Clinical teaching

Objectives
• Definition of concepts; clinical teaching and
clinical instructor
• Explain where clinical teaching occurs
• State the aim of clinical instruction
• Discuss teaching strategies appropriate for clinical
instruction
• Identify the qualities of clinical instructor
• What is involved in clinical instruction
• Reasons why clinical instruction is undertaken
 Definitions
• Clinical teaching-is the means by which
student nurses learn to apply the theory to
nursing so that an integration of theoretical
knowledge and practical skills in the clinical
situation becomes the art and science of
nursing
 Conti..
• Clinical instructor-a trained person who is
appointed to supplement the role of a
professional nurse in charge of the unit in
guiding and evaluating students’ clinical
competency
 Where it occurs
• ART clinics, inpatient, medical wards, labour
and delivery ward, counseling and testing
• Anytime; while a patient is present in the
ward, following a client visit, planned for the
future
 Aims of clinical instruction
• To assist students to identify the client’s
problem, the knowledge to understand and
resolve the problem and the skills they need
to provide the client’s care
 Strategies appropriate for clinical
instruction
Case presentation

• A collection of data around the patient who

has a particular condition with aim of learning
deductively about such a condition and its
management
• Case studies present problems, dilemmas &
ethical questions or areas
 Case presentation (cont)
• Students are required to examine the problem
in all its dimensions & then make judgemental
decisions & justify their choices
It covers the following aspects:
• Biographical data: age, gender, marital status,
occupation etc
• Social history
• Medical treatment
 Contents of case study (cont)
• Nature of complains
• Physical assessment
• Diagnosis

• Investigations & the results

• Nursing care plan
• Patient prognosis
• Commends & discussion
 Procedure

• Students collect data around the patient

• They analyze and organize such data to give a
rounded picture of the patients’ actual and
potential problems on the basis of criterion
stipulated above

• She then makes a presentation under the

guidance of the educator to a group of people
e.g. Colleagues. Other care givers
 Conti..
• This presentation is followed by discussions
that are meant to add to body of knowledge
of the students but also be beneficial to the
client in question and others who will present
with the same problem in future

• If a case presentation is done by a nurse, more

emphasis should be put on nursing
management
 Conti..
• Nursing students at varying levels of study can
do case presentations
• 1s year students can work more on data
collection and observations, but 2nd & 3rd year
students are expected to go deeper on
analysis and synthesis where they will work
more on problem solving , decision making
commends and recommendations.
 Conti..
• They may even create hypothetical cases that
will challenge their critical analytic thinking
capability and judgment
 Advantages

• Affords students an opportunity to integrate

various scientific courses taught theoretically
with clinical practice

• Gives patient care meaning, case presentation

should not only be on paper but
recommendations should be implemented on
patient care.
 Disadvantages

• It is time consuming
 Role play
Role play
It is also based on a simulation technique

• It requires spontaneous acting of a situation

by two or more participants under the
direction of a nurse educator
 Procedure
• Explain the situation to be acted to the
students
• Allocate roles/ preferably allow students to
volunteer and describe individual characters
(briefing/scene setting)
• Let students unleash their talents
spontaneously in approaching their roles and
portraying the characters they are enacting
 Conti..
• The rest of the groups are
spectators/audience. They watch, listen and
even make notes as they are going to
comment later on.
• This is followed by the discussion of the role
play. It is important for students to realize that
they are not criticizing each other on a
personal level but the ability of the role play to
pass on the ideal message
 Conti..
• Roles can be reversed so that each student
can feel how it is to be in another character.

• The success of role play as a teaching strategy

lies with proper scripting (scenario) and
appropriate briefing ( scene setting)
 Advantages

• Students tend to learn how it feels to be in

another person’s position e.g. a patient and
exhibit an emotional expectation of how you
would want to be treated
• It can be replayed and different approaches
tried as it simulated
 Conti..
• Gives patient care meaning as it is not
supposed to end with scripting but be
practiced in a real life setting
• Ideal for health education
• Stimulates critical analytic thinking of
students/audience
• Holds the attention of the group and breaks
the monotony of conventional lectures
 Disadvantages of role play

• Needs a competent nurse educator who can

create sound and practical scenarios and
setting the scene properly

• Students may get tired or become aggressive

when criticized by others during discussion.
Care should be taken during this period to
provide constructive criticism, not personal
attacks
 Conti..
• Students may not volunteer to role play
 Demonstration

• A visual presentation of a nursing technique

using actual /simulated equipment for the
purpose of showing nursing students how to
execute a task. In addition the reasons for a
technical procedure and dangers inherent in it
are explained
 Conti..
Step 1 Preparation
• Seek consent from the client
• Assemble equipment and make sure it is in
good working order
• Determine the number of students who may
be able to observe
• Determine the objectives of the specific
procedure to be demonstrated
 Conti..
• Make sure that students have been exposed
to the necessary theoretical background so
that they can correlate it with the actual
psychomotor activities. Warn them not make
embarrassing or anxiety inducing remarks
around the client

• Plan summary and the questioning session

 Conti..
Step2 the actual procedure

• Introduce client to students and vice versa

• Explain objectives and special points to
consider/observe

• Observe essential safety precautions in the

demonstration
 Step 2 (conti)
• Continuously communicate with client and
show and respond to his/her
concerns( patient’s consideration)
• Work systematically, and efficiently

• Adapt well without panic to any unexpected

occurrences, thus setting a good example for
students to emulate
 Conti..
• Give students time to practice the skill away
from the real life (OSCE) before they can give
return demonstrations in real life
 Conti..
Step 3 Evaluation

• Review the procedure, emphasize the

theoretical background

• Invite questions, stimulate discussions and

correct misconceptions
• Organize supervised return demonstrations
 Advantages
• Questions can be asked during a
demonstration
• It allows for discussion

• Repetition and stopping to illustrate a point is

possible
• More students can be able to
watch ,particularly if it is simulated
 Conti..
• Students become familiar with the use of
equipment

• Procedures which are not readily available can

be demonstrated in a simulated laboratory
 Disadvantages
• It invades patient’s privacy if it is done in real
life situation
• May limit students’ number
• Questions and answers may not be possible
around the patient except in general terms,
therefore correlation of theory may have to be
done away from the real life situation.
 Conti..
• It is time consuming

• Procedures may not be available for successful

demonstrations
 Qualities of clinical instructor
• Clinical proficiency/expertise
• Good interpersonal relationships

• Must have a good and updated theoretical

background as the basis for clinical guidance
• Must hold high professional standards, honesty,
integrity and objectivity. She should be able to
interpret and respect the norms and values of
her profession
 Conti..
• She must have an even temperament that balances
professional judgment and a sense of humour
• She must be resourceful

• She should be aware of resources that are at her

disposal in order to plan her teaching programmes
effectively e.g. A teachable moment.

• Ability to teach
 Conti..
• Should have a sense of responsibility and
accountability

• Critical analytic thinking

• Time management
 Nursing process
• Nursing is an art & science directed at
providing a human health care service which is
based on scientific principles

• It applies the nursing process of assessment,

planning, implementation, evaluation &
record keeping to the promotive, preventive,
curative & rehabilitative of total health care of
the people
 Conti..
• It is the methodology of nursing practice & can
be practised in clinical situation

• Provide means of individualised nursing

• Provide multidisciplinary approach to health
of an individual (holistic care)

• It is based on critical thinking

 Clinical evaluation
• Clinical evaluation: is the method used to
determine whether students are becoming
clinically competent in the practice of nursing

• Evaluation of students/employees is based on

their performance that rated on a certain
standard; therefore it is important that a
standardized evaluation tool is drawn for this
purpose
 Methods of evaluation
There are two standard evaluation tools
commonly used
[Link] list

• Shows a list of students’ behaviors expected to

be exhibited during a nursing intervention e.g.
Communication, safety, patient’s
consideration, Recording and reporting etc
 Conti..
• It does not require the means of indicating how
well the behavior was exhibited
• The assessor just ticks off when the behavior is
shown
• It may be designed in a manner that shows
either desired and undesired behaviors or just
the desired behaviors
• It is used for clinical skills which are specific and
clearly defined
 Conti..
Rating scale
• While a list of desired behaviors is still
established ,there is an indication of the degree
of performance which can be expressed either
in numbers or description e.g. 1-5 or
satisfactory ,unsatisfactory

• This descriptive attributes must first be

identified
 Conti..
• A panel of appraisers must define what they
mean

• Only measurable descriptions must be

included in a rating scale
Factors affecting validity and reliability of clinical evaluation

Assessor
• Lack of objectivity
• Lack of interest
• Halo effect
• Central tendency
• Assessor’s experience, motivation or
personality
 Conti..
Students

• Preparation

• Level of anxiety

• Presence of others
 Conti..
Methodology

• Objectives may be too general , thus fail to

guide the student in the right direction

• Behaviors may be poorly defined e.g.,

friendliness mistaken for familiarity
• Or silliness for assertiveness
 Why clinical instruction is undertaken
• To provide individualized care in systematic,
holistic approach
• To develop high technical competent skills
• To provide various procedure
• To collect and analyse the data