ERA UNIVERSITY

ERA COLLEGE OF NURSING

ASSIGNMENT
ON
“CLINICAL TEACHING”

Subject : Nursing Education

Submitted To, Submitted By,

Miss Godhuli Ghosh Archana Devi
Assistant Professor M.Sc.(N) 1st Year
Era College Of Nursing Era College Of Nursing

Submitted On:
CLINICAL TEACHING METHODS/PROGRAMME
INTRODUCTION:
A creative teaching-learning milieu provides the freedom for discovery so vital to learning
professional responsibilities. The clinical teacher who provides opportunities for learning through discovery
and makes teaching selections based on the democratic concept that for every right granted to an individual
there, is an equal responsibility should experience the job of self-fulfillment.

OBJECTIVES OF CLINICAL TEACHING METHODS:

o Understanding health, illness and health care system.
o Developing an awareness of own attitudes, values and responses to health and illness.
o Understanding of the interrelated roles of health care team.
o Developing clinical competencies like reasoning, psychomotor and interpersonal and communication
skills.
o Creating an ability to provide a scientific rationale for interventions.
o Developing self-management skills especially related to time and work load.
o Developing ability to process, record and use data effectively.
o Develop professional accountability.
o Acquire commitment to develop and maintain professional competence.

PRINCIPLES OF CLINICAL TEACHING:

1. Clinical teaching is a vital and irreplaceable component in preparing the nursing students for
professional practice.
2. Clinical teaching should reflect the nature of the professional practice.
3. Clinical teaching is important than classroom teaching.
4. The nursing student in the clinical setting is a leaner, not a nurse.
5. Sufficient learning time must be provided before performance is evaluated.
6. Clinical teaching must be supported by a climate of mutual trust and respect.
7. Clinical teaching and learning must focus on essential knowledge, skills and attitudes
8. Quality is more important than quantity.
9. Nursing student experience stress and anxiety in clinical teaching situations.

THE CLINICAL TEACHING METHODS:

 Laboratory Method
 Nursing clinic
 Bed side clinic
 Nursing Rounds
 Nursing Care Study
 Nursing Assignment
 Nursing Care Conference
 Nursing Team Conference
 Individual Conference
 Process Recording

1)Laboratory Method:
 According to Webster’s New Collegiate Dictionary the laboratory method had its
beginnings in the teaching of chemistry, whereby students went to a work room for purposes of
experimental study involving testing, analyzing and preparing chemical substances.

Purposes of Laboratory Method:

 To provide first hand experience with material or facts in the solution of problem, e.g. Science
Laboratory
 To provide experiences with actual situation such as Nursing Laboratory and Hospital Wards.
 To make student to become skillful in manipulation apparatus, practicing laboratory technique.
 It helps students to acquire scientific attitudes and scientific approach in problem-solving.
 It should be well-organised and well-planned with close coordination, between class and
laboratory work.
Types of laboratory required for demonstration, learning, research, treatment. Classroom, clinical,
community.

a) Scientific laboratory: teach physiology, physical science, chemistry, microbiology etc.

b) Nutrition laboratory: teach about food and practice of cooking for normal
c) Nursing art laboratory: demonstration of some techniques in nursing.

Limitation of Laboratory Work:

 Poor planning and lacks of direction of teacher may result in wasting student time, use of complicated
approaches and consumes time. Poor direction causes blind manual without an conception of the
purpose.
 Lack of budget in getting qualitative-laboratory equipment create insecurity in teachers to operative
them.
Techniques of the laboratory method:

There are three phases of laboratory method

a) Preparation phase:
o It requires establishment of objectives and plan of work
o It motivates the student by presenting problem together with effective method for its solution
o Teacher prepares the plan with cooperation of the student considering objectives not wasting
time
o Teachers allow time for maximum use of laboratory work
b) Work period:
o It refers to that period when demonstration, experimentation or practice for a skill in a nursing
procedure.
o To ensure an effective work period there must be adequate equipment and facilities including
basic tools
o There must be adequate supply of sufficient space, light and ventilation
c) Evaluation:
Group discussion, individual reports of findings, written report of principles learned is the
evaluation tool, which gives more opportunities to the student in mastering knowledge and to put
into practice.

2)NURSING CLINIC:
 “The nursing clinic or patient presentation utilizes the presence of a selected patient as its focus for group
discuss. It affords a direct experience in the discussion of principles and practices of nursing care relative to a
given patient. The purpose is the improvement of nursing care”.

Purpose:

o To apply theory into actual practice by observing inter-viewing and studying a patient.
o To apply knowledge and experience to the real life situation.
o To understand certain types of apparatus
o To improve the nursing care
Size: Small size, approximately 15 students

Preplanning the clinic:

o Determining the purpose of the clinic

o Selecting a patient for home students have given the nursing care.
o Securing the patients consent
o Selecting the setting to be used i.e. bedside or conference room.
o Providing advance preparation of the students.

Levels of Discussion:

o Introduction
o Patient centered discussion
o Post-clinic evaluation
Conclusion:

Clinics are valuable as a teaching and learning device because instruction is carried on in direct relation to
the patient. It develops the powers of observation and stimulates thought and consideration of the nursing care
of the patients.

3)BEDSIDE CLINIC:
There are numerous methods of teaching employed in nursing education in schools and colleges of
nursing. Among them, bedside clinic is also one. As we all know a planned teaching should not be
restricted to the classroom only. It is to carry out in the clinical area. It is one of the best methods of
teaching.

Purpose:

o To provide a learning experience for nursing student to collect information about the patient
with tact and skill
o To improve the students ability to solve nursing problems by detailed study and analysis of
nursing situation.
o To realize the need for understanding each patient as an individual in order to appreciate his
problems and outlook.
o It helps the student to do nursing care plan to fit the needs of individual patient on the basis of
his special problems
o To be able to recognize opportunities for health teaching in the hospital.
 o To understand certain types of apparatus being used on patients.
o To improve the quality of nursing care.

Steps involved in conducting the Bedside Clinic:

a) Planning technique:
o Determine the clinic to whom it is to be conducted, place, date and time of clinic to be held and
on what topic the students have to come prepared.
o Select a patient for whom students have given the care
o Secure the patient’s consent as his cooperation is essential during the clinic.

b) Conducting bedside clinic:

After preplan, the next step is conducting actual clinic.

The clinic should be conducted in the ward or in a class-room, which is adjacent to the ward. If such
conveniences are not there, the clinic should be held apart from other patients providing him sufficient
privacy in a corner of the ward.

o Physical and mental comfort is provided to patients

o Patient is kept at ease
o The clinic usually lasts for 30 minntes
o The number of students should not exceed 10-15 in number.

Advantages:

o Bedside teaching puts the student in an active actual situation

o Covers a limited groups of students
o Permits evaluation of degree to which educational objectives have been attained
o Develops qualities of observation and decision taking
o Ensures closer contact with reality (professional-patient health situation of community, colloaguos and
teachers)
o Permits comparison between reality and theory
o Enables students to develop self confidence
o Increases variability

Disadvantages:

o High personnel cost

o Sometimes puts the patient in a difficulty situation
o Poor standardization
o Narrow limits of utilization.

4)NURSING ROUNDS:
 “Nursing round is an excursion into patient’s area involving the students learning experiences. Nursing
rounds revealed that students responded to this method teaching enthusiasm.

Names according to the purpose:

o Information rounds
o Instructional rounds
o Problem solving rounds

Purposes of nursing rounds:

o To demonstrate symptoms important in nursing care

o Clarify terminology studied
o To compare patients reaction to disease and study the disease conditions
o To demonstrate effects of drugs; ie indication, action etc
o To illustrate skillful nursing care

Advantages of nursing rounds:

o Make classroom discussions more vivid and real and thus improve learning experiences
o Response of the patient is more natural
o Students can select patients with specific problems and plan proper nursing care.

The ways of conducting nursing rounds are as follows:

a) Patients are selected with nursing problems to reinforce their theoretical knowledge.
b) The group observes the behavior of the patient at the bedside and make proper comments.
o The group observes the equipments and articles under use.
o The students return to the classroom to discuss the nursing diagnosis and needed care for
patients.

Preparation by the Head Nurse:

The Head Nurse selects the patients before hand, according to the time available.
Rounds not lest longer than an hour.
The head nurse needs to read the patient’s histories, know the plan for their treatment
and its results, the patient’s progress and prognosis, their nursing care and its effectiveness.
She should post the time for rounds at least a week in advance and indicate the type of
preparation the nurse is to make, that in whether she is to know thoroughly the history care and
progress of her own patients or briefly that of all patients in the ward.
Rounds for staff nurses should be held separately from those of students. Rounds for
senior students should be held separately from those of junior students.
The central figure in nursing round is the patient. If the purpose of the round is
instructional or problem-solving the patient will be included in the discussion.

Method of conducting nursing rounds:

 A brief conference at the side of the patients room/ward has to be held.
Necessary data are given.
The purpose of the visit to the patient is outlined by the head nurse, special observation to be made or
pointed out at this time.
4-5 patients are selected for instructions. 4-5 min is spent.
The head nurse herself may present the uses or she may ask students who are assigned to these patients
to answer the questions of the group or her questions.
The students are asked to present the cases regarding other particulars.

5) NURSING CARE STUDY:

Closely aligned with the nursing care conference & nursing clinic is the nursing care study. Although, the
nursing care study is generally viewed as an individual learning activity rather than a group project, the
nursing care conference & clinic serve as vehicles for the development, study, evaluation, & implementation
of the nursing care study as presented by the student.

Definition:

“The nursing care study is a problem solving activity whereby, the student undertakes the
comprehensive assessment of a particular patient’s nursing problems leading to the planning, implementing, &
evaluating of appropriate nursing care measures. It provides opportunities for the application of previously
learned knowledge & skills to a patient for whom the student is providing daily nursing care”.

The student must have sufficient background information to cope with the problems yet have an opportunity
to channel previous learning in to new avenues of thought with each successive study. Students also need
sufficient library facilities & time to pursue the comprehensive study while actually giving nursing care to the
patient.

Suggestions for fostering the creative use of this tool follow:

a) When students are exposed to a total program of clinical nursing that builds on a problem-solving,
patient-centered nursing care approach, the concept becomes an integral part of the pattern of
learning they pursue.
b) As a natural corollary, the nursing care study should be used when the need exists at a particular time
for a particular student, because it is best method to use in accomplishing the objective.
c) Student who experiences the prevailing philosophy is flexibility in the use of teaching methods will
not resist or question the use or lack of it any more than any other method, & perhaps less than those
who are required to submit a quota of number of nursing care studies.
d) Guidelines for preparing nursing care studies should be limited to the basic directions regarding the
format of the written report, leaving opportunities for the students to organize their materials &
approaches to problem solving according to their own abilities.
e) A written nursing care study offers opportunities for students to learn to organize their thinking &
writing in logical order & acceptable form; meaningful relationships between theory & its application
to actual patient problems are perceived when the student presents the care study orally to the group
members.
f) The nursing care conference & clinic serve as useful media for the discussion of the nursing care
study from the early identification of the problem through periodic progress reports & final
evaluation & follow –up reports.
 g) Further investigation should be directed toward creating new approaches to the use of the nursing
care study or toward determining ways of combining the use of the nursing care study or toward
determining ways of combining the use of the nursing care study with other methods of teaching such
as care study with other methods of teaching such as case analysis or role-playing.

6) NURSING ASSIGNMENT (As a method of teaching )

Assignment in the clinical field is the nursing education-cum-service. Nursing assignment is a part of
organization in the clinical set up.

Definition of Assignment (General)

“It is that part of learning experience where the students are assigned with patients or other activities
concerning to patients laboratory”.

The assignment is one of the top most important phases of teaching because it gives the instructor an
opportunity to guide learning activities by choosing worth while objectives & attaining these objectives
through selection of proper learning activities based on the principles of learning. It is through the
assignment that the teacher is enabled to arouse interest, stimulate right mental promotional attitudes &
sets forth good study habits.

Methods of Assignment

In general there are three methods of assignment in clinical set up:

1. The patient method

2. The function method
3. The team method

1. Patient method: In the patient method of assignment a nurse is expected to give complete nursing care to
one or more patients including general nursing measures, treatments, medications, taking temperature, pulse,
respiration, serving nourishments & giving health instructions.

2. The functional method: when the function method is used, nurses are assigned to specific functions in the
ward such the temperature of all or giving general nursing care to a group of individuals.

3. Team method of assignment: In this method a group of patients are looked after by a group of hospital
staff & students (nursing team).the professional nurses is the leader.

Principle of student’s Assignments

1. The rotation of students through departments & wards according to the curriculum plan of their
course.
2. Sometimes, reassignments can be arranged according to the students who require the same kind of
experience.
3. First year students should be posted where they will receive the maximum supervision & guidance
from qualified nursing staff.
4. The departmental & ward sisters or nursing superin- tendent should be informed in advance regarding
the student’s assignments in their specialty.
 5. The individual student’s differences should also be informed to the staffs.
6. The record should be maintained of the number of hours spent on day, evening, and night duty in
each block of experience.
7. A record of sick leave & other types of leave utilized by the students also be maintained. If needed,
reposting or reassignment my be done.

Advantages of patient method of assignment

1. Patients have security & belongingness.
2. The nurse gets job satisfaction.
3. Interpersonal relationship is good.
4. The maximum learning takes place.

Advantages of functional method of assignment

1. It is having efficiency in the work, hence the term efficiency method.’
2. More work is turned out in less given period of time.
3. There is less confusion.
4. Skill is developed when the work is done repeatedly.

Advantages of team method of assignment

1. Team spirit is created in the team.
2. We can prepare nursing leaders.
3. Attitude of cooperation & co-ordination is learnt.
4. All the members of the team will give the nursing care under the guidance & supervision of the head
nurse.
5. No confusion in authority.

Disadvantages of patient method

1. More nurses are required.
2. Economic loss to an agency or to country.

Disadvantage of functional method

1. Patient does not get any security.
2. Nurses do not get satisfaction.
3. Individual needs are not considered.
4. Interpersonal relationship is very poor

Disadvantages of team method

If there is no cooperation within the team members, the work will not be done properly &
patient will suffer.
It is one of the best methods of teaching, by which, students get more learning experiences &
patient gets good care & good ward management.

7. NURSING CARE CONFERENCE:

Nursing care conference care conference as a method of teaching, which provides an opportunity for an informal
discussion of a problem & free exchange of knowledge & experience about the common interest & it consist of a group
discussion using problem solving techniques or nursing process.
Definition : A nursing care conference is a” curse of action discussion, the focus is on assessing the nursing
problem arriving at possible solutions, helping staff to examine a patient’s problems problems from his point
of view”.
Planning & preparation:
1. The organizers should prepare well in advance regarding particular conference
2. Before presenting, the student will have collected all the data regarding the patient. She will have
worked with that patient & collected information about the signs & symptoms since how long the
patient is sick. What are the laboratory finding? What about his family back grounds,
socioeconomic conditions, etc
3. The conference should be planned in relation to the objective of the conference & it should be
spontaneous in nature.
4. The student should be given ample opportunity to work in the ward for quite a good amount of
time before she is assigned to present in the conference.

Technique
1. The nursing care conference is used as a consultation tool to help in problem solving.
2. The teacher must be flexible & she will help the students during discussion.
3. The conference should involve all the students in discussion. The teacher involves all the student by
putting questions, giving guidance & rechanelling, if necessary.
4. Teacher has to draw out the potential of the students to the maximum in discussion . she will provide
ample time for the students to think.

Phases:
The nursing care conference is used as a consultation tool to help in problem solving. It has got three phases.

They are:
1. opening phase,
2. working phase
3. closing phase
1) Opening phase: The opening phase can be defined as the first two minutes of the
conference. The task is to make a commitment to work on a problem relating to a particular
patient. When happens during these few minutes often sets the tone the entire session.
2) Working phase: The task of the working phase is to arrive at a consensus on problem
identification & solution. Once the patient is selected we have found that a great deal of time
during this phase is spent in delieneating the problem clearly.
3) Closing phase: once the group has worked through the problem-solving and has decided on
solutions, the next phase is closure. The task here is to delegate responsibility to one or more of
the staff to act on the problems.
Advantages:
o It helps the students to collect the information in creative way
o It provides real practical learning environment to the students
o It fortifies the thinking of students, thereby the creativity and judgment capacity will be increased
o It provides free opportunity to think
o Each member will be actively participating in the conference.

Disadvantages:
o It will be little use if the students do not accustom to such situation.
o There are changes of using these conference hours for classroom teaching.

8. NURSING TEAM CONFERENCE:

Meaning of team nursing:

Team nursing as stated by Miss. Dorathy Finkiner, “The assignment method should be used which will
make possible the best nursing care to the patients, provide best experience to staff members, giving them
interest and challenge, and that will keep the unit functioning smoothly and effectively”.

Objectives of team nursing:

o Identifies the patient nursing problem
o Recognizes ability and limitation of various tem members
o Help to communicate the ideas, information on related nursing care
o Utilizes scientific information to influence the cause of nursing care
o Makes generalization from specific information that is factual
o Helps to report, interpret, channelize and carry out hospital or health care problems.

The major types of conferences

1. Team leader direction conferences
2. patient centred coferences
3. Nursing service management conferences
4. Intershift & interdepartmental conferences

Conference procedure
A time is planned each day for the members of the nursing team to meet as a group. During this
period, patient’s problems are identified & explored, & an approach is developed by the team.
The nursing care plans are revised or further developed, according to changing needs of patients.
Each member of the nursing team has recorded during the course of the day the response of the patient
to her care, questions & comments of the patient & individual notes are used as guides in conference.
The team leader, using the kardex as a guide, reads the patient’s name & objective of nursing care.
The members who have the contract with that patient and discuss his response to his care & any
addition information from the patient or his family.
Problems are identified by the group; a plan is projected for the solution of the problems. The kardex is
revised & the objective is altered by the leader.
The head nurse function as a resource & assist the team leader & the team members in identifying
nursing problems and developing nursing care plans the nursing team conference is the planning
stage for the team and assignment of nursing personnel for the following day is developed during
and immediately after the conference.

Advantages:
o It is used to plan for the daily continuity of nursing care that best meets the patients need.
o As a teaching tool, nursing team conference offers valuable opportunities for learning.
o It gives an ability to observe report and analyses significant findings input to its greatest test as
students are confronted with their daily responsibility.

9. INDIVIDUAL CONFERENCE:

The individual conference sometimes described as a conversation with a purpose, more simply, as an
interview. The two terms ‘interview’ and ‘conference’ are used interchangeably. The teacher may introduce
the student to new fields of knowledge, impart information to her regarding this field and strive to motivate
her in the acquisition.

Purposes:
o To guide in teaching
 o To acquire more knowledge
o To discover the interests, needs and problems of individual student.
o To help the student to help herself or himself.

Technique of individual conference:

Teacher should develop good rapport with the students
Allow him to speak or talk freely.
Teacher should not show any prejudice, emotionakl and reactions or bais.

Principles of individual conferences:

Establishment of a definite purpose and specific issues to be covered.
Knowledge of the student
Provide privacy
Provide sufficient time
Establish good rapport
Good listening
Positive effect
Recording of data

Practical uses:
 Diagnostic and remedial teaching in individual conference
 Supplemental teaching
 Discipline
 Clinical teaching
o The nursing care study
o Diagnostic and remedial purposes
o The nursing care plan
o Prevention and orientation to new clinical areas
o Evaluation.
Uses of nidividaual nconference in nursing course:
o It can be used to clarify it helps in supplement instructions
o It can be used to clarify class material
o It can also help to explain answers to questions of individual
o Itcan also used as means of assisting the individual in keeping up eith the classroom situation.

10. PROCESS RECORDING

Definition:
1. The process record as” verbatim account of a visit for purpose of bringing out the interplay between and the
nurse and the patient in relation to the objectives of the visit”.

2. Process recording as “an exact written report of the conversation between the nurse and patient during
the time that they were together. It is also record of the nurses feelings about what was going on at that time
and of the observations of the patient’s behavior during the conversation”.

Purposes and uses:

 The aim of the process recording is to improve the quality of the interaction of bette effect to the patient and
as learning experience for the nurse to continuously improve her clinical interaction pattern. When correctly
used, it
o Assists the nurse or student to plan structure and evaluate the interaction on a conscious rather than
intuitive level.
o Assists her to gain competency in interpreting and synthesizing raw data under supervision.
o Helps to consciously apply theory to practice.
o Helps the writer to develop an increased awareness of her habitual, verbal and nonverbal communication
pattern and the effect of those pattern on other.
o Helps the nurse to identify thoughts and feelings in relation to self and others.

Suggested outlines for process recording:

A short description of the patient, his name, age, educational level, health problems as much as known and
length of stay in the hospital. The date, time, place of interaction and a short description of the milieu of the
ward immediately prior to the interaction will be helpful in understanding the thoughts and feelings of the
patient. It is also helpful to record the thoughts and feelings of the nurse just before interaction.

Process recording in nursing:

Use of the process record in clinical nursing as a tool for developing skills of nurse patient relationships
should follow a logical pattern of:

a) Teacher-student collaboration in defining the specific objectives to be accomplished through the use of
the established goals.
b) Discussion of the relationship between the use of the process record and the accomplishment of the
established goals.
c) Careful, detailed explanation of the total observation, interviewing and recording process.
d) Preparation of the patient for the experience.
e) The students reporting of the interaction soon after its occurrence, including the student’s feelings,
actions and interpretation of feelings and actions communicated by the patient.
f) The students analysis of recordings serve as clues to self-understanding and understanding of the
patient’s needs.
g) Individual student-teacher conferences for the purposes of providing immediate feedback regarding the
students growth in self-understanding and understanding of the patients and
h) The use of clinical conferences for discussion of significant findings by students who are willing to
share their experiences with others.

BIBLIOGRAPHY:
1. B.T Basavanthappa, Nursing Administration, jaypee Publication, New Delhi 2 nd Edition 2009
Page No 302-305.