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Or, the story of how a nursing clinical instructor is attempting to teach the art of nursing


Or, the story of how a nursing clinical instructor is attempting to teach the art of nursing * * * * * * * * * * * * * * * * * I m relatively new to clinical teaching. – PowerPoint PPT presentation

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Title: Or, the story of how a nursing clinical instructor is attempting to teach the art of nursing

A Method for Achieving Affective Outcomes in the
Clinical Setting
  • Or, the story of how a nursing clinical
    instructor is attempting to teach the art of

Dear fellow student,
  • Im relatively new to clinical teaching. I
    attended the Colorado Center for Nursing
    Excellences Faculty Development Seminar in July
    of 2007 and began teaching first semester nursing
    students for UNC the Fall of 2007. A last minute
    addition to the faculty because they had an
    unexpected resignation, their crisis was my
    opportunity. I had the greatest group of nursing
    students ever assembled. They didnt judge me as
    I bumbled along learning my new role. We learned
    together and I will forever be in their debt.
  • Since then I have had more amazing students and
    am becoming much more focused on how Im using my
    clinical conference time with them. In this
    teaching unit Im sharing my personal philosophy
    of teaching and what has worked well for me in
    the hopes that you may join me in my passion for
    teaching nursing students the art of nursing.

Wise words
  • Gaberson and Oermann (1999) open their book
    Clinical Teaching Strategies in Nursing with this
    astute observation
  • Every clinical teacher has a philosophy of
    clinical teaching, whether or not the teacher
    realizes it. That philosophy determines the
    teachers understanding of his or her role,
    approaches to clinical teaching, selection of
    teaching and learning activities, use of
    evaluation processes and relationships with
    learners and others in the clinical environment
    (p. 1).

A philosophy?
  • As a new clinical instructor I didnt know that I
    had a philosophy but I knew this that
    nursing schools were great at turning out
    graduate nurses whose heads were full of
    knowledge and who knew they needed to be critical
    thinkers. But many of these new grads didnt know
    how to establish a caring, therapeutic
    relationship with a patient.
  • I wondered, Where did I learn to do this? It
    wasnt in school I learned it from a valued
    colleague. She told me to slow down, look my
    patient in the eye and ask, How are you doing?
    as a start. Its made all the difference in my
    practice and so this business of building caring
    relationships into nursing practice has become
    what I want to pass along to my students.
  • So, yes, as even as a new clinical instructor I
    guess I had a philosophy and a mission

Not theory too!
  • Im an oddball, Ill admit it I love nursing
    theory. A staff nurse colleague of mine recently
    came out of meeting complaining, Geez! That was
    the most boring meeting Ive ever been too! Teri,
    you wouldve loved it! (It was about theory).
  • I have many theories that support my practice and
    teaching. I wont bore you with all of them but
    Carpers is one I really cant get by without. I
    know you all have been introduced to Carpers
    ideas in Nursing Theory. You remember the theory
    that nursing knowledge has four discrete

Carper's Four Patterns of Knowing
  • Empirics, the science of nursing
  • Aesthetics, the art of nursing
  • Personal knowledge of self as a nurse and
  • Ethics, or moral knowledge, in nursing.
  • Nursing science is not enough even though its
    tough and messy we have to help nursing students
    achieve knowing in all the areas described by
    Carper (1979).

The Pew-Fetzer Task Force agrees
  • In its report Health Professions Education and
    Relationship-centered Care the Pew-Fetzer Task
    Force on Advancing Psychosocial Health Education
    called for practitioner education programs to
    include instruction in the knowledge, skills, and
    values necessary for quality practitioner-patient
  • self-awareness
  • understanding of the patient experience of health
    and illness
  • an ability to develop and maintain caring
  • effective communication

"Fine", you say, "so what part of all that do you
expect me to teach in the clinical setting?
  • Lindeman (1989) says clinical teaching should
    emphasize the use of self as a major component of
    the care process and the use of a post-experience
    reflective seminar or group reflective
    opportunity to enrich personal perspective.
  • (I can hear you say, Sure, no problem Ill get
    right on that)

Now you see my dilemma
  • So here I was passionate that nurses should
    learn how to develop and maintain caring
    relationships with their patients but I had no
    idea how to teach it
  • Thank goodness Im an intuitive-feeler
    Myer-Briggs type (INFP) with an accommodator Kolb
    learning style! Thanks to a University of
    Pennsylvania website I know my leading strength
    is creativity and per a numerology reading my
    purpose in life to show people new approaches
    (Millman 1993, p.217). All that lead me to depend
    on my usual strategy Develop my own method!

Product Warning Label
  • All thinking-judging Myers-Briggs types beware.
    While I really have attempted to choose learning
    exercises that are sensible this is not something
    I can really claim confidence in judging. The
    only evaluation process my method has been
    through is a crude thumbs-up or down evaluation
    by my students to the question of whether they
    found an exercise valuable. And while they gave
    a thumbs-up to everything Ive put them through I
    doubt this evaluation is sound since my students
    probably have guessed I find criticism hard to

Okay, my method for the moment anyway and
subject to change
The method is simple
  • With a foundation of a caring relationship with
    the instructor, the nursing student will engage
    in reflective writing and clinical conference
    activities that are directed at achieving
    affective outcomes in the clinical setting.
  • Starting with the foundation well go through
    each layer of the pyramid

Students want caring instructors
  • Sitzman and Leners (2006) report traits students
    identify with caring teachers
  • being non-judgmental, respectful, patient,
    available, dependable, flexible, supportive,
    open, warm, and genuine, etc. (p. 255).
  • genuinely caring about what happens to others,
    sensitivity to the uniqueness of each student,
    promoting awareness of self in each student,
    cultivating acceptance of differences in others,
    sharing genuine life/professional experiences,
    and provision of a supportive emotional,
    sociocultural, and spiritual environment (p.

Caring Student-Instructor Relationships Grounded
in Attachment Theory
  • Okay, so I couldnt resist another theory! My
    thanks for this one goes out to fellow student
    Mary Beth Wenger. We enjoyed a great time
    together a few months ago and she shared her
    notes from a conference on attachment theory.
    Originally a theory based on research of
    children, psychologists have expanded it to
    adults. I have found it useful in helping me
    support nursing students. Basically the theory
    says we all want someone to support us as we go
    out and explore new experiences and, if and when
    we get scared, we want the support of someone
    that we perceive to be bigger, stronger, wiser
    and kind.

The "Circle of Security" based on attachment
So, in practical language
  • I conceptualize my teaching based in an
    instructorstudent relationship no different than
    my nursing practice is based in the nurse-patient
    relationship. I strive to establish a caring,
    supportive relationship with each student. I tell
    my students I will do all I can to help them
    become the best nurse they can be. I also tell
    them I will do all I can to protect them from
    harm. When they make a mistake or experience what
    they perceive is disapproval or abandonment I
    make myself available to run to. I try to be
    the secure base and safe haven as
    conceptualized in the Circle of Security.

The next layer Reflection for Affective Learning
  • Wagner (1998) notes how many nursing students
    get lost in the day-to-day technical doing for
    patients and lose the sense of self (p.3).
    Wagner (1998) promotes reflection as how nursing
    students may become unlost.
  • Johns (1994) states, Caring is emotional work
    and as such, the reflection aims to enable the
    practitioner to recognize and value her own
    feelings (p. 115).

Practical Use of Reflection
  • I require reflective writing following each
    clinical encounter to encourage students to
    consider/recognize/ evaluate the impact of caring
    actions of self or others on the patient. The
    writing is required as an adjunct to traditional
    care plans in the clinical setting. A list of
    questions for reflection pertinent to the
    affective domain is provided in the course
    syllabus along with simple instructions. The
    written work is not graded but is required and
    support for their reflective process is attempted
    by returning feedback specific to the students
    story or the affective components of their

The top layer Clinical Conferences
  • I have tried several clinical conference
    activities over the last year aimed at achieving
    affective learning outcomes. I am amazed at how
    open and receptive students can be if you let
    them know there is no way to fail. Heres the
    list so far
  • Share their stories for why they chose nursing
  • Values clarification exercise
  • Role Model reflection exercise
  • Myers-Briggs Type identification exercise
  • Learning style identification exercise
  • Professional interests exercise
  • What makes me happy? exercise
  • Strengths identification exercise
  • Artistic expression of a memorable caring

My Nursing Book
  • I have been working on a new project this
    semester for my students. Envisioned as a way to
    pull together information from all the clinical
    conference exercises I call it My Nursing Book
    and it is a scrapbook of sorts. I have attached a
    copy of it as a Microsoft Word document for your
    review and it will provide the basis of the
    learning activity for this unit.
  • I am also in the midst of developing a collection
    of the clinical conference materials I use an
    instructor guide of sorts. A few of the pages I
    am working on will be posted as well.

  • Gaberson Oermann (1999) are so right when they
    say, Clinical learning also produces important
    outcomes in affect beliefs, values, attitudes,
    and dispositions that are essential elements of
    professional practice Students are socialized
    into the role of professional nurse in the
    clinical setting, where accountability is
    demanded and the consequences of choices and
    actions are readily apparent (p. 16,17).
  • As clinical instructors we have an obligation to
    provide learning opportunities that support our
    students in achieving these outcomes. I hope my
    intuitive model may provide food for thought
    for you as you consider your personal philosophy
    of teaching and develop your own personal model.

Final thoughts
  • Thinking back over the last year and remembering
    the students that I have had the privilege to
    teach, I am struck at the richness of the journey
    and I realize how blessed I have been. I have a
    sense of motherly pride for all my former
    students and I cant help but think that the
    reason I feel this way is because I sense in each
    the value of caring. I hope that each student
    will reach their potential in developing caring
    patient relationships because I believe this is
    what will provide them with the deep satisfaction
    that nursing has to offer. As I have told many of
    them, they are not guaranteed a rewarding
    practice but they will find it if they seek it
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