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A humanistic-educative approach to evaluation in nursing education
Article
A humanistic-educative approach to evaluation in nursing education Dolly Goldenberg and Pamela Dietrich A continuing challenge for nurse educators is to create a learning environment in which students receive fair and timely evaluations. Traditional or behavioural evaluation methods have been criticized as being too limited. A humanistic-educative evaluation method is offered with its emancipation of faculty and students and emphasis on collaboration, caring, creativity, critical thinking and self-assessment. A teacher±student shared home visit for a Family Nursing clinical assignment is provided to illustrate this approach. The potential benefit of the method for developing self-directed and competent professional nurses is proposed. & 2002 Published by Elsevier Science Ltd
Introduction
Dolly Goldenberg PhD, RN, Associate Professor, Pamela Dietrich Lecturer (at time of this writing), School of Nursing, The University of Western Ontario, London, Ontario N6A 5C1, Canada (Requests for offprints to DG, E-mail: dollyg@ rogers.com) Manuscript accepted: 17 October 2001
Nurse educators are faced with many challenges as they decide upon goals for their programmes, develop courses that will enable nursing students to learn essential competencies, and assess whether students and graduates demonstrate these competencies. They are called upon to consider the impact of health care reform on curriculum and teaching, reexamine the preparation of nurses, assume a greater role in teaching primary care with an emphasis on health promotion and prevention of illness, and extend opportunities for interdisciplinary practice in the delivery of health care (Oermann 1994). Nurse educators have been given this responsibility by society at large and by nurse registration bodies and accrediting agencies, to ensure that competent, safe and caring practitioners of nursing emerge. Accordingly, nursing students expect nurse educators to be accountable for the quality of their instruction, and for the fairness of their evaluations. Student evaluation, a vital component of the nurse-educator role, includes a set of dynamic, continuous processes that are generated and
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implemented by many participants within the teaching/learning environment. One purpose is to obtain information for making judgments about learners. If carried out in an environment of trust and respect, students' progress toward goal achievement can be determined, learning needs identified, and strategies proposed for improving student learning and competence (Reilly & Oermann 1999). Traditional methods of evaluation through the use of behavioural objectives and tools such as formalized and structured testing in classroom and clinical experiences, skill verification, checklists and rating scales, have been criticized as not adequate enough to provide a holistic assessment of individual learning (Bevis & Watson 1989, Wenzel et al. 1998). Many nurse educators have expressed dissatisfaction and frustration over these limited strategies, hence alternative evaluation methods are being sought to assess a broader range of student knowledge and capabilities. In fact, it has been more than a decade since the North American nursing education community met in Philadelphia in 1987 at the National League for Nursing's Fourth Nursing
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Education Conference, at which it was unanimously proposed to revolutionalize or transform nursing curricula from a training model to one that would educate caring, critically-thinking health professionals. To have faltered in this change would have been a, `disservice . . . injustice . . . to the profession . . . students . . . and those we are educated to care about' (Donley 1989, p. 2). Proposed, therefore, are evaluation strategies that include various levels of caring, critical thinking and synthesis in realistic contexts, problem-solving, selfreflection, personal responsibility, evidence of continuous life-long learning experiences, value improvement and accomplishment, which are developed in collaboration between student and teacher (Arter & Spandel 1992, Goldenberg 1994, Cole et al. 1995). The main purpose of this expository paper is to describe a way of critiquing student learning through humanistic-educative evaluation, and illustrate with an example of a student shared home visit for a Family Nursing clinical assignment. A second purpose is to explicate how evaluation of nursing students using a humanistic-educative approach, which is a student±teacher collaborative model based on negotiated standards or criteria for assessment (Bevis & Watson 1989/2000), can be integral to the development of self-directing, independent and competent professionals.
Background In the 1920s and 1930s previous evaluations, based on general descriptions of the ideal nurse and the nature of nursing, moved to early measurement and testing models, likening nurses to technicians. These were eventually replaced with pervasive, detailed behavioural objectives of the Tylerian era (Bevis & Watson 1989/2000), which began in the 1950s and continue in various forms today. Traditional evaluation of students was closely tied to course and curriculum objectives, and the criteria for evaluation of curricula were linked to student mastery of precise behavioural objectives. For over two decades, this behavioural, technical or Tyler model of education dominated curriculum development, instructional strategy design
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and evaluation of students. The model assumed that important things to be learned could be specified in terms of behavioural outcomes (Bevis & Watson 1989/2000). Evaluation based on behavioural objectives consisted of measuring and documenting students' abilities to meet or demonstrate these objectives. The measure of learning was a change in behaviour. This was particularly useful when nursing was viewed as a process of training and apprenticeship. No reported use of non-traditional methods of evaluation, as described below, had been found in the nursing literature prior to the 1970s (Patterson 1996). In the 1970s and 1980s, evaluation of student performance included not only outcomes of student learning determined by behaviours and knowledge acquisition, but by processes of learning, that is, complex cognitive abilities such as problem-solving, decision-making, and critical thinking (Bevis & Watson 1989/2000, Unger et al. 1993). In contrast to behaviourist models which equated successful learning with behavioural change, cognitive theorists regarded understanding and skill performance as successful learning. Understanding was considered the outcome of constructivist learning, a process of building new knowledge using cognitive processes that incorporate previous knowledge embedded in memory (Cust 1995). Understanding is evident when students operate on knowledge in various ways, such as explaining, giving examples, drawing implications, developing arguments, gathering and weighing evidence, solving problems, considering alternative viewpoints, and critical analysis of these (Cust 1995). In the clinical setting, this means that a nurse is able to perform with flexibility and creativity across settings, using memory and complex forms of abstract thinking. Competence and caring have recently been more strongly emphasized as we seek to respond to client needs in rapidly changing, complex social situations. Competence, in fact, has taken on more precise meaning, from research and clinical observation. Indicators such as ability to think critically, analyse and synthesize, demonstrate skill acquisition and mastery according to various taxonomies, levels of attainment, and consistency, are
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various attributes commonly used as descriptors of competence (Orchard 1992, Nicol et al. 1996, Reilly & Oermann 1999). Underlying philosophies and goals of nursing programmes, health care systems, and trends in educational theory have also shaped competency concepts. Currently, nurses who ascribe to a humanistic-educative paradigm, which is, `based on human science and human care' (Bevis & Watson 1989/2000, p. 268), and to responsive evaluation or student and societal needs, and which stemmed from the work of many in the 1970s and 1980s (Giorgi 1970, Stenhouse 1975, Freire 1976, Munhall 1982, Benner 1984, Eisner 1985, Watson 1988), emphasize working with students over time, setting broad learning goals, negotiating learning outcomes and what needs to be evaluated, and providing consistent feedback within the flexible relationships between teacher and student (Bevis & Watson 1989/ 2000, Cust 1995, Reilly & Oermann 1999). Previous notions of precise and predetermined objectives or levels of mastery run contrary to current expanded understanding of the complexity of human interactions, learning and experience that are inherent in humanisticeducative evaluation. Responsive or humanistic-educative evaluation involves a student±teacher partnership in the learning-evaluation endeavour. Partnership, as a model, evolved from the philosophy of student-centred learning based on a humanistic and liberal approach to education. `Humanism held that students were capable of planning, implementing, and evaluating their own learning' (Patterson 1998, p. 284). Humanisticeducative evaluation requires assessment of students' capabilities to analyse, critique, recognize insights and identify and evaluate assumptions about themselves and others and the world in which they live. It requires nurse educators to look at how students use the skill of inquiry to investigate the nature of lives and events, employ a variety of methods, anticipate, project and hypothesize from knowns to unknowns, how to search for structures, meanings and patterns, view wholes not just parts in relation to each other, and the ways in which to build upon prior
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knowledge and experience (Bevis & Clayton 1988). Nurse educators need to know how students engage in praxis, that is, how theory and practice inform each other, and how students evaluate their own learning and professional development. This is essential for evaluation of learning using a humanistic-educative approach.
Humanistic-educative evaluation In the humanistic-educative paradigm, a term which Munhall (1992, p. 375) described as `clumsy', educative learning involves finding meaning and significance in authentic personal experience, examining deeper structures in the study of nursing, and developing personal paradigm experiences. Learning and evaluation of learning, as noted previously, become more than establishing behaviours and determining how closely students meet these behaviours. This is a `shift' in learning and evaluation, away from viewing elements that are taught, and from tests that determine if parts have been learned (reductionism), to a view of the whole (holism), a pattern of inter-related phenomena in which students find a natural way to learn, criticize and evaluate, and become liberated from teacherformulated behaviours. It is involvement in a shared teacher±student activity. One should recall that in the humanistic-educative model, curriculum is defined as interactions that occur between teachers and students and among students (Bevis & Watson 1989/2000), and through these transactions evaluation of learning can take place. As with any paradigm that seeks to evaluate human learning, there is bound to be uncertainty and ambiguity. Bevis and Watson (1989/2000) advised that the probability of achieving greater clarity and accuracy in the humanistic-educative paradigm is increased by including learners in dialogue about their own learning. They proposed a `new' model of evaluation, in which they incorporated and synthesized ideas from Eisner (1985, 1994), Benner (1984), and Stenhouse (1975). This six-part model of looking, seeing, perceiving and intuiting, rendering, interpreting, and judging, called the Interpretive Criticism Model of Educational
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Connoisseurship, is a way to critique student learning. Although these authors admit that the model is incomplete, and not the only feasible way to evaluate from an intellectual perspective, they claim, nonetheless, that it is collaborative, liberating, caring and educational (Bevis & Watson 1989/2000, p. 286). With no validity or reliability figures possible for this paradigm, Bevis and Watson suggest that teachers, `forego the false security of numbers' and, `accept the inevitability of some uncertainty' (p. 280). The positive aspects include involvement of learners in interpretation and criticism, and heavy reliance on the shared and trusting relationship between students and teachers as co-learners, consistent with nursing as a human science.
recordings, portfolios, and nursing notes could show evidence of students' level of knowledge, and competency in problemsolving, decision-making and application of nursing practice skills. The following example illustrates criteria, indicators, and summaries of dialogue that were included in a set of evidences for learning and evaluation in the Family Nursing components of both first- and third-year undergraduate nursing courses at the School of Nursing, University of Western Ontario, Canada. Concepts and processes proposed by Bevis and Watson's (1989/2000) criticism (evaluation) model were used. One of the ends-in-view (goals) and five of the specific indicators (criteria) of student learning were as follows:
Evaluation of learning: example of a shared home visit
End-in-view ± Student elicits an understanding of the family's health situation(s).
A set of criteria from the Interpretive Criticism Model have been proposed as guidelines for assessing student learning. Bevis and Watson (1989/2000) likened this type of evaluation to a search for clues or evidence of learning, and recommended that teachers and students work together to construct criteria in the spirit of collaborative, participatory planning. After developing broad goals for a particular course, they create and collect these evidences at various points through the year. Evidences are found in every teacher±student interaction, every learning episode, and in any situation that is either planned or spontaneous. Evidence of student learning would become any piece of writing or dialogue that supports learning according to the criteria developed. Since writing and dialogue are essential prerequisites for both the learning and evaluation processes, examples of student writing and summaries of dialogue are necessary to provide the evidence. For example, a shared home visit might reveal aspects of a student's ability with interpersonal communication. A scholarly paper may demonstrate critical thinking, analysis and synthesis of ideas. Classroom debates and dialogue might indicate whether students think critically or how they respond to diversity among peers. Nursing care plans, case studies, teaching plans, process
Indicators
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1. Is attentive to the individual and collective needs of the family, including their developmental stage. 2. Initiates and cultivates a collaborative relationship characterized by genuineness, mutual respect, open communication and informality. 3. Explores the family's own understanding of health. 4. Assesses the strength/potential and resources, which individuals/families bring to the health situation. 5. Uses appropriate physical assessment skills to identify patterns and indicators of health and healing. Teachers and students worked together to collect and provide evidence of where and how these indicators occurred throughout the term. Using the six processes of evaluation proposed by Bevis and Watson (1989/2000) (looking, seeing, perceiving and intuiting, rendering, interpreting meaning and judging), the teacher was able to observe and work with the student during and following a shared home visit to a family in the community. Potential evaluation indicators and the summary description of teacher±student dialogue follow, as examples of the evaluation process used in these shared home visits.
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Looking ± A student might describe what s/he sees: perhaps a house, members of a family structure, or characteristics of the neighbourhood. The student then documents the observations in a family record or field note. Seeing ± A student might describe some of the more intricate details of a family experience, such as the health issues and characteristics of individual members of the family who are interacting with each other, and with the community at large. Perceiving and intuiting ± Together, the student and teacher might sense that something feels wrong, out of balance, or the student experiences some form of cognitive dissonance after leaving the home and uses own inner dialogue and response as a basis for further exploration at a subsequent visit. Rendering ± Through discussion following the visit, a student might describe what it was like, drawing upon analogies or metaphors in order to bring feelings and responses into conscious awareness, thought, and discourse. Later, in the journal, the student perceives, renders, and continues the inner dialogue in written form. Interpreting meaning ± This might include looking for and articulating patterns, themes, and meanings within the context of a broader picture of the family's experiences, assisting the student to formulate an appraisal of the current family situation. Judging ± This involves determining the importance of the episode or experience, and making decisions about future actions. There are two judgment processes occurring at the same time: making decisions with respect to the interventions and actions in the family, and making decisions with respect to the student's own learning. Both processes provide evidence of learning and progress toward the end-in-view (goal) for the course.
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The teacher and student used formative (ongoing) evaluation to view the shared home visit as a learning episode. The review was later summarized in the student's journal, as well as in a summative (final) critique, which the teacher wrote as an anecdotal note to the experience (Orchard 1992, 1994). Both of these written summaries were then co-validated and included in the student's course portfolio (see Fig. 1).
Additional evaluative strategies These are presented from the perspective of the strengths or advantages they offered. They were used in conjunction with the shared home visit, and included excerpts from students' journals; scholarly papers; multiple choice or short answer exams that test for facts, knowledge, application, and synthesis; take-home written assignments based on case studies; students' written reflections of a given class learning activity; case presentations discussed and debated in class or clinical conferences; written feedback from clinicians in the hospital or community settings (for example, an observed complete physical assessment on a newborn infant); a tape-recorded or videotaped interaction with assigned family members (clients), peers, or teacher, which was then reviewed and critiqued by students and other members of the learning team; and a self-selected assignment in which the student creatively demonstrated how an understanding of a given health situation was elicited. Students and teachers together decided which of these strategies to use and which were dependent on their negotiated decisions about what might constitute a comprehensive set of evidences. They also decided in which activities all students should engage, for example, a scholarly paper with an agreed-upon set of criteria for evaluation, as one of the critical and required assessment evidences for learning. Inherent in the above strategies were several important sources of evaluation. Self-evaluation was selected as a valuable method to identify students' own strengths, provide guidelines for self-directed learning, act as a vehicle for communication, foster
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Strengths observed Sound working relationship is well established. The family is comfortable with your presence and they offer much within the discussion to indicate their comfort and level of trust. Confident, spontaneous dialogue added to the atmosphere of `situation responsive nursing'. You let them begin with their needs for discussion first. Lots of positive attention to their strengths and success as a family unit. Managed a busy set of activities well with follow up on previous visits' discussion with respect to the mother's health and upcoming surgery, eldest sons's progress at school, and infant's activity and sleep patterns. You reinforced the importance of follow-through with specialist's appointment in collaboration with family physician's advice regarding effective birth control methods. Nice work with summarization at end of visit. Areas for development Continue with all that you are doing ± wonderful work ! Streamline visits a bit short where possible. May need to delineate role a bit more clearly ± consider how you might proceed if this were one of a 25-family caseload. In student role this is a point of flexibility. Now that volunteer is in place and there is much more stability of mom's emotional health and ability to cope as a family, set end of (month) as a possible goal for closure of visits. Main area for potential follow up: children's progress with the family's goals of successful blending of families and their longer term grieving of losses. Potential for future losses with extended family will require some anticipatory guidance with respect to community resources. Minor area of focus: continue to encourage mother to offer pablum from spoon vs. offering in a bottle and encourage mother to monitor baby's bowel patterns as new solid foods are introduced. May also need to anticipate her questions and familiarize yourself with current written information about infant feeding patterns. Perhaps you could start a resource file with them. Reminder re: availability of community well baby clinics and nursing services. Student Signature:
Faculty Signature:
Fig. 1 Feedback for shared home visit: summary of student-faculty discussion.
professional growth and learning, and provide teachers with information for summative (end-of-instruction) evaluation (Rideout 1994, Arthur 1995). Self-evaluation is a complex developmental skill, and students should be guided early in their programme, and in a systematic way. Furthermore, it had to be accompanied by student±teacher discussions in order to share observations and perceptions, identify student strengths and weaknesses and provide direction for learning and accomplishing goals (Best et al. 1990). Of benefit to the learner where student-centred learning methods are advocated (Green 1994), it provided that necessary component which made the teacher's subjective observations of the student more accurate and complete (Purdy 1997).
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Peer evaluation was used as it involved students of equal educational level working together in pairs or small groups in various settings, making significant valuable observations of each other's practice and learning. This strategy was also taught early in the programme, and according to Patterson (1996), was congruent with the outcomes sought and reflected the philosophy of the nursing curriculum. Client evaluation provided a valuable source of information about the care they received from students, and offered examples that contributed to the teacher's evaluation of student performance. Having students write about their experiences, note what clients expressed to them, and include clients' evaluations of the nursing care in their own
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self-evaluation, added to the substance of the evaluation. Clinician/External Examiner or a coassessment method of evaluation comprised a third party examiner to support the teacher's observations. It provided the advantage of an additional voice of experience and set of observations, thus strengthening the validity and objectivity of the evaluation. Ideally, clinicians or co-assessors who attend workshop training include staff nurses, directors of nursing, nurse practitioners, or staff educators.
Discussion Traditionally, the behavioural approach, although useful for training and instruction, offers little room for students' individual pursuits and enculturation into the profession. It has been criticized as stifling creativity, with rigid and restrictive guides for evaluation. On the other hand, the humanistic-educative model, with its underlying assumption of nursing as a human science, is viewed as facilitating students to cultivate creative and dynamic modes of nursing care, and offer a wider range of options, ideas, teaching and evaluation strategies. This was evident in the students' shared home visit. The focus on students' creative thought, considered to be the essence of education, and the dynamic co-equal relationship between student and teacher, reflects the humanistic-educative position regarding evaluation of student learning in nursing education. Applicability, strengths, and benefits of humanistic-educative evaluation, notwithstanding, several issues remain unresolved. There are challenges. One might question if this evaluative approach would satisfy accrediting bodies. What would be the costs in terms of school budgets and staff time? Would this method be acceptable to students and nurse educators more familiar with traditional methods? Would it suit all aspects of the school programme? It is difficult to postulate responses to these questions, but there is certain evidence in the literature that several issues have been considered. For example, some nurse educators have called for behaviourist paradigm-free
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accreditation and approval criteria in favour of research-based indicators of excellence, such as caring, critical and creative thinking in nursing practice (Bevis 1989). Although there is much work to be done to satisfy professional accrediting bodies, as an example, new educational rules in the USA, which depart from the behaviourist paradigm, have been adopted by the State of Georgia Board of Nursing. That Board now includes options for schools of nursing to respond to critical thinking, problem-solving, learner participation, shared power, creativity, collaboration by teachers and students, and reality-based situations for site visits, hitherto hidden (Gould & Bevis 1992). Humanisticeducative evaluation, with its emphasis on `emancipation of faculty and students, and caring, creativity and critical thinking, can be used [for accreditation purposes] without jeopardy' (Gould & Bevis, p. 133). In Canada, the Board of Accreditation of the Canadian Association of University Schools of Nursing, in view of, `new and emerging nursing education models and delivery methods', has `developed a plan for accrediting evolving Canadian nursing education programmes' (Thomas et al. 1998, p. 1±2), since most, if not all schools of nursing have adopted a caring paradigm. Despite insufficient evidence of costs or staff time, nurse educators at the University of Western Ontario who have used both behaviouristic and humanistic-educative methods of evaluation for class and clinical assessments (the authors included), have determined that there is relatively little difference. Traditional evaluation methods and tools that require tabulation of results from examinations, tests, checklists, and studentstipulated behavioural objectives, were equally as costly and time-consuming as humanisticeducative evaluation techniques. Admittedly, it does take time for nurse educators to feel comfortable with the method, and to use it as a means of developing students' self-awareness, direction, confidence and competence in nursing practice. Similarly, beginning nursing students, unfamiliar with this co-learner±evaluator approach, may find it disconcerting initially, but with knowledge and experience they come to appreciate the
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opportunity to participate in their own assessment and development as a nurse. Not all aspects of a programme may lend themselves to a humanistic-educative pattern. Students in their developmental phase, where some of the training aspects of nursing care are necessary, may still require behavioural qualities for teaching and evaluation. As Bevis and Watson (1989/2000) have stated: . . . all generic nursing education, which is the initial nursing education to licensure, has some content that lends itself to behaviourism regardless of level. But for certain aspects of baccalaureate education and most of master's and doctoral education, behaviourism is too limiting, in that there is the requirement that behavioural objectives be devised for all planned learning (p. 30). Interestingly, Munhall (1992) has suggested combining humanism, caring and behaviourism into a humanistic-behaviourist curriculum, or to use one for a specific situation and the other for a different situation. She states that we need not argue what matters more, as both approaches are critically important. Her suggestion is for a synthesis, a humanistic-behaviourist curriculum for teaching, learning and evaluation, which is what exists in many programmes whether hidden, exposed, formal or informal, adding that an overarching human science curriculum does contain nursing about human beings, and caring is included. Furthermore, many nurse educators would argue that despite teaching in a behaviourist school, their humanity, caring, concern, interpersonal relationships, and evaluation of students have always been humanistic and educative.
Implications for nursing education In response to rapid changes in health care, in client systems, client problems, expectations of service, nature of professional nurses' knowledge and skills, and in societal events as a whole, nurse educators, perhaps now more than ever, must be able to assure a well-informed, diverse public that graduates of nursing programmes are equipped to
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provide professional and safe nursing care. This involves evaluating students fairly and accurately, using multiple methods throughout the nursing programme, and developing student self-evaluative or assessment skills from the onset. Bartels (1998) proposed that self-assessment helps learners observe themselves in action, question the meaning of their observations against standards, look for alternative methods of self-correction, and with these skills, be `ready to assume their place as competent, insightful and reflective practitioners' (p. 135). It is also to be remembered that a significant purpose of selfevaluation is for nursing graduates to be able to function as responsible, accountable, autonomous, self-directing, independent practitioners, and determine their own needs for further personal and professional development (Purdy 1997). The humanisticeducative evaluation model incorporates these requisites, as well as addresses skills in learning to learn, initiating or responding to change, and maintaining a realistic perspective of practice related to societal needs at any point in time (Reilly & Oermann 1999). Nurse educators need to be better prepared to assess students within this broader, although somewhat ambiguous but all-encompassing perspective of evaluation, and become partners in assisting students to reach their goals. This may require relinquishing previous roles, as well as further study and experience with evaluation theories and processes, with effective observation techniques, documenting, counselling, developing students' decisionmaking, critical-thinking and self-reflection skills (Goldenberg 1994), and knowledge of role expectations and contributions of students, peers, clients and clinicians in the evaluation process. Educators of nursing students should also recognize that remaining positive and supportive during the assessment phase is most important. The climate in which evaluation takes place is critical to the way learners perceive and ultimately benefit from this process (Reilly & Oermann 1999). Humanistic-educative evaluation entails clarification of beliefs about evaluation itself, the view that it is a learning and growth experience, a trusting and caring
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teacher±student relationship with a wide array of assessment approaches for valid, open and fair co-assessment in all domains of learning: cognitive, psychomotor, and affective. It is a teacher±student partnership requiring negotiation of what is to be included in the assessment package. Humanistic-educative evaluation is not an entirely new paradigm. It consists of what has been taken from the best precepts, concepts and practices about learning and evaluation already known, and putting them together to form a reconceptualized whole or pattern. Some of the authors' colleagues have called this simply `evaluation with a heart'. But nurse educators need to gain more knowledge and experience in this albeit-revised form of evaluation, for it to be truly humanistic, educative and caring, and begin to embrace a more holistic perspective of interpretation and assessment of students' abilities. Education of faculty is, therefore, necessary. The challenge is for graduate programmes to offer curricula designed to prepare nurse educators for this skill. Application of humanistic-educative approaches for individual students in small classes, or for groups of students in large classes, should be considered. Although the basic elements of partnership, caring, creativity, critical thinking, and agreed-upon evidences of learning are similar in both situations, for large classes, negotiated evaluative criteria could be devised for the total group, or for peers or individual students within the group. Administrators of nursing programmes should ensure that their faculty have or will obtain such experience, and that the philosophy of the nursing programme reflects this view of evaluation. Nurse researchers should continue to investigate this and other methods of student evaluation for validity and reliability. Ultimately, by using a human science, human care approach in evaluation, students will obtain feedback that should make it possible for them to practice confidently as competent practitioners of professional nursing.
Summary and conclusions Since traditional or behavioural forms of evaluation, which were based primarily on
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directly observable, measurable objectives, have been found to be too limiting and restrictive to adequately assess all dimensions of nursing students' progress throughout their programme, nurse educators are seeking a more holistic, creative and liberal approach through the humanisticeducative model. Although complex and difficult to describe succinctly or in a few words, the process can be accomplished by collaborative methods about every student± teacher±client±clinician interaction, every learning episode, in any situation. While not a panacea, commitment and belief by nurse educators in caring practices and acquiring new ways of evaluating students is essential. It involves nurse educators who are willing to take risks, make a difference in freeing and empowering students, who believe that learning and evaluation is the mutual responsibility of teachers and students, and who acknowledge that learning is facilitated when students participate in their own evaluation. It requires nurse educators to act on the belief that a humanistic-educative evaluation will enable students to make relevant and informed decisions for providing safe nursing care. It also necessitates nurse educators, administrators and researchers to continue to substantiate the merits of this paradigm, empirically or by more rigorous research. Finally, success can be achieved through faculty development programmes, such as formal courses, workshops and/or conferences about this method of evaluation, and through mentoring by experienced faculty (Goldenberg 1994). Furthermore, empowering students to actively participate in their own learning and evaluation is critical to their development as competent, self-directing professionals, capable of assuming responsibilities inherent in our ever-changing and expanding health care system. References Arter J, Spandel V 1992 Using portfolios of student work in instruction and assessment. Educational Measurement 11(1): 36±44 Arthur H 1995 Student self-evaluations: How useful? How valid? International Journal of Nursing Studies 32(3): 271±276
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A humanistic-educative approach to evaluation in nursing education Dolly Goldenberg and Pamela Dietrich A continuing challenge for nurse educators is to create a learning environment in which students receive fair and timely evaluations. Traditional or behavioural evaluation methods have been criticized as being too limited. A humanistic-educative evaluation method is offered with its emancipation of faculty and students and emphasis on collaboration, caring, creativity, critical thinking and self-assessment. A teacher±student shared home visit for a Family Nursing clinical assignment is provided to illustrate this approach. The potential benefit of the method for developing self-directed and competent professional nurses is proposed. & 2002 Published by Elsevier Science Ltd
Introduction
Dolly Goldenberg PhD, RN, Associate Professor, Pamela Dietrich Lecturer (at time of this writing), School of Nursing, The University of Western Ontario, London, Ontario N6A 5C1, Canada (Requests for offprints to DG, E-mail: dollyg@ rogers.com) Manuscript accepted: 17 October 2001
Nurse educators are faced with many challenges as they decide upon goals for their programmes, develop courses that will enable nursing students to learn essential competencies, and assess whether students and graduates demonstrate these competencies. They are called upon to consider the impact of health care reform on curriculum and teaching, reexamine the preparation of nurses, assume a greater role in teaching primary care with an emphasis on health promotion and prevention of illness, and extend opportunities for interdisciplinary practice in the delivery of health care (Oermann 1994). Nurse educators have been given this responsibility by society at large and by nurse registration bodies and accrediting agencies, to ensure that competent, safe and caring practitioners of nursing emerge. Accordingly, nursing students expect nurse educators to be accountable for the quality of their instruction, and for the fairness of their evaluations. Student evaluation, a vital component of the nurse-educator role, includes a set of dynamic, continuous processes that are generated and
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implemented by many participants within the teaching/learning environment. One purpose is to obtain information for making judgments about learners. If carried out in an environment of trust and respect, students' progress toward goal achievement can be determined, learning needs identified, and strategies proposed for improving student learning and competence (Reilly & Oermann 1999). Traditional methods of evaluation through the use of behavioural objectives and tools such as formalized and structured testing in classroom and clinical experiences, skill verification, checklists and rating scales, have been criticized as not adequate enough to provide a holistic assessment of individual learning (Bevis & Watson 1989, Wenzel et al. 1998). Many nurse educators have expressed dissatisfaction and frustration over these limited strategies, hence alternative evaluation methods are being sought to assess a broader range of student knowledge and capabilities. In fact, it has been more than a decade since the North American nursing education community met in Philadelphia in 1987 at the National League for Nursing's Fourth Nursing
1
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Education Conference, at which it was unanimously proposed to revolutionalize or transform nursing curricula from a training model to one that would educate caring, critically-thinking health professionals. To have faltered in this change would have been a, `disservice . . . injustice . . . to the profession . . . students . . . and those we are educated to care about' (Donley 1989, p. 2). Proposed, therefore, are evaluation strategies that include various levels of caring, critical thinking and synthesis in realistic contexts, problem-solving, selfreflection, personal responsibility, evidence of continuous life-long learning experiences, value improvement and accomplishment, which are developed in collaboration between student and teacher (Arter & Spandel 1992, Goldenberg 1994, Cole et al. 1995). The main purpose of this expository paper is to describe a way of critiquing student learning through humanistic-educative evaluation, and illustrate with an example of a student shared home visit for a Family Nursing clinical assignment. A second purpose is to explicate how evaluation of nursing students using a humanistic-educative approach, which is a student±teacher collaborative model based on negotiated standards or criteria for assessment (Bevis & Watson 1989/2000), can be integral to the development of self-directing, independent and competent professionals.
Background In the 1920s and 1930s previous evaluations, based on general descriptions of the ideal nurse and the nature of nursing, moved to early measurement and testing models, likening nurses to technicians. These were eventually replaced with pervasive, detailed behavioural objectives of the Tylerian era (Bevis & Watson 1989/2000), which began in the 1950s and continue in various forms today. Traditional evaluation of students was closely tied to course and curriculum objectives, and the criteria for evaluation of curricula were linked to student mastery of precise behavioural objectives. For over two decades, this behavioural, technical or Tyler model of education dominated curriculum development, instructional strategy design
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and evaluation of students. The model assumed that important things to be learned could be specified in terms of behavioural outcomes (Bevis & Watson 1989/2000). Evaluation based on behavioural objectives consisted of measuring and documenting students' abilities to meet or demonstrate these objectives. The measure of learning was a change in behaviour. This was particularly useful when nursing was viewed as a process of training and apprenticeship. No reported use of non-traditional methods of evaluation, as described below, had been found in the nursing literature prior to the 1970s (Patterson 1996). In the 1970s and 1980s, evaluation of student performance included not only outcomes of student learning determined by behaviours and knowledge acquisition, but by processes of learning, that is, complex cognitive abilities such as problem-solving, decision-making, and critical thinking (Bevis & Watson 1989/2000, Unger et al. 1993). In contrast to behaviourist models which equated successful learning with behavioural change, cognitive theorists regarded understanding and skill performance as successful learning. Understanding was considered the outcome of constructivist learning, a process of building new knowledge using cognitive processes that incorporate previous knowledge embedded in memory (Cust 1995). Understanding is evident when students operate on knowledge in various ways, such as explaining, giving examples, drawing implications, developing arguments, gathering and weighing evidence, solving problems, considering alternative viewpoints, and critical analysis of these (Cust 1995). In the clinical setting, this means that a nurse is able to perform with flexibility and creativity across settings, using memory and complex forms of abstract thinking. Competence and caring have recently been more strongly emphasized as we seek to respond to client needs in rapidly changing, complex social situations. Competence, in fact, has taken on more precise meaning, from research and clinical observation. Indicators such as ability to think critically, analyse and synthesize, demonstrate skill acquisition and mastery according to various taxonomies, levels of attainment, and consistency, are
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various attributes commonly used as descriptors of competence (Orchard 1992, Nicol et al. 1996, Reilly & Oermann 1999). Underlying philosophies and goals of nursing programmes, health care systems, and trends in educational theory have also shaped competency concepts. Currently, nurses who ascribe to a humanistic-educative paradigm, which is, `based on human science and human care' (Bevis & Watson 1989/2000, p. 268), and to responsive evaluation or student and societal needs, and which stemmed from the work of many in the 1970s and 1980s (Giorgi 1970, Stenhouse 1975, Freire 1976, Munhall 1982, Benner 1984, Eisner 1985, Watson 1988), emphasize working with students over time, setting broad learning goals, negotiating learning outcomes and what needs to be evaluated, and providing consistent feedback within the flexible relationships between teacher and student (Bevis & Watson 1989/ 2000, Cust 1995, Reilly & Oermann 1999). Previous notions of precise and predetermined objectives or levels of mastery run contrary to current expanded understanding of the complexity of human interactions, learning and experience that are inherent in humanisticeducative evaluation. Responsive or humanistic-educative evaluation involves a student±teacher partnership in the learning-evaluation endeavour. Partnership, as a model, evolved from the philosophy of student-centred learning based on a humanistic and liberal approach to education. `Humanism held that students were capable of planning, implementing, and evaluating their own learning' (Patterson 1998, p. 284). Humanisticeducative evaluation requires assessment of students' capabilities to analyse, critique, recognize insights and identify and evaluate assumptions about themselves and others and the world in which they live. It requires nurse educators to look at how students use the skill of inquiry to investigate the nature of lives and events, employ a variety of methods, anticipate, project and hypothesize from knowns to unknowns, how to search for structures, meanings and patterns, view wholes not just parts in relation to each other, and the ways in which to build upon prior
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knowledge and experience (Bevis & Clayton 1988). Nurse educators need to know how students engage in praxis, that is, how theory and practice inform each other, and how students evaluate their own learning and professional development. This is essential for evaluation of learning using a humanistic-educative approach.
Humanistic-educative evaluation In the humanistic-educative paradigm, a term which Munhall (1992, p. 375) described as `clumsy', educative learning involves finding meaning and significance in authentic personal experience, examining deeper structures in the study of nursing, and developing personal paradigm experiences. Learning and evaluation of learning, as noted previously, become more than establishing behaviours and determining how closely students meet these behaviours. This is a `shift' in learning and evaluation, away from viewing elements that are taught, and from tests that determine if parts have been learned (reductionism), to a view of the whole (holism), a pattern of inter-related phenomena in which students find a natural way to learn, criticize and evaluate, and become liberated from teacherformulated behaviours. It is involvement in a shared teacher±student activity. One should recall that in the humanistic-educative model, curriculum is defined as interactions that occur between teachers and students and among students (Bevis & Watson 1989/2000), and through these transactions evaluation of learning can take place. As with any paradigm that seeks to evaluate human learning, there is bound to be uncertainty and ambiguity. Bevis and Watson (1989/2000) advised that the probability of achieving greater clarity and accuracy in the humanistic-educative paradigm is increased by including learners in dialogue about their own learning. They proposed a `new' model of evaluation, in which they incorporated and synthesized ideas from Eisner (1985, 1994), Benner (1984), and Stenhouse (1975). This six-part model of looking, seeing, perceiving and intuiting, rendering, interpreting, and judging, called the Interpretive Criticism Model of Educational
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Connoisseurship, is a way to critique student learning. Although these authors admit that the model is incomplete, and not the only feasible way to evaluate from an intellectual perspective, they claim, nonetheless, that it is collaborative, liberating, caring and educational (Bevis & Watson 1989/2000, p. 286). With no validity or reliability figures possible for this paradigm, Bevis and Watson suggest that teachers, `forego the false security of numbers' and, `accept the inevitability of some uncertainty' (p. 280). The positive aspects include involvement of learners in interpretation and criticism, and heavy reliance on the shared and trusting relationship between students and teachers as co-learners, consistent with nursing as a human science.
recordings, portfolios, and nursing notes could show evidence of students' level of knowledge, and competency in problemsolving, decision-making and application of nursing practice skills. The following example illustrates criteria, indicators, and summaries of dialogue that were included in a set of evidences for learning and evaluation in the Family Nursing components of both first- and third-year undergraduate nursing courses at the School of Nursing, University of Western Ontario, Canada. Concepts and processes proposed by Bevis and Watson's (1989/2000) criticism (evaluation) model were used. One of the ends-in-view (goals) and five of the specific indicators (criteria) of student learning were as follows:
Evaluation of learning: example of a shared home visit
End-in-view ± Student elicits an understanding of the family's health situation(s).
A set of criteria from the Interpretive Criticism Model have been proposed as guidelines for assessing student learning. Bevis and Watson (1989/2000) likened this type of evaluation to a search for clues or evidence of learning, and recommended that teachers and students work together to construct criteria in the spirit of collaborative, participatory planning. After developing broad goals for a particular course, they create and collect these evidences at various points through the year. Evidences are found in every teacher±student interaction, every learning episode, and in any situation that is either planned or spontaneous. Evidence of student learning would become any piece of writing or dialogue that supports learning according to the criteria developed. Since writing and dialogue are essential prerequisites for both the learning and evaluation processes, examples of student writing and summaries of dialogue are necessary to provide the evidence. For example, a shared home visit might reveal aspects of a student's ability with interpersonal communication. A scholarly paper may demonstrate critical thinking, analysis and synthesis of ideas. Classroom debates and dialogue might indicate whether students think critically or how they respond to diversity among peers. Nursing care plans, case studies, teaching plans, process
Indicators
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1. Is attentive to the individual and collective needs of the family, including their developmental stage. 2. Initiates and cultivates a collaborative relationship characterized by genuineness, mutual respect, open communication and informality. 3. Explores the family's own understanding of health. 4. Assesses the strength/potential and resources, which individuals/families bring to the health situation. 5. Uses appropriate physical assessment skills to identify patterns and indicators of health and healing. Teachers and students worked together to collect and provide evidence of where and how these indicators occurred throughout the term. Using the six processes of evaluation proposed by Bevis and Watson (1989/2000) (looking, seeing, perceiving and intuiting, rendering, interpreting meaning and judging), the teacher was able to observe and work with the student during and following a shared home visit to a family in the community. Potential evaluation indicators and the summary description of teacher±student dialogue follow, as examples of the evaluation process used in these shared home visits.
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Looking ± A student might describe what s/he sees: perhaps a house, members of a family structure, or characteristics of the neighbourhood. The student then documents the observations in a family record or field note. Seeing ± A student might describe some of the more intricate details of a family experience, such as the health issues and characteristics of individual members of the family who are interacting with each other, and with the community at large. Perceiving and intuiting ± Together, the student and teacher might sense that something feels wrong, out of balance, or the student experiences some form of cognitive dissonance after leaving the home and uses own inner dialogue and response as a basis for further exploration at a subsequent visit. Rendering ± Through discussion following the visit, a student might describe what it was like, drawing upon analogies or metaphors in order to bring feelings and responses into conscious awareness, thought, and discourse. Later, in the journal, the student perceives, renders, and continues the inner dialogue in written form. Interpreting meaning ± This might include looking for and articulating patterns, themes, and meanings within the context of a broader picture of the family's experiences, assisting the student to formulate an appraisal of the current family situation. Judging ± This involves determining the importance of the episode or experience, and making decisions about future actions. There are two judgment processes occurring at the same time: making decisions with respect to the interventions and actions in the family, and making decisions with respect to the student's own learning. Both processes provide evidence of learning and progress toward the end-in-view (goal) for the course.
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The teacher and student used formative (ongoing) evaluation to view the shared home visit as a learning episode. The review was later summarized in the student's journal, as well as in a summative (final) critique, which the teacher wrote as an anecdotal note to the experience (Orchard 1992, 1994). Both of these written summaries were then co-validated and included in the student's course portfolio (see Fig. 1).
Additional evaluative strategies These are presented from the perspective of the strengths or advantages they offered. They were used in conjunction with the shared home visit, and included excerpts from students' journals; scholarly papers; multiple choice or short answer exams that test for facts, knowledge, application, and synthesis; take-home written assignments based on case studies; students' written reflections of a given class learning activity; case presentations discussed and debated in class or clinical conferences; written feedback from clinicians in the hospital or community settings (for example, an observed complete physical assessment on a newborn infant); a tape-recorded or videotaped interaction with assigned family members (clients), peers, or teacher, which was then reviewed and critiqued by students and other members of the learning team; and a self-selected assignment in which the student creatively demonstrated how an understanding of a given health situation was elicited. Students and teachers together decided which of these strategies to use and which were dependent on their negotiated decisions about what might constitute a comprehensive set of evidences. They also decided in which activities all students should engage, for example, a scholarly paper with an agreed-upon set of criteria for evaluation, as one of the critical and required assessment evidences for learning. Inherent in the above strategies were several important sources of evaluation. Self-evaluation was selected as a valuable method to identify students' own strengths, provide guidelines for self-directed learning, act as a vehicle for communication, foster
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Strengths observed Sound working relationship is well established. The family is comfortable with your presence and they offer much within the discussion to indicate their comfort and level of trust. Confident, spontaneous dialogue added to the atmosphere of `situation responsive nursing'. You let them begin with their needs for discussion first. Lots of positive attention to their strengths and success as a family unit. Managed a busy set of activities well with follow up on previous visits' discussion with respect to the mother's health and upcoming surgery, eldest sons's progress at school, and infant's activity and sleep patterns. You reinforced the importance of follow-through with specialist's appointment in collaboration with family physician's advice regarding effective birth control methods. Nice work with summarization at end of visit. Areas for development Continue with all that you are doing ± wonderful work ! Streamline visits a bit short where possible. May need to delineate role a bit more clearly ± consider how you might proceed if this were one of a 25-family caseload. In student role this is a point of flexibility. Now that volunteer is in place and there is much more stability of mom's emotional health and ability to cope as a family, set end of (month) as a possible goal for closure of visits. Main area for potential follow up: children's progress with the family's goals of successful blending of families and their longer term grieving of losses. Potential for future losses with extended family will require some anticipatory guidance with respect to community resources. Minor area of focus: continue to encourage mother to offer pablum from spoon vs. offering in a bottle and encourage mother to monitor baby's bowel patterns as new solid foods are introduced. May also need to anticipate her questions and familiarize yourself with current written information about infant feeding patterns. Perhaps you could start a resource file with them. Reminder re: availability of community well baby clinics and nursing services. Student Signature:
Faculty Signature:
Fig. 1 Feedback for shared home visit: summary of student-faculty discussion.
professional growth and learning, and provide teachers with information for summative (end-of-instruction) evaluation (Rideout 1994, Arthur 1995). Self-evaluation is a complex developmental skill, and students should be guided early in their programme, and in a systematic way. Furthermore, it had to be accompanied by student±teacher discussions in order to share observations and perceptions, identify student strengths and weaknesses and provide direction for learning and accomplishing goals (Best et al. 1990). Of benefit to the learner where student-centred learning methods are advocated (Green 1994), it provided that necessary component which made the teacher's subjective observations of the student more accurate and complete (Purdy 1997).
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Peer evaluation was used as it involved students of equal educational level working together in pairs or small groups in various settings, making significant valuable observations of each other's practice and learning. This strategy was also taught early in the programme, and according to Patterson (1996), was congruent with the outcomes sought and reflected the philosophy of the nursing curriculum. Client evaluation provided a valuable source of information about the care they received from students, and offered examples that contributed to the teacher's evaluation of student performance. Having students write about their experiences, note what clients expressed to them, and include clients' evaluations of the nursing care in their own
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self-evaluation, added to the substance of the evaluation. Clinician/External Examiner or a coassessment method of evaluation comprised a third party examiner to support the teacher's observations. It provided the advantage of an additional voice of experience and set of observations, thus strengthening the validity and objectivity of the evaluation. Ideally, clinicians or co-assessors who attend workshop training include staff nurses, directors of nursing, nurse practitioners, or staff educators.
Discussion Traditionally, the behavioural approach, although useful for training and instruction, offers little room for students' individual pursuits and enculturation into the profession. It has been criticized as stifling creativity, with rigid and restrictive guides for evaluation. On the other hand, the humanistic-educative model, with its underlying assumption of nursing as a human science, is viewed as facilitating students to cultivate creative and dynamic modes of nursing care, and offer a wider range of options, ideas, teaching and evaluation strategies. This was evident in the students' shared home visit. The focus on students' creative thought, considered to be the essence of education, and the dynamic co-equal relationship between student and teacher, reflects the humanistic-educative position regarding evaluation of student learning in nursing education. Applicability, strengths, and benefits of humanistic-educative evaluation, notwithstanding, several issues remain unresolved. There are challenges. One might question if this evaluative approach would satisfy accrediting bodies. What would be the costs in terms of school budgets and staff time? Would this method be acceptable to students and nurse educators more familiar with traditional methods? Would it suit all aspects of the school programme? It is difficult to postulate responses to these questions, but there is certain evidence in the literature that several issues have been considered. For example, some nurse educators have called for behaviourist paradigm-free
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accreditation and approval criteria in favour of research-based indicators of excellence, such as caring, critical and creative thinking in nursing practice (Bevis 1989). Although there is much work to be done to satisfy professional accrediting bodies, as an example, new educational rules in the USA, which depart from the behaviourist paradigm, have been adopted by the State of Georgia Board of Nursing. That Board now includes options for schools of nursing to respond to critical thinking, problem-solving, learner participation, shared power, creativity, collaboration by teachers and students, and reality-based situations for site visits, hitherto hidden (Gould & Bevis 1992). Humanisticeducative evaluation, with its emphasis on `emancipation of faculty and students, and caring, creativity and critical thinking, can be used [for accreditation purposes] without jeopardy' (Gould & Bevis, p. 133). In Canada, the Board of Accreditation of the Canadian Association of University Schools of Nursing, in view of, `new and emerging nursing education models and delivery methods', has `developed a plan for accrediting evolving Canadian nursing education programmes' (Thomas et al. 1998, p. 1±2), since most, if not all schools of nursing have adopted a caring paradigm. Despite insufficient evidence of costs or staff time, nurse educators at the University of Western Ontario who have used both behaviouristic and humanistic-educative methods of evaluation for class and clinical assessments (the authors included), have determined that there is relatively little difference. Traditional evaluation methods and tools that require tabulation of results from examinations, tests, checklists, and studentstipulated behavioural objectives, were equally as costly and time-consuming as humanisticeducative evaluation techniques. Admittedly, it does take time for nurse educators to feel comfortable with the method, and to use it as a means of developing students' self-awareness, direction, confidence and competence in nursing practice. Similarly, beginning nursing students, unfamiliar with this co-learner±evaluator approach, may find it disconcerting initially, but with knowledge and experience they come to appreciate the
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opportunity to participate in their own assessment and development as a nurse. Not all aspects of a programme may lend themselves to a humanistic-educative pattern. Students in their developmental phase, where some of the training aspects of nursing care are necessary, may still require behavioural qualities for teaching and evaluation. As Bevis and Watson (1989/2000) have stated: . . . all generic nursing education, which is the initial nursing education to licensure, has some content that lends itself to behaviourism regardless of level. But for certain aspects of baccalaureate education and most of master's and doctoral education, behaviourism is too limiting, in that there is the requirement that behavioural objectives be devised for all planned learning (p. 30). Interestingly, Munhall (1992) has suggested combining humanism, caring and behaviourism into a humanistic-behaviourist curriculum, or to use one for a specific situation and the other for a different situation. She states that we need not argue what matters more, as both approaches are critically important. Her suggestion is for a synthesis, a humanistic-behaviourist curriculum for teaching, learning and evaluation, which is what exists in many programmes whether hidden, exposed, formal or informal, adding that an overarching human science curriculum does contain nursing about human beings, and caring is included. Furthermore, many nurse educators would argue that despite teaching in a behaviourist school, their humanity, caring, concern, interpersonal relationships, and evaluation of students have always been humanistic and educative.
Implications for nursing education In response to rapid changes in health care, in client systems, client problems, expectations of service, nature of professional nurses' knowledge and skills, and in societal events as a whole, nurse educators, perhaps now more than ever, must be able to assure a well-informed, diverse public that graduates of nursing programmes are equipped to
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provide professional and safe nursing care. This involves evaluating students fairly and accurately, using multiple methods throughout the nursing programme, and developing student self-evaluative or assessment skills from the onset. Bartels (1998) proposed that self-assessment helps learners observe themselves in action, question the meaning of their observations against standards, look for alternative methods of self-correction, and with these skills, be `ready to assume their place as competent, insightful and reflective practitioners' (p. 135). It is also to be remembered that a significant purpose of selfevaluation is for nursing graduates to be able to function as responsible, accountable, autonomous, self-directing, independent practitioners, and determine their own needs for further personal and professional development (Purdy 1997). The humanisticeducative evaluation model incorporates these requisites, as well as addresses skills in learning to learn, initiating or responding to change, and maintaining a realistic perspective of practice related to societal needs at any point in time (Reilly & Oermann 1999). Nurse educators need to be better prepared to assess students within this broader, although somewhat ambiguous but all-encompassing perspective of evaluation, and become partners in assisting students to reach their goals. This may require relinquishing previous roles, as well as further study and experience with evaluation theories and processes, with effective observation techniques, documenting, counselling, developing students' decisionmaking, critical-thinking and self-reflection skills (Goldenberg 1994), and knowledge of role expectations and contributions of students, peers, clients and clinicians in the evaluation process. Educators of nursing students should also recognize that remaining positive and supportive during the assessment phase is most important. The climate in which evaluation takes place is critical to the way learners perceive and ultimately benefit from this process (Reilly & Oermann 1999). Humanistic-educative evaluation entails clarification of beliefs about evaluation itself, the view that it is a learning and growth experience, a trusting and caring
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teacher±student relationship with a wide array of assessment approaches for valid, open and fair co-assessment in all domains of learning: cognitive, psychomotor, and affective. It is a teacher±student partnership requiring negotiation of what is to be included in the assessment package. Humanistic-educative evaluation is not an entirely new paradigm. It consists of what has been taken from the best precepts, concepts and practices about learning and evaluation already known, and putting them together to form a reconceptualized whole or pattern. Some of the authors' colleagues have called this simply `evaluation with a heart'. But nurse educators need to gain more knowledge and experience in this albeit-revised form of evaluation, for it to be truly humanistic, educative and caring, and begin to embrace a more holistic perspective of interpretation and assessment of students' abilities. Education of faculty is, therefore, necessary. The challenge is for graduate programmes to offer curricula designed to prepare nurse educators for this skill. Application of humanistic-educative approaches for individual students in small classes, or for groups of students in large classes, should be considered. Although the basic elements of partnership, caring, creativity, critical thinking, and agreed-upon evidences of learning are similar in both situations, for large classes, negotiated evaluative criteria could be devised for the total group, or for peers or individual students within the group. Administrators of nursing programmes should ensure that their faculty have or will obtain such experience, and that the philosophy of the nursing programme reflects this view of evaluation. Nurse researchers should continue to investigate this and other methods of student evaluation for validity and reliability. Ultimately, by using a human science, human care approach in evaluation, students will obtain feedback that should make it possible for them to practice confidently as competent practitioners of professional nursing.
Summary and conclusions Since traditional or behavioural forms of evaluation, which were based primarily on
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directly observable, measurable objectives, have been found to be too limiting and restrictive to adequately assess all dimensions of nursing students' progress throughout their programme, nurse educators are seeking a more holistic, creative and liberal approach through the humanisticeducative model. Although complex and difficult to describe succinctly or in a few words, the process can be accomplished by collaborative methods about every student± teacher±client±clinician interaction, every learning episode, in any situation. While not a panacea, commitment and belief by nurse educators in caring practices and acquiring new ways of evaluating students is essential. It involves nurse educators who are willing to take risks, make a difference in freeing and empowering students, who believe that learning and evaluation is the mutual responsibility of teachers and students, and who acknowledge that learning is facilitated when students participate in their own evaluation. It requires nurse educators to act on the belief that a humanistic-educative evaluation will enable students to make relevant and informed decisions for providing safe nursing care. It also necessitates nurse educators, administrators and researchers to continue to substantiate the merits of this paradigm, empirically or by more rigorous research. Finally, success can be achieved through faculty development programmes, such as formal courses, workshops and/or conferences about this method of evaluation, and through mentoring by experienced faculty (Goldenberg 1994). Furthermore, empowering students to actively participate in their own learning and evaluation is critical to their development as competent, self-directing professionals, capable of assuming responsibilities inherent in our ever-changing and expanding health care system. References Arter J, Spandel V 1992 Using portfolios of student work in instruction and assessment. Educational Measurement 11(1): 36±44 Arthur H 1995 Student self-evaluations: How useful? How valid? International Journal of Nursing Studies 32(3): 271±276
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