The client as educator: learning about mental illness through the eyes of the expert

Increasingly, educators are asking clients who have a mental illness to make a contribution to nursing students' learning as a way of informing their attitudes towards persons experiencing mental illness and thus enhancing care delivery. The nature of clients' involvement in the classroom and the quality of learning by students through this approach has rarely been questioned. This paper discusses a model of client/nurse educator collaboration in a mental health course with undergraduate nursing students. It draws on the nursing education experiences of the first author, and the personal views of the second author, a user of mental health services. Specifically, it addresses positive features of collaboration as perceived by students, client, and nurse educator and analyzes some of the challenges/issues for the nurse educator. In addition, it outlines helpful aspects of the collaborative process for both nurse educator and client, in particular, its impact on the client's personal well being. This kind of analysis is essential if we are to develop education models of such collaboration that are beneficial for all partners in the learning process.     

Collaborative Practice Through Nursing Case Management

A 528-bed community teaching hospital redesigned its patient care delivery system, implementing a collaborative practice model on the 30-bed inpatient rehabilitation unit in April 1990. This model is a patient-centered delivery model that encourages the healthcare team to facilitate the achievement of patient outcomes within effective time frames and with an appropriate use of resources. The collaborative practice model includes a nurse case manager's role for the staff nurse, which had as its framework the concept of nursing case management. Tested project management techniques were used to ensure a successful implementation process. Various strategies, such as using project teams and providing educational programs, were used to respond to the issues of role conflict and overlap, especially between social workers and nurse case managers. The implementation of this model provided a number of benefits, including improved interdisciplinary relationships and decreased length of stay.     

Focus on rehabilitation in the acute care setting: the role of the neuro clinical nurse specialist

Establishment of an early rehabilitation program for patients with neurological/neurosurgical illness or injury is the focus of this article. The Neuroscience Clinical Nurse Specialist (NCNS) is identified as having a major responsibility in initiating early rehabilitation in the acute care setting. Development of the rehabilitation program is discussed through the NCNS's roles as educator, clinician, consultant, and researcher. Implementation of the rehabilitation program emphasizes the use of the nursing process, the role of the staff nurse, active patient and family participation, and use of the interdisciplinary team approach. General concepts rather than specific practices are used in order to present an overview of the role.     

Blended roles: preparing the advanced practice nurse educator/clinician with a web-based nurse educator certificate program

Changing demographics, a nursing shortage, and various societal changes underscore the need for nurse educators and new nurse educator programs. This article describes a Web-based nurse educator program designed to prepare advanced practice nurses for faculty roles while simultaneously preparing them as clinicians. Guided by adult education theory and self-directed learning theory, the Web-based Nurse Educator Certificate (four Web-based nurse educator courses including a teaching practicum) has been developed and offered to clinical master's and postmaster's students. This article also describes student work with mentors, interactive Web-based teaching strategies, portfolios, graduate competencies, and initial evaluative data. In the first two years of the program, 48 students have taken at least one course in the Nurse Educator Certificate program and eight students have completed it. A Web-based nurse educator certificate program, as part of a clinical master's or postmaster's program, has the potential to help meet the faculty shortage.     

The nurse's role in cancer rehabilitation. Review of the literature

Rehabilitative nursing is an integral part of all phases of patient-centered care. The role of the nurse in addressing rehabilitation issues for cancer patients is one of teaching, counseling, and coordination. Nurses have made significant contributions to educational programs available to cancer patients and their families. The program structure, content, and setting are as varied as the potential patient. Site-specific support programs, as well as programs that identify and support positive coping behaviors, have been developed by nurses. In their efforts to maximize resource allocation in a variety of settings, nurses have developed roles and programs that promote the process of rehabilitation. This review of nursing literature provides a source for nurses wishing to continue designing programs that enhance rehabilitation.     

Raising awareness of learning disability needs in acute sector care: A reflective account of a workshop from the guest facilitator perspective

Nurse education has an essential role to play in reducing health inequality for people with learning disability [Michael, J., 2008. Healthcare for All: Report of the Independent Inquiry into Access to Healthcare for People with Learning Disabilities. Aldridge Press, London]. Many nurse education providers will need to use guest facilitators in order to raise awareness of best practice in caring for this client group for non learning disability branch students and their experiences as nurse educators will be of growing interest. This article critically reflects on an educational session for pre-registration adult branch nursing students which used a variety of teaching methods to facilitate a reflective, student centred, experiential learning approach. Self assessment based on the change between two self rating scales was used to assess learning, the session itself was evaluated by students using a feedback form and through the formal assessment of teaching by a nurse tutor. This article critically evaluates the preparation, delivery and evaluation of the session, emphasising the perspective of the guest facilitator – a practicing community learning disability nurse. The conclusion reflects on key learning from the teaching experience.     

The role of the nurse in cardiac rehabilitation programmes.

Cardiac rehabilitation programmes are intended to enhance the effect of acute treatment actions and to prevent risk factors, thus leading to an improvement in the patient's well being and recovery. Accordingly, all cardiac rehabilitation activities do not take place at the same time, which is the reason why the nurse's role changes in character over time. The aim of this paper is, therefore, to highlight the role of the nurse in cardiac rehabilitation programmes. The nurse's multiple roles in cardiac rehabilitation have a 'spider in the web-like' character and, depending on the phase of the patient's recovery, he/she acts as a container, a counsellor, a coach and an educator. To implement a successful cardiac rehabilitation, the nurse needs to have improved evaluation tools in clinical practice as well as to be self-critical and serve as a good role model. Finally, the cardiac rehabilitation nurse has to have a four-fold comprehensive perspective of the cardiac rehabilitation concept; an impact perspective, a timing perspective, a lifespan perspective, and a personal perspective.     

The influence of the family's perception of disability on rehabilitation outcomes.

The family plays an important role in facilitating positive rehabilitation outcomes with a disabled client. Thus, families must be involved in the rehabilitation process. For this to occur, the nurse must identify the characteristics of the family unit. This article presents a framework that supports the assessment of the family unit.     

Pressure sore prevention education with the spinal cord injured

The purpose of this qualitative single case study was to explore and describe the various formal and informal pressure sore prevention (PSP) educational encounters that occurred with an adolescent spinal cord injured client during his initial admission in an inpatient rehabilitation facility. Data collection supported the conclusion that nurses engaged most frequently in educational encounters with the client. Based on study findings, nurses should consider the following in planning client teaching: (a) assessing a client's learning style on admission and considering this when choosing teaching methods; (b) timing the delivery of PSP education to coincide with times when the information and skills would be most immediately applicable and relevant for the client; and (c) clarifying PSP measures of highest priority with clients while educating them. It also is suggested that rehabilitation nurses consider striking a balance between modeling important PSP measures in earlier phases of a rehabilitation program and encouraging client independence in these behaviors in later program phases.     

Pedagogical content knowledge for nurse educators: An intersection of disciplines

Pedagogical content knowledge (PCK) is the proverbial bar over which novice nurse educators must leap. However, relatively few nurse educators receive the formal graduate pedagogical training needed to smoothly transition from bedside nursing or advanced practice roles to the nurse educator role. Novice nurse educators who lack pedagogical preparation may experience frustration and failure when attempting to clear those bars and therein lays a problem. Novices nurse educators bring their own expectations to the teaching endeavor. They expect their clinical knowledge and experience to have equipped them with all that is necessary to teach nursing. Faculty are content experts but not yet experts of teaching, excelling only in providing or directing client care and providing clinical supervision to students. The lack of PCK creates a sometimes insurmountable disconnect between bedside nursing practice and nursing academia. Such dissonance often leaves the nurse educator in unfamiliar territory teaching by trial and error.     

Critical Thinking Ⅱ： Teaching Strategies to Foster Critical Thinking in Undergraduate Nursing Students： A Case Analysis Approach

护理是一门实用学科,“Critical Thinking”又是护理实践中必要的思维技能,由于临床中疑难杂症患者增多,科技进步以及医疗伦理的矛盾愈发突显,临床护士能够运用“Critical Thinking”促进患者健康显得更为重要。因此,护理教育者需要坚持探索有效的教学策略,使本科护生能做到“CriticalThinking”理论和实践的无缝衔接。     

The hospitalized patient with arthritis

Patients hospitalized with arthritis require the expertise of nurses with a solid medical and surgical background, a base upon which approaches to rheumatic disease can be developed. The nurse should play a primary role in planning a realistic and integrated schedule for meeting the patient's pharmacotherapeutic and rehabilitation needs, in reinforcing physical medicine principles and programs, and in serving as a liaison between patient and physician, patient and other health care providers, patient and family, and patient and community. The nurse is pivotal in assuring that the comprehensive care and educational needs of the patient with arthritis are met, whether hospitalized or in an out-patient setting.     

The impact of client selection on clinical teaching

Inclusion of gerontological nursing in curricula is emerging as an issue of concern to faculty of schools of nursing. Using research findings which view the setting and client selection as major determinants of learning outcomes, faculty are experimenting with teaching strategies which support a positive more realistic view of the elderly and their inherent potential and motivation for health. This paper examines the learning outcomes about ageing of a senior clinical experience at the baccalaureate level directed toward learning to nurse the elderly in a responsive and health promoting manner. Students were provided with an opportunity to become comfortable working with the elderly and their families in order to: 1 increase their level of knowledge about the process of ageing; and 2 incorporate this knowledge within a nursing framework by identifying critical aspects of development used in the health assessment of the elderly. The method of study was primarily experiential in nature with each student making a series of home visits over a 3-month period to one selected client family. Two groups of clients participated in the programme: clients in group A were maintaining themselves in their own homes, were not anticipating institutionalization and were in good health; clients in group B were in hospital for treatment of a major health problem but would be recuperating in their own homes. By using Palmore's Facts on Ageing Quiz, it was determined that client selection did in fact make a difference vis-à-vis learning outcomes about ageing and the aged.     

Documenting client education in rehabilitation: an interdisciplinary approach

Traditionally, the evaluative and therapeutic aspects of rehabilitation have been carefully planned, executed, and documented by the interdisciplinary team. However, the client education aspects of rehabilitation have been less well defined, poorly delegated among the disciplines, and rarely documented. An example of how educational activities can be incorporated into a client's rehabilitation program is presented. A sample instrument, the Pulmonary Rehabilitation Checklist, was developed to document client teaching related to chronic lung disease, with a format that can be adapted to meet the teaching needs of any client population. The many purposes served by the checklist are discussed: (a) It permits client and staff to select mutually appropriate goals; (b) it lists the learning objectives according to the discipline responsible for the teaching; (c) it centralizes the documentation of client teaching activities carried out by a variety of disciplines; and (d) it provides a means for the client and the rehabilitation team to assess at a glance progress toward achieving goals.     

Pulmonary rehabilitation after acute COPD exacerbation

Acute COPD exacerbation provides a window of opportunity for providing teaching, supportive care, and rehabilitation to a group of patients at high risk for complications and re-admissions. This article has attempted to make a case for the unique needs of this group of patients. Treatment of exacerbation is often viewed as "routine" by hospital staff and generally has focused upon the pharmacologic regimen of oxygen therapy, bronchodilators, antibiotics, and steroids. Within a few days, the patient is usually less dyspneic and is discharged with a combination of MDIs and a plan for steroid taper. All too often, the patient returns home with no idea of how to regain lost function or prevent future exacerbations. The use of the MAC provides a more complete picture of the unique needs and capabilities of COPD patients and brings together the collective expertise of the entire health team in designing a plan of rehabilitative care. Planned monitoring of the patient after discharge is an integral component to the success of the rehabilitation approach and the ability of the patient and family to move toward self-management of this chronic disease. Transitional care programs, community nurse referrals, telephone contacts, and outpatient visits are all appropriate methods for providing the type of support required to sustain rehabilitation. Traditionally, nurse researchers have examined psychosocial and functional performance outcomes of rehabilitation, however, nurses are in an ideal position to explore the methods of rehabilitation that yield the most positive outcomes over time and are sustainable over the course of the disease. Nursing can and should assume a leadership role in such initiatives.     

Assessment of learning needs of nurse educators: continuing education implications.

Because of current structure, content, and outcomes of master's nursing curricula, administrators responsible for hiring nurse educators often have no choice but to employ clinical experts as teachers. This article reports on the results of an investigation designed to ascertain the self-reported learning needs of nurse educators in a southern state. This investigation confirmed that nurse educators have numerous learning needs specific to fulfillment of the nurse educator role. Findings suggest that learning needs differed according to the educator's level of academic preparation and type of employment setting. The results provide useful insights for individuals planning continuing educational offerings for nurse educators with varied backgrounds.     

A guide to nursing students' written reflections for students and educators

Experiences from the clinical setting are ideal for building critical thinking skills if reflection is used as a teaching tool. Reflective writing is the purposeful and recurring inspection of thoughts, feelings, and occurrences that coordinate with experiences during practice. Reflecting on clinical experiences develops critical thinking ability, fosters self-understanding, facilitates coping, and leads to improvement in clinical practice (Kennison, 2006). Reflective writing allows students to combine clinical experiences and takeaways with didactic material to better understand both practice and instruction. Reflective writing is defined as an assignment that is focused on students’ experiences, like textbook readings, clinical experiences, or group activities, that highlights what the student has taken from the activity (McGuire et al., 2009). This study will explore reflective writing from the perspective of the nursing student and the nurse educator. The following questions will be answered: What are the benefits of reflective writing? Why would nurse educators want to use reflective writing in their nursing courses, both clinical and didactic? What are the barriers to using reflective writing for students and educators? What is the role of the nurse educator in student reflection?     

Teaching stoma-management skills: the importance of self-care

Patients undergoing stoma formation have to make major physical and psychological adjustments following surgery. Research indicates that the early promotion of stoma-management skills is, therefore, a critical concern for the hospital-based stoma care nurse. This article aims to explore how the stoma care nurse specialist can best utilize teaching opportunities in the pre- and post-operative periods. Teaching should be approached in an organized manner, underpinned by sound principles of teaching and learning using teaching plans where appropriate to ensure that no vital aspects are omitted. Realistic learning outcomes should be established in consultation with the patient according to his/her readiness and ability to learn. An organized exchange of information between hospital and community will ensure that teaching and support are continued following discharge from hospital promoting positive adjustment to stoma formation and thus facilitating successful rehabilitation.     

A qualitative case study review of role transition in community nursing

PURPOSE: This paper aims to describe existing community nursing practices and to explore factors that are associated with the transition of clinical practice from acute care settings to community care settings. METHOD: This qualitative case study assessment described existing community nurse practices and explored factors that were associated with the transition to community practice from acute care settings. The 48 participants in this case study were registered nurses who were working in community care nursing during the interview process. CONCLUSIONS: The results of this investigation revealed themes derived from data collection, including autonomy, client and family, education, and community as nursing work. This study indicated that making the transition to community-based nursing includes conceptual as well as emotional adjustments. Community nursing practice was seen by the participants as nursing that captures a holistic approach incorporating multiple dimensions from psychological, sociological, economic, and physical to spiritual aspects that provides services in interaction between the community nurse, the client, and the family. The findings indicate a need for additional supportive preparation strategies incorporated into nursing orientation and continuing education programs. Future research investigating agency culture and socialization would provide a more definitive survey of perceptions and competencies needed for role.