“Strategies for Effective Clinical Teaching and Evaluation”

(Introduction – Part 1)

Patricia A. Mahoney, MSN, RN, CNE

This presentation is a portion of one presented at ASUCONHI May 2, 2007Used with permission of P. A. Mahoney – All rights reserved

Objectives

• Analyze the relationship between clinical learning experiences, characteristics of learners and site, and the clinical evaluation process.

• Appreciate that a multiplicity of evaluation strategies can provide a complete picture of learners' abilities.

• Relate course goals, clinical learning objectives, and clinical activities to the evaluation process.

• Propose solutions to common clinical teaching and evaluation problems.

The word "curriculum" comes from a Latin word meaning, to run a race.

Might this explain the hectic pace of nursing programs?

Gitlin and Smyth (1989) comment that the word evaluation comes from its Latin origin meaning 'to strengthen' or ‘to empower’

The teacher's role as an assessor is an important one

Students can walk away from bad teaching, suggests Boud (1990), but they are unable to do so with regard to assessment.

SOME THINGS TO CONSIDER

• Clinical teaching is so difficult• Acuity of clients• Lack of clinical experiences• Variety of needs of learners• So many things to consider

Teaching to all Learning Domains• COGNITIVECOGNITIVE – understanding, knowing

• AFFECTIVEAFFECTIVE - attitudes, motivation, feelings and values. The expression of these often involves statements of opinions, beliefs, or an assessment of worth

• PSYCHOMOTORPSYCHOMOTOR – learners might physically do skills

Transfer knowledge from classroom to practice

• Problem Solving• Clinical Judgement• Management• Prioritizing• Documentation• Skills

– Psychomotor– interpersonal

• Cultural Competence• Attitudes & Values

– Client advocacy– Professionalism

LEARNER’S STRESS

• Numerous studies that note the stress of the clinical learner

– Stress increased as they advanced in program (Oermann & Standfest,1997)

– Clinical faculty may contribute to stress (Pagana,1988) (Oermann,1996)

As a Clinical Educator Need to• Be sure that the learning experience meets

desired outcomes• Insure that learners know requirements and

have required clinical skills• Be a resource to learners as well as a role

model (communication with client & family, perform skill)

• Evaluate learners and keep them informed of performance

Factors Influencing Learners to be Dishonest

• Stress, anxiety, expectation for success

• Valuing success at any cost• Competitiveness – ‘everyone cheats’• Large clinical groups, acute clients –

lack of time• Instill concept that ‘good nurses do

not make mistakes’• Faculty have difficulty in confronting

learners when learner is not meeting objectives

Let’s see if I can help you pull some innovative ideas out of the hat to be a more effective clinical teacher and evaluator

Base change on evidence-based nursing education practice or best practice

Evidence Based Nursing (EBN)

• nurses make clinical decisions using the best available research evidence, their clinical expertise and patient preferences.

Evidence-Based Teaching Practice(EBTP)

• Applying to teaching practice what has been learned from nursing education research

• “ ….EBTP has become the standard for assuring quality in teaching, helping us understand what works best in creating learning environments for learners in the classroom, in the lab, in the clinical area, or on-line.”

• JACOBSON, L. Shaping the Future. Spring 2004

Assessment in pre-licensure nursing education

Murray et. al., (1996) suggested, "Given the importance of assessment of learner performance in university teaching and in learners' lives and careers, instructors are responsible for taking adequate steps to ensure that assessment of learners is valid, open, fair, and congruent with course objectives."

Cognitive Domain

Currently the primary means of assessing cognitive nursing knowledge is via multi-choice items

Utilizing Analysis level Multiple-Choice Items

• Post clinical-conference– Have students look at a patient’s electrolytes and

compare in conference “Which would be your priority?”

• Online discussion– Students can discuss online rather than at end of

long clinical day

Analysis-Level ItemThe nurse is discussing infection control guidelines. The nurse

would be correct to say that a. ”A gown should be worn when taking the blood pressure

of a client with a methicillin-resistant Staphylococcus aureus (MRSA) wound infection.”*

b. “The door should be kept closed to the room of a client with a Clostridium difficile infection.”

c. “Disposable dishes should be provided for a client with Hepatitis B infection.”

d. “A surgical mask should be worn when caring for a client with pulmonary tuberculosis.”

Analysis-Level Item The nurse should intervene if the nurse notes a staff

membera. elevating the head of the bed of a client who had a

total knee replacementb. assisting a client with lung cancer who has just

returned from external radiation therapy to ambulate in the hall

c. allowing a client who is neutropenic to eat a cookie brought in by a visitor

d. wearing a disposable mask when giving an IV medication to a client with a methicillin-resistant

Staphylococcus aureus wound infection *

Multiple-response itemThe nurse is caring for a client who has a wound infected with

methicillin-resistant Staphylococcus aureus. Which of the following infection control precautions should the nurse take?

Wear a protective gown when entering the client’s roomPut on a particular respirator mask when administering

medications to the client Wear gloves when delivering the client’s meal tray Ask the client’s visitors to wear a surgical mask when in the

client’s roomWear sterile gloves when removing the client’s wound dressing Put on a face shield before irrigating the client’s wound

• The nurse is caring for a client in labor who has external fetal monitoring. The nurse notes the contraction pattern seen above. The nurse should

A. Turn the client on her left sideB. Increase the flow rate of the IVC. Notify the primary health care providerD. Continue to monitor the client *

Multiple-response itemGood way to use

Alternative Item FormatHelps promote critical

thinkingGives Learners

opportunity to see what analysis level items are like before seeing on exam

Difficult to grade using scantron if used on a traditional exam

Time to create these items

Not concerned about security so use in multiple groups