

METHOD

a national study, using a grounded theory approach. Thirty-one nurses were interviewed about their experiences of failing students in practice-based assessments.

FINDINGS

robust practical assessors have a 'core of steel', characterised as having five key features: solidarity, tenacity, audacity, integrity and dependability.

CONCLUSION

organisations should base their selection of practice assessors on how strongly they exhibit these five characteristics. Designating all current mentors as new practice assessors, when it is known that often they are reluctant to fail, could perpetuate failure to fail.

Nursing Educators' Experiences Regarding Students' Mistakes in Clinical Settings

Background:

There is always the possibility of mistakes for nursing students, given the nature of the clinical wards. Nursing educators are the primary figures responsible for the nursing students' performance in clinical wards. The present study intended to describe nursing educators' experiences in relation to clinical mistakes made by nursing students.

Materials and Methods:

The present research was conducted using a descriptive phenomenological approach in 14 nursing educators. Deep semistructured interviews were performed to gather data, and triangulation and member checking were utilized to ensure data integrity. The data were analyzed using Colaizzite seven-stage method.

Results:

The themes extracted through comparison and analysis included three main themes “encountering an unpleasant event“, “internal confrontation“ and “the change in the effectiveness of teaching“ besides 6 sub-themes including “emotional excitement“, “honest reaction to the issue“, “struggling with the fear of recurrence of the mistake“ “coping with the event“, “passive teaching“ and “trying to be enhance one's capabilities in teaching“

Conclusions:

Regardless of the possibility of gaining fruitful experiences from a clinical mistake, its occurrence could be followed by negative experiences and consequences for the educators. It is thus essential that appropriate packages in this regard be provided in the empowerment programs for young educators to prepare them for correct confrontation with mistake occurrence. It is suggested that further qualitative studies be conducted to extract the steps educators take in confrontation with nursing students' clinical mistakes.

Gut feeling: A grounded theory study to identify clinical educators' reasoning processes in putting students on a learning contract

AIM

To develop a substantive theoretical explanation that makes sense of the decision-making process that clinical instructors use to place students on a learning contract.

BACKGROUND

Clinical instructors are challenged with the task of objectively evaluating students using subjective tools such as anecdotal notes, diaries, unstructured observations and verbal feedback from other nurses. Clinical instructors' assessment decisions have a considerable impact on a variety of key stakeholders, not least of all students.

DESIGN

Grounded theory method and its heuristic tools including the logic of constant comparison, continuous memoing and theoretical sampling to serve conceptualisation were used in the process of data collection and analysis.

METHODS

Seventeen individual semi-structured interviews with clinical instructors in one university in Western Canada were conducted between May 2016-May 2017. Data were analysed using open, axial and selective coding consistent with grounded theory methodology. The study was checked for the Standards for Reporting Qualitative Research (SRQR) criteria (See Appendix S1).

FINDINGS

Three subcategories, "brewing trouble," "unpacking thinking" and "benchmarking" led to the study's substantive theoretical explanation. "Gut feeling" demonstrates how clinical instructors reason in their decision-making process to place a student on a learning contract.

CONCLUSION

Placing a student on a learning contract is impacted by personal, professional and institutional variables that together shift the process of evaluation towards subjectivity, thus influencing students' competency. A system-level approach, focusing on positive change through implementing innovative assessment strategies, such as using a smart phone application, is needed to provide some degree of consistency and objectivity.

RELEVANCE TO CLINICAL PRACTICE

Making visible the objective assessments currently being done by clinical instructors has the potential to change organisational standards, which in turn impact patient and clinical outcomes.

Just how bad does it have to be? Industry and academic assessors' experiences of failing to fail - A descriptive study

BACKGROUND

Failing to fail nursing students in clinical assessments is an internationally acknowledged issue that necessitates thorough examination. Despite the gravity of 'mis-grading' nursing students, current research exploring this subject is limited. Understanding the experiences of assessors when faced with an underperforming student may help illuminate some of the broad issues associated with failure to fail.

OBJECTIVES

To describe both tertiary and industry based assessors' experiences of grading nursing student performances in clinical courses when that performance was not a clear pass or fail.

DESIGN

A pilot study using a descriptive survey design was employed.

SETTING

Participants were drawn from all states and territories in Australia.

PARTICIPANTS

Academic and industry assessors of undergraduate nursing students across Australian universities participated in this study.

METHODS

A newly developed and validated survey was conducted via an online platform. Descriptive data were collected on assessors' experiences across the domains of the Invitational Theory: people; processes; programmes; policies and places.

RESULTS

Participants clearly had a strong duty of care to patients and the nursing profession. However, 23.5% of participants had given the benefit of the doubt to student performances. They reported failing student performances nevertheless reported passing students. Some participants experienced a number of coercive student behaviours. They perceived that the culture of the ward impacted on student performances in assessments. Inadequate time to assess students in clinical practice was reported by 44% of participants. Participants reported no differentiation between theoretical and clinical assessments in their organisations' assessment policies.

CONCLUSIONS

Assessors reported many challenges when assessing students who were not performing at requisite standards. This study furthered the extant literature around the impact of people and processes on assessors and failure to fail. For the first time, assessors' experiences of the assessment environment, programme design and organisational policies associated with grading marginal student performances are reported.

Evaluation of unsatisfactory student performance

BACKGROUND

The 'failure to fail' phenomenon has been reported in studies involving preceptors and students in nursing and in other practice professions, but it has yet to be the subject of exploration among clinical nursing instructors. Research has revealed that assigning a failing grade in a practice profession is not always a straightforward task; however, passing students who are incompetent in their nursing practice could have a deleterious impact on the quality and delivery of patient care.

METHODS

The author interviewed eight clinical instructors who had failed unsatisfactory students to gain an in-depth understanding of each instructor's experience in evaluating these students. Gadamer's hermeneutic principles were used to interpret the interview texts and dialogue with the participants through the hermeneutic circle of understanding, use of the researcher's prior experience and openness to new understanding.

FINDINGS

The experiences of the clinical instructors in this study suggest that they have struggled with their emotions, particularly when they were novices, during the multiple personal, professional and organisational challenges that they have encountered within their teaching roles and responsibilities.

DISCUSSION

The difficulties and challenges highlighted in this study may offer insight for academic stakeholders in nursing schools on how to mitigate these issues through developing an onboarding orientation and mentorship programme that will support faculty member development in the evaluation of unsatisfactory student performance.

Failure of faculty to fail failing medical students: Fiction or an actual erosion of professional standards?

OBJECTIVES

Literature has shown that some assessors assign passing grades to medical students who, in fact, should not have passed. This inability of the faculty to fail underperforming students can jeopardise the reputation of professional programs, be it in the medical field or beyond. Simultaneously, weak students become incompetent physicians and, thus, endanger the community they serve. The impetus for conducting this systematic review was to identify barriers to faculty in failing struggling medical students.

METHODS

The databases of MEDLINE, Scopus, Wiley online library, Cochrane library, OVID, Taylor and Francis, CINAHL, Springer link, ProQuest, and ISI Web of knowledge were searched using Medical Subject Headings (MeSH) terms 'Faculty failure' AND 'Failing students' AND 'Failure to fail' OR 'Assessment'. The data were synthesised, and the results were analysed.

RESULTS

This search showed a wealth of barriers to faculty contributing to a 'failure to fail' such as their concerns about legal action and an appeals process; the stress of failing students; a lack of knowledge about proper documentation; unavailability of support, resources, and offices for faculty; absence of administrative guidelines; and complex dismissal procedures discouraging the faculty from failing students.

CONCLUSION

Institutional faculty development programs and training workshops should facilitate the education of supervisors and assessors for timely evaluation and regular documentation of trainee assessment. The provision of legal advice in cases of appeal and professional support by the resource and support office is emphasised.

Clinical Instructors' Experiences Working with and Assessing Students Who Perform below Expectations in Physical Therapy Clinical Internships

Purpose: Clinical education is an integral component of the curriculum of all physical therapy (PT) entry-to-practice programmes in Canada. The literature indicates that working with and assessing students performing below expectations (SPBE) can be procedurally and emotionally difficult. Our study aimed to explore the experiences of clinical instructors (CIs) and the decision-making process involved when supervising SPBE in PT. Method: A total of 19 in-depth, semi-structured interviews were conducted with CIs, transcribed, and coded using qualitative thematic analysis. Results: Four factors appeared to be important for CIs when they were deciding how to assess SPBE: (1) features of student performance, (2) factors related to the CIs, (3) academic and clinical facility influencers, and (4) strategies and available resources. Concerns about safety and professional behaviour, a student's clinical reasoning skills, and a lack of progression were key factors that CIs considered in recommending a final grade. CIs were more likely to recommend a failing grade if there was a series of repeated incidents rather than an isolated incident. Conclusions: We make several recommendations for the student, CI, and facilities to consider to better support and facilitate the process of working with SPBE in PT clinical education.

Exploring mentors' interpretation of terminology and levels of competence when assessing nursing students: An integrative review

OBJECTIVES

The purpose of this integrative review is to evaluate the empirical and theoretical literature on the challenges mentors face in interpreting and assessing levels of competence of student nurses in clinical practice.

DESIGN

An integrative review of the literature.

DATA SOURCES

An extensive and systematic literature search was conducted covering the period 1986-September 2016 across twelve databases covering health and education related publications. Grey literature was searched from wide relevant sources.

REVIEW METHODS

Sources were eligible for review when they referred to mentor's interpretation or assessment of student nurses' level of competence in practice settings. Methodological rigor of the included studies was evaluated with the Mixed Methods Appraisal Tool.

RESULTS

After screening 1951 records by titles, abstracts and full text, 8 were selected for review. The methodological quality of the studies was moderate. The studies reported: Accurate and fair assessment of students is impeded by a lack of transparent and explicit criteria.

CONCLUSIONS

There is a need to establish a transparent and common language to distinguish between and facilitate interpretation of different levels of competence. Well-designed rubrics might offer the solution to the challenges faced in practice-based assessment and necessitates further research into their use.

Experiences of Iranian Nursing Students Regarding Their Clinical Learning Environment

PURPOSE

The aim of this study was to explain the experiences of Iranian nursing students regarding their clinical learning environment (CLE).

METHODS

Twenty-one nursing students participated in this qualitative study. Data were collected using semistructured interviews and analyzed using conventional content analysis.

RESULTS

Analysis of interviews identified six categories: educational confusion, absence of evaluation procedures, limited educational opportunities, inappropriate interactions with nursing staff, bullying culture, and discrimination. Systematic and consistent methods were not used in clinical education and evaluation of nursing students. In addition, there were inadequate interactions between nursing students and health-care staff, and most students experienced discrimination and bullying in clinical settings.

CONCLUSION

Findings showed that the CLE of Iranian nursing students may be inadequate for high-level learning and safe and effective teaching. Addressing these challenges will require academic and practice partnerships to examine the systems affecting the CLE, and areas to be addressed are described in the six themes identified.

Interrater Reliability and Usability of a Nurse Anesthesia Clinical Evaluation Instrument

BACKGROUND

No Student Registered Nurse Anesthetist (SRNA) clinical evaluation instrument (CEI) has undergone interrater reliability or usability testing, to the authors' knowledge. This project determined the interrater reliability and usability of a new SRNA CEI.

METHOD

This was a prospective, mixed qualitative and quantitative, fully crossed observational design with a usability survey. SRNAs' recorded performance during simulation was evaluated by participants, who also completed a usability survey.

RESULTS

Interrater reliability is high, intraclass correlation coefficient = .982, 95% CI [.884, .960], indicating strong agreement of SRNA clinical performance among participants (n = 10). Internal consistency is excellent (Cronbach's α = .943), indicating the CEI is constructed appropriately and participants found it easy to use.

CONCLUSION

This CEI may advance the aim of impartiality in the evaluation of SRNA clinical performance through an instrument that is reliable, with good construct, and ease of use. [J Nurs Educ. 2018;57(7):446-449.].

Failing to Fail in Undergraduate Nursing: Understanding the Phenomenon

AIM

The aim of the study was to explore and understand the phenomenon of "failing to fail."

BACKGROUND

Phase 1 of a mixed-methods study suggested faculty in clinical settings instructed students that should not have passed preceding placements; students in didactic settings also passed exams that merited a fail. Phase 2 explored this phenomenon.

METHOD

A multisite qualitative case study targeted baccalaureate and community college faculty to support analysis using replication logic. Data collection was conducted via semistructured interview.

RESULTS

Eighteen demographically diverse cases were recruited (including age, experience, and full-/part-time status). Factors supporting failing to fail included being good enough, clinical/didactic dichotomy, team grading, and being the bad guy.

CONCLUSION

The consistency of enabling factors suggests a collective approach is required to address failing to fail, including pedagogical preparation and cross-school mechanisms for ensuring grading parity. Effort must address integrity and teaching excellence in all aspects of nursing education.

Describing student performance: a comparison among clinical preceptors across cultural contexts

CONTEXT

Health professional student evaluation during experiential training is notably subjective and assessor judgements may be affected by socio-cultural influences.

OBJECTIVES

This study sought to explore how clinical preceptors in pharmacy conceptualise varying levels of student performance and to identify any contextual differences that may exist across different countries.

METHODS

The qualitative research design employed semi-structured interviews. A sample of 20 clinical preceptors for post-baccalaureate Doctor of Pharmacy programmes in Canada and the Middle East gave personal accounts of how students they had supervised fell below, met or exceeded their expectations. Discussions were analysed following constructivist grounded theory principles.

RESULTS

Seven major themes encompassing how clinical pharmacy preceptors categorise levels of student performance and behaviour were identified: knowledge; team interaction; motivation; skills; patient care; communication, and professionalism. Expectations were outlined using both positive and negative descriptions. Pharmacists typically described supervisory experiences representing a series of these categories, but arrived at concluding judgements in a holistic fashion: if valued traits of motivation and positive attitude were present, overall favourable impressions of a student could be maintained despite observations of a few deficiencies. Some prioritised dimensions could not be mapped to defined existing educational outcomes. There was no difference in thresholds for how student performance was distinguished by participants in the two regions.

CONCLUSIONS

The present research findings are congruent with current literature related to the constructs used by clinical supervisors in health professional student workplace-based assessment and provide additional insight into cross-national perspectives in pharmacy. As previously determined in social work and medicine, further study of how evaluation instruments and associated processes can integrate these judgements should be pursued in this discipline.

The failure to fail underperforming trainees in health professions education: A BEME systematic review: BEME Guide No. 42

BACKGROUND

Many clinical educators feel unprepared and/or unwilling to report unsatisfactory trainee performance. This systematic review consolidates knowledge from medical, nursing, and dental literature on the experiences and perceptions of evaluators or assessors with this failure to fail phenomenon.

METHODS

We searched the English language literature in CINAHL, EMBASE, and MEDLINE from January 2005 to January 2015. Qualitative and quantitative studies were included. Following our review protocol, registered with BEME, reviewers worked in pairs to identify relevant articles. The investigators participated in thematic analysis of the qualitative data reported in these studies. Through several cycles of analysis, discussion and reflection, the team identified the barriers and enablers to failing a trainee.

RESULTS

From 5330 articles, we included 28 publications in the review. The barriers identified were (1) assessor's professional considerations, (2) assessor's personal considerations, (3) trainee related considerations, (4) unsatisfactory evaluator development and evaluation tools, (5) institutional culture and (6) consideration of available remediation for the trainee. The enablers identified were: (1) duty to patients, to society, and to the profession, (2) institutional support such as backing a failing evaluation, support from colleagues, evaluator development, and strong assessment systems, and (3) opportunities for students after failing.

DISCUSSION/CONCLUSIONS

The inhibiting and enabling factors to failing an underperforming trainee were common across the professions included in this study, across the 10 years of data, and across the educational continuum. We suggest that these results can inform efforts aimed at addressing the failure to fail problem.

Failing Clinical Practice & the Unsafe Student: A New Perspective

Students who fail clinical courses is a long standing issue in nursing education. Although faculty intuitively "know" a student is in clinical difficulty, the research literature is limited to delineating and describing characteristics of these students. A retrospective analysis of students' files in which there was at least one clinical failure was conducted to identify clinical failure indicators. Files included students who were successful, required to withdraw, or voluntarily withdrew. This study integrates these characteristics in a manner not discussed in the literature. Two themes emerged that characterize student practices: (i) How students are in practice and (ii) Aspects of practice. A third theme surfaced as clinical teachers responded to these students by labelling the practice unsafe and increasing vigilance. A model was developed that shows the relationship between these characteristics and unsafe student practice.

Baccalaureate Minority Nursing Students Perceived Barriers and Facilitators to Clinical Education Practices: An Integrative Review

AIM

This integrative review synthesized baccalaureate minority nursing students' perceptions of their clinical experiences.

BACKGROUND

The diversity of the nursing workforce does not mirror the United States population. Attrition rates of minority nursing students remain higher than rates for White students. Literature examining facilitators and barriers to minority student success predominantly focuses on academic factors, excluding those relevant to clinical education.

METHOD

An integrative review using literature from nursing and education.

FINDINGS

Three common perceived barriers were identified: discrimination from faculty, peers, nursing staff, and patients; bias in faculty grading practices; and isolation.

CONCLUSION

Although little is known about the relationship between clinical failures and overall attrition, this review provides evidence that minority students encounter significant barriers in clinical education. To increase the diversity of the nursing workforce, faculty must address these issues and make modifications to ensure an equal opportunity at a quality education for all students.

Nurse students' experiences with clinical placement in outpatient unit - a qualitative study

BACKGROUND

The recent reforms in the health care sector have changed the requirements for professional nursing competence in the clinical field. The reforms have also required nursing education to consider different areas for clinical placements for their students, and outpatient units in hospitals have been increasingly formalized as clinical learning environments. The complex technologies in some of these units represent a challenge for students who have limited existing knowledge or experience. More focus on outpatient care has also led to fewer opportunities for studying the continuity of a patient's life situation. In order to meet these challenges, structured learning activities with special forms were developed by nursing educators and nurses at outpatient units. The aim of this study was to explore students' experiences of using structured learning activities as unit-specific learning outcomes and targeted reflection during clinical placements in an outpatient unit.

METHODS

Two focus group interviews were conducted with a total of seven nursing students who had experienced structured learning activities during clinical placements in an outpatient unit. Data were analyzed by means of content analyses.

RESULTS

This study shows that preparedness and guidance during placement were imperative for making the week in the outpatient unit meaningful. 'Being prepared', which was one of the categories, incorporated the subcategories 'being able to understand what to do', 'being at the right place at the right time' and 'being alert for new experiences'. The category 'being guided' which incorporated the subcategories 'from uncertainty to more confidence', 'from observer to seeking knowledge' and 'from focusing on technology to seeing the person' showed that the forms guided the students through the placement in the outpatient unit.

DISCUSSION

Students take a more active approach to seeking knowledge when given structured learing activities during clinical placement in outpatient unit.

CONCLUSIONS

This study shows that use of outpatient units for clinical placement in nursing studies has several challenges but also the potential for creating positive experiences for the students.

'Failure to fail' in nursing - A catch phrase or a real issue? A systematic integrative literature review

'Failure to fail' is the allocation of pass grades to nursing students who do not display satisfactory clinical performance. This issue can have significant implications for individual students and assessors involved, as well as for nursing professionalism and patient safety. The aim of this systematic integrative literature review was to determine what is currently known about the issue of 'failure to fail' within undergraduate nursing programs. A literature search of five databases up to May 2015 was conducted to identify primary research papers. The search yielded 169 papers of which 24 met the inclusion criteria. The majority of papers had moderate or good methodological rigour, with most of the literature originating from the Northern Hemisphere. Five main themes emerged: failing a student is difficult; an emotional experience; confidence is required; unsafe student characteristics; and university support is required to fail students. The results suggest that 'failure to fail' is a real issue in tertiary facilities, with many complex facets. Given the costs of nurse education and the potential social and professional costs of poor quality nursing graduates, further rigorous research is required in this area.

Patterns of clinical mentorship in undergraduate nurse education: A comparative case analysis of eleven EU and non-EU countries

BACKGROUND

In spite of the number of studies available in the field and policy documents developed both at the national and the international levels, there is no reliable data available regarding the variation of roles occupied by clinical mentors (CMs) across countries.

OBJECTIVES

To describe and compare the CM's role; responsibilities; qualifications; employment requirements and experience in undergraduate nurse education as enacted in 11 European Union (EU) and non- EU countries.

DESIGN

A case study design.

PARTICIPANTS AND SETTING

A panel of expert nurse educators from 11 countries within and outside of the EU (Croatia, Czech Republic, England, Iceland, Ireland, Italy, Poland, Serbia, Slovenia, Spain, and the USA).

METHODS

A questionnaire containing both quantitative and qualitative questions was developed and agreed by the panel using a Nominal Group Technique (NGT); four cycles of data collection and analysis were conducted involving key experts in nursing education in each country.

RESULTS

In all countries, there are at least two types of clinical mentorship dedicated to undergraduate nursing students: the first is offered by higher education institutions, and the second is offered by health care providers. Variation was noted in terms of profile, responsibilities and professional requirements to act as a CM; however, the CM role is mainly carried out by registered nurses, and in most countries there are no special requirements in terms of education and experience. Those who act as CMs at the bedside continue to manage their usual caseload, thus the role adds to their work burden.

CONCLUSIONS

Whilst it is imperative to have respect for the different national traditions in undergraduate nurse education, the globalisation of the nursing workforce and greater opportunities for student mobility during the course of their undergraduate education suggests that in areas such as clinical mentorship, jurisdictions, particularly within the EU, should work towards greater system harmonisation.