Christine Ewan

Clinical teaching in nursing

1 Clinical teaching.- 2 Foundations of clinical teaching and learning.- 3 Learning in the laboratory.- 4 The briefing: preparing students for clinical practice.- 5 Learning through clinical practice.- 6 Debriefing: reflecting on practice.- 7 From student to nurse.

Learning in the laboratory

Chapters 1 and 2 raised some of the important issues facing clinical teachers in nursing and explored the theoretical foundations upon which clinical learning and teaching may be based. Each of the following chapters draws on that material and relates it to the practice of clinical teaching. Using a self-instructional style a number of activities are suggested to enable you to draw on your own teaching practice as the basis for analysis and consideration of alternative approaches. Although the feedback which follows the activities can be read as a text in the usual way there are advantages in applying the practical examples provided to your own experience. The questions and activities may trigger ideas for your own teaching which may go unrecognized if the text is read without a gentle nudge from time to time.

Foundations of clinical teaching and learning

Effective clinical learning is a major objective in preparing professional nurses for the health care services. In the past, the constraints of hospital based schools and the demands of service on students’ learning time have prevented a full realization of those aims.

Learning through clinical practice

There is an assumption in the clinical learning cycle (Figure 5.1) that the clinical teacher and students proceed together from the briefing session into the clinical or community setting. In many programmes that is certainly the case. In other programmes the reality is very different. Several constraints operate: programme constraints, where the curriculum structure separates the theoretical component from the clinical component so that few classroom teachers are also clinical teachers; economic constraints and limited funding for the clinical teaching programme; logistic constraints due to increasing numbers of students and pressure on student to teacher ratios. These have all contributed to the re-consideration of the process of clinical teaching. Some programmes have sought solutions in the addition of clinical teachers whose responsibilities are for teaching only in the clinical/community setting itself. Other programmes have implemented mentor or preceptorship systems, involving clinical staff in student teaching.

Can the environment promote health? And how will we answer that question?

OR many of us, health-promoting environments represent a new frontier. Like all fronF tiers, it is difficult country; there is a chance of failure, and in some areas there is the certainty of failure, at least the next time around or the time after that. When Snow took the handle off the Broad Street pump he was, with this simple action, making a significant change to the environment. We don’t have a pump handle that can be wrenched off its mountings; now we have multinational companies, each with stockholders who expect a profit from their investment, and we have a set of consumer expectations which ensure that industries flourish, and a large number of people have repetitive and unstimulatingjobs. We do not all share the same environment. If people do not have a job or position within this industrial society, they will live at the margins, their environment will be poor, and we know that their health will suffer. A health-promoting environment is not a simple concept and in most cases it cannot be dealt with simply. This of course does not mean we should shy away from involvement; the world needs people who are passionately concerned with improving the environment we live in. There have been enormous environmental changes. The slave trade was a manifestation of a huge industrial complex spanning all continents. It must have seemed a fact of life, impregnable, an environmental factor that was necessary to the smooth running of modern industry, something that it was impossible to overturn. Yet ultimately it was overturned. (You might argue that we still have a slave trade in, say, the rag trade in a number of Asian countries, in the diamond mines of South Africa, in subsistence agriculture in India, in housework in many countries-but at least the original trade has gone.) More recently we have made significant advances in legislation and in changing public perceptions of smoking, so that at least in a number of countries smoking is no longer widely accepted. Can another environmental hazard be headed towards extinction? There are more environmental hazards than those of temperature, wind, fire and water. Our society can be a significant hazard.

From student to nurse

The previous chapters in this book have described the components of a cycle which represents a phased process of clinical teaching and learning. Representation of such a complex phenomenon in such a way is, of course, simplistic but it helps us to analyse the various parts of the teacher’s task and to question and improve some of those practices which we have long taken for granted. This chapter fills in the background to the clinical teacher’s task. It considers the context and culture of clinical teaching and the process of becoming a nurse. The clinical nurse educator is, above all, the colleague who is most responsible for initiating the novice to his or her profession. To do so without an appreciation of the subtleties of that process would be to miss the most potent opportunities available for shaping the future practice of nursing.

The briefing: preparing students for clinical practice

The briefing or pre-conference session has a special place in the clinical learning cycle (Figure 4.1). Its links with debriefing after clinical practice highlight the cyclical nature of clinical teaching. Whilst the lab is important in enabling students to master sets of clinical skills in a low-risk environment, the briefing—clinical practice—debriefing cycle concentrates on the students’ clinical assignments in the real world of clinical/community practice. Each of the three stages is distinct and well-defined demanding special skills of the clinical teacher and students. At the same time, each stage is linked to the others; the clinical teacher and students continue through the cycle in a gradual spiral to mirror the students’ progression from stage to stage.

Debriefing: reflecting on practice

Debriefing of students and the clinical teacher after clinical practice is the focus of this chapter (Figure 6.1). Debriefing is not the end of a cycle of learning and practice, rather it leads once again into briefing, clinical practice and debriefing.