Clinical nursing education: Constructing a teaching model from processes and practice

Rhonda Marriott

The current complexity of client care can only benefit from teaching approaches that foster critical reflection and independence of learning in nursing students in actual health care settings. There is value to the nursing profession in understanding the balance between intellectual, strategic and moral acts of teaching within a humanistic, authoritarian or liberal teaching style that stimulates, supports and develops clinical competence and self-direction of learning in students within a nurturing learning environment. In order to further understand the concept of clinical education, a naturalistic, case study inquiry was undertaken in Western Australia. The purposes of the study were first, to construct an understanding of clinical education, the complexities of the clinical educator’s role and responsibilities within the context of the clinical milieu. Second, the researcher aimed to theorise about the context and processes of clinical educators’ teaching and learning interactions with students in the clinical milieu that resulted from the three clinical educator cases. A particular focus in this study was to further understand the ways clinical educators guided aspects of students' learning that required critical thinking and reflective practice. In doing so, this dissertation explains the processes of clinical teaching as described by the participants and observed by the researcher. Clinical educators in pre-registration, undergraduate nursing programmes from two Western Australian universities were identified as major stakeholders in clinical nursing education and were invited to participate. The understanding of clinical education that resulted from the case study is developed and explained in this dissertation. Recent developments within clinical nursing education are marked by increasing complexity within a context of raised client expectations, cultural diversity, technological advances, and fiscal constraint. Within such a learning milieu, clinical educators develop plans for teaching based on knowledge of the curriculum and experience in clinical teaching. They respond to students’ expectations and needs, act as advocates for student initiated client care, and make professional judgements about students’ cognitive, psychomotor and affective competencies. The researcher applied a constructivist approach to create a contextual understanding of clinical educators’ role, responsibilities and processes of clinical teaching. Activities of teaching were identified as being intellectual and strategic (Green, 1971; Hellgren, 1985) and moral (Fenstermacher, 1990; Sirontik, 1990; Stewart, 1993). For the purpose of this dissertation, the intellectual, strategic and moral acts have been adopted for application to the findings on clinical teaching. Those findings were reconstructed in a model developed by the researcher which situates activities of clinical teaching within styles of teaching. The activities of clinical teaching referred to in this dissertation are intellectual, strategic and moral acts of teaching. The styles of teaching referred to in this dissertation are humanistic, authoritarian, liberal and misanthropic and were derived from the literature on Invitational Teaching (Purkey & Novak, 1984; Ripley, 1986). The researcher hypothesises about the regard for student learning that might arise from the various relationships in the model. This thesis adds to the practice of clinical education by suggesting the value of identifying clinical educators’ styles and strategies as a means to nurturing independent life-long learning in students. The benefit of self-direction is a professional who can effectively function regardless of the unpredictable circumstances inherent in the clinical setting and negotiate his/her own learning. Recommendations for further study include the need to validate the constructed model of clinical practice teaching and to determine if the model is predictive of effective clinical learning outcomes that can be validated against various levels of students. Also, there is a need to determine transferability and application of the clinical practice teaching theory to other countries with similar undergraduate academic preparation of Registered Nurses.

Clinical nursing education: Constructing a teaching model from processes and practice

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