Nursing Education and Coaching Feedback, Attitudes & Behaviors in Clinical Teaching Environment
Coaching and Giving Feedback In Nursing Education, Effective Clinical Teaching Behaviors and Attitudes In Nursing Education.
Coaching and Giving Feedback In Nursing Education
Coaching students to help them develop
clinical competency requires giving students feedback. Feedback, an essential
element in teaching and learning, is described as information communicated to
students as a result of an assessment of an action by students (Wells &
McLaughlin, 2014).
Feedback, when properly delivered, has a high potential for
learning and achievement. In clinical practice where assessments need to be
made about the extent to which clinical competencies are met, clinical faculty
have a variety of opportunities to offer feedback in response to performance
behaviors relating to psychomotor as well as cognitive and affective actions.
Regardless of the action, key considerations should be practiced. These
considerations are specificity, timing, consistency, continuity, and approach.
Approach is important because of its capacity to alleviate anxiety and enhance
engagement. Because of the variations in needs of students, each clinical
experience provides opportunities for feedback.
It is imperative that feedback
not be given only at documented, scheduled times for formative and summative
evaluations. Faculty should be cognizant of those actions that require
immediate interaction and those for which feedback can be delayed until a short
time later, but not too much later.
Methods must be identified to maintain data
for timely sharing both strengths and challenges with students, for example.
Faculty should create an efficient system for making brief written or
electronic anecdotal or mental notes. The delivery of feedback can take
multiple forms and depends on the situation.
Face-to-face, time-sensitive,
brief conferences (e.g., a few minutes) or electronic conversations or dialogue
are examples. Regardless of the method of delivery, guiding principles must be
applied and the learning intent of feedback should be provided. Knowing how to
give feedback regarding clinical performance and written clinical assignments
is an important element of teaching.
One method is to point out positive
aspects of performance as well as areas that require improvement. Some
situations may provide an opportune time to role-model. For example, if a
student fails to integrate communication while performing a procedure, faculty
can fill in the missing words. Such action may (or may not) alert the student
to an “aha” learning moment: “I failed to communicate. . . .”
The faculty
interjecting could have a lasting outcome. Debriefing and guided
reflections are forms of feedback often used immediately following a clinical
experience, nursing rounds, simulation, or presentation to determine the extent
to which expectations were met and identify any areas of concern (Overstreet,
2010).
In the process of making determinations, the discussion often evolves
into identifying areas needing improvement. Although debriefing sessions
generally take place in group settings (e.g., in clinical conferences), it is
not uncommon for sessions to occur on a one-on-one basis.
Faculty may take the
lead by posing specific questions and listening to responses to guide further
discussion. Students assume an active role in debriefing sessions and can take
the lead in initiating the process (Dreifuerst, 2012). Effective clinical
teachers are expected to have expertise in the “art” of teaching.
Equally
important are teacher behaviors that facilitate learning and support students
in their acquisition of nursing skills. Empirical evidence correlates specific
teaching methods with enhanced student learning.
A recent study suggests
effective clinical teaching involves the ability to optimize the environment to
provide meaningful learning experiences focused on predetermined objectives
(Gubrud-Howe & Schoessler, 2009).
Facilitation of cooperative learning,
active engagement, and the use of a variety of methods for learning has been
reported to be highly effective (Dahlke et al., 2012). Common examples of
cooperative strategies are peer teaching and pairing students for student-to-student
instructions.
Other effective behaviors include sharing anecdotal notes, using
objective language when giving feedback, probing to help students self-correct
misunderstandings, and communicating expectations clearly.
Effective Clinical Teaching Behaviors and Attitudes In Nursing Education
Teaching behaviors that facilitate students’
development in higher order thinking skills include prompts to help students
recognize the salient cues in a situation, prioritization, retrieval, and
application of theoretical and factual knowledge from coursework. Most
importantly, effective clinical instruction focuses on helping students to
think contextually with intent to understand the unique characteristics of the
patient’s situation at hand (Benner et al., 2010).
Included among motivational
strategies are discussing course goals and relating them to the practicum arena,
exhibiting enthusiasm about the profession, discerning student expectations,
establishing reward systems, and trying new and different teaching strategies.
Strategies that facilitate thinking modalities also include logic models
(Ellerman, Kataoka Yahiro, & Wong, 2006), case studies, and concept
mapping.
These strategies can be used in the classroom as a way to prepare
students for clinical practice and to bridge the gap between didactic courses
and clinical learning experiences. Teacher behaviors relating to interpersonal
skills are reported to affect student outcomes.
Behaviors such as showing
respect for students and treating students with respect (Dahlke et al., 2012),
correcting mistakes without belittling), and being supportive and understanding
are helpful. Nursing students experience stress and anxiety in clinical
learning situations (Elliott, 2002; Lo, 2002; Timmins & Kaliszer, 2002).
Negative relationships with faculty can contribute to anxiety (O’Mara et al.,
2014). The effective clinical teacher recognizes students’ need for supportive
and collegial relationships and develops an interpersonal style that promotes a
collegial learning environment; O’Mara et al., 2014). Positive relationships
are nurturing and can enhance learning.
Caring behaviors and a caring
environment are also essential (O’Mara et al., 2014). The literature points to
the importance of building relationships between students and teachers. It is
believed that the quality of their interaction affects learning outcomes
(Tanner, 2005).
Concepts that facilitate the building of relationships may
include the following: connections, caring, compassion, mutual knowing,
trusting and respecting, availability, knowledge, confidence, and communicating
(Gillespie, 2002). By knowing the students’ strengths, challenges and
individual goals, faculty are prevented from making assumptions and reacting to
students’ misunderstandings or poor performance.
Making assumptions regarding
student intent or motivation may be perceived by students as being disrespectful.
Making connections to identity early in the relationship assists faculty in
determining the elements needed to meet students’ learning needs (Dahlke et
al., 2012; O’Mara et al., 2014).
Teacher confidence is another factor that
enhances learning; teachers who lack confidence actually create distance
between themselves and the students they teach). This hinders the sense of
knowing and the possible connections that may have formed. A part of teacher
confidence is a foundation of knowledge.
When clinical teachers use their
expertise to support learning, the teacher student relationship is
strengthened. Cook (2005) engaged in a study to explore perceptions of teacher
behaviors that invite trust and create student anxiety.
The findings indicate
that teachers need to be aware of how their behaviors can be negatively
perceived by students, thus influencing the anxiety that occurs during the
clinical experience and ultimately affecting learning. Senior clinical faculty
should serve as role models and mentor junior clinical faculty to create a
legacy of effective clinical teaching.