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1. BASICS OF CLINICAL INSTRUCTION Sikha Chatterjee, MSN RN Amy Hayes, MSN RN October, 2008

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  • BASICS OF CLINICAL INSTRUCTIONSikha Chatterjee, MSN RNAmy Hayes, MSN RNOctober, 2008

  • ObjectivesDiscuss the roles of clinical educatorList the multiple components necessary to organize and implement a clinical experienceDescribe methods of effective clinical instructionNote 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:HolisticActiveIntellectualValues 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 1992A 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 1993Clinical 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. OConner

  • Characteristics of Clinical FacultyAttributes of successful nursing practice translate well into faculty roleCoordination/FacilitationNegotiationSupervisionConflict ResolutionTeaching

  • Personal Characteristics of Faculty

    Willingness to share knowledge and skillLet someone see nursing through your eyes , hands, and mindUse empathy to support the learnerRecognize individuality of the learner

  • Characteristics of Adult Learners

    Adults prefer to know why they need to learn something before undertaking to learn itAdults invest considerable energy to something that they want to learn and perceive value in learningAdult learners wish to be treated with respect and they are capable of self-directionAdults bring with them a volume of past experiences, including experiences with learning. These past experiences can be positive or serve as a barrierAdults want to learn materials that have practical application. They want to learn in real-life situationsKnowles, 1990

  • CompetenciesNLN has identified core competencies for nurse educatorsFacilitate learning and learner environmentUtilize assessment and evaluationAct as change agent and leaderFunction within the educational environmentPractice continuous positive improvementNLN 2005

  • Components of Teaching a Clinical Experience

  • *Planning a Clinical ExperienceReview syllabusChoose proper clinical site ***Communicate to clinical site; orient if necessaryPlan student orientation (see packet)Make a student schedule

  • Student Clinical OrientationSee checklist in packet exampleReview with studentsSyllabusMethods of instructionWritten assignmentsEvaluation process

  • ConsiderationsFacility limitationsStaff rolePatient participationEducator roleObservational or special experiences

  • Planning a Clinical DayArrive earlySelect patient assignments for studentsConsider student needsConfer with the staffPost the assignment with student activitiesPre and Post Conference

  • Time Management During Clinical DayEstablish a routineSchedule student interactionRoundMeds and treatmentsAssessments 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 LearningProblem SolvingObservation

  • Tools to Help Make the Methods WorkAsking questionsAnswering questionsFacilitating discussionExplaining everythingDemonstrating new or unfamiliar proceduresProviding feedback

  • POINTS TO REMEMBER:You are responsible for the actions of the learnerAlways develop a clear and specific plan of what aspects of nursing care you are responsible for, and what the learner is responsible forContinuously communicate with the learnerShare responsibilityEvaluate the learners performance with both positive and constructive feedback[www.chamberlain.edu/HealthcareEmployers/Preceptorship/Clinica..]

  • Evaluation

  • EvaluationFEEDBACK SHOULD BE:Specific rather than generalFactual rather than opinionatedDescriptive rather than judgmental (Alspach, 2000)

  • Student PreferencesTimely feedbackRecognition of positive, not just problemsClear understanding of expectationsRespectful environment and methodsNo surprises

  • Specifics of EvaluationVerbal feedbackEvaluation toolsRefer to course objectives/evaluation criteriaFocus on the action or performance in relation to criteria Keep good notes!

  • How to Address Performance Problems Verbal discussionWritten description of incidentConsult with supervisorDisciplinary tractStudent Contracts

  • Rewards to ExpectSatisfaction in seeing student progressIncreasing student confidenceThe beauty of the aha! momentAn opportunity to impact the future of nursingPersonal growth

  • Questions and SharingWhat are your concerns?What can we clarify?What about?...

  • ReferencesGiddens, 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), 200-204Headlines from the NLN: Summary of the Survey on Clinical Education in Nursing (2008), Nursing Education Perspectives, 29(4), 238-245Kalb, Kathleen A., (2008) Core Competencies: Inspiring Excellence in Nurse Educator Practice, Nursing Education Perspectives , 29(4), 217-219

  • This workforce solution was funded by a grant awarded under the Presidents Community-Based Job Training Grants as implemented by the U.S. Department of Labors Employment and Training Administration. The solution was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This solution is copyrighted by the institution that created it. Internal use by an organization and/or personal use by an individual for non-commercial purposes is permissible. All other uses require the prior authorization of the copyright owner.

    ****Should present a mechanism for protecting standards & public safety While supporting development of excellent practice. All programs must be approved by Indiana State Board of Nursing (ISBN). The curriculum is approved as submitted; therefore clinical hours must be met as stated, other requirements and objectives of the various courses should be satisfied. Many programs, including Ivy Tech, are also accredited by National League of Nursing (NLNAC). **Dozens of others could be added here: prioritization, clear communication skills, and organization , for example. Ask audience for other thoughts. Patience and hard work Role modeling, facilitation & prioritization are applicable to any clinical setting**Because of these principles, student nurses usually value the clinical experience as they can so easily see the relevance of the hands-on and real life aspects.*This is a partial list of some of the competencies the NLN has identified. These are ones that pertain most to the clinical setting.***The syllabus is the basis for what the course entails. It is the foundation for organizing and setting up the course. It must not contradict the program handbook. For instance, attendance and dress code policies are non-negotiable and not subject to individual instructor preference.***the clinical site may be pre-determined by the nursing program and not need to be selected by the individual instructor. There is a process of requesting clinical sites that usually requires planning months in advance. The patient population should generally allow students to give the type of care that is compatible with the objectives of the course in question.See examples of orientation packets, student schedules, instructor handbooks from the various clinical affiliates, etc. Program chair or experienced full-time faculty can assist you with finding these.Make sure you have reviewed and understand fully so you can explain to students and answer their questions.*Observational experiences generally need to be planned and scheduled in advance and should also be in line with the objectives of the course. There are guidelines for appropriate type and # of observational experiences for each clinical course. For example, for beginning med/surg course, students at our school or not scheduled routinely in observations. Med/surg II includes an OR rotation because that is the course that covers intraoperative nursing. Med/surg III is where students visit E.D. and critical care areas. Students in an OB/Peds course may go to a childbirth education course in the community or a day care. *Pre conf: Can be done different ways. Some faculty have more structured pre-conferences than others. Students can ask questions about their pts., clinical procedures or p

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