Elective course I

Clinical Nursing Education

Course advisor: Dr. Biftu Geda(PhD)

By Agezegn Asegid (PhD fellow)

 Outline of presentation
o Objective
o Essence of CE
o Issues in CE
o CE In HFUH
o Problem and solution
o Lesson learned

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Research question
• What is the current practice of clinical Nursing
education?

Specific objectives
1. To identify current issue using literature review
2. To identify current practice and gaps

3. Describe lesson learned from Elective I course

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Introduction
• Clinical education(CE)
o is the education provided in clinical settings is a
form of communication involving the application of
theoretical and technical knowledge as well as
knowledge about the organization of work and
interpersonal relationships (Phaneuf M 2005)

o Concept of clinical education first started with

concept of hospital based education by Abraham
Flexner (1910) cited from Cantatore F 2016)
(

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 Essence of CE
• Nursing is a profession based on experiential knowledge
in which clinical education can’t be substituted by class
room teaching or other means of learning (Gaberson et al. 2015).
 technical skill,
 Communication skill,
 intuition, and
 being empathetic

• We can’t think of next generation of nursing work force

having proper competency without proper clinical
education.

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 Issues in literature

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 Model issue
• Teaching model: helps to organize, lead and promote partnership
for attaining educational objectives

• teaching model should be adaptable to the changing situation and

innovative… for teaching future professions (Bvumbwe and Mtshali, 2018).
• Clinical teaching models :-
o Traditional or clustership model o Peer Teaching model
o Academic–practice partnerships o Preceptorship model
o Proposed Synergy Model of o Dedicated educational unit model(DEU)
o Clinical teaching associate model(CTA)
preceptorship o Modified clinical teaching associate
for Learning and Care(PSMPLC) model(MCTA)
o The capacity development facilitator
model
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 model ..continue
After selecting specific model… Specific teaching
strategy
• modeling,
• observation,
• case presentations,
• direct questioning,
• think aloud and
• coaching(Judy Lazarus, 2016)

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Clinical teacher related issues
• Who is effective in CE clinical staff or faculty?
o Clinical staff have more information(Dahlke S et al. (2016)
• What responsibility
o Create a climate of mutual trust and respect among teacher, student and
clinical staffs Gaberson et al, 2015).
(

• Challenges faced by teacher

o heavy workload
o Lack of opportunity to update knowledge and skill
o having an excessive number of students
o lack of student preparedness (Dağ GS et al. 2019; Habimana 2016)
• Teacher originated problem (shedadi H et al. 2018)
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Competency related issues
• Competency is the ability to perform a task with
desirable outcomes under the varied circumstances of
the real world.

• How and what is evaluated in assessment?

• Areas for competency evaluation:-
o Concept, theory and knowledge for clinical practice
o Use of evidence for practice
o Nursing process
o Psychomotor and technological skill

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 Competency….
• Indicators of competency:-
o continuing education, o direct observation,
o portfolios, o self-assessment(1st )
o examinations (OSCEs), o interview and
o peer review (assessment), o patient outcomes(2 nd
)

• 1st and 2nd preferable methods in assessing competency

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 Learner related issues
• Preference of learning style
• Visual (25%); Auditory (30%); Kinesthetic (45%)
• Preference of environment
• recognized as member of care giving team
• comfortable enough to make mistake and learn from them
• Preference of clinical educator quality
• supportive clinical teacher ; competent educator and unbiased evaluation
• Student motives and preparedness
• Faced challenges
• electronic devices and access to internet for literature review and
reflection report (Habimana 2016).

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Assessment and evaluation issues
• What and How to assess? And When to assess/

• How to maintain objectivity in assessment

• Three things to maintain fairness in evaluation:
1. the teacher identifies his or her own values, attitudes,
beliefs, and biases that may influence the evaluation
process;
2. clinical evaluation be based on predetermined outcomes or
competencies and
3. the teacher develop a supportive clinical learning
environment.

Gaberson et al.(2015)
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 Ethiopian context
• In Ethiopia Nationally harmonized Nursing curriculum (2014)
o student spent 68.65% of their time for the clinical skill
o preceptorship clinical education model
o teaching strategies
• like problem-based learning, bedside, seminar and various
written portfolio.
o Regarding evaluation, 360 evaluation and OSCE is indicated.
• No study to assess:-
• success and challenges of those methods
• attainment of curriculum competency.

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Research article: Ethiopia
1. Assessment of Factors Affecting Clinical Practice
Competency of Undergraduate Health Science Students
in Hawassa University, South, Ethiopia (Fikre R, 2016)

2. Knowledge and attitude towards nursing clinical

preceptorship among Ethiopian nurse educators: An
institution-based cross-sectional study. international
Journal of Africa Nursing Sciences (Andreas A. Teferraa, Daniel
Mengistu . 2017)

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 Ethiopian
 most of things are lagging behind
 neglected but top urgent area of
nursing education.

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 What is current practice of
Clinical nursing education?

1. Observation
2. Interview

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 What is current practice of Clinical nursing education?

Area Actual data

 Time spent :4hr/2wk
 Visit: Every Monday and Friday
 Round with student : Two times/wk/15 minute/room
 Student evaluation based on clinical evaluation format  
 Bed side Not evaluated
 Seminar Not evaluated
 Nursing care plan Evaluated
 Ward management Not evaluated
 No Actual patient contact with student
 No Feedback
Link not created

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What is current practice of Clinical nursing education?
o No skill performed by Clinical teacher
o Not Using first impression: Came at 3rd day
of the attachment after student lost interest

o No Orientation
o Student not assigned to room and to
specific patient/room

o No Communication of clinical teacher with

clinical staffs

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 Student related
o Less motivated to learn
o Not eager to know status of patients
o Less collaborate in care
o Undermine their significance
o No deliberate contact of patient
o No patient monitoring
o Moving from one ward to other without purpose
o Have not note book
o Browsing mobile at bedside and patient room
o Worn incomplete uniform
o Complete NCP at TV station and at Corridor
o Doesn't know objective, requirements of clinical course

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 Problems
No philosophical or methodological approach

Clinical instructor role was alarming

Less attention, mysterious evaluation and feedback

system

Insignificant involvement of clinical staff

Students less motivated and lacks passion

Not obeying ethical issue

Requirements was not comparable to student level

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 What is the current practice of Nursing clinical
education in HFUH?

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 I recommend
1. Establish empowered system for leading clinical
education
2. Good orientation and preparation for clinical
practice

3. Conducting proper clinical teaching

4. Proper evaluation and feedback practice

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Lesson learned
The review helped me
• to see global trends in clinical nursing education,
and major debatable issues
• to realize that clinical education is
• vital for nursing education
• many challenges on implementation

• scholars are working for new innovation

• To realize we already ignored the issue of CE.

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 Lesson….
Hospital visit helped me
• To sense the challenges of CE
• To appreciate
o the level of organization, coordination and motives
o level of accountability from all parties involved in education
o how the clinical environment is welcoming for nursing CE

• To concern
o how the skill was transferred in the nursing generation?
o How really schools assure competency attainment with the current practice
of CE?

• Thinking and rethinking

o which approach best fit for our context and how I can adapt the approach
is what always contemplate.
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 Conclusion

to reshape the title

knowing
what observing
actual
Rethink about the
literature
talk
practice scope
Helps to focus

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 Reference: sample
• Dağ GS et al. 2019 Difficulties in Clinical Nursing Education:
Views of Nurse Instructors'. International Archives of Nursing
and Health Care

• Lawal j et al.2016. Factors that influence the clinical learning

experience of nursing students at a Caribbean school of nursing.
Journal of Nursing Education and Practice Vol. 6, No. 4.
http://jnep.sciedupress.com

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 Thank you
for attending

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