Clinical Teaching Setting and Practice Learning Environments In Nursing Education

 Nursing Education and Clinical Teaching Setting and Practice Learning Environments

Teaching at Clinical Setting In Nursing Education, Practice Learning Environments In Nursing Education, Clinical Learning Resource Centers, Simulation Use in Nursing Education, Clinical Practica In Nursing Education, Acute and Transitional Care Environments In Nursing Education.

Teaching at Clinical Setting In Nursing Education

    The health care system is ever changing and the Patient Protection and Affordable Care Act (PPACA) (Patient Protection and Affordable Care Act, 2014) challenges faculty to prepare students for future roles and to practice in a health care system that is patient centered, wellness oriented, community and population based, and technologically advanced. 

   Clinical settings within a variety of health care systems have also become highly complex. Clinical learning occurs in actual health care environments and laboratory settings where students apply their acquired knowledge and skills as they think critically, make clinical decisions, and acquire professional values necessary to work in the practice environment. 

    The purpose of this topic is to describe the environments for clinical teaching and learning, how the curriculum relates to clinical teaching, roles and responsibilities of clinical teachers, and teaching methods and models that facilitate learning in clinical environments.

Practice Learning Environments In Nursing Education

     The environment for practicum experiences may be any place where students interact with patients and families for purposes such as acquiring needed cognitive skills that facilitate clinical reasoning and decision-making as well as psychomotor and affective skills. 

    The practicum environment, also referred to as the clinical learning environment (CLE), is an interactive network of forces within the clinical setting that influence students’ clinical learning outcomes. 

    The environment also 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). The CLE introduces students to the expectations of the practice environment, as well as the roles and responsibilities of health care professionals. 

    To accomplish these outcomes, a variety of experiences are required in multiple settings. These settings may be special venues within schools of nursing or within acute care settings or communities. It is essential that practice environments be supportive and conducive to learning so that students will develop the qualities and skill abilities needed to become competent professionals (O’Mara et al., 2014). 

    The following section describes these settings. Included among these are practice learning centers such as learning labs, acute and transitional care, and community based environments.

Clinical Learning Resource Centers

    To foster a nonthreatening and safe learning environment, the practice learning center is used at several stages of students’ learning. These centers encourage guided experiences that allow students to practice and perfect a variety of psychomotor, affective, and cognitive skills such as critical thinking and clinical reasoning before moving into complex patient environments. 

    Simulation is one example of a teaching method used in the practice learning center. This method is increasingly used to evaluate knowledge acquisition as well as skill sets (Jeffries, 2014).

Simulation Use in Nursing Education 

    According to the National Council of State Boards of Nursing (NCSBN, 2005), “simulation is a teaching strategy used to validate the complex and comprehensive skill required of health care professionals.” 

  Simulation-based learning is designed to replicate the reality of the clinical environment to provide participants with opportunities to practice and refine clinical reasoning, skilled procedures, and inter professional collaboration. Schiavenato (2009) also states, “The human patient simulator (HPS) or high-fidelity mannequin has become synonymous with the word simulation in nursing education” (p. 388). 

    The explosion of simulation as a standard clinical learning activity is evident in the literature and a recent multisite study validates the use of this modality in clinical education (Hayden, Smiley, Alexander, Kardong Edgren, & Jeffries, 2014). This study included 10 prelicensure sites and used a three-group quasi experimental research design. 

    The control group had traditional clinical experiences with no more than 10% of their time spent in simulation. One experimental group had 25% of their clinical time in simulation, and the other experimental group spent 50% of their clinical time in simulation. 

    The study began with the first clinical courses and used multiple measures to assess participants’ nursing knowledge and clinical competency throughout the entire program of study. Study participants also rated how their learning needs were met in both simulation and in the clinical environment. 

    Study results found no significant differences between all groups among assessment measures. The study validates simulation as high-quality clinical learning experience that can be used to replace a significant number of traditional clinical hours.

 Virtual Clinical Practica In Nursing Education

    Given the challenges of finding sufficient clinical experiences for students, faculty are exploring the use of virtual clinical experiences made possible by online technologies that can create virtual clinical environments (Knapfel, Moore, & Skiba, 2014) and use existing technologies such as electronic intensive care units and telehealth capabilities to create opportunities for clinical experiences focused on providing opportunities to practice critical thinking, clinical reasoning, communication, and teamwork as a member of the inter professional team (Sepples, Goran, & Zimmer-Rankin, 2013). 

    The virtual clinical practicum (VCP) is designed to provide a live clinical experience to nursing students from a distance. Students gain clinical experience and practice skills and clinical judgment using telehealth technologies in which students observe a nurse taking care of a patient in a clinical setting without going to the actual clinical site, or as a registered nurse in masters doctoral programs who are learning to provide the care. 

    The students can interact with the nurse, other members of the inter professional team, and the patient using telehealth technology. The VCP process is developing as a potential solution in response to limited clinical practice sites as well as limited clinical experts, and for specific populations such as acute care pediatric patients. VCP provides needed clinical learning opportunity, especially in rural areas. 

Acute and Transitional Care Environments In Nursing Education

  Acute and transitional care environments provide clinical experiences for undergraduate and graduate students preparing for advanced practice roles. Experiences in these environments enable undergraduate students, in particular, to exemplify caring abilities and practice the use of cognitive, psychomotor, and communication skills as they interact with patients and their families. 

    These environments have become increasingly complex. A recent multisite study found that the complexity relates to factors such as extensive use of technology (e.g., electronic health records), rapid patient and staff turnover, high patient acuity, and complex patient needs (McNelis et al., 2014). 

    These sites are suitable for learning experiences that focus on providing care in complex clinical settings, but faculty must consider the level of the student, the focus of the experience and the increased risk to patient safety when students have clinical assignments in these units.