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BASICS OF CLINICAL INSTRUCTION

Sikha Chatterjee, MSN RNAmy Hayes, MSN RN

October, 2008

Objectives Discuss the roles of clinical educator List the multiple components

necessary to organize and implement a clinical experience

Describe methods of effective clinical instruction

Note to reader: Please view under “normal” view to see additional notes on slides 5,7,9,10.12,13,14,15,16,17,18,19,21,22,23,and 24

What is Clinical Instruction? Components identified:

– Holistic– Active– Intellectual– Values – Development of nursing identity

»Headlines of NLN Survey

Definitions of Clinical Education“An exchange between practicing professional to enable the development of professional skills” – Butterworth 1992“A term used to describe a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations” -- Department of Health 1993“Clinical Supervision is a practice focused professional relationship that enables a clinician to reflect on their practice with the support of a skilled supervisor. Through reflection the clinician can further develop their skills, knowledge, and enhance their understanding of their own practice” – Nursing and Midwifery Council 2004

PurposeGOAL OF NURSING EDUCATION:

“The ultimate goal of nursing education is to prepare the student to think critically, communicate accurately, and perform indicated therapeutic nursing interventions in patient care..” – Andrea B. O’Conner

Characteristics of Clinical Faculty Attributes of successful nursing

practice translate well into faculty role– Coordination/Facilitation– Negotiation– Supervision– Conflict Resolution– Teaching

Personal Characteristics of Faculty

Willingness to share knowledge and skill

Let someone see nursing through your eyes , hands, and mind

Use empathy to support the learner Recognize individuality of the learner

Characteristics of Adult Learners

Adults prefer to know why they need to learn something before undertaking to learn it

Adults invest considerable energy to something that they want to learn and perceive value in learning

Adult learners wish to be treated with respect and they are capable of self-direction

Adults bring with them a volume of past experiences, including experiences with learning. These past experiences can be positive or serve as a barrier

Adults want to learn materials that have practical application. They want to learn in real-life situations

» Knowles, 1990

Competencies NLN has identified core competencies for

nurse educators– Facilitate learning and learner environment– Utilize assessment and evaluation– Act as change agent and leader– Function within the educational environment– Practice continuous positive improvement

»NLN 2005

Components of Teaching a Clinical Experience

12

Planning a Clinical Experience

1. Review syllabus2. Choose proper clinical site ***3. Communicate to clinical site; orient if

necessary4. Plan student orientation (see packet)5. Make a student schedule

Student Clinical Orientation

See checklist in packet example Review with students

– Syllabus– Methods of instruction– Written assignments– Evaluation process

Considerations

Facility limitations Staff role Patient participation Educator role Observational or “special

experiences”

Planning a Clinical Day

Arrive early Select patient assignments for students

– Consider student needs– Confer with the staff– Post the assignment with student activities

Pre and Post Conference

Time Management During Clinical Day

Establish a routine Schedule student interaction Round Meds and treatments Assessments and documentation

Constructing the Experience There is no one way or method to teach

clinical skills. This is a process of choosing from a repertoire

of methods depending on the learner and practice setting.

This must involve active participation in learning.

POSSIBLE METHODS: Experiential Learning Problem Solving Observation

Tools to Help Make the Methods Work

Asking questions Answering questions Facilitating discussion Explaining everything Demonstrating new or unfamiliar

procedures Providing feedback

POINTS TO REMEMBER: You are responsible for the actions of the learner Always develop a clear and specific plan of what

aspects of nursing care you are responsible for, and what the learner is responsible for

Continuously communicate with the learner Share responsibility Evaluate the learner’s performance with both

positive and constructive feedback[www.chamberlain.edu/HealthcareEmployers/

Preceptorship/Clinica…..]

Evaluation

EvaluationFEEDBACK SHOULD BE: Specific rather than general Factual rather than opinionated Descriptive rather than judgmental

» (Alspach, 2000)

Student Preferences Timely feedback Recognition of positive, not just

problems Clear understanding of expectations Respectful environment and methods No surprises

Specifics of Evaluation Verbal feedback Evaluation tools Refer to course objectives/evaluation

criteria Focus on the action or performance

in relation to criteria Keep good notes!

How to Address Performance Problems

Verbal discussion Written description of incident Consult with supervisor Disciplinary tract Student Contracts

Rewards to Expect Satisfaction in seeing student

progress Increasing student confidence The beauty of the “aha!” moment An opportunity to impact the future

of nursing Personal growth

Questions and Sharing

What are your concerns? What can we clarify? What about?...

References Giddens, J., Brady, D., Brown, P., Wright, M., Smith,

D., and Harris, J. (2008), A New Curriculum for a New Era of Nursing Education, Nursing Education Perspectives, 29(4), 200-204

Headlines from the NLN: Summary of the Survey on Clinical Education in Nursing (2008), Nursing Education Perspectives, 29(4),

238-245 Kalb, Kathleen A., (2008) Core Competencies:

Inspiring Excellence in Nurse Educator Practice, Nursing Education Perspectives , 29(4), 217-219

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