A few months ago, a colleague of mine was cleaning her basement and found some old copies of Nurse Educator. Knowing I would be interested, she mailed them to me. I thought you would enjoy learning about the articles that were published in the May/June 1978 issue of Nurse Educator, compared with the articles in this current issue. Forty years ago, there were only 4 articles in an issue of the journal (and no departments). Those articles examined competency-based education in nursing, issues with clinical evaluation tools and clinical grading, needs assessment as a basis for curriculum planning, and a learning theory that facilitated the growth of students toward self-actualization and responsibility.
There is no shortage of articles today on competency-based education in nursing. In 1978, competency-based education was viewed as a broad framework for guiding curriculum development and more narrowly as a model for designing an individual unit of instruction such as a module.1 In both of these views, the focus was on establishing outcomes to be met by students but also recognizing that students have diverse learning needs and goals, are capable of guiding their own learning, and learn best in an environment of trust and where they feel supported by the teacher. That still holds true today. Some schools have used a competency-based education framework for designing their nursing programs, allowing students to receive credit for previous experience and learning and to work at their own pace until predetermined competencies are met.
If you had a chance to read Seldomridge and Walsh's2 article on clinical grade inflation ahead of print, you will appreciate the article on clinical grading written 40 years ago, in which the authors discussed problems with the clinical evaluation tool in their nursing program.3 Faculty had difficulty grading students' performance using their tool, which rated students as always, usually, sometimes, or never meeting the standards. Some students, though, had an opportunity to perform a skill or competency only one time. The authors developed new guidelines for grading clinical practice from "A" excellent to "E" failing, based on students' attainment of minimal behaviors, extent of preparation, initiative in seeking assistance, problem solving skill, resourcefulness, growth, accountability, creative use of the nursing process, and application of scientific rationale. I am not convinced the new rating scale of A to E with those detailed guidelines was more valid and reliable than the original scale. Clinical evaluation continues to be difficult to do, and no matter how many times you revise your evaluation tool, observing and rating students' performance are rarely clear-cut. This is the nature of clinical evaluation. To me, what is most important is for clinical teachers and preceptors to appreciate the difficulty in interpreting students' performance and consider the many factors that can influence it in a clinical setting. In all of our programs, we should ensure that every clinical teacher and preceptor understands what the competencies on the tool mean and what "passing" performance looks like. If you are observing students' performance in the clinical setting or in simulation, be sure you are aware of your own values and potential biases that might influence your observations and judgments.
The third article in the 1978 issue described the importance of a needs assessment as a basis for developing a curriculum.4 A thorough needs assessment allows faculty to plan a curriculum that meets the needs of the profession and society (and I would add: meets the needs of the students). The fourth article provided a learning theory, which combined other theories, for faculty to use in nursing, with examples of how the author applied the theory in her own courses.5 The other pages in the issue were advertisements for books (the pediatrics textbook was 490 pages and cost $9.95) and for multimedia (35-mm slides)!
The authors in 1978 had good advice for nurse educators, some of which remains useful today. I hope that our articles in this issue provide good advice for faculty and clinical educators today and for the next few years.
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