FACULTY OF NURSING AND ALLIED HEALTH SCIENCES
SEMESTER MAY / 2018
TEACHING IN NURSING
MATRICULATION NO. : 830604086822001
IDENTITY CARD NO. : 830604-08-6822
TELEPHONE NO. : 012-5837958
E-MAIL : [email protected]
LEARNING CENTRE : PERAK LEARNING CENTRE
Nursing is a noble profession as it is very popular since the time of Florence Nightingale who is known as ‘the lady with the lamp’. She used to nurse patients even though it was dark and there were no electricity. However, it is not an easy work like how people think. According to “International Council of Nurses”(2018), nursing includes autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Key role of nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people, advocacy, promotion of a safe environment, research, participation in shaping health policy and in-patient and health systems management, and education.
A nurse need to complete a basic nursing program course of 3 years in general nursing which is recognized and approved by the appropriate regulatory authority for example like ‘Lembaga Jururawat Malaysia’ for our country (“International Council of Nurses”,2018). Nursing is known as practice-based profession, not only about theory, but it is also clinical education as well. According to Elliott (2014), clinical education is an essential part of every undergraduate nursing curriculum. The important benefits are that it allows students to put theory into practice and experience the realities of the practice-based nursing profession. The importance of clinical nursing education is undeniable in personal, professional and clinical skills development. Through nursing education, nursing students will be able to acquire essential knowledge and skills to assist public health (Heidari & Norouzadeh, 2015).
Significance of Implementing Clinical Teaching in Nursing Education
According to Heidari & Norouzadeh (2015), clinical education is the most important part of nursing education whereby the students can put their theory of nursing to practice as all know that nursing is a practice-based profession. Therefore, clinical teaching is the major and essential curriculum in nursing education. A nurse becomes efficient when theory is applied to clinical practice, then they will get knowledge and experience.
2.1 Develop analysis and synthesis skills, attitude and knowledge
It is important to stimulate students to develop analysis and synthesis skill, attitude as well with knowledge for professional development. Clinical teaching offers an approach that is customized to the type and location of the practical training like for example department like medical,surgical,oncology, neurology nurses will teach according to the location of practice and also the supervising nurse selects and prepares experiences for the student, works with her to establishes the connections between theory and practice, create the planned learning program in result to events, observe the student’s work, supports the student when she has emotional responses, helps her move towards the accomplishment of program objectives and, generally, assists in her personal development (Phaneuf,2010).
2.2 Practice evidence-based learning and critical thinking
It is very important to start practice evidence based practice(EBP) and critical thinking in our nursing practice. Currently I am working in labour room and I notice most of the nurses don’t implement EBP. They only talk according to experience but not according to any studies. When we talk according to EBP, even the doctors will respect the quality the nurses have. I had a situation whereby I was ordered to give IM Dexamethasone 12mg stat to a patient with pre-eclampsia, but I refused because i have read a research saying that steroids during high blood pressure among pregnant mothers will cause acute pulmonary oedema(APO) which means retention of fluid which will cause shortness of breath and subsequently collapsed. The doctor also agree to my explanation because I am talking according evidence.Evidence-based practice is a vital part of enhancing critical care nursing practice, which is essential for providing quality care to patients. Adopting EBP to your culture improves patient outcomes and patient, family, and health care provider satisfaction. It can also reduce costs and the risk of harm by decreasing unnecessary tests and procedures (Larsen, London,& Emke ,2016).
According to Larsen, London,& Emke (2016), reflection has been an important aspect of clinical skill. Moreover, the timely self-monitoring of knowledge and abilities is also more accurate than wide self-assessment, therefore making it a key aspect of self-regulated learning. Research has shown that the repeated recall of facts leads to improve the memory. Reflection involves the recall of experience and repeated, frequent reflection may improve the memory of experiences as well. Clinical teaching will teach the students to reflect the mistakes and learn the right way. For example, I have seen medication error which occur when I was a nursing student. The nurse serve fleet enema to an old patient whose operation was canceled and the specialist scolded the nurse front of me and the patient. I went back to my hostel and recall the incident. We all know serving medication should be according the doctor order and standard of procedure but why still error occur. Since then, I always do procedure according the standard of procedure.
Emphasis Strength of Teaching and Learning in Clinical Environment
The outcome of teaching and learning in clinical environment is always positive. It teaches us how to become competent.
3.1 Peer learning and support
According Lahunga(2018), learning and peer support is known as one of the strength of clinical teaching. Most of the studies believes that the model offers a chance to students learn from each other, which assist learning especially when clinical instructor is not available or busy. Some identified peer learning and support of classmates as an important aspect in positive clinical learning. Peer learning experience allows students to share ideas, solve problems and experience common clinical learning, which promotes directed learning, and increase the confidence of students and reduce concerns(Lahunga,2018). I had an experience of learning from my senior how to do aseptic technique dressing in orthopedic ward and she taught me so well as she was in her 6th posting and I was just 2nd posting.
3.2 Problem-centred learning
Student get opportunities to learn from patient’s problem like the disease the patient is having for example patient with breast cancer who is undergoing chemotherapy will give the opportunity to the students to learn and get information from the patient. Learning experience is earned from the amount of time which is spend in the clinical area and how competent a student can be(Hong,2018). Some apply the knowledge into practice and learn faster. Clinical instructor take part in various levels with the curriculum, they can choose clinically better activities that best suit the learning needs of the students and are consistent with the goals and objectives of the course(Lahunga,2018 ).
3.3 Experiential learning
Learning from experience is also something very important. When we perform an activity frequent times or regularly, we will always end up memorizing the procedure especially when we are in a general ward. We will always take over report, then we do the bed, do the observation or serve medication for the patient. We learn because we are exposed to it. Student’s exposure in a multiple settings is a benefit so that they can gain familiarity with multiple clinical units. Students can have flexibility in moving from one clinical learning experience to another. Most of the students who completed their second and third year clinical placements showed enhanced learning engagement. Furthermore, students who possess an understanding of and integrate within an organization were found to cope or manage better when transitioning into a graduate nurse role(Lahunga,2018).
3.4 Individual and team learning.
Another strength of clinical teaching and learning is that by combining the knowledge and experience from an individual to a team. That will increase the knowledge as well with experience. It is important to have a session of sharing the experience before the time in the clinical area finish so that they will be able to gain knowledge. Similar like group revision. I had my practicum during my mental health posting where by we was having a session of sharing our case study and share the medication and the management of the patients and we was able to score the subject.
3.5 Guidance and support for novice students.
One of the strength is the support and guidance provided to novice students particularly during the first placement. The quality teaching, safety, and evaluation tend to be more important for a novice students than advanced students. Therefore, the guidance and supportive learning environment created by clinical instructor is important in maximizing the quality of clinical learning outcomes, particularly for novice students (Lahunga,2018). I believed that not everyone can become an expert immediately, all novice will learn and become an expert from experience which is earned. The experience will make the student become a skillful and hands on nurse in future.
Challenges of Teaching and Learning in Clinical Environment Based on Own Experiences.
Most of the undergraduates will face challenges during teaching and learning in clinical environment. Well, I had my own experience during my basic nursing training, my midwifery training and also during my practicum recently.
4.1 Ineffective communication
In the year 2005, when I was doing my basic in diploma in nursing, I was posted in medical ward for 2 weeks. I wasn’t ready as I don’t have any experience working in hospital before. On the first day itself, I received an order from the staff nurse to clean the patient but I was not so sure how to clean it. I went to ask the staff nurse again but I was scolded by her front of other staff for not knowing to perform a simple work. I was very sad about the incident. However, after my clinical instructor informed the staff nurse that this is our first posting in semester 1 and ask help to guide us in future. Communication is very important from beginning itself. If the staff nurse knew earlier that it was our first time, she will not shout at me. According to Jamshidi, Molazem, Sharif, Torabizadeh, & Najafi Kalyani (2016), It is advisable that the effective communication skills should be taught to students before they enter the clinical environment so that they will know the differences between the clinical environment and the classroom environment.
4.2 Inadequate readiness
I mean to say that I was not prepared as I was lack in knowledge and practical skills. Nursing in general was fine because we will learn with time but when come to specialized nursing for example like during my midwifery course, I was not having enough knowledge to apply into practice as I am coming from a general ward. I was worried as I am going to care for 2 lives which was the mother and fetus and, I only had some memory of basic nursing when I was posted to obstetric department. I never had experience conducting delivery, interpret CTG, vaginal examination, induction of labour, care of high risk patient and so on, but still I had no choice but to continue with the practical. I was thought for 10 weeks theory before sent to labour room. I was very nervous because there was a red alert in the labour room on our second day of practical. The patient collapsed and attended by all staff in the department and everything was so fast. i was ordered by the doctor to prepare for a forceps delivery but I couldn’t do it as I was not having knowledge and skill to recognize the forceps. The doctor scold me and chase me out from the suite because I was useless she said. It is very depressive when we unable to apply knowledge and skill and this was 1 of the challenge I went through. According to Jamshidi, Molazem, Sharif, Torabizadeh, ; Najafi Kalyani (2016), lack of theoretical knowledge and practical skills as one of the problems involved in care-giving. Therefore,it is important for the students to discovered that they are theoretically and practically prepared as they take tests and give care in the skill lab before students enter the clinical environment.
4.3 Emotional reaction
I had an experience during my basic nursing clinical posting. I was posted in a medical ward during my first semester. While making the bed, I requested one of the patient to wake up from the bed so that I could do her bed. I never knew that the patient was asked to complete rest on bed due to unstable angina by the doctor. Then, she woke up and tried standing but she straight collapsed on the floor. Everyone attended her immediately and the patient was intubated but there were no bed available in GICU. I begged the patient from 7.30am to 1.25pm and she was pronounced death. I had so much of stress after the incident because I feel I am the cause of her death. That was the first incident happen and I was traumatized my whole life. According to Jamshidi, Molazem, Sharif, Torabizadeh, ; Najafi Kalyani (2016), nursing students will have stress in confronting the clinical environment an it will affects their general health and disturbs their learning processes.Stress is one of these students’ experiences in the clinical environment and the causes of nursing students stress in the clinical environment is due to three types of stress which are the educational plan, stress due to the educational environment, and factors concerning the students.Nursing students young age when entering the clinical environment and their social and emotional lack of experience lead to stress and psychological problems.
4.4 Inadequate time
During my clinical training from basics to my recent practicum, I notice that the time given for the clinical posting is in adequate. For example, 2 weeks was given for mental health posting which was not adequate. It is not easy to learn everything in 2 weeks as mental health is a large topic. I also notice that lately there is more classes then being at the clinical area. For example, during my midwife course, the time for practical was not enough. We need to conduct 20 deliveries in a year course but we are only given 8 weeks in that 1 year to be in labour room to conduct cases. We always have to compete with the house officer and the junior midwife students who also wants to conduct. We were more into theory then in practical and the outcome of the midwife now is not that quality like those days. I have seen the outcome as I am 1 of their mentor to teach them in labour room currently. They don’t know how to differentiate a normal and abnormal CTG. It is sad but dangerous as well because we are dealing with life of a mother and baby, so we must be prepared to deal with any kind of situation. I will teach the beginner novice to become an expert like me soon.
As a conclusion, clinical teaching and learning has a very major part in nursing practice. We know that it is known as nursing theory applied to nursing practice to enhance the skills and make a competent students. Clinical teaching is a very complex process. It involves various dimensions with high quality teaching and learning in clinical contexts which is updated through the condition of all factors that alleviate student’s learning, improve teacher’s teaching and supervisory skills. The role of teachers is important in this process to promote the feedback and reflection to balance the other factors, such as adequate patient combine and deprived students. Clinical teaching is significant because able to develop evidence based practice, self-reflection, hands-on skills which is very important even though there is multiple challenges during my clinical practicum but still I will say that clinical teaching and learning is the reason of nurses being very competent and skillful. As everyone says ‘practice always make it perfect’.
Cederbaum, J., ; Klusaritz, H. (2009). Clinical Instruction: Using the Strengths-Based Approach with Nursing Students. The Journal of nursing education. 48. 422-8. 10.3928/01484834-20090518-01.
Elliott, M. (2014). Clinical education: a challenging component of undergraduate nursing education, Contemporary Nurse, 12:1, 69-77, DOI: HYPERLINK ;https://doi.org/10.5172/conu.12.1.69; 10.5172/conu.12.1.69
Heidari, M. R., ; Norouzadeh, R. (2015). Nursing students’ perspectives on clinical education. Journal of Advances in Medical Education & Professionalism, 3(1), 39–43.
Hong, L. (2018). Teaching in Nursing (1st ed., pp. 58-60). Open University Malaysia.
International Council of Nurses. (2018). Retrieved from HYPERLINK "http://www.icn.ch/who-we-are/icn-definition-of-nursing/" http://www.icn.ch/who-we-are/icn-definition-of-nursing/
Jamshidi, N., Molazem, Z., Sharif, F., Torabizadeh, C., & Najafi Kalyani, M. (2016). The Challenges of Nursing Students in the Clinical Learning Environment: A Qualitative Study. The Scientific World Journal, 2016, 1-7. doi: 10.1155/2016/1846178
Larsen, D. P., London, D. A., & Emke, A. R. (2016). Using reflection to influence practice: student perceptions of daily reflection in clinical education. Perspectives on Medical Education, 5(5), 285–291. http://doi.org/10.1007/s40037-016-0293-1
Luhanga, F. (2018). The traditional-faculty supervised teaching model: Nursing faculty and clinical instructors’ perspectives. Journal Of Nursing Education And Practice, 8(6), 124. doi: 10.5430/jnep.v8n6p124
Phaneuf, M. (2010). LEARNING AND TEACHING IN CLINICAL SETTINGS Ebook. Retrieved from HYPERLINK ;http://www.infiressources.ca/…/LEARNING_AND_TEACHING_I..; http://www.infiressources.ca/…/LEARNING_AND_TEACHING_I..