Nursing Education and Inter Professional Education, Schedule Assignments & Effective Teaching for Clinical Practicum

Inter Professional Clinical Education For Clinical Practicum In Nursing Education, Evaluating Experiences for Clinical Practicum In Nursing Education, Scheduling Clinical Practicum Assignments In Nursing Education, Effective Clinical Teaching for Clinical Practicum In Nursing Education.

Inter Professional Clinical Education For Clinical Practicum In Nursing Education

    Learning to collaborate with the many health
care groups involved in patient care can be a daunting task. Through these
experiences, nursing students can learn to work collaboratively with a variety
of health disciplines. Therefore, students should be provided with
opportunities to work as members of inter professional teams and in practice
environments where practice models are used for joint planning, implementation,
and evaluation of outcomes of care. 

    The goal of inter professional education is
to foster development of teamwork competencies while enhancing contribution to
each profession. Inter professional simulations may assist students in health
care disciplines such as nursing, medicine, pharmacy, and respiratory therapy
to learn about the clinical management of a variety of patients. 

    Several recent
studies demonstrate interprofessional simulations may improve patient care
through shared learning, development of collaborative team functioning, and
shared knowledge creation leading to trust and thoughtful decision making
(Bandali, Craig, & Ziv, 2012; Reese, Jeffries, & Engum, 2010;
Smithburger, Kane-Gill, Kloet, Lohr, & Seybert, 2013; Strouse, 2010). 

    Nursing faculty are increasingly participating in teams and designing
interprofessional clinical courses and learning experiences. Successful course
development and implementation depend on faculty’s commitment to the goal of
interprofessional practice and a wide range of additional factors. For example,
educators must demonstrate professional respect and role clarity. 

    Educators
must also have the ability to secure clinical facilities and develop schedules
for clinical experiences that are compatible with the concurrent coursework and
curriculum progression in each discipline. Other factors include identification
of content and experiences with similarities, differences, and overlaps, as
well as clarification of autonomy and role interdependency. 

    Success depends on
the ability to identify philosophical similarities and differences in clinical
practice and to establish clear communication through avenues such as frequent
interdisciplinary clinical conferences. An expected outcome of
interprofessional education is increased future collaboration among
professionals (Interprofessional Education Collaborative Expert Panel, 2011). 

    The assumption is that students who are taught together will learn to
collaborate more effectively when they later assume professional roles in an
integrated health care system. Rewards and benefits of interprofessional
practice and education include clearer understanding of roles and better
employment opportunities for graduates. 

    The long-term outcome is improved
access to care, quality care, and increased patient satisfaction and safety.

Evaluating Experiences for Clinical Practicum In Nursing Education

    Students are required to demonstrate multiple
behaviors in cognitive, psychomotor, and affective domains. Consequently,
clinical faculty must evaluate students in each of these areas. The evaluation
must be both ongoing (formative evaluation) to assist students in learning and
terminal (summative evaluation) to determine learning outcomes. 

Scheduling Clinical Practicum Assignments In Nursing Education

    Although faculty schedule clinical
practicum experiences to promote learning, there is ongoing dialogue about the
best way to schedule experiences, with emphasis placed on the length of the
experiences (hours per day, number of days per week, number of weeks per
semester), the timing of the experiences in relation to didactic course
assignments, and student needs. 

    Faculty should consider course goals related to
both theory and clinical courses and integration of theory content with
clinical experiences when making scheduling decisions. When the learning goal
is to integrate students into a clinical setting or when the students are
working with a preceptor, students may work the same shift as the nurse with
whom they are paired. 

    Many acute care hospitals have a 8-hour shift option,
whereas others have only 12-hour shifts. Giving students the opportunity to
work the 12- hour shift affords the full scope of practice in any given nurse’s
day. Students are able to quickly see and experience the role of the nurse. 

    In
one small study of senior nursing students in a second-degree program working a
12-hour shift, Rossen and Fegan (2009) found that benefits included that
students felt accepted by staff, had better socialization, and experienced a
realistic work environment; disadvantages included decreased teaching time from
the faculty. 

    Although a shorter clinical day allows for skill acquisition,
there is little time for the development of extensive critical thinking,
clinical reasoning, and evaluation of care. It is equally important that
students be exposed to the unit’s structure, operations, and culture. 

    Although
results of research about outcomes and student satisfaction with timing and
scheduling of clinical experiences offer some guidance, faculty also must consider
additional variables such as availability of patients, clinical facilities,
course schedules, and student needs. 

    Scheduling is frequently influenced by the
desire to have concurrent classroom and clinical experiences so that knowledge
can be transferred and applied immediately. Clinical scheduling can be further
complicated by the need to coordinate schedules of students from more than one
school of nursing. Thus, ideal scheduling may not be a reality.

Effective Clinical
Teaching for Clinical Practicum In Nursing Education

    Clinical teaching must use multiple
instructional techniques and teaching tactics to develop and adapt to the
environment in which students have opportunities. The clinical instructor
should implement activities aimed to foster mutual respect and support for
students with each other while they are achieving identified learning outcomes. 

    Faculty who teaches in practicum environments are the crucial links to
successful experiences for students. Research about clinical teaching over time
consistently indicates that effective clinical teachers are clinically
competent, communicate clear expectations, are approachable, and can coach
students through difficult patient situations (Dahlke et al., 2012). 

    Additionally, students indicate effective clinical teachers have knowledge of
the clinical environment and curriculum, make clinical learning enjoyable
through supportive actions, express empathy, and communicate passion for the
profession). 

    Making clinical learning enjoyable involves helping students
connect theory to practice and applying clinical reasoning while using a
patient-centered approach to addressing problems (Dahlke et al., 2012). 

    Being
knowledgeable and being able to share practice wisdom with students in clinical
settings is essential. Such knowledge includes an understanding of the theories
and concepts related to the practice of nursing. Equally important is an
ability to convey the knowledge in an understandable manner. 

    Karuhije (1997)
directs attention to three discrete teaching domains that will facilitate
acquisition of the teaching skills needed to foster success in clinical
settings: instructional, interpersonal, and evaluative. Instructional refers to
approaches or strategies used to facilitate a transfer of knowledge from
didactic to practicum. Strategies may include questioning and peer or patient
teaching. 

    Faculty should be cognizant that the type of questions can cover a
range during exchanges with students. Faculty should also be mindful of the
manner in which questions are constructed to facilitate positive effects on
learning. 

    Questions that ask students to analyze and synthesize information, to
make clinical judgments, to evaluate outcomes of care, or to propose
alternative courses of action result in more learning than simple recall. In clinical
practice, factors such as the nature of the situation and available time are
likely to influence the types of questions raised. 

    Effective clinical teaching
requires educators to coach students as they learn clinical reasoning and
judgment. Clinical reasoning is a “complex process that uses cognition,
metacognition, and disciplinespecific knowledge to gather and analyze patient
information, evaluate its significance, and weigh alternative actions”
(Simmons, 2010, p. 1151). 

    Clinical judgment is the outcome of the clinical
reasoning process and is defined as “an interpretation or conclusion about a
patient’s needs, concerns or health problems and/or the decision to take action
(or not), and to use or modify standard approaches, or to improvise new ones as
deemed appropriate by the patient’s response” (Tanner, 2006, p. 204). 

    Clinical
reasoning occurs when an individual has the ability to reason about the details
of a particular clinical situation and identify what is salient (Benner et al.,
2010; Tanner, 2006). Effective and efficient clinical reasoning is derived from
knowing the patient, grasping baseline data, and understanding the case
(Gillespie & Patterson, 2009). 

    Clinical reasoning requires knowledge,
skills, and abilities grounded in reflection. Clinical reasoning is supported
by an individual’s capacity for self-regulation and leads to the development of
expertise (Kuiper, Pesut, & Kautz, 2009). 

    Beginning students struggle with
the ability to engage in clinical reasoning required to make sound judgments.
The novice student does not have the ability to identify the subtle or relevant
cues seen in a patient whose health condition is changing and for whom
complications are beginning to occur. 

    Faculty can assist students in
identifying these subtle and relevant cues and start to collaborate with other
health care professionals to provide the interventions needed to anticipate
potential problems and consider the options aimed toward eliminating or
treating complications (Cappelletti, Engel, & Prentice, 2014).