CLINICAL LEARNING ENVIRONMENT

A clinical learning environment is defined as an authentic clinical space

with actual patients where students practice their clinical skills with the

outcome of professional competence development and an eventual

readiness to become registered nurses.

Fundamental aspects of CLEs
 Fundamental aspects of CLEs
• Safety
Ensuring the safety of patients, students, and faculty is paramount. Implement safety
protocols, infection control measures, and risk management strategies. Promote a
culture of safety that encourages reporting and learning from errors.
• Supervision and Mentorship
Assign experienced preceptors or mentors to guide and supervise students. These
mentors should provide constructive feedback, answer questions, and facilitate skill
development. They should serve as role models for professional behavior.
• Patient-Centered Care
Encourage students to deliver patient-centered care that respects patients’ values,
preferences, and dignity. Promote communication skills, empathy, and cultural
sensitivity.
• Resource Availability
Ensure that students have access to the necessary resources, including
medical equipment, supplies, electronic health records, and up-to-date
clinical guidelines.
• Evidence-Based Practice
Promote the use of evidence-based practice by encouraging students to
critically appraise research literature, integrate evidence into patient care
decisions, and evaluate the outcomes of their interventions.
• Clinical Reasoning
Help students develop clinical reasoning skills, which involve critical
thinking, problem-solving, and the ability to make sound clinical
judgments based on available evidence.
• Professional Development
Support students in their ongoing professional development by
providing opportunities for continuing education, certification, and
career advancement.
 Purposes of Clinical Learning Experience
• To provide opportunities for the nursing students to: Encounter reality
in the practice of nursing.
❑Synthesize learning, i.e., integrating know-ledge and skills in nursing
practice in real situations.
❑Practice activities according to course objectives.
• To provide opportunities for the faculty member to:
❑Assist, help, guide, reinforce, correct, and help competent
performance.
❑Evaluate the performance of students in the natural setting.
Principles of Planning Clinical Experiences
❖Expected Learning from the Experience
❖Background of the Students
❖Duration of the Experience
❖Learning Opportunities Available in the Clinical Setting
❖Size of the Group
Factors Influencing the Selection of Clinical Learning Experiences
❑Objectives of Clinical Experience
❑Level of the Students
❑Availability of Experiences
❑Duration and Timing of Experience
❑Abilities and Attitude of Faculty Members
 PRACTICE MODEL
• Practice models of clinical learning is the one which is practiced in the
clinical area for the students by nursing educational institutions/
colleges/universities.

• There are different types of clinical practice models. Stokes and Kost
(2012) described three models, i.e., traditional, preceptor, and
collaborative.
Traditional Model
The educator provides the instruction and evaluation for a small group
of nursing students onsite during clinical experience. As per the
guidance of the Indian Nursing Council, one faculty must not supervise
more than ten students.
Preceptor Model
The expert nurse in the clinical setting works with the students on a one-
to-one basis in the clinical setting. Preceptors are staff nurses and other
nurses employed by clinical agencies who provide on-site clinical
instruction for the assigned students and their ongoing patient care
responsibilities. The preceptor guides and supports the learner and
serves as a role model. They are commonly used for final-year nursing
students.
Collaborative Model
Nursing education collaborates with:
Clinical agencies and the community to respond to meet the
community’s healthcare needs. Clinical agency and nursing program
that involves sharing clinical teaching role by the nurses working in
hospitals and academic faculty members -the nurses teach students in
the clinical setting, and the faculty member serves as course indicators.
Faculty member teaches two groups of students, as in the traditional
model.
Integrated Education and Practice Model
It is practiced in the college of nursing, CMC, Vellore. Like the
traditional model, the hospital’s clinical supervisor cares for 6 to 8
students. The nursing faculty assumes a dual role, i.e., primarily a
teacher in college and also the manager in the hospital. The nurses in the
hospital also participate in clinical teaching, like the collaborative
model.
CHARACTERISTICS OF EFFECTIVE CLINICAL TEACHERS
❖Interpersonal aspects
❖Role model
❖Relationship: rapport, genuineness, respect
❖Enjoys nursing and teaching
❖Competence: Theoretical and clinical
❖Attitude to the profession
❖Teaching ability: Knowledge of the philosophy of school curriculum
❖Evaluation practices
❖To participate in the teaching, supervising, and evaluating students on
the wards.
❖To guide students to get the required clinical experience.
❖To hold conferences with groups of students to discuss their
assignments.
❖To discuss the individual patient assignments with the junior and
senior nursing officers.
❖To participate in the morning ward reports of patients.
❖To discuss with the students the methods of evaluating their nursing
care performance or client care performance in the area as a whole.
The evaluation methods and criteria may differ depending on the
nature of the posting, i.e., hospital or community health area.
WRITING CLINICAL LEARNING OUTCOMES/PRACTICE
COMPETENCIES
❖Identify the Purpose
❖Consult Relevant Standards
❖Involve Stakeholders
❖Use Action Verbs
❖Be Specific and Clear
❖Use Bloom’s Taxonomy
❖Include Relevant Content
❖Consider Different Domains
❖Incorporate Clinical Context
❖Prioritize Safety and Ethical Considerations
❖Review and Revise
❖Seek Input and Feedback
 CLINICAL TEACHING STRATEGIES
Clinical teaching methods are used to learn about the patients. This
method studies the patient’s condition, status, observation, discussed
treatment, car, etc. The clinical techniques include case methods,
nursing records reports, bedside clinics, conferences, process records,
nursing process concept mapping, etc. These methods are the best
methods for teaching clinical skills
Purposes
❑To gain knowledge and understand concepts related to patient care
❑Gaining clinical knowledge.
❑To acquire good communication skills.
❑Building nurse-patient relationships.
❑Giving nursing education to the students.
Role of Teacher in Clinical Teaching Methods
Teacher plays a vital role in clinical teaching. Teachers should have
positive attitudes toward teaching. The teacher should have friendship
relations among the students. He provides knowledge by demonstration,
practical, and procedure manner. He is evaluating the student’s ability
and performance.
Advantages
❖It provides knowledge about the patients.
❖It is helpful for better treatment.
❖We learn the patient’s condition practically in the patient’s presence.
❖It promotes problem-solving skills.
❖We can gain knowledge of the hospital environment.
❖It provides information about the medical management.
 PATIENT ASSIGNMENT
Definitions
• A nursing care delivery model is a method used to provide patient
care. The nursing care delivery models describe which healthcare
worker will perform what tasks, who is responsible, and who has the
authority to make decisions.

• Match the number and type of caregivers to patient care needs

Functions of Patient Assignment
Classic Nursing Care Models
➢Total patient care/case method
➢Functional nursing
➢Team nursing
➢Primary nursing
➢Case management
Total Patient Care
• Nurse is responsible for planning, organizing, and performing all care.
• Oldest method of organizing patient care
• Typically performed by nursing students
• Common use areas: intensive care unit (ICU) and postanesthetic care
unit (PACU).
• Total Patient Care
Functional Nursing
• Staff members assigned to complete specific tasks for a group of
patients.
• Evolved during World War II as a result of a nursing shortage.
• Unskilled workers trained to perform routine, simple tasks.
• Common use area: operating room
Team Nursing
• RN as team leader coordinates care for a group of patients
• Evolved in the 1950s to improve patient satisfaction
• The goal was to reduce fragmented care
• Common use areas: most inpatient and outpatient areas
Case Management
• First introduced in the 1970s by insurance companies.
• Hospitals adopted the model in the 1980s.
• Value demonstrated through research.
Primary Nursing
• Definition
• The RN assumes 24-hour responsibility for planning and evaluating
the patient’s care from admission through discharge.
• Origin: During the 1960s Cultural Revolution in the US, the need for
autonomy in nursing was felt.
• Founded: Marie Manthey (1970)
 HYBRID MODELS
➢Modular Nursing
➢Modification of team nursing
➢Patient unit is divided into modules or units with an RN as team
leader.
➢The same team of caregivers is assigned consistently to the same
geographic area.
➢Concept evolved to increase RN involvement in care.
 CONCEPT MAPPING
Concept mapping is a valuable clinical teaching method in nursing and healthcare
education. It involves creating visual representations of complex concepts, helping
students organize information, understand relationships between concepts, and
enhance critical thinking skills.
Here’s how concept mapping can be used as a clinical teaching method in nursing
education:
❖Clarifying Complex Concepts
❖Active Learning
❖Encouraging Critical Thinking
❖Assessment and Evaluation
❖Identifying Knowledge Gaps
❖Facilitating Active Discussions
❖Enhancing Memory Retention
❖Application to Patient Care
❖Integration of Theory and Practice
❖Customization for Various Learning Styles
❖Continuous Learning
❖Feedback and Reflection
 PROJECT
Definitions
❖“A project is a problematic act carried to completion in its natural
setting.” —J A Stevenson
❖“A project is a wholehearted purposeful activity proceeding in a social
environment”. —Kilpatrick
❖“A project is a bit of real life that has been imported into the school.”
—Ballard
Need For Project-based Learning
❖Projet-based learning helps students develop skills for living in a
knowledge–based, highly technological society.
❖Project-based learning and the use of technology bring new relevance
to the learning at hand.
❖Project-based learning lends itself to authentic assessment.
❖Project-based learning promotes lifelong learning.
Principles of the Project Method
❖Principle of purpose
❖Principle of activity
❖Principle of experience
❖Principle of social experience
❖Principle of reality:
❖Principle of utility
Criteria for Selecting a Project
❖Selected topic should have educational value, and it should be
worthwhile.
❖It should not take overtime
❖It should not be challenging
❖We should consider the cost and availability of materials.
❖If the whole course is planned on a project basis, there is a danger of
improper organization.
❖It should be selected according to the will of the students.
Types of project
• Producer type: The emphasis is on constructing a material object or
article. e.g., models of the area
• Consumer type: Where the objective is to obtain either direct or
various experiences, such as reading and learning from stories,
listening to musical delectation, etc.
• Problem type: The chief purpose is to solve a problem involving the
intellectual processes. E.g., methods of purifying water.
• Drill type: Where the objective is to attain a certain degree of skill in
a reaction-as learning a vocabulary, e.g., skill in swimming
• Learning project: When the chief concern is acquiring some ability,
e.g., learning to read effectively.
• Individual project: It may be planned for each student, or each
student may individually solve the same task.
• Group project: This type of project is planned for a class or a group.
Advantages

❖It keeps the students free of thought and action while doing the work.
❖It provides the interest and ability of the students.
❖It provides more creative constructive thinking for the students.
❖It helps to know the individual differences.
❖It helps the students to think logically and scientifically before
starting the project.
❖It facilitates the development of doing ability, and related learning is
coordinated by implementing them.
❖It provides the growth of the individual through the activity.
 Debate
Definition
The Oxford Advanced Learner’s Dictionary defines debate as a formal
discussion of an issue at a public meeting or in a parliament and an
argument or debate expressing different opinions.
An academic debate consists of two teams (positive and negative)
debating a resolution/ proposition. The teams alternate, giving speeches.
The speeches have time limits, as do the intervals.
Skills Developed for the Students
❑Confidence: Belief in themselves and their abilities and the desire to
participate in all classes.
❑Curiosity: The passion for discovery through practical tools for
research, organization, and presentation.
❑Critical thinking: How to explore the world through the lens of a
curious mind.
❑Communication: Oral and written skills and strategies for lively,
respectful discussions and disagreements.
❑Control: Eliminate the fears of public speaking.
❑Creativity: The desire to explore, create and invent.
 Game
At the beginning of the 20th century, Dewey and the Gestalt theorists
introduced the theory of gaming as a teaching strategy. Although digital
game-based learning has the potential to offer a safe and convenient
environment that could lead to nursing students developing essential
skills, nurse educators are typically slow in adopting this resource.
Ongoing education and technological advances have meant that children
engage with resources such as video games at an early age.
Benefits of Game
❖Goal orientated learning.
❖Fun.
❖Motivates.
❖Captures interest.
❖Problem solving.
❖Opportunity to design and create (coding).
❖Can create friendly competition.
❖Incentives.
❖Badges for achievement.
❖Safe environment to explore, succeed, and, importantly, fail.
 Roleplay
Definition
An educational technique in which people spontaneously act out problems of human
relations and analyze the enactment with the help of other role players and
observers.
Purpose of Role-playing in Nursing Education
❖To develop specific skill
❖To develop a situation to analyze
❖To develop an understanding of the points of view of others.
❖Increasing student’s insight into typical ways of dealing.
❖Length of the role play will make the situation clear, and awareness can be created
in the minds of the students.
Principles of Role Play
❖As a teaching technique, role-playing is based on the philosophy that
meanings are in people, not words or symbols.
❖Creating a teaching situation that can lead to a change in self-concepts
requires a distinct organizational pattern.
❖Should be flexible.
❖Should be a stimulant to think and should not be an escape from
disciplines of learning.
Types of Role-playing
Sociodrama
It deals with people’s interactions with other individuals or groups, e.g.,
mothers, nurses, leaders, etc. It always involves situations of more than one
person and deals with problems that a majority of the group faces in
executing their roles.
Psychodrama
Practiced in a group setting, mainly concerned with a particular individual’s
unique needs and problems. It should not be attempted except under the
guidance of a trained therapist.
 PROBLEM-BASED LEARNING (PBL)
Problem-based learning (PBL) is one such effort where students face a
real-life scenario of patients and are expected to interpret by their own
understanding and reasoning abilities. Teachers act as facilitators here
and provide resources. Intense use of such resources, group discussions,
peer support, and virtual technologies helps students with self-directed
learning.
Role of teacher in PBL
The teacher’s responsibility in PBL is to provide the educational
materials and guidance that facilitate learning. The principal role of the
teacher as a facilitator or academic coach is to guide the learners. The
teacher’s role minimizes as learners become more proficient in the PBL
learning process. The teacher supervises the assessment reports
provided by the student. The teachers also appreciate the students’
efforts and manage the students’ problem-solving activities. Here, the
teacher does not give facts or test students’ recall power via
memorization of facts.
 QUESTIONING
Definition
❖Question is the request for information or opinion.
❖Questioning is the act of asking questions to gather information,
clarify, understand, or initiate discussion. It’s a fundamental part of
communication and cognition, used in education, research, problem-
solving, interviews, and daily conversations.
Purposes of Questioning
❑Arouse curiosity in student.
❑Stimulate interest in the topic.
❑Clarify the concepts.
❑Emphasize critical points.
❑Enhance the problem-solving ability.
❑Encourage students to search for new information.
❑To assess the student’s abilities, interests, and needs.
❑Ascertain students’ knowledge level to aid in modifying instruction.
Levels of educational objectives (Bloom’s taxonomy)
 WRITTEN ASSIGNMENT
Assignments are part of the internal evaluation process, which would be
of immense value as an additional learning instrument. Students can
receive many assignments, such as essays, literature reviews, annotated
bibliographies, critical reviews, reflective journals, and case studies,
depending on the need and learning situations. Essay assignment is the
most common among them. Academic essay writing increases students’
expertise in some particular subject area and is also helpful in refining
their analytic and writing skills. Essay writing involves four phases –
analysis and planning, literature collection, drafting, and editing.
Types of Assignments
❖Essay
❖Literature Review
❖Annotated Bibliography
❖Critical Review
❖Case Study
❖Reflective Journal
❖Experiment Write-up
❖Project Report
 RECORDING
Process recording is used in psychiatric nursing to enhance the
therapeutic relationship between the nurse and the patient. It is a method
of documenting the communication between the nurse and the patient
during a therapeutic session. The process recording captures the verbal
and nonverbal communication during the session and helps the nurse
analyze the interaction and reflect on their communication style. This
article will discuss the importance of process recording in psychiatric
nursing, its purpose, the steps involved, and how it can improve patient
Importance of Process Recording
Process recording is a valuable tool in nursing as it helps nurses reflect
on their communication skills, identify areas for improvement, and
develop strategies to enhance therapeutic communication with patients.
It is also a way of documenting the patient’s progress and provides a
record of the therapeutic session that can be used to inform the patient’s
care plan.
Purpose of Process Recording
The purpose of process recording is to capture the
communication between the nurse and the patient during a
therapeutic session. The recording is used to analyze the
interaction and reflect on the nurse’s communication style,
identify areas for improvement, and develop strategies to
enhance the therapeutic relationship. It also documents the
patient’s progress and informs their care plan.
Steps Involved in Process Recording
• Preparation: The nurse should prepare for the therapeutic session by
reviewing the patient’s chart, identifying the patient’s goals and
objectives, and planning the therapeutic approach.
• Recording: During the therapeutic session, the nurse should record
the conversation between themselves and the patient. The recording
should capture the verbal and nonverbal communication during the
session.
• Analysis: After the session, the nurse should listen to the recording
and analyze the communication. The analysis should focus on the
nurse’s communication style, the patient’s response, and areas for
improvement.
• Reflection: The nurse should reflect on the analysis and identify areas
for improvement in their communication style. They should develop
strategies to enhance their therapeutic communication with the patient.
• Documentation: The process recording should be documented in the
patient’s chart to inform the patient’s care plan.
 How Process Recording Can Improve Patient Care
• Process recording can improve patient care by enhancing the
therapeutic relationship between the nurse and the patient. It allows
the nurse to reflect on their communication style and develop
strategies to improve communication with the patient. This, in turn,
can improve the patient’s trust in the nurse, increase their engagement
in therapy, and improve their outcomes.
• Process recording can also document the patient’s progress and inform
their care plan. It provides a record of the therapeutic session that can
be used to track the patient’s progress and inform future therapeutic
interventions.