Creating a Learning Environment in Clinical Education

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

2. 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

3. Aspects of Environment Affecting Student Learning • Quality of student preparation • Characteristics of instructor • Characteristics of unit/unit staff • Peer support • Past clinical experiences Cahn, D. (2002) J. of Nsg Educ. 41:2:69-75.

4. Clinical Education • Critical thinking development • Problem-solving abilities • Specialized psychomotor & technological skills • Professional value system Gaberson, K. & Oermann, M. (1999). ClinicalTeaching Strategies in Nursing. NY: Springer.

5. Expectations of Clinical Placements • Application of knowledge • Development of skills • Development of attitudes & values inherent in the profession of nursing Chan, D. J. of Nsg Ed. (2002) 41:2:69-75

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

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

8. Expectations of Clinical Teachers Coach & Guide • Assisting students to plan care • Assisting students to deliver care • Developing relevant nursing skills • Assessing student understanding of patient status Gillespie, M. J. of Adv. Nsg. (2002) 37:6:566-576

9. 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

10. How do we become clinical teachers? Scanlan, J.M. Nsg & Health Care Perspectives, (2001), 22:5:240

11. The Student Experience • Anxiety • Vulnerability • Change in role from classroom thinker to “real-world” doer • Competing demands

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

13. 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 Supportive Aspects of Clinical Experience Betz, C. J. of Nsg Educ. (1985) 24:301-302 in Chan, 2001

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

15. 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

16. 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

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

18. Problem-solving Teaching & learning Subject Knowledge Relationship Building Role- Modeling Learner Knowledge Patient Knowledge Learning Environment

19. How do we actually do all this?

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

21. 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,

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

23. 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.