3-d_workshop powerpoint presentation-ronnie deford

Presented by:Ronnie DeFord, BSN, RN, CCRN(University of Phoenix Master’s in Nursing Education

Practicum Project)

Summarize the role of the Clinical Instructor from expert to novice and the knowledge necessary to perform the role.

Compare and Contrast the various assessment and evaluation tools for clinical instruction.

Relate the best practices in clinical instruction to current practice.

Objectives

Today’s Trends and ShortagesState of Nursing

Nursing Shortage?AACNArizonaNationwide

What is the ISSUE today?Clinical Adjunct Faculty

Clinical Expert ≠ Clinical Instructor

(AACN, 2008), (Bastable, 2008), (West, Borden, Bermudez, Hanson-Zalot, Amorim, & Marmion, 2009)

Clinical Education Trends

• The Ideal Candidate• Master’s Level or above• Clinical Expert• Competent Educator

• The Actual Candidate• Baccalaureate Level• Clinical Expert• Inexperienced Educator

Clinical Faculty

http://www.google.com/imgres?imgurl=http://shop.advanceweb.com/images/products/2008/NW/NW_profess_accessories/badge_tacs_pins/06383_NurseEducateLapelPin_NW/06383_NurseEducateLapelPin_NW_med.jpg&imgrefurl=http://shop.advanceweb.com/Jewelry/Pins/6383-Nurse-Educator-Lapel-Pin.aspx&usg=__D-ViGMbKHuU-OsRyHgeoELvDHmI=&h=290&w=279&sz=74&hl=en&start=3&tbnid=1GdRcvBDd4wD2M:&tbnh=115&tbnw=111&prev=/images%3Fq%3Dnurse%2Beducator%26hl%3Den%26gbv%3D2%26tbs%3Disch:1&itbs=1

The ProblemDo Clinical Instructors lack the proper

education to enhance their delivery in the clinical setting?

The DataLevel of Degree at EntryAssessments and EvaluationsClinical Instructor workshops that provide

instruction The Solution

Provide workshops that educate Clinical Instructors on the basics and best practices.Bridge the gap between practice and theory

Clinical Instructor SurveySent Out to Six Universities asking for volunteersRandom email response

Respondents (n=20)11 different colleges

Data SummarySpreadsheet and Graphs

Majority were BSN’sWhat is missing?

But…..are we prepared before going in?

Level of Degree at Entry Level to Clinical Instructor Role

65%

24%

1%

10%

BSN Degree

MSN Degree

MSN-ED Degree

ASN + Non-Nursing

If we provide teaching…..What do we teach?What is already in use?

Common Themes…..but wait….. No Instruction????

Yes!60% suggested education and mentorship

What should be included?Annotated Bibliography

Journal ArticlesMentorTextsColleagues

Is there a Need for Clinical Instructor Education and Training?

Yes

No

““We need facilities to We need facilities to provide us with training and provide us with training and a mentor who will help us a mentor who will help us the first time out there”the first time out there”

Cognitive Knowledge

Affective Attitudes

Psychomotor Skills

(Emerson, 2007), (Bloom, Engelhart, Furst, Hill & Krathwohl, 1956), (Krathwohl, Bloom & Masia, (Emerson, 2007), (Bloom, Engelhart, Furst, Hill & Krathwohl, 1956), (Krathwohl, Bloom & Masia, 1956)1956)

Domains of LearningBloom’s Taxonomy…….Old School

No other area of education requires all Three domains like clinical education does!No other area of education requires all Three domains like clinical education does!

Old Version…Old Version… New Version…New Version…

http://www.odu.edu/educ/roverbau/Bloom/http://www.odu.edu/educ/roverbau/Bloom/blooms_taxonomy.htmblooms_taxonomy.htm

Which does the NCLEX use for their Test Plan?

The Knowledge Dimension

1.Remember

2.Understand

3.Apply

4.Analyze

5.Evaluate

6.Create

A.Factual Knowledge

B.Conceptual

Knowledge

C.Procedural

Knowledge

D.MetaCognitive

Knowledge

The Cognitive Process Dimension

•Two Dimensional Table•Examine the verb and the noun to decide placement

•Verb-cognitive INTERSECTIONS!

•Noun-knowledge(Anderson & Krathwohl, 2001)

Let the Games Begin!

We will return in 15 minutes……….

Pop/Snack MachineCold Bottled Water

www.funnypostcard.comwww.funnypostcard.com

Dr. Roberta Emerson CCRN Alumnus Associate Professor Washington State University College of Nursing Spokane Washington

Author of Nursing Education in the Clinical Setting (2007)

About Lifelong Learning…..

“Admitting fallibility while caring deeply about what and who we teach, being open to change and willing to risk, and sharing success with our peers, clinical nurse educators leave their mark on their students, their profession, and the future of health care and society”

Thank you Dr. Emerson for your mentorship and guidance…….

Barbara Miholich, MSNFor being my second mentor….

Daniel Faretta, RN, MBA, BSNFor being the perfect colleague and collaborator!

Tracie Schroeder, MBA, MHA, PMPFor sharing her vast knowledge of Assessment and

everything in between!Gerald Fox, MBA

For sharing his technical aspect on things!

Thank you for your contributions that made a difference!

Tootsie Rolls for your Sweet Tooth?NO………….. Objectives and Bloom’s levels of taxonomy

Very Important in Clinical SettingWe must build on their knowledge, attitudes, and skills.

Questions and Assignments must increase in the level of difficulty If we lack the knowledge, our students lack the experience

and growth…..

A novice problem…… A professional nurse educator solution

Take responsibility for that which you do not know

((EmersonEmerson, 2008) , 2008)

BennerNovice to Expert

The StudentYes…..the Clinical

InstructorStress/Anxiety in new

rolesRevisiting the Novice

role

Adult Education TheoryAndragogy

Malcolm KnowlesSelf DirectionProblem CenteredLife ExperiencesApplicable Now

Trust and Respect=A Must

Knowing your Models

((O’ConnorO’Connor, 2007), 2007)

Professional RolePractitionerLeaderScientist

Transferor of Knowledge

Why is this Important?Used with Permission from Maria O’Rourkewww.RoleBasedPractice.comPhone: 415.461.1433Email: [email protected]

Maria O’Rourke Model of the Professional Role

Thoughts?

Gaberson and Oermann (2007)Direct QuoteClinical=Real Life ExperiencesNursing=Professional Practice Discipline

Clinical Instruction is Expensive So…Learn in the Classroom…Apply/Test in Clinical

Do you see the Problem Here?

Role TransitionExpert to Novice to Expert

How?Assume the Professional Role/Clinical Educator Role

Teaching is an Art Reach Out and Seek Perform Role with Competency

Know your Roles!

Orange Cards….Stand Up!

Clinical Educator Role

Clinical ExpertLeaderRole ModelInterpersonal

Relationships Liaison

TeacherEvaluator

Copyright 2010. All Rights Copyright 2010. All Rights ReservedReserved

(Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010) (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010)

The Basics…

KnowledgeableShares ItTheoryPractice

Clinical CompetenceTransition

Bedside to Clinical Instructor

Bridge the Gap


Knows PurposeProtects PatientsProtects StudentsPrepares StaffPromotes Best PracticeLearning AssignmentsGuided Observation


Caring BehaviorsProfessional Behaviors“How to Think Like a

Nurse”Skill CompetencyWar Stories


#1 Student StressorAttributes of a Clinical

Instructor What are they?

Clinical Instructor Expectations

Student ExpectationsCollege of Nursing

ExpectationsClinical Site Expectations


Green Cards…..Stand Green Cards…..Stand Up!Up!PINK Cards……Stand Up!PINK Cards……Stand Up!

FacilitateThe Process

ID OutcomesAssess LearnersPlan ActivitiesGuideEvaluate

Skilled in Clinical Teaching (YELLOW CARD #1)

StimulateSupportGuide (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010) (Gaberson & Oermann, 2007), (Emerson, 2007), (Caputi, 2010)

Assesses Student LearningReflects CompetencyReflects Level of Learning

Transfer of LearningStrategies

FormativeSummative What can be What can be

Learned?Learned?What has been What has been

Learned?Learned?


In the Kitchen Area………Will return in one hour……….

www.googleimage.comwww.googleimage.com

How do I teach?DemonstrationWar StoriesQuestioningListeningNursing RoundsKNOW…best practices!

Bridge that Gap Between Theory and Bridge that Gap Between Theory and Practice!Practice!

The Gateway to Best Practices in Clinical Instruction…

AssessmentsCare PlansConcept MappingCase StudiesReflective JournalingAnecdotal NotesQuestion and AnswersGrand RoundsCompetency Skills

ChecklistsOne Minute PaperTeaching PlanShift Report

EvaluationsStudent Self-EvaluationFormative EvaluationsSummative EvaluationsAnecdotal NotesObservationsClinical ConferencesOral Presentations

YOU NEED TO COMMUNICATE THE EXPECTATIONS!

Best Practices ?

Care PlansAnalysis of ProblemsPlan of CareGuides LearningProblem Solving?Critical Thinking?Time to Move On?

(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010),

Not another Care Plan!Not another Care Plan!www.googleimage.comwww.googleimage.com

Concept MappingGraphical ArrangementKey ConceptsRelationshipsGreat Group Activity

Post Conference

(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010), (DeYoung, 2009)

http://www.m2hnursing.com/N210/http://www.m2hnursing.com/N210/hyperkalemia.jpghyperkalemia.jpg

Reflective JournalingReflect on clinicalRecord perceptionsExamine DecisionsProvide Feedback



Case StudiesForm of SimulationUnfolding Case StudyStimulate Critical ThinkingFlexibleTheory ApplicationDiscussion QuestionsInnovationFacilitationThink Out LoudChoose WiselyPurchase or Develop

(Emerson, 2007), (Gaberson & Oermann, 2007), (Caputi, 2010)(Emerson, 2007), (Gaberson & Oermann, 2007), (Caputi, 2010)

Anecdotal NotesRemembering It All?Feedback ONLYWeekly FormativeShare with StudentLegal Document


How do I keep up with 10 students?How do I keep up with 10 students?www.googleimage.comwww.googleimage.com

Question and AnswersStimulate/EngageCritical ThinkingOpen Ended


Grand RoundsInstructor/Students

Visit Patients? Privacy Issues



CompetenciesTracks LearningLegal DocumentCommunicates


One Minute PaperApplication/AnalysisTheory to PracticeFeedback


Future Future Nurse!Nurse!


Teaching PlanIndividual or GroupBrochuresPresentations4 parts


Shift ReportSBARListen to ReportGive ReportSocialization


Tools are only as good as the faculty who implement them.

Students are ‘overwhelmed’ with writingLet them Think

Not all students learn the same wayLet them choose their assessment

Read what the Experts sayJournals, Texts

Share your KnowledgeJournal club of educators from many

universities

(Emerson, 2009), (Gaberson & Oermann, 2007), (Caputi, 2010),

What are the steps?1. Know your:

1. Objectives2. Assessments3. Evaluation Tools

2. Communicate in Advance the Expectations for how a student will be evaluated!

-Saves you much heartache down the road! Purposes of Evaluation

Identify existing Abilities/Aptitudes Were the outcomes achieved? What learning needs or areas need improved? Satisfactory level of performance?

Evaluations


Student Self-EvaluationFuture PreparationObjectives/

CompetenciesStudents view of

ProgressOpportunity for

Feedback

(Gaberson & Oermann, 2007), (Caputi, 2010)(Gaberson & Oermann, 2007), (Caputi, 2010)

Evaluations

Anecdotal NotesGuides the EvaluationAssessment to

Evaluation

Susan performed a head to toe assessment today without assistance and meets competency. Susan was observed placing a PIV which required 2 prompts by instructor. Susan observed a Lumbar puncture, asking appropriate questions. Susan demonstrated critical thinking during several discussions today about her patient and in regards to sepsis. Susan lacks assertiveness when interacting with the patients families and needs frequent encouragement to communicate with the families and provide teaching. Susan and instructor discussed her progress and made goals for next week which include being more assertive in family teaching and practicing skills at giving/receiving report using SBAR.

(Caputi, 2010), (Gaberson & Oermann, 2007)(Caputi, 2010), (Gaberson & Oermann, 2007)


Formative EvaluationsFeedback on ProgressIdentify Further LearningNOT gradedExtensiveWhat Can Be Learned

Summative EvaluationsSummarizes CompetenciesEnd or MidpointDelivers Grade

Pass/FailRating Scale?PeriodicWhat Has Been Learned

Requires Face to Face Discussion!

(Caputi, 2010), (Gaberson & Oermann, 2007), (Emerson, 2008)(Caputi, 2010), (Gaberson & Oermann, 2007), (Emerson, 2008)

ObservationsValid/Reliable?Observe more than

onceRefer to CompetenciesSampling of

PerformanceRecord

Oral PresentationsCommunication

NCLEX SafetySBARPatient

IdentificationTeamworkCollaborationDelegation

Evaluations

(Caputi, 2010), (Gaberson & Oermann, 2007), (Emerson, 2008)(Caputi, 2010), (Gaberson & Oermann, 2007), (Emerson, 2008)www.googleimage.comwww.googleimage.com

Clinical ConferencesVerbal Feedback

Very EssentialBe Creative

Student EngagementNot Time to Lecture


6 students3 patient assignments

Pick on Friday nightUse patient information form; 30 minutes

3 take ‘special’ assignmentsAll 3 are assigned the patient assignments above

1 does ABC, Maslow, APIE Prioritization Write 500 words on Friday night

1 does Relationships and how patient information relates to each other Write 500 words on Friday night

1 does the charge position Write 500 words on Friday night

Ignativicius (2010) Nurse Educator BootCampIgnativicius (2010) Nurse Educator BootCamp

Students were ENGAGED!Those with patients shared their dayThe priorities nurse shared the NANDAThe relationships nurse shared the CONCEPT MAPThe charge nurse shared her role and how

decisions were made.Students were excited!Students were jumping up and drawing on the concept

map!Students revealed MORE about their critical thinking

than when they did care plans!

Ignativicius (2010) Nurse Educator BootCampIgnativicius (2010) Nurse Educator BootCamp

“When your students graduate and embark on their own professional practice journey, what will they hear when your voice comes to mind? What will they carry into their future practice that is a reflection of your teaching, your caring, your values and beliefs about nursing?..........

Clinical Nursing Instruction is the door to the real world of nursing. What students experience as they step through it will impact the view they see and the future world they create………….

Clinical nursing faculty hold the key…”

To those who participated in the survey…To those who spread the word about this

workshop…To those who offered assistance…To all of you for attending today… AND…. To all the experts in the field of clinical

instruction (Benner, Blach, Caputi, DeYoung, Emerson, Gaberson & Oermann, Ignativicius, Nightengale, and O’Connor)

Who have led the way for others….

Please take the time to fill out the evaluation formImportant final step in Practicum

Drop off in the Basket as you Leave Today

See your Handouts for all references cited in this PPT presentation.

3-d_workshop powerpoint presentation-ronnie deford

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