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CHAPTER 13 CLINICAL TEACHING

INTRODUCTION OF CLINICAL TEACHING

Clinical teaching is a complex enterprise. It is so complex that few researchers have tackled the issues that need to be addressed. Little of our present clinical teaching is grounded in research but instead is grounded in tradition, common sense, and feasibility. We do not really know, for example, how many hours of clinical experience are needed for undergraduate nursing education, graduate education, for orientation of new staff nurses, or for teaching ancillary staff.

We have little empirical evidence of which model of clinical yields the best results. Within each clinical model, we do not know the best student-teacher ratio or how much supervision is actually needed, or whether quantity of patient assignment is more important than quality of assignments. We do not know the relative effectiveness of written assignments for clinical students (Barnard & Dunn, 1994; Oermann, 1996b; Tanner, 2006).

It is the complexity of the clinical setting that makes research so difficult.

There are so many variables that are difficult to control:
The severity of patient illness Widely varying settings

Differences in nursing and educational personnel

Variable staffing patterns Varied student motivation and preparation

 Yet, it is the same complexity that makes the clinical setting such a rich learning environment.

Until there is more research to guide us, we must function with the empirical evidence that we have and base our actions on the collective wisdom brought to us by more than a century of recorded clinical teaching experiences.

PURPOSE OF THE CLINICAL LABORATORY

QUESTIONS? WHAT kind of learning takes place in the clinical setting? WHAT are the real purposes behind having learners spend time clinical agencies?

I. It seems obvious to expect theory and practice to come together in the clinical laboratory.
Learners should have the opportunity to apply the theoretical concepts, rules, and propositions they have learned in the classroom.

 They are able to build on the cognitive schemata that developed in the classroom as they add real-life application.
A proposition such as, Frequent change in body position helps prevent decubitus ulcer can be tested with a variety of a patients to see how and under what condition s it holds true.

 Learners not only test the proposition but learn when to apply it, and they practice the techniques of implementations(Dunn, Ehrich, Mylons, & Hansford, 2000).
The proposition becomes more than a memorize fact; it takes on life and meaning as it applied to real patients.

 Learners see how this one piece of information fits into the whole picture of patient care in a more realistic way than they ever could in a classroom.

II. It is in the clinical laboratory that many skills are perfected.

Complex psychomotor skills may be practiced initially in a skills laboratory, but to be mastered, they often require a live than a simulated situation.

 For i.e : learners can practice colostomy care endlessly in a simulation lab, but they will never be experts until they work with variety of patients who have different stomas and different skin conditions and contours, using varied equipment.

 Infante(1985), in her classic study of the clinical laboratory, noted that the opportunity for observation in an essential element of clinical learning. The skill of observation can be taught in simulated situations, but learners need repeated experience of observing patients in changing circumstances so that they know what to look for in changing situations.

 Problem -solving, decision-making, and critical thinking skills are also refined in the clinical laboratory. Students should learn the basics of these skills before entering the clinical setting. The ultimate practice using these cognitive skills under the guidance of an educator and other professional staff in real-life settings.(Roche, 2002)

 Learners also gain organization and time management skills in clinical settings(Oermann & Gaberson, 2007).
Again, no simulation can prepare students as thoroughly as the live laboratory when it comes to organization. It is in real clinical practice, with the help of the instructor, that learners find out how to organize all the data

that bombards them, all the request made of them, and all the intellectual and psychomotor required of them.
They learn to set priorities by having repeated practice in doing so in complex situations. It is in the clinical laboratory that the skill of delegation is practiced and truly learned.

 Culturally competence is a skill that can be learned well in the clinical labortory(Ormann & Gaberson, 2002).
Learners may know a lot of theory about how to approach clients from different cultures, but they become comfortable and more expert in cross-cultural care when they care for culturally diverse clients.

 The educator may plan student assignment with cultural expose in mind.

III. Finally, learners of nursing become socialize in the clinical laboratory(Chan, 2002).
They learn about which behaviors and professionally acceptable or unacceptable.
They learn about professional responsibility.

values

are

 The clinical laboratory is a place where consequences for ones actions are readily apparent and accountability is demanded.
The knowledge and skills students have learned become integrated into the nursing role. They begin to see staff, as well as faculty, as role models, and they have opportunities to interact with members of other disciplines on a professional level.

 Some nursing students expressed the belief that developing a sense of team membership was one of their most important goals in clinical laboratory(Dunn et al., 2000)

IV. Students also learn how to relate to patients professionally and gain a patients perspective of illness, which leads to more caring behaviors(Forthergil-Bourbonnais & Higuchi, 1995).

 For all of these reasons, learners need spend time in clinical settings, and educators need to learn how best to use that time.

MISUSE OF THE CLINICAL LABORATORY

As Infante(1985) points out clearly, the clinical laboratory has historically been misused at all levels of nursing education.
Nursing students, for instance, have been sent to the clinical setting to gain work experience rather than to achieve educational objectives.

 Clinical objectives should be clear and specific as those for the classroom or skills laboratory.
Objectives should focus on the application of knowledge and skills more than on learning the future employee role.

 Misuse of the clinical setting also occurs when novices are given too much responsibility for patient care. Expecting too much from fledging learners causes anxiety, instructor fatigue, and increased chance of errors.
Learners should not function independently in situations with relatively high levels of risk.

 They should provide care in circumstances for which they are well qualified and for which they have had preliminary guidance.
Objectives for beginning learners should be quite limited, focusing on specific processes of care.

 It is only after specific components of care have been practiced that the learner is a able to integrate previous learning and provide total care.

 A third misuse of the clinical laboratory occurs when learners are supervised and evaluated more than they are taught
Educators who talk about supervising" learners in the clinical laboratory may be revealing an unconscious attitude toward the student activity.

 They may expecting learners to perform rather than to "practice.

One study conducted by Wilson(1994) found that nursing students were constantly aware that the instructor was evaluating them.

 In this situation where this belief is true, learners area at a real disadvantage, because they probably cannot do their best job of learning when they know they have to simultaneously perform for an evaluation.
Evaluation of clinical performances must be separated from practice time.

THANKS FOR LENDING YOUR EARS!

Denise Justine

May M. Lau-an
BSN-IIB Lailanie C. Guinto

HEALTH EDUCATION