The Clinical ConferenceThe Clinical Conference

Compiled by: Compiled by:

Donna Cooke RN BSN Donna Cooke RN BSN

Dorothy Dooley BN RN, IBCLC Dorothy Dooley BN RN, IBCLC

Patricia Meyer RN BSN Patricia Meyer RN BSN

This presentation will include the following This presentation will include the following content on the pre clinical conference, the post content on the pre clinical conference, the post clinical conference and the pre/post clinical clinical conference and the pre/post clinical conference.conference.

• DefinitionsDefinitions

• Teaching Approaches/AdvantagesTeaching Approaches/Advantages

• Additional AdvantagesAdditional Advantages

• DisadvantagesDisadvantages

• ActivitiesActivities

DefinitionsDefinitions

Pre Clinical ConferencePre Clinical Conference

• ““Preclinical conferences are small group Preclinical conferences are small group discussions that precede clinical learning discussions that precede clinical learning activities” (p.181) that can be conducted in a activities” (p.181) that can be conducted in a group setting or one to one; and is a time for group setting or one to one; and is a time for students to prepare for their experience, seek students to prepare for their experience, seek clarification, think through plans of care and clarification, think through plans of care and examine client’s information and problems examine client’s information and problems (Gaberson and Oermann, 1999).(Gaberson and Oermann, 1999).

Post Clinical ConferencePost Clinical Conference

“ “Postclinical conferences are held at the Postclinical conferences are held at the conclusion of clinical learning activities” conclusion of clinical learning activities” (p.182) and is a time for discussion, sharing (p.182) and is a time for discussion, sharing experiences and emotions, peer support and experiences and emotions, peer support and critique, looking over the day and analyzing critique, looking over the day and analyzing experiences (Gaberson and Oermann, 1999).experiences (Gaberson and Oermann, 1999).

Teaching Approaches and Teaching Approaches and AdvantagesAdvantages

Pre Clinical Conference Teaching Pre Clinical Conference Teaching Approaches/AdvantagesApproaches/Advantages Teacher directed discussion in a conference Teacher directed discussion in a conference

room primarily aimed at student planning room primarily aimed at student planning activities in advance of their clinical assignment activities in advance of their clinical assignment to ensure discussion of their plans of care based to ensure discussion of their plans of care based on their review of the literature, specific to their on their review of the literature, specific to their client’s care. Students learn how to apply theory client’s care. Students learn how to apply theory to practice, how to defend their critical thinking to practice, how to defend their critical thinking skills and client care decisions, how to express skills and client care decisions, how to express feelings, and how to explore the role of the feelings, and how to explore the role of the nurse (Mitchell and Krainovich, 1982).nurse (Mitchell and Krainovich, 1982).

Student centered on the unit where the focus is Student centered on the unit where the focus is on client centered care in immediate on client centered care in immediate assessment of clients by the student and assessment of clients by the student and reprioritization of care based on client’s reprioritization of care based on client’s present status as well as discussion with present status as well as discussion with instructor regarding re-evaluation of care instructor regarding re-evaluation of care (Mitchell and Krainovich,1982).(Mitchell and Krainovich,1982).

Post Clinical Conference Teaching Post Clinical Conference Teaching Approaches/AdvantagesApproaches/Advantages• Circle format: promotes a feeling of collegiality, Circle format: promotes a feeling of collegiality,

augments the group process augments the group process

• Instructor as a facilitator: portrays the instructor Instructor as a facilitator: portrays the instructor as a role model, reinforces learning as a lifelong as a role model, reinforces learning as a lifelong process, and ensures productive use of time process, and ensures productive use of time

• Build self confidence by focusing and stressing Build self confidence by focusing and stressing the positive aspects of the day, creating a the positive aspects of the day, creating a positive atmosphere, encouraging specificity positive atmosphere, encouraging specificity and promoting peer feedback and promoting peer feedback

(Copeland, 1990).(Copeland, 1990).

• Instructor as a facilitator encourages student Instructor as a facilitator encourages student participation, facilitates the investigation of participation, facilitates the investigation of commonalities and differences in care, commonalities and differences in care, examine the role of the practicing nurse, and examine the role of the practicing nurse, and share their affective experiences (Matheney as share their affective experiences (Matheney as cited in Mitchell and Krainovich, 1982).cited in Mitchell and Krainovich, 1982).

• Grounded on specific objectives which ensure Grounded on specific objectives which ensure coverage of clinical objectives (DeYoung as coverage of clinical objectives (DeYoung as cited in Letizia, 1998).cited in Letizia, 1998).

• Use of an informal atmosphere is conducive to Use of an informal atmosphere is conducive to learning (Werner-McCullough and L’Orange learning (Werner-McCullough and L’Orange as cited in Letizia, 1998).as cited in Letizia, 1998).

• Using a variety of techniques and approaches Using a variety of techniques and approaches such as creativity and student - centered such as creativity and student - centered approaches can enhance the learning approaches can enhance the learning experience, improve student and group experience, improve student and group problem-solving, promote team building and problem-solving, promote team building and encourage maximum use of the post encourage maximum use of the post conference experience (Werner-McCullough conference experience (Werner-McCullough and L’Orange, 1985).and L’Orange, 1985).

• Student centered approach encourages Student centered approach encourages dialogue where students share experiences, dialogue where students share experiences, work through problems and assign meaning to work through problems and assign meaning to complex interactions (Rossignol, 2000). complex interactions (Rossignol, 2000). Student participation and student – to – student Student participation and student – to – student participation in this approach helps foster participation in this approach helps foster critical thinking skills (Collins, Brown and critical thinking skills (Collins, Brown and Newman as cited in Rossignol, 1997).Newman as cited in Rossignol, 1997).

Use of high levels of discourse (teacher Use of high levels of discourse (teacher centered: high level questions from instructors, centered: high level questions from instructors, elaboration of student ideas by instructor, elaboration of student ideas by instructor, instructor probing questions; and student instructor probing questions; and student centered: student participation and student to centered: student participation and student to student participation) (Rossignol, 1997). student participation) (Rossignol, 1997). Previous studies (Barnes; Craig and Page; Previous studies (Barnes; Craig and Page; Scholdra and Quiring; Wink as cited in Scholdra and Quiring; Wink as cited in Rossignol, 1997) provide evidence that both Rossignol, 1997) provide evidence that both teacher and student – centered activities may teacher and student – centered activities may foster the use of more high cognitive level foster the use of more high cognitive level questions and in turn, critical thinking skills. questions and in turn, critical thinking skills.

An environment that moves beyond low cognitive An environment that moves beyond low cognitive level questions to that of high level cognitive level questions to that of high level cognitive questions (teacher centered) may foster the questions (teacher centered) may foster the development of cognitive skill: critical thinking development of cognitive skill: critical thinking skills, decision - making skills, and problem - skills, decision - making skills, and problem - solving skills in students (student centered) solving skills in students (student centered) (Gaberson and Oermann, 1999; Oermann, 1997; (Gaberson and Oermann, 1999; Oermann, 1997; Oermann, 1999; Rossignol, 2000; Sellappah, Oermann, 1999; Rossignol, 2000; Sellappah, Hussey, Blackmore and McMurray, 1998), Hussey, Blackmore and McMurray, 1998), facilitate the consolidation of clinical experiences facilitate the consolidation of clinical experiences (Sellappah et al.,) and development of clinical (Sellappah et al.,) and development of clinical competence (Wink, 1993). Higher level competence (Wink, 1993). Higher level questioning by instructors may encourage higher questioning by instructors may encourage higher level questioning among students (Wink, 1993).level questioning among students (Wink, 1993).

• Instructor as a facilitator asks high level Instructor as a facilitator asks high level questions to help students with in depth questions to help students with in depth reflection and to constructively critique each reflection and to constructively critique each other’s interpretation of events (Matheney as other’s interpretation of events (Matheney as cited in Mitchell and Krainovich,1982).cited in Mitchell and Krainovich,1982).

• Fosters problem solving (DiRenzo; Mitchell Fosters problem solving (DiRenzo; Mitchell and Krainovich; Reilly and Oermann; Werner-and Krainovich; Reilly and Oermann; Werner-McCullough and L’Orange as cited in Letizia, McCullough and L’Orange as cited in Letizia, 1998).1998).

• Use of imagery may enhance discussions and Use of imagery may enhance discussions and learning (Skurski as cited in Letizia, 1998).learning (Skurski as cited in Letizia, 1998).

• Education imagery where the instructor takes Education imagery where the instructor takes the student through a process of quiet the student through a process of quiet relaxation to discuss feelings, perspectives of relaxation to discuss feelings, perspectives of the situation, and make decisions to improve the situation, and make decisions to improve client care. It allows students freedom to client care. It allows students freedom to discuss what they feel is important and discuss what they feel is important and actively includes students in learning (Skurski, actively includes students in learning (Skurski, 1985).1985).

Computer conferencing serves as an Computer conferencing serves as an environment in which students can “exchange environment in which students can “exchange ideas, solve problems, explore alternatives, ideas, solve problems, explore alternatives, and create new meanings along a connected and create new meanings along a connected journey” ( Andrusyszyn and Billings as cited journey” ( Andrusyszyn and Billings as cited in Babenko-Mould, Andrusyszyn and in Babenko-Mould, Andrusyszyn and Goldenberg, 2004, p.149). Goldenberg, 2004, p.149).

Computer conferencing provides a connection Computer conferencing provides a connection between students and faculty who are between students and faculty who are otherwise isolated geographically, support otherwise isolated geographically, support through encouragement from others in the through encouragement from others in the group, learning from discussion of group, learning from discussion of experiences, and sharing by giving and experiences, and sharing by giving and receiving each others perspectives and insights receiving each others perspectives and insights (Babenko-Mould, Andrusyszyn and (Babenko-Mould, Andrusyszyn and Goldenberg, 2004). Goldenberg, 2004).

Computer conferencing may contribute to Computer conferencing may contribute to students sense of connection and self students sense of connection and self confidence, sense of control/power over confidence, sense of control/power over learning and augmentation of group process learning and augmentation of group process skills (Babenko-Mould, Andrusyszyn and skills (Babenko-Mould, Andrusyszyn and Goldenberg, 2004), and enable students to Goldenberg, 2004), and enable students to access global links by extending enquiry access global links by extending enquiry beyond local links and issues (Colling and beyond local links and issues (Colling and Rogers as cited in Babenko-Mould, Rogers as cited in Babenko-Mould, Andrusyszyn and Goldenberg, 2004).Andrusyszyn and Goldenberg, 2004).

Pre and Post Clinical Conference Pre and Post Clinical Conference Teaching Approaches/AdvantagesTeaching Approaches/Advantages The use of narrative pedagogy, a deductive The use of narrative pedagogy, a deductive

approach to teaching and learning where approach to teaching and learning where students and instructors as well as clinicians students and instructors as well as clinicians share and interpret their experiences in the share and interpret their experiences in the context of nursing education. The facilitator context of nursing education. The facilitator encourages students to share the significance encourages students to share the significance and the meaning of their learning to enhance and the meaning of their learning to enhance their ability to be reflective practitioners. Use their ability to be reflective practitioners. Use of attentive behaviors creates an open of attentive behaviors creates an open environment for thinking about the meaning of environment for thinking about the meaning of the clinical experience (Andrews et al., 2001).the clinical experience (Andrews et al., 2001).

May involve the use of instructors who are May involve the use of instructors who are initially “leaders, facilitators, and ‘energizers’ initially “leaders, facilitators, and ‘energizers’ who promote participation and encourage who promote participation and encourage questioning and analysis by all members of the questioning and analysis by all members of the group” (p.29) but then as the group advances, group” (p.29) but then as the group advances, the students assume the instructors role “thus the students assume the instructors role “thus learning the group interaction of nursing learning the group interaction of nursing professionals.”( Wink, 1995, p.30). Group professionals.”( Wink, 1995, p.30). Group discussions and analytic questioning advance to discussions and analytic questioning advance to higher levels as the experience evolves (Wink, higher levels as the experience evolves (Wink, 1995). 1995).

• Discussions where the instructor promotes critical Discussions where the instructor promotes critical thinking and problem - solving skills as well as thinking and problem - solving skills as well as provides a supportive educational environment provides a supportive educational environment which involves the use and progression from low which involves the use and progression from low level to high level questioning (Gaberson and level to high level questioning (Gaberson and Oermann, 1999; Oermann, 1997; Oermann, Oermann, 1999; Oermann, 1997; Oermann, 1999).1999).

• Socratic Method of questioning, comparing and Socratic Method of questioning, comparing and synthesizing where students are asked open-ended synthesizing where students are asked open-ended questions, allowing students to work through questions, allowing students to work through difficult concepts, examine different points of difficult concepts, examine different points of view and seek clarification (Gaberson and view and seek clarification (Gaberson and Oermann, 1999; Oermann, 1997).Oermann, 1999; Oermann, 1997).

• Instructors though the use of their own critical Instructors though the use of their own critical thinking skills and awareness of learning thinking skills and awareness of learning styles, course objectives and evaluations; can styles, course objectives and evaluations; can influence student learning by using a deeper influence student learning by using a deeper approach to learning. Students draw meaning approach to learning. Students draw meaning from past experiences, develop higher level from past experiences, develop higher level assessments, students are engaged in learning assessments, students are engaged in learning and are encouraged to comprehend complex and are encouraged to comprehend complex topics (Oermann, 1997; University of topics (Oermann, 1997; University of Technology Sydney, 2004). Technology Sydney, 2004).

Achieving approach encourages students to Achieving approach encourages students to strive and compete for high grades and strive and compete for high grades and therefore help them understand the effort therefore help them understand the effort required to do well in assessments. Here required to do well in assessments. Here students are well organized, good time students are well organized, good time managers, act as role models and select managers, act as role models and select students with similar goals for education. The students with similar goals for education. The instructor should take the role to influence the instructor should take the role to influence the student to function in both a deeper and student to function in both a deeper and achieving approach (University of Technology achieving approach (University of Technology Sydney, 2004). Sydney, 2004).

• A group effort that contributes to the A group effort that contributes to the attainment of course/clinical objectives such as attainment of course/clinical objectives such as theory review, critical thinking, problem theory review, critical thinking, problem solving, and fine-tuning of psychomotor skills. solving, and fine-tuning of psychomotor skills. Students begin to apply research, examine Students begin to apply research, examine ethical issues and evaluate the effectiveness of ethical issues and evaluate the effectiveness of their own and their peers’ application to the their own and their peers’ application to the nursing process, and is an environment where nursing process, and is an environment where students explore their personal feelings and students explore their personal feelings and attitudes related to the care of the client attitudes related to the care of the client (Oermann, 1997;Wink, 1995).(Oermann, 1997;Wink, 1995).

• Experiential learning through a simulated Experiential learning through a simulated setting to foster improved problem solving and setting to foster improved problem solving and decision making. Faculty control the teaching decision making. Faculty control the teaching environment, learning is reinforced through environment, learning is reinforced through peers and educator, use of good tools to peers and educator, use of good tools to promote affective learning (emotions, values, promote affective learning (emotions, values, perspectives), increases communication skills, perspectives), increases communication skills, develops leadership, and complex issues can develops leadership, and complex issues can be worked through (Gaberson and Oermann, be worked through (Gaberson and Oermann, 1999).1999).

Additional AdvantagesAdditional Advantages

Pre Clinical Conference Pre Clinical Conference AdvantagesAdvantages

• Foster critical thinking and clinical decision Foster critical thinking and clinical decision making skills development as well as enhances making skills development as well as enhances the clinical learning experience (Wink, 1995).the clinical learning experience (Wink, 1995).

• Enhance analysis of theory concepts, Enhance analysis of theory concepts, conceptualize the role of nurses, and use the conceptualize the role of nurses, and use the “nursing process to think logically and make “nursing process to think logically and make decisions” (Mitchell and Krainovich, 1982, decisions” (Mitchell and Krainovich, 1982, p.824).p.824).

Post Clinical Conference Post Clinical Conference AdvantagesAdvantages • Provides an opportunity for empirical study of Provides an opportunity for empirical study of

approaches and activities to student learning approaches and activities to student learning processes and outcomes (Letizia, 1998; Letizia processes and outcomes (Letizia, 1998; Letizia and Jennrich, 1998).and Jennrich, 1998).

• Contributes to the attainment of the course and the Contributes to the attainment of the course and the clinical objectives (Wink as cited in Letizia, clinical objectives (Wink as cited in Letizia, 1998).1998).

• An opportunity to enhance clinical learning An opportunity to enhance clinical learning (Lister as cited in Letizia, 1998).(Lister as cited in Letizia, 1998).

• May provide a method to apply theory to May provide a method to apply theory to practice (DiRenzo as cited in Letizia, 1998).practice (DiRenzo as cited in Letizia, 1998).

• Opportunity for students and faculty to interact Opportunity for students and faculty to interact and learn from each other (Rossignol, 2000).and learn from each other (Rossignol, 2000).

• Enhances the capacity for clinical decision making Enhances the capacity for clinical decision making

• Increases self confidence Increases self confidence

• Improves group process skills Improves group process skills

(Reilly and Oermann as cited in Letizia, 1998).(Reilly and Oermann as cited in Letizia, 1998).

• Students can “evaluate and critique care, … Students can “evaluate and critique care, … explore … the basis of problems encountered explore … the basis of problems encountered during the clinical laboratory [and] alternative during the clinical laboratory [and] alternative ways to accomplish … objectives” (Wink, ways to accomplish … objectives” (Wink, 1995, p. 29).1995, p. 29).

• Is an important environment in the Is an important environment in the development of cognitive, affective and development of cognitive, affective and behavioral learning of nursing students behavioral learning of nursing students (Letizia and Jennrich, 1998; Reilly and (Letizia and Jennrich, 1998; Reilly and Oermann as cited in Letizia, 1998).Oermann as cited in Letizia, 1998).

• Educators can create an informal tone to enable Educators can create an informal tone to enable nursing students to feel free to openly discuss nursing students to feel free to openly discuss topics without being evaluated (Gaberson and topics without being evaluated (Gaberson and Oermann, 1999; Oermann, 1997; Mitchell and Oermann, 1999; Oermann, 1997; Mitchell and Krainovich, 1982; Werner-McCullough and Krainovich, 1982; Werner-McCullough and L’Orange, 1985).L’Orange, 1985).

• Encourages student learning from other Encourages student learning from other students, improves communication and group students, improves communication and group dynamics within a small group (Werner-dynamics within a small group (Werner-McCullough and L’Orange, 1985).McCullough and L’Orange, 1985).

• Can be flexible. Example: Nursing rounds can Can be flexible. Example: Nursing rounds can be carried out in a conference room to decrease be carried out in a conference room to decrease student and instructor fatigue and allow for student and instructor fatigue and allow for limited discussion (Werner-McCullough and limited discussion (Werner-McCullough and L’Orange, 1985). L’Orange, 1985).

Pre/Post Clinical Conference Pre/Post Clinical Conference AdvantagesAdvantages• Meet planned goals and maximize the use of Meet planned goals and maximize the use of

timetime

• Students apply research, examine ethical Students apply research, examine ethical issues, and evaluate the effectiveness of their issues, and evaluate the effectiveness of their own and their peers’ application of the nursing own and their peers’ application of the nursing processprocess

• Attends to affective issues for the students: Attends to affective issues for the students: stress, apprehension, values, beliefs, and stress, apprehension, values, beliefs, and incident debriefing incident debriefing

(Wink, 1995).(Wink, 1995).

The structure and timing of conferences are The structure and timing of conferences are flexible to ensure quality is enhanced. That is, flexible to ensure quality is enhanced. That is, they do not have to happen at the beginning or they do not have to happen at the beginning or end of a day, and may be cancelled if students are end of a day, and may be cancelled if students are fatigued; they do not have to happen in the fatigued; they do not have to happen in the agency or on the same day as clinical; can be agency or on the same day as clinical; can be forfeited in favor of accomplishment of objectives forfeited in favor of accomplishment of objectives elsewhere; may vary in length, shorter at the elsewhere; may vary in length, shorter at the beginning of the course because of the increased beginning of the course because of the increased time students need to perform learning activities, time students need to perform learning activities, and longer toward the end of the course as and longer toward the end of the course as students become more proficient and are able to students become more proficient and are able to reflect more meaningfully (Wink, 1995).reflect more meaningfully (Wink, 1995).

DisadvantagesDisadvantages

Pre Clinical Conference Pre Clinical Conference DisadvantageDisadvantage

• May be rushed due to the demands of the unit May be rushed due to the demands of the unit and client care.and client care.

Post Clinical Conference Post Clinical Conference DisadvantagesDisadvantages• May be unstructured in discussions leading to May be unstructured in discussions leading to

boredom in studentsboredom in students

• Since it typically occurs at the end of the day, Since it typically occurs at the end of the day, energy levels may be low energy levels may be low

(DeYoung as cited in Letizia, 1998).(DeYoung as cited in Letizia, 1998).

• Computer conferencing may impose barriers Computer conferencing may impose barriers such as connection through internet access and such as connection through internet access and time availability (Babenko-Mould, time availability (Babenko-Mould, Andrusyszyn and Goldenberg, 2004).Andrusyszyn and Goldenberg, 2004).

• If using educational imagery, the instructor If using educational imagery, the instructor needs to feel comfortable and confident with needs to feel comfortable and confident with the technique to foster discussion and improve the technique to foster discussion and improve decision-making (Skurski, 1985).decision-making (Skurski, 1985).

Pre/Post Clinical Conference Pre/Post Clinical Conference DisadvantagesDisadvantages

• Can be used as a substitution or distraction for Can be used as a substitution or distraction for other learning activities (Wink, 1995). other learning activities (Wink, 1995).

• If a surface level of learning approach is used, If a surface level of learning approach is used, it promotes only memorization of information it promotes only memorization of information (University of Technology Sydney, 2004).(University of Technology Sydney, 2004).

• They take up time; up to 30% of the clinical They take up time; up to 30% of the clinical day (Wink, 1995).day (Wink, 1995).

Conference ActivitiesConference Activities

Pre Clinical Conference ActivitiesPre Clinical Conference Activities

• Student planning activities and discussion of Student planning activities and discussion of plans of care for their clinical assignment plans of care for their clinical assignment based on their review of the literature specific based on their review of the literature specific to their client’s health statusto their client’s health status

• Teacher centered using mock reports, Teacher centered using mock reports, discussion, role playing and demonstration discussion, role playing and demonstration

(Mitchell and Krainovich, 1982).(Mitchell and Krainovich, 1982).

• Nursing rounds where students gain an Nursing rounds where students gain an opportunity to speak in front of peers’, opportunity to speak in front of peers’, improve decision making skills, meet other improve decision making skills, meet other clients, apply theory to practice, generate clients, apply theory to practice, generate enthusiasm, promote ideas for research, learn enthusiasm, promote ideas for research, learn pathophysiology, compare diagnosis and client pathophysiology, compare diagnosis and client response to care, and faculty see where response to care, and faculty see where priorities in the supervision of students are priorities in the supervision of students are needed (Skurski, 1985).needed (Skurski, 1985).

Post Clinical Conference ActivitiesPost Clinical Conference Activities

• Individual and group reflection Individual and group reflection

• Student evaluation by instructor Student evaluation by instructor

• DebateDebate

(Reilly and Oermann as cited in Letizia, 1998).(Reilly and Oermann as cited in Letizia, 1998).

• Sharing of clinical experiences Sharing of clinical experiences

• Review and critique of clinical activities Review and critique of clinical activities

• Examination of behaviors used in clinical Examination of behaviors used in clinical decision making decision making

(Mitchell and Krainovich as cited in Letizia, (Mitchell and Krainovich as cited in Letizia, 1998).1998).

• Discussion of clinical concerns and issues Discussion of clinical concerns and issues (Mitchell and Krainovich; Reilly and Oermann (Mitchell and Krainovich; Reilly and Oermann as cited in Letizia, 1998).as cited in Letizia, 1998).

• Exploration of feelings and attitudes of students Exploration of feelings and attitudes of students related to patient care (Wink as cited in Letizia, related to patient care (Wink as cited in Letizia, 1998).1998).

• Discussion of learning objectives realized Discussion of learning objectives realized during the day and how they fit into the during the day and how they fit into the curriculum (Matheney as cited in Mitchell and curriculum (Matheney as cited in Mitchell and Krainovich, 1982).Krainovich, 1982).

• Discussion of clinical experiences, case Discussion of clinical experiences, case studies, coverage of theoretical content, studies, coverage of theoretical content, nursing ethics, student presentations, guest nursing ethics, student presentations, guest speakers, nursing research, audiovisual speakers, nursing research, audiovisual presentations, psychomotor skill presentation, presentations, psychomotor skill presentation, quizzes or tests, group lunch, tour of other quizzes or tests, group lunch, tour of other units, patient rounds (Letzia, 1998).units, patient rounds (Letzia, 1998).

• Questioning, ethical debates and use of Questioning, ethical debates and use of multimedia (Mitchell and Krainovich, 1982).multimedia (Mitchell and Krainovich, 1982).

• Group problem solving, nursing rounds, clinical Group problem solving, nursing rounds, clinical testing and role playing, all to enhance student testing and role playing, all to enhance student learning and problem-solving. Clinical testing learning and problem-solving. Clinical testing assists students to look at areas of strengths and assists students to look at areas of strengths and areas for improvement. Role playing can improve areas for improvement. Role playing can improve communication skills, assertiveness skills, communication skills, assertiveness skills, examine personal perspectives, attitudes and examine personal perspectives, attitudes and encourage accountability. Instructors can promote encourage accountability. Instructors can promote group collaboration and a safe environment which group collaboration and a safe environment which provides opportunities for positive and negative provides opportunities for positive and negative feedback from peers and instructor (Werner-feedback from peers and instructor (Werner-McCullough and L’Orange, 1985). McCullough and L’Orange, 1985).

• Nursing rounds, an approach to promote Nursing rounds, an approach to promote problem solving where students practice problem solving where students practice “verbal presentation of organized and pertinent “verbal presentation of organized and pertinent data” (p.34), involves preparation of client data” (p.34), involves preparation of client information, understanding of the plan of care information, understanding of the plan of care and allows the instructor to ask questions to and allows the instructor to ask questions to develop a deeper level of understanding. This develop a deeper level of understanding. This approach “helps students fit the pieces of the approach “helps students fit the pieces of the puzzle together and to have a more in-depth puzzle together and to have a more in-depth understanding of the patients” (Werner-understanding of the patients” (Werner-McCullough and L’Orange, 1985, p.34). McCullough and L’Orange, 1985, p.34).

• Case study use may help incorporate curriculum Case study use may help incorporate curriculum concepts (Krawczyk as cited in Letizia, 1998).concepts (Krawczyk as cited in Letizia, 1998).

• Computer conferencing allows flexibility in time and Computer conferencing allows flexibility in time and meeting students learning needs (Hee Soon et al.; meeting students learning needs (Hee Soon et al.; Rose, Frisby, Hamlin and Jones as cited in Babenko-Rose, Frisby, Hamlin and Jones as cited in Babenko-Mould, Andrusyszyn and Goldenberg, 2004).Mould, Andrusyszyn and Goldenberg, 2004).

• Walking rounds where students walk as a group to Walking rounds where students walk as a group to meet each client, and each student has input into meet each client, and each student has input into assessing the client and asking questions. One student assessing the client and asking questions. One student presents the client condition, treatment, diagnosis, presents the client condition, treatment, diagnosis, interventions, pertinent tests and lab reports. The interventions, pertinent tests and lab reports. The group works together to discuss disease processes, group works together to discuss disease processes, assessing clients, questioning and ideas to improve assessing clients, questioning and ideas to improve care (Werner-McCullough and L’Orange, 1985). care (Werner-McCullough and L’Orange, 1985).

Pre/Post Clinical Conference Pre/Post Clinical Conference ActivitiesActivities

• Students cooperatively engage in group Students cooperatively engage in group discussion where they clarify, defend and seek discussion where they clarify, defend and seek research based alternatives to their care plans, research based alternatives to their care plans, express feelings openly, and practice decision express feelings openly, and practice decision making by problem solving as a group (Wink, making by problem solving as a group (Wink, 1995).1995).

• Role play (improve communication and Role play (improve communication and leadership skills) (Gaberson and Oermann, leadership skills) (Gaberson and Oermann, 1999; Wink, 1995).1999; Wink, 1995).

• Case study (computer simulation or written Case study (computer simulation or written format), case method and grand rounds; all format), case method and grand rounds; all which help to develop problem solving which help to develop problem solving ability, decision making skills and develop ability, decision making skills and develop sound judgments in a practice setting sound judgments in a practice setting (Gaberson and Oermann, 1999).(Gaberson and Oermann, 1999).

• Group discussions and analytical questioning Group discussions and analytical questioning with advancement to higher level questioning with advancement to higher level questioning as the experience evolves (Wink, 1995). as the experience evolves (Wink, 1995). Discussion can be used for group debriefing Discussion can be used for group debriefing for students to discuss perceptions, learn from for students to discuss perceptions, learn from each other and share emotions about the each other and share emotions about the clinical experience as well as encouraging self-clinical experience as well as encouraging self-evaluation in students, and identification of evaluation in students, and identification of students own learning needs (Gaberson and students own learning needs (Gaberson and Oermann, 1999).Oermann, 1999).

• Debates over content, use of clinical incidents Debates over content, use of clinical incidents or case studies, games to enhance pulling or case studies, games to enhance pulling through concepts of pharmacology, lab results through concepts of pharmacology, lab results analysis and pathophysiology, encouraging the analysis and pathophysiology, encouraging the moto “analyze everything”, and allowing moto “analyze everything”, and allowing misconceptions or errors to be addressed misconceptions or errors to be addressed (Wink, 1995). Debates and discussion give (Wink, 1995). Debates and discussion give students opportunities and are challenged to students opportunities and are challenged to compare and synthesize information compare and synthesize information (University of Technology Sydney, 2004). (University of Technology Sydney, 2004). Games add diversity to learning, improves Games add diversity to learning, improves decision making, helps with retention of decision making, helps with retention of knowledge and motivates students (Gaberson knowledge and motivates students (Gaberson and Oermann, 1999).and Oermann, 1999).

ReferencesReferences

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