Chapter 13 (Heduc)

7/28/2019 Chapter 13 (Heduc)

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4 PICS 1WORD


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A C V I L I C N R


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T R A H C N G F E I L


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C H A P T E R 1 3

C L I N I C A L

T E A C H I N G


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Clinical teaching is a complex enterprise. It isso complex that few researchers have tackled theissues that need to be addressed. Little of our presentclinical teaching is grounded in research but instead isgrounded in tradition, common sense, and feasibility.We do not really know, for example, how many hoursof clinical experience are needed for undergraduate

nursing education, graduate education, for orientationof new staff nurses, or for teaching ancillary staff.

INTRODUCTION OF CLINICAL TEACHING


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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 howmuch supervision is actually needed, or whether quantityof 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) .


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It is the complexity of the clinical setting that makesresearch so difficult.

There are so many variables that are difficult tocontrol:

The severity of patient illness Widely varying settings

Differences in nursing and educational personnel Variable staffing patterns

Varied student motivation and preparation


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

Until there is more research to guide us, we mustfunction with the empirical evidence that we have andbase our actions on the collective wisdom brought to

us by more than a century of recorded clinicalteaching experiences.


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QUESTIONS?

WHAT kind of learning takes place in the clinical setting?

WHAT are the real purposes behind having learners spendtime clinical agencies?

PURPOSE OF THE CLINICAL

LABORATORY


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I. It seems obvious to expect theory andpractice to come together in the clinicallaboratory.

Learners should have the opportunity to apply thetheoretical concepts, rules, and propositions they havelearned in the classroom.


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They are able to build on the cognitive schemata thatdeveloped in the classroom as they add real-lifeapplication.

A proposition such as, Frequent change in body positionhelps prevent decubitus ulcer can be tested with avariety of a patients to see how and under what conditions it holds true.


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Learners not only test the proposition but learn when toapply it, and they practice the techniques of implementations(Dunn, Ehrich, Mylons, & Hansford,

2000).

The proposition becomes more than a memorize fact; ittakes on life and meaning as it applied to real patients.


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Learners see how this one piece of information fits intothe whole picture of patient care in a more realistic waythan they ever could in a classroom.


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II. It is in the clinical laboratory that manyskills are perfected.

Complex psychomotor skills may be practiced initiallyin a skills laboratory, but to be mastered, they oftenrequire a live than a simulated situation.


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For i.e : learners can practice colostomy care endlessly ina simulation lab, but they will never be experts until theywork with variety of patients who have different stomas

and different skin conditions and contours, using variedequipment.


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Infante(1985), in her classic study of the clinicallaboratory, noted that the opportunity forobservation in an essential element of clinicallearning.

The skill of observation can be taught insimulated situations, but learners need repeatedexperience of observing patients in changingcircumstances so that they know what to look for inchanging situations.


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Problem -solving, decision-making, andcritical thinking skills are also refined in theclinical laboratory. Students should learn the basicsof these skills before entering the clinical setting.

The ultimate practice using these cognitive skillsunder the guidance of an educator and otherprofessional staff in real-life settings.(Roche, 2002)


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Learners also gain organization and timemanagement skills in clinical settings(Oermann & Gaberson, 2007).

Again, no simulation can prepare students as thoroughlyas the live laboratory when it comes to organization. It isin real clinical practice, with the help of the instructor,that learners find out how to organize all the data


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that bombards them, all the request made of them, and allthe intellectual and psychomotor required of them.

They learn to set priorities by having repeated practice indoing so in complex situations.

It is in the clinical laboratory that the skill of delegationis practiced and truly learned.


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Culturally competence is a skill that can be learned wellin the clinical labortory(Ormann & Gaberson, 2002).

Learners may know a lot of theory about how to approachclients from different cultures, but they becomecomfortable and more expert in cross-cultural care whenthey care for culturally diverse clients.


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The educator may plan student assignment with culturalexpose in mind.


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III. Finally, learners of nursing becomesocialize in the clinical laboratory(Chan,2002).

They learn about which behaviors and values areprofessionally acceptable or unacceptable.

They learn about professional responsibility.


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The clinical laboratory is a place where consequences forones actions are readily apparent and accountability isdemanded.

The knowledge and skills students have learned becomeintegrated 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.


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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)


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


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For all of these reasons, learners need spend time inclinical settings, and educators need to learn how best touse that time.


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As Infante(1985) points out clearly, the clinical laboratoryhas historically been misused at all levels of nursingeducation.

Nursing students, for instance, have been sent tothe clinical setting to gain work experience ratherthan to achieve educational objectives .

MISUSE OF THE CLINICAL

LABORATORY


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Clinical objectives should be clear and specific as thosefor the classroom or skills laboratory.

Objectives should focus on the application of knowledgeand skills more than on learning the future employee role.


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Misuse of the clinical setting also occurs when novicesare 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 situationswith relatively high levels of risk.


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They should provide care in circumstances for which theyare well qualified and for which they have had preliminaryguidance.

Objectives for beginning learners should be quite limited,focusing on specific processes of care.


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It is only after specific components of care have beenpracticed that the learner is a able to integrate previouslearning and provide total care.


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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 .


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In this situation where this belief is true, learners area ata real disadvantage, because they probably cannot dotheir best job of learning when they know they have to

simultaneously perform for an evaluation.

Evaluation of clinical performances must be separatedfrom practice time.


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THANKS FOR LENDINGYOUR EARS!

Denise May M. Lau-anBSN-IIB

Justine Lailanie C. Guinto

HEALTH EDUCATION

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Chapter 13 (Heduc)