Clinical Teaching in Nursing

Clinical Teaching in Nursing

Clinical Teaching in Nursing Ruth White Visiting Fellow School of Medical Education University of New South Wales Australia and Christine Ewan Professor and Dean Faculty of Health and Behavioural Sciences University of Wall on gong Australia SPRINGER-SCIENCE+BUSINESS MEDIA, BV.

First edition 1991 1991 Springer Science+Business Media Dordrecht Originally published by Chapman & Hall in 1991 Typeset in 10/12 pt Palatino by Best-set Typesetter Ltd, Hong Kong ISBN 978-0-412-32700-1 ISBN 978-1-4899-3354-6 (ebook) DOI 10.1007/978-1-4899-3354-6 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication data White, Ruth, 1926- Clinical teaching in nursing 1 Ruth White and Christine Ewan.- 1st ed. p. cm. Companion v. to: Teaching nursing 1 Christine Ewan and Ruth White. c1984. Includes bibliographical references and index. 1. Nursing-Study and teaching. I. Ewan, Christine E. II. Ewan, Christine E. Teaching nursing III. Title. [DNLM: 1 Clinical Competence. 2. Education, NurSing. 3. Teaching-methods. WY 18 W587c] RT90.W55 1991 61O.73'07-dc20 DNLM/DLC for Library of Congress 91-20220 ClP

Contents Preface vii 1 Clinical teaching 1 1.1 What is clinical teaching? 1 1.2 The environment for clinical teaching and learning 3 1.3 Implications of the clinical learning environment 6 1.4 Challenges 13 1.5 Framework of the book 18 2 Foundations of clinical teaching and learning 19 2.1 Introduction 19 2.2 Educational foundations 20 2.3 Nursing theory foundations 33 3 Learning in the laboratory 41 3.1 Introduction 41 3.2 The clinical learning cycle 41 3.3 The lab in nursing programmes 43 3.4 Purposes of the lab 46 3.5 Design of the lab - physical facilities 51 3.6 Managing the lab session 54 3.7 Models of lab teaching and learning 58 3.8 Curriculum design and lab teaching and learning 61 3.9 Learning problems and teaching skills 66 3.10 Increasing motivation for learning in the lab 77 3.11 Reactions of learners in the lab 82 3.12 The role of the clinical teacher in the lab 84 4 The briefing: preparing students for clinical practice 86 4.1 Introduction 86 4.2 Are briefing sessions necessary? 87

vi Contents 4.3 Purposes of the briefing session 89 4.4 Preparing for the briefing session 95 4.5 Planning a programme of briefing sessions 96 4.6 Conducting the briefing session 103 4.7 Practice-based briefing sessions 108 4.8 The role of the clinical teacher in the briefing session 116 5 Learning through clinical practice 118 5.1 Supporting 122 5.2 Observing 126 5.3 Guiding 130 5.4 Facilitating 135 5.5 Resourcing 138 5.6 The environment for clinical learning and teaching 142 5.7 Clinical assignments 147 5.8 Quality of the clinical experience 155 5.9 Roles of the clinical teacher with students in the clinical/community setting 162 6 Debriefing: reflecting on practice 165 6.1 Introduction 165 6.2 Purposes of debriefing 166 6.3 Preparing for debriefing 168 6.4 Conducting the debriefing session 172 6.5 Debriefing the students' experiences 174 6.6 Roles of the clinical teacher in the debriefing session 186 6.7 Concluding comments on the clinical learning cycle and the clinical teacher 187 7 From student to nurse 189 7.1 Becoming a nurse 189 7.2 How does socialization occur? 191 7.3 What are the implications for the clinical teacher? 194 7.4 What can the teacher do? 195 Bibliography 197 Index 210

Preface This book aims to assist clinical teachers in the practice of clinical teaching. It assumes that clinical teachers will bring to their task a background knowledge of educational principles, experience in a clinical nursing field, knowledge of substantive nursing content, a love of teaching and a desire to share with their students the joys, tears, challenge and wonder of learning in the clinical setting. The format is designed around a set of commonly encountered problems and encourages readers, whether on the threshold of a career as a clinical teacher or those who are experienced, to think through their responses to the problem situation before reading on to a disclosure of possible courses of action. In brief, the book is a companion to Teaching Nursing: A Self Instructional Handbook (Ewan and White, 1984). The authors' interest in clinical teaching can be traced through a number of years in a variety of teaching careers with multidisciplinary health professional groups, of whom nurses comprise the majority of practitioners. As senior lecturers in the School of Medical Education, the authors were involved in developing and teaching a Master of Health Personnel Education Degree course; the students (or Fellows) in that programme were all graduates from a broad range of health care disciplines - nursing, medicine, physiotherapy, occupational therapy, nutrition, dentistry, health education, health resources management, radiography, social work, community development, occupational safety and health. Issues of clinical teaching were raised both during course work and also, more searchingly, by Fellows who chose a clinical education problem as the focus of the research project component of the degree (Higgs, 1982; Ritchie, 1986; Lumby, 1987; Tan, 1987; Kermode, 1987; Mill, 1989; Pratt, 1989; Sando, 1989).

viii Preface Both authors have been involved in research projects in clinical teaching which involved observational study of clinical teaching, interviews with students and teachers and development of videotaped clinical teaching scenarios for use in clinical teaching in nursing, medicine and physiotherapy. The research indicated that some commonly held assumptions about clinical teaching needed to be challenged. Assumptions such as the following were not borne out by our observations of clinical teaching: 1. Being an effective lecturer in the lecture hall or classroom guarantees effective teaching in a clinical setting. 2. Being an expert clinician ensures that a person would also be an expert clinical teacher. 3. Clinical teaching skills are no different from classroom teaching skills. Funding was obtained from the Clive and Vera Ramaciotti Foundations for a two-year project to develop a series of videotaped segments on clinical teaching microskills.* During that project, observations of clinical teaching and interviews with clinical teachers revealed that most programmes in nursing had adopted a pattern of systematic progression through the presentation of theory, laboratory practice, briefing or preconference before clinical practice and debriefing or post-conference after clinical practice. Some programmes added a further component to obtain feedback on all stages of 'the clinical learning cycle' from teachers and students involved. While it is true that the briefing and debriefing segments of the cycle appear in many fields of education, and that extensive exploration of their use has been documented (Goldhammer, 1969; Matheney, 1969; Turney et al., 1982; Schon, 1988; Boud, et al., 1985; Boud, 1988; Smyth, 1984, 1986) the full cycle of learning has important implications for clinical teachers in nursing. Whereas, in the past, students were expected to take from theory what was required for practice without intermediary learning stages and preparation for practice, the cycle offered a logical progression for students and teachers and a close link of theory with practice. The clinical learning cycle provides the framework of the book. A second project, funded in 1988 by the Bicentennial Foundation, * Positive Practices. Microskills for clinical teachers in nurse education. Audio Visual Unit, University of New South Wales, Sydney. Teaching Practices. Microskills for teachers in medical education and the therapies. Audio Visual Unit, University of New South Wales, Sydney.

Preface ix through the Committee to Review Australian Studies in Tertiary Education, enabled the production of a set of taped programmes." This project aimed to provide examples of ways the clinical teacher could include social and behavioural science perspectives in clinical teaching. The assumption was that the application of biological sciences has certain universal similarities, but that the social context is culturally, locally and often individually bound. There are fewer models of application to follow than in the biological or physical sciences. The Bicentennial project sought to identify Australian material appropriate to each critical incident in nursing. This book draws on some of the material and observations gained during those two projects and the contribution of staff and students in Health Professional Schools is acknowledged with warm appreciation. Critical Incidents in Clinical Teaching. Perspectives from the Social and Behavioural Sciences. Audio Visual Unit, University of New South Wales, Sydney.