CLINICAL TEACHING

BY GROUP 5
The Purposes of the Clinical
Laboratory
 What kind of learning occurs
in a clinical setting?
 What are the purposes behind

having learners spend time in

clinical agencies?
Infante (1985)

The opportunities for

observation is an essential
element of clinical learning.
 Problem solving, decision making, and
critical thinking skills are also refined in the
clinical laboratory.
 Learners also gain organization and time
management skills.
 Cultural competence is a skill that can be
learned well.
 Learners also become socialized.
Misuse of the Clinical Laboratory
 Theclinical laboratory has historically
been misused at all levels of nursing
education.
 Occurs when:
◦ Novices are given too much responsibility
for patient care
◦ Learners are supervised and evaluated
more than they are taught.
Models Of Clinical Teaching
Infante (1985)
 Develop a model that relies heavily on
keeping nursing students in a skills
laboratory until they are proficient
with skills
 Studentsare then sent to the clinical
area and assigned to practice specific
psychomotor skills.
Packer (1994)
 Contends more information about
clinical practice should be taught in
the classroom before learners go to
the clinical area.
◦ Permits a lot of interaction with the
teacher.
Models for Undergraduate
Nursing Students
A. Traditional Preceptorship
 Student is taught and supervised by a
practicing nurse employed by health
care while educator oversees the
process and indirectly supervises the
student. (Billay & Yonge, 2004)
B. CTA Model
 Clinical Teaching Associates Model
 Designed for two-day clinical experience
 Relives stress on educator who doesn’t
know the patients well in the first day and
taps the expertise of the staff nurse in
teaching psychomotor skills
(HunBerger, et al 2000)
B. CTA Model
1ST DAY 2ND DAY

• orientation to the unit

• educator takes over
teaching and supervisory
• clinical assignments
role
Roles of Educator & Preceptor
I. Educator
 Responsible for overseeing the educational
experience

 Ultimately responsible for student learning

outcomes

 Must meet periodically with preceptor to talk

about the students’ learning needs and
progress
Roles of Educator & Preceptor
I. Educator
 Meets with students in conference on a
regular basis
 Shares responsibility for evaluation and
grading along with preceptors
Roles of Educator & Preceptor
II. Preceptor
 Orients students to:
 Agency
 Patients
 Patient care
 Asks learners questions to ensure that
they understand what they are doing
 Evaluates student learning
Orling and Hallberg (2001)
 Studied preceptors’ perceptions of what
they do for learners and found two major
themes:
a. Sheltering students while learning
b. Facilitating students’ learning
Components of a Comprehensive
Orientation for Preceptors
1. Purpose and expected outcomes of the
clinical education of learners
2. Overview of the school curriculum as it
relates to the clinical experience
3. Skills that can be expected of learners
entering the preceptorship
4. Principles of adult learning
5. Common errors made by students and
common misconceptions.
Components of a Comprehensive
Orientation for Preceptors
6. Roles and responsibilities of the preceptor,
the educator, and the student
7. Interactions with learners and relationship
with educators
8. Introduction to course syllabi
9. Planning learning experiences
10. Clinical teaching strategies
Components of a Comprehensive
Orientation for Preceptors
11. Overview of evaluation procedures and
measuring instruments
12. Legal implications of working with learners
Preparing For Clinical
Instruction
 If the educational institution is NOT part of a
health care system, Clinical Agency Site must
be chosen.
 If the educator is part of the staff

development department, clinical units within

the agency must still be identified.
 Selection of clinical sites must be done

methodically.
Availability of Role Models
◦ An often overlooked aspect of learning.
Establishing Contracts with Clinical
Agencies
1. Educator’s role to gather data that will lead
to data contract
2. Educator should set up a meeting once
arrangements have been made for clinical
units
3. After preparations have been made, educator
must start with final preparations which
include making specific assignments for
learners.
Goldenberg and Iwasiw (1988)
 Conducted an investigation of the criteria
used by educators in selecting students’
clinical assignments
 Three most important criteria:
1. Students’ individual learning needs
2. Patients’ nursing care needs
3. Matching of patients’ needs with students’
learning needs
Wierda and Natzke (2000)
 Described another method of pairing
students on the same assignment but in
overlapping shifts
Conducting A Clinical
Laboratory Session
PRECONFERENCE

PRACTICE SESSION

POSTCONFERENC
E
Preconference
 Planning of patient care continues
 Tentative nursing diagnoses are discussed
 Possible nursing interventions are discussed
 May be use to help learners organize their
day & prioritize the care they must give.
Practice Session
 Structure may vary a great deal
 Variety of teaching methods can be used:
a. Scavenger hunt – help orient learners to the
clinical unit
b. Combinations of strategies (demonstration with
explanation, asking and answering questions,
coaching techniques)
Practice Session
 QUESTIONING
◦ Assist learners in developing problem-solving
and decision-making skills

 COACHING
◦ Help learners set goals for themselves
◦ Guide through psychomotor skills and refine
thinking processes
Krichbaum (1994)
 Studentlearning (Baccalaureate
students) is significantly related to
preceptor behaviors
Pedagogies
A. Observation assignments
 Used routinely in clinical education
 Supported by social cognitive theory
Pedagogies
B. Nursing Rounds
 A pedagogical strategy
 Involves a group of learners and their
instructor visiting patients to whom the
learners are assigned
 Assigned students interact with the patient
Pedagogies
B. Nursing Rounds
 PURPOSES
 To expose learners to additional nursing
situations
 To encourage them to consult each other
in planning and evaluating care
 To provide many opportunities to apply
classroom theory to patient situations
 To compare and contrast patient care
Pedagogies
C. Shift Report
 A unique time for learning (Yurkovich & Smyer,
1998)
 A way for students to learn the uniqueness of
nursing communication and the means of
professional socialization
Pedagogies
D. Technology Use
 Both a teaching strategy and a learning
resource
 Two emerging forms of technology used in
clinical field
 Personal Digital Assistant/ Hand-held
Computer
 Nightingale Tracker System
Personal Digital Assistant
 Designed for multiple functions (information
storage, retrieval and input, electronic mail)
 Enables students to access textbooks, drug
references, infectious disease information,
immunization guidelines, medical language
translations, standardized nursing care plans, and
medication calculators
 Strength: ability to provide instant information at the
point of care.
 Help change the focus of learning from
memorization to accessing information when needed
Nightingale Tracker System
 Applies basic handheld computer functions to
community based clinical nursing education.
 Developed by Fuld Institute for Technology in Nursing
Education (FITNE)
 Includes a dedicated computer server and a customized
PDA device that provides the students in the patients
home with data and communication abilities
 Enables the student to access clinical data in the home,
to speak to the faculty member via telephone line, and
to document care through touch screen menus using
the Omaha Patient Care Record System
Pedagogies
E. Learning Contract
 Written agreement between
instructor/supervisor and learner which
include:
 Learning objectives
 Learning resources to achieve the objective
 Learning experiences planned
 Time line
 Evaluation plan
Pedagogies
E. Learning Contract
 Learner Role - To develop a learning contract
with the instructor based on his own learning
needs, interest, and skills.
 Instructor Role - To consult with the learner in
the development of objectives, to make
resources available, and to validate
achievements/arranged for it to be validated
by someone else
Sample Learning Contract for New Staff Nurse
During Orientation
LEARNING RESOURCES ACTIVITIES AND MEANS OF
OBJECTIVES NEEDED ACCOMPLISHMENTS VALIDATION
Analyze the essential
Literature elements of
Improved Instructor will
search communication in this
communication evaluate the
scenario
skills with therapeutic
After talking with
families of dying Assignment of adequacy of the
families, recount the
patients terminally ill conversation
conversation with the
patients
preceptor
Instructor will
Procedure Perform the skill in the
evaluate
manual Skills Laboratory
performance
Correctly
Practice in Skills
perform Perform the skill on Preceptor will
Laboratory
colostomy care the patient with evaluate
Assignment to a
Pedagogies

F. Journal Writing
 Logs; Reflective Journals; Narrative Pedagogy
 Promote active learning and reflective practice
 Built on the theory of constructivism
 A cognitive theory that proposes individual learners
actively construct their own learning on the basis of
their prior knowledge, experiences, and
interactions with their environment
Journal Writing

PURPOSES
 Gaining meaning from experiences
 Making connections between theory and practice
 Appreciating others’ perspectives
 Developing critical-thinking skills
 Documenting the science of nursing
 Way of coping with highly emotional/traumatic
incidents in professional life
Journal Writing
TYPES
1. Directed Journals
 Describe a critical event that took place in
clinical days
 Importance of event/case
 What is learned from the situation/nursing
theory helped in understanding what
happened
 What is to be done differently when the
situation is encountered again
Journal Writing
TYPES
2. Critical Thinking Papers
 Asks students to identify key
problems/events in caring for the patient
to identify underlying assumptions that the
patient/student brings to the situation, the
meaning of these issues for the
patient/student
Journal Writing
TYPES
3. Reflective Practice
 Involves looking back over what happened
in practice in an effort to improve or
encourage professional growth
Post conference
 USES:
1. Pointing out application of theory to practice
2. Analyzing the different way the patients with
similar illnesses differ in their response to
nursing care and treatment
3. Group problem-solving
4. Evaluating nursing care
Post conference
 USES:
5. Have each learner report what was done for
his/her patient
6. Means to help socialize learners into the world
of nursing and give another opportunity to help
them think like a nurse
Post conference
 Points to Remember
1. Have objectives in mind for the session
2. Let learners take the lead in determining of
much of the direction of the conference
3. Begin with just one or two learners’ experience
with the other participants asking questions and
contributing to the discussion by comparing
and contrasting their own experiences
4. The primary topic for the discussion should fit
in with the objectives
Post conference
 Points to Remember
5. Educators should take the role of coaches for
cognition, monitoring the thinking levels and
attempting to raise it through higher order
questions
6. Educators should encourage learners to analyze
ethical issues related to patient care
7. Time should be allotted for learners
8. Post-conferences may go online
Evaluating Learner Progress
Evaluating Learning Progress
 Least favorite task
 Need feedback and judgment of their work
 How they are doing at one level before

progressing to the next

 Determine how well they are meeting

objectives and to certify that they are safe

practitioners
Choices Regarding Evaluation
 Formative Or Summative
 Norm Reference Or Criterion Reference
 Type Of Grading System
 Behaviors To Be Evaluated
Formative vs. Summative Evaluation
FORMATIVE SUMMATIVE

 Ongoing feedback given to the  Summary evaluation given at the

learner throughout the learning end of the learning experience
experience
 Assess whether the learner has
 Strengths and weaknesses achieve the objectives and is
ready to move on to the next
 Prevents learners from being
experience
surprised and unprepared
 Graded
 Non-graded
Clinical Evaluation
 Always involves summative evaluation
 May involve formative evaluation
 Learners have the right to know how they are

progressing and educators can protect

themselves against charges
 May be given on an incident, daily, or weekly

basis
Formative Feedback
ORAL or WRITTEN
 Written Feedback – often move valuable

because learners can take time to read and

absorb information

ANECDOTAL RECORDS/CLINICAL PROGRESS

NOTES
 Written Formative Evaluation notes
Tomey (2000)
 Recording observations of what the learner
says or does including the date, a description
of the incident and comments
 Longitudinal view of learners’ progress
 Keeping detailed weekly records of a learner’s
clinical experience is time-consuming yet
without such data, formative or summative
evaluation is dependent on the instructor’s
memory
Norm Referenced vs. Criterion
Referenced Evaluation
NORM REFERENCED
 A learner is compared to a
reference group of learners
either those on the same cohort
or in a norm group
 Relative to group performance
CRITERION REFERENCED
 Compares learner with a well
defined performance criteria
 Criterion-referenced tool
-defines the behavior expected
at each level of performance

 Students’ behavior is  Fairer

characterized as below average,
 Learners are informed of the
average, or above average
behaviors expected of them to
 Unless evaluation tool is specific pass
about what average behaviors
 Grading system is less
are like the process may be
subjective
unreliable
Grading System
A. Assigning letter grades
B. Using a pass/fail or
satisfactory/unsatisfactory approach
Rines (1963)
 Clinical grades should always be given on a
pass/fail or satisfactory/unsatisfactory basis
since – “Human behavior of any description is
much too complex to permit such fine
discriminations”
 Letter grades are impractical and unfair
Walsh and Seldumridge (2005)
 When letter grades are given there is a
tendency toward grade inflation because of
the subjectivity involved and difficulty in
making fine grading distinctions of observed
behavior
Pass/Fail System:
Criterion Reference Evaluation
 Theory & Clinical Practice are combined in
one course
 Letter grades are given for theory
 Pass/Fail are given for clinical component
 Total course grade = Theory grade + Pass

Clinical Work
 Fail = Theory Grade + Fail Clinical Work
Grading System
 Point at which students should be graded for
clinical work:
 When they are teaching
 When they are formally evaluating and grading
performance
Woolley, Brian, & Davis (1998)
 System of evaluation with a final one day
clinical examination based on the New York
Regents College Performance Examination
 Labor intensive and extensive scheduling
 1st Half - Learning time
 Last Half – Final grade
Behaviors to be Evaluated
 Areas of Performance
Use of nursing process
Use of health-promoting strategies
Psychomotor skills
Organization of care
Maintaining patient safety
Ability to provide rationale for nursing care
Behaviors to be Evaluated
 Areas of Performance
Ability to individualize care planning and
intervention
Therapeutic communication
Ability to work with a professional team
Professional behaviors such as following policies,
being on time, maintaining confidentiality and
being accountable for ones own actions
Written documentation of care
Sources Of Evaluation Data
 Direct observation by instructors produces most
of the data
 Learner self evaluation is a good source of data,
but is never an easy task
 Data may also be gathered from agency staff
and formal evaluation is seldom sought from
staff members unless they are serving as
preceptors
 Written work and college laboratory work
performed by the learner can be evaluated and
incorporated as part of the clinical grade
Conference Between Educator And
Learner
 Conferences should be held with the learner
at least halfway through and then at the end
of the evaluation period
 The more specific and concrete the educator

is the more the learner will benefit from the

evaluation.
Negative Information can be given in two
ways
“Anna, you have great difficulty implementing the
nursing process. You need to develop skill in
selecting appropriate nursing interventions for your
patients.”

“Anna, in planning care for your patients, you have

had difficulty in selecting the appropriate
interventions that meet their specific needs. For
example, when you cared for Paul the 10-year old
with cerebral palsy, you tried to involve him in a
game that was inappropriate for someone with his
level of disability.”
Clinical Evaluation Tools
Instrument or Tools for Clinical
Evaluation
 These instruments should meet the following
specifications:
 The items derive from the course or unit objective
 The items must be measurable in some way, it
must be possible to collect substantiating data
 The items and instructions for use should be clear
to all who must use the tool
 The tool should be practical in design and length
 The tool must be valid and reliable
Interesting Tools
 Three interesting tools that appear in the
literature that have been tested for reliability
and validity are:
1. The Rating Scales (Bondy, 1983-84)
2. The Community Family Nursing Clinical Evaluation
Tool (Hawranik, 2000)
3. The Clinical Evaluation Tool (Krichbaum, Rowan,
Duckett, Ryden, Savik, 1994)
TOOLS DESCRIPTION

FIVE POINT
 Reflects criterion-referenced levels of competency
RATING SCALE
 Can be applied to any clinical setting
(Bondy)

 Contains items on the nursing process,

HAWRANIK’S
professional growth and leadership
TOOL
 Used in most home-health settings

 Generic
CLINICAL
 Covers items on health promotion, nursing
EVALUATION
process, safety, scientific knowledge,
TOOL
multicultural care, therapeutic relationships, and
(Krichbaum, et al)
professional behavior
A summative evaluation of clinical
performance may determine a nursing
students ability to stay in nursing
school, a refresher nurse’s freedom to
reenter the profession, or a staff nurse
orientee’s likelihood of holding a
position in an organization.
 Albao, Chissel
 Espinosa, Mariz Sherine
 Galanza, Rachel Joy
 Lagasca, Mere
 Milla, Kimberly
 Miralles, Doreen
 Palompon, Ma. Rafaela
 Santos, Sheanne Lou

BSN 3y3-2