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should be individualized using support- ive strategies, including tutoring, advising, counseling, and skill building. Activities supporting remediation are simulation, case presentation, and incorporation of theoreti- cal and scholarly resources (Evans & Harder, 2013; Gallant, MacDonald, & Smith Higuchi, 2006; Walker-Cillo & Harding, 2013).
Remediation is useful to assist a strug- gling student to learn and achieve the minimum standards for practice and to suc- cessfully complete the academic program.
Nurse educators can identify individuals who have performed poorly on actual and simulated clinical encounters and exami- nations. Once the individual is identifi ed, a structured plan can be developed. This plan is structured to facilitate a positive and supportive learning environment. It should include clearly stated learning objectives, utilize multiple sources of evidence, and give timely feedback (Evans & Harder, 2013;
Gallant et al., 2006).
SYNOPSIS
Remediation methods used include close observation, repetition, self-directed learn- ing, structured classes, scenarios, and case studies. Mechanical simulators and standard- ized patients can be used to bring particular clinical populations to the remediation expe- rience. Regardless of the method, it is impor- tant to keep the remediation focused on the individual (Audétat, Laurin, & Dory, 2013;
Evans & Harder, 2013; Klamen & Williams, 2011; Lynn & Twigg, 2011).
The use of mechanical simulators is an effective method of remediation. Case sce- narios allow for repetitious learning with immediate feedback and debriefi ng. This method allows for identifi cation of weak- nesses and strengths of the individual. Case scenarios can also be used with standardized patients who are trained to portray a real patient encounter to simulate a set of symp- toms with realistic interaction with the nurse (Klamen & Williams, 2011).
Challenges to remediation include underutilization or no utilization of Nursing Education Perspectives, 28(6),
315–321.
Martha S. Morrow Mary T. Quinn Griffi n
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LINICALR
EMEDIATIONDEFINITION
Clinical remediation is the act or process of correcting defi ciencies in nursing practice and promoting safe patient care through the implementation of learning strate- gies to improve critical thinking and clini- cal performance (Evans & Harder, 2013;
Merriam-Webster Dictionary Online). Clinical remediation may result from academic, clinical practice, and regulatory defi ciencies identifi ed through examination, observa- tion, peer review, or failure to successfully complete the minimum standard of care (Evans & Harder, 2013; Walker-Cillo &
Harding, 2013).
APPLICATION
The application of clinical remediation is multifaceted in nursing education. Nursing education does not end with the conferring a degree or giving a diploma. Continuing edu- cation is a journey that all nurses, regardless of fi eld of practice, travel for successful and safe clinical practice. Remediation plans can be used in academia and clinical practice, as well as for regulatory policies to maintain minimum practice standards.
Remediation begins with identifi ca- tion of defi ciencies that can lead to unsafe practice. Clinical remediation is an orga- nized process comprising objectivity, open- ness, and transparency. It is essential that the process respects the right to due pro- cess when engaging in clinical remedia- tion. Remediation can be achieved through student-centered remediation that is adapt- able to learning needs and defi ciencies. Plans
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clinical failure. Nurse Educator, 31(5), 223–227.
Google.com. Retrieved from https://www .google.com/#q=remediation+definition a nd ht t ps://w w w.go og le.com/#q=
clinical+defi nition
Klamen, D. L., & Williams, R. G. (2011). The effi cacy of a targeted remediation process for students who fail standardized patient examinations. Teaching and Learning in Medicine, 23(1), 3–11.
Lynn, M. C., & Twigg, R. D. (2011). A new approach to clinical remediation. Journal of Nursing Education, 50(3), 172–175.
Merriam-Webster Dictionary Online. Retrieved from http://www.merriam-webster.com/
dictionary/remediation.
Walker-Cillo, G. A., & Harding, A. (2013).
The art of remediation in professional emergency nursing practice. Advanced Emergency Nursing Journal, 35(2), 129–142.
Theresa M. Campo
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LINICALS
CENARIOSDEFINITION
The term scenario is derived from the Latin word scaenarium, indicating a place for build- ing a stage; scaena is the term for the stage itself. A scenario is a collage of events or series of actions that unfold during a perfor- mance. Clinical scenarios in nursing address relevant events that occur in the actual exe- cution of health care. During the last decade, a theoretical model and guidelines have emerged to steer the advancement of inter- active student learning scenarios in nursing education and clinical practice.
APPLICATION
Clinical scenario applications have been used by the aeronautic, automotive, mili- tary, and other industries to develop the best defensive tactics for the prevention of error theoretical and conceptual frameworks
in the development of the intervention(s), delay in remediation, as well as stress and anxiety. These challenges can be overcome with the use of a well-developed plan and intervention. Early identifi cation of a prob- lem followed by early intervention is the key to remediation success. Mutual respect between the educator and the individual is the foundation for the initiation of any plan, as well as guiding the individual to refl ect and discuss progress (Audétat et al., 2013;
Evans & Harder, 2013).
RECOMMENDATIONS
Clinical remediation has been a main- stay of nursing education and will remain an integral part of a student’s education.
Technological advancements, computeriza- tion, and simulation will continue to be an important component of the remediation process. Integrating case scenarios with mechanical simulation and the use of stan- dardized patients can lead to profi cient actual patient encounters and care. The use of virtual simulation can also be integrated in the remediation plan.
The cost of the faculty, technology, and resources may have an impact on the future of nursing education and remediation.
Sharing of resources by various schools can help overall fi nancial viability through the sharing of simulation labs, faculty, and com- puter resources. Collaboration among health care professionals is integral to safe patient care. Patient safety, standards of care, and professional development are the ultimate goal of remediation.
Audétat, M. C., Laurin, S., & Dory, V. (2013).
Remediation for struggling learners:
Putting an end to “more of the same.”
Medical Education, 47(3), 230–231.
Evans, C. J., & Harder, N. (2013). A formative approach to student remediation. Nurse Educator, 38(4), 147–151.
Gallant, M., MacDonald, J. A., & Smith Higuchi, K. A. (2006). A remediation process for nursing students at risk for
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for graduate students (Einion, 2013; Velok &
Smedley, 2014).
Simulation scenarios have been incor- porated into the employment setting for licensed providers to learn new techniques and maintain and strengthen skills that are necessary for events that rarely occur. Clinical scenarios are a mechanism for integrating individual skills into complex operational capabilities. Clinical scenarios are designed to develop and enhance team interaction, giving students the opportunity to improve communication, decision making, and team discipline (Liaw et al., 2014).
Although simulation scenarios can be traced back to several decades, current designs are more realistic and congruent with the complexity nurses encounter in the workplace. Clinical scenarios provide students with a means to safely under- stand the potential for failure while gath- ering the necessary data to make critical decisions in real-time replication. Jefferies (2005) identifi ed six critical areas as essen- tial components for clinical scenarios:
objectives, planning, fi delity, complexity, cues, and debriefi ng. Continued efforts in simulation scenario education produced theoretical frameworks for generating sce- narios (Jeffries & Rogers, 2009). Sixteen studies from the United States and the United Kingdom have used frameworks in undergraduate and graduate curricula to design and evaluate respective simulation scenarios. Students reported that partici- pation in clinical scenarios provided more opportunity for problem solving and that the experience positively affected critical thinking. Analysis of the student outcomes demonstrated improvement in patient safety competencies, higher levels of stu- dent satisfaction with the learning method, and increased confi dence regarding clinical skills (LaFond & Van Hulle Vincent, 2013).
Waxman (2010) introduced an evidence- based practice (EBP) template for construct- ing clinical scenarios as a means to promote effective learning. The template was derived from EBP data to advance clinical reasoning skills. Key elements of the template include and promotion of safety. Scenarios are a com-
ponent of the broader category of simulation education that incorporates low- and high- fi delity manikins, skill and task trainers, virtual reality trainers, and computer-based simulators. The scenario requires a model or laboratory that represents the real-world clinical process. Simulation characterizes the operation of the model or activities that mimic the clinical reality (Jefferies, 2005). A scenario is the enacted performance creating opportunity for a high level of realistic inter- activity for students to learn and develop con- fi dence. A specifi cation of the details of the enactment and the order of the activities is required. Written materials are prepared for the faculty and a separate script is designed for the student. An important aspect of the clinical scenarios is the debriefi ng segment, which includes refl ection on the experience, the student’s performance, and what was learned (Schneider Sarver, Senczakowicz, &
Slovensky, 2010).
SYNOPSIS
Scenarios have been written to address essential domains of nursing practice including technical and functional training, problem solving, decision making, and team- based competencies (Schneider Sarver et al., 2010). They are increasingly used in nurs- ing education throughout the United States and internationally. Both prelicensure and advanced clinical skills require active listen- ing, effective communication, knowledge, and competence appropriate to the individ- ual’s education and experience. The scenario must match the specifi c level of the under- graduate student while advancing in various degrees of complexity. Both simple vignettes and complex scenarios were rated by stu- dents as benefi cial in helping them to set priorities, develop critical thinking, acquire assessment skills, and gain an awareness of the nurse’s role (Guhde, 2011). Scenarios used in graduate programs, particularly the post-scenario refl ection, have been identifi ed as an effective teaching method for graduate faculty and a positive learning experience
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A refl ection and evaluation. British Journal of Midwifery, 21(12), 893–897.
Guhde, J. (2011). Nursing students’ percep- tions of the effect on critical thinking, assessment, and learner satisfaction in simple versus complex high-fi delity simulation scenarios. Journal of Nursing Education, 50(2), 73–78.
Jeffries, P. R. (2005). A framework for design- ing, implementing and evaluating simu- lations used as teaching strategies in nursing. Nursing Education Perspective, 26(2), 96–103.
Jeffries, P. R., & Rogers, K. (2009). Theoretical framework for simulation design. In P.
R. Jeffries (Ed.), Simulation in nursing edu- cation: From conceptualization to evalua- tion (pp. 21–34). New York, NY: National League for Nursing.
Jeffries, P. R., Beach, M., Decker, S. I., Dlugasch, L., Groom, J., Settles, J., & O’Donnell, J. M.
(2011). Multi-center development and test- ing of a simulation-based cardiovascular assessment curriculum for advanced prac- tice nurses. Nursing Education Perspectives, 32(5), 316–322.
LaFond, C. M., & Van Hulle Vincent, C.
(2013). A critique of the National League for Nursing/Jeffries simulation frame- work. Journal of Advanced Nursing, 69(2), 465–480.
Liaw, S. Y., Koh, Y., Dawood, R., Kowitlawakul, Y., Zhou, W., & Lau, S. T. (2014). Easing student transition to graduate nurse:
A SIMulated Professional Learning Environment (SIMPLE) for fi nal year stu- dent nurses. Nurse Education Today, 34(3), 349–355.
Schneider Sarver, P. A., Senczakowicz, E. A.,
& Slovensky, B. M. (2010). Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Journal of Nursing Education, 49(10), 578–586.
Shinnick, M. A., Woo, M. A., & Mentes, J. C.
(2011). Human patient simulation: State of the science in prelicensure nursing edu- cation. Journal of Nursing Education, 50(2), 65–72.
Velok, K., & Smedley, A. (2014). Using refl ec- tion to enhance the teaching and learning techniques to measure learning and vali-
dation criteria for written scenarios. Data from the SIMulated Professional Learning Environment (SIMPLE) provided further evidence of the value of clinical scenarios for baccalaureate students. The students believed that they were better prepared for transition- ing to the workplace as a result of the clini- cal scenario experience (Liaw et al., 2014).
The health care environment is continuously changing, thus challenging educators to pro- vide a safe platform for learning while pre- paring graduates to apply clinical reasoning skills in the actual setting. Clinical scenarios prepare the learner to quickly organize data derived from multiple sources, process the data, and identify priority needs. Evaluation, refl ection, and feedback provide the learner with the opportunity to safely advance in profi ciency.
RECOMMENDATIONS
Multisite trials with large sample sizes have been called for to thoroughly evaluate the effect of simulation scenarios on prelicensure stu- dents (Shinnick, Woo, & Mentes, 2011). Jeffries et al. (2011) reported on the effectiveness of a highly complex simulation-based cardiovas- cular assessment curriculum for advanced practice nurses (APN). There was participation from four university-based nursing programs distributed across the United States, with a small number of participants from each insti- tution. Logistic challenges, human resources, and cost have posed obstacles to conduct- ing more multisite trials. Complex and well- constructed clinical scenarios have emerged primarily in the medical surgical practice areas. Future effort should include the devel- opment of maternal infant and child scenar- ios that address childbearing and parenting.
Substantial validation of the effi cacy and cost- effective improvement of student learning and patient outcomes will provide valuable infor- mation for broadening the use of clinical sce- narios in nursing education.
Einion, A. (2013). OSCE assessment for emer- gency scenarios in midwifery education:
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education-based units, peer education teams, and simulation support.
Clinical nursing education in the acute care setting often encompasses a faculty member taking a group of 8 to 10 nursing students into the acute care setting after a patient has been assigned to the stu- dent the day before. Clinical preplanning often occurs in the setting where the stu- dent gains insight and knowledge the day before the clinical experience and develops a plan of care for the patient in advance.
Preceptorship is also utilized in the acute care setting. Student nurses can be assigned to a preceptor, and the student and the pre- ceptor develop a schedule for clinical expe- riences for the student. Education-based units are emerging in the acute care setting where a unit is identifi ed as an education unit and the nurses in this unit receive training in their role as a preceptor or a clinical support nurse. These units have a strong focus on clinical education for nurs- ing students, and the environment is often a student-friendly setting that research supports as a method to enhance learning (Balakas & Sparks, 2010).
In the community-based setting, nurs- ing students most often gain their clinical experience through the use of preceptors who agree to develop a relationship with the educational institution where they will pre- cept students during their care of patients in the community. Most often, these agen- cies are home care or hospice affi liated. The clinic setting is considered a unique envi- ronment within the community experience in general but with many overlapping expe- riences found in the traditional community setting. Many clinic settings are located near acute care facilities and provide care to patients who mainly remain in the com- munity after the clinic visit but may be admitted to the acute care setting (Balakas
& Sparks, 2010).
By defi nition, the simulation experi- ence could occur in any of the available clinical settings if the appropriate simula- tion equipment were available. Most often, this is accomplished through the use of a of midwifery students. British Journal of
Midwifery, 2(22), 129–133.
Waxman, K. T. (2010). The development of evidence-based clinical simulation scenarios: Guidelines for nurse educa- tors. Journal of Nursing Education, 49(1), 29–35.
Anne Marie Mitchell
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LINICALT
EACHINGDEFINITION
The defi nition of clinical teaching has evolved over the years. Clinical teaching is a time-limited process, whereby the teacher and student develop a partnership within a shared environment in such a way that the teacher’s primary, operational frame of ref- erence is maintained as the legitimate means for affecting the student’s behavior toward intended purposes (White & Ewan, 2002).
While many of these core aspects remain active today, progress in the area of clini- cal teaching in nursing has led to expansion of this defi nition to include aspects such as clinical preceptorship, peer-learning dyads, and simulation (Sims-Giddens, Helton, &
Hope, 2010).
APPLICATION
When considering the application of clini- cal teaching in the education of nurses and their future nursing practice, several themes emerge as being important. Clinical teach- ing can occur in any setting where a nurse is actively providing care for a patient. The primary settings utilized in the clinical edu- cation of nurses include acute care settings, community-based settings, clinic settings, and simulation settings. In each of these set- tings, an environment-specifi c approach to clinical education can be provided. The meth- ods of clinical education that are provided across these settings include preceptorship,
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Coe, 2013). Overall, the literature supports the need for development and utilization of unique clinical learning opportunities to meet the growing demands for nurses.
RECOMMENDATIONS
In nursing education, while classroom and simulation experiences make essential contributions to students’ knowledge and skill development, the clinical experience remains the cornerstone of nursing educa- tion (Luhanga, Billay, Grundy, Myrick, &
Yonge, 2010). The culture of evidence-based practice should start in the clinical teaching setting and continue on in clinical nursing practice (Balakas & Sparks, 2010). Continued growth in the quantity and quality of nurs- ing research focused on nursing education will help to continue to address the clinical teaching needs of future nursing students.
Austria, M., Baraki, K., & Doig, A. (2012).
Collaborative learning using nursing student dyads in the clinical setting.
International Journal of Nursing Education Scholarship, 10(1), 1–8.
Balakas, K., & Sparks, L. (2010). Teaching research and evidence-based prac- tice using a service-learning approach.
Journal of Nursing Education, 49(12), 691–695.
Benner, P., Stuphen, M., Leonard, V., & Day, L. (2010). Education nurses: A call for radical transformation. San Francisco, CA: Jossey Bass.
Christiansen, A., & Bell, A. (2010). Peer learn- ing partnerships: Exploring the experi- ence of pre-registration nursing students.
Journal of Clinical Nursing, 19(5–6), 803–810.
Goodstone, L., Goodstone, M. S., Cino, K., Glaser, C. A., Kupferman, K., & Dember- Neal, T. (2013). Effect of simulation on the development of critical thinking in associate degree nursing students.
Nursing Education Perspectives, 34(3), 159–162.
Hendricks, S. M., Wallace, L. S., Narwold, L., Guy, G., & Wallace, D. (2013). Comparing trained faculty member who maintains the
simulation equipment in a central location.
The simulation experiences can be tailored to address multiple care situations that could occur in any of the settings, promoting criti- cal thinking skills (Goodstone et al., 2013).
SYNOPSIS
The literature, as it relates to clinical nursing education, is considered weaker when com- pared to clinical nursing research (Schneider, Nicholas, & Kurrus, 2013). The literature sup- ports the use of clinical preceptors as an effective means for supporting clinical nurs- ing education (Hendricks, Wallace, Narwold, Guy, & Wallace, 2013). The use of clinical peer dyads, where students work in peer groups with senior-level students mentoring lower- level students, is also supported as an effec- tive method for clinical instruction (Austria, Baraki, & Doig, 2012; Christiansen & Bell, 2010). Clinical peer dyad data show positive results from both the student and patient per- spectives. Simulation experiences for nurs- ing students, including standardized patient encounters, are supported in the literature as a supplementary experience for students and can help improve patient safety and enhance the students’ critical thinking skills (Kaplan
& Ura, 2010; Pacsi, 2008). Ongoing concerns documented in the literature that have had an impact on clinical teaching include nursing shortage, lack of clinical space, restrictions on the number of students per faculty or per unit, and competition with other schools of nursing (Benner, Stuphen, Leonard, & Day, 2010). Also supported in the literature would be the utilization of clinical staff nurses who have joint appointments with schools of nursing to improve access to clinical special- ists. The utilization of staff nurses who are not jointly hired is also supported, with the majority of these nurses receiving additional training on clinical teaching (Kowalski et al., 2007; Seldomridge & Walsh, 2006). The lit- erature supports the development of clinical partnerships between schools of nursing and units in acute care settings that are designated as educational units (Moscato, Nishioka, &