Coaching Feedback, Attitudes and Behaviors in Clinical Teaching Environment In Nursing Education

Nursing Education and Coaching Feedback, Attitudes & Behaviors in Clinical Teaching Environment

Coaching and Giving Feedback In Nursing Education, Effective Clinical Teaching Behaviors and Attitudes In Nursing Education.

Coaching and Giving Feedback In Nursing Education

    Coaching students to help them develop clinical competency requires giving students feedback. Feedback, an essential element in teaching and learning, is described as information communicated to students as a result of an assessment of an action by students (Wells & McLaughlin, 2014). 

    Feedback, when properly delivered, has a high potential for learning and achievement. In clinical practice where assessments need to be made about the extent to which clinical competencies are met, clinical faculty have a variety of opportunities to offer feedback in response to performance behaviors relating to psychomotor as well as cognitive and affective actions. 

    Regardless of the action, key considerations should be practiced. These considerations are specificity, timing, consistency, continuity, and approach. Approach is important because of its capacity to alleviate anxiety and enhance engagement. Because of the variations in needs of students, each clinical experience provides opportunities for feedback. 

    It is imperative that feedback not be given only at documented, scheduled times for formative and summative evaluations. Faculty should be cognizant of those actions that require immediate interaction and those for which feedback can be delayed until a short time later, but not too much later. 

    Methods must be identified to maintain data for timely sharing both strengths and challenges with students, for example. Faculty should create an efficient system for making brief written or electronic anecdotal or mental notes. The delivery of feedback can take multiple forms and depends on the situation. 

    Face-to-face, time-sensitive, brief conferences (e.g., a few minutes) or electronic conversations or dialogue are examples. Regardless of the method of delivery, guiding principles must be applied and the learning intent of feedback should be provided. Knowing how to give feedback regarding clinical performance and written clinical assignments is an important element of teaching. 

    One method is to point out positive aspects of performance as well as areas that require improvement. Some situations may provide an opportune time to role-model. For example, if a student fails to integrate communication while performing a procedure, faculty can fill in the missing words. Such action may (or may not) alert the student to an “aha” learning moment: “I failed to communicate. . . .” 

    The faculty interjecting could have a lasting outcome. Debriefing and guided reflections are forms of feedback often used immediately following a clinical experience, nursing rounds, simulation, or presentation to determine the extent to which expectations were met and identify any areas of concern (Overstreet, 2010). 

    In the process of making determinations, the discussion often evolves into identifying areas needing improvement. Although debriefing sessions generally take place in group settings (e.g., in clinical conferences), it is not uncommon for sessions to occur on a one-on-one basis. 

    Faculty may take the lead by posing specific questions and listening to responses to guide further discussion. Students assume an active role in debriefing sessions and can take the lead in initiating the process (Dreifuerst, 2012). Effective clinical teachers are expected to have expertise in the “art” of teaching. 

    Equally important are teacher behaviors that facilitate learning and support students in their acquisition of nursing skills. Empirical evidence correlates specific teaching methods with enhanced student learning. 

    A recent study suggests effective clinical teaching involves the ability to optimize the environment to provide meaningful learning experiences focused on predetermined objectives (Gubrud-Howe & Schoessler, 2009). 

    Facilitation of cooperative learning, active engagement, and the use of a variety of methods for learning has been reported to be highly effective (Dahlke et al., 2012). Common examples of cooperative strategies are peer teaching and pairing students for student-to-student instructions. 

    Other effective behaviors include sharing anecdotal notes, using objective language when giving feedback, probing to help students self-correct misunderstandings, and communicating expectations clearly.

Effective Clinical Teaching Behaviors and Attitudes In Nursing Education

    Teaching behaviors that facilitate students’ development in higher order thinking skills include prompts to help students recognize the salient cues in a situation, prioritization, retrieval, and application of theoretical and factual knowledge from coursework. Most importantly, effective clinical instruction focuses on helping students to think contextually with intent to understand the unique characteristics of the patient’s situation at hand (Benner et al., 2010). 

    Included among motivational strategies are discussing course goals and relating them to the practicum arena, exhibiting enthusiasm about the profession, discerning student expectations, establishing reward systems, and trying new and different teaching strategies. Strategies that facilitate thinking modalities also include logic models (Ellerman, Kataoka Yahiro, & Wong, 2006), case studies, and concept mapping. 

    These strategies can be used in the classroom as a way to prepare students for clinical practice and to bridge the gap between didactic courses and clinical learning experiences. Teacher behaviors relating to interpersonal skills are reported to affect student outcomes. 

    Behaviors such as showing respect for students and treating students with respect (Dahlke et al., 2012), correcting mistakes without belittling), and being supportive and understanding are helpful. Nursing students experience stress and anxiety in clinical learning situations (Elliott, 2002; Lo, 2002; Timmins & Kaliszer, 2002). 

    Negative relationships with faculty can contribute to anxiety (O’Mara et al., 2014). The effective clinical teacher recognizes students’ need for supportive and collegial relationships and develops an interpersonal style that promotes a collegial learning environment; O’Mara et al., 2014). Positive relationships are nurturing and can enhance learning. 

    Caring behaviors and a caring environment are also essential (O’Mara et al., 2014). The literature points to the importance of building relationships between students and teachers. It is believed that the quality of their interaction affects learning outcomes (Tanner, 2005). 

   Concepts that facilitate the building of relationships may include the following: connections, caring, compassion, mutual knowing, trusting and respecting, availability, knowledge, confidence, and communicating (Gillespie, 2002). By knowing the students’ strengths, challenges and individual goals, faculty are prevented from making assumptions and reacting to students’ misunderstandings or poor performance. 

    Making assumptions regarding student intent or motivation may be perceived by students as being disrespectful. Making connections to identity early in the relationship assists faculty in determining the elements needed to meet students’ learning needs (Dahlke et al., 2012; O’Mara et al., 2014). 

    Teacher confidence is another factor that enhances learning; teachers who lack confidence actually create distance between themselves and the students they teach). This hinders the sense of knowing and the possible connections that may have formed. A part of teacher confidence is a foundation of knowledge. 

    When clinical teachers use their expertise to support learning, the teacher student relationship is strengthened. Cook (2005) engaged in a study to explore perceptions of teacher behaviors that invite trust and create student anxiety. 

    The findings indicate that teachers need to be aware of how their behaviors can be negatively perceived by students, thus influencing the anxiety that occurs during the clinical experience and ultimately affecting learning. Senior clinical faculty should serve as role models and mentor junior clinical faculty to create a legacy of effective clinical teaching.