EDITORIAL
On Clinical Teaching
F ew would question the importance of clinical
teaching and leaming in a practice discipline
like nursing. Yet we continue to have a surpris-
ing dearth of published scholarly works address-
ing this most significant aspect of nursing education. In
reviews ofthe literature published in the mid-1980s, de
Tornyay (1984) and Pugh (1983) reported very few studies
on teaching clinical skills and evaluation of student
performance. In the last decade, fewer than 10% of the
articles published in the Journal of Nursing Education
have explicitly focused on clinical teaching. While there
have been a substantial number of studies on student
perceptions of effective clinical teachers (Bell, this issue of
JNE; Pugh, 1983), many ofthe otber important questions
about clinical teaching and learning go unresolved.
Last winter, we issued a call for papers on cliniced
teaching and received an impressive number of manu-
scriptsfar more than we could publish in a single issue of
JNE. Those accepted for publication in this issue of JNE
represent the wide range of topics and points of contro-
versy in clinical teaching. Several themes emerge from
this collection of papers:
The need to continue to explore the epistemol-
ogy of our practice, and its relation to nursing
education. Most of us understand the age-old practical
difficulty offindingclinical experiences that correspond to
classroom learning; more than ever, clinical faculty are
challenged to provide experiences in settings where
adequate clinical supervision can be provided, with clients
who are not so acutely ill that we worry about their safety.
The challenge is confounded by our commitment to helping
students apply what they've learned in the classroom, and
avoid situations in which they've not had ample classroom
instruction. Packer, in what should he a controversial
proposal, suggests a solution to these and other problems
in clinical teaching: to "teach clinical practice in the
classroom situation, with classes small enough for student-
teacher dialogue."
I think we need much more work on the knowledge of
our practicehow students learn from practice, how they
gain deeper understanding of chnical phenomena, all the
ways in which they must fill out and/or challenge
theoretical learnings in practice. We cannot afford to view
practice only as the instrumental application of theory to
patient care.
The complexity of clinical teaching. Those of us
involved in clinical teaching don't need to be told that it is
November 1994, Voi. 33, No. 9
plain hard work, and extraordinarily complex. Taken
together, the articles in this issue remind us of all the
reasons that this is so: the complex practical considera-
tions in selecting and organizing learning experiences
(Barnard & Dunn, Packer), the challenges of fairly
evaluating the quahty of student's clinical practice (Krich-
baum and associates), the expectations of the clinical
teacher held by students (Sieh & Bell, Wiseman, Canales),
and the anticipation of new nursing roles with health care
reform (Ausberger & Rieg).
The evolving de^nition of nursing faculty. One
of the significant changes for nursing education in the
future is a radically transformed view of who are faculty
(National League for Nursing, 1993). Melander and
Roberts describe an innovative approach to developing
partnerships with clinical experts, incorporating the best
features of staff preceptorships with those of faculty-
directed clinical experiences.
The changing priorities in clinical education,
with increasing emphasis on health promotion.
Increasingly, we expect nurses to practice in naturally
occurring clinical sites, where people live and workin
the home, schools, community gathering places {Na-
tional League for Nursing, 1993). Ausherger and Rieg
describe a restructuring of pediatric clinical experiences
to include community-based experiences emphasizing
normal growth and development and health promotion
practices.
So, with this issue of JNE, have we added to the body of
knowledge related to clinical teaching? Yes, we have, a bit:
we know a little more about what students expect of their
clinical teachers; we have a new instrument for evaluation
of clinical performance that has had initial psychometric
testing and holds potential for more widespread use; we
know a little more about ways of organizing clinical
experiences; and we've considered new ways to expand our
clinical teaching resources through staff clinical teaching
associates. But we're in a Whitewater of change, and we
have much more work to do: getting clear on what we
expect clinical nursing practice to be as we move into the
new millenium, helping students develop the intellectual
and practical skills that will enable them to move flexibly
in a changing health care system, developing clinical sites
that model the ideals of community-based practice, and,
importantly, having processes of curriculum, evaluation,
and scholarship that allow for responsible and sensible
responses to change.
387
EDITORIAL

In coming issues of JNE, we'll take up these challenges W.L. (Ed.), Review of Research in Nursing Education. Thoro-
again. fare, NJ: Slack, pp. 61-78.

References
de Tornyay, R. (1984). Research on the teaching-learning process
in nursing education. In Werley, H.J., & Fitzpatrick, J.J.
(Eds.), Annual Review of Nursing Research, 2, 193-210. New
York: Springer. Christine A. Tanner, PhD, RN, FAAN
National League for Nursing. (1993). A vision for nursing Editor
education. New York: Author.
Pugh, E.J. (1983). Research on clinical teaching. In Holzemer,

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388 Journal of Nursing Education