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Preparedness for Clinical Practice among Nursing Students

Tracheostomy care and suctioning is part of a registered nurses scope of practice. In third
year these skills are learned by nursing students in the laboratory setting. In preparation to learn
these skills students review the theory components and may observe videos of the skills being
performed on mannequins. In the laboratory setting the skills are also practiced on humanoid
mannequins, however, differences do exist between this simulation and clinical practice. For
example, in the laboratory tracheostomy suctioning is performed using real suction catheters
with the suction turned on but there is often no or little liquid secretions to suction of the right
consistency and the mannequin does not exhibit a gag reflex or any other reflexes. These
differences can make the first time the skill is performed in clinical practice unnerving.
Several weeks into my chronic care clinical placement, I had the opportunity to care for a
patient who had a tracheostomy. This patient had had her tracheostomy for approximately eight
years prior to having a stroke which resulted in her current hospitalization. The stroke left her
bedridden. This patient required tracheostomy suctioning due to the buildup of thick mucus in
her airway that was impeding her ability to breathe. As part of the care for this patient I had the
chance to perform the tracheostomy suctioning. Another nurse first demonstrated the technique
before offering me the suction catheter to continue suctioning. I found the patients response to
suctioning to be unnerving. To me it appeared that the patient was experiencing severe
discomfort and was potentially choking. The other nurse in the room ensured me that this was a
normal response.
Having been a long time since I was able to practice the skill in the laboratory setting to
preforming it in the clinical setting, I also felt unsure of my technique and ability. I felt
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unprepared for the situation. Without the support of the nurses that were with me on both
occasions I suctioned the tracheostomy of this patient, this experience could have potentially
deterred me from seeking out additional opportunities to practice this skill.
Many factors affecting the ability of nursing students to perform skills in clinical practice
have been identified. Houghton et al (2013) identified three main themes after interviewing
nursing students. The themes, the real world, fitting in, and supervision and support,
helped clarify what helped and hindered performing skills in clinical practice (Houghton et al.,
2013). Factors that helped students prepare for the implementation of clinical skills as registered
nurses included having support and supervision from the staff, having confidence in their
abilities, and having learning opportunities in the clinical setting as well as in the laboratory
setting (Houghton et al., 2013). The reality shock of the hospital setting and the gap between
how the skills are taught in the laboratory experience and clinical experience were a main
hindrance of students abilities (Houghton et al., 2013). Houghton et al. (2013) address these
hindrances by suggesting staff have an understanding of how students fit in to the clinical
environment and being supportive of their practice.
In 2003, Guillaume Alinier found that Objective Structural Clinical Examinations
(OSCE) were positively viewed by both instructors and students in enhancing learning of clinical
skills and preparing students to perform skills in the hospital setting. OSCE give the students an
opportunity to practice clinical skills in a more realistic but still controlled environment that
mimics the clinical one (Alinier, 2003). They have been shown to provide nursing students with
more confidence in their abilities through demonstration of skills through the use of scenarios
(Alinier, 2003). OSCE are not currently a part of the curriculum at Trent University, but having
researched and reviewed the benefits of this type of learning, I think they would have been
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beneficial in providing additional support and practice for me as well as other students that feel
unprepared to perform certain skills in clinical practice.
This opportunity provided me with a chance to review how confident I feel in my ability
to perform certain complex clinical skills and what I need in order to have greater confidence. In
future practice I think it is not the skill that is being performed that is the important factor in my
confidence in performing the skill but all the factors around me. Having support from another
nurse and having had learning opportunities to walk through the skill and practice it are very
important. In the continuation of my practice to avoid situations in which I feel overwhelmed or
unprepared for a situation, I should take time to collect myself, review what I already know, look
up the steps, as well as discuss the process with a more experienced nurse. Also need to
recognize that the first couple times I perform a skill in clinical practice will be different from
my lab experience. Recognizing these differences will support me in becoming a competent
nurse.







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References
Alinier, G. (2003). Nursing students and lecturers perspectives of objective structured clinical
examination incorporating simulation. Nursing Education Today, 23, 419-426.
doi:10.101650260-6917(03)00044-3
Houghton, C. E., Casey, D., Shaw, D., & Murphy, K. (2013). Students experiences of
implementing clinical skills in the real world of practice. Journal of Clinical Nursing, 22,
1961-1969. doi: 10.1111/jocn.12014