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Goals of Clinical Nursing Education
 

Goals of Clinical Nursing Education

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    Goals of Clinical Nursing Education Goals of Clinical Nursing Education Presentation Transcript

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