CLINICAL TEACHING
integrated into a nursing role.
-is grounded in tradition, common sense and
feasibility
-a complex enterprise
Variables that is difficult to control:
• severity of patient illness
• widely varying settings
• differences in nursing and
educational personnel
• variable staffing patterns
• varied student motivation and
preparation
PURPOSE OF CLINICAL LABORATORY
theory + practice = clinical laboratory
1. Observation (INFANTE 1985)
- is an essential element of clinical
learning.
2. Problem-solving and decision-making
skills are also refined.
-prioritization by having repeated practice in
doing so in complex situations
3. Gain organization and time management
skills.
-how to organize data that bombards the
learners
4. Cultural competence
-become more comfortable and more expert
with cross cultural care when they care for
culturally diverse clients,
5. Socialization
-learn about professional responsibility
-the clinical laboratory is a place where
consequences for one’s actions are readily
apparent and accountability is demanded.
-knowledge and skills learned becomes
-learns how to relate to patients
professionally and gain a patient’s
perspective of illness that leads to more
caring behaviors.
MISUSE OF CLINICAL LABORATORY
Infante points out clearly that clinical
laboratory have historically been misused at
all levels of nursing education.
-nursing students have been sent to the
clinical setting to gain work experience
rather than to achieve educational objectives
- misuse of clinical setting also occurs when
novices are given too much responsibility
for patient care
-when learners are supervised and evaluated
more than they are taught
MODELS OF CLINICAL TEACHING
Traditional and best known model
-groupings by 8-12 to a clinical agency and
assign the learners to patients.
-educators work closely as possible with
each learner
NEWER MODELS
-INFANTE developed a model that relies
heavily on keeping nursing students in a
skills laboratory until they are proficient
with skills.
-PACKER, she contends that more
information about clinical practice should be
taught in the classroom before learners go to
the clinical area.
PERCEPTORSHIP MODELS
Perceptorships- increase clinical experiences
for students and expose them to more of the
realities of the work world, which would
reduce reality shock.
-affords potentially increasing learning
during clinical time
-allows students to learn from practitioners
with a high skill being guided by faculty
who have a wealth of knowledge.
BARRIERS:
1. Some faculty members fear that staff
education do not really have time to
supervise students which could lead to
serious errors.
2. They believed that because preceptors do
not know school’s curriculum very well,
there will not be adequate correlation
between theory and practice.
3. There is realistic fear that eventually the
health care agencies will say they must
charge for preceptor time.
2 Major Themes of Perceptor’s perceptions
of what they do for learner
1. Sheltering students while learning
2. Facilitating student’s learning
Components of a Comprehensive
Orientation for preceptors
1. Purpose and expected outcomes of the
clinical expectations of learners.
2. Overview of the school curriculum as it
relates to the clinical experience.
3. Skills that can be expected of learners
entering the perceptorships
4. Principles of adult learning.
5. Common errors made by students and
common misconception.
6. Roles and responsibilities of the
preceptor, educators, and the student.
7. Interactions with learners and relationship
with educators.
8. Introduction of course syllabi
9. Planning learning experiences
10. Overview of evaluation on procedures
and measuring procedures and measuring
instruments.
11. Legal implications of working with
learners.
PREPARATION FOR CLINICAL
INSTRUCTION
Educators must do a lot of planning before
clinical instructions begin:
-selection of site
-availability of learning experience there
-gather data that will lead to contract
Observation Assignments
-expresses the importance of observation in
the learning process
Nursing Rounds
-learners and their instructors visiting
patients to who learners are assigned
-exposes learners to additional situations and
to additional nursing situations and to
encourage them to consult each other in
planning and evaluating care
-it provides many opportunities to apply
classroom theory to patient situations and to
compare and contrast patient care.
-patients must be asked for permission for
the group to visit and energy and effort must
be made to keep patient information
confidential.
Shift Report
-enabling the learners to listen to or give a
shift report is a useful teaching strategy
-unique time for learning (Yurkovich &
Smyer)
-way for students to learn the uniqueness of
nursing communication and is a means of
professional socialization
Learning Contracts
-useful way to structure and guide learning
in the clinical setting
-defined as the written argument between
instructor and learner spelling out the
learners outcome
Written Assignments
-Individualized care plans
-Clinical logs or journals
-Brief critical thinking exercise following
their clinical laboratory sessions
-critical through paper
-written assignments are given for clinical
learning because it can yield measurable
outcomes and help learners think like a
nurse
Post Conference
-unstructured seminars that allow for
creativity but can dissolve to
meaninglessness
-usually held at the end of a physically and
emotionally draining practice session
-opportunity to stimulate critical thinking
-are means to help socialize learners into the
world of nursing and are another opportunity
to get them to think like a nurse
EVALUATING LEARNER PROGRESS
Clinical Evaluation- studied little, written
about extensively and talked about
excessively.
-remains a difficult,
subjective, time consuming and often
puzzling chore
-least favourite task of nurse
yet inescapable
-learners in the clinical area
need the feedback and judgment of their of
their work that evaluation gives them
Formative and Summative Evaluation
Formative Evaluation-ongoing feedback
given to the learner throughout the learning
experience
-helps the learner identify
strengths and weaknesses and
meek the learning objectives
efficiently
Summative Evaluation-given at the end of
the learning experience
Norm Referenced and Criterion-Referenced
Evaluation
Norm-referenced evaluation-learner is
compared with a reference group of learners,
either that in the same cohort or in a norm
group.
Criterion-referenced evaluation-compares
the learner to well defined performance
criteria rather than comparing him or her to
other learners
Behaviors to be evaluated
Areas of performance to be evaluated:
-nursing process
-use of health promoting strategies
-psychomotor skills
-organization of care
-maintaining patient safety
-ability to provide rationale for nursing care
-ability to individualize care planning and
intervention
-therapeutic communication
-ability to work with professional team
-professional behaviors like following
policies, being on time, maintaining
confidentiality and being accountable for
one’s own actions
-written documentation of care
Clinical Evaluation Tool
1. The items should derive from course or
unit objectives.

2. The items must be measurable.

3. The items and instructions for use should

be clear to all that must use the tool.

4. The tool must be valid and reliable.

3 Tools that appear in the Literature that

have been tested for reliability and validity:

1. Rating skills (BONDY)

2. Community, family nursing clinical

evaluation on tool (HAWRANIK)

3. Clinical evaluation tool (KIRCHBAUM,

ROWAN DUCKET, RYDEN and SAVIK)

*Bondy developed 5-point rating scale

*Hawranik’s tool-contains items o the

nursing process and professional growth and
leadership and could be used in evaluating
students in most home-health settings.

*Krichbaum’s clinical evaluation tool id

generic enough that it could be used in
almost any clinical experience. It covers
items on health promotion, nursing process,
safety, scientific knowledge, multi cultural
care, therapeutic relationships and
professional behaviour.