Clinical Learning Aspects In Nursing Education
Whats is Clinical Teaching
The definition of clinical teaching
has evolved over the years. Clinical teaching is a time-limited process,
whereby the teacher and student develop a partnership within a shared
environment in such a way that the teacher's primary, operational frame of reference
is maintained as the legitimate means for affecting the student's behavior
toward intended purposes (White & Ewan, 2002) While many of these core
aspects remain active today, progress in the area of clinical teaching in
nursing has led to expansion. of this definition to include aspects such as
clinical preceptorship, peer learning dyads, and simulation (Sims-Giddens,
Helton, & Hope, 2010).
Implementations of Educational Aspects In Clinical Areas
When considering the application of
clinical teaching in the education of nurses and their future nursing practice,
several themes emerge as being important. Clinical teaching can occur in any
setting where a nurse. is actively providing care for a patient. The primary
settings used in the clinical education of nurses include acute care settings,
community-based settings, clinic settings, and simulation settings. In each of
these settings, an environment-specific approach to clinical education can be
provided. The methods of clinical education that are provided across these
settings include preceptorship. education-based units, peer education teams,
and simulation support.
Clinical nursing education in the acute care setting often encompasses a faculty member taking a group of 8 to 10 nursing students into the acute care setting after a patient has been assigned to the student the day before. Clinical pre-planning often occurs in the setting where the student gains insight and knowledge the day before the clinical experience and develops a plan of care for the patient in advance. Preceptorship is also used in the acute care setting.
Student nurses can be
assigned to a preceptor, and the student and the preceptor develop a schedule
for clinical experiences for the student. Education based units are emerging in
the acute care setting where a unit is identified as an education unit and the
nurses in this unit receive training in their role as a preceptor or a clinical
support nurse. These units have a strong focus on clinical education for
nursing students, and the environment is often a student-friendly setting that
supports research as a method to enhance learning (Balakas & Sparks, 2010).
In the community-based setting, nursing students most often gain their clinical experience through the use of preceptors who agree to develop a relationship with the educational institution where they will precept students during their care of patients in the community. Most often, these agencies are home care or hospice affiliated. The clinic setting is considered a unique environment within the community experience in general but with many overlapping experiences found in the traditional community setting.
Many clinic settings are located near acute care
facilities and provide care to patients who mainly remain in the community
after the clinic visit but may be admitted to the acute care setting (Balakas
& Sparks, 2010). By definition, the simulation experience could occur in
any of the available clinical settings if the appropriate simulation equipment
were available. Most often, this is accomplished through the use of a trained
faculty member who maintains the simulation equipment in a central location.
The simulation experiences can be tailored to address multiple care situations
that could occur in any of the settings, promoting critical thinking skills
(Goodstone et al. al, 2013).
Purposes of Clinical Educational Aspects
The literature, as it relates to clinical nursing education, is considered weaker when compared to clinical nursing research (Schneider, Nicholas, & Kurrus, 2013). The literature supports the use of clinical preceptors as an effective means for supporting clinical nursing education (Hendricks, Wallace, Narwold, Guy, & Wallace, 2013). The use of clinical peer dyads, where students work in peer groups with senior-level students mentoring lower-level students, is also supported as an effective method for clinical instruction (Austria, Baraki, & Doig, 2012; Christiansen & Bell, 2010).
Clinical peer data show positive results from both the student and patient perspectives, Simulation experiences for nursing students, including standardized patient encounters, are supported in the literature as a supplementary experience for students and can help improve patient safety and enhance the students' critical thinking skills (Kaplan & Lira, 2010; Pacs, 2008) Ongoing concerns documented in the literature that have had an impact on clinical teaching include nursing shortage, lack of clinical space, restrictions on the number of students per faculty or per unit, and competition with other schools of nursing (Benner, Stuphen, Leonard, & Day, 2010).
Also supported in the literature would be the utilization of clinical
staff nurses who have joint appointments with schools of nursing to improve
access to clinical specialists. The utilization of staff nurses who are not
jointly hired is also supported, with the majority of these nurses receiving
additional training on clinical teaching (Kowalski et al. 2007, Seldomridge
& Walsh, 2006). The literature supports the development of clinical
partnerships between schools of nursing and units in acute care settings that
are designated as educational units (Moscato, Nishioka, & Coc, 2013).
Overall, the literature supports the need for development and utilization of
unique clinical learning opportunities to meet the growing demands for nurses.
Contribution of Clinical Learning In Students Education
In nursing education, while classroom and simulation experiences make essential contributions to students' knowledge and skill development, the clinical experience remains the cornerstone of nursing education (Luhanga, Billay, Grundy, Myrick, & Yonge, 2010). The culture of evidence-based practice should start in the clinical teaching setting and continue on in clinical nursing practice (Balakas & Sparks, 2010). Continued growth in the quantity and quality of nursing research focused on nursing education will help to continue to address the clinical teaching needs of future nursing students.
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