The evolution of simulation and its contribution to competency

Nurse educators are challenged to implement teaching strategies that promote learners' clinical competency and critical-thinking skills. Additionally, these educators are asked to base their curriculum decisions, teaching practices, and evaluation methods on current research findings. Simulation offers a unique mode for experiential learning and evaluation, but the appropriate use of the spectrum of simulation typology requires strategic planning. Although simulation provides educators with new educational opportunities, the potential use of simulation in competency testing cannot be achieved until educators and researchers acquire the knowledge and skills needed to use this education strategy, develop realistic case scenarios, and design and validate standardized and reliable testing methods. Numerous pressures exist for clinical settings to document the competencies of their employees. Simulation could be used in the practice environment to promote and validate the clinical judgment and competency of nurses.     

Student feedback on teaching: Some issues for consideration for nurse educators

In this paper, we outline some key points about student feedback for nurse educators to consider. For nursing students, providing feedback offers an opportunity to communicate whether relevant and effective learning has occurred. Given the importance of student feedback for the quality of learning and teaching, and the significant resources invested in it, it is essential that accurate feedback is obtained and responded to by nurse educators. The aim of this paper, therefore, is to present an overview of factors influencing the quality and reliability of student feedback of their theoretical and clinical learning experiences, and ways the feedback might be used by educators for improving teaching and career enhancement. Nurse educators need to be prepared to respond to well‐intentioned feedback without undue defensiveness to ensure good and effective teaching. Ultimately, feedback systems that are well managed should benefit nursing students, nurse educators and their respective institutions.     

Nursing students' and clinical educators' perceptions of characteristics of effective clinical educators in an Australian university school of nursing

BACKGROUND: This study is a replication of research undertaken by Mogan and Knox in 1987, which investigated and described characteristics of 'best' and 'worst' clinical educators. They developed and used an instrument known as the Nursing Clinical Teacher Effectiveness Inventory (NCTEI), a 48 item checklist that describes discrete characteristics clustered into five subscales or categories: teaching ability; interpersonal relationships, personality traits, nursing competence and evaluation. The tool has since been used in several countries including Greece, Hong Kong, Israel and North America and is the instrument most frequently used to identify effective clinical teaching characteristics of clinical educators. AIM: The aim of the present study was to administer the NCTEI to undergraduate nursing students and clinical educators in a school of nursing at an Australian university to explore the perceived characteristics of effective clinical educators as rated by students and educators, and the significant differences and commonalities between these perceptions. FINDINGS: Results indicate that the category of Interpersonal Relationships was the most highly valued characteristic rated by both Australian students and clinical educators, and both groups (students and educators) ranked the subset of personality as the lowest amongst five categories. In common with Mogan and Knox, this study found that students who had not been exposed to real clinical situations prior to commencing nursing studies ranked items related to interpersonal relationships more highly than students who had previous nursing experience. Although there were no statistically significant differences in the two groups, students were more concerned with evaluation while clinical educators were more concerned with nursing competence. CONCLUSION: This study is the first research to be reported in Australia, which has simultaneously compared both students' and educators' perceptions and the first to replicate Mogan and Knox's seminal work. Findings point to the need for clinical educators to value interpersonal relationships with students as well as clinical competence.     

Teaching the Musculoskeletal Examination: Are Patient Educators as Effective as Rheumatology Faculty?

Background: Effective education of clinical skills is essential if doctors are to meet the needs of patients with rheumatic disease, but shrinking faculty numbers has made clinical teaching difficult. A solution to this problem is to utilize patient educators.

Purpose: This study evaluates the teaching effectiveness of patient educators compared to rheumatology faculty using the musculoskeletal (MSK) examination.

Method: Sixty-two 2nd-year medical students were randomized to receive instruction from patient educators or faculty. Tutorial groups received instructions during three, 3-hr sessions. Clinical skills were evaluated by a 9 station objective structured clinical examination. Students completed a tutor evaluation form to assess their level of satisfaction with the process.

Results: Faculty-taught students received a higher overall mark (66.5% vs. 62.1%,) and fewer failed than patient educator-taught students (5 vs. 0, p = 0.02). Students rated faculty educators higher than patient educators (4.13 vs. 3.58 on a 5-point Likert scale).

Conclusion: Rheumatology faculty appear to be more effective teachers of the MSK physical exam than patient educators.     

Where is the evidence for teaching methods used in nursing education?

Twenty-first century maternal-child faculty members are now being encouraged to base their teaching practice on sound evidence. Finding that evidence, however, can be challenging. This article discusses not only the current state of research on teaching in nursing, but also how and where educators can access information about teaching that is based on research. It also describes strategies educators can use to develop an evidence-based approach to teaching. Topics included in this discussion include recommended literature resources in nursing and education, bibliographic database search techniques, guides for appraisal of quantitative and qualitative research, and relevant nursing education and general education professional organizations. In addition, an evidence hierarchy from the field of education is introduced to rank educational studies in nursing. If nurse educators are to apply the evidence-based process used in clinical practice to the practice of nursing education, more research is needed in this field.     

The application of student-centered teaching to nursing education

Nursing education in Taiwan is currently facing an extensive reform toward student-centeredness. However, few articles were found in the Taiwanese nursing literature focusing on student-centered teaching and nurse educators in Taiwan may have different interpretations of it. Misinterpretation of the term 'student-centeredness' may lead educational reform into inconsistency or ineffectiveness. This study aims to expand student-centered teaching's application to nursing education, stressing that not only the teaching techniques but also a consistent thinking approach is essential for educational reform. The content of this article addresses the meaning of student-centeredness and the differences between teacher-centeredness and student-centeredness. The article also advocates Weimers' five key changes toward student-centered teaching: the balance of power, the function of content, the role of the teacher, the responsibility for learning, and the purpose and process of evaluation, and further expounds their application to nursing education. Hopefully this article can provide Taiwanese nursing educators and students with an explicit view of student-centeredness and facilitate a more effective application of it to educational reform in nursing.     

Faculty and student perceptions of effective clinical teachers

The following study has been conducted to discover the characteristics of an effective clinical teacher as described by faculty and students in a selected baccalaureate school of nursing. Through determination of these characteristics, clinical teachers can improve their teaching methodology and provide a more effective learning environment for the learner. The identification of these characteristics also has implications for graduate nursing education, as clinical teachers are being prepared in this arena to enter the teaching environment. Administrators should consider utilization of these characteristics for teacher evaluation purposes. Nursing educators must attempt to bridge the gap between what educators and students perceive as characteristics of the effective clinical teacher. The ultimate goal to be achieved from identification of effective clinical teacher characteristics, as determined in this study, is improvement in clinical teaching.     

Academic maturity: qualifications to teach the nurse professionals of the future

In a recent survey of Queensland academic managers and graduates of pre-registration and nursing postgraduate programs, it was found that within levels of management there exists a disparity related to the minimal qualifications of educators of nurses. The preferred minimal level of academic preparation of heads of departments of nursing was generally ess than that proposed by recent consumers of tertiary education. Recent postgraduate and graduate students displayed their academic maturity through their preferences for highly qualified and academically qualified educators at all levels. The variety of educators involved in tertiary education included academics teaching within universities; clinical laboratory teachers teaching the skills of nursing practice; clinical faci itators who are responsible for groups of students in the clinical area; and clinical mentors, the clinicians who support and nurture students on a one-to-one basis. Ten managers of nursing programs (N=20), fourteen postgraduates (N=61) and 90 graduates (n=302) of Queensland tertiary nursing programs responded to the survey. While the final samples were small, the outcomes suggest increasing graduate expectations of thei educators and the need for a re-evaluation of measures of quality in academic teaching.     

Clinical decision-making in senior nursing students in Iran

Clinical decision-making is the basis for professional nursing practice. This can be taught and learned through appropriate teaching and clinical experiences. Unfortunately, it has been observed that many graduates are unable to demonstrate suitable clinical decision-making skills. Research and study on the process of decision-making and factors influencing it assists educators to find the appropriate educational and clinical strategies to teach nursing students. To explore the experience of nursing students and their view points regarding the factors influencing their development of clinical decision-making skills. An exploratory qualitative approach utilizing grounded theory methods was used; focus group interviews were undertaken with 32 fourth year nursing students and data were analysed using constant comparative analysis. Four main themes emerged from the data: clinical instructor incompetency, low self-efficacy, unconducive clinical learning climate and experiencing stress. The data indicated that students could not make clinical decisions independently. The findings of this study support the need to reform aspects of the curriculum in Iran in order to increase theory-practice integration and prepare a conductive clinical learning climate that enhances learning clinical decision-making with less stress.     

The use of teaching portfolios to promote excellence and scholarship in nurse education

Achieving excellence in nurse education and demonstrating scholarship in teaching is a challenge for nurse educators who find themselves torn between maintaining high standards in nurse education and their own need for recognition and promotion in an environment that primarily favours research and publications over excellence in teaching. The use of a teaching portfolio is a way to display excellence in nurse education and to provide a public display of teaching scholarship. While not a new concept in nursing education, it has some originality in its application to practising nurse educators. However, the requirement for and guidelines on the development of a portfolio for nurse educators (other than those undertaking educational training) has been little explored. The aim of this paper is to explore the concept of a teaching portfolio as a vehicle to demonstrate excellence and scholarship among seasoned nurse educators. The process of developing a teaching portfolio at one university setting is outlined, so that other teachers are enlightened to the potential benefits of this activity.     

Clinical instructors' knowledge and perceptions about nursing care of older people: A pilot study

With an aging population, the majority of nurses will spend their careers working with older people. Currently, there is scant research about clinical instructors' knowledge and perceptions about nursing care of older people despite their instrumental role in preparing nurses for practice. The purpose of this study was to explore clinical instructors' knowledge and perceptions about nursing care of older people. A mixed methods approach was used. Fifteen clinical instructors and 15 nurse educators employed on specialized units for older people completed questionnaires. Independent t-tests were administered. Five of the clinical instructors also participated in semi-structured interviews, which were analyzed using thematic analysis. Findings indicated that clinical instructors had significantly lower scores on knowledge and perceptions about nursing care of older people than practice-based nurse educators. Further, clinical instructors found it difficult to integrate specialized knowledge about nursing care of older people along with other aspects of their teaching. They also reported that it was challenging to support learning about best practices for older people within the current clinical context, which was complex and fast-paced. This study reinforces the need for professional development opportunities for clinical instructors to support their instrumental role in preparing students for practice with older people.     

Gentle interruptions: transformative approaches to clinical teaching

This conceptual article, drawn from the authors' shared teaching experiences and recent student and clinician evaluation data, set out to reveal and then address some common problems faced by clinical educators and nursing students in the time-constrained, complex, specialized field of clinical learning. We explain and argue the benefits of transformative learning and outline specific strategies for building skills in transformative education, such as interrogating clinical routines and habits, teaching diplomacy skills, and using a process of interruption. Clinical educators can use these strategies to move beyond unwittingly serving the status quo toward consciously contributing to change.     

Student's perceptions of effective clinical teaching revisited

Despite a wealth of research on clinical teaching, the criteria for determining what constitutes effective clinical teaching remain poorly defined [Cholowski, K., 2002. Nursing students' and clinical educators' perceptions of characteristics of effective clinical educators in an Australian university school of nursing. Journal of Advanced Nursing 39 (5), 412-420]. This paper reports on two studies exploring second and third year nursing student's perceptions of effective clinical teaching over 14 years (1989-2003). The aim of the inquiry was to compare student's perceptions in diploma and baccalaureate programs within existing clinical contexts. This research used a generative approach to elicit learner's views of what teacher characteristics and contextual influences impact them in clinical settings. A convenience sample of 30 students at the end of second and third years volunteered to be interviewed in-depth for each study. The first study was conducted in a diploma program, whereas in the second study all but a few students were elected to complete a four year baccalaureate nursing degree. Findings from both studies are remarkably consistent. Students in both studies rated teacher knowledge as most important followed by feedback and communication skills. Teacher knowledge appeared critical in four areas: as it pertains to the clinical setting, the curriculum, the learner and teaching/learning theory. How well students perceived that they were accepted by staff, student-teacher ratios and peer support also appeared to impact student's views of effective clinical teaching. This research has implications for employment and evaluation practices for teachers in applied fields such as nursing. The study raises questions about the recent trend toward temporary employment of clinical teachers and in the separation of academic and clinical roles of nurse educators.     

An innovative model of supportive clinical teaching and learning for undergraduate nursing students: the cluster model

Students look forward to their clinical practicum to learn within the context of reality nursing. As educators we need to actively develop models of clinical practicum whereby students are supported to engage and learn in the clinical learning environment. The aim of this paper is to describe an innovative model of supportive clinical teaching and learning for undergraduate nursing students as implemented in a large teaching hospital in New South Wales, Australia. The model of supportive clinical teaching and learning situates eight students at a time, across a shift, on one ward, with an experienced registered nurse from the ward specialty, who is employed as the clinical teacher to support nursing students during their one to two week block practicum. Results from written evaluation statements inform the discussion component of the paper for a model that has proved to be successful in this large healthcare facility.     

Teaching can never be innocent: fostering an enlightening educational experience

Becoming cognizant of the actual and potential oppressive dimensions of the teaching practices of nurse educators is essential in establishing a more democratic and enlightening experience for both teachers and students. Although there has been an ardent trend toward the promotion of critical thinking and reflective ability among nursing students, rarely has attention focused on the ability of nurse educators to be critically reflective of their own teaching. The authors pose key questions about the reality of nursing education today and how it can sometimes continue to reflect a philosophy that seems to contravene the notion of a more liberated approach to teaching. In that process, they reflect critically on the subtle incongruities and complexities between teachers' intentions and their practice.     

Clinical teaching practices of nurse educators at a public college of nursing in South Africa: A survey study

Standardisation of clinical teaching practices by nurse educators for undergraduate students is vital, especially within large nursing education institutions distributed over multiple campuses. This quantitative study investigated current clinical teaching practices of nurse educators at a Public College of Nursing in South Africa. A total of n = 68 nurse educators were selected from 5 campuses over a two-month period (April–May 2016), using convenience sampling. Data was collected with a structured questionnaire, the design of which was informed by the Dundee Three Circle Outcomes Model for Clinical Teaching. The results showed that 37% (n = 25) of the nurse educators had above 10 years of clinical teaching experience. Of the 66% (n = 45) who had formal education on clinical teaching practices, 49% (n = 33) received in-service education. Most nurse educators were willing to share amongst colleagues documents they used for clinical teaching, to promote standardisation of teaching practices. Further, they evidenced best clinical practices regarding planning for assessment and clinical placement of students. However, there were significant variations in the majority (seven) of the nine investigated clinical teaching practices among participants. In-service education was positively correlated to best clinical teaching practices (Chi square (d.f. = 2, n = 68) = 7.24; p = .027; V = 0.33 Medium).     

Human patient simulation versus case study: Which teaching strategy is more effective in teaching nursing care for the hypoglycemic patient?

With the ever-increasing safety concerns presented in a health care setting, it is imperative that nursing students are prepared for the demand of utilizing the skill of critical thinking while providing care to patients experiencing hypoglycemia. Nurse educators strive to implement different teaching strategies to promote critical thinking skills. The purpose of the study was to evaluate the effectiveness of two teaching strategies: human patient simulation (HPS) and a single case study during diabetes education. In addition, the study was used to validate the inclusion of HPS in the authors' nursing program curriculum. A quasi-experimental, two-group pretest and posttest design was utilized to evaluate these teaching strategies. Faculty also completed an objective clinical evaluation, which evaluated students' clinical reasoning, and all students completed a postsurvey evaluating the teaching strategies. Study results indicated the pretest average scores for both groups were identical. The posttest results for the case study group were slightly higher than the simulation group results. On the clinical evaluation tool, the simulation group scored much greater than the case study group. Both results were statistically significant. The postlesson survey results were greater overall for the simulation group on all statements. All students agreed or strongly agreed that simulation was effective. According to the student test results and clinical evaluations, both teaching strategies are beneficial in nursing education; moreover, the student surveys and comments validated the addition of simulation as a valuable teaching strategy. As a result of this research, HPS was formally implemented into the nursing curriculum.     

How should the effectiveness of problem-based learning in occupational therapy education be examined?

Our aim in discussing the issue of educational outcomes of PBL has been to provoke discussion among occupational therapy educators and researchers. Future collaboration and research should involve occupational therapy educational programs that use PBL and those who have yet to access this teaching-learning method. Multisite studies would allow the evaluation of different teaching methods of clinical reasoning and their respective efficacies. Germane instruments that are easy to use and that effectively measure clinical reasoning in occupational therapy must be developed to supplement the qualitative research that is being undertaken. Such research will support and validate the use of resources and constructively contribute to accountability. PBL may be valuable for promoting adaptive learning in students, which will help them and the profession stay informed and proactive and ensure best practice in a rapidly changing health care environment. This article is a call for educators to collaborate in educational outcome research studies. The traditional methods of evaluation, such as pass rates on national certification examinations, may not demonstrate the multidimensional learning and cognitive growth acquired in PBL; therefore, there is a need to generate validating research about the efficacy of PBL in occupational therapy education. If we are to undertake the challenging task of measuring the development of clinical reasoning, research will require creativity and reflection, hallmarks of the PBL process.