Effective Clinical Education For Nurses

Roles and challenges of clinical instructors

Discuss about the Identifying clinical learning need using structured.

Nurses who are involved in clinical education have a great responsibility while training students, this can be witnessed where training takes place in a fast-paced and a high workload environment. According to DiPaola and Wagner, 2018; Cather et al. (2006) on the roles and challenges of clinical instructors for instance, various learning objectives were suggested for the experience of clinical learning including: Improved knowledge and skills by the nursing students, refine nursing efficiency, uphold improved clinical independence and demonstrating competency and collaboration as a clinician.

With these goals in mind, it is important to discuss what would constitute a good learning environment which is a critical factor to consider when planning and implementing learners experience in clinical setting as suggested by (DiPaola and Wagner, 2018).  The diversity of members involved in clinical training add to the richness of experience. Furthermore, the students’ personalities and set of skills are different from their preceptors, this is a fact that should be appreciated and accepted by both preceptors and the students. It is evident that a good learning environment is only possible where preceptors and other clinical staff value students. As a result of this, there is improved preceptors openness, improved relationship and respect for student’s perspective in the clinical teaching setting according to (Papastavrou et al., 2016). There is a need to understand the student’s responsibility and by spending some time together and once a trust is established it’s possible to extend the students responsibilities according to (Flott and Linden, 2016). National Education Association, 2010). Therefore, most effective and positive learning environment can only be achieved through trust, honesty and respect. Such environment will enable students explore new ideas, reflect on their studies in meaningful ways without fear of being judged. For example, students who expresses fear in learning situation have limited ability to engage in a good communication with supervisors and loss of critical thinking as suggested by (Flott et al., 2016).

Preceptor preparedness is an area of consideration when planning and implementing learners experience in clinical setting. Our own experiences as clinical instructors have taught as that there is no formal preparation when taking the role of. For example, according to study by (Wu et al., 2016), the findings revealed that most preceptors felt unprepared when taking the role of clinical teaching especially in the area of teaching and assessment. New P.H.D holders staff recruited in the clinical teaching setting are frequently given the task of teaching new courses to, yet most of them still lack teaching experience and have no further training on teaching skills. Therefore, should the recruitment of preceptors be based on availability and level of education, and not experience, ability and interest, this will jeopardize clinical learning experience (McSharry and Lathlean, 2017; Gaberson& Oermann, 2010). According to report of conference from Audiology Education summit preceptors’ qualities in clinical education was categorized according to; preparedness, level of education, experience, skills, knowledge and personal traits as suggested by (Carey et al., 2018; Frazer et al., 2014). Moreover, indicators for clinical instructor include the ability to: model best practices, provide appropriate feedback, maintain ethical and legal practices; encourage professional growth and promote skills building. All these are interconnected to clinical teaching objectives that promote student’s ability to improve knowledge and skills, refine their nursing practice efficiency and effectiveness and improved clinical independence.

Characteristics of a good learning environment

The equipment and physical environment should also be considered as factors. It is crucial to provide learners with exclusive and private spaces to reduce the overall interruption from others happenings within the clinical setting as suggested by (Papastavrou et al., 2016).

The student’s expectation is also an area of considerations. For example, the nursing students should be allowed to express their expectation freely. According to study by (Antohe et al., 2016), students have certain expectorations from their supervisors such as; being tolerant to student’s independence, good communication skills, being approachable, ability co to give a constructive feedback, help students develop confidence, appreciate unique learning pace by each student, and being a role model for the students. For example, according to (Burns et al., 2006), such expectation by the students are important in improving students clinical knowledge and independent in nursing practice. Moreover, prompt feedback and understanding from the side of the preceptor was also listed by the students. Trust between the academic staff and student is another core expectation from the students and cited as key factor for consideration as suggested by (Frazer et al., 2014).

• Clinical Learning Need: Cardiopulmonary resuscitation CPR Training for EMS Nurses.

Cardiopulmonary resuscitation (CPR) has been identified as the key to patient survival in emergency cardiac arrests cases (Pettersen et al., 2017). Furthermore, various studies has reported that quality CPR is critical for the patient survival according to. At the same time, real time objective feedback during training for nurses has been identified as a recipe for improving CPR performance by the emergency medical Service (EMS) nurses according to (Smart et al., 2015). When patients are in emergency situation when CPR if performed their heart will continue to receive blood flow hence e keeping the oxygen supply to the brain is kept. Resulting to less brain damage improving the patient’s survival chances. PR is mostly performed by the first responder’s nurses as part of the Emergency Response Team (ERT), therefore there is a great need to retrain nurses on the CPR skills through continuous professional education programs (CPE). This type of training can be offered to the ERT nurses through continuous assessment, supervision and evaluation of their CPR skills. The key metrics of CPR procedure involves chest compression depth and rate, followed by release between compressions, no-flow time ventilation volume and rate.

In EMS Unit there is a need for continuous assessment, supervision and evaluation of the nurse’s skills on the Basic life support (BLS) to enhance their learning with regards to nursing practice (Dyson, 2019). Continuous assessment described as formative, process-oriented, informal, internal, learner-involved, and/or self-referenced in nature. It can take the form of daily work that include presentation, class participation and practicals that involves CPR performance procedures among others. At the same time, evaluation should be a learning process and it’s not meant to punish or to intimidate nursing officers within the EMS. In most cases, nursing officers have a negative perception that evaluation is meant to punish failures and supervision is nagging. Whenever, there is no effective implementation of supervision, assessment and evaluation among the professional nurses, the result is lack new knowledge and skills among the nurses within the clinical practice according to (Riley et al., 2014). It’s worth noting that valuable feedback through learner’s easement is effective for and efficient determination of officer’s professional growth.

Preceptor preparedness

Rationale for the CPR Training as part of Continuous professional education (CPE) for Emergency Medical service Nurses.

Several death can occur due to unsuccessful CPR. For example, an estimated 350,000 deaths occurred in Europe due to failure to perform quality CPR according to (Smart et al., 2015). In recent years introduction of new devices and training EMS nurses on how to use them have drastically improved the quality of CPR resulting to increased patients survival rate during emergency situations such as cardiac arrest. A patient in cardiac arrest emergency situation has ten minutes to die should administration of CPR fails to happen as suggested by (Shehata, 2016).

For example, professional competencies for nursing officers have been determined through subjecting nursing staff to continuous assessment and training on news devices and skills in performing CPR. Moreover, professional competencies have been used as foundation for improvement of learning need assessment as suggested by (Razavykia et al., 2012). For example, nurses who are directly involved in provision of emergency medical service (EMS) and educators are confronted with overwhelming responsibility of providing immediate emergency nursing care that is critical for the survival of a patient. According to the findings by (Larkin et al., 2006), in the year 2003 alone about 114 million persons passed through emergency room among them 16.2 million were transported using EMS ambulances in the United States of America. Hence there is an immediate need to for continuous learning by the EMS service providers.

References

Antohe, I., Riklikiene, O., Tichelaar, E., & Saarikoski, M. (2016). Clinical education and training of student nurses in four moderately new European Union countries: Assessment of students’ satisfaction with the learning environment. Nurse education in practice, 17, 139-144.

Carey, M. C., Kent, B., & Latour, J. (2018). The experiences of peer assisted learning (PAL) on the learning of undergraduate nursing students in clinical practice: A qualitative systematic review.

Dyson, L., Hedgecock, B., Tomkins, S., & Cooke, G. (2009). Learning needs assessment for registered nurses in two large acute care hospitals in Urban New Zealand. Nurse Education Today, 29(8), 821-828.

DiPaola, M., & Wagner, C. A. (2018). Improving instruction through supervision, evaluation, and professional development. IAP.

Flott, E. A., & Linden, L. (2016). The clinical learning environment in nursing education: a concept analysis. Journal of advanced nursing, 72(3), 501-513.

Frazer, K., Connolly, M., Naughton, C., & Kow, V. (2014). Identifying clinical learning needs using structured group feedback: First year evaluation of pre-registration nursing and midwifery degree programmes. Nurse education today, 34(7), 1104-1108.

Gaberson, K., & Oermann, M. (2010). Clinical teaching strategies in nursing. Springer publishing company.

McSharry, E., & Lathlean, J. (2017). Clinical teaching and learning within a preceptorship model in an acute care hospital in Ireland; a qualitative study. Nurse education today, 51, 73-80.

National Education Association. (2010). Teacher assessment and evaluation: The national education association’s framework for transforming education systems to support effective teaching and improve student learning. Retrieved from National Education Association website: https://www. nea. org/home/41858. htm.

Papastavrou, E., Dimitriadou, M., Tsangari, H., & Andreou, C. (2016). Nursing students’ satisfaction of the clinical learning environment: a research study. BMC nursing, 15(1), 44.

Pettersen, T. R., Mårtensson, J., Axelsson, Å., Jørgensen, M., Strömberg, A., Thompson, D., & Norekvål, T. M. (2017). European cardiovascular nurses’ and allied professionals’ knowledge and practical skills regarding cardiopulmonary resuscitation. European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 1474515117745298-1474515117745298.

Razavykia, M. (2012). Evaluation of the educational needs in the nursing students of the Islamic Azad University of Hamedan 2010. Procedia-Social and Behavioral Sciences, 31, 564-567.

Riley, T. A. (2014). Assessing clinical staff learning needs, part 1: structure and process for clinical nurse specialist student projects. Clinical Nurse Specialist, 28(1), 63-68.

Shehata, M. S. (2016). The introduction of Booster Cardio Pulmonary Resuscitation Training fro nurses working in Accident and Emergency Department.

Smart, J. R., Kranz, K., Carmona, F., Lindner, T. W., & Newton, A. (2015). Does real-time objective feedback and competition improve performance and quality in manikin CPR training–a prospective observational study from several European EMS. Scandinavian journal of trauma, resuscitation and emergency medicine, 23(1), 79.

Wu, X. V., Enskär, K., Heng, D. G. N., Pua, L. H., & Wang, W. (2016). The perspectives of preceptors regarding clinical assessment for undergraduate nursing students. International nursing review, 63(3), 473-481.