CLINICAL METHODS

OF TEACHING

Prof HCL Rawat

Era university Lucknow

Page  1
 INTRODUCTION

Learning is not a spectator sport.

Students do not learn much by just
sitting in class listening to teachers,
memorizing prepackaged
assignments, and spitting out
answers. They must talk about what
they are learning and relate it to live
examples.
Contd….

 “Students learn what they care about

and remember what they understand.”
Ericksen,1984
 “When students are actively involved
in learning they learn more than when
they are passive recipients of
instruction.”
Cross, 1987
Contd…
 Nursing education is a practice discipline, the
students will learn the subject matter by doing
the things and practicing the skills.
 Nursing is an art and science.
 Involves human lives, so training and
experience should be supported by good clinical
teaching.
Academia – Practice Gap
LIST OF CLINICAL TEACHING
METHODS
1. Case method:
 Case study
 Case analysis
 Case incident
2. Bed side clinic
3. Clinical conferences
4. Nursing rounds
5. Nursing care plan
6. Process recording
7. Demonstration
 1. CASE METHOD

Originated many centuries ago when Hippocrates used it as a

method of teaching medicine.

Florence Nightingale used a modification of case study.

Contd…

Case-based teaching is a
technique well suited to the
graduate and post-graduate
health sciences curriculum. It
provides the learner an
opportunity to integrate and
apply core knowledge, build
critical thinking skills, and
implement clinical skills within a
safe and facilitated learning
environment.
3 Distinct methods used in teaching with
cases. These are:
Case Study
Case Analysis
Case incident
 CASE STUDY
Definition:
The case study describes the life history of an individual or all
of the factors which affect a situation. It tries to give as much
breadth and depth of an individual or situation as possible.
 Nursing Case Study
Places emphasis on actual nursing
care of the patient and therefore
referred to as nursing case study.
Comprehensive study is made of the
individual patient to bring about full
understanding of the needed nursing
care.
 VALUES OF NURSING CASE STUDY

 Provides opportunity for student to solve nursing problems.

 Stimulates critical and reflective thinking.
 The student learns the scientific method of approaching a problem.
 The student learns to see the patient as an individual.
 This enables her to record actual care given to the patient as well as
the study of the theoratical treatment of the disease.
 Helps the student to integrate knowledge of various subjects.
PRINCIPLES TO FOLLOW FOR GOOD CASE
STUDY

 Emphasis should be on the individual needs of the patient.

 Take sufficient time to study the patient.
 Refer sufficient material.
 Have frequent clinical conferences.
FORM AND PRESENTATION OF CASE
STUDY

WRITTEN
CASE
STUDY

ORAL CASE
STUDY
 WRITTEN CASE STUDY
ADVANTAGES
 Individual assessment of the
student
 Self expression in writing
 Experience in organizing and
writing a paper in scientific
way
 Source for future reference
DISADVANTAGES
 Leaves no opportunity to
branch out and incorporate
new ideas once the study is
completed
 Time consuming to rewrite
into an acceptable form
ORAL NURSING CARE STUDY
ORAL CASE STUDY

ADVANTAGES DISADVANTAGES
 Directs student’s thinking  No opportunity for writing
into new channels. and other creative
 Better personal expression.
understanding and  No record.
relationship.
 Time saving.
 Opportunity for public
speaking experience.
 Thrill of achievement.
 CASE ANALYSIS METHOD

DEFINITION:
The method of teaching and learning in which a concrete case is
presented for analysis and discussion by a group of students.
TECHNIQUES FOR EFFECTIVE CASE
ANALYSIS
ESTABLISHMENT OF ATMOSPHERE
Student

Content
Teacher Patient
Contd…

.
 Permissive and non
. authoritarian atmosphere .
 The instructor should minimize
his/her own contribution to the
discussion but will pinpoint
Positive
dilemmas.
 Pinpointing positive points
first.
Negative

Positive
FEATURES OF CASE ANALYSIS
METHOD

 Students learn from each other.

 Take responsibility for their own learning.
 Prepares extensively and thoroughly.
 Students are responsible for their own conclusion.
 ROLE OF TEACHER

 Careful study of the technique involved.

 Extensive exploration of case histories.
 Careful preparation of group
participants.
 ROLE OF STUDENT

Possesses sufficient depth of understanding and the theoretical

background necessary for analyzing the client situation.
 THE CASE INCIDENT METHOD
Modification of case analysis method.
Describes very briefly a critical or crucial situation.
EATURES OF CASE INCIDENT METHO
 Focuses on one problem or issue.
 Less complex.
 Variety of cases can be used to illustrate different or similar
incidents.
5 STEP PROCEDURE FOR CASE
INCIDENT

1) Study an incident.
2) Gather and Organize information on the case as a whole.
3) Formulate an issue for decision and action.
4) Make decision with reasoning.
5) Reflecting on the case as a whole.
 2. BED SIDE CLINIC

 Utilizes the presence of a selected patient as its focus for group

discussion.
 The group visits the client or the client may be brought to the
conference room during the discussion.
 Useful when some members of the group are unfamiliar with the
client or when there are special observations which need to be
discussed in more meaningful way.
STEPS OF CONDUCTING BED SIDE CLINIC

1) PLANNING
Determine the clinic
Select a Patient
Secure the patient’s consent
2) CONDUCTING BED SIDE CLINIC
Conducted in ward or adjacent area
Comfort of patient
Clinic lasts for 30min
Number of students not to exceed 10-15
PHASES OF DISCUSSION IN BED SIDE
CLINIC

• INTRODUCTION PHASE
1

• PATIENT CENTERED DISCUSSION

2

• POST CLINIC EVALUATION

3
 CLINICAL
6. CLINICAL CONFERENCES
CONFERENCES

It is a form of group
discussion about some
aspect of clinical
practices.
 TYPES

HEALT
INDIVID
H
UAL
TEAM
 a) INDIVIDUAL CONFERENCES

 It means ‘conversation with the purposes’.

 The two terms :
 interview
 conferences are used interchangeably.
 PURPOSES OF CONFERENCES

 To guide in teaching.
 To acquire more knowledge.
 To discover the interests, needs and the problems of the individual
student.
 To help the student to help herself/himself.
 TECHNIQUES OF INDIVIDUAL CONFERENCES

 Teacher should establish good rapport with the student

 Allow student to talk freely .
 Teacher should not show any prejudice, emotional reactions or bias.
 Provide privacy
 Provide sufficient time
 Good listening is required
 PRACTICAL USES

 Diagnostic and remedial teaching in individual conferences.

 Supplemental teaching.

 Discipline.
 ADVANTAGES OF THE INDIVIDUAL
CONFERENCES IN NURSING COURSES

 It can be used to clarify class material.

 It helps in supplement instructions.
 It can also help to explain answers to questions of individuals.
 DISADVANTAGES

 Trained /expertise person required.

 Some times lack of interest either on the part of teacher or student.

 B) HEALTH TEAM CONFERENCES.
 It is a group of professional persons involved in accomplishment of
common goals for the purpose of interchange of ideas.
 In the Hospital physician will be the leader of the team:
• The client & his family
• The graduate staff nurse
• The social workers
• The nutritionist
• The clergy man.
• The occupational therapist
• The physical therapist
• Other allied professional workers.
 OBJECTIVE

 To assess the health needs of the client.

 To solve these problems through comprehensive approaches.

 ADVANTAGES

 Bridge the gap b/w the theory and practice.

 Develop critical thinking, clinical decision making skills.
 Increase confidence in their abilities to express themselves with
clarity and logic.
 Explore feelings attitudes and values affecting practice.
 DISADVANTAGES

 Careful planning needed.

 3. NURSING ROUNDS

 A small group of staff member not more than 5 and a leader or

teacher visit, the bedsides of clients. Teaching faculties, Nursing
students, taking rounds of the hospitals wards. It helps the nursing
members know about all the patients in wards , their problems and
ways of solving .Time required for each patient is 4-5mint.
 PURPOSES

 Demonstrate important clinical manifestations in clients.

 Clarify terminology used and studied.
 Compare clients reaction to disease.
 Demonstrate the effects of drugs .
 Illustrate skillful nursing care.
 Compare method of meeting nursing needs.
 Acquaint nurses with all patients.
TYPES

INSTRUCTIONAL
ROUNDS

PROBLEM SOLVING
ROUNDS
 FEATURES OF NURSING ROUNDS

 Able to observe the client condition review the care provided and
collect information from the patient.
 Observe the client in the client’s own environment.
 Observe the interaction of the teacher.
 ADVANTAGES

 Improve learning experiences.

 Response of the patient is more natural.

 Student can select patients with specific problems and plan proper
nursing care.
 DISADVANTAGES

 Requires very careful planning.

 Small group of students can be taken at a time.

 4. NURSING CARE PLAN

NURSING PROCESS
 The original concept of nursing process was introduced in the
1950s as a three-step process of assessment , planning ,and
evaluation based on the scientific method of observing ,measuring
gathering the data, and analyzing the findings.
 After refinement three step process was expanded. These are:
Assessment, Problem identification, Planning, Implementation,
Evaluation.
 COMPONENTS

 Patient’s problem
 Nursing objectives
 Nursing actions
 Rationale
 Evaluation
 PATIENT’S PROBLEM

The patient problem are a nursing problem. It may be actual or

potential. They should be priority wise.

NURSING OBJECTIVES

These refer to the goals that are set for nursing actions to help solve the
patient’s problem .The patient’s response will indicate that objectives have
been achieved.
 NURSING ACTIONS

These are associated with each problem or objective ,as a means of

accomplishing the goals and resolving the problem.

EVALUATION
Evaluation is an ongoing process, the nurse finds out whether the
planned nursing interventions has met the objectives and whether
reassessment further planning ,implementation& evaluation are
needed.
 NURSING CARE PLAN
ASSESSMENT NURSING OBJECTIVE NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION

-Ability to ineffective To maintain •Instruct the •Uncontrolled Breathing

maintain Airway effective client on the coughing is pattern
upright clearance breathing proper method tiring maintained.
position. related to pattern of controlled &ineffective.
-Cough excessive cough.
(productive, &tenacious •Teach the pt
effective) secretions. measures to •Thick
sputum(odor, reduce the secretions
character, viscosity of are difficult to
amount etc.) secretions. expectorate
&can cause
mucus plug.
Auscultate the This
lungs before assessment
&after the helps evaluate
clients cough. the
effectiveness
of the client’s
cough effort.

Encourage or Good oral

provide good hygiene
mouth care promotes a
after sense of well-
coughing. being
&prevents
mouth odor.
 ADVANTAGES

 It provide daily care to the patient.

 It helps in fulfill the need of the patient.
 Some time cost effective patient care.
 DISADVANTAGES

 Time consuming .

 Expertise person require

 5. PROCESS RECORDING

Process recording is a written account or

verbatim recording of all that transpired during
and immediately following the nurse-patient
interaction.
FEATURES

 Written during or immediately following the

interaction
 Can be used for Educational and Teaching, purpose.
 Can be used as Therapeutic tool .
PURPOSES

 Improve the quality of nurse-patient interaction.

 Assist the student nurse to plan, structure & evaluate
the interaction.
 Gain competency in interpreting and synthesizing
raw data under supervision.
 To identify thoughts and feelings in relation to self an
d others
 To increase observational skills
 Ability to identify the problem and gain problem solvi
ng skills.
PRE-REQUISITE FOR PROCESS RECORDING

Physical setting: Calm and quiet environment

Obtaining consent
Maintaining confidentiality
 TECHNIQUE IN USING PROCESS
RECORDING
1. Preparing the student for process recording:
- The teacher must help the student to define clearly the
appropriate objectives to be accomplished regarding nurse-
patient interaction.
- Teacher should help the student to learn how to go about
writing a process record.
CONTD…..
II Recording nurse-patient interaction:
 The exact verbatim report of the patient-nurse conversation.
 The student’s conscious feeling and her interpretation of the
patient’s feeling.
 Analysis for meanings and clues to the patient’s needs.
 The instructor’s and the student’evaluation of the total process
record experiences .
CONTI….

III Evaluating the nurse patient interaction:

 Data have been collected by the student.
 Analyze the data i.e. time consuming.
 Discussion.
 Exploring the behavioural response of the students.
Identify the patient’s needs represented by his behavior.
After completion of this assignment, comment and evaluate the goals
achieved or not.
 PROCESS RECORD USED BY NURSING
INSTITUTIONS

 The instructor discuss the process record with student focusing on

the student’s development and skills improvement in nurse-patient
relationship. The student evaluate s the process record as a learning
experience at the end of the assignment.
 SUGGESTED FORMAT FOR PROCESS
RECORDING
 Name of the patient, Age, Diagnosis, Date & Time
 Introductory part:
 Appearance of the patient and his behavior.
 Setting of the interaction.
 Nurses feeling’s and thought’s prior to interaction.
 Reason for selecting the patient.
OBJECTIVES OF THIS INTERACTION

What the nurse said & did

Nurse’s feelings

What the
patient Analysis of patient’s response
said &did Nurse’s
thoughts Evaluation includes communication
techniques used by the nurse
Conti….

 Total time taken………………………………………

 Nurse’s thoughts immediately after the

interaction……………………………………………………
 RECORD OF INTERACTION B/W THE
NURSE AND PATIENT

 Truthful Recording of what the Nurse said and did and what the
patient said and did including any non-verbal behavior of the
patient like eye contact, biting the nails ,breaking of fingers etc.
 ADVANTAGES

 It is a evaluation Tool.

 Active participation.
 DISADVANTAGES

 Time consuming.

 Require expertise person for collection the data.

DEMONSTRATION

Small group learning, proceeded by theoretical

explanation and succeeded by practice
Teaches by exhibition and explanation
Covers all of the steps your students need
to learn a skill.
Essential Characteristics of a good demonstration

Follow these principles:

•Demonstrator should understand the entire procedure.
•All equipment should be assembled and pretested before the
demonstration takes place.
•Advance knowledge
•A positive approach should be used.
•Everybody should have a good view of the demonstration
•Running comments.
•The Setting for the demonstration should be as true to the life
as possible.
•A discussion period should always follow the demonstration
•Page
Prompt
 73
Practice.
 Demonstration
Advantages
Provides an opportunity for observational
learning.

Adaptable to both group and individual teaching.

It activates several senses, therefore it increases
learning.
It clarifies the underlying principles by
demonstrating the why of a procedure
It correlates theory with practice
 Demonstration
Disadvantages
Number of students is limited.

Does not allow for individual pace and

learning.

High cost in personnel and time.

Expert teacher required