Clinical Teaching Methods

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CLINICAL TEACHING METHOD, REKHA.C.R,1ST_{YR M.SC(N)[Type text]} _{Page 1}

INDEX OF CONTENTS

S.no CONTENTS PAGE

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 - Role play

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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 about the purposes of clinical education and the responsibilities of the teachers and learners in clinical setting. To change their practice of clinical teaching , initially educators should reflect on their fundamental beliefs

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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 include knowledge, skills and attitude 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.

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(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 purposeful, complex, movement oriented activities that involve an overt physical response 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.

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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.

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 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 intern on one to one basis, 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.

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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 students in the clinical setting collaboratively with clinical instructor. The faculty member works with clinical teaching associate to coordinate the overall clinical experience of the students, assist students in clinical performance and serve as a resource.

Faculty may conduct teaching for staff , provide consultation in clinical setting and assist with discharge planning. Majority of the nursing institutions attached

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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 acquire advanced knowledge for practice , develop clinical and technological skills 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.

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CLINICAL TEACHING METHOD, REKHA.C.R,1ST_{YR M.SC(N)[Type text]} _{Page 9}  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

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CLINICAL TEACHING METHOD, REKHA.C.R,1ST_{YR M.SC(N)[Type text]} _{Page 10}  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 clarity of presentation

 Enthusiasm and stimulation of interest

 Group interaction skills

 Clinical supervision skills

 Clinical competence and professionalism

GUIDELINES 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.

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CLINICAL TEACHING METHOD, REKHA.C.R,1ST_{YR M.SC(N)[Type text]} _{Page 11}  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 is often used with group discussion. Hippocratus had used it as a method of teaching medicine . in 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 been extensively used as a prime method of teaching than any other methods. Florance nightingale 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 of exceptionally interesting cases and later quizzed 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:

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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.

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CLINICAL TEACHING METHOD, REKHA.C.R,1ST_{YR M.SC(N)[Type text]} _{Page 13}  Develop a mind that has the power to transfer from

familiar type of problems 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 facts and to discuss ways which make them appropriate for the solution of the problem.

 Extend the ability to utilize data from experience as a test of validity of the ideas already obtained with flexibility to revise goals and procedures 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:

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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.

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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

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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

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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

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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

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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.

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CLINICAL TEACHING METHOD, REKHA.C.R,1ST_{YR M.SC(N)[Type text]} _{Page 20} 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,

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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 care study

Advantage of oral nursing care study

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differences of the student.

 It provides an opportunity for self-expression in writing.  It provides experience in

organizing and writing a paper in a scientific manner.

 It provides a source of material for future reference.

opportunity for the instructor to direct a student’s thinking into new channels and to correct errors of information.

 It serves as a basis for a better personal understanding and a relationship between a instructor and 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 is invited after presentation, the

case becomes

cooperation and all benefits from the study. This is a source of motivation to the student

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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 nursing care study

Disadvantages of nursing care study

 It leaves no opportunity once the study is complete, to branch out and intertwine novel ideas.

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

 It does offer an opportunity for writing and other creative expression because only notes are used for presentation.

 It leaves no record for future references.

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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.

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 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

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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 nonverbal 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.

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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 nurse- patient 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.

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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 skills while

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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 patient-centered 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

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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 though the purpose may not have been accomplished. The evaluation discussion offers an 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.

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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.

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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.

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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.

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'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 simple questions are asked to obtain the needed 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

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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.

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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.

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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

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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.

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# 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.

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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.

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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.

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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

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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

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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.

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 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:

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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.

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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.

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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

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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. Students are to be oriented to new clinical area.

iii. 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

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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.

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• 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.

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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

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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