Clinical Teaching Methods

INDEX OF CONTENTS S.no

CONTENTS

1

Introduction of clinical teaching

2

Definition of clinical teaching

3

Philosophy of clinical teaching

4

Outcome of clinical teaching

5

Clinical teaching model

6

Clinical teaching skills

7

Factors influencing clinical teaching

8

Guidelines for selecting clinical teaching

9

Clinical teaching methods:

A

- Case method

B

- Process recording

C

- Nursing clinic

D

- Bed side clinic

E

- Individual conference

F

- Group conference

G

- Nursing care conference

H

- Teaching rounds

I

- Nursing assignment

J

- Morning and evening reports

PAGE

- Role play - Field trip

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 1

CLINICAL TEACHING METHODS INTRODUCTION: The clinical teaching is a type of group conference in which a patient or patients is or are observed and studied, discussed,

demonstrated

And

directed

towards

the

further

improvement of nursing care. In nursing clinical teaching may be given by the doctor in order to discuss the medical aspects of a patient’s condition more vividly that can be done in the class room. Alternatively the clinical

can be given by any faculty member

that is clinical instructor or tutor or ward staff and will concentrate on a particular patient’s needs as a person and how the doctor’s treatment orders can be met by the right understanding and nursing care. PHILOSOPHY OF CLINICAL TEACHING : Philosophy determines the teacher’s understanding of his or her roles, approaches to clinical teaching, selection of teaching and learning activities, use of evaluation processes and relationships with learners and

others in clinical setting. Philosophy of clinical

teaching is a set of beliefs education and

the

about the

purposes of clinical

responsibilities of the teachers and learners

in clinical setting. To change their practice of clinical teaching , initially educators should reflect on their fundamental beliefs CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 2

about the values of clinical education, roles and relationships of teachers and learners and hoe desired outcomes are best achieved. OUTCOMES OF CLINICAL TEACHING: Outcome of clinical teaching attitude

include

knowledge, skills

and

that are accomplished through clinical teaching and

learning. (A)Knowledge : clinical learning activities

should focus

on the

development of the knowledge that can not be acquired

in

the classroom or in any other learning setting. Knowledge outcomes include cognitive skills in the (a) problem solving (b) critical thinking (c) decision making. (a) Problem solving : ability is significant outcome as the problems related to the patient’s

or in the health care

environment is unique , complex and ambiguous and often requires

innovative

methods

of

reasoning

and

problem

solving strategies. (b) Critical thinking : it is a process used to determine a course of action following data collection that is relevant and appropriate, analyze the validity and utility of the data , evaluating multiple lines of reasoning and arriving to

valid

conclusions.critical

thinking

is

enhanced

by

attitudinal dimensions of self confidence, maturity and inquisitiveness.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 3

(c) Decision making : it involves gathering, analyzing, weighing and valuing informations in order to choose the best course of action from a number of alternatives. (B) Skill :It

is

the most

significant

outcome

of clinical

teaching.

There is three types of skills included in this. (a) Psychomotor skills : They

are

activities

purposeful,

that

involve

complex, an

movement

oriented

physical

response

overt

requiring neuromuscular co-ordination. They compass the ability to carry out proficiently, smoothly and consistenly under carrying conditions and within

appropriate time

limits. (b) Inter

personal skills :

They are used to assess the patient’s needs, to plan and implement patient care , to evaluate the outcome of care and to record and disseminate that

information. These

skills are communication using the teaching process and therapeutic use of self. (c) Organizational skills : Nurse require these skill in order to set priorities, manage conflicting expectation and sequence their work to perform efficiently. Clinical learning activities provide opportunity

for

learners

to

develop

leadership,

followership and management skills. (C )

attitudes :

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 4

Clinical learning

produces

important

outcomes

in

attitudes and values that represent the humanistic and ethical dimensions of nursing. Professional nurses are

expected to

inculcate and act on certain values with regard to patient care and

to

use

the

process

of

koral

reasoning,

value

clarification and value injury. These values are developed and internalized through the process of professional socialization. CLINICAL TEACHING MODEL : Criteria for selection of clinical teaching model: there

is

no

one

model that

meets

the

need

of

nursing

programme. The teacher should select a model considering the following factors: 

Educational philosophy of the nursing program



Philosophy of faculty about clinical teaching



Goals

and

desirable

learning

outcome

of

the

clinical

course and activities 

Level of the nursing student



Type of clinical setting



Availability of expert nurses and health professionals in the practice setting to provide clinical instruction



Willingness

of

health

care

personnel

to

participate

in

teaching students.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 5

 TRADITIONAL MODEL : The clinical instruction and evaluation of a group of students are executed by academic faculty member who were

supervising the

students during

the

clinical

experience. Advantages of the model: 

Assist students in using concepts and theories learned in the classroom.



Teacher

can

select

appropriate

learning

experience

for

students that are congruent with learning objectives Disadvantages of traditional model: 

A teacher may be attached with

a large number of

students for clinical instruction where she may not be able to meet the demands of all students. 

Teachers without clinical experience may find difficulty to establish

relationships with health care professionals or

may require

extensive time to establish the same.

 PERCEPTOR MODEL : An expert nurse works with the basis,

intern on one to one

in the clinical setting. In addition to one to one

teaching , the preceptor guides and supports

the learner

and serve as a role model. A faculty member from the nursing program serves as a liaison between the nursing institution and clinical m setting. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 6

Advantages of preceptor model: 

Promotes socialization



Bridges the gap between the theory and the practice.



Allows the inter to gain an understanding of how to function as a staff nurse.



Develop self confidence.



Improve decision making skills ,



Learn new skills under the guidance of the preceptor Disadvantages of the preceptor model:



There

is

lack

of

integration

of

theory

, research

and

practice. 

Lack

of

flexibility

in

reassessing

students

to

other

preceptors, if needed.  CLINICAL TEACHING ASSOCIATE MODEL.: This model involves a staff nurse who instructs a small group

of

nursing

collaboratively member

works

coordinate students, serve as a Faculty

with with

the

students

in

clinical

instructor.

clinical

overall

assist

students

teaching

clinical in

the

clinical

setting

The

faculty

associate

experience

clinical

of

performance

to the and

resource. may

conduct

teaching

for

staff , provide

consultation in clinical setting and assist with discharge planning.

Majority

of

the

nursing

institutions attached

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 7

with

hospitals do follow this model in order to enhance

learning.

 CLINICAL TEACHING PARTNERSHIP MODEL : This

model

varies

with

institutions

but generally

a

collaborative relationship between the clinical area and nursing program involving advanced practice nurse and faculty member. Advantages of clinical teaching partnership model: 

Students develop

acquire clinical

advanced and

knowledge

for

technological skills

practice and

,

gain

understanding of the role for which student prepare By working closely with a person in that role. Disadvantages of clinical partnership model: 

Advanced practice nurse is not available in all clinical setting in Indian situation.

CLINICAL TEACHING SKILLS: 

Assess learning needs of the students, recognizing and accepting the individual differences.



Communicates the objectives and expectations very clearly to students before providing clinical experiences to the students.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 8



Considers

students

needs

and

goals in

planning

the

clinical experiences. 

Plan assignments that help in application of theoretical knowledge in clinical practice and promote acquisition of knowledge and development of skills.



Structures clinical assignments and activities

in clinical

practice so that they can accumulate on one another. 

Explain

accurately

concepts

and

theories

applicable

to

patient care. 

Demonstrates sffectively clinical skills procedures and use of technology.



Provides opportunity for students to exercise clinical skills and

procedures

considering

the

individual

differences

among students. 

Provide adequate exercises for students to solve problems, arrive at clinical decision and use of critical thinking.



Guides

learning

and

student’s

use

of

resources for

learning. 

Is available always for students and especially when thay need assistance.



Provides specific timely feed back on student’s progress.



Encourages students to execute self evaluation



Correct mistakes immediately and supervises till

students

perform correctly. 

Display fairness in evaluation



Uses variety of clinical Tching:

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 9

 

strategies to create interest among students. Serves as role model for students.

FACTORS INFLUENCING CLINICAL TEACHING: Irby

and

papadak

ids

identified

6

factors

that

are

associated with excellence in clinical teaching. 

Knowledge and analytical ability



Organization and



Enthusiasm and stimulation of interest



Group interaction skills



Clinical supervision skills



Clinical competence and professionalism

GUIDELINES

clarity of presentation

FORSELECTION

OF

CLINICAL

TEACHING

METHODS: 

Selection of method

must be appropriate to objectives and

desired behavioral changes. 

Selection of method must be in accord with

principles

of

learning. 

Selection of method must be in accord with capacity of the student. Know your student.



Selection of method must be in accordance with availability of resources.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 10



Selection of method must be in accord with teacher’s ability to use it effectively and creatively.know yourself.

CLINICAL TEACHING METHODS: I)

CASE METHOD: The case method of teaching and learning used

with group

discussion. Hippocratus

as

method

teaching

a

of

medicine .

in

is often

had used it 1940

Gragg

wrote an article which introduced a new case system of instruction and described the teachers and the students roles

there

in.

in

nursing

case

method

has

extensively used as a prime method of teaching any

other

methods.

Florance

nightingale

been than

used a

modification of the case study in the teaching of nursing students. She adviced students to own a note book to make a note quizzed

of exceptionally interesting cases and later

them to evaluate how much of learning had

taken place. There are three methods of which are identified as ; 

Case study



Case analysis method



Case incident method A) CASE STUDY:

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 11

Case

study

describes

the

life

history

of

an

individual or all of the factors which affect a situation. It gives

the

breadth

and

depth

of

an

individual .

the

nursing case study centers on the patient, his problems, his needs and nursing care. Both medical and nursing care studies almost attain the well rounded picture of the patient from the onset of the problem that is before hospitalization as well as entire facts about his illness and treatments. B) CASE ANALYSIS METHOD: Case analysis method of teaching focus on a central

situation

which

requires

some

decision

or

solution . it presents a concrete case for analysis and discussion

by a group of students under the guidance

of the clinical instructor.

Adequate information presented

to the students for them to make judgements

on the

problem or situation.

Objectives of the

case analysis method :

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 12



Develop a mind that has the power familiar type of problems

to transfer from

to new ones and to be able to

explain wisely the basis for a decision. 

Develop the ability to master a tangle of circumstancial evidence , selecting important factors from a

whole set

of facts and weighing their importance in the

context of

the base. 

Enlarge the ability to utilize ideas, to test them against the facts of

the problem , to examine ideas

and to discuss ways the solution 

and facts

which make them appropriate for

of the problem.

Extend the ability to utilize data from experience as a test

of

validity

of

flexibility to revise

the

ideas

already

goals and procedures

obtained

with

when the

need arises. 

Expand the ability and communicate thoughts to others in a way which stimulates further thought.



Develop the ability to use ideas in theoretical form to create a framework of general propositions from a problem solving experiences.

General guides to use case analysis method: Establishment of atmosphere:

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 13

The teacher must establish a permissive non-authoritarian injunction to

think

along certain

lines

preferred

by

the

instructor. And she should treat each student with respect, tolerance and will

to understand.

All these would facilitate

student to express their ideas and gain familiarity with difficulties in reaching conclusions and communicating others. Student Preparation for discussion of the case: An important prelude to productive group discussion relevant and meaningful. Each student should be provided with a written copy of case to be discussed. Bauer has developed an excellent student guide for interpreting case material. He defines case interpretations as a process of analysis and synthesis which goes through following series of phases. 1. Identifying important event or events in the case. It might be the problem of impersonal relationship, a controversy over an issue etc. 2. Setting the stage for analysis of the case by choosing an appropriate frame of reference or conceptual model, for example , a theory which focuses on person or their attitudes. 3. Identifying and classifying the parts or the elements in the case . These may be persons , relationships, values, customs etc. 4. Specifying

the relevant attributes or variables in these

elements. These may be qualitative or quantative.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 14

5. Relating these elements to one another to see if any type of sequence or correlation or pattern changes . This is the beginning of synthesis phase and purpose is trying to see trying to see the structure of the case as a whole. 6. Explaining these connections or patterns by going deeper than merely establishing connections or correlations. This is done by applying abstract principles or theories to concrete events in case. 7. Examining critically the concepts or the themes used to determine their adequacy and to suggest their possible alternatives and revisions. 8. Applying the knowledge and understanding gained through the case analysis by suggesting how decisions and actions in the case could have been improved recommending a course of action or a change in policy. Cases grow change during discussion : The background of knowledge , skills and experience of each student influences the way in which he/ she deals with each case. One student may identify himself /herself with a character in the case; other may project his / her own feelings and attitudes into this situation; a third student may deal with stereo types rather than with the people the case. All these phenomena are typical and have to be dealt with if the support of the class is to be maintained and if a leaning is to result. Gragg identifies three objectively discernible phases through which students pass CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 15

typically when learning by means of case analysis. They are given below: 1. Discovering the inability to think of everything that his fellow students can think of. It is discouraging to students after having prepared a case as well as they can, to listen for an hour in class to

other students, bringing out all sorts of

interpretations and arguments that they had no thought of. 2. Accepting easily and without fear the need for cooperative help. When this happens students learn to draw more fully on each other’s ideas in working out problems. 3. Recognizing that teacher does not always necessarily know the best answers and even when she does seem to know them, each student is still free to present and to hold his / her own views. When student reaches this point he/ she is ready to make the independent progress. He/ She is Operating as a responsible member of the community taking help when needed but taking his / her own decisions without fear of disapproval or search for an authoritative crutch to lean upon.

C) CASE INCIDENT METHODS : Case incident method of teaching is a modification of the case analysis method. Originated by Paul and Faith Pigors. It focuses on a critical or crucial incident in a case or situation which requires immediate decision and action. It does CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 16

not present any background information ;it just pinpoint the incidents which requires solution.

The case incident may be

used in various ways. It may be used in such a way that part of the procedure is to gather the background information on the case or to describe what would be needed to make a logical decision. The most usual way of using the case incidents is to state the incident and then to ask the student what they would do in a similar situation and to give their seasons for their decisions. The students may be asked to make written statements which would be discussed later in the class. The case incident of teaching may be used in class room. In clinical conferences, in testing and evaluating

students. Many of the

objectives identified for the use of the complete case analysis method of teaching and learning also may be attained through the use of this technique but not with the same degree of depth and understanding, for it is a much less complicated and rigorous technique of learning and teaching. The Pigors , the originators of the case incident technique, suggest that it be used in a five phase process. Phase 1: The Incident: After discussing the various factors which may influence the behavior of adult hospital, the class is presented with an incident taken from a life situation . Phase 2: Getting the facts: The students are now asked what information they need before they can make an effective and intelligent decision. The leader has the fact of the case and gives them as requested by the group. A group member may CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 17

be asked to summarize the fact that are brought out before, to check if any aspect is left out Without explanation. These may be highlighted on the blackboard. When the facts have been developed adequately, the group is ready to enter the next phase. Phase 3: Determining the source of the problem and the consequences :

In this phase the group tries to determine

what the crux of the problem is that needs immediate decision and what the possible consequences may be if an immediate decision is not made and acted upon. Phase 4: Stating decisions and reasons for decisions by individuals students : Each student is asked to write she would have done in that particular situation. Phase 5: Identifying the major decision and issues raised by the individual students through group discussion: If the class group is small, each student can be given opportunity to give her decision and reasons for it, which are then discussed by the group. In contrast , if the class is large, small group may get together and clarifies issues raised and summarize the decision reached before joining the full class for discussion. The objective of this phase is to identify and to discuss the major decisions and issues raised by the

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 18

individual members of the class and to classify them into categories. D) NURSING CARE STUDY: Nursing case study describes the actual nursing care of the patient. It is a case study in which there is a holistic of the individual patient to bring about complete understanding of the required nursing care, to provide a factual basis on which to plan and to implement nursing care, to get a perspective and understanding of patients total care, with particular emphasis on continuity of the patient care. A nursing care study may be hypothetical one , it may be a real life one, either previously written or presently being studied and prepared by a student.

Advantages of Nursing Care Study: 1. Stimulates students to utilize critical thinking, reflective

practical skills. 2. Students learn to see the patient as a person. Students are

directed to consciously plan a program of nursing care adapted to the need of a patient. 3. It accentuates health and social aspects of nursing . CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 19

4. It points out the relationship and the cooperation of the

various disciplines interested in patient’s problems. 5. Acquaints

the

students

with

professional

literature

pertaining to nursing problems. 6. Enables the students to compare the book and clinical

picture. 7. Helps the student to integrate all his / her knowledge of the

various subjects. 8. Contributes to the building up of a specific body of

knowledge in nursing science. General Principles in the Use of the Care study: Students should study the patient’s state of health and self help abilities , his / her cultural background, his / her economic level, his / her hobbies , and interests , for an understanding

of all these factors will contribute to the

patients welfare. He / she should study the medical aspects of the patients condition as this knowledge is essential to render timely nursing care. Subsequent with the data collection from the patient pertaining to health and illness. Formulation of nursing

diagnosis

and

description

of

the

defining

characteristics of a patient, helps the student understand the patient’s condition better. All these constitute the first part of the care study and the second part involves with activities which the nursing student will be concerned in giving holistic care to the patient. It involves rendering nurse –initiated, CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 20

physician-initiated and collaborative management of the patient . Nursing care study serves as an excellent medium to help the student develop skills and techniques needed to function well the nursing team. Emphasis should be on the individual needs of the patient and how these needs met throughout nursing. Nursing care study serves as an excellent means for the student to demonstrate his / her nursing skills , his/ her scientific

knowledge , his / her sociologic and

physiological insight into problems of the patient and his / her skill in interpersonal relations with the patient as a nurse. forms and presentation: The nursing care may be : (a)Written and (b)Oral.

Advantages of written and oral nursing care study Advantage of written nursing Advantage of oral nursing care care study  It provides for individual

study  It

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

provides

an Page 21

differences

of

the

student.  It

instructor

provides

opportunity

an

for

self-

expression in writing.  It provides experience in organizing and writing a paper

in

a

scientific

manner.  It provides a source of material reference.

opportunity

for

future

to

student’s new

for

the

direct

thinking

channels

correct

a

into

and

errors

to of

information.  It serves as a basis for a better

personal

understanding

and

relationship

between

instructor

and

a a the

student.  It is time saving. It does not

require

lengthy

recopying of notes into acceptable form.  It offers an opportunity for

public

speaking

experience.  Discussion after

is

invited

presentation,

case

the

becomes

cooperation

and

all

benefits from the study. This

is

a

source

of

motivation to the student CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 22

because he / she shares the benefits of his /her study with other student ts.  The

student

feels

the

thrill of achievement in presenting

his

/

her

study to others.

Disadvantage of written and oral nursing care study Disadvantages

of

written Disadvantages of nursing care

nursing care study

study

 It leaves no opportunity once

the

study

is

does

opportunity

offer for

writing

and

and

expression because only

intertwine

novel

 It needs a great deal of time to rewrite into an acceptable form.

notes

other

an

complete, to branch out ideas.

II)

 It

are

creative used

for

presentation.  It leaves no record for future references.

PROCESS RECORDING:

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 23

A learning tool which aids a student to develop observation and communication skills . DEFINITION OF PROCESS RECORDING: 1. The process record as "a verbatum account of a visit for purpose of bringing out the interplay between and the nurse and the patient in relation to the objectives of the visit". —Walker 2. Process recording as "an exact written report of the conversation between the nurse and patient during the time that they were together. It is also record of the nurse's feelings about what was going on at that time and of the observations of the patient's behavior during the conversation. -Hudson 3. Process recording is a written reports or verbatum recording of all that transpired immediately before, during and immediately following the nurse-patient interaction. It may be written during the interaction or immediately after the one-to-one interaction.

PURPOSE OF PROCESS RECORD:  Guide the student in the development of self-awareness of own behaviours-verbal and nonverbal on patient.  Encourage students to use variety of strategies to accomplish the stated communication goal.  Enable

student

to

become

more

objective

in

the

processing of patient messages. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 24

 Create opportunity for students to propose alternative response to patient messages for faculty feedback.  Provide the student with the comparative record of own progress in the development of communication skill.  Help the teacher to gain understanding of student’s progress

in

the

ability

towards

therapeutic

communication. The process record may be used as a data-collecting instrument for the following three purpose communication. 1. As a teaching tool 2. As a self-evaluating tool 3. As a therapeutic tool. PROCESS RECORDING TECHNIQUE: There are three important phases in process recording that are give below : 1. Prepare the student for process recording 2. Prepare nurse – patient interactions. 3. Evaluating the interactions by the instructor and the students.

1. Prepare the student : The teacher must assist the student to define clearly the appropriate objectives to be accomplishing regarding nurse-patient interactions. Then, the process record as a teaching and learning tool should be discussed with the light of these objectives and also to determine how it can be used best to CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 25

accomplish the desired goals. Subsequent with this, teacher should guide the students to write process records. 2. Recording nurse- patient interactions: When used as a learning tool there are four significant parts in process recording. They are (a) the exact verbatim report of the patient- nurse conversation (b) The students conscious feelings and his / her interpretation of the patients feelings (c) Analysis for meanings and clues to patients need and (d) The Instructors and students evolutions of the total process recording experience. There are number of conditions which have to be met if process recording is to be an effective teaching and learning instrument. They are :  A minimum of two people  Reassurance of the patient regarding the confidentiality of the interview. The student also must be impressed with the importance of keeping the interview material confidential.  Recording of all verbal interaction.  Notations of thoughts, feelings and actions that the student experiences during the interaction.  Notations on the non- verbal communication of the patient.  Notation of the interaction done as soon as possible after interaction

occurs.

Noting

the

time

lapse

between

interaction and actual recording.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 26

3.Evaluating the nurse-patient interactions : Following the interaction data have been collected by the student, the teacher and student have the subject matter or material of the learning experience. Analysis of the data should be recognized as the crux of the learning experience. Failure to follow up the recording of an interaction with analysis of guidance in the analysis of the interaction process renders the data fruitless and frustrates the student’s effort. This element of analysis of data is time consuming and should be considered by the teacher before he / she selects the process recording as a teaching tool. During the process of analyzing the recordings, the objectives of the learning experience should be kept in focus. The teacher needs to guard against dealing with process recording as written work to be handed in by the student , corrected and returned . If the teacher to aid the student to further to stage of self- evolution, he / she must discuss the process record with the student. Rather than evaluating a student behavioral response , the teacher should help the student to explore the reason for such a response and the possible effects it might have on nursepatient interaction. This would result in deeper understanding of students behavior and effect that his or her behavior may have on others . As the students still increases he / she may assume greater responsibility for independent analysis of the patient communication and his / her own. Thus , self- evaluation is an integral part of process recording analysis.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 27

Advantages of Process Recording.  Helps students to have an objective look of his or her own communication skills.  Provides teacher with an accurate account of the students clinical learning experience.  Assists the teacher to explore the areas where students require improvement a refine in communication skills.

Disadvantages of Process Recording :  Lengthy involvement of time in teaching and implementing this tool.  It cannot record all subtle nuances such as tones of voice, mannerisms, timing etc. as well as other non verbal cues which a nursing student could miss. III) NURSING CLINIC: The nursing clinic or patient presentation utilizes the presence of a selected patient as its focus for group discussion. It affords a direct experience in the discussion of principles and practices of nursing care relative to a given patient. The purpose is the improvement of nursing care. Students have the opportunity to sharpen

their

observation

and

interviewing

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

skills

while Page 28

simultaneously developing increased ability to see relationships between the patient's concept of his health and nursing problems and his resources for coping with the total problem and the nurse's concept of the patient's problem and how it might be solved. The most effective nursing clinics are those that are planned, which involves (i) determining the purpose, (ii) selecting a patient for whom students have given nursing care, (iii) securing the patient's consent and proper legal clearance, (iv) selecting the setting to be used—the patient's bedside or a conference room visited by the patient; and (v) providing advance preparation of the student in terms of the name of the patient, the purpose, place, date and time, and any specific instructions regarding preparation for the discussion. The group discussion generally consists of three phases: (i) the introduction, (ii) the patient-centered discussion, and (iii) the evaluation discussion; the patient is present only during phase two. The introductory phase serves to acquaint the students with the patient's background, presenting nursing care situation, the purpose of the discussion, significant observations, types of questions to be asked, and needed information. During the patientcentered discussion, a few simply asked questions directed to the patient are usually sufficient for obtaining the needed information. Ample opportunities should be allowed for patients to verbalize their needs and how they see their particular problem. Sometimes demonstrating a particular nursing care measure or allowing the CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 29

patient to do so is sufficient for meeting the purpose. When the patient appears unresponsive or tired, it is wise to close the discussion,

even

accomplished.

The

though

the

evaluation

purpose

may

discussion

not

offers

have an

been

excellent

opportunity for students to evaluate the patient's behavior, ability to solve his own problems, and various other aspects. The students can be evaluated in terms of their observations and ability to use problem-solving techniques. The discussion should be summarized in terms of application of background knowledge to the given nursing care problem and goals accomplished, with provisions made for follow-up on comparisons between the student's views of the patient's problems and the patient's views of his problems. Such an approach opens the door to many other ways of developing the student's views of the patient's problems and the patient's.

This same basic pattern can be adapted easily for use in planning and implementing interdisciplinary patient-centered clinics. The modification would be in terms of identifying kinds of input needed from each team member and seeking appropriate contributions from each. The nursing clinic is a group discussion which utilizes the presence of a selected patient, whereby the nursing aspects are presented and discussed.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 30

In a nursing clinic the patient's medical history and therapy are discussed only briefly, but the emphasis is on the nursing problems, including the physical, mental and social aspects. Purpose: 1. To apply theory into actual practice by observing interviewing and studying a patient. 2. To apply knowledge and experience to the real life situation. 3. To understand certain types of apparatus. 4. To improve the nursing care. Size: Small size, approximately 15 students. Preplanning the Clinic 1. Determining the purpose of the clinic. 2. Selecting a patient for home students have given the nursing care. 3. Securing the patient's consent. 4. Selecting the setting to be used, i.e. bedside or conference room. 5. Provicing advance preparation of the students. Levels of Discussion: 1. Introduction.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 31

2. Patient centered discussion. 3. Post-clinic evaluation discussion. IV) BEDSIDE CLINIC Bedside clinic always entails the presence of the patient. Either the group visits bedside or the patient is brought to the conference room. FORMS OF BEDSIDE CLINICS  Clinics may be given by the doctor in which case symptoms and medical therapy are emphasized.  Nursing clinics are conducted by head nurse by clinical instructor PURPOSE 1. To provide a learning experience for nursing student to collect information about the patient with tact and skill. 2. To improve the student's ability to solve nursing problems by detailed study and analysis of nursing situation. 3. To realize the need for understanding each patient as an individual in order to appreciate his problems and outlook. 4. It helps the student to do nursing observation in an organised systematic way. 5. To be able to work out a nursing care plan to fit the needs of individual patient on the basis of his special problems.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 32

6. To be able to recognize opportunities for health teaching in the hospital. 7. To understand certain types of apparatus being used on patients. 8. To improve the quality of nursing care. STEPS

INVOLVED

IN

CONDUCTING

THE

BEDSIDE

CLINIC

Planning technique: • Determine the clinic to whom it is to be conducted, place, date and time of clinic to be held and on what topic the students have to come prepared. • Select a patient for whom students have given the care. • Secure the patient's consent as his cooperation is essential during the clinic. Conducting bedside clinic: After preplan, the next step is conducting actual clinic. The clinic should be conducted in the ward or in a class-room, which is adjacent to the ward. If such conveniences are not there, the clinic should be held apart

from other patients providing him sufficient

privacy in a corner of the ward. • Physical and mental comfort is provided to patients. ▪ patient is kept at ease. • The clinic usually lasts for 30 minutes. • The number of students should not exceed 10-15 in number. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 33

'The discussion relative to the nursing clinic consists of three phases. • introduction phase  Patient centered discussion • post clinic evaluation . I) Introduction phase: This phase serves to acquaint the student with the patient back grouping, presenting

nursing care situation, the

purpose of the clinic, significant observation to be made, type of question to be asked, etc. II)

patient centered discussion: During this phase a few obtain the needed

simple questions are asked to

information from patient. No question

which hurts the feelings of the patient should be asked. Ample

opportunities should be allowed for patient to

'verbalize his needs and how he perceives his particular problem. Soon after second phase of clinic patient should be sent to the ward by thanking him for his cooperation. III)

Post-clinic evaluation: It offers an excellent opportunities for students to evaluate the patient behaviour, ability to sole his own problems and various other aspects. The student can be evaluated in terms of their ability to meet the stated purposes of clinic through their observations and ability to meet the

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 34

stated purposes of clinic through their observations and ability to use problem solving technique. The nursing clinic provides an excellent opportunity to show symptoms and to show how to use different appliances in any particular condition and how nursing situations and problems have been met. Advantages of Bedside Clink/Bedside Teaching: 1. Bedside teaching puts the student in an active actual situation. 2. Covers a limited group of students. 3. Permits evaluation of degree to which educational objectives have been attained. 4. Develops qualities of observation and decision taking. 5. Ensures closer contact with reality (Professional-patient health situation of community, colloaguos and teachers). 6. Permits comparison between reality and theory. 7. Enables students to develop self-confidence. 8. Increases variability. Disadvantages of Bedside Clinic Bedside Teaching : 1. High personnel costs. 2. Sometimes puts the patient in a difficult situation.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 35

3. Poor standardization. 4. Narrow limits of utilization.

V)

INDIVIDUAL CONFERENCE

Individual conference is described as conversation with purpose. This specific purpose in the interview is to obtain facts or to provide information. The skills essential in successful use of individual conference are skills in observation; in the use of setting; in the establishment of rapport; in meeting resistance ; in recognizing ambivalent feelings; in the establishment of authority; in the use of questions and silence as a skillful procedure. The individual conference can be used by the clinical instructor to clarify class material, to supplement instructions, to explain answers to questions of individual students which do not concern the entire class. It can also be used as a means of assisting the individual who is having difficulties in keeping up with the class or the student with the potentiality of advancing ahead of the group as a whole. Individual conferences facilitates nursing students to understand the relationship between class content of courses and the application of problems of nursing practice and patient care. It can be a means or bringing unity to the entire nursing course, by helping the student in integrating his / her previous knowledge and experience in relation to the present learning experience. Purposes: CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 36

1. To guide in teaching. 2. To acquire more knowledge. 3. To discover the interests, needs and the problems of the individual student. 4. To help the student to help herself/himself. Teachnique of the individual Conference: 1. Teacher should establish good rapport with the students. 2. Allow him to talk freely 3. Teacher should not show any prejudices, emotional reaction or bias Principles of individual conference: 1.establishment of a definite purpose and specific issues to be covered. 2. knowledge of the student 3. provide privacy 4. provide sufficient time. 5. establish good rapport 6. good listening 7. positive effect 8. recording of data CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 37

VI)

GROUP CONFERNCE

Conference is the act of consulting together. It always involves a two way flow of conversation. Group should be small enough so that member will be permitted to participate.

BENEFICIARIES OF THE GROUP CONFERENCE : The subjects discussed in short group conferences are often of importance the entire nursing staff. Conferences may be conducted by a student nurse , staff nurse , the assistance head nurse or head nurse. SUBJECTS SUITABLE FOR GROUP CONFERENCES : The best subject matter for the conference is patient care. The following subjects lend themselves well to the group conferences : #

Individualized nursing care . The need for health teaching ,

symptoms to observe , methods to determine progress, suggestion to approach the patient , way to help a discouraged patient. # Importance of accurate recording on a patient whose diagnosis is not established or one who is manifesting unusual symptoms. # An unusual drug or treatment which is being used in the ward for one or more patients. # Routine investigations and specific diagnostic tests in relation to specific patients having such tests that day. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 38

# New hospitals or ward routines. # Changes in nursing procedures. # Review of procedures which are unfamiliar or which are not being performed well. # Display of equipment which has been damaged by improper care, misuse, methods of prevention and so on. TIME FOR CONFERENCE : Group conference may be held at any period of the day when the staff is free to attend , that is, during a period of relatively light ward activity. But when it is planned on same hour weekly, the staff’s can make themselves free during that hour. PLACE FOR CONFERENCE : There are four requisites for the place where conference are held.  The patients must not be able to hear any part of the discussion.  Seating arrangements are essential.  Patient’s signals must register in the conference room unless some members of the staff remains away from the meeting to care for patients.  The place for conference should be one where interruptions will be minimal. VII) NURSING CARE CONFERENCES:

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 39

Nursing care conference is a method of teaching, which provides an opportunity for an informal discussion of a problem and free exchange of knowledge and experience about the common interest and it consists of a group discussion using problem solving techniques or nursing process. Nursing care conferences are so "old hat" and so identified with basic nursing education that their potential value in staff development and continuing education is often unrecognised. Within the institution, particularly at the unit level, a nursing care conference can provide a good learning experience for all the staff who share a common nursing problem in providing care to a specific patient. A nursing care conference is designed around a consultation visit of a clinical nurse specialist. But more frequently they are designed for the staff of a specific nursing unit, and are planned around some aspect of nursing care or focus on a scientific nursing problem presented by a patient in that unit. A nursing care conference is a "course of action discussion, the focus is on assessing the nursing problem arriving at possible solutions, helping staff to examine a patient's problems from his point of view". Planning and Preparation : 1. The organisers should prepare well in advance regarding particular conference. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 40

2. Before presenting, the student will have collected all the data regarding the patient. She will have worked with that patient and collected information about the signs and symptoms since how long the patient is sick, the laboratory finding, his family back grounds, socioeconomic conditions, etc. 3. The conference should be planned in relation to the objective of the conference and it should be spontaneous in nature. 4. The student should be given ample opportunity to work in the ward for quite a good amount of time before she is assigned to present in the conference. Technique: 1. The nursing care conference is used as a consultation tool to help in problem solving. 2. The teacher must be flexible and she will help the students during discussion. 3. The conference should involve all the students in discussion. The teacher involves all the students by putting questions, giving guidance and rechanelling, if necessary. 4. Teacher has to draw out the potentials of the students to the maximum in discussion. She will provide ample time for the students to think. Phases

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 41

The nursing care conference is used as a consultation tool to help in problem solving. It has got three phases. They are: (1) Opening phase, (2) Working phase (3) Closing phase. Opening phase: The opening phase can be defined as the first two minutes of the conference. The task here is to make a commitment to work on a problem relating to a particular patient. What happens during these few minutes often sets the tone for the entire session. Working phase: The task of the working phase is to arrive at a consensus on problem identification and solution. Once the patient is selected we have found that a great deal of

time during this

phase is spent in delieneating the problem clearly. In some conferences there is a difference of opinion among the nurses, often the data are inconsistent or incomplete. It is helpful the group focus their discussion by asking direct questions, rephrasing what the group has said and summarising. Sometimes, when data on the patient are incomplete the group will try to fill in. If the consultant and group view the absent data as critical to the solution, time is better spent in getting the facts than in speculation. Conference time can be used to identify just what information is needed. The CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 42

problems are identified and the group can often reach its own solutions. Offering concrete solutions to problem behavior allows the staff to feel they are getting something from the group and the consultant who offers alternatives and support to a frustrated staff establishes credibility and does them a great service and she should be careful to ask the group's opinion on the validity of her suggestions. Closing phase: Once the group has worked through problem-solving and has decided on solutions, the next phase is closure. The task here is to delegate responsibility to one or more of the staff to act on the problems. Advantages 1. It helps the students to collect the information in creative way, i.e. the students will be able to validate the data pertaining to the situation and appropriateness. 2. It provides real practical learning environment to the students. 3. It fortifies the thinking of students, thereby the creativity and judgement capacity will be increased. 4. It provides free opportunity to think. 5. Each member will be actively participating in the conference. Disadvantages CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 43

1. It will be of little use if the students do not accustom to such situation. 2. There are chances of using these conference hours for classroom teaching.

VIII) TEACHING ROUNDS : The aim of teaching round is to acquaint nurses/ student nurses with all patients on the ward in order that better understanding and more purposeful care may be achieved for each patient. Usually all patients are visited on rounds and the visit is accompanied by a discussion pertaining to each patient’s care. Ways of conducting rounds : The teacher with a group of student nurses goes to patient’s room. The discussion should take place outside the door out of patient’s hearing and then the group moves towards the patient and converse few minutes and further to next patient. The discussion must of necessity be brief including only outstanding points if the purpose is to visit all the patients on the ward. TYPES OF WARD ROUNDS :  Rounds with doctors.  Rounds to discuss psychological problems.  Nursing rounds.  Medical round for nurses. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 44

 Rounds with physical therapists.  Social service rounds. ROUNDS WITH DOCTORS : Sometimes the emphasis in teaching rounds is on medical aspects of patient’s condition and care. A professor may take medical interns to discuss the patients on the service. Often the patient is examined in the presence of a nurse. It is highly valuable experience for staff and student nurses to accompany group of doctors. The student should accompany with head nurse or clinical instructor in order to

clarify concepts not understood by the

student. Social service rounds : This is conducted by the medical social worker and attended by doctors and nurses, keep the nurses in touch with social problems of the patients and plans which are being made for their care following

hospitalization

.

Student

nurses

should

be

given

opportunity to attend theses rounds and value of discussion is increased if the nursing implications are also highlighted. Rounds to discuss psychological problems of patients: In hospitals with psychiatry makes rounds with medical and nursing students to discuss the psychological problems of all the patients. IX)

NURSING ASSIGNMENT: DEFINITION OF ASSIGNMENT :

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 45

The assignment applies to that part of instructional activity devoted to the clear recognition and acceptance by the pupil of the next unit of learning to take place and of the processes by which this learning may be achieved most effectively. DEFINITION OF CLINICAL ASSIGNMENT It is that part of learning experience where the students are assigned with patients or other activities concerning to patients in clinical laboratory. OBJECTIVES 1. To provide the patient with the best possible nursing care. 2. To plan assignments which are interesting to nurses and stimulating to their professional growth. 3. To provide a well-rounded educational experience for student nurses. 4. Achieving good ward management. METHODS OF ASSIGNMENT Generally there are three methods of assignment : 1. Patient method. 2. Functional method. 3. Team method. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 46

1. Patient method : This method of assignment involves a nurse n rendering complete nursing care to one or more patients including complete nursing cares to one or more patients including complete nursing care, treatments , medications , taking vital signs, serving food and patient education. When she completes her duty or during break hours, her group of patient is handed over to another nurse for the period of her absence in order that the patient may still receive individualized care. ADVANTAGES OF PATIENT METHOD: Individualized nursing care is possible: When one nurse is responsible for the total care of the patient she comes to him as a person. She also extends her knowledge about the patient’s symptoms and treatment. Patient develops a sense of belongingness and develops trust on the nurse and will express about his problems and progress to the nurse without reluctant. Better Nursing Education : When nursing care is patient centered, the student

knows the

patient as an individual . She gains better knowledge of disorders and

the

way

in

which

they

affect

the

patient

physically,

psychologically and socially. When the nurse / student nurse is assigned to provide total patient care she has an opportunity to make her plans for their patient’s care and to observe the results of her efforts. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 47

Satisfaction of the nurse : Nurse attains satisfaction when she has professional contact with the patient and the opportunity to observe her plans of his care materialize. 2.Functional Method : In this method of assignment , nurses are assigned to specific functions in the ward such as administrating medications or providing hair wash to all patients. The functional method may be used at some periods when there is shortage for nurses. Very young students may not be capable of providing total patient care when they can be assigned this method. Advantages of Functional Methods: More can be accomplished in a given period of time because there are fewer interpretations, there is less confusion and because skill develops when a purposeful activity is repeated often in a short period of time.

3.Team Method : This method is in limited use in modified form it is followed in some hospitals. The appearance of large numbers of practical nurses and nurses aides in hospitals make it imperative that some way be found to give these groups sufficient supervision. This result has been the development of the team method of CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 48

assignment in which two or more members of nursing staff, one being designated as leader, are assigned to work together in giving care to a group of patients. The team leader is always a professional nurse. The members may be graduate or student professional or practice nurses, nurses aids or any combination of these. Advantage Of Team Method : This method has resulted largely because of shortage of lack of professional nurses to provide total care of the patient. Disadvantage Of Team Method: It can be performed by individuals with less knowledge, skill and judgment resulting in lack of execution of independent nursing interventions.

CRITERIA FOR EFFECTIVE ASSIGNMENT i.

Students are to be informed of the objectives of their assignment to a particular ward/unit of the area/ hospital for clinical experience.

ii. iii.

Students are to be oriented to new clinical area. Students are to be given the learning experiences which are outlined in the objectives for particular clinical experiences.

iv.

Students

are

to

given

facilities

to

practice

nursing

according to principles taught. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 49

v.

Only recognized wards of the hospital or community are to be selected for students to achieve required learning experience.

vi.

Assignments

have

to

be

assigned

according

to

the

consistent level of learning that students have reached, or attained. vii.

Proper guidance and supervision has to be provided to the students during their clinical experience.

viii.

Sufficient time to be provided to carry out the assignment allotted to the students.

ix.

Student's performance should be evaluated and discussed with the students for their improvement, correction, etc.

x.

Students should be given opportunities for working in a team.

xi.

Students are to be encouraged to develop a pride in the nursing profession.

xii.

Students are to be watched, that high standard of patient care are being practised by all concerned.

PRINCIPLES OF STUDENT'S ASSIGNMENTS: • The rotation of students through departments and wards should be according to the curriculum plan of their course. • Sometimes, reassignments can be arranged according to the students who require the same kind of experience. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 50

• First year students should be posted where they will receive the maximum supervision and guidance from qualified nursing staff. • The departmental and ward sisters or nursing superintendent should be informed in advance regarding the student's assignments in their speciality. • The individual student's differences should also be informed to the staffs. • The record should be maintained of the number of hours spent on day, evening, night duty in each block of experience. • A record of sick leave and other types of leave utilized by the students also be maintained. If needed, reposting or reassignments may be done.

FACTORS TO CONSIDER WHILE PLANNING ASSIGNMENTS 1. The previous clinical experience of the students should be considered. 2. Students must be given sufficient time to study the patient's records. 3. Proximity of patients should be considered. 4. Assignments should be varied frequently enough to maintain the interest of students.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 51

5. Sociological and the psychological aspects of the patient should be considered.

X)

MORNING AND EVENING REPORTS:

DEFINITION:

A report summarizes the services of the nurse and or the agency. Reports may be in the form of an analysis of some aspect of a service. TYPE OF REPORTS 1. Oral report 2. Written report Oral report: Oral reports are given when the information is

for

immediate use and not for permanency. They may be based on material included in a written report. An oral Report is made by the nurse who is assigned to patient care to another nurse who is planning to relieve her. The head

nurse makes oral reports to the

supervisor, the nursing office and the doctor. Written reports: Reports are written when the information is used by several people or is more or less or permanent value. Day and night report

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 52

census, interdepartmental reports to admitting and business office, are all included in written report. CRITERIA FOR A GOOD REPORT Report should be made promptly, if they are to serve their purpose well. A good report is clear, concise, complete. If it is written all pertinent, identifying data are included, the data and time, the people concerned, the situation, the signature of the person making the report. It

is

clearly

stated

and

well-organized

for

easy

understanding. No extraneous material is included. Good oral reports are expressed and presented in an interesting manner and important points are emphasized. A good report is unhurried. reports between the head nurse and her assistant : The assistant head nurse should know everything pertinent to the management of the ward even though she may never be concerned with parts of the information. The well-informed assistant head nurse knows the condition of all patients, the treatment they are receiving, observations which are to be made, changes in the ward and hospital routine, etc. In other words, she CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 53

has all the information she needs to keep the ward running smoothly without interruption of waste of time. When the head nurse returns to the wards after hours or days of absence, the assistant head nurse tells her all changes in the situation including the condition, the patients and happening during her absence. It is advisable for the head nurse and her assistant to keep, in a note book or in a note pad memoranda of information which they plan to report. Reports Between Nurses Who Are Assigned to Bedside Care Contents reports of students and staff nurses to those who are to relieve them include the condition of all patients assigned to her care treatments, and medications which have been given and those which are due, adaptations in method required by each patient, information about the patient as a person and his diagnosis if these are not already known to the relieving nurse. Reports to the Clinical Instructor: Reports to the clinical instructor include everything in the ward situation which affects the educational process. Hence they receives the same report relating to patients as that given to the administrative supervisor. Since she is responsible for teaching the instructor especially needs information about concerning new drugs as well as therapeutic and diagnostic measures which are being used. Report of the Charge Nurse to the Physician: CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 54

The specific information which every doctor expects to receive from the nurse incharge of the ward relates to his patients under her care. He wishes to be told of the symptoms which they show, the results of treatment, inability to carry out his orders and difficulties or mistakes in doing so. Day, Evening and Night Reports : The change of shift report is the oldest report in the nursing service. Since, its longevity attests to its importance in carrying forward the goals of the enterprise. Though, it has undergone so many changes over the years, it remains essentially a transmission instrument for the care of patients from one set of works to another, using a written report, the nursing care plan as contained in a card file, and patients charts. Some institution include only the sickest patients in the written report. Others include them all. It may help the day nurses to start the day more easily if the night nurse includes in her report a list of the patients on whom new orders have been written. The daily census, or the number of patients in the hospital at midnight, furnishes important source material for hospital statistics. It can be readily understood that census figures must be correct. XI)

ROLE PLAY:

DEFINITION : CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 55

Role playing is a relatively new educational technique in which people spontaneously act out problems of human relations and analyze the enactment with the help of other role players and observers. Role playing, sociodrama and psychodrama are closely related and the terms role-playing and sociodrama are frequently interchangeable. PURPOSES OF ROLE-PLAY IN NURSING 1. To convey information. 2. To develop specific skills. 3. To develop a situation for analysis. 4. To prevent alternative courses of action. 5. To prepare for meeting future situations. 6. To develop understanding of points of view of others. 7. Increasing their insight into typical ways of dealing with them. PRINCIPLES OF ROLE-PLAY 11. To convey information. 2. To develop specific skills. 3. To develop a situation for analysis. 4. To prevent alternative courses of action. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 56

5. To prepare for meeting future situations. 6. To develop understanding of points of view of others. 7. Increasing their insight into typical ways of dealing with them. SETTING UP OF ROLE-PLAYING 1. Define the problem to be considered and the nursing situation in a meaningful manner to all students in the class. 2. Identify the characters in the situations and ask for volunteers to play these roles. 3. Ask the participants to try to place themselves in the position of the characters. 4. Caution the participants against the desire to express their own ideas and opinions. 5. Each class member selects one role and identifies herself with it, listens and tries to anticipate what the persons in the situation might say or do. 6. Never rehearse for role playing. 7. At any point during a dramatization participants may hold a short conference to clarify the problem under study. 8. The length of the role play will depend upon how long it takes to make the nursing situation clear and the students become aware of feelings and thoughts of these in the actual situation.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 57

9. At the end of the activity time should be given for a discussion. ROLE OF A TEACHER IN ROLE-PLAY OF TEACHING 1. This provides the teacher with the opportunity to note individual student needs by observing and analyzing her needs in a real life situation. 2. Assist the student in meeting her own needs by either giving her or encouraging group members to give her on the spot suggestions. 3. Encourage independent thinking and action by stepping aside on giving indirect guidance to emphasize them to themselves. 4. The teacher can correct the errors and use the role-play for specific teaching on the subject. VALUES OF ROLE-PLAYING 1. Develop skill in leadership, interviewing and social interaction. 2. Develop sensitivity to others feelings. 3. Develop skill in group problem solving. 4. Develop ability to observe and analyze situations. 5. Practice selected behaviors in a real-life situation without the stress of making a mistake. LIMITATIONS OF ROLE-PLAY: 1. Role-play places undue emphasis on the dramatic aspects.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 58

2. It cannot be used successfully till the group understands and accepts it as a method of learning. XII) FIELD-TRIP: A field-trip is a visit especially planned for its possible contribution to the objectives of the curriculum, course, project, lesson or other unit of instructions. Field trip is one of the most concrete and most realistic educational procedures. It is one of the oldest method used even by the early Greek teachers. DEFINITION: An educational trip is defined as 'an educational procedure by which the students obtain first hand information by observing places, objects, phenomena or activities and process in their natural setting, to further learning'. PURPOSES 1. To provide real life situations for first hand information. 2. To supplement classroom instruction, to secure definite information for a specific lesson. 3. To serve as a preview of a lesson and for gathering instructional materials. 4. To verify previous information, class discussions and conclusion of individual experiments.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 59

5. To serve as a means of arousing specific interest in materials objects, places or processes. 6. To create teaching situations for cultivating observation, keenness, and discovery. 7. To serve as a means to develop positive attitudes values, and special skills. ORGANISATION AND PROCEDURE OF FIELD-TRIP A. Preplanning. B. Actual conduct of the trip. C. Evaluation. A) Preplanning : • By teacher • By students By the teacher : 1. Decide on the trip. 2. Know the resources. 3. Obtain administrative sanction of school/college. 4. Dealings with the organisation - obtain permission, data and time, visit and know the resources. Inform the objectives. 5. Arrange transport, time, date. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 60

6. Prepare the students with theoretical base. Teacher plans with the students: 1. Formulate objectives. 2. List down specific information to be obtained. 3. Formulate questions to be asked to the guide and prepare guide sheet. 4. If a large group, divide and allot specific jobs. 5. Brief them-equipments or accessories needed, data and time of transport, actual location, set up, conduct and behavior during the trip, safety precautions to be observed. B)Actual conduct of the trip: 1. Follow the schedule. 2. Strictly follow safety precautions. 3. Observe and collect information needed. 4. Collect source/study materials if provided. 5. Teacher supervisors, and call attention to the pertinent points. 6. Observe formalities and extend courtesies. Points to Remember • Trip should follow in an orderly manner. • Do not cause disturbance to the organisation. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 61

C)Evaluation phase : 1. Should be done as early as possible. 2. Students write a report with the observations, effectiveness of the trip, and difficulties faced. 3. Teacher evaluates the reports by the student. 4. Teacher prepares an evaluation and along with specific observations from the students maintains a record which can be referred later. 5. Conducts discussion with the students. VALUES OF FIELD TRIP 1) It breaks monotony of the classroom and provides real

life

experiences. 2) It

furnishes first hand information to supplement and to

enrich the classroom instruction. 3) It

provides opportunity in learning attitudes and positive

values, i.e. cooperation, discipline. 4) They correlate and blend school life with the outside world, providing direct touch with persons and with community situations. 5) It provides opportunities in learning and acquiring skills, i.e. observation, communication, critical and social skills. 6) Students develop better understanding of the aetiologic factors of disease. CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 62

7) Field

trips arouse interest and vitalize instruction thereby

providing motivation, i.e. it provides opportunity to have above participations and gears motivation. 8) It helps to create situations which in turn help to develop observation and keenness. 9) Offers an opportunity to apply that which has been taught to verify what has been learned. 10)

They serve as an effective means of correlating the

subjects of the curriculum. 11)

They provide opportunity to consider and to solve

problems arising from individual and group participation in a natural social situation. DISADVANTAGES OF FIELD TRIPS 1. Field trip is time-consuming. 2. Careful planning is required. 3. Many parties to be involved, cooperation, coordination of various agencies required. 4. Transportation may be a problem. 5. Since the students are going out of school/college premises it is risky, safety precaution essential. 6. If the group is too large, effective observation becomes difficult. 7. Inability to schedule the trip in time when the unit is taught.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 63

8. It involves cost, i.e., sometimes cost involvement is more. SUMMARY: The

objectives

of

clinical experience are obtained through

various methods of clinical teaching. Each method of clinical teaching has its own merits and demerits. It is the responsibility of the clinical instructor to select the apt method of clinical teaching based on the objectives, type of experience and the level of the students involved in the scenario.

CLINICAL TEACHING METHOD, REKHA.C.R,1ST YR M.SC(N)[Type text]

Page 64