Development of ‘Clinical Instructor’s/Tutor’s Task Inventory’: A Methodological Study

Ruchi Saini, Sukhpal Kaur

Abstract : Introduction: Clinical instructors or tutors apart from classroom and clinical instruction, perform variety of other tasks to meet the basic objective of preparing well-trained and knowledgeable nurses to meet health demands of the public. Objectives: To explore various job-related tasks performed by clinical instructors/tutors and to develop ‘Clinical Instructor’s/ Tutor’s Task Inventory (CITI)’ and  ‘Clinical Instructor’s/ Tutor’s Task  Inventory (CITI) Assessment Scale’. Methodology: A methodological research design was chosen. The ‘Clinical Instructor’s/ Tutor’s Task Inventory (CITI)’ was developed in five phases. In the first phase, the preliminary draft of CITI and CITI Assessment Scale was developed based on Focus Group Discussions (FGDs) with clinical instructors and nursing students and literature search on web, books and job-descriptions of clinical Instructor/Tutor from various nursing educational institutions. In the second phase, content validity of CITI and CITI Assessment Scale was established through Delphi Rounds (08 experts). Two Delphi rounds were undertaken and modifications were made as suggested by Delphi panellists. The first try out of CITI and CITI Assessment Scale was done by ten nursing faculty in one of the nursing educational institution of Punjab to check its feasibility and validity. The changes were made after pilot study and third Delphi round was conducted. In the fourth phase, CITI Assessment Scale was administered to 161 nursing faculty in 08 selected private nursing educational institutions of Punjab and its reliability was checked. In the fifth phase, after administration of CITI Assessment Scale, an informal discussion was done among nursing faculty to determine the comprehensibility, feasibility and understandability. Results: The Item-Content Validity Index (I-CVI) of tasks on ‘Clinical Instructor’s/ Tutor’s Task Inventory (CITI)’ ranges between0.8 to 1.0 while the scale- content validity index (S-CVI) was 0.89. The overall reliability of CITI Assessment Scale was computed using Cronbach alpha and was found to be 0.943. The CITI was found comprehensive and easy to understand. However, CITI Assessment Scale was found to be time-consuming. Conclusion: A comprehensive, feasible and valid CITI along with reliable CITI Assessment Scale was developed. It is recommended to use this inventory for job-analysis of clinical instructors and tutors.

Keywords

Clinical Instructor; Job descriptions; Focus Group Discussions; Delphi Technique; Content Validity Index; Reliability

Correspondence at

 Dr. Ruchi Saini

Clinical Instructor

National Institute of Nursing Education (NINE) PGIMER, Chandigarh.

Introduction

Teaching in nursing gives the nursing faculty an opportunity to share their knowledge along with clinical expertise to new entrants to the profession or nurses returning to practice with advanced preparation. The nursing faculty apart from teaching in the class and clinical settings assume several other responsibilities such as advising and/or mentoring students, evaluating student’s assignments, participating in the committee activities of nursing school and college/university, attending faculty meetings, engaging in writing/publishing research, presenting at conferences, maintaining certification and/or clinical competence1-3. NCSBN Board of Directors (National Council of State Boards of Nursing) in 2007- 20084 set up the Faculty Qualifications Committee with the objective to review and present recommendations for future faculty qualifications and roles. The committee members made their recommendations for future faculty qualifications and describes nursing faculty as a ‘collaborator’, ‘director of student learning’ and ‘role model’ as three broad categories of faculty roles which incorporates all the various roles that nursing faculty members currently are responsible for and will be responsible for in the future. faculty so that there is clarity of expected roles and responsibilities performed by them. In the current scenario, though the regulatory bodies in Nursing have well- defined various job positions, education and experience requirements to assume them; there is lack of clarity about their expected roles and responsibilities. Since the clinical instructors/tutors are the basic level nursing faculty who plays a significant role in teaching nursing skills to the nursing students, there is a felt need to develop an inventory of well-defined job-tasks of clinical instructors/tutors to fulfil expected roles.

Objective

To explore and develop an inventory of roles and responsibilities performed by clinical instructor or tutor in nursing college.

Materials and Methods

A methodological study design was adopted to develop ‘Clinical Instructor’s/ As per Adams State College, Colarado5 Faculty Handbook, the nursing faculty is expected to demonstrate a commitment to professional nursing, maintain clinical expertise, provide professional service to the community, participate in ongoing professional development, utilize best practices to enhance the learning environment and serve as a professional role model.

Since the teaching role in nursing requires performance of variety of tasks, there is a requirement of well-written job description for different cadres of nursing Tutor’s Task Inventory (CITI)’ and ‘Clinical Instructor’s/ Tutor’s Task Inventory (CITI) Assessment Scale’ for the clinical instructors/tutors working in selected private nursing educational institutions of Punjab. Permission to conduct research study was taken from the principal of the involved nursing educational institutions. The ethical clearance was taken from the institutional ethics committee of each nursing educational institution. The development of CITI was done in five phases as depicted in the Table 1.

Table 1: Development of Clinical Instructor’s/tutor’s Task Inventory (CITI)

Phases 1	·               Focus-group Discussions with Clinical Instructors/tutors ·               Focus-group Discussions with Nursing Students ·               Literature Search ·               Developing an Item Pool ·               Preparation of Preliminary Draft
Phase 2	Validation phase ·               Selection of panel of experts ·               Delphi Round I ·               Delhi Round II
Phase 3	·               Pilot Study (1st Try out) ·               Delphi Round III
Phase 4	Establishing Reliability of CITI Assessment Scale (2nd Try out)
Phase 5	Feedback

 Phase 1: Preparation phase involved the development of preliminary draft of CITI and CITI Assessment Scale. It included conduction of 8 FGDs, each of 30-35 minutes duration in one of the private nursing educational institution of Punjab to have a broader view of various tasks performed by clinical instructors/tutors. Four FGDs were conducted with clinical instructors/tutorsandfour FGDs were conducted among nursing students who were under direct clinical supervision of clinical instructors or tutors. Each FGD consisted of five subjects.

Based on the results of FGDs and relevant literature search through Google Scholar, CINHAL, PubMed, Ovid SP, Embase and books, job descriptions of certain nursing educational institutions and researcher’s own experience, an item pool was generated and organized into preliminary draft of CITI and CITI Assessment Scale.

Phase 2: This phase involved the content validity of CITI and CITI Assessment Scale using Delphi Technique. A panel of 08 experts from the field of nursing education and administration were selected. After obtaining a written informed consent, they were invited to participate in the Delphi Rounds either telephonically or through personal contact or E-mail. Two Delphi Rounds were conducted to reach the final consensus. During each round, the copy of draft was given to the experts and they were requested to check each item for face validity and content validity. Their suggestions were categorized on a 4-point likert scale: relevant; quiet relevant but need minor corrections;somewhat relevant and need modifications; irrelevant and remove the item. After, two Delphi rounds, CITI thus developed, contained three parts: Part-A: demographic profile of nursing faculty; Part- B: Task inventory and Part-C: an open-ended question to get subjective information regarding additional tasks performed by clinical instructor/tutor. The Task inventory included 107 tasks categorized under 09 domains namely: Classroom/Theoretical Teaching (13 tasks); Clinical Teaching (25 tasks); Clinical Supervision (08 tasks); Nursing Skill Lab Teaching (18 tasks); Guidance and Counselling (04 tasks); Administrative Assistance (21 tasks);

Research and Publications (07 tasks); Continuing Nursing Education (03 tasks) and Miscellaneous Work (08 tasks). The frequency of the performance of each task was identified on CITI Assessment Scale which is a 7-point likert scale: almost everyday/every time; few times a week (3-4 times); few times a month (3-4 times); few times a year (3-4 times); rarely; never and on need basis.

Phase 3 (First Try out): In this phase, the CITI alongwith CITI Assessment Scale was given to 10 nursing faculty (02 lecturers and 08 Clinical Instructors) in one of the private nursing educational institutions of Punjab. CITI was found comprehensive and understandable. Modifications on Likert Scale of CITI Assessment scale were done as per the findings of pilot study and incorporated in the final draft. The third Delphi round was conducted and the final draft of CITI Assessment Scale was re- circulated to experts and common consensus was achieved. The item-content validity index (I-CVI) for each item on CITI ranges between 0.8 to 1.0 while the scale- content validity index (S-CVI) comes out to be 0.89.

Phase 4: In this phase, the second try out was conducted to assess the reliability of CITI using CITI Assessment Scale. The study population included 161 nursing faculty from 08 nursing educational institutions of Punjab. Inclusion criteria was nursing faculty (clinical instructors/tutors, lecturers/assistant professors, associate professors, professors) who were present at the time of data collection; nursing faculty designated as clinical instructors/tutors who were working for more than one year in the selected area and were directly involved in clinical and classroom instruction. With discussion with the Principal of each nursing educational institute, arrangements were made to gather nursing faculty in a faculty room. An utmost care was taken not to disturb the routine schedule of the institute. After obtaining an informed written consent, each subject was given self- administered CITI Assessment Scale.It took 20-25 mins to complete the CITI Assessment Scale.

The reliability of CITI Assessment Scale was assessed using SPSS (version 20). Cronbach alpha was calculated to check the internal consistency of CITI Assessment Scale. The overall reliability of Clinical Instructor’s/Tutor’s Task Inventory Assessment Scale was 0.943. The domain- wise reliability and the scale mean of CITI Assessment Scale is depicted in Table 2.

Table 2: Domain-wise reliability of CITI Assessment Scale (CITI)

Sr. No.	Task	Reliability (Cronbach alpha)	Scale Mean
I	Classroom/Theoretical Teaching	0.731	40.21
II	Clinical Teaching	0.859	71.88
III	Clinical Supervision	0.889	22.71
IV	Nursing Skill Lab Teaching	0.824	52.42
V	Guidance and Counseling	0.794	15.99
VI	Administrative Assistance	0.847	76.69
VII	Research and Publications	0.829	34.55
VIII	Continuing Nursing Education	0.831	12.40
IX	Miscellaneous Work	0.903	107.98

Table 3 shows the reliability of Classroom/Theoretical teaching domain. There were total 13 tasks. The Cronbach alpha was 0.731 with the scale mean of 40.21. When corrected item to total correlation was applied on 13 tasks,04 tasks had corrected item to total correlation <0.2 showing their incompatibility with the scale. When an individual item was deleted, the value of Cronbach alpha was not increased even for a single task, it means that all the tasks were contributing to the total reliability and no single tasks could be discarded.

Table 3: Reliability of items on CITI Assessment Scale in the Domain of Classroom/Theoretical Teaching

(N=161)

Task	Scale Mean if Item Deleted	Corrected Item-Total Correlation	Cronbach alpha if Item Deleted
Planning
Prepares lesson plan for the class.	36.58	0.330	0.702
Prepare topic-wise lecture notes	38.34	0.170*	0.727
Plans and prepares educational/A.V. aids for the class	36.36	0.232	0.720
(transparencies, charts, ppts etc.)
Execution
Delivers lecture in the class using educational/A.V. aids.	36.98	0.195*	0.728
Encourages and stimulates students in classroom discussion.	38.02	0.308	0.705
Encourage critical-thinking ability/problem-solving skills	37.63	0.307	0.705
among students.
Guides students in the preparation of various assignments	37.06	0.317	0.703
or group activities.
Evaluation
Daily Assessment
Encourages and evaluates students during classroom	38.39	0.331	0.704
discussion through questioning.
Formative Assessment
Plans evaluation criteria for formative assessment of the students	37.06	0.340	0.701
Evaluates student’s classroom assignments, tests,	37.84	0.195*	0.723
group activities etc.)
Prepares question papers for various exams.	36.54	0.338	0.699
Conducts theory examinations for students.	36.34	0.333	0.702
Summative Assessment
Participates in university theory examination	35.04	0.114*	0.737

* Items in the inventory which shows items to total correlation <0.2 Scale Mean = 40.21; Cronbach alpha = 0.731

Table 4 and Table 5 show that the domain of Clinical Teaching (Cronbach alpha = 0.859 with overall Scale Mean was 71.88) and Clinical Supervision (Cronbach alpha = 0.889 with overall scale mean 22.71) was highly reliable. It was found that when corrected item to total correlation was applied on 25 tasks of Clinical Teaching and 08 tasks of Clinical Supervision, none of item has value <0.2. It means all the items are compatible with the respective scales and contributing to their total reliability.

Table 3: Reliability of items on CITI Assessment Scale in the Domain of Classroom/Theoretical Teaching

(N=161)

Task	Scale Mean if Item Deleted	Corrected Item-Total Correlation	Cronbach alpha if Item Deleted
Planning
Participates in planning clinical placement of students.	67.63	0.333	0.857
Prepares and communicates clinical rotation plan to the students.	68.05	0.478	0.852
Provides copy of clinical rotation plan of students to clinical	68.17	0.298	0.858
areas/community etc.
Prepares himself/herself (clinical instructor) for	69.46	0.369	0.856
demonstrations of clinical procedures.
Pre-instruct students for clinical placement.	68.84	0.487	0.852
Collaborates with the sister in-charge of the ward/unit or the college	68.49	0.440	0.854
authorities to provide adequate number of articles in the unit to
provide nursing care by the students.
Arrange articles from college to practice in the ward/clinical.	67.96	0.365	0.856
Execution
Orients the students to the clinical areas.	68.83	0.425	0.854
Assigns patients to the students based on the objectives of	69.32	0.515	0.851
clinical placement.
Guides students to apply ‘Nursing Process’ while providing patient	69.80	0.491	0.853
care. (assess, plan, implement and evaluate)
Demonstrates nursing care procedures at bedside.	69.14	0.443	0.853
Confirms safety and comfort of the patient during nursing care.	70.06	0.449	0.854
Takes return demonstrations of nursing procedures from students.	70.02	0.482	0.854
Ensures that students give correct return demonstration or attain	69.89	0.401	0.855
proficiency in nursing care procedures.
Provides at least two opportunities for students to learn (such as	68.82	0.264	0.859
facilitating them to observe rare or special procedures in their or
other clinical areas; demonstration of procedures).
Facilitate involvement of the nursing staff of the ward/unit in clinical	68.69	0.266	0.860
learning of the students.
Teaches/facilitates students to write clinical assignments	69.55	0.419	0.854
(nursing care plans/case presentations/case studies/health talks,
drug book, diary etc.)
Conducts nursing rounds or bedside clinics for students.	69.71	0.518	0.851
Teaching handing/taking over of emergency drugs, MLC files and other	68.21	0.448	0.853
necessary information/articles from staff nurses.
Teaches how to prevent needle-stick injury while working with patients.	69.45	0.265	0.859
Signs log books of students.	69.71	0.457	0.853
Evaluation
Plans clinical evaluation criteria for formative assessment.	68.73	0.419	0.854
Prepares formative evaluation tools for the clinical posting (e.g. student	68.81	0.525	0.851
clinical evaluation performa, evaluation performa for health talks,
case presentations etc).
Checks/corrects/evaluates clinical assignments of the students	69.81	0.566	0.851
(nursing care plans, case presentations, health talks, drug book,
daily diary, patient care procedures etc.)
Conducts or assists in the conduction of internal and external practical	67.85	0.332	0.857
exams of the students.

* Items in the inventory which shows items to total correlation <0.2   Scale Mean = 71.88; Cronbach alpha = 0.859

Table 5: Reliability of items on CITI Assessment Scale in the Domain of

Clinical Supervision

(N=161)

Task	Scale Mean if Item Deleted	Corrected Item-Total Correlation	Cronbach alpha if Item Deleted
Available all the time during clinical posting hours	20.81	0.456	0.889
Provides supportive supervision to students in the clinical area.	20.83	0.607	0.880
Guides and supervises students during nursing care	20.84	0.584	0.881
provided by the students
Provides continuous feedback and suggestions for	20.72	0.862	0.882
improvement to the students during clinical posting.
Encourages peer review sessions/group discussions	19.81	0.347	0.899
during clinical presentations.
Supervises students while providing health education	20.85	0.854	0.881
to the patients/clients.
Encourages mutual interaction, mutual respect and
trust between:
·           student-student	20.66	0.770	0.869
·           student-teacher	20.75	0.761	0.870
·           student-patient	20.71	0.765	0.870
·           Student and other health care providers.	20.71	0.769	0.870
Discusses & rectify clinical problems of the students.	20.44	0.586	0.881

Table 6 and Table 7 show reliability analysis of Nursing Skill Lab Teaching and Guidance and Counselling domain. The cronbach alpha for Nursing Skill Lab teaching was 0.824 with overall scale mean of 52.42 and that for Guidance and Counselling was 0.794 with overall scale mean of 15.99. When corrected item to total correlation was applied on 18 tasks and 04 tasks of each domain respectively, none of the item has value <0.2. It means all the items are compatible with the scale and contributing to their total reliability.

Table 8 shows Cronbach alpha for Administrative Assistance as 0.847 with overall scale mean of 76.69. When corrected item to total correlation was applied on 21 tasks, one item (Assists in inspection of the college) shows corrected item to total correlation <0.2 showing their incompatibility with the scale. When an individual item was deleted, the value of Cronbach alpha did not increased even for a single task, it means that all the tasks were contributing to the total reliability and no single tasks could be discarded.

Table 6: Reliability of items on CITI Assessment Scale in the Domain of Nursing Skill Lab Teaching

(N=161)

Task	Scale Mean if Item Deleted	Corrected Item-Total Correlation	Cronbach alpha if Item Deleted
Planning
Plans demonstration of nursing procedures in the skill lab.	49.75	0.374	0.817
Prepares lesson plan for the demonstration of nursing procedures.	49.12	0.333	0.820
Divides students in various groups for the demonstration of	49.84	0.379	0.817
nursing procedures.
Execution
Demonstrates nursing procedures to the students in lab.	50.02	0.484	0.812
Discusses issues/problems related to nursing procedures	49.78	0.335	0.820
with the students
Provides time to students to practice nursing procedures.	49.75	0.292	0.822
Observes and guides students practicing nursing procedures in the lab.	49.93	0.420	0.815
Takes return demonstrations of nursing procedures from	50.18	0.358	0.818
the students in the lab.
Signs log books, procedures books of the students.	50.14	0.374	0.817
Arranges dummies, equipments, supplies etc. for the demonstration	50.08	0.408	0.816
of nursing procedures in lab
Prepares list of items to be purchased	48.87	0.458	0.813
Prepares list of items to be repaired	48.56	0.478	0.811
Writes indent for procurement of items	48.81	0.573	0.806
Arranges for repair of the broken items	48.63	0.439	0.814
Maintains lab inventory and stock register.	49.48	0.455	0.813
Supervises lab attendant in carrying out activities related to	49.16	0.415	0.815
lab maintenance.
Teaches students handling of lab articles.	49.68	0.364	0.818
Teaches students maintenance of lab inventory.	49.40	0.462	0.812

Scale Mean = 52.42; Cronbach alpha = 0.824

Table 7: Reliability of items on CITI Assessment Scale in the Domain of

Guidance and Counselling

(N=161)

Task	Scale Mean if Item Deleted	Corrected Item-Total Correlation	Cronbach alpha if Item Deleted
Discusses issues/ problems/ concerns/ progress of the	12.35	0.603	0.743
students with parents and takes measures to solve them.
Counsels students regarding their problems.	12.39	0.648	0.719
Brings student’s problems to the notice of college authorities, if needed.	12.06	0.677	0.703
Arranges meeting of the student with the counsellor	11.18	0.493	0.793

Scale Mean = 15.99; Cronbach alpha = 0.794

Table 8: Reliability of items on CITI Assessment Scale in the Domain of Administrative Assistance

 (N=161)

Task	Scale Mean if Item Deleted	Corrected Item-Total Correlation	Cronbach alpha if Item Deleted
Academic Assistance
Participates in course planning.	72.89	0.411	0.841
Participates in unit plan.	73.11	0.417	0.841
Regularly checks classroom room equipments, supplies and teaching aids.	73.32	0.478	0.838
Participates in making arrangements for clinical placement/observatory
visits of students:
Writes letter for obtaining permission	72.67	0.449	0.839
Meets concerned authorities	72.61	0.535	0.836
Provides copy of rotation plan of students in respective clinical areas.etc.	72.90	0.554	0.835
Taking/handing over the work either in the classroom or clinical area
to other senior faculty members.	73.17	0.589	0.834
Records and Reports
Maintains records of the students. (class attendance, clinical attendance)	74.81	0.406	0.841
Supervises student’s health, welfare and security.	73.99	0.433	0.840
Maintains records of the students: health records, cumulative records,	73.89	0.414	0.841
internal assessment, admission records, leave record etc.
Submits reports of the student’s progress, attendance to the senior	73.59	0.425	0.840
faculty for compilation.
Writes and keeps anecdotes of the critical incidents.	73.78	0.484	0.838
Meetings and Inspections
Participates in faculty or other significant meetings.	73.32	0.494	0.838
Conducts inspection rounds of the college and hostel in coordination	72.77	0.447	0.839
with other faculty members.
Assesses living conditions for students in hostel in coordination with	72.42	0.406	0.841
other faculty members.
Assists in inspection of the college.	72.96	0.158*	0.850
Coordination
Participates/Coordinates with other staff for curricular/	73.45	0.236	0.847
extra-curricular activities of the college.
Maintains good inter-personal relationship with the health care	74.14	0.232	0.848
providers in the clinical area.
Coordinates with other health care providers in providing conducive	73.89	0.270	0.846
clinical learning environment.
Conflict Management
Identify and resolve the conflict of students, staff working in the clinical area to ensure conducive learning environment.	73.29	0.359	0.843
Error Management
Take measures to resolve errors committed by students while handling patients. (e.g. drug errors etc)	73.57	0.451	0.839
Accident Management
Taking necessary measures to resolve accidents such as	73.58	0.458	0.839
needle stick injury as per policy of the hospital.
Teaching how to prevent needle-stick injury while working with students.	74.04	0.219	0.848

Table 9 and Table 10 show that the items under the domain of Research and Publications (Cronbach alpha = 0.829; Scale Mean = 34.55) and Continuing Nursing Education (Cronbach alpha = = 0.831; Scale Mean = 12.40) were highly reliable. It was found that when corrected item to total correlation was applied on 07 tasks of Research and Publications and 03 tasks of Continuing Nursing Education, none of item has value <0.2. It means all the items are compatible with the respective scales and contributing to their total reliability.

Table 9: Reliability of items on CITI Assessment Scale in the Domain of Research and Publications

(N=161)

Task	Scale Mean if Item Deleted	Corrected Item-Total Correlation	Cronbach alpha if Item Deleted
Plans and writes research projects/proposals as per	29.92	0.599	0.803
institute/college research policy.
Conducts research as per protocols.	29.81	0.619	0.798
Writes research/review papers.	29.63	0.671	0.790
Writes books and other relevant literature for the students	29.29	0.659	0.797
Writes relevant literature for the patients.	29.45	0.604	0.801
Presents research papers/posters in various conferences.	29.08	0.555	0.811
Supervises and guides students in research projects.	30.15	0.403	0.840

Scale Mean = 34.55; Cronbach alpha = 0.829

Table 10: Reliability of items in the Domain of Continuing Nursing Education

(N=161)

Task	Scale Mean if Item Deleted	Corrected Item-Total Correlation	Cronbach alpha if Item Deleted
Participates/Coordinates in planning of various professional	8.57	0.629	0.828
activities such as conferences/workshops/seminars etc.
alongwith other senior faculty members.
Participates/Coordinates in the organization of various	8.12	0.699	0.758
in-service/ continuing nursing education programs.
Participates herself/himself in various professional activities	8.11	0.748	0.710
such as conferences/workshops/seminars etc. or continuing
education/training programs to uplift their body of knowledge.

Table 11 shows that the Cronbach alpha for items under the domain of Miscellaneous work was 0.903 with overall scale mean of 107.98. When corrected item to total correlation was applied on 08 tasks, one item(Doing personal work not related to to total correlation <0.2 showing their incompatibility with the scale. When an individual item was deleted, the value of Cronbach alpha was not increased even for a single task, it means that all the tasks were contributing to the total reliability and no

Table 11: Reliability of items on CITI Assessment Scale in the Domain of Miscellaneous Work

 (N=161)

Task	Scale Mean if Item Deleted	Corrected Item-Total Correlation	Cronbach alpha if Item Deleted
Plans other activities such as
·          classroom assignments	104.66	0.439	0.901
·          group activities	104.67	0.437	0.901
·          field visits	103.75	0.608	0.897
·          exhibition	103.43	0.593	0.897
·          health melas	103.18	0.632	0.896
·          seminar	103.34	0.635	0.897
·          workshop	103.29	0.608	0.897
·          practice teachings	103.96	0.533	0.898
Organizes activities such as
·          field visits	103.11	0.586	0.897
·          exhibition	103.01	0.575	0.898
·          health melas	102.94	0.653	0.896
·          seminar	103.04	0.709	0.895
·          Workshop	102.97	0.683	0.896
·          Practice teachings	103.39	0.638	0.896
Evaluates group activities organized by students such as
·          exhibition	103.16	0.558	0.898
·          health melas	102.94	0.587	0.897
·          seminar	103.11	0.611	0.897
·          workshop	103.22	0.671	0.896
·          practice teachings	103.45	0.560	0.898
Prepares time-table for the classes.	104.25	0.205	0.906
Ensures immunization of nursing students.	103.54	0.326	0.903
Relieving other faculty members in the event of their leave	103.53	0.204	0.908
of any kind.
Getting involved in other work as asked by the principal	105.13	0.244	0.907
from time to time.
Doing personal work not related to college or academics.	102.52	0.167*	0.906

Phase 5: This phase involved feedback

Tutor’s Task Inventory (CITI)’ and ‘CITI of Clinical Instructor’s/Tutor’s task Inventory (CITI) from the nursing faculty. An informal discussion with the nursing faculty revealed that the Clinical Instructor’s/Tutor’s task Inventory (CITI) was comprehensive and easy to understand and helps them in recalling some of the significant work they missed out during classroom and clinical Assessment Scale’. The basic purpose of Delphi technique is ‘to obtain the most reliable consensus of opinion of a group of experts by a series of intensive questionnaires interspersed with controlled opinion feedback’6. A panel of 08 experts based on knowledge and experience were selected for Delphi rounds, however, instruction. They appreciated that such Linstone7 suggested a suitable minimum inventories defined the c linical instructor/tutor role and should be developed for all the cadre of nursing faculty. However, clinical instructor and tutors expressed their concerns regarding their multi-dimensional role and lack of time to fulfil all the responsibilities.

Discussion

Job descriptions are written documents describing the expected roles and responsibilities attached with each job position. They can be used to assess the performance of worker. Though the clinical instructors or tutors carry out standard tasks of classroom and clinical instruction, there are number of other tasks performed by them in different nursing educational institutes. Thus, present study was taken up to develop an inventory of tasks performed panel size of seven but it may ranges between 4 and 3000. Thus, the decision about the size of panel of experts is practical and realistic and takes into account factors such as time and expense. Total three Delphi Rounds were conducted. Literature suggested minimum of two Delphi rounds. Walker and Selfie8 pointed out that repeated Delphi rounds may lead to fatigue by the experts and increased attrition.

The content validity index of CITI was calculated after three Delphi rounds. Content validity index is the degree to which an instrument has an appropriate sample of items for the construct being measured9. As suggested by Lynn10, two types of content validity index were calculated: the content validity of individual items (I-CVI) and the content validity of overall scale (S-CVI). The Item-Content Validity Index (I-CVI) of tasks by ‘Clinical Instructor’s/Tutor’s task inventory (CITI)’and the CITI Assessment Scale to measure discrepancies between expected and performed roles and responsibilities. In the present study, initially, a broad information about the tasks performed by clinical instructors/tutors was obtained through Focus Group Discussions (FGDs) with clinical instructors/tutors and nursing students. A Delphi technique was then chosen to develop ‘Clinical Instructor’s/ on ‘Clinical Instructor’s/ Tutor’s Task Inventory (CITI)’ ranges between 0.8 to 1.0 and the scale- content validity index was 0.89.

The reliability of CITI Assessment Scale was established on 161 nursing faculty in 08 selected private nursing educational institutions of Punjab. The reliability of CITI Assessment Scale calculated using Cronbach alpha was 0.943. Most of the available instruments to assess quality of clinical teachers such as Clinical Learning Environment Inventory11estimated reliability using Cronbach alpha indicating internal consistency12.

A feedback from the nursing faculty revealed that the Clinical Instructor’s/Tutor’s task Inventory (CITI) was comprehensive and easy to understand and helps them in recalling some of the significant work they missed out during classroom and clinical instruction. The ‘Clinical instructors/tutors Task Inventory (CITI)’ thus developed contained various tasks performed by clinical instructors and tutors under nine domains: classroom/theoretical teaching; clinical teaching; clinical supervision; nursing skill lab teaching; administrative assistance (sub-domains: academic assistance; records and reports; meetings and inspections; coordination; conflict management; error management and accident management); research and publications; continuing nursing education and miscellaneous work. The CITI is comprehensive, feasible and valid along with reliable CITI Assessment Scale. It is recommended that CITI shall be made readily available to clinical instructors and tutors in nursing educational institutes for their reference to expected roles and responsibilities. The CITI Assessment Scale can be used by managers for the annual performance review of nursing faculty.

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