For nursing students, a substantial part of their education involves clinical practice. There is literature to indicate that when students have a positive experience in the practice setting, they are more likely to undergo meaningful learning. (Flagler, Loper-Powers, & Spitzer, 1988; Wood, 1982). According to literature, a positive experience which enhances student comfort, reduces anxiety and increases the student's self-confidence is more likely to promote the student's ability to apply energy creatively and to achieve learning goals. As the clinical setting is a laboratory in which to learn as well as an interpersonal environment, the cues that the students receive from their teacher can play an important part in the students self-confidence and learning outcomes. This paper will discuss strategies that the writer has used to promote positive learning for students in the practice setting. Although this paper only addresses student learning in nursing, it could be useful information for teachers in other disciplines who are involved in clinical teaching.
Benoliel (1988) identified learning as an emotional experience that involved the whole person and resulted in change. It is an activity that is synonymous with the learner assimilating knowledge and skills into their sense of selfhood, feeling secure and attaining self-esteem. As for teaching, the author postulated that it had "little to do with giving facts and information but much to do with creating an environment where the students were challenged to testing new ideas and achieving a sense of contribution towards their own learning" (Benoliel, 1988:340). It may not be inappropriate then to infer that good clinical teaching involves providing students with guidelines, resources, and avenues for growth and professional development. Whilst most clinical teachers are knowledgeable about strategies that they can use either obtained from literature or trial and error from their own experience, the writer feels strongly that this knowledge should be shared. The content of this paper is thus mainly based on the personal experience of the writer who had worked with students in the clinical setting for 12 years. Information obtained from students in an informal focal group interview will also be presented within the text.
'Someone who sort of has a very sound knowledge of what they are talking about...they know what they talking about...they are not sort of drifting through it like...you can do it this way or you can do it that way...someone you feel confident to put questions to...The teacher must be able to demonstrate to students the links between the various theoretical knowledge from different study units so that students can see the 'whole or gestalt' picture of how everything that they had learned in the classroom fitted into the clinical milieu. For example, say the student has just collected a urine sample from a patient. The student could be asked to explain the anatomy and physiology of the kidneys and common microbes found in urine (this could be drawn from their Human Biology and Microbiology lectures). The student could also be encouraged to reflect on their Behavioural Health Sciences lectures regarding human dignity and what it would have been like for the patient to have an intimate procedure done to them. Several other questions could be posed to the student in a non threatening manner so that a single action is seen holistically. This in this writer's experience has promoted meaningful learning.
Students who fall into the sensate dimension of personality as described by Jung (1972) tend to assimilate knowledge starting from the specific and work towards the general. In teaching these students for example about diabetic care, the teacher needs to focus on a specific care required by a diabetic patient such as how to actually administer the insulin injection rather than teaching about the general care of a diabetic patient. For example:
'It is self-directed, I appreciate that, I don't expect the tutor to stand there and tell us everything but when you are in an unfamiliar environment and you are not fully confident, I need to be spoon-fed every bit of information about any particular thing I'm doing...just the few basic important points I need to know...'On the other hand, students with an intuitive personality tend to assimilate knowledge from the general to the specific (Rorden, 1987). In this case the teacher in explaining about how to perform a surgical dressing would help the student by first going through the principles of asepsis before going through the actual procedure.
'I think you need some sort of overall idea rather than the tutor go through it step by step...it is very difficult to remember every little step...'
'Someone who perceives your needs...someone who provides positive reinforcement as well as criticism...someone who can really support you all the way...at times all you need is for the tutor to say" that was great"...'In situations where teachers need to correct students, they need to clearly convey to students that it is their behaviour that the teacher is not happy about rather than being unhappy with them as people. Students should not be made to feel that their personhood has been put on the line which could damage their self esteem as highlighted by this comment
'A tutor who is approachable...someone you feel you can get information, its a two way thing...someone you feel who has a genuine interest in your progress...a tutor who enjoys nursing because otherwise we get a negative feeling from them...'
'You know you have messed up the dressing...you don't need someone to tell you...even if they said 'be careful about your aseptic technique...something like that and you will think about it the next time you do a dressing...you will remember that the tutor picked up on what you did wrong last time...'and is congruent with Mogan and Knox (1987) whose study found that the worst clinical teachers were perceived by students as those that lacked empathy and belittled them when they made a mistake.
Finally, clinical teachers should present as role models. They need to show students that they are well prepared for teaching and seen as self- confident skilled clinicians who took responsibility for their own actions and who fostered mutual respect.
"The teacher who walks in the shadow of the temple, among his followers, gives not of his wisdom but rather of his faith and his lovingness...he is indeed wise he does not bid you enter the house of his wisdom, but rather leads you to the threshold of your mind."
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|Please cite as: Henderson, S. (1995). Clinical teaching involves more than evaluating students. In Summers, L. (Ed), A Focus on Learning, p121-125. Proceedings of the 4th Annual Teaching Learning Forum, Edith Cowan University, February 1995. Perth: Edith Cowan University. http://lsn.curtin.edu.au/tlf/tlf1995/henderson.html|