Prepared by: Mae Michelle F. Aguilar RN

GOALS OF CLINICAL NURSING EDUCATION

To learn the goals of Clinical Nursing Education.

To shed light on issues or challenges Student Nurses encounter in transitioning from the clinical laboratory to the actual clinical setting.

To be aware of the Clinical Instructor’s role in creating or implementing solutions and strategies to address these issues.

OBJECTIVES

THE ULTIMATE GOAL…

The GOALS of the clinical nursing education are to enable students to:

Apply Theoretical Learning to patient care situations through the use of critical thinking skills to recognize and resolve patient care problems and the use of the nursing process to design therapeutic nursing interventions and evaluate their effectiveness.

Develop communication skills in working with patients, their families and other healthcare providers.

Demonstrate skill in safe use of therapeutic nursing interventions in providing care to patients.

Evidence caring behaviors in nursing actions.

Consider the ethical implications of clinical decisions and nursing actions.

Experience the various roles of the nurse within the health care delivery system.

Gain a perspective on the contextual environment of health care delivery system.

Applying Theoretical Learning to Patient Care Situations

Theoretical learning to practical learning.

Theory becomes a reality as students make the connection between the “usual” case presented in the classroom to the “actual” case with which they are involved.

Abandoning “Book Learning” may cause eager trepidation for student nurses.

C.I. INTERVENTION: Clinical Instructors must be skilled with assessing the degree of anxiety presented by each student. CHANNEL unfocused functional anxiety to maximize learning and DIFFUSE dysfunctional anxiety to permit safe performance.

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The CLINICAL LABORATORY is where the theoretical begins to make sense and a great deal of integration of theoretical and practical knowledge becomes possible.

Exposure to an array of clinical situations is essential to fine-tune the student’s observational skills, recall, application abilities and problem solving skills.

C.I. INTERVENTION: Devise approaches to enhance critical thinking. ConferencingJournalingStructured Questioning “What ifs..”“War Stories”

Use of the Nursing Process makes it easier to understand the intellectual connections necessary to apply theory in practice.

Assessment

Nursing Diagnosis

PlanningImplementation

Evaluation

* TOOL CLINICAL DECISION MAKING

Teach student to write Nursing Care Plans using the Nursing Process

However when the use of the Nursing Process is reduced to a framework for the written care plan rather than an active approach to thinking may devalue critical thinking.

“…to learn and not to do is really not to learn. To know and not to do is really not to know.”

― Stephen R. Covey, The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change

Developing Communication Skills

Social Communication to Professional Communication.

Focus is on the development of THERAPEUTIC COMMUNICATION SKILLS

In therapeutic communications, students are adept at:

InterviewingCounselingTeaching PatientsDocumenting observations and interventionsDelegating up and down the chain of health care

workers.

Each of these strategies requires:

Attentiveness to the objective of interactionThe best means of structuring the interactionApplicable language to use

Professional Communication is GOAL DIRECTED.

Initial interactions must be carefully planned and mentally rehearsed.

Students must be skilled in listening to and observing their communication partners, interpreting what is said and crafting a response.

Students sometimes are anxious to deliver a message that they fail to listen to the responses that would improve the message.

C.I. INTERVENTION: Assist the student to listen better by encouraging her to slow down to allow silence and provide the time and space needed for both patients to think before talking.

Nurses use “Common Language” readily translating medical jargons to patients and their families. Adjustments must be made according to:

age, educational level, culture, native language, and existing communication problems.

Use of non-verbal communication such as touch, facial expressions and reassuring vocalizations.

Students learn the nuances in skilled communication with patients from observations from interactions of clinical instructor and the staff with the patient.

C.I. INTERVENTION: Pointing out effective approaches or one that is less than successful and articulates the critical elements of the interaction can help students grasp the full dynamic of the episode.

Nurses use “Nurse Talk” with one another, particularly co-workers.

Loaded with acronyms and terms specific to the clinical environment.

For students this could be baffling and intimidating.

C.I. Intervention: Serve as a translator, accepting student’s inability and interpreting the nurse talk for them.

“Delegation Talk” another type of communication to be mastered by students.

DOWN – when an aspect of nursing care is to be provided by another.

UP – when a nurse is requesting an intervention by a physician or a supervisor.

How to: WHAT needs to be done, WHY and WHEN it needs to be done, HOW it should be done and expectations for RESPONSE and REPORT back to delegator.

Students are uncomfortable delegating to individuals who are more knowledgeable and skilled than they are which can interfere with communication.

C.I. INTERVENTION: Have students practice with one another to master the language

“Professional Tongue” uses medical terminology and nursing terminology to provide a precise description or explanation of a situation.

e.g. Completing written documentation on patient status and end-of-shift report, discussing patient’s condition during rounds or in teaching other professionals.

C.I. INTERVENTION: Developing the professional tongue can be enhanced by insisting on its use in student reports to staff members at the conclusion of the clinical day or in conference presentations.

PROCESS RECORDING - system used for teaching nursing students to understand and analyze verbal and nonverbal interaction. The conversation between nurse and patient is written on special forms or in a special format.

Quote about communication

Demonstrating Skill in the Use of Therapeutic Nursing Interventions

CLINICAL AREA is where students learn their technical skills.

Doing transcends thinking or communicating. This enables students to feel useful and is generally accompanied by a sense of accomplishment.

Students are afraid to make an error and harm and even kill the patient. They also worry that patients may find them inept, will feel like a guinea pig or will insist that students be replaced by a “real nurse”.

Therapeutic nursing interventions requires simultaneous performance of caring behaviors, technical skills, and intellectual manipulations of critical thinking.

C.I. INTERVENTION: Can advance skill development by attending to the details the student is unable to see when performing a technical task.

The C.I. must assume a complementary role as to refrain from taking over when a student is amidst a procedure.

SAFETY is the primary concern when students are learning in the clinical setting.

C.I. INTERVENTION: Allocate time fairly to provide all students with relatively equivalent opportunities to learn the technical skills required.

Skillful use of questioning and verbal rehearsals of care activities can create opportunities for teaching the “why” behind the “how” as well as alerting students of issues associated with intervention.

Evidencing Caring Behaviors in Nursing Actions

Caring – involves relief from suffering, providing comfort, and a general “connectedness” with the patient.

Caring that is “doing for” should be replaced by caring that is empowering and enabling.

Students are not able to…

They do not view the patient as a functioning whole, as a member of a family system or society.

This tunnel vision is not due to the lack of data on these larger issues. The student’s focus is on the immediate situation and is more self-absorbed than other-directed.

C.I. INTERVENTION: Role-modeling the caring component of nursing care delivery is an essential part of the clinical instructor’s role.

Complimenting students reinforces caring behaviors.

Students are able to recognize failure to care in other staff members and are often verbal about this.

C.I. INTERVENTION: Channeling outrage into a discussion helps students to understand caring as reflected in actions as well as general attitudes of concern and compassion.

CONSIDERING ETHICAL IMPLICATIONS OF CLINICAL DECISIONS AND NURSING ACTIONS

Ethical Action involves “doing what is right” in a situation that involve alternative possibilities for action.

The nurse considers which clinical decisions and nursing actions best reflect the patient’s expressed wishes and underlying values.

Also entails the consideration of clinical decisions and nursing actions reflecting the “best good” in the situation from the patient’s perspective.

Students are often self rather than other-centered. They focus more on the performance more than on the recipient of the care being performed.

Translating a code of ethics presented in the classroom into action is beyond the ability of most nursing students. Their clinical knowledge base is still developing.

C.I. INTERVENTION: Use the conference time to review each student’s plan of care for the day, pointing out specific situations that might call for a change in the routine approach for a given patient.

Focused questioning of what constitutes the “best good” for this patient can help students consider ethical implications of the situation.

Ethical Behavior entails taking responsibility for ones actions.

Students often bring classroom morality to the clinical setting.

C.I. INTERVENTION: Establish standards of clinical morality at the outset of the clinical experience. Encouraging questionsConsultation with othersLooking up answersVerifying activities before performing themAdmitting to errors

Consistency in managing student errors while maintaining patient safety is essential in promoting clinical morality.

Gaining Perspective on the Contextual Environment

Clinical Nursing Education takes students through a series of experiences with patients of all ages receiving different health care for a full array of conditions in a variety of settings.

Clinical setting varies in pace of activities that occur there.

Reflected in the urgency of time constraints, as well as in the rapidity of changes in patient condition.

Students must become attuned and responsive to these changes.

C.I. INTERVENTION: Provide an orientation to the clinical setting including pace and time constraints as factors impacting patient care.

Also related to pace is the amount of noise in the clinical environment.

Acute care environments are notoriously noisy and this noise can increase student anxiety and even interfere with their ability to think through clinical situations.

C.I. INTERVENTION: Set a time-out to re-organize the situation or move it to a quieter venue.

Institutional environments also contain many workers who affect the atmosphere of the setting and often compete with one another for access to the patient.

C.I. INTERVENTION: Assist in identifying roles and functions of all the workers in the health care facility.

Support students in asserting their rightful position as care providers and patients advocates.

Amount of technical equipment and the degree to which health care providers rely on technology in

monitoring patients’ conditions varies with each setting.

Greater reliance on technology tends to result in a degree of depersonalization.

C.I. INTERVENTION: Focus on how the to equipment is being used in the specific patient situation and what observations of the patient are necessary to support the technology.

Governing rules and operational realities of a given clinical setting varies from each institution.

C.I. INTERVENTION: Orient students about procedures or protocols like documentation procedures and priority tasks

In today’s health care system economics affects the care environment.

Waste materials – inevitable when students are learning – may be viewed as a minor catastrophe by the staff.

Small economics may be practiced. Changing of linens on alternate days if they are

not soiled.Charges of supplies must be accurately allocated.

Staffing may be adjusted because students are scheduled to be on the unit despite contractual stipulations that students will not substitute as staff.

C.I INTERVENTION: Sensitizing students to economic realities while maintaining an environment that is supportive of learning and that maintains standards of care.

Experiencing the Variety of Professional Nursing Roles

Students are charged with providing full care to one or more patients, except for treatments they have not yet learned.

The reality: Professional nurses rarely, if ever, provide full care to patients.

Nurses accomplish patient goals by delegating and by managing a multi-worker/multitask approach to patient care.

“The major focus of clinical learning will be nursing management through the continuum of care, collaboration, teambuilding and the study of patient outcomes within the organizational context of the network.” (Mundt, 1997)

Leadership – involves articulating a goal that can be embraced by others and motivating performance toward goal achievement.

Leadership is demonstrated in direct patient care.

Change agency, research and advocacy are nursing roles that are similarly inherent in a student’s clinical experience.

C.I. INTERVENTION: Highlighting these roles in post conference activities increases student’s awareness of the multifaceted profession they are about to enter.

OVERALL GOAL: Prepare students for future practice through current learning experiences.

“The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.”

― William Arthur Ward

“ Thank you!”