Inter Professional Education, Schedule Assignments and Effective Teaching for Clinical Practicum In Nursing Education

Nursing Education and Inter Professional Education, Schedule Assignments & Effective Teaching for Clinical Practicum

Inter Professional Clinical Education For Clinical Practicum In Nursing Education, Evaluating Experiences for Clinical Practicum In Nursing Education, Scheduling Clinical Practicum Assignments In Nursing Education, Effective Clinical Teaching for Clinical Practicum In Nursing Education.

Inter Professional Clinical Education For Clinical Practicum In Nursing Education

    Learning to collaborate with the many health care groups involved in patient care can be a daunting task. Through these experiences, nursing students can learn to work collaboratively with a variety of health disciplines. Therefore, students should be provided with opportunities to work as members of inter professional teams and in practice environments where practice models are used for joint planning, implementation, and evaluation of outcomes of care. 

    The goal of inter professional education is to foster development of teamwork competencies while enhancing contribution to each profession. Inter professional simulations may assist students in health care disciplines such as nursing, medicine, pharmacy, and respiratory therapy to learn about the clinical management of a variety of patients. 

    Several recent studies demonstrate interprofessional simulations may improve patient care through shared learning, development of collaborative team functioning, and shared knowledge creation leading to trust and thoughtful decision making (Bandali, Craig, & Ziv, 2012; Reese, Jeffries, & Engum, 2010; Smithburger, Kane-Gill, Kloet, Lohr, & Seybert, 2013; Strouse, 2010). 

    Nursing faculty are increasingly participating in teams and designing interprofessional clinical courses and learning experiences. Successful course development and implementation depend on faculty’s commitment to the goal of interprofessional practice and a wide range of additional factors. For example, educators must demonstrate professional respect and role clarity. 

    Educators must also have the ability to secure clinical facilities and develop schedules for clinical experiences that are compatible with the concurrent coursework and curriculum progression in each discipline. Other factors include identification of content and experiences with similarities, differences, and overlaps, as well as clarification of autonomy and role interdependency. 

    Success depends on the ability to identify philosophical similarities and differences in clinical practice and to establish clear communication through avenues such as frequent interdisciplinary clinical conferences. An expected outcome of interprofessional education is increased future collaboration among professionals (Interprofessional Education Collaborative Expert Panel, 2011). 

    The assumption is that students who are taught together will learn to collaborate more effectively when they later assume professional roles in an integrated health care system. Rewards and benefits of interprofessional practice and education include clearer understanding of roles and better employment opportunities for graduates. 

    The long-term outcome is improved access to care, quality care, and increased patient satisfaction and safety.

Evaluating Experiences for Clinical Practicum In Nursing Education

    Students are required to demonstrate multiple behaviors in cognitive, psychomotor, and affective domains. Consequently, clinical faculty must evaluate students in each of these areas. The evaluation must be both ongoing (formative evaluation) to assist students in learning and terminal (summative evaluation) to determine learning outcomes. 

Scheduling Clinical Practicum Assignments In Nursing Education

    Although faculty schedule clinical practicum experiences to promote learning, there is ongoing dialogue about the best way to schedule experiences, with emphasis placed on the length of the experiences (hours per day, number of days per week, number of weeks per semester), the timing of the experiences in relation to didactic course assignments, and student needs. 

    Faculty should consider course goals related to both theory and clinical courses and integration of theory content with clinical experiences when making scheduling decisions. When the learning goal is to integrate students into a clinical setting or when the students are working with a preceptor, students may work the same shift as the nurse with whom they are paired. 

    Many acute care hospitals have a 8-hour shift option, whereas others have only 12-hour shifts. Giving students the opportunity to work the 12- hour shift affords the full scope of practice in any given nurse’s day. Students are able to quickly see and experience the role of the nurse. 

    In one small study of senior nursing students in a second-degree program working a 12-hour shift, Rossen and Fegan (2009) found that benefits included that students felt accepted by staff, had better socialization, and experienced a realistic work environment; disadvantages included decreased teaching time from the faculty. 

    Although a shorter clinical day allows for skill acquisition, there is little time for the development of extensive critical thinking, clinical reasoning, and evaluation of care. It is equally important that students be exposed to the unit’s structure, operations, and culture. 

    Although results of research about outcomes and student satisfaction with timing and scheduling of clinical experiences offer some guidance, faculty also must consider additional variables such as availability of patients, clinical facilities, course schedules, and student needs. 

    Scheduling is frequently influenced by the desire to have concurrent classroom and clinical experiences so that knowledge can be transferred and applied immediately. Clinical scheduling can be further complicated by the need to coordinate schedules of students from more than one school of nursing. Thus, ideal scheduling may not be a reality.

Effective Clinical Teaching for Clinical Practicum In Nursing Education

    Clinical teaching must use multiple instructional techniques and teaching tactics to develop and adapt to the environment in which students have opportunities. The clinical instructor should implement activities aimed to foster mutual respect and support for students with each other while they are achieving identified learning outcomes. 

    Faculty who teaches in practicum environments are the crucial links to successful experiences for students. Research about clinical teaching over time consistently indicates that effective clinical teachers are clinically competent, communicate clear expectations, are approachable, and can coach students through difficult patient situations (Dahlke et al., 2012). 

    Additionally, students indicate effective clinical teachers have knowledge of the clinical environment and curriculum, make clinical learning enjoyable through supportive actions, express empathy, and communicate passion for the profession). 

    Making clinical learning enjoyable involves helping students connect theory to practice and applying clinical reasoning while using a patient-centered approach to addressing problems (Dahlke et al., 2012). 

    Being knowledgeable and being able to share practice wisdom with students in clinical settings is essential. Such knowledge includes an understanding of the theories and concepts related to the practice of nursing. Equally important is an ability to convey the knowledge in an understandable manner. 

    Karuhije (1997) directs attention to three discrete teaching domains that will facilitate acquisition of the teaching skills needed to foster success in clinical settings: instructional, interpersonal, and evaluative. Instructional refers to approaches or strategies used to facilitate a transfer of knowledge from didactic to practicum. Strategies may include questioning and peer or patient teaching. 

    Faculty should be cognizant that the type of questions can cover a range during exchanges with students. Faculty should also be mindful of the manner in which questions are constructed to facilitate positive effects on learning. 

    Questions that ask students to analyze and synthesize information, to make clinical judgments, to evaluate outcomes of care, or to propose alternative courses of action result in more learning than simple recall. In clinical practice, factors such as the nature of the situation and available time are likely to influence the types of questions raised. 

    Effective clinical teaching requires educators to coach students as they learn clinical reasoning and judgment. Clinical reasoning is a “complex process that uses cognition, metacognition, and disciplinespecific knowledge to gather and analyze patient information, evaluate its significance, and weigh alternative actions” (Simmons, 2010, p. 1151). 

    Clinical judgment is the outcome of the clinical reasoning process and is defined as “an interpretation or conclusion about a patient’s needs, concerns or health problems and/or the decision to take action (or not), and to use or modify standard approaches, or to improvise new ones as deemed appropriate by the patient’s response” (Tanner, 2006, p. 204). 

    Clinical reasoning occurs when an individual has the ability to reason about the details of a particular clinical situation and identify what is salient (Benner et al., 2010; Tanner, 2006). Effective and efficient clinical reasoning is derived from knowing the patient, grasping baseline data, and understanding the case (Gillespie & Patterson, 2009). 

    Clinical reasoning requires knowledge, skills, and abilities grounded in reflection. Clinical reasoning is supported by an individual’s capacity for self-regulation and leads to the development of expertise (Kuiper, Pesut, & Kautz, 2009). 

    Beginning students struggle with the ability to engage in clinical reasoning required to make sound judgments. The novice student does not have the ability to identify the subtle or relevant cues seen in a patient whose health condition is changing and for whom complications are beginning to occur. 

    Faculty can assist students in identifying these subtle and relevant cues and start to collaborate with other health care professionals to provide the interventions needed to anticipate potential problems and consider the options aimed toward eliminating or treating complications (Cappelletti, Engel, & Prentice, 2014).