Models of Clinical Teaching

INTERNATIONAL INTER-UNIVERSITY E-CONFERENCE 2021

‘Closing the Gap in teaching and practice:

Outlook on Comprehensive Nursing Education’

23^RD & 24^TH JUNE 2021

between Department of Nursing

Faculty of Medicine and Health Sciences University Malaysia Sabah (UMS)

MALAYSIA

My Stunning University

Welcome to UMS.

This amazing University has sea and mountains within 999 acres of land

FACULTY OF MEDICINE AND HEALTH SCIENCES

UMS

MODEL OF CLINICAL

TEACHING

I can understand why we need to talk about it again ………….

Everything changed within a blink of an eye.

Our previous practices have become the old norm.

Everything needs a new way of execution.

Perhaps this time we should discuss what is the most appropriate model for clinical teaching in the midst of this pandemic

EVOLUTION OF MODEL OF CLINICAL TEACHING IN NURSING

Year Research / Projects Trend of study

1980- 1990 Towards effective clinical teaching in nursing Effectiveness of Clinical Teaching

1990 -2000 A collaborative preceptor model for clinical

teaching of beginning nursing students Collaboration and Integration 2001- 2010 Evaluation of clinical teaching models

for nursing practice Roles of the Clinical teacher 2012 The Development of a Malaysian Model of

Internship Programme (MyMIP)

Roles of Preceptor for new nurses in the early stage of profession

2010 - 2020 A model of nursing students' evolution to

proficient novice registered nurses Students perspectives Student self-confidence with clinical

nursing competencies in a high-dose simulation clinical teaching model

a “high technology for clinical simulation to take place

2021 Clinical Education in Nursing: Current Practices

and Trends technology to support and

enhance learning in clinical settings

MOVEMENT CONTROL ORDER IN MALAYSIA

Phase Date

1) Movement Control Order (MCO/PKP, 18 March 2020 - 3 May 2020)

Phase 1 18 March 2020 - 31 March 2020

Phase 2 1 April 2020 - 14 April 2020 Phase 3 15 April 2020 - 28 April 2020 Phase 4 29 April 2020 - 3 May 2020

Conditional Movement Control Order (CMCO/PKPB, 4 May 2020 - 9 June 2020)

Phase 1 4 May 2020 - 12 May 2020

Phase 2 13 May 2020 - 9 June 2020

Recovery Movement Control Order (RMCO/PKPP, 10 June 2020 - 31 March 2021) Phase 1 10 June 2020 - 31 August 2020

Phase 2 1 September 2020 - 31 December 2020 Phase 3 1 January 2021 - 31 March 2021

2) MCO by states (11 January 2021 - 31 May 2021)

Each states switch between MCO, CMCO, RMCO, EMCO, and semi-EMCO depending on the COVID-19 condition in each states.

3 ) Total lockdown (1 June 2021 - 28 June 2021) Phase 1 1 June 2021 - 14 June 2021^[4]

Phase 2 15 June 2021 - 28 June 2021

FACTORS DELAYING THE ADMISSION OF STUDENTS BACK TO CLINICAL AREAS

Students are not even allowed to enter the fully equipped

skills room

• This created a stressful situation for both educators and students.

Students did not get the opportunity to care for "real" patients and families and

transfer what was learned in simulation

and class in relation to patient care.

Students do not have the chance to

compare their patient's conditions and

responses to the concepts they are learning

in class

.

Students are not able to develop as

professionals roles and learn to interact

with other health care providers

Students are not exposed to ethical situations, some of which are resolved

differently than the scenario they examined

in class

Students do not have an opportunity to

collect and analyze data, think through

possible approaches to use, and make

informed decisions within the context of

patient-centered care

Because …………

We know students learn best in a positive, supportive and real learning environment

The real environment is totally different sensation from classroom or online teaching

.

CENTRALITY FIELD OF EDUCATION

• Malaysian curriculum, must not dilute its rigor, must meet the required hours, and provide similar experiences in conducting individual casework, group work, community work including any form of clinical works

• This is to fulfil the outcome-based learning system, whilst adhering to MCO rules and regulations implemented by the Ministry of Higher Education and the government.

MOVEMENT CONTROL ORDER IN MALAYSIA

Phase Date

1) Movement Control Order (MCO/PKP, 18 March 2020 - 3 May 2020)

Phase 1 18 March 2020 - 31 March 2020

Phase 2 1 April 2020 - 14 April 2020 Phase 3 15 April 2020 - 28 April 2020 Phase 4 29 April 2020 - 3 May 2020

Conditional Movement Control Order (CMCO/PKPB, 4 May 2020 - 9 June 2020)

Phase 1 4 May 2020 - 12 May 2020

Phase 2 13 May 2020 - 9 June 2020

Recovery Movement Control Order (RMCO/PKPP, 10 June 2020 - 31 March 2021) Phase 1 10 June 2020 - 31 August 2020

Phase 2 1 September 2020 - 31 December 2020 Phase 3 1 January 2021 - 31 March 2021

2) MCO by states (11 January 2021 - 31 May 2021)

Each states switch between MCO, CMCO, RMCO, EMCO, and semi-EMCO depending on the COVID-19 condition in each states.

3 ) Total lockdown (1 June 2021 - 28 June 2021) Phase 1 1 June 2021 - 14 June 2021^[4]

Phase 2 15 June 2021 - 28 June 2021

THREE TIMES LOCKED

17

^TH

MARCH 2020 – 28

^TH

JUNE 2021

• From 17th march 2020 until today we experienced 3 times locked down.

• We went through this pandemic ordeal for almost a year and six months.

• Much we have learned about the difficulty of students who were not directly able to begin clinical placement to this day.

The Most Unique Group We Have Ever Come Across…….

This is the group of students most affected by Pandemic covid 19.

The group has only 34 students

They have enrolled into the program in 2020.

Their learning theory was all through online approaches

After almost one and a half years they have not yet set foot in clinical placements.

Attempts to Alleviate Challenges -Clinical Placement Catastrophe-

• The Department has moved forward as early as the first MCO. We started initially with video recording and online teaching of procedures.

• We could feel that both parties: the lecturers and students had little satisfaction with such approaches

• We make improvements day by day to clinical teaching and improvise the placements.

• We succeeded in conceptualizing the whole process of clinical teaching structures

ONLINE CLINICAL TEACHING For Critical thinking

Process

SIMULATED WARD ENVIRONMENT Problem solving skills

ONLINE CLINICAL AURA

For Clinical attitude Development

SIMULATED SKILL LAB PLACEMENT

For skills based Competency

CLINICAL SEARCH ENGINE TO ASSIST IN

CARE DATABASE BY

CLINICALKEYS

OUR CLINICAL TEACHING MODEL (OCTM) – FRAMEWORK

Show and Tell

Return Demonstration

Discussion Re

enforcement

Students Demonstrate Procedures

Student Discuss at Bed side teaching

CLINICAL PLACEMENT IN SIMULATED WARD

ENVIRONMENT Student Apply the knowledge on

patient care

ASSESSMENT AND EVALUATION OF

CLINICAL PLACEMENT

1. Skills competency 2. Application of

knowledge on Patient Care 3. Clinical Attitude

Self Reflection

CLINICAL PLACEMENT IN SIMULATED SKILLS

LAB

LEVEL OF COMPETENCE WILL BE MEASURED

STUDENTS ROTATION WILL TAKE PLACE BETWEEN SIMULATED CSL TO SWE TILL PLACEMENT COMPLETES

THE PROCESS OF OCTM

ONLINE CLINICAL TEACHING / AURA

ONLINE

CLINICAL TEACHING/ AURA

Ten principles of care in nursing procedure:

before, during and after Students wear

uniforms

Socratic questioning Demonstration Return Demonstration

ONLINE

RETURN DEMONSTRATION SESSION

Over the course of a year and a half there were several times students were allowed to be in the skills room. Students took this opportunity with the Clinical Instructor to perform clinical placements. Students undergo the placement based on scenarios, developed according to learning outcomes required.

CLINICAL PLACEMENT IN SIMULATED SKILL

LABORATORY DURING PANDEMIC

Development of Skills Competency

“Scenario Based” – Approach

ANOTHER

CLINICAL PLACEMENT DURING PANDEMIC

An atmosphere of a small hospital

Students feel the atmosphere as if they were in

a real clinical placement

CRITICAL THINKING AND PROBLEM SOLVING

SESSION – ON SIMULATED PATIENT

DURING WARD ROUNDS at UHC

Everything is Real EXCEPT the Patient

THEY TRANSLATE THE ONLINE CLINICAL TEACHING

(OTCM) INTO PRACTICE

A clinical search engine and point-of-care database

that provides online resources

CLINICAL ASSESMENT

SCENARIO-BASED APPROACH

CLINICAL ASSESSMENT

We are always looking forward to buying time when opportunities open up for the Clinical Assessment

PREPARATION FOR OCTM

NEGOTIATION ( FACULTY & HUMS/ UHC) STRATEGIZING STAFF

DEVELOPING LEARNING PACKAGES SCHEDULLING

COLLABORATION FOR SWE ENVIRONMENT DEVELOPMENT BUDGETING / INSTRUMENT

ACADEMIC SUPPORT STAFF TRAINING

CLINICAL TEACHING PACKAGES BASED ON LEARNING OUTCOMES -AS STRUCTURED TEACHING GUIDES-

• SIMULATED LEARNING EXPERIENCE

• SIMULATED PATIENTS

• BRIEFING

• EQUIPMENT / SUPPLIES

• ASSESSMENT

• REFLECTION

OUR CLINICAL TEACHING MODEL ( OCTM)

COVID-19 Pandemic Effects on Nursing Education: Looking Through the Lens of a Developing Country

Chinwendu F. First published: 29 January 2021

A cyclical approach to educational emergencies should be embraced: prepare, cope and recover

To consider and embrace all the strategies that are needed in cases of emergencies, because COVID-19 is just one pandemic,

Other emergencies could happen, they are inevitable, and the only solution is to prepare, respond, cope and recover as quickly as possible

(Azzi-Huck & Shmis 2020).

I just read this article a few days ago after the development of OCTM was made

EVALUATION OF PROGRAM IMPLEMENTATION

An Evaluation was conducted on OCTM soon after those

students had gone through almost 10 months the training and 6 weeks of clinical placement alternately in the

Clinical Skill Lab and University Health center.

EVALUATION OF CLINICAL PLACEMENT

Mainly focusing on this affected group, N=34 (100%)

Exploring on the experience of clinical placement at the Clinical Skill Lab and University Health Center during Pandemic Covid 19

EVALUATION OF OCTM

1. Effectiveness of Online Clinical Teaching Approach

2. Supervision at Simulated Ward Environment 3. Self-efficacy and Confidence Level on

Transfer of Clinical Knowledge - Online

INSTRUMENT

1. Frequency on Students Satisfaction Questionnaire Brysiewycz, P. ( 2009)

2. Generalized Self-Efficacy Scale. Schwarzer, R., & Jerusalem, M. (1995 )

3. The Satisfaction Level of Undergraduate Medical and Nursing Students Regarding Distant Preclinical and Clinical Teaching . Dutta (2020)

Effectiveness : Online Clinical Teaching Approach

Students Satisfactions

Strongly agree 4 44%

Agree 3 27% 71 %

Neutral 0 26% 26 %

Strongly disagree

and Disagree 1 3%

3 %

Supervision in Simulated Ward Environment at UHC

Overall Satisfactions

Strongly agree 4 13%

Agree 3 18% 31%

Neutral 0 15% 15%

Strongly Disagree

and Disagree 1 54% 54 %

Supervision in Simulated Ward Environment at UHC

Students Satisfaction

Strongly agree 4 13%

Agree 3 18% 31%

Neutral 0 15% 15%

Strongly Disagree

and Disagree 1 54% 54 %

Placement OVERALL CONFIDENCE LEVEL AND SELF EFFICASY

1 2 3 4 5

Not at all Slightly Somewhat Quite Extremely

CSL 18% 82%

SWE 28 % 72%

SELF EFFICASY AND CONFIDENCE LEVEL

TRANSFER OF CLINICAL KNOWLEDGE (CSL&SWE)

Our Assumptions

• Students feel less comfortable being in SWE (UHC) due to the limited space.

• This initiative is a new initiative.

• Perhaps the implementation of this initiative will take time for CI to master and students to understand the concept of simulated ward environment

• The CIs who are at SWE are the same Cis supervising the students at CSL

Strongly agree 4 13%

Agree 3 18% 31%

Neutral 0 15% 15%

Strongly Disagree

and Disagree 1 54% 54 %

AREAS OF IMPROVEMENT

(Should we faced another emergencies/ adversities , they are inevitable, and the only solution is to prepare)

IMPROVING OUR COLLABORATION

WE ARE JUST BEGINNING IT WILL PROBABLY COME TRUE

IMPROVING TEACHING AND LEARNING PACKAGES

• SIMULATED LEARNING EXPERIENCE

• SIMULATED PATIENTS

• BRIEFING

• EQUIPMENT / SUPPLIES

• ASSESSMENT

• REFLECTION

STAFF TRAINING

WE NEED

FUTURE POST GRADUATE STUDENTS

to explore in depth the concept of OTCM in a more effective and scientific manners

Teresa, PhD, RN, CNE, ANEF|Gaberson, Kathleen B., PhD, RN, CNOR, CNE, ANEF, 2017Reflections on Clinical Teaching in Nursing Oermann, Marilyn 2016 Clinical Teaching Strategies in Nursing, 5th Edition,Oermann, Marilyn H., PhD, RN, ANEF, FAAN|

Shellenbarger, Chinwendu F. First published: 29 January 2021 COVID-19 Pandemic Effects on Nursing Education: Looking Through the Lens of a Developing Country

Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy scale. In J. Weinman, S. Wright, & M. Johnston, Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35-37). Windsor, UK: NFER-NELSON. Nursing students' evaluation of the introduction of nursing diagnosis focused tutorials in a university degree programme

•March 2009

Dutta S,Ambwani S, Lal H, Ram K, Mishra G, Kumar T,Varthya SBThe Satisfaction Level of Undergraduate Medical and Nursing Students Regarding Distant Preclinical and Clinical Teaching Amidst COVID-19 Across India 2020

DorienUlenaers^aJoepGrosemans^abWardSchrooten^aJochenBerg Clinical placement experience of nursing students during the COVID-19 pandemic: A cross-sectional study; 2021. Nurse Education Today

Sam, Amir H. PhD, FRCP; Millar, Kate R. MBChB; Lupton, Martin G.F. MBBS, MA, MEd, MRCOG :Digital Clinical Placement for Medical Students in Response to COVID-19 (2020) . Academic Medicine

Council of Dean of Health . Clinical placements and Covid-19–what you need to know. 2020

Laurence Drew And Vicky Naidoo. Surviving clinical placement during the pandemic. 04 DECEMBER, 2020 BY

P Anne Scott¹,Anne Matthews,Marcia Kirwan. What is nursing in the 21st century and what does the 21st century health system require of nursing?(2015).

Philomena Anne Scott& Anne M athew 2021. What is nursing in the 21st century and what does the 21st century health system require of nursing?

Mirna A.Fawaz^aAyman M.Hamdan-mansour^bahmadtassi^{a (2018)} Challenges facing nursing education in the advanced healthcare environment.

nternational Journal of Africa Nursing Sciences

Fernanda Raphael Escobar Gimenes* and Fabiana Faleiros(2014)Nursing Challenges for the 21st Century Journal of Nursing and Care

Sharon Wallace PhD, MSN, RN, CCRN-K,Monika S. Schuler PhD, FNP-BC, CNE,Michelle Kaulback EdD, RN, FNP-BC,Karen Hunt MS, RN, RD, CNE,Manisa Baker2021.

Nursing student experiences of remote learning during the COVID-19 pandemic. Nursing Forum

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