Concept of Conference General Description In Nursing Education

Afza.Malik GDA

Nursing Education and Concept of Conference General Description

Concept of Conference General Description In Nursing Education

Concept of Conference General Description In Nursing Education, Implementation of Conference General Description Concept In Nursing Education.

Concept of Conference General Description In Nursing Education

    Students often focus solely on their assigned client or clients. In relation to other unit activities and to the experiences of other students, they sometimes seem to have blinders on. The V-8 Conference allows students to share experiences about their clients and to learn from each other. 

    Essentially, the V-8 Conference is a group-experienced Ah-hah Journal. Students share information that’s newly learned, surprising, never thought about, or not previously known. The strategy gets its name from a familiar vegetable drink. The slogan “Wow, I could have had a V-8!” expresses an Ah-hah. 

   V-8 Conferences give students an opportunity to discuss their experiences and learn vicariously about clients or clinical issues. Keeping a 5-minute time frame, yet also allowing informal discussion, ensures that the entire group participates. 

    The V-8 Conference may simply evolve in the direction of the conversation or may have a specific focus area selected by the group or the instructor. Students and orientees benefit greatly by hearing about the Ah-hahs of every member of the group Preparation and Equipment Little preparation is required with this strategy. 

    In fact, once the conversation is under way, you should provide very little input, allowing the students to lead the discussion. You may want to look over your available clinical days and select a focus to provide a direction for each V-8 Conference. As a paediatric nursing instructor, I have two major goals in mind for clinical rotations. 

    I hope that, in addition to learning safe, skilled, and organized clinical care, my students will embrace the concepts of family cantered care and developmental care. Because these are such high priorities of mine, I use two V-8 Conferences, one to address each issue. 

    I present the topic at the beginning. Then the students discuss their personal observations and related client information in terms of their experiences. The assigned focus guides them in asking questions and relating facets of client care.

Implementation of Conference General Description Concept In Nursing Education

    You can assign a discussion group leader for the V-8 Conference or allow the leader to emerge naturally. Discussion leaders can be rotated to ensure equal participation and leadership experiences.

    A few possible topics are:

    Family cantered care

    Organizational skills needed to be a nurse

    End-of-life care

    Managing the critically ill client

    Gearing care toward a client’s developmental, not chronological, age

    Clinical research protocols

    Ethical issues in the clinical area

    Delegation and working with unlicensed assistive personnel    

    Staffing and scheduling    

    Use V-8 Conferences as part of the debriefing process during nursing orientation. Ask students to share their experiences and discuss common issues, frustrations, positive experiences, and areas for growth. Novice nurses may be relieved to learn that others feel the same way or confront similar stressors.

    Use V-8 Conferences as times to reinforce teamwork, collaboration, collegiality, mutual support, and learning. Foster problem solving, decision-making, and critical thinking skills. Make sure the V-8 Conference doesn’t become a complaint session, take on a competitive edge, or become a dreaded part of the clinical day.    

    Students should see the V-8 Conference as their opportunity to learn and to talk. Intervene only if the conversation is inappropriate or contrary to the objectives of the clinical rotation.

    Conferences may be held before, during, or after clinical or orientation days, or during clinical meetings held at other times.

    Pre-conferences may take place before client care, when students are apprehensive, or after a hard shift, when they’re exhausted. Either way, conferences need to be fun, creative, and informative. Encourage students to enjoy this time and see the value of sharing and learning together.

    Provide snacks or have a V-8 Conference during a meal time to foster a sharing atmosphere. Documentation Case Study General Description the Documentation Case Study is one of my favorite clinical strategies. One of the greatest challenges for a nursing student or new employee is to master an agency’s unique documentation procedures. 

    Each facility has slightly different forms, expectations, and policies. In addition, different units, groups, or areas may differ subtly in what they mean by “note,” “charting by exception,” or “keeping up with your charting.” Accrediting agencies have certain parameters for safe and legal documentation, but documentation guidelines may be interpreted differently within those constraints. 

    The Documentation Case Study was developed in response to these challenges. The case study is completed during clinical orientation and allows students to practice documentation skills before recording data in an actual medical record. 

    Case Study is one strategy that takes a long time to develop. Once written, though, it can be used again and again. The strategy also makes it much easier to teach and learn agency documentation. First, you need to acquire the flow sheets, documentation policies, and other forms from the agency. 

    Develop a case study and take the client through a care shift. As the shift proceeds, invent little detours that can present a documentation challenges. Develop the case with assessments, clinical information, interventions, and outcomes, all of which need to be documented. 

    You can be as creative as you like, use this case and appropriate forms to construct an activity best conducted during the orientation phase of learning. Example of the Strategy at Work Here is the form I developed. Feel free to adapt it for your personal needs.

 Use the Documentation Case Study early in orientation to teach important documentation skills. This exercise is a good way to reinforce the military 24-hour clock often used in clinical agencies.

    Have the students fill out the forms in pairs or trios, allowing for teamwork and team building. You may collect this form or allow students to keep it to use as a guide for future documentation.

    This exercise allows students to practice and make mistakes safely. The Documentation Case Study prevents a common error of new nurses documenting just as the nurse before them did. Students and new nurses need to see the importance of valid documentation that reflects educated, thorough assessments and interventions.

    For observational experiences such as the operating room, post anesthesia care unit, intensive care units, and emergency department, obtain documentation forms and flow sheets to discuss with students. These will help to clarify the documentation processes in the different areas. 

    Clinical Questioning General Description Questioning students in the clinical area is a true art. It’s not easy to catch up with eight to 12 nursing students or orientees, and difficult to assess their progress and preparation for clinical work. 

    Clinical Questioning is a valuable tool you can use to determine a new nurse’s readiness for increased challenge, safety in the clinical setting, strengths, and areas of future growth. This strategy is designed for the rapid assessment of individual progress. Alfaro Lefevre5 discussed the need for students to attend to three concepts in clinical thinking:

1. Thinking ahead (in preparation for the clinical experience)

2. Thinking in action (concurrently with client care)

3. Thinking back (reflecting on care delivered) 

    These concepts provide a framework for Clinical Questioning. Preparation and Equipment Sage nursing instructors in both practice and academic settings can determine quickly when students or nurses are prepared, knowledgeable, and safe in the clinical area. 

    They ask a few basic questions, honing in on clinical decision-making, assessment, and critical thinking. As a clinical instructor, you need several of these questions “up your sleeve” in today’s high-acuity health-care environments. Select and adapt the questions to the clinical unit or specialty and to your own style. 

    Write them on an index card and carry it with you, tape to a clipboard, or memorize it. Have the questions available before or during client care. Use these questions readily with students to ensure their eligibility to provide client care. 

    Tell your students that there may be more than one correct answer; this knowledge fosters critical thinking and creative problem-solving. Example of the Strategy at Work Develop your own questions or adapt these: What will you do today to make a difference in the life of this client? What will you do to make your client better today? What did you, or what will you, spend the most time doing today? 

    What one thing will you do differently the next time you take care of your client? Why is your client on that medication? How will you know the medication or treatment was successful? What complications are you worried about with this client? What signs and symptoms would indicate a deterioration of the client’s condition? 

    How did you prepare to take care of your client? What do you think concerns your client the most? What information do you need to get from the client record as soon as you assume his or her care? What three things that you heard in report will be priorities for you during your shift? 

    What three things will be most important to report to the staff when we leave? What procedures and interventions did you witness that can be done in other ways? What aspect of the procedure would be different?

    Students generally find Clinical Questioning threatening and can feel judged. If you develop your questions in a nurturing, supportive manner, students will find it easier to express themselves articulately. Try to present Clinical Questioning as an opportunity for students to learn and demonstrate their level of knowledge.

    Ensure that students know your expectations for clinical preparation. Be clear about how much they should know regarding the disease process, medications, care plan, and client specifics. Emphasize that preparation for clinical experience is a professional expectation, not an option, and that it shows the nursing instructor that the student is ready to provide care. 

    Make sure students know when to expect Clinical Questioning and how it will take place. A colleague of mine announces a set time before which students may solicit information from the client and staff, consult the medical record, and research questions. After that time, the student should be able to answer the instructor’s Clinical Questions.

    Provide your Clinical Questions in the course materials or syllabus to make students aware of potential questions while they’re preparing. Use Clinical Questioning to assess completion of orientation, achievement of objectives, and safety in the clinical area. 

    Provide students with positive and negative, as well as formative and summative, information. Balancing teaching   and evaluation can be one of the great challenges of clinical teaching. Clinical Questioning should be part of both processes.

    Use Clinical Questioning topics to shape student evaluations. Have students self evaluate their performance using these questions as the basis for knowledge, preparation, and critical thinking. If you use objective evaluation tools to substantiate clinical performance, the focus stays on clinical course objectives and experiences during rotation.

    Make sure you don’t single out any students during Clinical Questioning. The tendency is to assess weaker students repeatedly which can make them feel “picked on.” Offer the same amount of feedback to all your students, although its composition can differ drastically from one student to another. 

    Use the Book in Clinical General Description In clinical supervision, it’s hard to keep up with what students are learning or have learned in didactic and previous clinical courses. Students sometimes deny experience or knowledge. They may feel overwhelmed, not wish to be held accountable, or truly forget some of the vast amount of information they’ve learned or heard in nursing school. 

    Use the Book in Clinical allows instructors, students, and orientees to consider what’s learned in class and how it applies to the clinical area. Students bring their texts to the clinical area, look up needed information, and base conferences on their texts and other resources. 

    This strategy also fosters inquiry skills, in which nurses actively research and investigate topics rather than simply learn by rote or authority. Preparation and Equipment Faculty who teach both clinical and didactic courses have a head start. Not only do they know what’s being taught in class, they can help students apply that information to their clients. 

    Part time or exclusively clinical faculty often need to pursue such information themselves to know what’s going on in the classroom. The same is true for agency staff development faculty embarking on creating a valuable orientation for a new employee. 

    All instructors should attend to the logic of the curriculum and think about how their courses fit into the total program objectives. Informal conversation with other faculty can clarify what clinical objectives, psychomotor skills, organizational abilities, and assessments students have mastered in previous courses. 

    Course outlines and syllabi are useful. All faculty should have a copy of the textbook that corresponds to each clinical area. The text will show what students have read for class and how they’re preparing for clinical rotations. Example of the Strategy at Work I Use the Book in Clinical continuously rather than as an isolated event. 

    Clinical preparation is of paramount importance in safe client care. By knowing what’s in their textbooks and remembering what has been discussed in their didactic classes, students can be held accountable and encouraged to apply their knowledge clinically. As classroom information grows more complex and students begin to care for high-acuity clients, it’s imperative for them to make that connection.

    Before their clinical experience, students and orientees can present a client’s medical diagnosis and nursing priorities using their textbook preparation. The presentation, which should be kept brief, may be done during pre-conference time.

    Staff development instructors may find it helpful to consult local nursing programs. They can provide valuable information about their curricula and show how students have learned from clinical experience at their agency.

    During conference, students can discuss what they learned in class about specific conditions, and can apply their knowledge to each other’s clients. Your role is to make sure the information is valid and appropriate.

    Students have difficulty with the concepts of multiple diagnoses, comorbidities, and conflicting priorities brought on by severe health issues. They often expect a client to have only one diagnosis and become flustered with the complexity of the client’s actual condition. Use the Book in Clinical helps students to unravel information and apply it to individual clients and their needs.

    Have both new and seasoned nurses peruse the textbooks on the unit. This tactic reminds them of lessons learned in nursing school and changes that may have occurred since that time. 

    Reflection on their clinical learning can help them continue to learn and grow. Sharing textbook knowledge and experience can inspire discussion about practice issues, leading to Research Moments and Clinical Area Questioning Research at Work.

    Use case studies, critical thinking exercises, and test questions in nursing texts to connect didactic learning with clinical practice. Field Trips General Description We are all familiar with class field trips from our early school years. What we didn’t always appreciate is that these trips were carefully planned around our learning needs. Similarly, Field Trips are a carefully planned facet of nursing clinical instruction. 

    As is noted by Herrman, Saunders, and Selekman,6 Field Trips are useful when additional experience is needed to complement what students customarily learn at clinical agencies. Preparation and Equipment Field Trips can take a considerable amount of planning or very little. Students may attend alone, in pairs, or in groups. 

    Example of the Strategy at Work I experienced this strategy during my own nursing education. My instructor was way before her time. She contended that to provide holistic nursing care, students needed to be acquainted with the community and the neighborhood around the agency.

     She had us go to a local restaurant and arranged for us to be given a free portion of a local favourite food, visit the city hall and learn about the town, and window shop through local businesses to get a feel for the community. 

    My students now use this “shoe leather” survey in wellness and community courses to get to know different communities and to learn about the needs of clients outside the agency. Two ways I have used this strategy were in a pharmacology class. Students were asked to take two “field experiences.” Here are the guidelines from their syllabus about these Field Trips.

    Arrange for students to visit and tour large metropolitan medical centres if current clinical sites are limited to community hospitals. Students learn a lot from Field Trips to emergency departments with helipads, large intensive care units, and specialty areas. Agencies with significant nursing workforce needs often use these tours for recruitment and marketing.

    Have students complete a community Scavenger Hunt as part of a Field Trip. As in my nursing school experience, arrange for them to visit local establishments and access local information to understand the community better.

    Pediatric nursing students can visit a toy store to learn about safe toys, developmental guidelines for toy choice, and how children play. If they compare prices, explicitness of directions, age recommendations, and safety aspects, they’ll be able to provide anticipatory guidance for parents and caregivers.

    Pharmacology students can visit drugstores to peruse over the-counter medications. Ask them to compare generic versus brand-name medications. Have them read the directions and determine the reading level of those directions. 

    Ask them to consider the challenges experienced by people with visual impairment, for whom English is a second language, or with poor fin motor skills. Their assessments can include medication administration instructions, childproof caps, and resources for people with low literacy skills or language disparities.

    Have students visit the local grocery store. Consider the needs of special populations, such as the elderly or those with disabilities, in navigating grocery stores with narrow aisles, carrying groceries inside the store and home, storing food, and preparing foods that come with complex instructions.

    As in the Scavenger Hunt, have students take a Field Trip within their clinical agency, such as to the medical library, the laboratory complex, or the research areas. One nursing instructor used a Field Trip to an art gallery to reinforce what the students knew about wellness and the role of nursing (Wikstrom7).

    Use shoe leather (walking) or windshield (driving) surveys for students to assess a community. Most community or wellness textbooks have a format for assessing a community’s health. These can be adapted for the specific needs of the course and the clinical experience.

    Make sure Field Trips are objective driven and a necessary component of clinical education. Use Injection Field Trips to let your students practice giving immunizations. Contact a school health centre, local affiliated health-care agencies, public health clinics, or local pharmacies for opportunities to give annual influenza injections. 

    Students come away with a great feeling of accomplishment and skill mastery while providing a valuable community service. To bring home the challenges imposed by living in a wheelchair, one nursing instructor had students navigate the college campus in wheelchairs. 

    Pairs of students, one in the chair and one assisting, experienced wheelchair accessibility or its lack, the reactions of others, and the environmental obstacles related to traffic, crowds, physical strength, and time constraints. Use Ah-hah Journals or Online Discussion Groups to evaluate the experience and students’ levels of learning. 

    Learning From Each Other: Peer Teaching and Peer Team Leadership General Description In one of the quotations used in this book, Johnson and Johnson2 state, “Everyone is both a student and a teacher.” Learning From Each Other embraces that philosophy. 

    In this strategy, instructors develop Peer Teaching and Peer Team Leadership activities in which students may assume the role of teacher. Students are assigned to these experiences on a rotational basis, allowing everyone to gain experience in leading and teaching others. 

    Preparation and Equipment Assign students or orientees to both teaching and leadership roles during the clinical or orientation period. Students may be given some instruction on their role, methods of organizing data, and limitations on the role to ensure safe and efficient client care. 

    Teaching the Peer Teaching concept has been used a lot in nursing programs. Most programs require that a senior student be assigned to a junior clinical group for 1 to 4 days. During that time the Peer Teacher functions as an assistant nursing instructor, ensuring that tasks are completed, answering questions, and providing an extra pair of eyes and hands for the instructor. 

    Before becoming Peer Teachers, senior students must complete the clinical rotation in which they’ll be teaching and meet with the instructor to share expectations of the experience. Students are often more comfortable asking questions of the Peer Teacher. 

    In turn, Peer Teachers often feel a great sense of accomplishment when they can share what they know, realizing how much they’ve learned and grown during their time in nursing school. Nursing students often feel that there’s always more to learn. As a result, they may lack a sense of accomplishment about their learning. 

    This strategy gives them insight into how much they know and how far they’ve come. Following the Peer Teacher strategy, the Peer Teacher and the students evaluate the experience and the individual students’ levels of performance in both roles. The Peer Teachers may also self evaluate and compare their teaching and leadership styles with those described in the literature. 

    Peer Team Leadership the Peer Team Leadership concept is similar except that student from the same orientation or clinical group function as leaders for a specific period. They assist students with care, monitor task completion, ensure timely documentation, and seek out the assistance of the instructor as needed. 

    This experience helps build organizational skills, models leadership behaviours, and builds rapport within the clinical or orientation group. Again, the evaluation of self and others is an important part of this strategy.

    This strategy is helpful for busy nursing instructors in high-acuity areas. It’s important to remember that faculty alone are responsible for evaluating students. Also, agencies may have explicit policies about faculty supervision of students giving medications and completing skills.

    Clinical orientees may have a Peer Teacher or Peer Team Leader who rotates from among the nursing staff, increasing the rapport between staff and orientees and providing a mentor for clinical work.

    The Peer Team Leader may continue as a resource for new nurses who have just come off orientation. This tactic keeps a new nurse from feeling totally isolated in a newly independent role.

    Make sure that Learning From Each Other strategies breed team spirit and foster individual contribution. Students may become competitive in these roles, degrading group collaboration and individual feelings of success.

    Encourage students in the clinical area to Learn From Each Other by introducing each other to their clients and engaging in active discussions about client needs and nursing implications. Doing so encourages us to learn from our colleagues throughout our professional career.

    In classroom settings, encourage students to Learn From Each Other by setting up study groups, making up test questions for each other, and tutoring each other after they discover their strengths and areas for growth.

    Creative incentives course credit, free parking, attendance at educational conferences, award certificates, credit for service learning or volunteer hours may be given in return for tutoring services.

    Have students and orientees pair up senior students or those who have cared for complex conditions should assist junior or new students. This method reinforces the teamwork inherent in nursing.

    Use Pass the Problem, V-8 Conferences, or the One-Minute Class to discuss common client issues, with the Peer Teacher or Peer Team Leader moderating the conversation. Solicit the input of the Peer Teacher or the Peer Team Leader to enhance student clinical evaluations. 

    Clinical Puzzle General Description I learned this strategy from a class participant. The exercise was developed as a playful activity for clinical groups, with each student responsible for a portion of the project. First, the group chooses a client with a specific medical diagnosis or condition. 

    Then, before the clinical day, each student is given a puzzle piece with a word or words such as Nursing assessments, Lab data, History, Diagnostics, Medications/Effectiveness, Surgeries/Procedures, Discharge issues, Family issues, Developmental assessment, and Psych emotional issues. 

    The number of students in the group will affect what’s written on the puzzle piece. Students use “down time” in clinical rotations to review the client’s chart, consult other resources to investigate the condition, and talk with the client about the assigned aspect of care. 

    Permission must be obtained before the students interact with the client. The instructor should take care not to overburden the client with too many eager students. During post-conference that day or pre-conference the next day, students put the Clinical Puzzle together to create a comprehensive, holistic picture of the client and the medical condition. 

    Preparation and Equipment Find a children’s puzzle with as many pieces as there are students in the group. Writing the individual “assignment” on each puzzle piece is the only other task. For the first clinical day in a rotation I generally assign students in pairs. This affords them more time than usual to research a client’s condition and care. 

    For the subject of the Clinical Puzzle, I select the most common diagnosis on the unit and a client with that condition. I don’t assign any student to care for that client; all the students must start this assignment on an equal footing. I’ve used this strategy to help students understand type 1 diabetes mellitus and leukaemia, but it’s appropriate for many medical conditions.

    You can select the nursing or medical diagnosis most appropriate for the needs of the clinical unit. Students can research hypothetical or actual clients to complete the Clinical Puzzle.

    Monitor the students’ work on this assignment to ensure that clinical work is being attended to. Also, the students’ activities must not overwhelm the client or the client’s nurse. Students need to see how each piece of information fits together to make up the client’s clinical picture. 

    A missing puzzle piece, just like a missing care component, skews the way we see the client and affects our care planning. To conclude this exercise, it’s valuable to discuss how all the different pieces fit together. One Minute Class General Description Like the One-Minute Care Plan, the One Minute Class gives students the opportunity to present a client to the group. 

    The presentation must communicate integral information while filtering out anything extraneous. Although the talk may last longer than 1 minute, students are encouraged to condense information to provide a “snapshot” of the client in a brief period. One of the greatest skills this exercise develops is the ability to focus. 

    Essentially, students discriminate the “need to know” from the “nice to know.” Only the highest priorities are discussed because there’s no time for less important details the student’s day, the client’s personality, or insignificant aspects of the client’s treatment. 

    This strategy differs from Grand Rounds in asking students to focus on the nursing care and priorities identified in the One-Minute Care Plan. Preparation and Equipment Little preparation is required for this exercise. You can develop a format for the assignment or use the One Minute Care Plan to guide the presentation. 

    Example of the Strategy at Work Unlike Grand Rounds, which is most effective when the students are most knowledgeable, these strategies may be used early. The One-Minute Class and the One-Minute Care Plan complement each other and provide a means for students to organize their thoughts and their care. 

    During orientation I introduce the students to a client on the unit (after getting the client’s and family’s permission). I assess the client briefly and then leave the room (thanking the client and family again). 

    I then pull the client’s chart and show the students where to find the most information: the history and physical examination notes, the nursing database, and the progress notes. These sources give the students a glimpse into the medical record. I pass out the One Minute Care Plan form and we discuss the client’s potential problems and issues. 

    We discuss priorities and select two nursing diagnoses. I then verbally complete the One Minute Care Plan form and demonstrate the One-Minute Class. Students are assigned to present their clients in the same way at subsequent conferences. Selecting a variety of clients will enrich the experience.

    Students can use the One-Minute Care Plan or Pass the Problem information as the basis for their One-Minute Class. For deeper pathophysiological perspective on the client’s condition, see the student-led Seminar For the client’s personal experience, see Grand Rounds.

    The One Minute Class may take place before the scheduled shift, when students are apprehensive about having to provide care, or after the clinical day, when they’re exhausted after a hard shift. Either way, these conferences must be fun, creative, and informative. Encourage students to enjoy this time and see the value of sharing and learning together.

    Conferences may be held at any time and may even take place during clinical meetings. Orientees and novice nurses can use the One-Minute Class during their orientation period. You can use Clinical Questioning to form the structure for the One-Minute Class. Film Clips in Clinical General Description as in the Short Clips strategy, film clips can reinforce concepts during clinical rotations. 

    As we’ve seen, many films show content relevant to clinical issues. Showing a short clip and talking about it can generate discussion about issues outside a particular clinical area. If nothing else, Film Clips in Clinical provides a diversion from the usual conference format. 

    For this strategy, it’s important to develop “thinking questions” based on clinical objectives, and to reinforce the nursing implications of events shown in the clip. Encourage your students to relate the Film Clip concepts to current clients, activities, and experiences. 

    Preparation and Equipment A laptop computer provides a portable, convenient way to show video footage. Clips saved to a CD or from a DVD may be shown to small clinical groups. Larger groups may need a VCR or DVD player (see Short Clips for details). 

    Film Clips in Clinical should focus on clinical interactions, care of clients, legal and ethical issues, or other issues not always observable in the clinical area. Herrman8 has examined the use of films to enhance nursing education. Example of the Strategy at Work shows some videos you can use to enhance clinical instruction.

    Make popcorn and show Film Clips in Clinical on the last day of rotations to end the experience on a pleasant note. Have students do a Quick Write, Ah-hah Journal, or Online Discussion to document their reactions to the clip and answer selected thinking questions.

    Show a clip and then have students play Twosies as a role-playing response to an interchange between actors. Ask students to rewrite the scene, making it more therapeutic or positive. Adhere to copyright and fair use laws while showing Film Clips in Clinical. Make sure students see this strategy as a valuable clinical experience and not a frivolous exercise. 

    Choose your clips and thinking questions carefully, keeping the course objectives in mind. Let’s Be Real in Clinical General Description Often the small size of clinical groups and the intense relationship with instructors lead to thought-provoking and emotionally charged discussions. 

    Let’s Be Real in Clinical helps an instructor mold these discussions into positive learning experiences. Theoretical learning, preconceived notions about nursing, and workplace realities all come together in the clinical area. This part of a nursing student’s education can be very stressful. 

    Venting concerns and hearing the advice of a trusted mentor are as valuable as learning cognitive and psychomotor nursing skills. In this strategy, the instructor simply opens a conversation with the words “Let’s Be Real in Clinical.” The discussion that evolves may take many directions and contributes to the socialization aspect of nursing. Preparation and Equipment No preparation is needed. 

    You merely set the stage and ground rules for open and honest communication. Example of the Strategy at Work I developed this strategy in response to a question I received from a student. During post-conference one day, I noticed that the entire group was exhausted. 

    They had worked hard, learned a lot, and had little idle time to reflect on the day’s events. In addition, they weren’t looking forward to sitting for almost an hour in post conference. One student stated, “We were all so busy today. There were eight of us and six nurses and everyone was busy. How do the nurses do it when students aren’t there to help out?” 

    I suppressed a chuckle and the retort on the tip of my tongue: “Often staff feel they work harder when students are on the floor than when they’re not.” Then I realized this was a great opportunity to discuss some of the realities of staff nursing. We discussed staffing, organizational skills, setting priorities, letting go of “nice to do but not necessary” tasks, and gaining nursing competence through experience. 

    The students discussed these topics in light of the day’s experiences, moving on to include their perceptions of reality from both class and clinical work. Let’s Be Real in Clinical sets apart a time to voice concerns and discuss the realities of nursing from a personal and a professional perspective. 

    One question I like to ask involves the role of nursing in the healthcare system. It’s often said that nurses have a difficult time defining what we do. To glean students’ perceptions I ask, “If nursing were to disappear tomorrow, what would be missing?” 

    This question stimulates much discussion on the place of nursing in health care, the historical development of the nurse’s role, and what role nurses will play in the future.

    Select questions to open the Let’s Be Real in Clinical discussion, such as:

 • How do nursing staff manage multiple client needs?

 • How is the staffing different on off shifts, weekends, and holidays?

• How do families handle the complex care of clients at home?

• Will I be able to do this?

• Is NCLEX® really that hard?

• What are my job options in nursing?

• How should I decide where to work after graduation?

 • How do people work and live with that disease?

• How do I talk with clients about sex and sexuality?

• What about nursing care is most important to me?

• What nursing specialty appeals the most to me?

• What issues affect the smooth management of a nursing unit?

 • How do I care for clients who have value systems different from my own?

• What characteristics do I value most in a nursing leader?

 • Do I want to pursue a higher level of education in nursing?

• Why do some nurses leave nursing?

• What are the pros and cons of 8-, 10-, and 12-hour shifts?

• What skills do I bring to nursing that guide me toward a certain clinical area or specialty?

 • What qualities do I value in selecting a nursing mentor?

• Why do they say nurses eat their young?

 • What are the staff’s perceptions of nursing students in this agency?

• How has the nursing shortage affected the role of the nurse?

• How have the costs of health care affected the role of the nurse?

• How do policies and politics affect the role of the nurse?

 • How are clients different now than 10 years ago?

• What legal and ethical challenges does nursing face in the coming years?

 • How will advances in medical technology be reflected in nursing care?

• Do you prefer the “high-tech” or the “high-touch” components of nursing care—and are they mutually exclusive?

• These questions and a Let’s Be Real in Clinical discussion give students the opportunity to vent fears, seek information, and share experiences. The strategy enhances team spirit and fosters greater cooperation in the clinical group.

• Let’s Be Real in Clinical discussions may be adapted for Online Discussion Groups, Ah-hah Journals, or Quick Writes.

• This strategy is well received at the end of a clinical rotation or orientation period, when trust is high. Let’s Be Real in Clinical provides a transition to the next clinical experience or to independent nursing.

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