Utilizing Evidence Based Practice in Clinical Nursing Instruction

1. Utilizing Evidence Based Practice in Clinical Nursing Instruction Elizabeth Peters, R.N. Nicole Romasanta, R.N. Mindy Thompson, R.N.

2. Identification of the Problem Clinical nursing instruction techniques vary greatly among different nursing programs and nursing instructors. Does nursing research uncover any teaching strategies for nursing educators to utilize in the clinical learning environment?

3. Identification of the Problem Connecting classroom, skills lab, and clinical experiences Clinical confidence Retention rates Student and Instructor satisfaction Key ingredients?

4. PICO Question Will utilizing researched teaching methods/strategies in the clinical setting establish more consistent outcomes for nursing students in terms of retention, clinical confidence, and satisfaction of both student and instructor, compared to providing little to no utilization of researched teaching techniques in the clinical setting?

5. Significance of the Problem Demand for high quality nurses and the nursing shortage 8 core competencies universal and applicable to all nursing courses, environments, levels of nursing, and nursing positions

6. 8 Core Competencies In focusing on the eight core competencies, professional nurses are created and introduced to the nursing field, thereby protecting and building the strength, integrity, and future of nursing. In focusing on the eight core competencies, professional nurses are created and introduced to the nursing field, thereby protecting and building the strength, integrity, and future of nursing.

7. Impact of the Problem Positive and beneficial clinical experiences impact the students� success, attitude, and satisfaction Successfully completing a program with confidence in skills and knowledge and satisfaction is imperative for the community and patients Because of the continuing nursing shortage, communities depend on well educated, satisfied, and confident nurses Providing consistency with curriculum and clinical experiences is important to ensure knowledge of material and skills

8. Impact of the Problem Delivery of safe, patient centered care has long been a priority among nursing educators, but nursing students may not be able to adequately translate concepts learned within the classroom into nursing practice. Nurse educators must develop teaching strategies to provide nursing students with the knowledge, skills, and attitudes necessary to provide quality patient care (Girdley, Johnsen, and Kwekkeboom, 2009, p. 702)

9. Effective Teaching Techniques Traditional clinical education model Preceptor model Strengths perspective model Peer learning model Concept-based learning model

10. Literature Review Traditional Clinical Education Model Total patient care for one to two patients Day before spent preparing nursing care plan Task focused rather than patient focused Increasingly impractical, as patient turnover increases

11. Literature Review Preceptor Model Nursing student works under the supervision of RN who are part of the clinical staff Preceptor Model compared to Cluster model where a nursing instructor is on unit with students in 1:8 ratio or less Staff RNs often reported the experience of �role overload� when faced with nursing management of patients and the time needed to teach also (Croxon & Maginnis, 2008, p. 240).

12. Literature Review The student�s preference for the cluster model over the preceptor model using a Likert scale was higher in all four categories: opportunity to achieve clinical objectives opportunity to practice clinical skills degree of support from facilitator/preceptor opportunity for one-on-one instruction from the facilitator/preceptor (Croxon & Maginis, 2008, p. 239

13. Literature Review Strengths Perspective Model Popular in social work education, can be adapted to nursing education Focuses on the emphasis of the student�s skills, knowledge, and problem solving skills in the instructor/student relationship Learning Contract Emphasizes empowering the students, dialogue and collaboration between instructor and student, and helping the student to recognize his or her internal strengths (Cederbaum & Klusaritz, 2009, p. 424).

14. Literature Review Peer Learning One student acts as tutor for other students, or students working together in small groups Advantages working in pairs provided emotional and physical support openness in communicating with peers versus the instructor learning was facilitated by the sharing of information Disadvantages a lack of autonomy and independence from caring for the patients while in pairs �felt less like a real nurse� (Chojecki et al., 2010, p. 11).

15. Literature Review Concept-Based Learning Guide student�s critical thinking, offering a bridge between theory and practice Increases their exposure to the given concept and its manifestations in a variety of patients Nursing rounds

16. Literature Review Summary Nursing clinical experiences should be structured (McCallum, 2004; Rego, 2009) Provide critical thinking opportunities for students to engage in (Angel, Duffey, & Belyea, 2000) Allow the student to focus on patient-centered care, rather than task centered care (Croxon & Maginnis, 2004). Students should be evaluated with the use of an objective tool, rather than just the subjective opinion of the instructor (Karayurt, Mert, & Beser, 2008; Cheraghi, Hassani, Yaghmaei, & Alavi-Majed, 2009) Clinical objectives should be clearly outlined in advance Post conference time used to answer student questions and engage in critical discussion of patient encounters from the clinical day (Hsu, 2007; Hanson, 2008). Theory learning in the classroom should be correlated with the clinical experience (Hsu, 2006)

17. Strategies to Improve Clinicals Annual clinical education for instructors Focus on the dynamics of the instructor and student relationship Clinical tools that could benefit the learning experience How to relate theory classroom content into the clinical setting also provide the instructors a platform to meet to exchange nursing clinical techniques utilized in the past that were effective and ineffective with studentsalso provide the instructors a platform to meet to exchange nursing clinical techniques utilized in the past that were effective and ineffective with students

18. Implement Written Tools Improve and facilitate nursing student learning The relevance of completing clinical paperwork in relationship to meeting the goals of the clinical should be made clear by the instructor

19. Examples of Written Tools Assessment checklist to help students identify safety risks and to focus care on the patient (Girdley, Johnsen, & Kwekkeboom, 2009, p. 703) Likert type scale used to assess students� self-efficacy in clinical performance (Cheraghi, Hassani, Yaghmaei, & Alavi-Majed, 2009) Objective scale used to assess nursing students� performance in the clinical setting (Karayurt, Mert, & Beser, 2008) Learning contract to facilitate the cooperative relationship between instructor and student and to outline clear objectives for the semester (Cederbaum & Klusaritz, 2009, p. 426).

20. Post Conference Provide students a forum for critical thinking and discussion among peers and instructor Critical reflection of learning experiences and clinical problem solving Role plays, experience sharing, report reading, and assessment discussion Nurse educators should be properly trained how to lead effective nursing clinical post-conferences

21. Cost Faculty to organize and present annual clinical education Annual allowance to clinical instructors

22. Evaluation of Clinical Strategies Student satisfaction and confidence with learned skills Survey students at the completion of each clinical rotation as well as at the end of the program Clinical instructor satisfaction Survey students at six months and one year after they have graduated from the program, passed their licensure exam, and begun their career as a licensed practical nurse. Retention rates of both students and instructors

23. Questions?