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Presented by:Ronnie DeFord, BSN, RN, CCRN(University of Phoenix Master’s in Nursing Education
Practicum Project)
Summarize the role of the Clinical Instructor from expert to novice and the knowledge necessary to perform the role.
Compare and Contrast the various assessment and evaluation tools for clinical instruction.
Relate the best practices in clinical instruction to current practice.
Objectives
Today’s Trends and ShortagesState of Nursing
Nursing Shortage?AACNArizonaNationwide
What is the ISSUE today?Clinical Adjunct Faculty
Clinical Expert ≠ Clinical Instructor
(AACN, 2008), (Bastable, 2008), (West, Borden, Bermudez, Hanson-Zalot, Amorim, & Marmion, 2009)
Clinical Education Trends
• The Ideal Candidate• Master’s Level or above• Clinical Expert• Competent Educator
• The Actual Candidate• Baccalaureate Level• Clinical Expert• Inexperienced Educator
Clinical Faculty
The ProblemDo Clinical Instructors lack the proper
education to enhance their delivery in the clinical setting?
The DataLevel of Degree at EntryAssessments and EvaluationsClinical Instructor workshops that provide
instruction The Solution
Provide workshops that educate Clinical Instructors on the basics and best practices.Bridge the gap between practice and theory
Clinical Instructor SurveySent Out to Six Universities asking for volunteersRandom email response
Respondents (n=20)11 different colleges
Data SummarySpreadsheet and Graphs
Majority were BSN’sWhat is missing?
But…..are we prepared before going in?
Level of Degree at Entry Level to Clinical Instructor Role
65%
24%
1%
10%
BSN Degree
MSN Degree
MSN-ED Degree
ASN + Non-Nursing
If we provide teaching…..What do we teach?What is already in use?
Common Themes…..but wait….. No Instruction????
Yes!60% suggested education and mentorship
What should be included?Annotated Bibliography
Journal ArticlesMentorTextsColleagues
Is there a Need for Clinical Instructor Education and Training?
Yes
No
““We need facilities to We need facilities to provide us with training and provide us with training and a mentor who will help us a mentor who will help us the first time out there”the first time out there”
Cognitive Knowledge
Affective Attitudes
Psychomotor Skills
(Emerson, 2007), (Bloom, Engelhart, Furst, Hill & Krathwohl, 1956), (Krathwohl, Bloom & Masia, (Emerson, 2007), (Bloom, Engelhart, Furst, Hill & Krathwohl, 1956), (Krathwohl, Bloom & Masia, 1956)1956)
Domains of LearningBloom’s Taxonomy…….Old School
No other area of education requires all Three domains like clinical education does!No other area of education requires all Three domains like clinical education does!
Old Version…Old Version… New Version…New Version…
http://www.odu.edu/educ/roverbau/Bloom/http://www.odu.edu/educ/roverbau/Bloom/blooms_taxonomy.htmblooms_taxonomy.htm
Which does the NCLEX use for their Test Plan?
The Knowledge Dimension
1.Remember
2.Understand
3.Apply
4.Analyze
5.Evaluate
6.Create
A.Factual Knowledge
B.Conceptual
Knowledge
C.Procedural
Knowledge
D.MetaCognitive
Knowledge
The Cognitive Process Dimension
•Two Dimensional Table•Examine the verb and the noun to decide placement
•Verb-cognitive INTERSECTIONS!
•Noun-knowledge(Anderson & Krathwohl, 2001)
Let the Games Begin!
We will return in 15 minutes……….
Pop/Snack MachineCold Bottled Water
www.funnypostcard.comwww.funnypostcard.com
Dr. Roberta Emerson CCRN Alumnus Associate Professor Washington State University College of Nursing Spokane Washington
Author of Nursing Education in the Clinical Setting (2007)
About Lifelong Learning…..
“Admitting fallibility while caring deeply about what and who we teach, being open to change and willing to risk, and sharing success with our peers, clinical nurse educators leave their mark on their students, their profession, and the future of health care and society”
Thank you Dr. Emerson for your mentorship and guidance…….
Barbara Miholich, MSNFor being my second mentor….
Daniel Faretta, RN, MBA, BSNFor being the perfect colleague and collaborator!
Tracie Schroeder, MBA, MHA, PMPFor sharing her vast knowledge of Assessment and
everything in between!Gerald Fox, MBA
For sharing his technical aspect on things!
Thank you for your contributions that made a difference!
Tootsie Rolls for your Sweet Tooth?NO………….. Objectives and Bloom’s levels of taxonomy
Very Important in Clinical SettingWe must build on their knowledge, attitudes, and skills.
Questions and Assignments must increase in the level of difficulty If we lack the knowledge, our students lack the experience
and growth…..
A novice problem…… A professional nurse educator solution
Take responsibility for that which you do not know
((EmersonEmerson, 2008) , 2008)
BennerNovice to Expert
The StudentYes…..the Clinical
InstructorStress/Anxiety in new
rolesRevisiting the Novice
role
Adult Education TheoryAndragogy
Malcolm KnowlesSelf DirectionProblem CenteredLife ExperiencesApplicable Now
Trust and Respect=A Must
Knowing your Models
((O’ConnorO’Connor, 2007), 2007)
Professional RolePractitionerLeaderScientist
Transferor of Knowledge
Why is this Important?Used with Permission from Maria O’Rourkewww.RoleBasedPractice.comPhone: 415.461.1433Email: [email protected]
Maria O’Rourke Model of the Professional Role
Thoughts?
Gaberson and Oermann (2007)Direct QuoteClinical=Real Life ExperiencesNursing=Professional Practice Discipline
Clinical Instruction is Expensive So…Learn in the Classroom…Apply/Test in Clinical
Do you see the Problem Here?
Role TransitionExpert to Novice to Expert
How?Assume the Professional Role/Clinical Educator Role
Teaching is an Art Reach Out and Seek Perform Role with Competency
Know your Roles!
Orange Cards….Stand Up!
Clinical Educator Role
Clinical ExpertLeaderRole ModelInterpersonal
Relationships Liaison
TeacherEvaluator
Copyright 2010. All Rights Copyright 2010. All Rights ReservedReserved
(Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010) (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010)
The Basics…
KnowledgeableShares ItTheoryPractice
Clinical CompetenceTransition
Bedside to Clinical Instructor
Bridge the Gap
(Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010) (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010)
Knows PurposeProtects PatientsProtects StudentsPrepares StaffPromotes Best PracticeLearning AssignmentsGuided Observation
(Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010) (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010)
Caring BehaviorsProfessional Behaviors“How to Think Like a
Nurse”Skill CompetencyWar Stories
(Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010) (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010)
#1 Student StressorAttributes of a Clinical
Instructor What are they?
Clinical Instructor Expectations
Student ExpectationsCollege of Nursing
ExpectationsClinical Site Expectations
(Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010) (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010)
Green Cards…..Stand Green Cards…..Stand Up!Up!PINK Cards……Stand Up!PINK Cards……Stand Up!
FacilitateThe Process
ID OutcomesAssess LearnersPlan ActivitiesGuideEvaluate
Skilled in Clinical Teaching (YELLOW CARD #1)
StimulateSupportGuide (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010) (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010)
Assesses Student LearningReflects CompetencyReflects Level of Learning
Transfer of LearningStrategies
FormativeSummative What can be What can be
Learned?Learned?What has been What has been
Learned?Learned?
(Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010) (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010)
In the Kitchen Area………Will return in one hour……….
www.googleimage.comwww.googleimage.com
How do I teach?DemonstrationWar StoriesQuestioningListeningNursing RoundsKNOW…best practices!
Bridge that Gap Between Theory and Bridge that Gap Between Theory and Practice!Practice!
The Gateway to Best Practices in Clinical Instruction…
AssessmentsCare PlansConcept MappingCase StudiesReflective JournalingAnecdotal NotesQuestion and AnswersGrand RoundsCompetency Skills
ChecklistsOne Minute PaperTeaching PlanShift Report
EvaluationsStudent Self-EvaluationFormative EvaluationsSummative EvaluationsAnecdotal NotesObservationsClinical ConferencesOral Presentations
YOU NEED TO COMMUNICATE THE EXPECTATIONS!
Best Practices ?
Care PlansAnalysis of ProblemsPlan of CareGuides LearningProblem Solving?Critical Thinking?Time to Move On?
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010),
Not another Care Plan!Not another Care Plan!www.googleimage.comwww.googleimage.com
Concept MappingGraphical ArrangementKey ConceptsRelationshipsGreat Group Activity
Post Conference
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
http://www.m2hnursing.com/N210/http://www.m2hnursing.com/N210/hyperkalemia.jpghyperkalemia.jpg
Reflective JournalingReflect on clinicalRecord perceptionsExamine DecisionsProvide Feedback
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
www.googleimage.comwww.googleimage.com
Case StudiesForm of SimulationUnfolding Case StudyStimulate Critical ThinkingFlexibleTheory ApplicationDiscussion QuestionsInnovationFacilitationThink Out LoudChoose WiselyPurchase or Develop
(Emerson, 2007), (Gaberson & Oermann, 2007), (Caputi, 2010)(Emerson, 2007), (Gaberson & Oermann, 2007), (Caputi, 2010)
Anecdotal NotesRemembering It All?Feedback ONLYWeekly FormativeShare with StudentLegal Document
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
How do I keep up with 10 students?How do I keep up with 10 students?www.googleimage.comwww.googleimage.com
Question and AnswersStimulate/EngageCritical ThinkingOpen Ended
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
Grand RoundsInstructor/Students
Visit Patients? Privacy Issues
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
www.googleimage.comwww.googleimage.com
CompetenciesTracks LearningLegal DocumentCommunicates
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
One Minute PaperApplication/AnalysisTheory to PracticeFeedback
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
Future Future Nurse!Nurse!
www.googleimage.comwww.googleimage.com
Teaching PlanIndividual or GroupBrochuresPresentations4 parts
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
Shift ReportSBARListen to ReportGive ReportSocialization
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
Tools are only as good as the faculty who implement them.
Students are ‘overwhelmed’ with writingLet them Think
Not all students learn the same wayLet them choose their assessment
Read what the Experts sayJournals, Texts
Share your KnowledgeJournal club of educators from many
universities
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010),
What are the steps?1. Know your:
1. Objectives2. Assessments3. Evaluation Tools
2. Communicate in Advance the Expectations for how a student will be evaluated!
-Saves you much heartache down the road! Purposes of Evaluation
Identify existing Abilities/Aptitudes Were the outcomes achieved? What learning needs or areas need improved? Satisfactory level of performance?
Evaluations
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
Student Self-EvaluationFuture PreparationObjectives/
CompetenciesStudents view of
ProgressOpportunity for
Feedback
(Gaberson & Oermann, 2007), (Caputi, 2010)(Gaberson & Oermann, 2007), (Caputi, 2010)
Evaluations
Anecdotal NotesGuides the EvaluationAssessment to
Evaluation
Susan performed a head to toe assessment today without assistance and meets competency. Susan was observed placing a PIV which required 2 prompts by instructor. Susan observed a Lumbar puncture, asking appropriate questions. Susan demonstrated critical thinking during several discussions today about her patient and in regards to sepsis. Susan lacks assertiveness when interacting with the patients families and needs frequent encouragement to communicate with the families and provide teaching. Susan and instructor discussed her progress and made goals for next week which include being more assertive in family teaching and practicing skills at giving/receiving report using SBAR.
(Caputi, 2010), (Gaberson & Oermann, 2007)(Caputi, 2010), (Gaberson & Oermann, 2007)
www.googleimage.comwww.googleimage.com
Formative EvaluationsFeedback on ProgressIdentify Further LearningNOT gradedExtensiveWhat Can Be Learned
Summative EvaluationsSummarizes CompetenciesEnd or MidpointDelivers Grade
Pass/FailRating Scale?PeriodicWhat Has Been Learned
Requires Face to Face Discussion!
(Caputi, 2010), (Gaberson & Oermann, 2007), (Emerson, 2008)(Caputi, 2010), (Gaberson & Oermann, 2007), (Emerson, 2008)
ObservationsValid/Reliable?Observe more than
onceRefer to CompetenciesSampling of
PerformanceRecord
Oral PresentationsCommunication
NCLEX SafetySBARPatient
IdentificationTeamworkCollaborationDelegation
Evaluations
(Caputi, 2010), (Gaberson & Oermann, 2007), (Emerson, 2008)(Caputi, 2010), (Gaberson & Oermann, 2007), (Emerson, 2008)www.googleimage.comwww.googleimage.com
Clinical ConferencesVerbal Feedback
Very EssentialBe Creative
Student EngagementNot Time to Lecture
(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)
6 students3 patient assignments
Pick on Friday nightUse patient information form; 30 minutes
3 take ‘special’ assignmentsAll 3 are assigned the patient assignments above
1 does ABC, Maslow, APIE Prioritization Write 500 words on Friday night
1 does Relationships and how patient information relates to each other Write 500 words on Friday night
1 does the charge position Write 500 words on Friday night
Ignativicius (2010) Nurse Educator BootCampIgnativicius (2010) Nurse Educator BootCamp
Students were ENGAGED!Those with patients shared their dayThe priorities nurse shared the NANDAThe relationships nurse shared the CONCEPT MAPThe charge nurse shared her role and how
decisions were made.Students were excited!Students were jumping up and drawing on the concept
map!Students revealed MORE about their critical thinking
than when they did care plans!
Ignativicius (2010) Nurse Educator BootCampIgnativicius (2010) Nurse Educator BootCamp
“When your students graduate and embark on their own professional practice journey, what will they hear when your voice comes to mind? What will they carry into their future practice that is a reflection of your teaching, your caring, your values and beliefs about nursing?..........
Clinical Nursing Instruction is the door to the real world of nursing. What students experience as they step through it will impact the view they see and the future world they create………….
Clinical nursing faculty hold the key…”
To those who participated in the survey…To those who spread the word about this
workshop…To those who offered assistance…To all of you for attending today… AND…. To all the experts in the field of clinical
instruction (Benner, Blach, Caputi, DeYoung, Emerson, Gaberson & Oermann, Ignativicius, Nightengale, and O’Connor)
Who have led the way for others….
Please take the time to fill out the evaluation formImportant final step in Practicum
Drop off in the Basket as you Leave Today
See your Handouts for all references cited in this PPT presentation.