"Meeting the Learning Needs of
Clinical Nurse Teachers:
A Pilot Program"
Mrs Lisa McKenna
RN, RM, BEdSt, GDipHlthAdmin&InfoSys
Clinical Coordinator
Caroline Chisholm School of Nursing
Monash University
Lisa.McKenna@Nursing.monash.edu.au
Abstract
Clinical teaching practices can influence the quality of learning experiences for students of nursing. However, sound clinical teaching can also enhance health teaching for clients, their families and colleagues. This paper discusses a short pilot course in clinical teaching developed to address the needs of registered nurses involved in clinical teaching, or those who may be interested in developing a career pathway in education. The results highlight the effectiveness of the course and implications for developing future courses to address the needs of nurses involved in teaching in clinical areas.
Clinical Teaching
Clinical teachers play a crucial role in assisting nursing students to apply theory learnt in the classroom, into practice within the clinical environment. The value of sound clinical teaching practices cannot be questioned, assisting students to develop personally and professionally as well as in developing vital clinical nursing skills (Fawcett & McQueen, 1994). Within the classroom, clinical laboratories and within clinical placements, students view the clinical teacher as a role model (Howie, 1988).
Although clinical teachers are generally considered to be experts within their preferred clinical environments, assistance is required in providing further education that will enhance the ability of clinical teachers to assist students apply learned theory into practice. Within nursing education, there remains a gap between knowing how to carry out the nursing role and the theory that remains a classroom activity (Craddock, 1993). For effective learning to occur within the clinical setting, clinical teachers need to understand the mechanisms by which learning takes place. Such knowledge can aid the clinical teacher in adapting classroom learning into practice, in recognising learning problems and developing strategies for overcoming these difficulties, as well as providing methods for enhancing the clinical learning experience. Flagler, Loper-Powers and Spitzer (1988) view the clinical teacher as a first level quality control, ensuring the maintenance of clinical practice standards. Whilst it is becoming increasingly recognised that clinical teaching is a complex role, little is currently available to assist clinical teachers to improve and develop their skills (White & Ewan, 1994).
Developing a Pilot Program
Generally, clinical teachers receive minimal preparation before undertaking their clinical roles. Following a series of events, a need was identified within the author's nursing school for clinical teachers to have a better understanding of the theory and practice of clinical teaching. It was envisaged that given this, clinical learning of undergraduate students would be greatly enhanced and meet a recognised deficit.
A pilot program was developed within the school to be offered initially as a continuing education course. The course was marketed to provide for the learning needs of nurses currently involved in clinical teaching but also to address needs of nurses interested in developing a career pathway in clinical teaching. For the initial program, classes were held weekly for six weeks in the evenings totalling fifteen hours of instruction. Course content was determined according to identified needs of both groups. A different focus was introduced in each session, as follows:
Session 1: Introduction to clinical teaching; roles,
models and resources
Session 2: Educational and nursing theories in clinical
teaching
Session 3: The clinical learning cycle
Session 4: Clinical teaching methods
Session 5: Clinical assessment
Session 6: Problems in clinical teaching
In order to enhance participant learning and assist with the application of learning into the clinical environment, workplace exercises were provided following most sessions and these were evaluated within the classroom setting the following week.
Evaluation Results
Following completion of the pilot course, a course evaluation was distributed to participants. Information was sought to identify the area where the participant was working at the time, reasons for undertaking the course and whether course expectations were met. In addition, participants were asked to rate content presented in the course to determine the relative value of each topic for participants. Of the fourteen participants, questionnaires were received from eight (57%).
Participants were questioned as to the area where they were currently working. The results (table one) illustrate that participants were clinical teaching in a range of capacities. From the results it also appears that some individuals were involved in teaching across more than one course, that is, undergraduate, postgraduate and hospital-based programs. Others were either not currently involved in clinical teaching, or were working concurrently in other capacities.
TABLE 1
AREA WHERE PARTICIPANT WORKING AT TIME OF COURSE
(n=8)
Clinical teaching - undergraduate students 4 (50%)
Clinical teaching - postgraduate students 2 (25%)
Clinical teaching - hospital-based program 2 (25%)
Working in another area (eg. ward) 4 (50%)
In part one of the questionnaire, participants were questioned about their reasons for undertaking this course. Responses encompassed three main areas: interested in clinical teaching and wanting to know more (50%), understanding the role currently being carried out by the participant (25%), and to improve current clinical teaching practices (25%). All participants (100%) expressed that the course met their expectations and perceived learning needs.
Part two of the questionnaire involved participants rating the topics presented in the program on a scale of 1 - 5 where one was "not useful" to five which was "very useful". The mean and standard deviation for these ratings is presented in Table two.
TABLE 2
COURSE SESSION/ TOPIC EVALUATION
Mean S.D.
SESSION 1
Roles of the clinical teacher 4.29 1.24
Environments for clinical teaching/learning 4.00 1.00
Models of clinical teaching 3.86 0.81
Teaching resources in the clinical setting 4.14 0.48
SESSION 2
Benner's theory of skill acquisition 3.75 0.21
Stages of learning 4.13 0.41
Elements of memory 4.13 0.70
Types of learning in nursing 4.00 1.00
Learning styles 3.75 0.50
Writing learning objectives 3.88 0.70
SESSION 3
Clinical learning cycle 4.43 0.57
Visit to nursing laboratory 3.71 0.90
SESSION 4
Selecting clinical teaching methods 4.29 0.48
Types of clinical teaching methods 4.71 0.23
SESSION 5
Methods of clinical assessment 4.38 0.27
Problems of clinical assessment 4.38 0.55
SESSION 6
Problems in clinical teaching 4.57 0.62
The overall results suggest that participants found the content to be useful overall. Areas perceived by participants to be most beneficial included roles of the clinical teacher, the clinical learning cycle, clinical teaching methods, clinical assessment and problems in clinical teaching. The least useful were perceived to be models of clinical teaching, learning styles and the visit to the nursing laboratory. From the standard deviations of the results, for a number of areas including roles of the clinical teacher, environments for clinical teaching/learning, types of learning there appeared to be a wide spread of opinion as to the perceived benefit to the individual participant. This may be partially attributed to the variety of settings from which participants came and differing individual requirements.
The final component of the questionnaire posed two questions to participants:
What topics should be included in the course in future that were not covered?
What topics should be left out of the course in future?
Six participants provided responses to the first question. Two people suggested that a discussion of the psychological aspects of dealing with students would be useful, whilst other individuals suggested employing a simulated clinical teaching session, role play, dealing with more practical problems and ways of addressing the needs of failing and more advanced students. From the feedback generated, a pleasing aspect was that no areas identified that require elimination from the program in future.
Discussion
Whilst the number of questionnaires received was small and this limits the results obtained, a range of worthwhile feedback was received, providing useful information for this course in future. It was reassuring that despite the range of practice areas of the participants, individual learning needs could still be met. From the results, it appears that the topics presented were appropriate and relevant to the participants' individual needs. Given the diversity of participants' work environments, it is evident that broad clinical teaching skills are advantageous for registered nurses regardless of the specific nature of their practice setting. This characteristic may reflect the spread of means in the topic evaluations where the most practical areas were found to be most useful for participants. Further, this pilot course has highlighted the need for registered nurses currently involved in clinical teaching to have access to opportunities for professional development.
Future development of this clinical teaching course should seek to address a number of other areas identified by the participants through the questionnaire. These include addressing the psychological aspects of clinical teaching from both student and teacher perspectives. In addition, examining areas such as the particular needs of failing and exceptional students will assist clinical teachers to master their roles.
Conclusion
Clinical teachers facilitate students' application of learned knowledge and practical skills into the clinical setting. This role can be enhanced through educational programs developed to meet their particular learning needs , providing information on a range of topics encompassing both nursing and educational facets. Such educational programs have the ability to influence the effectiveness and quality of clinical education and ultimately on student learning outcomes in clinical settings. Sound clinical teaching skills can also greatly enhance the functioning of registered nurses at working in a variety of clinical areas. The application of educational theories in ward-based teaching has the potential to ensure greater effectiveness in health teaching for clients, their families and colleagues.
While the educational program outlined in this paper has only been a pilot program requiring some modification, the need to offer educational programs in the area of clinical teaching has been highlighted. With the introduction of other programs such as this, the quality of learning experiences in clinical settings can be expected to become greatly enhanced.
References
- Craddock, E. (1993). "Developing the facilitator role in the clinical area", Nurse Education Today, 13, pp.217-224.
- Fawcett, T.N. & McQueen A. (1993). "Clinical credibility and the role of the nurse teacher", Nurse Education Today,14, pp.264-271.
- Flagler, S., Loper-Powers, S. & Spitzer, A. (1988). "Clinical teaching is more than evaluation alone", Journal of Nursing Education, 27 (8), pp.342-348.
- Howie, J. (1988). "The effective clinical teacher: A role model", Australian Journal of Advanced Nursing, 5(2), pp.23-26.
- White, R. & Ewan C. (1994). Clinical Teaching in Nursing, Chapman and Hall, London.
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