Introduction
This essay paper reflects on my teaching effectiveness and efforts necessary in teaching students in the clinical setting. It takes into consideration learning theories, models, and strategies used in delivering content to learners. Much of the theories and models are discussed based on research conducted. These strategies helped improve students’ thinking as they were placed into real-life situations rather than being learners through listening only Clinical teaching and learning in a clinical environment focuses on real problems in the context of professional practice (Smith et al., 2004). I tried to motivate my students through active participation which allowed them to have purposeful interaction with the experience. Teaching and learning strategies at that level required recurrent thinking. This was because the fundamental concepts learned previously required to be applied as learners built on and learned beyond nasogastric insertion basics. Once learners developed an attitude of inquiry and knowledge based on the nasogastric insertion process, I allowed them to develop and use knowledge in clinical situations. I also used the learning lab for simulated learning as well as theories and models studied. The lab offered students a safe, controlled environment to develop critical thinking. Simulations in the learning lab promoted students’ exploration of various options available in nursing care. In this learning environment, learners were given a chance to question, explore, and experiment using simulated patient examples (Timby, 2008). Students were allowed to apply reasoning skills without constraints of limited time and reflect on decisions made during the course of the experience.
Considering peer feedback, I needed to reflect on my teaching strategies, theories, and models (Burton, 2000). I used the rating as an essential component of the teaching evaluation system. It helped establish strengths and weaknesses as well as analyze techniques used in a clinical setting (Rose, 2005). The review of my reflective teaching session brought me to surface alternative teaching strategies that I could apply to make it more engaging and clear to learners (Mantsoukas & Jasper, 2004). Feedback assisted effectively in determining those skills which have not been acquired, that offer learners the opportunity to reflect on their dismal performance. The sections discussed below include a review of related literature, the clinical teaching process of nasogastric insertion procedure, recommendations, and conclusion.
A Review of Related Literature
Nasogastric tubes are usually inserted by nurses. Nursing responsibilities in this process include maintaining the tube patent, implementing the prescribed use, and removing the tube when it has accomplished its therapeutic use (Timby, 2008). The process of inserting a nasogastric tube involved preparing the patient, conducting pre-intubation evaluation, and inserting the tube. Nursing students must understand that most patients experience anxiety about having to swallow a tube. They should know how to effectively communicate with clients to convince them to agree to the procedure. For instance, suggesting to clients that the tube diameter is smaller than most places of food. This may foster the outcome. They should be taught skills on explaining the procedure and providing instructions on how the patient can assist while the tube is being inserted (Keisey & Ewing, 2008). This may further reduce the patient’s anxiety. One of the most important ways to support patients is to provide them with some means of control. For example, the nurse can establish a signal with a patient, such as the patient raising the hand, to indicate that the patient needs a pause during the tube’s passage (Spencer, 2008).
Nurses need a focused assessment before insertion. This focused assessment includes the patient’s level of consciousness weight, bowel sounds, abdominal distention, the integrity of nasal and oral mucosa, ability to swallow, and cough, and any nausea and vomiting (Timby, 2008). Evaluation outcomes serve as a yardstick for future comparisons and may suggest a need to modify the procedure or equipment used (Nasmith, 2001). The main goal of assessment is to determine which nostril is best to use when inserting the tube and the length to which the tube will be placed (Neary, 2000).
In the presented section, I also used the reflection model based on reflective theories and caring pedagogies. Its effectiveness was approved by theoretical approaches that I presented below in the literature review.
The primary concern of nurses when inserting nasogastric tubes, are to cause as little discomfort as possible, to preserve the integrity of the nasal tissue, and to locate the tube within the stomach, not in respiratory passages (Keisey, 2008). Once the tube is at the final mark, the nurse must confirm the location within the stomach. The physical evaluation methods that nurses use to determine the distal location of a nasogastric tube include; aspirating fluids, auscultation of the abdomen, and testing the PH of aspirated liquid. If the aspirated liquid appears clear, brownish yellow or green, the nurse can conclude that the source is the stomach. The nurse can also instill a 10ml or more of air while listening with a stethoscope over the abdomen (Timby, 2004).
Effective Theories, Models applied to a Clinical Teaching Process
Learning about the major models of clinical education creates a range of benefits because it empowers clinical education experience. Informal clinical educations are striving to ameliorate the overall planning, structuring, and integrating the clinical practice for the purpose of favoring specific modes of interaction between healthcare professionals and patients (Rose and Best, 2005, p. 29). In this respect, the necessity of introducing models, theories and pedagogies is crucial for improving and amplifying the introduction of complex unity of theoretical frameworks to be applied in the clinical education field.
Teachers should be aware of the importance of the reflective practice that provides a number of benefits and merits. Specifically, it can facilitate the clinical teaching process that moves from performing at a rational level to a more humanistic approach that involves caring pedagogy. The relationship between the teacher and the student should be highly interactive, connected and infused with trust by its nature. It should be a caring relationship between the teacher and learners (Lyans, 2010). Experiences in learning that encourage dialogue increase awareness of divergent ways of knowing. Every teaching period is an opportunity for teachers to model caring (Susskind, 2005).Interpretive pedagogies are involved in interpretation of context for learning and challenge teacher-centered assumptions of outcome based nursing education. Thus, the faculty becomes co-learners within interpretive pedagogies (O’Connor, 2006; Oermann, 2009). In whole, the all above-evaluated theories can greatly contribute to the clinical teaching session at issue because they cover all aspects and constraints of teacher-learner interaction in the clinical environment.
According to Croxon and Maginnis (2009), clinical environment provides student with opportunities to learn on an experimental basic. In order to create a consistent learning environment, the nursing staff should available, friendly, and wiling to teach. In this respect, students should have equal opportunities for developing competence and confidence in clinical skills and focus on student learning needs rather the ones expressed by the nursing facilities. Consequently, the researchers offer a preceptor model for students that consists students’ working under the control of individual nurses (Croxon and Maginnis, 2009, p. 238). Such an approach can be effective in case the teaching model is introduced to small groups of students.
Similarly to Croxon and Maginnis (2009), Delunas and Rooda (2009) underscore the necessity to introduce efficient teaching models and approaches because they have a potent impact on the quality of patient care. Specifically, they also apply the partnership teaching models that would allow to teach students under the auspices of registered nurses. The clinical collaboration models engage the nursing to work as clinical assistant that would monitor the clinical teaching process. In fact, such a model can be advantageous for the nurses professionals because can improve their communication and collaborative skills that in future can positively influence their interaction with patents. In addition, the introduction of clinical expertise is another valuable experience for nurse student to gain while working in a clinical environment.
Unlike the previous studies presented above, Lindahl et al. (2009) resort to a three-stage student-centered clinical education model that is based on reflective learning model. In particular, the model focuses on human caring science that is narrowed to the analysis of patients’ experience. Indeed, empirical observations and individual evaluation can fill in the gap between theory and practical application in the field of clinical education. This proposed model, however, can be used in combination with problem-based learning as presented by Ehrenberg and Haggblom (2007) who consider it a priority to advance students’ cognitive skills and broaden their experience in making important decisions.
One of the salient theories that should be introduced into the clinical teaching process is the analysis of adult learning theories proposed by Knowles et al (2005). Specifically, the presented school of thought has defined certain characteristics of adult learners. First of all, adults are more self-directed and autonomous. They are motivated enough to direct themselves and, therefore, teachers much engage adult participants into the learning process and facilitate their academic advancement. In particular, they should direct the participants at discovering the major topics and working on particular projects reflecting their interests. Second, adult learners have a greater founder of knowledge and life experience that relates to family responsibilities, work-related activities, and previous education. In this respect, they should refer to their experience and use as the basis for further education. The learners will also have richer theoretical and conceptual background. Third, the adults have a problem-centered orientation. They know which goals should be achieved and appreciate the educational curriculum where all problems and goals are clearly defined. Finally, adult learners are ready to learn, which means that they focus primarily on lessons that might come helpful in their present and future profession. Using these implications can greatly contribute to understanding the differences and advantages of teaching adult learners who are more motivated and goal-oriented. This specifically concerns the nurses who work already and who want enhance their knowledge and competence in the field.
Finally, the clinical teaching process can be significantly by implementing behaviorist and humanist theories that can serve a curriculum foundation. These theoretical frameworks can contribute to shaping behavior and psychomotor skills and developing problems-solving skills. This combined approach is highly recommended to be applied to daily teaching practice. According to O’Connor, “the behaviorist approach involves stimulus substitution, where a second stimulus, usually unassociated with the primary stimulus-evoking behavior, is substituted for the first to yield a response” (2006, p. 36). Therefore, it is important for teachers to study behavioral patterns to implement the ones that reflect learning.
Humanist theory should also be implemented because nurses should be learnt to ethically behave and response to patients and clients in an ethically justified manner. Specifically, collaborative learning and effective assistance will help learner adjust their knowledge in a clinical setting. Hence, humanistic theory is a teaching method assuming that humans are inherently good and have unlimited potential for self-development and professional growth. Consequently, the framework focuses on personal freedom, self-determination, choice, and self-actualization (Keating, 2010, p. 64). In addition, this theory also places an emphasis on cognitive and reflective processes that are vital for promoting an academic process and acquiring new knowledge in the field of clinical practice. The development of humanistic approach has been due to the Rogers, a theorist who believes that people value love, respect, attention, and respect that positively influences their behavior and attitude to the process of learning (Keating, 2010, p. 64). Therefore, both methods should be implementing in clinical teaching session for foster an academic process.
In ensuring the success of teaching/learning process, I used relevant pedagogies which included traditional, caring and interpretive. Traditional pedagogy uses teaching and learning approaches derived from behavioral learning theories (Titsworth, 2004). When it comes to nasogastric tube insertion as a nursing practice, heavy emphasis is in skill acquisition. This is because behavioral theory supports both procedural learning and skill acquisition (Emerson, 2009). Thus, traditional pedagogy is not only appropriate but also superior compared to others. Simulation approach was intended to increase learner confidence in handling nasogastric tube insertion procedure effectively (Smith & Johnson, 2002) In essence; therefore, learner feedback was necessary. Nasogastric tube insertion is learnt by all students within the fundamental curriculum (Medley and Horne 2005). Therefore, the learning outcomes, although minimally rigorous, formed the basis for future consideration.
The Clinical Teaching Process
The clinical teaching process consist of several stages involving the planning and presentation of material, teaching and explaining the new concepts and ideas, evaluation and providing feedback.
- Planning and presentation: I presented learners with information relating to the rationale for Nasogastric tube insertion procedure. I also gave them a brief review of relevant anatomy and physiology, as well as the correlating nursing diagnoses, interventions, and outcomes (Spencer, 2008). I then allowed learners to observe me performing the skill in an iterative manner with explanations throughout nasogastric tube insertion procedure. Finally, I allowed learners too practice as much as possible on the mannequins available in the nursing laboratory. By applying this approach, I expected learners to review information prior the initial lecture and apply to nursing laboratory to practice nasogastric tube insertion skills before the end of competency evaluation. In addition, learners were provided information on access, basic verbal and written instructions for use, and hardware requirements for home installation (Naismith & Steinert, 2001). I made it clear to students during orientation process, that the use of a simulator was not included as part of their grade; rather, it was an available resource to supplement their current learning (Jafferies, 2005). At this time, students were given a survey inquiring about their previous use of a computer, current comfort level with learning on a computer, and their anxiety and comfort level with performing hands-on nursing skills (Schaefer & Manuel, 2003).
- Teaching and explaining: Having exposed learners to the learning content, I made them aware of the experience; they began to form mental reactions to their stimuli, and became prepared more for nasogastric tube insertion experiences. At this level, I set the stage for learning by presenting basic concepts of nasogastric tube insertion procedure. My main goal was to develop skills in applying knowledge in the delivery of nursing care. However, I made sure learners acquired knowledge prior to their application. At this point in learning, I used lecture method as an effective strategy for the introduction of content (Smith 2002). However, my learners needed extra teaching and learning strategies that gave them opportunity to manipulate and process basic content. Other strategies I employed in enabling learners to apply basic content on nasogastric tube insertion process include; study guides, case studies, and group discussions. Case studies strategy enabled me to teach students on how Nasogastric insertion concepts are applied in clinical situations. Through this approach, I was able to show students how selected nasogastric tube insertion interventions focused on patient outcomes.
- Evaluation: I also allowed students to participate actively in classroom discussions. Through students’ involvement in classroom discussions, they were able to learn from other students while developing their personal thinking skills on the subject matter. In this strategy, learners were able to challenge each other’s ideas and opinions. I continuously monitored the students’ use of thinking and thoughtfulness and intervened as appropriate to redirect groups.
- Feeback: I used study guides strategy that enabled learners to seek out basic information relating to nasogastric tube insertion procedure. The study guides directed learners to reply questions about nasogastric tube insertion. Patient scenarios promoted commencement of application thinking (Timby & Smith, 2004). This encouraged students to independently search for information encouraging them to discover things for themselves. As learners study new material, I provided them with adequate opportunity that encouraged them to ask why and how. This enhanced the value of students’ own learning the new information.
Recommendations
My presentation would have been more complete and interesting with the use of reflective journals. Students’ use of journals was an important strategy to encourage reflection on an experience and to evaluate their performance and responses to the experience. Through reflection, learners were able to get an opportunity to weigh, consider, and select. The use of reflective journals encouraged learners to think about their exposure and to examine the components as well as the overall experience. To be more effective, I would have given specific guidelines on what information to include in the journal. For instance, reflective journals allowed learners to describe patient care situations, and were able to give analysis of important events in delivery of patient care. The development of critical thinking was enhanced when learners were asked to identify decisions or priorities set during the clinical experience.
Preferring caring pedagogy as the core teaching philosophy can be efficient in the course of interaction with students because it provide them with deeper comprehension of the essence of collaboration and communication between the nursing professional and the patient. In this respect, I was planning to rely more on the preceptor model and student-centered model proposed by the researchers. Viewing the teaching strategies from this retrospective will allow me to understand the major constrains in teaching that are specifically based on students learning styles and their perception of the material.
Conclusion
The challenge of professional clinical education lies in the production of care providers who can think critically. Nurses face tremendous challenges as a result of changing health care, acuity of patients and a dynamic culture. Nursing education must attune itself to considering critical thinking concept (Titsworth, 2004). This consideration involves evaluation of all elements of the teaching and learning process, such as; teaching/learning strategies, curriculum, and evaluation measures; and learner-centered teaching strategies or approaches used to advance critical thinking (Neary, 2000). These approaches assisted greatly in the development of engagement, critical thinking, clinical reasoning and innovative practice. The outcomes from these teaching strategies enabled learners to take more responsibility for their own learning and display more maturity as learners (Hodges, 2006).
In a clinical learning environment, students should think like nurses. To do so, they needed to use critical thinking and reflection as a strategy to evaluate evidence. Nurses with enhanced personal attributes turn to be superior nurses, and are in good positions to offer satisfactory patient care. It is vital that practical experiences nurses that nursing students’ get is related to theoretical learning to develop an environment that enhances reflection on nursing practice, teachers need to increase their attention on student learning, strategies they are sure work, facilitate learning process, allow students to discover by themselves without interference, and others (Neary, 2000). Reflective teaching offers learners an opportunity to take a clinical decision and acting on those decisions. The clinical teaching/learning environment offers teachers stimulating chances develop their teaching specialization (Emerson, 2009). Nevertheless, improvement of teaching and learning is the responsibility of all stakeholders. Teachers needed to encourage students to challenge and reflect on health care experience, and to connect with the information. Learners also needed constructive, supportive feedback and teachers who accorded their feelings respect. Reflection on teaching is an integral part of professional development. It significantly facilitated learners’ progress towards becoming successful clinical teacher.
Reference List
Burton, A.J. (2000). Reflection: nursing’s practice and education panacea, Journal of Advanced Nursing, 31 (5).
Croxon, L. L., & Maginnis, C. C. (2009). Evaluation of clinical teaching models for nursing practice. Nurse Education in Practice, 9(4), 236-243.
Delunas, L. R., & Rooda, L. A. (2009). A New Model for the Clinical Instruction of Undergraduate Nursing Students. Nursing Education Perspectives, 30(6), 377-380
Ehrenberg, A. C., & Haggblom, M. M. (2007). Problem-based learning in clinical nursing education: Integrating theory and practice. Nurse Education in Practice, 7(2), 67-74.
Emerson, R. (2009). Nursing Education in Clinical Teaching. Sydney: Elsevier Health Sciences.
Hodges, L. (2006). Preparing faculty for pedagogical change: Helping faculty deal with fear. Bolton: MA: Anker Publishing Company.
Jefferies P. (2005). Framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nurs Educ Perspect. 2005; 26(2):96–103.
Keating, S. B. (2010). Curriculum Development and Evaluation in Nursing. New York: Springer Publisher Company.
Keisey, J., & Ewing, C. (2008). Clinical Skills in Child Health Practices. Sydney: Elsevier Health Sciences.
Knowles, M. C., Holton, E. F., and Swanson, R. A. (2005). The Adult Learner: The Definite Classic in Adult Education and Human Resource Development. US: Butterworth-Heinemann.
Lindahl, B. B., Dagborn, K. K., & Nilsson, M. M. (2009). A student-centered clinical educational unit – Description of a reflective learning model. Nurse Education in Practice, 9(1), 5-12.
Lyans, N. (2010). Handbook of Reflection and Reflective Inquiry. Bolton: MA: Anker Publishing Company.
Mantsoukas, S., & Jasper, M. A. (2004). Reflective practice and daily ward reality: a covert power game. Journal of Clinical Nursing, 13, 925–933.
Medley C.F., Horne C. (2005). Using simulation technology for under-graduate nursing education. J Nurs Educ. 44(1), 31–34.
Naismith, L., & Steinert, Y. (2001). The evaluation of a workshop to promote interactive lecturing. Teaching and Learning in Medicine, 13, 43-48.
Neary, M. (2000). Teaching, Assessing and Evaluation for Clinical Competence. Sydney: Wolter Kluwer Health
O’Connor, A. (2006). Clinical Instruction and Evaluation: A Teaching Resource. Sydney: Elsevier Health sciences.
Oermann, M. (2009). Evaluation and Testing in Nursing Education. Sydney: Elsevier Health Sciences.
Rose, M., & Best, D. (2005). Transforming practice through clinical education, professional supervision and mentoring. London: Elsevier Churchill Livingstone.
Schaefer, M., & Manuel, D. (2003). Analysing the teaching style of nursing faculty: Does it promote a student-centered or teacher-centered learning environment? Nursing Education Perspectives, 24, 238-245.
Smith, B. & Johnson, Y. (2002). Using structured clinical preparation to stimulate reflection and foster critical thinking, Journal of Nursing Education, 41(4), 182-186.
Smith, F., & Duell, J, & Martin C. (2004). Clinical Nursing Skills: Basic to Advanced Skills. Upper Saddle River, NJ: Pearson Education.
Spencer, J. (2008). ABC of learning and teaching in medicine: Learning and teaching in the clinical environment, 326.
Susskind, E. (2005). PowerPoint’s power in the classroom: Enhancing students’ self-efficacy and attitudes. Computers & Education, 45, 203-215.
Timby, B. (2008). Fundamental Nursing Skills and Concepts. Sydney: Wolter Kluwer Health.
Timby, B., & Smith, N. (2004). Essentials of Nursing Care of Adults and Children. Sydney: Wolter Kluwer Health.
Titsworth, S. (2004). Students’ Note Taking: The Effects of Teacher Immediacy and Clarity. Communication Education, 53, 305-320.