Nursing Education and Complementary Clinical Experiences In Clinical Learning Environment

Nursing Grand Rounds In Clinical Learning Environment 

    The
practice of nursing grand rounds is a teaching strategy that uses the patients’
bedside for direct, purposeful experiences. These experiences may involve
demonstration, interview, or discussion of patient problems and nursing care.
Rounds also afford an excellent opportunity for the exchange of ideas about
patient care situations, which may involve clinical faculty, students, and
staff.

    The use of rounds as a teaching strategy requires planning. Planning
includes obtaining permission from the patient and providing information about
the nature of the rounds and the role the patient will play. After the session,
patient participation should be acknowledged and some form of debriefing should
occur, including planning for subsequent rounds.

Concept Based Learning Activities In Clinical Learning 

   Concept-based learning activities are a
type of experience used recently in clinical education (Gubrud-Howe &
Schoessler, 2009; Nielsen, 2009; Nielsen, Noone, Voss, & Matthews, 2013).
This learning activity is designed to develop deep learning and pattern
recognition of a particular health problem or medical diagnosis. 

  Concepts are
identified for students to study in the context of the patient care
environment. Fluid and electrolytes is an example of a concept students may
explore. Each student completes an in-depth assessment of a patient with a
fluid and electrolyte problem. The pathophysiology, treatment, pharmacology,
and patient response to care is explored. 

    The faculty facilitates comprehensive
discussion of each case and directs discussion so students begin to see the
similarities and differences between each patient in an effort to begin to
identify salient findings related to each case. The faculty help students
identify unexpected findings in the patients’ situation related to the concept
being studied and help students recognize current or potential complications
that need to be addressed. 

    Students are not responsible for care but need to
address any safety issues that emerge as they are assessing their assigned
patient. This activity allows the student to focus on critical thinking about
the concept being studied without the distraction of attending to tasks
associated with general patient care (Nielsen et al., 2013). 

    Communicating the
focus of this assignment and learning activity with staff is essential to avoid
misunderstanding of the student’s role on the unit (Gubrud Howe &
Schoessler, 2009).

Written Assignments In Clinical Learning 

    Written assignments generally complement
clinical experiences and are considered to be useful in that they facilitate
development of critical thinking and clinical reasoning and they promote an
understanding of content. Such assignments may include short papers, clinical
reasoning papers, nursing care plans, clinical logs, journals, and concept
maps. 

    Findings from research on the use of clinical logs indicate that their
use provides opportunities for students to reflect on clinical experiences,
communicate with the teacher, identify mistakes and negative experiences, and
learn from these experiences.

Point-of-Care Technology and Mobile Health

    Nurses are increasingly using handheld
devices, electronic health records, and other point-of-care technologies in the
clinical setting, and faculty must provide opportunities for students to become
familiar with their use. 

   Simulated electronic health records can be embedded in
clinical simulations as preparation for their use in the clinical agency or as
a substitute for learning when agency policy precludes students’ use of them in
the agency. 

    Smart phones equipped with reference software enable access to
clinical information; care plans; and nursing, procedure, and evidence-based
practice guidelines; and can provide access to skills videos and patient
teaching materials (Zurmehly, 2010). 

   Increasingly, nurses are using software
applications (“apps”) on a smartphone to diagnose, monitor, and teach patients
in community-based settings; students must have experience using these
point-of-care and mobile health technologies as well. 

Models for Clinical Education In Clinical Learning

    Several models for clinical education are
used to educate nursing students. These models, alternatives to the traditional
model, include preceptorship, associate model, paired model, academia service
partnerships, and adjunct faculty joint appointments. 

    These models have evolved
to increase capacity for clinical placements, facilitate development of
competency for today’s practice, manage faculty shortages, prepare graduates to
be competent for practice, and foster closer ties with clinical agencies (Delunas
& Rooda, 2009; Murray, Crain, Meyer, McDonough, & Schweiss, 2010;
Neiderhauser, Macintyre, Garner, Teel, & Murray, 2010; Niederhauser,
Schoessler, Gubrud-Howe, Magnussen, & Codier, 2012; Nielsen et al., 2013). 

    Given the diversity of health care settings, faculty shortage, and the need for
reduced faculty-to-student ratios, new models serve to enhance effective
student learning, facilitate development of clinical skills, and promote role
development.