Clinical Practicum for Understanding the Curriculum, Students and Clinical Teaching Environment In Nursing Education

Nursing Education and Clinical Practicum for Understanding the Curriculum, Students and Clinical Teaching Environment

 

Clinical Practicum Experiences Across the Curriculum Understanding the Curriculum In Nursing Education

    The curriculum, composed of a series of well-organized and logical entities, guides the selection of learning experiences and clinical assignments, organizes teaching learning activities, and informs the measurement of student performance. The manner in which the curriculum is organized guides the planning of learning experiences in a logical, rational sequence.

   The curriculum is designed to build on prior knowledge and to reinforce the application of learning. While this description of curriculum relates to process, this does not preclude faculty’s use of creative and innovative methods in clinical environments. Creative methods have a high potential to motivate students and facilitate construction of knowledge to be applied in practice. 

    Studies focused on perceptions of both clinical instructors and students indicate understanding the whole curriculum is a critical aspect of clinical instruction (Bisholt et al., 2014; Dahlke et al., 2012; Wyte Lake, Tran, Bowman, Needlemann, & Dobablian, 2013). 

    As students’ progress and engage in varied practicum experiences, it is faculty’s responsibility to interpret the curriculum and to describe the relationships between course competencies and practicum experiences.

Understanding the Student In Clinical Setting In Nursing Education

    Clinical experiences provide opportunities for students to practice the art and science of nursing, which enhances their ability to learn. To maximize these experiences, faculty must have full knowledge and understanding of each student. The nursing student population is culturally diverse and includes members of varied age groups, many ethnic and racial groups, and an increasing number of men. 

    This population is also likely to include persons with (or without) prior degrees from a variety of disciplines, as well as those who possess many different health care experiences and technological skill levels.

   In addition, students differ in their learning styles, levels of knowledge, and preferences for learning experiences; therefore, faculty must make concerted efforts to balance the students’ learning needs, interests, and abilities when selecting clinical experiences without losing sight of the curriculum and expected competencies and outcomes. 

    Such action can be facilitated by making an assessment of the knowledge, culture, and skills of the learner. Such an assessment helps the faculty determine whether students possess the cognitive, critical thinking, clinical reasoning, decision making, psychomotor, and affective skills needed for the experiences. 

Understanding the Clinical Environment In Nursing Education

    The clinical environment has been described as a place where students synthesize the knowledge gained in the classroom and make applications to practical situations. Chan (2002) describes the CLE as “the interaction network of forces within the clinical setting that influences student learning outcomes” (p. 70). 

    A number of forces affect expected learning outcomes, including the availability of staff for supervision and coaching, and the degree of student-centeredness exhibited by the clinical teachers (Chan, 2002; Newton, Jolly, Ockerby, & Cross, 2012). Additionally, opportunities available for students to pursue individual learning outcomes define the effectiveness of the clinical environment (Newton et al., 2012). 

    The extent to which the clinical environment values nurses’ work and provides an adaptive culture that embraces innovation, creativity, and flexible work practices also are important aspects that set the stage of effective learning (Newton et al., 2012). 

    These forces, coupled with the need to adjust to an environment that requires an integration of thinking skills and performance skills, often result in increased anxiety among students. Creating a supportive clinical environment involves comprehensive orientation of students to the environment, ensuring they are prepared to perform necessary skills and encouraging creative and critical thinking (Ganley & Linnard Palmer, 2010). 

    Creating an environment where students are expected to succeed also reduces student anxiety (Ganley & Linnard-Palmer, 2010). Traditionally, clinical rotations have consisted of short blocks of time spent on a unit caring for a patient or two, mostly performing nursing skills with little or no time dedicated to focus on integration of theory, application of critical thinking, and clinical reasoning. 

    Often there is minimal focus on providing feedback or effective evaluation of the interventions performed. Additionally, the focus of the CLE is often focused on the operational aspects of the unit. Nursing staff are expected to meet productivity goals and are caring for patients that are extremely ill with multiple health care needs in complex and dynamic organizations. 

    Nurses intuitively want to be good role models and nurture students but often do not have the time to do so. Faculty must balance the operational needs of the unit with the importance of ensuring that students receive feedback and have the opportunity to focus on daily learning goals related to clinical course outcomes. 

    Regardless of location of the practice setting, faculty and staff should provide an environment in which caring relationships are evident. The clinical practice environment should be a place where students feel that they are accepted and their contributions are appreciated by individuals with whom they interact (Chan, 2002). 

    Attributes of staff such as warmth, support in obtaining access to learning experiences, and willingness to engage in a teaching relationship are considered helpful.

Selecting Clinical Practicum Experiences In Nursing Education

    Practicum experiences refer to all activities in which students engage in the practice of nursing. Such experiences are essential for knowledge application, skill development, and professional socialization. 

    Practicum experiences are selected and planned to provide students with opportunities to work across settings and manage care for varied populations with emphasis on applying theory content from the classroom to the clinical experiences. Clinical experiences should include an emphasis on the nursing roles related to health promotion and disease prevention. 

    Selection of practicum learning experiences requires all faculty to be knowledgeable about clinical education and have a sound understanding of the curriculum, the learners, and the learning environment. The practicum experiences should also help students prepare for outcomes in a progressive, developmental manner. 

    Experiences with patients from diverse populations and with different levels of wellness should be provided. Faculty should take advantage of opportunities to use their creative talents, clinical skills, and expertise to ensure that all students have opportunities to interface virtually or directly with a variety of patient populations. 

    As faculty begin to plan the clinical experience, it is essential to determine the goal of the particular clinical experience for that day. For the beginning student, focused clinical experiences in which the student is to focus on specific objectives and to achieve specific competencies incorporating individual learning needs requires faculty to create focused, goal-oriented learning activities (Gubrud Howe & Schoessler, 2009). 

    In a focused clinical learning activity, instead of providing all required care for one or two patients, students can focus on becoming proficient at a particular skill by practicing that skill for several patients. 

    For example, students may interview several patients to work on communication skills, perform vital sign assessments on multiple patients to develop this particular skill set, or focus on learning standards of care in a specialty area. Organizing learning experiences allowing students to assign and delegate care or give and receive reports are other examples of focused clinical learning activities. 

    The purpose of focused clinical learning is to design clinical learning experiences focusing on repetitive practice related to a particular skill set. Focused experienced should integrate students’ individual learning needs and focus on course outcomes. 

    Other learning goals may emphasize facilitating students’ ability to synthesize information, integrate didactic and clinical knowledge, develop clinical reasoning and judgment skills, and plan care for groups of patients (Benner et al., 2010; Tanner, 2010). Here, assignments that involve planning care for patients with complex needs and for multiple patients are appropriate. 

    These integrative clinical experiences prepare students for transition to practice and typically occur toward the end of the program. The selection of experiences should be consistent with the desired course and curriculum outcomes, which may be multiple and specific to the nursing program. 

    For example, the expected outcomes for students in an undergraduate degree nursing program are different than those for students in a graduate degree program. Therefore, the learning experiences and clinical environment that are selected and the practice opportunities that are offered to students should be congruent with the program outcomes.