To learn the goals of Clinical Nursing
To shed light on issues or challenges Student
Nurses encounter in transitioning from the
clinical laboratory to the actual clinical setting.
To be aware of the Clinical Instructor’s role in
creating or implementing solutions and
strategies to address these issues.
The GOALS of the clinical nursing
education are to enable students to:
Apply Theoretical Learning to patient care
situations through the use of critical thinking
skills to recognize and resolve patient care
problems and the use of the nursing process
to design therapeutic nursing interventions
and evaluate their effectiveness.
Develop communication skills in working with
patients, their families and other healthcare
Demonstrate skill in safe use of therapeutic
nursing interventions in providing care to
Evidence caring behaviors in nursing actions.
Consider the ethical implications of clinical
decisions and nursing actions.
Experience the various roles of the nurse
within the health care delivery system.
Gain a perspective on the contextual
environment of health care delivery system.
Applying Theoretical Learning to Patient
Theoretical learning to practical learning.
Theory becomes a reality as students make
the connection between the “usual” case
presented in the classroom to the “actual”
case with which they are involved.
Abandoning “Book Learning” may cause eager
trepidation for student nurses.
C.I. INTERVENTION: Clinical Instructors must
be skilled with assessing the degree of anxiety
presented by each student.
CHANNEL unfocused functional anxiety to maximize learning and
DIFFUSE dysfunctional anxiety to permit safe performance.
The CLINICAL LABORATORY is where the
theoretical begins to make sense and a great
deal of integration of theoretical and practical
knowledge becomes possible.
Exposure to an array of clinical situations is
essential to fine-tune the student’s
observational skills, recall, application abilities
and problem solving skills.
Use of the Nursing Process makes it easier to
understand the intellectual connections
necessary to apply theory in practice.
* TOOL CLINICAL
Teach student to write Nursing Care Plans
using the Nursing Process
However when the use of the Nursing
Process is reduced to a framework for the
written care plan rather than an active
approach to thinking may devalue critical
“…to learn and not to do is really not
to learn. To know and not to do is
really not to know.”
― Stephen R. Covey, The 7 Habits of Highly Effective
People: Powerful Lessons in Personal Change
Developing Communication Skills
Social Communication to Professional
Focus is on the development of THERAPEUTIC
In therapeutic communications, students are
Documenting observations and interventions
Delegating up and down the chain of health care
Each of these strategies requires:
Attentiveness to the objective of interaction
The best means of structuring the interaction
Applicable language to use
Professional Communication is GOAL
Initial interactions must be carefully planned
and mentally rehearsed.
Students must be skilled in listening to and
observing their communication partners,
interpreting what is said and crafting a
Students sometimes are anxious to deliver a
message that they fail to listen to the
responses that would improve the message.
C.I. INTERVENTION: Assist the student to
listen better by encouraging her to slow down
to allow silence and provide the time and
space needed for both patients to think before
Nurses use “Common Language” readily
translating medical jargons to patients and
Adjustments must be made according to:
age, educational level, culture, native
language, and existing communication
Use of non-verbal communication such as
touch, facial expressions and reassuring
Students learn the nuances in skilled
communication with patients from observations
from interactions of clinical instructor and the
staff with the patient.
C.I. INTERVENTION: Pointing out effective
approaches or one that is less than successful and
articulates the critical elements of the interaction
can help students grasp the full dynamic of the
Nurses use “Nurse Talk” with one another,
Loaded with acronyms and terms specific to
the clinical environment.
For students this could be baffling and
C.I. Intervention: Serve as a translator,
accepting student’s inability and interpreting
the nurse talk for them.
“Delegation Talk” another type of
communication to be mastered by students.
DOWN – when an aspect of nursing care is to be
provided by another.
UP – when a nurse is requesting an intervention
by a physician or a supervisor.
How to: WHAT needs to be done, WHY and
WHEN it needs to be done, HOW it should be
done and expectations for RESPONSE and
REPORT back to delegator.
Students are uncomfortable delegating to
individuals who are more knowledgeable and
skilled than they are which can interfere with
C.I. INTERVENTION: Have students practice
with one another to master the language
“Professional Tongue” uses medical
terminology and nursing terminology to
provide a precise description or explanation of
e.g. Completing written documentation on
patient status and end-of-shift report,
discussing patient’s condition during rounds
or in teaching other professionals.
C.I. INTERVENTION: Developing the
professional tongue can be enhanced by
insisting on its use in student reports to staff
members at the conclusion of the clinical day
or in conference presentations.
PROCESS RECORDING - system used for
teaching nursing students to understand and
analyze verbal and nonverbal interaction. The
conversation between nurse and patient is
written on special forms or in a special format.
Demonstrating Skill in the Use of
Therapeutic Nursing Interventions
CLINICAL AREA is where students learn their
Doing transcends thinking or communicating.
This enables students to feel useful and is
generally accompanied by a sense of
Students are afraid to make an error and
harm and even kill the patient. They also
worry that patients may find them inept, will
feel like a guinea pig or will insist that students
be replaced by a “real nurse”.
Therapeutic nursing interventions requires
simultaneous performance of caring
behaviors, technical skills, and intellectual
manipulations of critical thinking.
C.I. INTERVENTION: Can advance skill
development by attending to the details the
student is unable to see when performing a
The C.I. must assume a complementary role as
to refrain from taking over when a student is
amidst a procedure.
SAFETY is the primary concern when students
are learning in the clinical setting.
C.I. INTERVENTION: Allocate time fairly to
provide all students with relatively equivalent
opportunities to learn the technical skills
Skillful use of questioning and verbal
rehearsals of care activities can create
opportunities for teaching the “why” behind
the “how” as well as alerting students of
issues associated with intervention.
Evidencing Caring Behaviors
in Nursing Actions
Caring – involves relief from suffering,
providing comfort, and a general
“connectedness” with the patient.
Caring that is “doing for” should be replaced
by caring that is empowering and enabling.
They do not view the patient as a functioning
whole, as a member of a family system or
This tunnel vision is not due to the lack of data
on these larger issues. The student’s focus is
on the immediate situation and is more self-
absorbed than other-directed.
C.I. INTERVENTION: Role-modeling the
caring component of nursing care delivery is
an essential part of the clinical instructor’s
Complimenting students reinforces caring
Students are able to recognize failure to care
in other staff members and are often verbal
C.I. INTERVENTION: Channeling outrage into a
discussion helps students to understand caring
as reflected in actions as well as general
attitudes of concern and compassion.
CONSIDERING ETHICAL IMPLICATIONS
OF CLINICAL DECISIONS AND
Ethical Action involves “doing what is right”
in a situation that involve alternative
possibilities for action.
The nurse considers which clinical decisions
and nursing actions best reflect the patient’s
expressed wishes and underlying values.
Also entails the consideration of clinical
decisions and nursing actions reflecting the
“best good” in the situation from the patient’s
Students are often self rather than other-
centered. They focus more on the
performance more than on the recipient of
the care being performed.
Translating a code of ethics presented in the
classroom into action is beyond the ability of
most nursing students. Their clinical
knowledge base is still developing.
C.I. INTERVENTION: Use the conference time
to review each student’s plan of care for the
day, pointing out specific situations that
might call for a change in the routine
approach for a given patient.
Focused questioning of what constitutes the
“best good” for this patient can help students
consider ethical implications of the situation.
Ethical Behavior entails taking responsibility
for ones actions.
Students often bring classroom morality to
the clinical setting.
C.I. INTERVENTION: Establish standards of
clinical morality at the outset of the clinical
Consultation with others
Looking up answers
Verifying activities before performing them
Admitting to errors
Consistency in managing student errors while
maintaining patient safety is essential in
promoting clinical morality.
Gaining Perspective on the Contextual
Clinical Nursing Education takes students
through a series of experiences with patients
of all ages receiving different health care for a
full array of conditions in a variety of settings.
Clinical setting varies in pace of activities that
Reflected in the urgency of time constraints,
as well as in the rapidity of changes in patient
Students must become attuned and
responsive to these changes.
C.I. INTERVENTION: Provide an orientation to
the clinical setting including pace and time
constraints as factors impacting patient care.
Also related to pace is the amount of noise in
the clinical environment.
Acute care environments are notoriously noisy
and this noise can increase student anxiety
and even interfere with their ability to think
through clinical situations.
C.I. INTERVENTION: Set a time-out to re-
organize the situation or move it to a quieter
Institutional environments also contain many
workers who affect the atmosphere of the
setting and often compete with one another
for access to the patient.
C.I. INTERVENTION: Assist in identifying roles
and functions of all the workers in the health
Support students in asserting their rightful
position as care providers and patients
Amount of technical equipment and the
degree to which health care providers rely on
varies with each
Greater reliance on technology tends to result
in a degree of depersonalization.
C.I. INTERVENTION: Focus on how the to
equipment is being used in the specific patient
situation and what observations of the patient
are necessary to support the technology.
Governing rules and operational realities of a
given clinical setting varies from each
C.I. INTERVENTION: Orient students about
procedures or protocols like documentation
procedures and priority tasks
In today’s health care system
economics affects the care
Waste materials – inevitable
when students are learning –
may be viewed as a minor
catastrophe by the staff.
Small economics may be practiced.
Changing of linens on alternate days if they are
Charges of supplies must be accurately allocated.
Staffing may be adjusted because students are
scheduled to be on the unit despite
contractual stipulations that students will not
substitute as staff.
C.I INTERVENTION: Sensitizing students to
economic realities while maintaining an
environment that is supportive of learning and
that maintains standards of care.
Experiencing the Variety of
Professional Nursing Roles
Students are charged with providing full care
to one or more patients, except for treatments
they have not yet learned.
The reality: Professional nurses rarely, if ever,
provide full care to patients.
Nurses accomplish patient goals by delegating
and by managing a multi-worker/multitask
approach to patient care.
“The major focus of clinical learning will be
nursing management through the continuum
of care, collaboration, teambuilding and the
study of patient outcomes within the
organizational context of the network.”
Leadership – involves articulating a goal that
can be embraced by others and motivating
performance toward goal achievement.
Leadership is demonstrated in direct patient
Change agency, research and advocacy are
nursing roles that are similarly inherent in a
student’s clinical experience.
C.I. INTERVENTION: Highlighting these roles in
post conference activities increases student’s
awareness of the multifaceted profession they
are about to enter.
OVERALL GOAL: Prepare students
for future practice through current
“The mediocre teacher tells. The
good teacher explains. The superior
teacher demonstrates. The great
― William Arthur Ward