College of Allied Medical Professions

Department of Medical Technology

Angeles University Foundation
Angeles City

A Formal Written Report for

Health Education:
Clinical Teaching

Submitted by:
Fajutagana, Maria Clarice D.
Lagman, Joseph Bryan Y.
Medina, Pearl Louise R.
Group 10
BSMT 3F

Submitted to:
Mrs. Rowena B. Dizon

September 6, 2015

10.1 PURPOSE OF CLINICAL LABORATORY

1. It is in the clinical laboratory that many skills are perfected.
-

Complex psychomotor skills may be practiced initially in a skills

laboratory, but to be mastered, they often require a live rather than
simulated situation.

2. Infante (1985), noted that the opportunity for observation is an

essential element of clinical teaching.
-

Learners need repeated experience observing patients in changing

circumstances so that they know what to look for in changing
situations.

3. Problem-solving and decision-making skills are also refined in the

clinical laboratory (Fothergill-Bourbonnais & Higuchi , 1995).
-

Learners need practice using these cognitive skills under the

guidance of an educator and other professional staff in real-life
settings.

4. Learners also gain organization and time management skills in clinical

settings (Gaberson & Oermann, 1999).
-

It is in real clinical practice, with the help of the instructor, that

learners find how to organize all the data that bombards them, all the
requests made of them, and all the intellectual and psychomotor
tasks they must perform.
They learn to set priorities by having repeated practice in complex
situations.

5. Cultural competence is a skill that can be learned well in the clinical

laboratory (Gaberson & Oermann, 1999).
-

Learners may know a lot of theory about how to approach clients

from different cultures, but they become comfortable and more
expert with cross cultural care when they care for culturally diverse
clients.

6. Learners become socialized in the clinical laboratory (Chan, 2002).

-

They learn which behaviors and values are professionally acceptable

or unacceptable. They learn about professional responsibility.
The clinical laboratory is a place where consequences for ones
actions are readily apparent and accountability is demanded.
They begin to see staff as role models and they have opportunities to
interact with members of other disciplines on a professional level.
Developing a sense of team membership is one of the most

important goals in the clinical laboratory (Dunn et al., 2000).

Students also learn how to relate to patients professionally and gain
a patients perspective of illness that leads to more caring behaviors.
(Fothergill-Bourbonnais & Higuchi, 1995).

MISUSE OF THE CLINICAL LABORATORY

1. Students have been sent to the clinical setting to gain work experience
rather than to achieve educational objectives.
- Clinical objectives should be as clear and specific as those for the
classroom or skills laboratory.
- Objectives should focus on the application of knowledge and skills
more than they do on learning the future employee role.
2. When novices are given too much responsibility for patient care.
- Expecting too much from fledgling learners causes anxiety, instructor
fatigue, and increased chance of error.
- Learners should not be functioning independently in situations with
relatively high levels of risk.
- They should be providing care in circumstances for which they are
well qualified and for which they have had preliminary guidance.
- Objectives for beginning learners should be quite limited, focusing on
specific processes of care. It is only after specific components of
care have been practiced that the learner is able to integrate
previous learning and provide total care.
3. When learners are supervised and evaluated more than they are taught.
- Educators who are supervising learners in the clinical laboratory may
be expecting learners to perform rather than to practice.
- A certain amount of supervision must take place, but the emphasis
should be on teaching and guiding, with the understanding that
mistakes will be made.
- Learners are at a real disadvantage when they are constantly aware
that the instructor was evaluating them because they cannot do their
best job of learning when they know they have to simultaneously
perform for and evaluation.
- Evaluation of clinical performance must be separated from practice
time.

10.2 MODELS OF CLINICAL TEACHING

1.Traditional method
- Instructors accompany groups (8-12 learners) to a clinical agency
and assign the learners to patients.
2. Infante (1985) developed a model that relies heavily on keeping students
in a skills laboratory until they are proficient with skills.
- Sent to clinical area where they are assigned to practice specific
psychomotor and other skills.
- Instructor may or may not be present.
3. Packer (1994) contend that more information about clinical practice
should be taught in the classroom before learners go to the clinical area.
- Course taught in the classroom, with small groups of students that
would permit a lot of interaction with the teacher.
- Case studies and questioning would be heavily used to apply
theories, and students would, with guidance, propose nursing care
approaches and discuss the alternatives, possible outcomes and
financial, organizational, or ethical ramifications.
- In the course of discussion, the educator would guide the learners to
think about setting priorities, time management, working with and
interdisciplinary team, delegation and professional communication.
- After taking the course, students would be more self-confident and
better able to handle clinical situations in the real world.
Preceptorship Models
1.Traditional Preceptorship
A student is taught and supervised by a practicing nurse employed
by the health care agency while an educator oversees the process
and indirectly supervises the student
2. CTA Model
- Clinical Teaching Associate collaborate with educators in teaching
small groups of students.
- The educators is more involved in the teaching process than in
traditional preceptorships, with the staff preceptor, educator and
student forming a learning triad.
Preceptorship
Increase clinical experience for students and expose them more of the
realities of the work world, which should reduce reality shock
Allows students to learn from practitioners with a high skill level while still
being guided by faculty

10. 3 PREPARATION FOR CLINICAL INSTRUCTION

1. Educators must do a lot of planning before clinical instruction begins
2. Clinical agency sites must be chosen (methodically)
3. Contracts must be drawn up between the school and the clinical agency
- Data of a written contract includes the availability of conference space, parking,
and locker space
- Contract includes the maximum student-faculty ratio, evidence of completion of
health records and possibly criminal background checks for students and faculty,
and evidence of malpractice and general liability insurance for students and
faculty
4. Educator should set up a meeting with the agency staff
5. Educator can proceed with the final preparation for clinical instruction(e.g. making
specific assignments for learners on a weekly or daily basis)
6. Goldenberg and Iwasiw (1998) conducted an investigation of the criteria used by
educators in selecting students clinical assignments
Three most important criteria used in the selection process:
1. Students individual learning needs
2. Patients nursing care needs
3. Matching of patients needs with students learning needs
10. 4 CONDUCTING A CLINICAL LABORATORY SESSION
1. Preconferences
- Learners share some of the results of their research from the
previous day
- Good time to answer students ask questions about their
assignments
- Help learners organize their day and prioritize the care they must
give
- Discusses and plans on patients care
2. Practice Session
- Follows the preconference
- Combinations of strategies such as return demonstration with
explanation, asking and answering questions, and coaching
techniques are used
- Like a checklist
3. Postconferences
- Ideal opportunity for:
pointing out applications of theory to practice,
analyzing the different ways that patients with similar illness
differ in their response to nursing care and treatment
Group solving

Evaluating nursing care

Learners to report what they
Postconferences Challenges:
It is often unstructured that allow for creativity but can
dissolve into meaninglessness
It is usually held at the end of a physically and emotionally
draining practice session
Few learners seem to believed that they learned everything
they could have learned during their practice time and feel
that a postconference is just a boring postmortem session.

Pedagogies that are found to be effective in many clinical settings:

Observation Assignments
- Supported by Social Cognitive Theory
- Observing students as they perform skills they usually cannot
perform
Rounds
- Involves a group of learners & their instructor visiting patients to
whom theyll be assigned
- purpose is to expose learners to additional clinical situations and
encourage them to consult each
Shift Report
- Being able to attend endorsements
- A way for students to learn the uniqueness of nursing communication
and is a means of professional socialization
Learning Contracts
- A written agreement between instructor and a learner, spelling out
the learners outcome objectives
Journal Writing
- Clinical journals promote active learning and reflective practice and
are built on the theory of constructivism.

10. 5 EVALUATING LEARNER PROGRESS

Evaluation remains a difficult, subjective, time-consuming and often puzzling
chore. It is usually the least favorite task of nurse educators, yet it is inescapable.
Why evaluate?
Learners in the clinical area need the feedback and judgment of their
work
They need to know how they are doing at one level before progressing to
the next.
To determine how well the objectives are met.
To certify that they are safe practitioners.
Before beginning the process of evaluation, the individual educator or group
of educators must make several philosophical and practical choices.
Formative vs. Summative Evaluation
Norm referenced vs. Criterion referenced
Grading system
Behaviors evaluated
Formative and Summative Evaluation
Formative evaluation is the ongoing feedback to the learner throughout the
learning experience.
- Identify strengths and weaknesses
- Meet the learning objectives efficiently
- May be graded or nongraded
Summative evaluation is a summary evaluation given at the end of the
learning experience.
- Assess whether the learner has achieved the objectives
- Results in a grade of some type being given
Learners have a right to know how they are progressing in their clinical
work, and educators can protect themselves against charges that they
violated due process of law if they can prove that a learner was kept
apprised of clinical progress or lack of it.
Formative feedback may be given orally or in writing.
Oral feedback - instructor should keep notes about what transpired.
Written feedback - more valuable; learner can take time to read and
absorb the information and the educator can keep a copy for future
reference.

Written formative evaluation notes are often called anecdotal records or

clinical progress notes.
Tomey (2000) advocates recording observations of what the learner says or
does including the date, a description of the incident, and comments. Lacking
such written documentation, the instructor who is called on to justify a summative
evaluation is on shaky ground.
NORM-REFERENCED AND CRITERION REFERENCED EVALUATION
Norm-referenced evaluation a learner is compared with a reference group
of learners either those in the same cohort or in a norm group.
- Evaluation and grading are relative to the performance of the
group
- Characterized as, below average, average, or above
average.
- unless the evaluation tool is specific about what average
behaviors are like, the process may be unreliable.
Criterion-referenced evaluation is that which compares the learner to welldefined performance criteria rather than comparing him or her to other
learners.
- Defines the behavior expected at each level of performance (Cottrell
et al., 1986).
- Fairer than norm-referenced education.
- Grading is less subjective when criteria are spelled out and each
learner is held to that standard.
GRADING SYSTEMS
2 most common options for grading:
Assigning letter grades
Using pass/fail or satisfactory/unsatisfactory approach
Rines (1963) strongly asserted that clinical grades should always be given on a
pass/fail or satisfactory/unsatisfactory basis since human behavior of any
description is much too complex to permit such fine discriminations as required
in assigning numerical or letter grades.
Sources of evaluation data:
Instructor, students, administrators
Patients, agency staff
Records
Conferences between educator and learner:
The evaluation results should be shared with the learner.

 Conference should be held at the half way through and the end of the
evaluation period.
Positive feedback must be given along with the negative.
10. 6 CLINICAL EVALUATION TOOLS
The instrument or tool used for clinical evaluation should meet the following
specifications:
1. The items should derive from the course or unit objectives.
2. The items must be measurable in some way. It must be possible to
collect substantiating data.
3. The items and instruction for use should be clear to all that must use the
tool.
4. The tool should be practical in design and length.
5. The tool must be valid and reliable (Carpenito & Duespohl, 1981).
The educator is in a position of power over the learner.
The learner should receive due process in all aspects of evaluation and its
outcome.
- Due process includes the consistent application of fair criteria based on
evidence and professional judgment (Scanlan, Care & Gessler, 2001).
Educators must take clinical evaluation very seriously and do all they can to
be sure the process is clear, understandable to the learners and
professionally justifiable.
Working with learners in the clinical laboratory is a hectic, demanding and
sometimes anxiety-producing experience. Yet, it is also the aspect of teaching
that often brings the greatest satisfaction and reward.
REFERENCE/S:
De Young, Sandra (2003). Teaching Strategies for Nurse Educators. pp. 238254
Infante, M. S. (1985). The clinical laboratory in nursing education (2 nd ed.).
New York: Wiley.
Packer, J. L. (1994). Education for clinical practice: An alternative approach.
Journal of Nursing Education, 33(9), 411-416
Rines, A. (1963). Evaluating student progress in learning the practice of
nursing (Nursing Education Monograph). New York: Teacher College,
Columbia University.
Gaberson, K. B., & Oermann M. H. (1999). Clinical teaching strategies in
nursing. New York: Springer
Goldenberg, K. & Iwasiw, C. L. (1988). Criteria used for patient selection for
nursing students hospital clinical experience. Journal of Nursing Education,
27(6), 258-265.

 Hawranik, P. (2000). The development and testing of a community health

nursing clinical evaluation tool. Journal of Nursing Education, 39(6), 266-273.
Chan, D. (2002) Development of clinical learning environment inventory:
Using the theoretical framework of learning environment studies to assess
nursing students perceptions of the hospital as a learning environment.
Journal of Nursing Education, 41(2), 69-75.