BED SIDE CLINIC

INTRODUCTION:
Bed side clinic is a method of clinical teaching, where a patient’s medical history and therapy used is
discussed in brief followed by identification of patient’s problems. The bed side, clinic, also at times
mentioned as nursing clinic always entails the presence of the patient and has been one of the most effective
methods of clinical instruction. New knowledge is acquired through the observation and study of an actual
patient.

DEFINITION BEDSIDE CLINIC:

Bedside clinic is defined as teaching in the presence of the patient. A clinical teacher and a group of learners
sees a patient, listens to the history (from patient or learner), elicits or verifies physical signs, discusses
provisional diagnosis, diagnostic or therapeutic options. During this the teacher will observe learners’
patient interactions and their thinking skills.

GENERAL GUIDE FOR THE BEDSIDE CLINIC

1. The bedside clinic can be held at the bedside or arrangements can be made to bring the patient to the
classroom near the wards.

2. The bedside clinic can be conducted by the doctors, wards sister, clinical instructor or even by a
student nurse. The usual duration is of 30minutes. The group in attendance at the clinic should be
small enough to gather around the bed in an informal way in order to make the patient feel at ease.

3. Patient chosen for clinical demonstration should have typical rather than unusual conditions.

4. Prior permission should always be taken from the patient for presenting him to the group and the
purpose of the discussion. He should be the centre of attention and nothing should be done or told
which may hurt the patient’s feeling or embarrass the patient. Patient may be requested to talk
something about his /her family disease, onset, signs and symptoms.

5. Usually, the patient is not present for the entire discussion. Before she is brought in to the ward
classroom or the group goes to the bedside, one of the nurse who knows the patient describes her/his
personal characteristics, family background , physical and mental condition etc. the nursing care and
problems related to his /her therapy is also discussed . after this the group interacts with the patient ,
ask him or her question for clarification. When he is no longer needed patient is asked to go to his
 bed. The discussion follows, questions which are answer in the group. The material is summarised,
important points emphasised and an evaluation done as to the effectiveness of the clinic.

TEACHING WITH PATIENTS

1. Pre-bedside teaching:
Prepare, plan, orient plan what you are going to teach, prepare the patient and collect together useful
clinical resources before the students arrives.

2. Bedside teaching:
Introduce, interact, observe, instruct, summarize maintain a clear introduction body and close to your
session to help students learned.

3. Post-bedside teaching:

Debrief, feedback, reflect, Prepare

TECHNIQUES FOR THE BEDSIDE CLINIC

The recommended techniques for bedside clinic are as follows:

A. Base all teaching on patient data.

This means that case presentations, either complete or partial, must be made succinctly, that all data
bearing on a particular problem be presented together, that not all problems necessarily be discussed,
that the presenter make clear an overview of the patient's situation, that the purpose of subsequently
visiting the patient be made clear, and that time be allowed for questions between presentation and
patient visit so that no confusion or ambiguity persists

B. Conduct bedside clinic with concern for the patient's comfort and dignity

The bedside clinic should be conducted with concern for the patient’s comfort and dignity. bedside clinic
is both productive for the learners and respectful of the patient if these guidelines are followed:

1. Common human courtesy guides the asking of patient permission and the introduction of teacher,
learners and the proposed activities,
2. Physical examinations and procedures are performed and practiced with appropriate explanation.
3. All conversations, information transfer, and technical discussions are made in a way that the patient is
included and understands,

4. The patient is actively engaged in a three-way dialogue with the teacher and learners regarding the
medical problem-solving process, with conclusions (tentative or firm and so stated) made clear to the
patient, and

5. Student sees the patient afterward, perhaps during usual work rounds, to clarify questions, concerns,
and misconceptions, and bring the teaching event to a productive close.

C. Use bedside teaching opportunities to demonstrate and practice medical and surgical
procedures.
Many medical and surgical procedures are actually a series of sequential steps, each of which must be
performed correctly and in proper sequence. Teachers must be aware of the level of sophistication at
which a learner is currently functioning and match their teaching to that level. Teaching at a level of
understanding that is higher or lower than that of the learner is unproductive, frustrating or both.

The teacher can use the following 12 steps to help the learner progress.

Introductory Phase
1. State the objective of the skill teaching about to be done, and the specific performance that is expected
at the conclusion of the teaching.
2. Explain the rationale and importance of the skill.
3. Present a description of the necessary equipment and materials and an overview of the skill's basic
sequential steps.
4. Explain how each sequential step is done.

5. Demonstrate the entire skill, using the technique of either backward chaining or forward lengthening.
.
PracticePhase

6. Give specific instructions on what to practice and how.

7. Observe and practice closely and give frequent brief promptings about how the learner is doing.
8. Provide generous quantities of feedback generated by the learner, his peers and the instructor.
9. Allow a period of independent practice time.
 10. Certify each student on the entire skill
.11. Provide precision practice under realistic stress situations.
12. Prompt and give feedback only rarely.

D. Use bedside teaching as a special opportunity to give learners feedback.

The term "feedback" in an educational setting refers to the process of giving learners information about
current performance so that they may improve it in the future. Feedback can be either positive or
negative. Positive feedback is given to reinforce good behaviour, and negative feedback is used to
change bad behaviour.
Bedside teaching is some of the most enriching, intimate teaching that a teacher can do. The
opportunities for directly demonstrating procedures, directly observing learner skills, and giving
immediate substantive feedback to learners are unmatched in other clinical teaching formats.

ADVANTAGES OF BEDSIDE CLINIC

Bedside teaching rounds have many benefits for students, teachers, patients and the hospital

1. ADVANTAGES FOR STUDENTS

 Teaching at bedside clinic are memorable and motivating

We all have memories from our own student days. Our recall of special patients, errors we made on
rounds and the lessons learnt testified to the effectiveness of teaching round. These memories are
superior to those gained from pages of books. There is nothing like being involved actively to motivate
the student.

 Skills in history taking and in physical diagnosis

Acquired skills in history taking and in physical diagnosis are the obvious benefits of bedside teaching.
With these skills we can make diagnosis of many diseases without any laboratory aids, e.g. measles,
Down syndrome. Similarly clinical findings often permit us to rule out certain diagnostic hypotheses.
The value of taking a history and performing a physical examination also becomes clear at the bedside.
The formulation of diagnoses and therapeutic plans before the results of laboratory studies are revealed
sharpens clinical reasoning and leads to a more discerning use of the laboratory.
  Integration of theoretical knowledge with practical skills

Bedside is the place where we can help students to make the transition from a pre-clinical environment
to one in which they are expected to use the problem solving and decision making ability. Here their
knowledge of basic sciences is put to practical use.

 Help students see disease as an illness happening to a human being

At the bedside, the learners begin to see disease as an illness happening to a human being. The clinical
setting is the ideal situation in which to tackle sensitive ethical issues.

 Teach them proper behaviour

Bedside teaching allows to observe the attitudes and behaviour of students. It gives the opportunity to
teach them proper behaviour. They learn not to sit during the patient encounter without permission. They
learn not call the patient by his or her first name. They learn to respect the patient. They also learn to
mind their language, to avoid medical jargons or terms that may frighten the patient.

2. ADVANTAGES FOR PATIENT

Bedside clinic are also beneficial for the patients.

 Bedside clinic demonstrate our interest in and concern for the patient.
They love the attention. During bedside rounds, patients can observe their care givers in action and
gain a better understanding of the team caring for them. They learn that you respect them, interested in
them and are communicating with them.

 Give the patient a chance to ask questions (promotes better communication)

The patients have an opportunity to participate in their own care. They may add information and
clarify details.

 Bedside clinic is therapeutic

The patients learn that their opinions and feelings matter when decisions are made about their care.
Their fears are addressed, their anxieties are soothed, and they learn more about their illnesses.
  Patients can appreciate that teaching is important function of the hospital
At bedside, the patient learns the chief secondary purpose of institution, that of teaching students. The
patients become participants in this and no longer feel like laboratory animals caged for student
experimentation.

3. ADVANTAGES FOR THE TEACHER

The teachers also benefit from the bedside clinics. Bedside teaching allows the information on the
performance of the students. Teaching helps to learn more. It enables us to fulfil one of our obligations as
nurse and to help train future nurses.

OBSTACLES TO BEDSIDE CLINIC

 Bedside clinic is valuable and important but it appear to be declining. A study of potential obstacles
revealed that time was considered to be the most significant factor interfering with bedside teaching.
Pressures to see more patients, shortened hospital stays and competing demands for increased
documentation are contributing to this decline.
 Preceptors may avoid beside clinic because of concern for patient comfort.
 Many teachers may feel uncomfortable in the role of bedside teacher. Lack of experience, unrealistic
expectations and discomfort with teaching in the presence of the patient can lead to a reluctance to
teach at the bedside.
 NURSING CARE CONFERENCE

It is essentially the same as bedside clinic. But the patient is usually not present for any part of the class.
This method can be used when the entire group is well acquainted with the patient and the group would have
nothing new to learn from going to see him. It is however, important to note that the group member must
have enough opportunity to know the patient , read patient history, progress notes, laboratory findings,
nurses notes.

ROLE OF CLINICAL INSTRUCTOR IN LEADING NURSING CARE CONFERENCE

o The clinical instructor acts as the leader, must be sensitive to the group; to interest or lack of
interest: to agreement or differences of opinion; to the facial expressions and to all those little
things which show the attitude of the group members; to the subject under discussion or to
the speaker.
o She needs to be poised and have patience and should not answer question too quickly, but
wait until the students have had an opportunity to think through the solution.
o Clinical instructor should be able to guide the discussion.
o She should be able to correct wrong impression and give individuals time to complete
unfinished statements.
o The subject or areas chosen for discussion should be closely related to student’s daily
experiences in the department so that they may feel that they are really being helped and
guided in understanding nursing situations, in solving nursing problems. The success of this
type of teaching greatly depends upon the topic or areas chosen for discussion.
o Keep a brief record of topic, discuss the students contribution, her attitude her problems and
achievements.

SUBJECTS FOR NURSNG CARE CONFERENCES:

The following are a few suggestions and areas where nursing care conferences can be held:
1. Nursing care needs of particular patients or group of patients with poor prognosis, mental illness
etc
2. Conferences on nursing procedures, gaps in nursing e.g., failure to record fluid intake and output
accurately, maintaining nurses record.
3. Reports of nursing care problem, nursing projects.
PURPOSE OF NURSING CARE CONFERENCE:

 To portray the nursing problems typically associated with a particular disease with such factors as
social, age or ethical background and to picture the related nursing care with a specific individual.
 To learns ways to help clients, identify their needs and solves their own problems.
 To suggest approaches to the patient and planning ways to help himself.

ADVANTAGES:
 Comfortable/Quiet
 Confidential
 Time efficient
 Good for work rounds, presentation skills and mini-lectures

DISADVANTAGES:
 No patient contact
 Relies on presentation/chart