How To Teach Clinical Nursing

Transcription

1 An Innovative Nursing Education Network to Promote High Quality, Compassionate Health Care Oregon Consortium for Nursing Education OCNE Do not replicate without permission

2 Academic and Employer Partners: Transitioning Student Nurses to Clinical Practice NM Nursing Educators Conference Redefining and Redesigning Best Practices in Clinical Nursing Education Paula Gubrud-Howe EdD RN FAAN June 9, 2015 Albuquerque, New Mexico Oregon Consortium for Nursing Education OCNE Do not replicate without permission

3 Clinical Education Redesign From Random Access Opportunity to Purposeful Design More than redesign --TRANSFORMATION Oregon Consortium for Nursing Education OCNE Do not replicate without permission

4 Clinical Education - From Mother Duck to (Tanner 2010) Do not copy without permission.

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7 Clinical Education Transformation: We hatched a plan

8 From Random Access New Models of Clinical Education Designed to Prepare a New Nurse with competencies beyond those in our traditional nursing programs with deeper understanding of prevalent health care conditions and situations prepared to function in times of chronic nurse shortage prepared to lead and influence policy Oregon Consortium for Nursing Education OCNE Do not replicate without permission

9 Implementation Plan Phase I Data Gathering/Leader Identification/Unfreezing 36 Site Visits Meetings with over 400 key informants from academic and workplace Phase II Clinical Education Summit 1 October 2006 Phase III- Supported 7 pilot projects with guidance from experts guidance Oregon Consortium for Nursing Education OCNE Do not replicate without permission

10 Implementation Plan Phase IV 1 Clinical Education Redesign Group (CERG) Outcome is the Model 2 Clinical Education Summit 2 May 2008 Present new OCNE Model developed by CERG Increase implementation of the model and encourage involvement from all partner schools Phase V. Implementation of the Model and Comprehensive Evaluation on 4 campuses Funded by FIPSE Oregon Consortium for Nursing Education OCNE Do not replicate without permission

11 Partnership Model - CERG

12 Clinical Education Redesign Group 32 academic and practice partners across the state Met over the course of a year Developed model Expectations of students, clinical partners and faculty Intentional design of learning activities Linked to developmental needs of learner Oregon Consortium for Nursing Education OCNE Do not replicate without permission

13 Purposes of Clinical Education Fill out, extend, deepen theoretical knowledge Develop practical knowledge Develop skilled know-how Develop habits of thought: Clinical Judgment Critical thinking & perspective-taking Ethical reasoning Develop understanding of self as instrument of care Oregon Consortium for Nursing Education OCNE Do not replicate without permission

14 Assumptions OCNE Curriculum Assumptions Pedagogical Assumptions Partnership Assumptions Oregon Consortium for Nursing Education OCNE Do not replicate without permission

15 OCNE Curriculum Assumptions Model based in OCNE competencies spiraling and reflection Focus on prevalent populations seeking deep understanding Variety of learning activities to attain proficiency in OCNE competencies Model moves away from total patient care as the primary model of learning Oregon Consortium for Nursing Education OCNE Do not replicate without permission

16 Pedagogical Assumptions Optimal learning is contextual & conceptual Learning activities are as close to actual nursing practice as feasible Support should be appropriate to the level of the student Learning experiences should be scaffolded Every activity has a deliberate intention Oregon Consortium for Nursing Education OCNE Do not replicate without permission

17 Partnership Assumptions A collaborative partnership supports learning though shared language & values Optimal learning occurs in a learning environment in which all learn Efficient use of time and resources for all Reduce workload for faculty and staff Oregon Consortium for Nursing Education OCNE Do not replicate without permission

18 Discussion Questions What is the focus of the practice we are preparing our graduates for? Is it generalist practice? Is it specialty practice? Identify 2-3 partnership assumptions that can guide clinical education redesign in New Mexico. Oregon Consortium for Nursing Education OCNE Do not replicate without permission

19 CLINICAL LEARNING MODEL Oregon Consortium for Nursing Education OCNE Do not replicate without permission

20 CLINICAL LEARNING MODEL Oregon Consortium for Nursing Education OCNE Do not replicate without permission

21 Concept Based: Learning about a specific concept or diagnosis Purpose is to support pattern recognition critical to the development of clinical judgment Students learn to notice when the expected pattern is present or not present Students learn to recognize the normal trajectory of a particular problem or standard treatment and notice when the trajectory disrupted Oregon Consortium for Nursing Education OCNE Do not replicate without permission

22 Concept Based Essential Characteristics Direct observation of Clients Students actively involved in data collection and analysis Students are not responsible for client care Students compare and contrast Helps student learn what is important to notice Collaborative Learning Oregon Consortium for Nursing Education OCNE Do not replicate without permission

23 Discussion- Think Pair-Share Take a minute to jot down a couple of ideas you have for concept-based clinical experiences. Share your ideas with your neighbors Consider sharing with the entire group Oregon Consortium for Nursing Education OCNE Do not replicate without permission

24 CLINICAL LEARNING MODEL Do not copy without permission. Oregon Consortium for Nursing Education OCNE Do not replicate without permission

25 Case Based Purpose of this clinical activity is to teach students to think like a nurse through exposure to client case exemplars. Essential Characteristics Involve authentic clinical problems Highly prevalent nursing practice situations and low volume high stakes situations Encompasses seminar discussion of written, simulated or computer-based cases

26 Bringing MegaCases to Life Follow-up to in-class case work Faculty/theater student can play Mega Case role Gives students a chance to follow through on what more they would like to know Script out some possible responses

27 CLINICAL LEARNING MODEL. Oregon Consortium for Nursing Education OCNE Do not replicate without permission

28 Intervention Skill Based Beyond technical skills Includes developing skill with communication and assessment Linked with preparatory and reflective assignments

29 CLINICAL LEARNING MODEL Oregon Consortium for Nursing Education OCNE Do not replicate without permission

30 Focused Direct Client Care Purpose is for the student to gain progressive experience in the actual delivery of nursing care and to build and understand the role of developing relationships with patients Essential Characteristics The assigned focus for a care experience allows the student to apply a growing knowledge and skill base to client care.

31 Focused Direct Client Care Essential Characteristics Focused differentiates it from the concept total patient care with the focus identifying the learning expectations and based on the course outcomes and student developmental level. Students learn to establish and nurture the nurse/client relationship and integrate the ethics of caring for individuals.

32 Focused Direct Client Care Essential Characteristics The student learns to notice the salient features of the situation and through coming to know the client s individual and unique responses to disease, illness and treatment. Focusing on the client s care needs also involves learning to interpret findings and craft response tailored the client.

33 Focused Direct Client Care Essential Characteristics Students learn to incorporate the workflow of the agency into the care they are providing. Students begin to learn to engage in the constant organization and prioritization activity that is required in dynamic care environments.

34 CLINICAL LEARNING MODEL Oregon Consortium for Nursing Education OCNE Do not replicate without permission

35 Integrative Experience Purpose is to provide opportunity for the student to pull all elements of prior learning into an authentic clinical practice situation. Purpose is also to begin the transition into practice

36 Integrative Experience Essential Characteristics Rather than the student being assigned to a particular client, the student is assigned to work with a registered nurse (CTA) and provides client care with, and under the direction of, the registered nurse. This is also an opportunity for the student to be integrated into the practice community and transition from the student to the professional nurse role.

37 Integrative Experience Essential Characteristics The student practices integration of knowledge, clinical judgment and competencies while providing client care and studies the role of the registered nurse as it is expressed in a particular organizational environment. Characteristics of a good integrative experience include opportunities for the student to practice nursing in an organizational context including experience with the rules, norms, culture and infrastructure

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39 Emerging role of the CTA Faculty CTA Student Oregon Consortium for Nursing Education OCNE Do not replicate without permission

40 Relationships Student Client Faculty CTA Unit Oregon Consortium for Nursing Education OCNE Do not replicate without permission

41 Designing a Clinical Education Curriculum Sequencing the elements into a curriculum. The prominence of elements of the model will vary with the developmental level of the student and the goals of the curriculum Oregon Consortium for Nursing Education OCNE Do not replicate without permission

42 Early Clinical Learning Experiences Concept Based Case Based Intervention-Skill Based Direct- Focused Care Oregon Consortium for Nursing Education OCNE Do not replicate without permission

43 Mid-Program Learning Experiences Case Based Focused Direct Patient Care Concept Based Intervention Skill Based Oregon Consortium for Nursing Education OCNE Do not replicate without permission

44 End-of-program clinical experiences Integrative Experience Intervention- Skill Based II Concept- Based Case-Based Oregon Consortium for Nursing Education OCNE Do not replicate without permission

45 Discussion Questions What is compelling about OCNE s clinical transformation? What is the ideal approach to redesigning clinical education in New Mexico? What are the barriers to change? What are resources are needed? Oregon Consortium for Nursing Education OCNE Do not replicate without permission

46 In times of drastic change, it is the learners who inherit the future. The learned usually find themselves equipped to live in a world that no longer exists. Eric Hoffer

47 Questions and Comments

48 For more information Visit us at

49 References Gubrud, P., & Schoessler, M. (2010). OCNE clinical education model. In N. Ard & TM Valiga (Eds) Clinical nursing education: Current reflections (pp ). New York: National League for Nursing Gubrud-Howe, P., & Schoessler, M. (2008). From random access opportunity to a clinical education curriculum. Journal of Nursing Education, 47(1), 3-4. McNelis, A.M., Ironside, P.M Ebright,P.R, Dreifuerst, K. ACNS-BC, Zvonar, S. E & Susan C. Conner. (2014). Learning nursing practice: A multisite, multimethod investigation of clinical education. Journal of Nursing Regulation, 4 (4),

50 References continued Niederhauser, V., Schoessler, M., Gubrud-Howe, P, Magnussen,L, & Codier. (2012). Creating innovative model of clinical nursing education. Journal of Nursing Education, 51(11) Nielsen, A. (2009). Concept-based learning activities using the clinical judgment model as a foundation for clinical learning. Journal of Nursing Education,48(8), Nielsen, A.E., Noone, J., Voss, H. & Matthews. (2013). Preparing nursing students for the future: An innovative approach to clinical education. Nurse Education in Practice, 13(2013),

51 References continued Tanner, C.A. (2006). Thinking like a nurse: a researchbased model of clinical judgment. Journal of Nursing Education, 45(6), Tanner, C. A. (2010). From mother duck to mother lode: Clinical education for deep learning. Journal of Nursing Education, 49,(1), 3-4. Tanner, C.A., Gubrud-Howe, P., & Shores, L. (2008). The Oregon Consortium for Nursing Education: A Response to the Nursing Shortage. Policy, Politics and Nursing Practice, 9(3):