Assignment Implementation Strategy for Clinical Learning Environment In Nursing Education

Nursing Education and Assignment Implementation Strategy for Clinical Learning Environment

Strategies for Implementing Clinical Assignments As Part of Practicum, No of Assignments and Student Faculty Ratio, Role Decision In Clinical Assignment.

Strategies for Implementing Clinical Assignments As Part of Practicum

    Clinical assignments are an integral part of nursing practicum experiences. Several strategies for making clinical assignments have been adopted for clinical teaching. The strategy used in clinical instruction is often determined by factors such as the skill level of the student, the patient acuity level, the number of assigned students, and the availability of patients and resources, including the availability of technology. 

No of Assignments and Student Faculty Ratio

    Traditional and alternative strategies, such as dual assignments, multiple assignments, and clinical conferencing, are discussed. The traditional strategy is one in which nursing students are taught in a clinical setting with a varying faculty-to-student ratio. 

    Ratios should be determined with an aim for facilitating optimum learning, knowledge of regulatory and agency requirements, and consideration of the workflow of the unit or agency. Most importantly, consideration of patient safety and quality care is essential (Ironside & McNelis, 2010; McNelis et al., 2014). 

    The rationale for these ratios relates to the effect of increased numbers of students on patient safety (Ironside & McNelis, 2010). From a student’s perspective, this strategy involves the assignment of one student to one or two patients. 

    The students assume responsibility for the nursing interventions needed in the care of the patient and may work alone in planning, implementing, and evaluating nursing activities. Alternatives to the traditional method of clinical assignment are dual and multiple assignments. 

    The dual assignment strategy (Fugate & Rebeschi, 1991) involves assigning two students to one patient. This alternative is useful when the level or complexity of care is beyond the capabilities of one student. Because students must work closely to implement care, collaboration and communication between the students are requisites for effective use of this strategy. 

    Benefits of this strategy include improved time management, opportunities for collaboration and peer support, and fewer numbers of patients for which the faculty is responsible. When dual assignments are made, faculty have the responsibility of ensuring that each student understands his or her specific responsibility. 

    For 2-day clinical rotations, roles may be reversed on the second day of care). Such reversal makes it possible for both students to direct care to the patient. The strategy of multiple assignments is useful for beginning students and in situations where a limited number of patients are available. This strategy involves the assignment of three students per patient. 

Role Decision In Clinical Assignment

    Three roles are assumed: the doer who provides the care; the information gatherer or researcher who is responsible for obtaining information needed for the safe care of the patient; and the observer who observes the student, the researcher, the student patient interactions, the responses of the patient to his or her care, and the family members. The observer also makes suggestions for improving care. 

    As with dual assignments, the roles for each student must be clearly defined. Adequate time must be made available for collaboration and discussion among students and faculty. The multiple assignment approach must meet learning objectives. 

    Glanville (1971) conducted a study to determine the effectiveness of this method as an approach to clinical teaching. Results revealed similarity in the extent to which objectives were met and in the levels of achievement for students assigned to the multiple assignment approach and those assigned to the traditional method. 

    VanDenBerg (1976) randomly assigned 22 first-year associate degree students to two groups, one of which used traditional assignments and one of which used multiple assignments. Results showed that students assigned to the multiple assignment group demonstrated a significant increase in nursing knowledge compared with those assigned to the traditional group. 

    In light of the increasing complexity of learning environments and the instability of the patient census, consistent clinical assignments and multiple placement assignments were compared to determine learning outcomes (Adams, 2002). 

    Here, consistent means that students were assigned to a unit for a specific time frame or used more than one unit during the period. Quantitative measures revealed no difference in the two methods of clinical rotation. However, the perceptions of the benefit of consistent clinical assignments were positive. 

    In summary, faculty, staff, and students play a significant role in determining assignments. Assignments are made according to a number of factors, including course objectives, learner needs, skill level, complexity of the clinical environment, and patients’ acuity. The assignments may be implemented as solo or multi student experiences. Each has been considered beneficial in enhancing learning.