CLINICAL TEACHING

IN NURSING

Hacettepe University Faculty of Nursing

Nursing Services Administration Department
HEM423 EDUCATION IN NURSING
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Objectives

At the end of this lesson you will be able to:

• Describe the role of the teacher in clinical setting

• List at least five criteria of selecting clinical setting
• Discuss the factors that effect clinical teaching
• Relate active learning with the clinical teaching

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Clinical Learning Environment (CLE)

• … is the environment that provides opportunities for students to

integrate theoretical nursing knowledge into nursing care, cultivate
clinical reasoning and judgment skills, and develop a professional
identity.

(O’Mara, McDonald, Gillespie, Brown, & Miles, 2014).

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Through clinical placements, nursing
students learn to:
• integrate theoretical knowledge into the planning and implementation of
patient care
• develop therapeutic communication and psychomotor skills
• practice ethical decision-making in clinical situations
• socialize to the workplace environment, and
• function as a member of the healthcare team
(McKenna, McCall, & Wray, 2010).
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 A Philosophical Context For
Clinical Teaching
• Using a philosophy of clinical teaching to
improve clinical education.
• Philosophy is a system of enduring shared
beliefs and values held by members of an
academic or practice discipline.
• Gives meaning and direction to practice
• Provides a basis for decision making
• Determines whether one’s behaviours is
consistent with one’s belief

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 A Philosophical Context For
Clinical Teaching
• Every clinical teacher has a philosophical
approach to clinical teaching, whether
or not the teacher realizes it.

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Approaches to The teacher’s
clinical teaching understanding of
his or her role
Selection of
teaching and
learning
activities
Philosophy of clinical
teaching determines;
Relationships
with learners
and others in
the clinical
environment Use of evaluation
process
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 Philosophy of Clinical Teaching

Mutual trust
Mutual respect

To support learning and student growth

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 Clinical education should reflect the nature of
professional practice!

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 Professional practice areas are…

complex

instable

uncertain

uniqueness

Presence of value conflicts

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Time is important!

• Clinical setting is a place where

students can test theory as they apply
it to practice.
• Skill acquisition is a complex process
that involves making mistakes and
learning how to correct and then
prevent those mistakes.
• Sufficient learning time should be
provided before performance is
evaluated.
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 QUALITY is more IMPORTANT than QUANTITY

The length of time spent in clinical activities is no guarantee of the

amount or quality of learning that results.
Example: 2-hour activity that results in critical skill learning is far more
valuable than an 8-hour activity that merely promotes repetition of
skills and habit learning.

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 Essentials of Clinical Teaching

• Teachers must have clear, realistic expectations of the desired

outcomes of clinical learning.
• What knowledge, skills and values can be learned only in clinical
practice and not in the classroom or through independent learning
activities?
• How many hours should be spent in clinical area, how and where
clinical learning takes place?

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 CLINICAL
PRACTICE

SIMULATION

CLINIC
LABORATORY

DEMONSTRATION

THEORY
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• Planning for clinical teaching should begin with identifying learning
outcomes that are necessary for safe, competent nursing practice.
These outcomes should be related to the three domains of learning:

COGNITIVE Knowledge and intellectual skills

physical movement,
PSYCHOMOTOR coordination, and use of the
motor-skill areas

AFFECTIVE Professional attitude, values and

beliefs

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Cognitive Domain
• Transfer knowledge learned in classroom and through independent
learning activities to real-life situations.
• Clinical learning activities should focus on the development of
knowledge that can not be obtained in the classroom or other settings.
• Knowing how to practice nursing involves high level cognitive abilities
such as problem solving, critical thinking, decision making and clinical
reasoning.

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 Clinical reasoning is a “complex process that uses
cognition, metacognition, and discipline specific
knowledge to gather and analyze patient
information, evaluate its significance, and weigh
alternative actions” (Simmons, 2010, p. 1151).
Clinical
reasoning &
clinical
judgement 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).

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 Some problems are related to patients and their health
needs; some arise from the clinical environment. Most clinical
problems tend to be complex, unique and ambiguous. The
nursing process itself is a problem solving approach.

Critical thinking is a process used to determine a course of

action involving collecting appropriate data, analyzing the
validity and utility of the information, evaluating multiple
lines of reasoning and coming to valid conclusions. It is
purposeful, outcome-directed and evidence based.

Decision making process involves gathering, analyzing,

weighing and valuing information in order to choose the best
course of action from among a number of alternatives.
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 • Includes ability to perform
proficiently and consistently
Psychomotor under varying conditions and
Domain within appropriate time limits.

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 Affective Domain

• Clinical learning also produces important affective

outcomes; beliefs, values, attitudes and dispositions
that are essential elements of professional nursing
practice.
• Affective outcomes represent the humanistic and
ethical dimensions of nursing.
• To hold and act on certain values with regard to
patient care such as respect for the patient
uniqueness, supporting patient autonomy and right to
choose and the confidentiality of patient information.

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 Examples of clinical learning
environment
• Clinical cases, unfolding case studies, scenarios
• Acute and transitional care environments
• High fidelity simulation
• Virtual clinical practicum
• Community-based environments (such as ambulatory, long-term,
home health, hospice, homeless shelters, social agencies, health
maintenance organizations, and worksite venues and summer camps)

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 Selection of clinical sites should be based
on important criteria such as;
• compatibility of school and institution
Selecting philosophy
Clinical • availability of opportunities to meet
learning objectives
Settings • institution licensure or accreditation
• availability of positive role models
and physical resources

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 Selecting Clinical Settings (cont.)
Assesment of potential clinical institutions should address the following criteria:

• Level of the learner • Staff relationships with teachers and

• Degree of control by faculty learners
• Geographical location • Orientation needs
• Physical facilities • Opportunity for interdisciplinary
activities
• Institution requirements

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 • Clinical competence
Preparation • Familiarity with the clinical environment
of Faculty • Role modeling behaviors;
1. Professional characteristics
Members 2. Respectful
3. Intentional actions
4. Deliberate explanations of actions

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Preparation Ideally nursing staff members would be eager
to work with the faculty member to help
of Clinical students meet their learning goals.
Staff
• Clarification of roles
• Level of learners
• Learning outcomes
• Positive role modeling
• Students are NOT NURSES

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Preparing the
Learners

COGNITIVE PREPARATION
• It includes information about
the learning objectives, the
clinical institution and the roles
of teacher, student and staff
member.

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Preparing the Learners (cont.)

AFFECTIVE PREPARATION
• It includes strategies for managing their anxiety and for
fostering confidence and positive attitudes about learning.
• Mild or moderate anxiety often serves to motivate students
to learn, but excessive anxiety hinders concentration and
interferes with information processing and learning.

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Preparing The
Learners (cont.)

• PSYCHOMOTOR PREPARATION
• When learning complex skills, it is more
efficient for students to practice the
parts first in an environment such as
simulation center or skills laboratory.
• In such a setting students can
investigate and discover alternative
ways of performing skills and they can
make errors and learn to correct them
without fear of harming patients.

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Orientation to the Clinical Institution

• The geographical location of the instiution

• The physical setup of the specific unit where students will be placed
• Names, titles, and roles of personnel
• Location of areas such as rest rooms, dining facilities, conference room, locker
rooms, public telephones, and library
• Information about transportation and parking
• Agency and unit policies
• Daily schedules and routines
• Patient information documentation systems

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 • Teachers cannot provide the experience; they
can provide only the opportunity for the
experience.
Active • The teacher’s role is to plan and provide
learning in appropriate activities that will facilitate
learning.
clinical • The teacher is a facilitator of learning and
settings acquisition of new knowledge and skills.
• The student is an active participant.

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 When students actively involved in their learning,

How faculty can

Positive They can be
help them in
student-teacher honest about
developing
relationship their learning
their clinical
need
competence
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 Some additional benefits;
Active • Students can reflect on their clinical experience
and put their thoughts into words which leads to
learning in new knowledge and deeper learning
• Fosters critical thinking
clinical • Encouraging student-faculty interaction
settings • Cooperation among students
• Emphasize time on task with prompt feedback

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 1. Identifying the outcomes for learning
Process of 2. Assessing learning needs
Clinical 3. Planning clinical learning activities
4. Guiding students
Teaching: Five
5. Evaluating clinical learning and
Components performance

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 Assessing Learning Needs

Individual characteristics of
students that may
Assess the student’s
influence their learning and
present level of knowledge
clinical performance (age,
and skill
learning style, cultural
background..)

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 Planning Clinical Learning Activities

• Clinical activities include the evidence on the effectiveness of the

clinical teaching method and learning activities being considered,
characteristics of the clinical setting, and teacher availability to
guide learners.
• The main considerations are the competencies to be developed in
the clinical practicum, or outcomes to be met in the clinical
component of the course, and individual learner needs.

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 Guiding Students

1. Observing clinical performance

2. Questioning learners to encourage critical thinking but
without interrogating them.

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Stresses of Students in Clinical Practice
• Students face uncertanities and unique situations that may not have
encountered prior learning
• Students are unsure about approaches and interventions
• Students fear making mistakes
• A lack of knowledge and skill to provide care to patients
• Unfamiliarity in the clinical setting
• Being observed and evaluated by the teacher

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Evaluating Clinical Learning and Performance

Formative: Summative:
• This evaluation provides • This evaluation takes place at
information about further the end of the learning process
learning needs of student and to ascertain whether course
where additional clinical outcomes heve been achieved
instruction is needed. and competencies developed.

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 Small
Observation
segments

Giving Linking feedback

Specificity
to actual
Feedback behavior

Positive/critical/
Sandwich positive
technique (Non
judgmental)

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 • Several models for clinical education are
used to educate nursing students. These
models, alternatives to the traditional
model, include:
• Preceptorship
Models for
• Associate Model (Clinical Teaching
Clinical Associate)
Teaching • Academic–Service Partnerships
• Adjunct Faculty Joint Appointments
• Dedicated Education Units
• Residency Models

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 QUESTIONS&COMMENTS?
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