Goals of Clinical Nursing Education


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Goals of Clinical Nursing Education

  1. 1. Goals of Clinical Nursing Education Apply theory to patient care Communicate effectively Perform safe therapeutic interventions Exhibit caring behaviors Apply ethical perspectives
  2. 2. Apply theory to patient care <ul><li>Ideal versus real </li></ul><ul><li>Identify problems and solutions </li></ul><ul><li>Use conferencing, journaling, structured questioning (what if), and war stories </li></ul><ul><li>Nursing process </li></ul>
  3. 3. Communicate effectively <ul><li>Selecting and using appropriate strategies in specific situations </li></ul><ul><li>Interviewing, counseling and teaching </li></ul><ul><li>Documentation </li></ul><ul><li>Goal directed professional communication/delegation </li></ul><ul><li>Listen and allow periods of silence </li></ul><ul><li>Use common cultural competent language </li></ul>
  4. 4. Perform safe therapeutic interventions <ul><li>Doing enables student to feel useful and is generally accompanied by sense of accomplishment </li></ul><ul><li>Urge to care competes with need to practice </li></ul><ul><li>Tendency to focus on skill and not patient </li></ul><ul><li>Teach the why behind the how </li></ul>
  5. 5. Exhibit caring behaviors <ul><li>Caring for others primary reason for becoming a nurse </li></ul><ul><li>Doing for needs to be replaced with caring about </li></ul><ul><li>Student’s focus on immediate and self </li></ul><ul><li>Role modeling is essential </li></ul><ul><li>Compliment students when they exhibit caring behaviors </li></ul>
  6. 6. Apply ethical perspectives <ul><li>Doing what is right </li></ul><ul><li>Students unlikely to be able to implement ethicals responses e.g. won’t delay a morning bath even though patient had a rough night </li></ul><ul><li>Instructor should focus on the best good for the patient and conference with students prior to/after clinicals </li></ul>
  7. 7. Perspective on Contextual Environmental Issues <ul><li>Pace </li></ul><ul><li>Noise </li></ul><ul><li>Many workers with different roles </li></ul><ul><li>Technical equipment </li></ul><ul><li>Rules of various institutions </li></ul><ul><li>Economic realities </li></ul>
  8. 8. Professional Roles <ul><li>Rare for a nurse to provide full care </li></ul><ul><li>The major focus of clinical learning will be nursing management through the continuum of care, collaboration, team building, and the study of patient outcomes </li></ul>
  9. 9. Getting Started <ul><li>Nursing education is a team sport – </li></ul><ul><li>faculty, support staff, clinical staff, </li></ul><ul><li>liaison support personnel, and students comprising clinical group. </li></ul>
  10. 10. Components <ul><li>Trust in instructor’s competence </li></ul><ul><li>Communication important </li></ul><ul><li>Open to criticism </li></ul><ul><li>Instructor needs to spend time on the unit </li></ul><ul><li>Respect </li></ul><ul><li>Energy and excitement about nursing </li></ul><ul><li>See instructor in action </li></ul><ul><li>Don’t abandon students or embarrass them </li></ul>
  11. 11. Before clinical begins <ul><li>Assemble clinical group on own turf </li></ul><ul><li>Establish group identity </li></ul><ul><li>Initial meeting introductions, directions, safety issues, schedules, </li></ul><ul><li>dress, equipment needs, individual expectations, anxieties, bracket information on students as background not final evaluation </li></ul>
  12. 12. First Days <ul><li>Orientation: tour, introduction staff members, history, mission, </li></ul><ul><li>philosophy of care, patient rooms, </li></ul><ul><li>equipment, special procedures/rules, </li></ul><ul><li>unit rounds </li></ul><ul><li>A scavenger hunt is a great idea </li></ul><ul><li>Conference times and sites </li></ul><ul><li>Instructor’s background information </li></ul>
  13. 13. Establishing Ground Rules <ul><li>Providing structure assists clarifies expectations </li></ul><ul><li>Accountability: integrity and dependability </li></ul><ul><li>Responsibility: Be prepared, actively participate, complete assignments, and maintain safety </li></ul><ul><li>Professional Decorum: follow dress code, cell phones, collegiality, confidentiality, remember you are a guest in facility, keep horseplay and giggling out of clinical </li></ul>
  14. 14. Setting Expectations <ul><li>Set expectations high and students will strive to achieve them </li></ul><ul><li>Reveal your modus operandi </li></ul><ul><li>Identify written assignments </li></ul><ul><li>Clarify clinical evaluation procedures </li></ul><ul><li>Begin with open, friendly, good-humored approach </li></ul><ul><li>Learning can be enjoyable and relaxing </li></ul>
  15. 15. Teaching and Learning Strategies for the College Laboratory Setting <ul><li>Preclinical testing of skills is an effective strategy for reducing anxiety related to initial transfer of skill learning from a laboratory to a clinical setting </li></ul><ul><li>Focus on single set of skills </li></ul><ul><li>Psychomotor skills requires the development of a kinesthetic sensitivity </li></ul>
  16. 16. Types of Learners in Laboratory <ul><li>Abstract conceptualization(thinking) </li></ul><ul><li>Reflective observation(watching) </li></ul><ul><li>Concrete experience(feeling) </li></ul><ul><li>Active experimentation(doing) </li></ul>
  17. 17. Learning’s Four Stage Cycle <ul><li>Concrete experience </li></ul><ul><li>Reflective observation </li></ul><ul><li>Abstract conceptualization </li></ul><ul><li>Active experimentation </li></ul>
  18. 18. Laboratory <ul><li>Location of items and supplies </li></ul><ul><li>Lack of items </li></ul><ul><li>Scheduling </li></ul><ul><li>Who’s on first base? </li></ul><ul><li>Competency testing </li></ul><ul><li>Knowledge mastered in previous courses </li></ul>
  19. 19. Structuring Laboratory Experiences <ul><li>One skill is taught at a time </li></ul><ul><li>Introduce skill </li></ul><ul><li>Film or video </li></ul><ul><li>Demonstration without talking and then with explanation </li></ul><ul><li>Practice </li></ul><ul><li>Return demonstration </li></ul>
  20. 20. Peer Teaching <ul><li>Deputize students as peer teachers </li></ul><ul><li>Enhances content mastery </li></ul><ul><li>More likely to ask questions of a peer </li></ul><ul><li>One-on-one instruction is enhanced </li></ul><ul><li>Makes use of all knowledge and skills in a group </li></ul><ul><li>Time efficient </li></ul>
  21. 21. Other techniques <ul><li>Pair students </li></ul><ul><li>Use mental imagery/Scenarios </li></ul><ul><li>Use groups of three: patient, nurse, observer </li></ul><ul><li>Games (jeopardy) and role playing </li></ul><ul><li>Campus clinical with scripted roles </li></ul>
  22. 22. Integrating the Cognitive Basis for Psychomotor Skills <ul><li>Concept mapping: schematic depictions of learner’s knowledge related to the identified skill </li></ul><ul><li>Helps identify gaps in knowledge </li></ul><ul><li>Vee heuristics link theory and practice elements of a skill by asking a focus question that is answered both theoretically (why) and practically (how) </li></ul>
  23. 23. Goals for Clinical Experience as Perceived by the Student <ul><li>To cause no harm to patient </li></ul><ul><li>To help patients </li></ul><ul><li>To integrate theory-based knowledge from lecture and reading into clinical practice </li></ul><ul><li>To learn nursing clinical practice skills </li></ul><ul><li>To look good as a student </li></ul><ul><li>To look good as a nurse </li></ul>
  24. 24. Looking Good as a Student <ul><li>Answering all questions correctly </li></ul><ul><li>Performing all skills flawlessly </li></ul><ul><li>Being involved in clinical learning activities at all times that the instructor is present </li></ul><ul><li>Having the right answers in instructor-student interactions </li></ul>
  25. 25. Looking Good as a Nurse <ul><li>Achieving the goal of helping patients </li></ul><ul><li>Mastering new aspects of nursing care </li></ul><ul><li>Being organized </li></ul><ul><li>Feeling confident and competent in performing nursing care </li></ul>
  26. 26. Selecting Clinical Learning Experiences <ul><li>Curricular Goals as determined by the nursing program </li></ul><ul><li>Learning environments that have been identified as the places where these goals will be pursued </li></ul><ul><li>Clinical expertise of the instructor </li></ul><ul><li>Characteristics of the students </li></ul>
  27. 27. Contingency Planning Options <ul><li>Acuity level high: pair students </li></ul><ul><li>Acuity level low: multiple patient </li></ul><ul><li>assignments to develop organizational and management skills, case studies, “worst case scenarios”, off-unit experiences such as observing diagnostics, outpatient clinics, etc. </li></ul>
  28. 28. Alternative Approaches to Clinical <ul><li>“ lung rounds” </li></ul><ul><li>Succession of students performing techiques with one patient </li></ul><ul><li>Concept-based learning activities: </li></ul><ul><li>guidelines are developed for each major concept to be addressed in the course and students analyze concept as it plays out in clinical area. </li></ul>
  29. 29. Techniques to Help Students Prepare for Clinical Experience <ul><li>Give clinical assignment day before the clinical experience </li></ul><ul><li>Teacher-created data collection forms </li></ul><ul><li>Daily nursing care plans </li></ul><ul><li>Individual student form with “verbal connection” with instructor in which instructor is able to verify adequacy of student preparation </li></ul>
  30. 30. Clinical Focus Guidelines <ul><li>Developed for each clinical experience </li></ul><ul><li>Expected learning outcomes </li></ul><ul><li>Activities in which student should engage in order to achieve outcomes </li></ul><ul><li>Critieria used in evaluating learning at the end of the semester </li></ul><ul><li>Receive guidelines at beginning of semester </li></ul><ul><li>Help staff know what students need </li></ul>
  31. 31. The Clinical Preconference <ul><li>Little documentation that this is effective </li></ul><ul><li>Change of shift = preconference? </li></ul><ul><li>Some instructors attend change of shift report themselves </li></ul><ul><li>Instead of preconference quizzing do grand rounds </li></ul><ul><li>Preconferences may be good at the beginning but not the end </li></ul>
  32. 32. Teaching/Learning Principles <ul><li>Readiness to learn (fully present) </li></ul><ul><li>Teachable moment </li></ul><ul><li>How is the day going for you? </li></ul><ul><li>Has thus and so raised any concerns for you? </li></ul><ul><li>Variety to prevent boredom </li></ul><ul><li>Repetition “do you remember what you did with thus and so?” </li></ul>
  33. 33. Teaching/Learning Principles <ul><li>Students approach new situations as unique with no thought that they have had similar type experiences </li></ul><ul><li>What happens when function is impaired? What might be the s & s? </li></ul><ul><li>Least helpful to say “look it up” </li></ul><ul><li>Make learning meaningful by making progress toward their goals. </li></ul>
  34. 34. Managing Off-Unit Experiences <ul><li>Enable students to observe “normal” people </li></ul><ul><li>They are outside the control of the instructor </li></ul><ul><li>Specific objectives should be developed for all off-unit sites </li></ul><ul><li>Guides to who to report to, what to expect, dress, etc. </li></ul>
  35. 35. Off-Unit Experiences <ul><li>Report experiences in writing </li></ul><ul><li>Connect off-unit experiences to in-class experiences </li></ul>
  36. 36. Serendipitous Opportunities <ul><li>Take advantage of unusual one of a kind experiences </li></ul><ul><li>If the situation is pertinent to nursing practice, it will serve the purpose of fostering learning in the clinical setting </li></ul>
  37. 37. The Clinical Postconference <ul><li>Provides time for reflection </li></ul><ul><li>Contributes to achievement objectives </li></ul><ul><li>Examines commonalities/differences in patient responses </li></ul><ul><li>Permits to vicariously share experiences </li></ul><ul><li>Allows for debriefing </li></ul><ul><li>Provides for experience in groups </li></ul>
  38. 38. Clinical Postconference <ul><li>Should involve group participation </li></ul><ul><li>Move questioning to a higher level that stimulates discussion </li></ul><ul><li>Most conferences last 50-60 minutes </li></ul><ul><li>Discussion of clinical experiences or a presentation of case studies </li></ul><ul><li>Role play, quizzes, tour of units, nursing rounds, guest speakers </li></ul>
  39. 39. Clinical Postconference <ul><li>Identify a focus for discussion </li></ul><ul><li>Support sharing of information </li></ul><ul><li>Encourage active involvement </li></ul><ul><li>Provide nonthreatening feedback </li></ul><ul><li>Assist students to identify relationships, trends, patterns </li></ul><ul><li>Facilitate group process </li></ul>
  40. 40. Instructional Strategies for the Clinical Setting <ul><li>Demonstrations </li></ul><ul><li>War Stories </li></ul><ul><li>Questioning </li></ul><ul><li>Listening: paraphrasing, perception checks, summarizing, I-statements </li></ul><ul><li>Case Studies </li></ul><ul><li>Seminars </li></ul><ul><li>Nursing rounds </li></ul><ul><li>Written assignments: care plans, synthesis paper, focus on specific areas </li></ul>
  41. 41. Critical Thinking <ul><li>Transfer and application of knowledge and skills to a new situation. </li></ul><ul><li>Process: </li></ul><ul><li>Define a problem contextually </li></ul><ul><li>Maintain an open attitude of inquiry </li></ul><ul><li>Learning to ask circular not linear questions </li></ul><ul><li>Examine underlying assumptions and making hypotheses </li></ul><ul><li>Reflexively examine the situation prior to drawing conclusions </li></ul><ul><li>Decide what to believe and do and </li></ul><ul><li>Evaluate hypothesis, assumptions, and interventions </li></ul>
  42. 42. Reflective Practice <ul><li>Making sense or meaning out of an experience and to incorporate this experience into one’s view of self and the world. </li></ul>
  43. 43. Reflective Practice <ul><li>Sense of inner discomfort triggered by a life experience </li></ul><ul><li>I.D. of concern </li></ul><ul><li>Openness to new information from internal and external sources </li></ul><ul><li>Resolution occurs through insight </li></ul><ul><li>A change is experienced in self </li></ul><ul><li>A decision is made whether to act on the outcome </li></ul>
  44. 44. Strategies for Promoting Critical Thinking and Reflective Practice <ul><li>Higher-order cognitive questioning </li></ul><ul><li>Why questions are used </li></ul><ul><li>Debriefing </li></ul><ul><li>Journaling </li></ul><ul><li>Process recordings </li></ul><ul><li>Self-evaluation </li></ul>
  45. 45. Supervision of student performance of technical skills <ul><li>Letting go; maintaining a watchful presence </li></ul><ul><li>Knowing when to jump in; jeopardizes student safety </li></ul><ul><li>Setting priorities with regard to patient care demands; look at holistic picture. </li></ul><ul><li>Flexibility in completing tasks </li></ul>