Nursing Education and Learning Environments for Clinical Teaching
Clinical Cases, Unfolding Case Studies, Scenarios, and Simulations In Nursing Education
Simulated experiences that provide opportunities for students to integrate psychomotor, critical thinking, and clinical reasoning decision-making skills are equally valuable in assisting students to critically evaluate their own actions and reflect on their own abilities to apply theory to practice.
The use of the high-fidelity HPS is one example of using realistic scenarios to prepare students for clinical experiences, substitute for unavailable or unpredictable clinical experiences, or enhance clinical experiences in a safe environment.
The use of HPS helps transition the student from the classroom to the practicum environment. Students’ learning with the HPS method can be enhanced, patient care can be optimized, and patient safety can be improved.
Additional benefits may include enhanced learning in a risk-free environment, promotion of interactive learning, repeated practice of skills, and immediate faculty or tutor feedback.
Cases, unfolding case studies, and scenarios
are lower fidelity strategies but are equally helpful in preparing students for
clinical experiences and bridging the gap between classroom and practice
(Benner, Sutphen, Leonard, & Day, 2010; McNelis et al., 2014).
Community Based Environments In Nursing Education
The health care delivery system and implementation of the PPACA is continuing to shift nursing practice from acute care hospital environments to the outpatient and community settings.
These changes have resulted in care provided through the medical home model (Henderson, Princell, & Martin, 2012) and an increased use of community agencies such as ambulatory, long-term, home health, and nurse-managed clinics; hospice; homeless shelters; social agencies (e.g., homes for battered women); physicians’ offices; health maintenance organizations; and worksite venues and summer camps.
The use of technology such as video conferencing, wireless remote communication, information systems, and online courses has made it possible for clinical experiences in a community based environment to occur at a distance. The transition to community based teaching requires the faculty to ensure that learning opportunities available in the clinical placement allow the student to achieve the learning objectives.
Faculty must adapt clinical learning experiences and incorporate skills used to develop competency with new technology and modify teaching methods (Bisholt, Ohlsson, Kullén Engström, Sundler Johansson, & Gustafsson, 2014). Additionally, faculty must adapt to methods of clinical supervision such as being accessible by mobile phone and texting.
Establishing appropriate and sufficient learning experiences in the community may be difficult and challenging. These challenges often relate to economic constraints and the changes in nurse staffing patterns, with a resultant lack of time for professionals to facilitate skill development and serve as role models.
These challenges may require faculty to be creative in their use and selection of resources within these environments and to consider establishing partnerships with the service agencies. Using community-based settings creates opportunity for critical thinking, understanding the health care system, and development of communication skills.
Faculty can provide other experiences using simulation or
the clinical learning laboratory to assist students to develop proficiency in
skills traditionally performed in the acute care setting.
Learner Centered Clinical Education Environment In Nursing
Every health care environment and specific unit within these environments has a culture. The culture of the immediate environment affects teaching and learning (O’Mara et al., 2014). For example, the culture or patterns of actions and behaviors of the health care professionals can be observed in their attitudes, interactions, teamwork, and commitment to quality and safe patient care.
Staffing levels, acuity of patients, anxiety of staff, and workload can influence these actions and behaviors. These aspects of the culture of the environment can in turn influence the time staff has to devote to students. The culture of the environment may also result in behaviors related to lateral violence.
Lateral violence is often observed, witnessed, and verbalized by students. These verbalizations provide an opportunity for faculty to implement strategies and assist students with processing what they may be seeing, hearing, and feeling, and thus lessen the effects of these behaviors on students’ learning.
For
example, faculty can hold debriefing sessions, listen to students’ perceptions,
and make concerted efforts to balance students’ feelings and thoughts by using
appropriate strategies to soften, yet not deny, the reality of the culture.
Selecting Health Care Environments In Nursing Education
Regardless of the practice environment, faculty are responsible for selecting appropriate CLEs within health care agencies and other organizations such as schools and social service agencies. Faculty must be aware of what particular systems are in place within the program to negotiate contracts that are congruent with the philosophies of the school of nursing and the agency, as well as those that specify the rights and responsibilities of both.
Determinations must be made about regulation and accreditation status, adequacy of staff, the patient population for needed experiences, expected course outcomes, and whether or not the practice model is compatible for intended uses and curriculum needs. In addition, the adequacy and availability of physical resources (e.g., conference space) for students and faculty should be determined.
Finding a practice environment that meets all specified needs is becoming a challenge because of factors associated with the delivery of health care. For example, rapid patient turnover often means faculty have to select available patients rather than those that best meet students’ learning needs.
This limitation in patient availability can create opportunities for faculty to be creative in the manner in which learning experiences are selected and teaching strategies used. Regardless of the limitation, the role of the faculty is to assist students in making learning connections focused on application of content presented in the classroom to clinical practice.
Dual clinical and classroom assignments for faculty may assist in making those necessary connections between clinical and classroom. “The very strength of pedagogical approaches in the clinical setting is itself a persuasive argument for intentional integration of knowledge, clinical reasoning, and skilled know-how and ethical comportment across the nursing curriculum” (Benner et al., 2010, p. 159).
Thus faculty have a significant role
in helping students to make the necessary connections between clinical and
classroom experiences as they learn to think and act like a nurse (Tanner,
2002), in spite of limitations for clinical learning in the health care
environment.
Building Relationships with Personnel within Health Care Agency Environments
The ability of the clinical faculty to facilitate students’ learning can be enhanced when an effective working relationship is established within the clinical agency. Effective relationships begin with effective communication, which must be practiced in an ongoing manner to maintain relationships and facilitate learning (Dahlke, Baumbusch, Affleck, & Kwon, 2012).
This requires having an understanding of the environment and the roles of the individuals within the environment, adapting teaching approaches to the situation, and establishing relationships aimed toward enhancing the educational experience. These elements do not exist in isolation but are patterned to dovetail with or complement other roles.
Information should be shared continually, clearly, and consistently about goals, competencies, and expected outcomes; the level of students; practice expectations; the clinical schedule; and related information. Such information enables staff to assist with identification of appropriate experiences for students.
Inasmuch as clinical faculty have the primary responsibility for teaching and guiding students in the clinical environment, others often assist in the process. Therefore, the sharing of expectations with the staff is critical.
Ensuring an orientation to the practicum environment and having students engage with staff early in the clinical experience promote positive student–staff interaction and provide opportunities for role clarification and the development of collegial relationships.
A consistent demonstration of awareness of the mission and values of the agency through actions that are inherently respectful is crucial. Follow-up communication provides an avenue for those within the practice environment to keep abreast of changes.
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