NUR 5032

1. Chapter 24
Crafting the Clinical Experience: A
Toolbox for Healthcare
Professionals

2. Crafting the Clinical Experience: A
Toolbox for Healthcare
Professionals
• Role Preparation
• Implementing the Role
• Student Issues
• Evaluation of Clinical Learning

3. Crafting the Clinical Experience: A
Toolbox for Healthcare Professionals
• Optimal clinical learning is best achieved when
the teacher is a true educator.
• The clinical experience is a time in which the
student applies theory to practice.
• Establishing and maintaining professional
boundaries with students, remaining current
in practice, and teaching and implementing
evidence-based practice is an art and a science.

4. Role Preparation
• Although an educator may be an expert
clinician in his or her field, as an
educator, he or she may nor have the
foundation necessary to be a successful
clinical teacher.
• The educational institution must provide
the necessary mentoring for new faculty.

5. Role Preparation
• Scholarship Roles
– Discovery–the need for scientific inquiry
into the discipline of healthcare professions
– Integration–meaning, perspective, making
connections across disciplines, and placing
specialties in a broader context.

6. Role Preparation
• Scholarship Roles
– Teaching––the art of professional
education. Many educators are not taught
how to teach clinically.
– Application—calls upon the educator to
maintain competency in the clinical field

7. Role Preparation
• Clinical Instructor Teaching Strategies
– Creating and maintaining an open, collegial
relationship
– Adapting the experience of the student
– Facilitating clinical reasoning
– Making time for the student
– Receiving environmental support

8. Implementing the Role
• Clinical Orientation
• Crafting the Clinical Experience
• Clinical Rounds
• Clinical Decision Making
• Postclinical Conferences
• FIDeLity
• Conducting the Clinical Day

9. Implementing the Role
• Five Dimensions of passion that provide
a framework for clinical teaching
– Commitment
– Achievement
– Trust
– Caring
– Collaboration

10. Implementing the Role
• Clinical Orientation – How to Get off to a Good
Start
– The clinical instructor must complete all required
agency orientation and be knowledgeable of agency
policies and procedures.
– Instructors cannot just drop students off at the site
and expect the hospital staff to take over.
– Clinical instructors need to communicate clear
expectations for each clinical experience.

11. Implementing the Role
• Crafting the Clinical Experience
– It is critical to craft the clinical experience so
that the assignments match the course
objectives and are congruent with
theoretical concepts.
– An assignment sheet shows everyone which
students are working with which patients.

12. Implementing the Role
• Crafting the Clinical Experience
– It is imperative to follow agency policies
regarding the procedures in which students
may or may not participate.
– Credibility as a clinical instructor will be
tested by staff and students.
– Providing students with positive examples
as well as examples of omissions or errors
helps guide students’ reflective practice.

13. Implementing the Role
• Clinical Rounds
– Provide an opportunity to observe students
interacting with their patients and family
members.
– Use the teachable moment.
– Clinical instructors should use higher level
questions to facilitate critical thinking skills.
– Provide the students with an experience
that keeps them engaged and places them in
the role of a total patient care provider

14. Implementing the Role
• Clinical Rounds
– By eliciting feedback from both the student
and staff members, the instructor will be
able to determine whether an assignment is
too challenging or is not keeping the student
engaged.
– Developing self-awareness in students is a
professional priority.

15. Implementing the Role
• Clinical Decision Making
– Students progress from assessment decision
making to interventional decision making
with the capability of appraisal with risk to
themselves as well as to the patients
– Instructor must monitor and support the
student throughout the clinical day and
semester by being present and providing
feedback for the decisions they make

16. Implementing the Role
• Postclinical Conferences
– Taking Action Based Upon Analysis of
Patient Information
– Applying Evidence-Based Research to
Practice
– Incorporating Evidence-Based Practice
– Peer-to-Peer Feedback

17. Implementing the Role
• FIDeLity
– Taking Action Based Upon Analysis of
Patient Information
– Applying Evidence-Based Research to
Practice
– Incorporating Evidence-Based Practice
– Peer-to-Peer Feedback
– Frequent, immediate, discriminating,
lovingly

18. Implementing the Role
• FIDeLity
– Frequent
• Feedback needs to be often
– Immediate
• Immediate open ended questions
• With delayed feedback students cease to care
about why their answer or activity was good or
not

19. Implementing the Role
• FIDeLity
– Discriminating
• distinguishing features of good and poor
performance in ways that are clear to students
are imperative
– Lovingly
• Empathy and personal understanding is an
essential component in providing the feedback

20. Implementing the Role
• Conducting the Clinical Day
– The structure is based on a plan for both
instructor and students.
– Patient care assignments for each clinical
experience must be tied to course
objectives.
– Plan and track times for specific
interventions.

21. Implementing the Role
• Conducting the Clinical Day
– The student is responsible for keeping the
staff informed of the outcome of
interventions implemented.
– It is the student’s responsibility to provide
accurate and timely patient status reports.

22. Student Issues
• A good clinical educator knows the
student’s background and learning
needs.
• Early intervention is recommended with
students who are not doing well in
clinical to improve their performance.
• At times the clinical instructor may be
called upon to manage a challenging
student situation

23. Student Issues
• Unprofessional Behavior
– May be observed by the clinical instructor or
reported by someone else.
– Students should be engaged early on in the
significance of professional accountability for
security and confidentiality related to
information technology.
– It is the instructor’s role to enforce compliance
with issues such as absenteeism, tardiness, dress
codes, etc.

24. Student Issues
• Incivility
– Defining clear guidelines and setting
boundaries should begin on the first day of
the clinical experience.
– If clinical instructor’s interventions with the
student are unsatisfactory, he or she should
seek guidance from a senior faculty
member.

25. Student Issues
• Academic Dishonesty and Unethical
Behavior
– It is the instructor’s responsibility to comply
with policy and report violations.
– Students may view unethical clinical
behaviors differently from unethical
classroom behaviors.
– Altering charts or failing to report errors
can be signs of more serious problems and
may affect patient outcomes.

26. Student Issues
• Safety
– Reporting and investigating causal system
failures and revealing the primary error to
the physician and the patient is the primary
role of the healthcare professional.
– The instructor must assess each student’s
preparation for delivering safe patient care
prior to the beginning of the clinical
experience.

27. Student Issues
• Safety
– The clinical instructor must document and
provide feedback to a student who has had a
breach of patient safety.
– The clinical instructor must follow agency
guidelines for reporting such incidents.

28. Evaluation of Clinical Learning
• Evaluation is an opportunity for growth.
• Should be based on a standard
evaluation tool.
• The instructor must collect enough data
on which to base the evaluation against
behavioral outcomes over time.

29. Evaluation of Clinical Learning
• Formative evaluation should allow
students the opportunity to internalize
the process of self reflection and self
discovery in his or her personal practice.
• Say what you mean, and mean what you
say.

30. Evaluation of Clinical Learning
• The final clinical evaluation allows the
instructor to analyze and deliver to the
student the progress of clinical
performance over time.
• The summative evaluation prepares the
student to move forward in the program
with guided input regarding their
current state of practice.

31. Evaluation of Clinical Learning
• Learning contracts or clinical warning
forms are used by clinical instructors to
delineate unsafe clinical practice or
breaches in professional practice.
• These documents become part of the
evaluation process and become part of a
remediation plan.

32. Evaluation of Clinical Learning
• Clinical Practice Failure
– Clinical failure is the lack of clinical
competence and the inability of the student
to meet course objectives.
– Not all students succeed.
– Some students decide on different career
paths; for other students it is a wake up call
to work harder.

33. Evaluation of Clinical Learning
• Clinical Practice Success
– Students who have inherited a passion for
lifelong learning from their clinical
instructors will be well equipped and
resilient to meet the demands as they grow
in their professional roles

34. Evaluation of Clinical Learning
• Clinical Practice Failure
– Students who fail may attempt to blame
failure on the clinical instructor, hence the
importance of the paper trail.
– In the face of clinical failure, what really
matters is how the student and teacher
interact.
– Teachers need to become partners who
stand with, rather than against, vulnerable
students.

35. Conclusion
• Optimal learning outcomes are not
achieved when the teacher is just an
authority figure and content expert.
• In order for expert clinicians to become
effective teachers, additional knowledge
and skills are required.