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CLINICAL TEACHING METHODS

Teaching in a clinical setting is entirely different as compared to teaching in other settings (e.g.,

classroom, laboratory, etc.) because in the clinical area there are real situations with real patients as

compared to hypothetical situations created in classroom teaching. It provides an ample opportunity for a

student to observe the various nursing procedures, day-to-day routines of staff nurses which is important for

them to prepare themselves for their future roles. Sound theoretical knowledge base is a prerequisite to learn

better in the clinical area. In India, the nursing profession is struggling with incongruence of what is taught

in theory classes with what is applicable in practice. In theory classes, students are taught extensively.

1. Definition: Clinical teaching is an individualized or group teaching to the nursing students in the clinical

area by the nurse educators, staff nurse and clinical nurse manager. Clinical teaching is a Client and family

centered approach.

2. Steps in clinical teaching:

1.Formulating
objectives

2.
5. Determining
Implementing the student
& evaluating knowledge by
the sessions. conducting a
test

3. Planning
the content for
4. Organizing
ward teaching
the
depending on
programme
the student’s
knowledge
3. Philosophy / Principles of clinical Teaching:

Clinical education should reflect the nature of professional practice. Clinical teaching is more

important than class room teaching. The nursing student in the clinical setting is a learner, not a Nurse.

Sufficient learning time should be provided before performance is evaluated. Clinical teaching is supported

by a climate of mutual Trust & respect Clinical teaching & learning should focus on essential knowledge,

skill & attitude. The espoused curriculum may not be the curriculum in use. Quality is more important than

quantity.

4. Possible goals of clinical teaching

1. Recording and reporting information


2. Physical examination
3. Perform skills procedures
4. Interpret data
5. Solve scientific and professional problems
6. Communicate information reliably
7. Develop familiarity with health care services and facilities
8. Develop appropriate attitude towards patients and allied health workers
9. Accumulate factual health care knowledge
10. Acquire positive attitudes to independent learning

5. Advantages of clinical teaching

1. Opportunity to gather additional information from the patient


2. Directly observes student’s skills
3. Role model skills and attitudes
4. Humanizes care by involving patients
5. Encourages the use of understandable and nonjudgmental language
6. Active learning process
7. Patients feel a part in the learning process
8. Improves patient’s understanding of their disease

6. Guide lines for selection of methods adapted for use in clinical teaching
Selection of method must be;

1. Appropriate to objectives and desired behavioural changes


2. In accordance with the principles of learning
3. In accordance with the capacity of students
4. In accordance with the availability of resources
5. In accordance with the teacher’s ability to use it effectively and creatively

7. Types of clinical teaching methods


A. Case Method - a) Case study b) Case analysis c) Care plan
B. Nursing Rounds and Reports
C. Bedside Clinic
D. Conference - a) Group conference b) Individual conference c) Staff conference d) Nursing care
conference e) Team conference
E. Process recording

A. Case Method -
Case method used in three forms. They are a) Case study b) Case analysis c) Case incident Technique.

a. Case study: Nursing case study is a detailed study of the patient while providing care to that patient

by a student nurse. Case study is also considered as a method of research. Usually, a rare clinical

disorder is selected for the case study and the assigned student nurse follows that patient for a

particular period with an intention to develop comprehensive nursing care abilities. The patient is

selected by the student in consultation with the clinical instructor or ward nurse.

 The student makes an in-depth study of the patient and his/her problems.
 The student has to provide nursing care to the patient for a long time (4 to 5 days).
 The student presents the case study to the class or group for a discussion.
 A written guide should be given to the student on lining the types of information.
Advantages of nursing care study: The concentrated effort on the part of the student to define and

solve the problems in the patient care arouses interests in him and results in better nursing care. The

students learn to recognize the effect of personal and social factors on illness and recovery, to

organize the information and identify the problems. The student also learns about the problem

solving approach to nursing. The report may act as a reference material for the student. The student

can present the report in front of the group and it should be evaluated in terms of content,

organization, clarity of thought and interest. The oral presentation helps the student to speak in front

of the group.

b. Case analysis: a concrete analysis and discussion by a group of students under the leadership of the

instructor. Sufficient information is presented to the students to make judgment of problem or

situation in case.
c. Case incident Technique: a critical incident technique which requires immediate decision and action

is taken from a case and presented to the students for their analysis and decision. No background

information is given to the students in detail at the time of incident. The instructor will have facts

about the case; can be given as requested by the students.

B. Nursing Rounds and Reports

Nursing rounds is an excursion into patient’s area involving the students learning experiences. In

nursing rounds the patient history and the medical aspects of his/her care are included only as a

background for understanding the nursing care. The registered nurse responsible for the patient should

answer questions aroused in the group. Suggestions are made by the members of the group. Suggestions

discussed in the rounds will be recorded. Rounds may extend only up to one hour

Types: Information giving rounds, Instructional rounds, and Problem solving rounds.

Advantages: Increases the learning ability Increases interest to share ideas & Knowledge with others for

the benefit of the client Response of the client is more natural Students can select client with specific

problem & plan for proper nursing care.

Disadvantages: requires very careful planning, A small group of students can be taken at a time.

C. Bedside Clinic

Bedside clinic always help to study the problems typically associated with a particular disease or

disorder. Always ensure the presence of the patient. Either the group visits the patient or the patient is

brought to the conference room. Patients with typical cases rather with unusual conditions are selected.

During the clinic the patient may be asked to speak something about the course of illness, symptoms and

involves the family members and plan for discharge. Brief history and therapy, nursing problems are

presented along with the nursing care including physical, mental and social components. Nursing clinic

can be conducted by the head nurse or the clinical instructor. Before the client entry the head nurse

points out the group the observations which should made while he/she is present. When the patient no

longer needed should send back. This is usually followed by a discussion and question and answer

round. The Material is summarized and the most important points are emphasized. The clinic lasts for

about 30 min finally it is evaluated by the head nurse and the group members.
It is a teacher-centric method useful for small groups of students (not more than 10–15 students). It is

conducted by the clinical instructor or nursing faculty or sometimes by a clinical nurse educator, doctor,

or ward in charge.

 Bedside clinic is conducted in the presence of the patient. It can be medical, nursing or

combined (based on type of topic). Prior information to group about patient and venue is

provided by the concerned nurse educator or clinical instructor. The teacher has to select a

topic and a patient with typical signs and symptoms.

 The patient's or relative's consent should be taken to conduct bedside clinic.

 Brief the patient about the aim of the bedside clinic, students’ numbers and the level of

students and what the student will do and for how long.

Advantages: The student nurse is getting an opportunity to observe, analyze & make decision in

nursing care Remembers the nursing measures for longer time since directly they involved.

D. Conference - a) Group conference b) Individual conference

a) Group conference: It is a small group teaching method (i.e., not more than 10–12 students). In a

group conference, a group of students and their instructors meet for an informal discussion of clinical

problems. A subject of common interest related to the clinical area is discussed. Suggestions derived

from the various group conferences are informed to the head nurse.

Role of the Clinical Instructor in Leading Group Conference


 They must be sensitive to the group.
 Should be poised and have patience.
 Guide the discussion.
 Correct wrong impressions.
 Choose the area or subject of discussion.
Pros of Group Conference

 Helps students to develop problem-solving and team-building skills, and the ability to express

themselves assertively.

b) Individual conference: Individual conference is a student-centric teaching strategy in clinical area. It

may be of two types: planned and unplanned or incidental. It especially deals with the individual

student's clinical competence, care ability, nursing skills, performance and achievements related to
clinical experience. The clinical instructor, while organizing individual conference, should respect

individuality, provide a comfortable atmosphere which is conducive to learning and maintain a

record of the conference.

Advantages: It takes care of learning difficulty of individual students and encourages them to overcome

it. Boosts self-confidence and sense of security among students.

E. Process recording

An exact written report of the conversation between the nurse and the patient during the time they

were together and a record of the nurses feelings about what was going on at the time, and as for as possible,

how the patient said what he did. – Hudson

PURPOSE

1. To assist the students in acquiring, understanding of and competence in interpersonal relationships.


2. Used as a teaching tool, Self-evaluation tool, Therapeutic tool.

Elements studied in process recording are;


Conversational skill, Skills in interviewing for a specific purpose, Verbal and Non-verbal cues to the patient

needs, Skill in meeting the patient’s needs, Awareness of behavior in relation to the patient, Control of

behavior as a result of awareness, Recurrent themes in the nurse patient interaction, Skills in verbal

intervention, Interaction patterns

Phases

Preparing the student for process recording


Teacher guides the student to define clearly the objectives to be accomplished in nurse patient

interaction

Recording nurse patient interaction


Recording exact report of nurse patient interaction

The student’s conscious feelings and her interpretation of patient feelings

Analysis for meanings and clues to patient’s needs

The instructors and the student’s evaluations of the total process recording experience
Evaluating the nurse patient interaction
The teacher and the student analyze the recordings based on the objectives.
Self evaluation by the student
Develop keener insight into the behavior of the patient.