Creating a Learning Environment in Clinical Education Partners in Teaching January 8, 2004 Pat Ceri RN, MN.

Creating a Learning Creating a Learning Environment in Clinical Environment in Clinical

EducationEducation

Creating a Learning Creating a Learning Environment in Clinical Environment in Clinical

EducationEducationPartners in Teaching Partners in Teaching

January 8, 2004January 8, 2004Pat Ceri RN, MNPat Ceri RN, MN

What is Learning Environment

• The conditions, forces and external stimuli which affect the individual; a network of forces and factors which surround and affect one (Bloom, 1965)

• Basic ideas and principle of teaching and learning in a clinical area

• Context of nursing care – Unit staff & culture– Clinical instructor

Cahn, D. (2002) J. of Nsg Educ. 41:2:69-75.

Aspects of Environment Affecting Student

Learning

• Quality of student preparation• Characteristics of instructor• Characteristics of unit/unit staff• Peer support• Past clinical experiences

Gaberson, K. & Oermann, M. (1999). ClinicalTeaching Strategies in Nursing. NY: Springer.

Clinical Education

• Critical thinking development• Problem-solving abilities• Specialized psychomotor &

technological skills• Professional value system

Chan, D. J. of Nsg Ed. (2002) 41:2:69-75

Expectations of Clinical Placements

• Application of knowledge• Development of skills• Development of attitudes & values

inherent in the profession of nursing

Paton, B. (2003)Unready-to-hand as Adventure: Knowing within the Practice Wisdom of Clinical Nurse Educators.

Clinical Practice• Opportunity to learn how to learn in a

continually changing and complex organization

• Handle ambiguity, complexity, uncertainty, conflict and instability, to think like professionals, develop personal responsibility and accountability, problem-solve, and make decisions

Chan, D. (2002). J. of Nsg Ed. (2002) 41:5:69-75

Expectations of Clinical Teachers

• Monitor students’ needs• Monitor clients’ needs• Monitor clinicians’ needs• Respond to unplanned activities• Practical teaching• Assessing students• Supporting students• Facilitating students’ learning

•

Gillespie, M. J. of Adv. Nsg. (2002) 37:6:566-576

Expectations of Clinical TeachersCoach & Guide

• Assisting students to plan care• Assisting students to deliver care• Developing relevant nursing skills• Assessing student understanding of

patient status

Characteristics of Good Clinical Teachers

• Interpersonal aspects:– Role modeling– Relationship: rapport, genuineness, respect– Enjoys nursing and teaching

• Competence:– Theoretical and clinical– Attitude to profession

• Teaching ability: – Knowledge of philosophy of school & curriculum

– Evaluation practices

Scanlan, J.M. Nsg & Health Care Perspectives, (2001), 22:5:240

How do we become clinical teachers?

The Student Experience

• Anxiety• Vulnerability• Change in role from classroom

thinker to “real-world” doer• Competing demands

Paton, B. (2003). Unready-to hand as Adventure....

The Experience of Clinical Practice

• Envisaging oneself as a nurse• Coping with technology• Negotiating with physicians• Facing suffering and death• Learning skills of involvement• Learning to cope with ones feeling of

inadequacy

Betz, C. J. of Nsg Educ. (1985) 24:301-302 in Chan, 2001

Supportive Aspects of Clinical Experience

Strengthen students’ independent professional growth and encourage peer-level interactions with other health care professionals

• Autonomy & recognition

• Role clarity• Job satisfaction• Quality of

supervision• Peer support• Opportunity for

learning

Saarikoski, M. & Leino-Kilpi, H. (2002) Int. J. of Nsg Studies. 29:3:259-267

“Good” Clinical Learning Environments

• Non-hierarchical structure• Teamwork• Good communication• Positive atmosphere• Good team spirit• Working together• Motivated staff• Supportive of students• High quality nursing care

Crawford, MW & Kiger, AM (1998) JAN 27:1:157-164

Phases of Adaptation to Clinical: Adaptation

• Description– New area, anticipated characteristics of pt/needs– Reputation of unit– Physical orientation– Getting to know the staff– Insecurity, lack of knowledge, anxiety

• Strategies: – reading ward objectives, observing, practising new

procedures, seeking role models, questioning, seeking reassurance

• Barriers: excess anxiety, insufficient support, unrealistic expectation

.

Crawford, MW & Kiger AM (1998) JAN 27:1:157-164

Phases of Adaptation to clinical: Stabilization

• Strategies– Beginning awareness of gaps in knowledge

• More probing questions

– Increased discrimination of performance against standards Able to cope with most situations

– Helping others– Aware of increasing knowledge

Crawford, MW & Kiger AM (1998) JAN 27:1:157-164

Phases of Adaptation to Clinical: Consolidation

• Strategies– Expertise the goal, managing complexity – Minimal supervision– Application of theory to practice– Evaluation against standards

• Barriers: – Perception of not meeting expectations

Teaching & learning

Teaching & learning

Problem-solving

Problem-solving

Relationship

Building

Learner

KnowledgeLearning

Environment

Subject

Knowledge

Patient

Knowledge

Role-Modeling

Strategies• The teacher• The unit/clinical area• The student• The faculty

An experienced instructor says:

I try to eliminate as many of the stressors for the students as possible through making feedback & expectations clear, applying the rules equally, gradual immersion of the student into the clinical workload, a welcoming greeting from the unit manager,

dealing with concerns promptly, negative feedback given in a confidential manner & location, not correcting a student in front of a patient.

I ensure that I have credibility with the unit manager and clinical staff and health team members through current knowledge regarding the area, sharing my resources with staff, familiarity with the equipment in use and the policies and procedures on the unit.