A perspective on clinical evaluation in nursing education.

Clinical evaluation in nursing education is an important activity with potentially serious implications for students, teachers, and the recipients of nursing care. The evaluation of student learning in the clinical area has been the focus of much effort and energy as educators struggle with issues arising from the subjective nature of clinical evaluation and the role of clinical instructors as both teachers and evaluators. In this paper, the objectivity-subjectivity debate is reviewed and the limits of evaluation practices based solely in positivism are discussed. The teacher-evaluator and formative-summative distinction is viewed as a false dichotomy which enforces power differentials and impoverishes student learning. A case is built for clinical evaluation as a form of inquiry, the purpose being the discovery and verification of the process and product of the teaching and learning of nursing practice. Fourth generation evaluation is proposed as a basis for evaluation practices that address the unique and context-dependent nature of clinical practice, are capable of producing credible and dependable clinical evaluations, and are supportive of empowering teacher-student relationships.