clinical teaching grp5 3y3-2

8/8/2019 Clinical Teaching Grp5 3y3-2

1/77

BY GROUP 5


2/77


3/77

` What kind of learning occurs in a

clinical setting?

` Whatare the purposes behindhaving learnersspend time in

clinical agencies?


4/77

The opportunities for observationis an essential element of clinical

learning.


5/77

` Problem solving, decision making, and critical

thinking skills are also refined in the clinical

laboratory.

` Learnersalso gain organization and timemanagement skills.

` Cultural competence isaskill that can be

learned well.

` Learnersalso become socialized.


6/77

` The clinical laboratoryhashistorically

been misused atall levels of nursing

education.` Occurs when:

Novicesare given too muchresponsibility for

patient care Learnersare supervised and evaluated more

than theyare taught.


7/77


8/77

` Develop a model thatreliesheavily on

keeping nursing students in askills

laboratory until theyare proficient with

skills

` Studentsare then sentto the clinical area

and assigned to practice specific

psychomotorskills.


9/77

` Contends more information about clinical

practice should be taught in the classroom

before learners go to the clinical area.

Permitsa lot of interaction withthe teacher.


10/77


11/77

` Studentistaughtand supervised bya

practicing nurse employed byhealth care

while educatoroverseesthe processand

indirectlysupervisesthe student.(Billay &Yonge, 2004)


12/77

` Clinical Teaching Associates Model

` Designed fortwo-day clinical experience

`

Relivesstress on educatorwho doesnt knowthe patients well in the first dayand tapsthe

expertise ofthe staff nurse in teaching

psychomotorskills

(HunBerger, et al 2000)


13/77

1ST DAY 2ND DAY

orientation to the unit

clinical assignments

educatortakes over

teaching and supervisory

role


14/77

I. Educator

Responsible foroverseeing the educational

experience

Ultimatelyresponsible forstudent learning

outcomes

Must meet periodically with preceptorto

talk aboutthe students learning needsandprogress


15/77

I. Educator

Meets withstudents in conference on a

regularbasis

Sharesresponsibility forevaluation and

grading along with preceptors


16/77

II. Preceptor

Orientsstudentsto:

Agency

Patients

Patient care

Asks learners questionsto ensure thatthey

understand whattheyare doing

Evaluatesstudent learning


17/77

` Studied preceptors perceptions of whatthey do

forlearnersand found two majorthemes:

a. Sheltering students while learning

b. Facilitating students learning


18/77

1. Purpose and expected outcomes ofthe clinical

education of learners

2. Overview ofthe school curriculum as itrelatesto

the clinical experience

3. Skillsthat can be expected of learners entering

the preceptorship

4. Principles ofadult learning5. Common errors made bystudentsand common

misconceptions.


19/77

6. Rolesand responsibilities ofthe preceptor,the

educator,and the student

7. Interactions with learnersand relationship with

educators

8. Introduction to course syllabi

9. Planning learning experiences

10. Clinical teaching strategies


20/77

11. Overview of evaluation proceduresand

measuring instruments

12. Legal implications of working with learners


21/77


22/77

` Ifthe educational institution isNOT part ofa

health care system,Clinical AgencySite must be

chosen.

` Ifthe educatoris part ofthe staff developmentdepartment, clinical units within the agencymust

still be identified.

` Selection of clinical sites must be done

methodically.


23/77

Availability of Role Models

An often overlooked aspect of learning.


24/77

1. Educatorsrole to gatherdatathat will lead to

data contract

2. Educatorshould set up a meeting once

arrangementshave been made forclinical units3. Afterpreparationshave been made, educator

muststart with final preparations which include

making specific assignments forlearners.


25/77

` Conducted an investigation ofthe criteria used by

educators in selecting students clinical

assignments

` Three most important criteria:1. Students individual learning needs

2. Patients nursing care needs

3. Matching of patients needs withstudents learningneeds


26/77

` Described anothermethod of pairing students on

the same assignment but in overlapping shifts


27/77


28/77


29/77

` Planning of patient care continues

` Tentative nursing diagnosesare discussed

`

Possible nursing interventionsare discussed` May be use to help learners organize theirday &

prioritize the care they must give.


30/77

` Structure mayvarya great deal

` Variety ofteaching methods can be used:

a. Scavenger hunt help orient learnersto the clinical

unit

b. Combinations of strategies (demonstration with

explanation,asking and answering questions,

coaching techniques)


31/77

` QUESTIONING Assist learners in developing problem-solving and

decision-making skills

` COACHING Help learnersset goals forthemselves

Guide through psychomotorskillsand refine thinking

processes


32/77

` Student learning (Baccalaureate students)

issignificantlyrelated to preceptor

behaviors


33/77

A. Observation assignments

Used routinely in clinical education

Supported by social cognitive theory


34/77

B.Nursing Rounds

A pedagogical strategy

Involvesa group of learnersand theirinstructor

visiting patientsto whom the learnersare assigned

Assigned students interact withthe patient


35/77

B.Nursing Rounds

PURPOSES

To expose learnersto additional nursing

situations

To encourage them to consult each otherin

planning and evaluating care

To provide many opportunitiesto apply

classroom theoryto patientsituations

To compare and contrast patient care


36/77

C.Shift Report

A unique time forlearning (Yurkovich & Smyer, 1998)

A way forstudentsto learn the uniqueness of

nursing communication and the means of

professional socialization


37/77

D.Technology Use

Bothateaching strategyand a learning resource

Two emerging forms oftechnology used in clinical

field

Personal Digital Assistant/Hand-held

Computer

Nightingale TrackerSystem


38/77

` Designed formultiple functions(information storage,

retrieval and input, electronic mail)

` Enablesstudentsto accesstextbooks, drug references,

infectious disease information, immunization guidelines,medical language translations,standardized nursing care

plans,and medication calculators

` Strength: abilityto provide instant information atthe point

of care.` Help change the focus of learning from memorization to

accessing information when needed


39/77

` Applies basic handheld computerfunctionsto communitybased clinical nursing education.

` Developed byFuld Institute forTechnology in Nursing

Education (FITNE)` Includesa dedicated computerserverand a customized

PDA device that providesthe students in the patientshomewith dataand communication abilities

` Enablesthe studentto access clinical data in the home,tospeak to the faculty memberviatelephone line,and todocument care throughtouchscreen menus using theOmaha PatientCare Record System


40/77

E.Learning Contract

Written agreement between instructor/supervisor

and learnerwhich include:

Learning objectives

Learning resourcesto achieve the objective

Learning experiences planned

Time line

Evaluation plan


41/77

E.Learning Contract

Learner Role - To develop a learning contract with

the instructorbased on his own learning needs,

interest,and skills.

Instructor Role - To consult withthe learnerin the

development of objectives,to make resources

available,and to validate achievements/arranged

foritto be validated bysomeone else


42/77

LEARNINGOBJECTIVES

RESOURCESNEEDED

ACTIVITIESANDACCOMPLISHMENTS

MEANS OFVALIDATION

Improved

communication

skills with familiesof dying patients

Literature search

Analyze the essential

elements of

communication in this

scenario

Instructorwill

evaluate the

therapeutic

adequacy ofthe

conversationAssignment of

terminally ill

patients

Aftertalking withfamilies,recount the

conversation withthe

preceptor

Correctly perform

colostomy care

Procedure

manual

Perform the skill in the

SkillsLaboratory

Instructorwill

evaluate

performancePractice in Skills

Laboratory Perform the skill on the

patient withsupervision

ofthe preceptor

Preceptorwill

evaluate

performance with

patient

Assignmentto a

patient with

colostomy


43/77


44/77

PURPOSES

Gaining meaning from experiences

Making connections between theoryand practice

Appreciating others perspectives

Developing critical-thinking skills

Documenting the science of nursing

Way of coping withhighly emotional/traumatic incidents in

professional life


45/77

TYPES

1. Directed rn ls

Descri e a critical e entt attook lace inclinical days

Importanceofe ent/case

at is learned fromt e situation/nursingt eory helped inunderstanding hat happened

hat is toedonedifferently henthesituation is encountered again


46/77

TYPES

2. Critical Thinking Papers

Asksstudentsto identify key problems/events

in caring forthe patientto identify underlyingassumptionsthatthe patient/student bringsto

the situation,the meaning ofthese issues for

the patient/student


47/77

TYPES

3. Reflective Practice

Involves looking back overwhathappened in

practice in an effortto improve orencourage

professional growth


48/77

` USES:

1. Pointing outapplication oftheoryto practice

2. Analyzing the different waythe patients withsimilar

illnesses differin theirresponse to nursing care andtreatment

3. Group problem-solving

4. Evaluating nursing care


49/77

` USES:

5. Have each learnerreport what was done forhis/her

patient

6. Meansto help socialize learners into the world ofnursing and give anotheropportunityto help them

think like a nurse


50/77

` Pointsto Remember

1. Have objectives in mind forthe session

2. Let learnerstake the lead in determining of much of

the direction ofthe conference

3. Begin withjust one ortwo learners experience with

the otherparticipantsasking questionsand

contributing to the discussion by comparing and

contrasting theirown experiences

4. The primarytopic forthe discussion should fit in with

the objectives


51/77


52/77


53/77

` Least favorite task

` Need feedback and judgment oftheirwork

` How theyare doing at one level before

progressing to the next` Determine how well theyare meeting objectives

and to certifythattheyare safe practitioners


54/77

` Formative OrSummative

` Norm Reference OrCriterion Reference

` Type Of Grading System

` BehaviorsTo Be Evaluated


55/77

FORMATIVE SUMMATIVE

Ongoing feedback given to the

learnerthroughoutthe learning

experience

Strengthsand weaknesses

Prevents learners from being

surprised and unprepared

Non-graded

Summary evaluation given atthe

end ofthe learning experience

Assess whetherthe learnerhas

achieve the objectivesand isready

to move on to the next experience

Graded


56/77

` Always involvessummative evaluation

` May involve formative evaluation

` Learnershave the rightto know how theyare

progressing and educators can protectthemselvesagainst charges

` May be given on an incident, daily, orweekly basis


57/77

ORAL orWRITTEN

` Written Feedback often move valuable because

learners can take time to read and absorb

information

ANECDOTAL RECORDS/CLINICAL PROGRESS

NOTES

` Written Formative Evaluation notes


58/77

` Recording observations of whatthe learnersays

ordoes including the date,a description ofthe

incidentand comments

` Longitudinal view of learners progress

` Keeping detailed weeklyrecords ofa learners

clinical experience istime-consuming yet without

such data, formative orsummative evaluation is

dependent on the instructors memory


59/77

NORM REFERENCED CRITERION REFERENCED

A learneris compared to a

reference group of learners either

those on the same cohort orin a

norm group

Relative to group performance

Students behavioris characterized

asbelow average,average, or

above average

Unless evaluation tool isspecific

about whataverage behaviorsare

like the process may be unreliable

Compares learnerwitha well

defined performance criteria

Criterion-referenced tool -defines

the behaviorexpected at each levelof performance

Fairer

Learnersare informed ofthe

behaviors expected ofthem to

pass

Grading system is lesssubjective


60/77

A. Assigning lettergrades

B. Using a pass/fail or

satisfactory/unsatisfactoryapproach


61/77

` Clinical gradesshould always be given on a

pass/fail orsatisfactory/unsatisfactory basissince

Human behaviorofany description is muchtoo

complex to permitsuch fine discriminations

` Lettergradesare impractical and unfair


62/77

` When lettergradesare given there isatendency

toward grade inflation because ofthe subjectivity

involved and difficulty in making fine grading

distinctions of observed behavior


63/77

` Theory & Clinical Practice are combined in one

course

` Lettergradesare given fortheory

`

Pass/Fail are given forclinical component` Total course grade = Theory grade + PassClinical

Work

` Fail = Theory Grade + Fail Clinical Work


64/77

` Pointat whichstudentsshould be graded for

clinical work:

x When theyare teaching

x

When theyare formally evaluating and gradingperformance


65/77


66/77

` Areas of Performance

Use of nursing process

Use ofhealth-promoting strategies

Psychomotorskills

Organization of care

Maintaining patientsafety

Abilityto provide rationale fornursing care


67/77

` Areas of Performance

Abilityto individualize care planning and intervention

Therapeutic communication

Abilityto work witha professional team

Professional behaviorssuchas following policies, being

on time, maintaining confidentialityand being

accountable forones own actions

Written documentation of care


68/77

` Direct observation by instructors produces most ofthe data

` Learnerself evaluation isa good source of data,but is neveran easytask

` Data mayalso be gathered from agencystaffandformal evaluation isseldom sought from staffmembers unlesstheyare serving as preceptors

` Written work and college laboratory work

performed bythe learnercan be evaluated andincorporated as part ofthe clinical grade


69/77

` Conferencesshould be held withthe learnerat

leasthalfwaythroughand then atthe end ofthe

evaluation period

` The more specific and concrete the educatoris

the more the learnerwill benefit from the

evaluation.


70/77

Anna,you have great difficulty implementing thenursing process. You need to develop skill in selecting

appropriate nursing interventions foryourpatients.

Anna, in planning care foryourpatients,you have haddifficulty in selecting the appropriate interventionsthat

meettheirspecific needs.Forexample, when youcared forPaul the 10-yearold with cerebral palsy,youtried to involve him in a game that was inappropriate

forsomeone withhis level of disability.


71/77


72/77

` These instrumentsshould meetthe followingspecifications:

The items derive from the course orunit objective

The items must be measurable in some way, it mustbe possible to collectsubstantiating data

The itemsand instructions foruse should be cleartoall who must use the tool

The tool should be practical in design and length

The tool must be valid and reliable


73/77

` Three interesting toolsthatappearin the literature

thathave been tested forreliabilityand validity

are:

1. The Rating Scales(Bondy,1983-84)2. The CommunityFamilyNursing Clinical Evaluation Tool

(Hawranik,2000)

3. The Clinical Evaluation Tool (Krichbaum, Rowan,

Duckett, Ryden,Savik,1994)


74/77

TOOLS DESCRIPTION

FIVE POINTRATING SCALE

(Bondy)

Reflects criterion-referenced levels of competency Can be applied to any clinical setting

HAWRANIKS

TOOL

Contains items on the nursing process, professional

growthand leadership

Used in mosthome-healthsettings

CLINICAL

EVALUATION

TOOL

(Krichbaum, et al)

Generic

Covers items on health promotion, nursing process,

safety,scientific knowledge, multicultural care,

therapeutic relationships,and professional behavior


75/77

` A summative evaluation of clinical

performance may determine a nursing

studentsabilityto stay in nursing school,arefreshernurses freedom to reenterthe

profession, orastaff nurse orientees

likelihood ofholding a position in anorganization.


76/77

` Albao,Chissel

` Espinosa,Mariz Sherine

` Galanza, Rachel Joy

` Lagasca,Mere

` Milla,Kimberly

` Miralles,Doreen

` Palompon,Ma. Rafaela

` Santos,Sheanne Lou

BSN 3y3-2


77/77

clinical teaching grp5 3y3-2

Documents