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Teaching Strategies and Methods 3 5 9 mputerized simulation, emulated patients.

: :nts to remember while preparing simulations: 7"he simulation should: tiate the problem in a realistic manner, it should contain the elements a nurse would encounter in the real -tuation. .fleet problem solving process by requiring a series of sequential interdependent decisions. able the learner to obtain the necessary information d o r feedback related to a previous decision as input to the next step, he consequences of errors should be built into the nation, and learners should not be able to reverse rong decisions, rather they should deal with the - mplications or delays that result from such errors. 5 The s i m u l a t i o n s h o u l d a c c o m m o d a t e a l t e r n a t i v e solutions if these are possible in real life.
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its c a p a c i t y to p r o m o t e transfer of l e a r n i n g are diminished. 5. Learners may not find the simulation relevant to their situation. Conclusion Simulations can be used in teaching and evaluation of psychomotor skills, cognitive skills and communication skills. CLINICAL TEACHING METHODS USED IN NURSING Introduction The clinical teaching is a type of group conference in which a patient or patients is (are) observed and studied, discussed, demonstrated, and directed towards the improvement and further improvement of nursing care. In nursing clinical teaching may be given by the doctor in order to discuss the medical aspects of a patient's condition more vividly than can be done in the classroom. Such a class will usually follow, or be followed by, a further consideration of the range of conditions to which the disease seen in the patient, belongs. Alternatively, clinical teaching may be given by any faculty member, i.e. clinical instructor or tutor, or ward staff and will concentrate on a particular patient's needs as a person and how the doctor's treatment orders can be met by the right u n d e r s t a n d i n g and n u r s i n g care. In nursing commonly used clinical teaching methods includes: 1. Nursing clinics/bedside clinic. 2. Nursing rounds. 3. Nursing assignments. 4. Nursing care conferences. 5. Morning and afternoon reports. 6. Team nursing conferences. 7. Health team conferences. 8. Individual conferences. 9. Field visits. 10. Process recording, etc. Vast amounts of research have given little substantiating evidence to suggest that certain teaching methods or devices automatically produce better results than others. The current movement is toward the development of theoretical research designs for the study of the processes of teaching and learning and their ultimate effects on self-appropriated l e a r n i n g . T e a c h e r s m u s t rely on c u r r e n t l y a v a i l a b l e information and their own resourcefulness in the selection,

=.ntages of Simulations It actively engages learners in the application of knowledge and skills in realistic situations. I It is useful in promoting transfer of learning from the classroom to the clinical setting. I The controlled setting of the simulation m a k e s it possible to have consistency in learning experiences from learner to learner. - Simulations permit application of theory to practice when access to clinical settings is limited or impossible. :' Simulations can motivate learners to learn prerequisite content before tackling the simulation, because they challenge learners to integrate a large body of content. Students can receive feedback on the appropriateness of their action during simulation. It provides participants to deal with the consequences of their actions. I Students can learn without harming the patient. Disadvantages of Simulation ".

|. Simulations are time consuming to develop particularly if they are to mirror realistic situations. 2. Mechanisms for feedback of data may require the use of sophisticated materials. 3. Costs of developing and reproducing a simulation may not be recovered even with repeated use. 4. If the simulation emits aspects of reality situations important to learners, the realism of the simulation and

3 6 0 Nursing Education adaptation, and evaluation of effective teaching-learning objectives to be accomplished, the students, and the abil of the teacher. Creativity, in the use of these method methods and devices. Educators continue to seek ways of having personal and reflected by the individual teacher's distinctive manner d close contact with master teachers who inspire through their performance in a given situation. ability to communicate their knowledge of the subject field and their understanding of the student as an individual. GUIDELINES FOR SELECTION OF METHODS Although there is no substitute for intimate contact with the ADAPTED FOR USE IN CLINICAL TEACHING expert teacher, it must be remembered that one cannot guarantee that small groups of students with a teacher offer A creative teaching-learning milieu provides the freedom the best educational opportunities. The very nature of this for discovery so vital to learning professional responsienvironment would, in some instances, merely perpetuate bilities. In an article Mereness describes six freedoms _ I mediocrity; it is possible for a given student or group of responsibilities she believes should be provided b\ . students to learn more by being exposed to expert knowledge educational institution. The clinical teacher who provida opportunities for learning through discovery and mi through one or several modes of education. Utilization of a teaching selections based on the democratic concept tfad wide variety of communications media as an integral part for eveiy right granted to an individual there, is an equm of the total teaching-learning process may lead the way to responsibility should experience the job of self-fulfilr. . creativity by offering students opportunities to pursue This broad concept offers clinical teachers the o p p o r t u r individual inquiry along with tutorial assistance from truly to increase their potential for fostering creativity ti expert teachers who do not impose their views and attitudes their ability to purposefully select and adapt a wide rar.a on the students. Just as we recognize that a single learning of teaching methods to the clinical setting. The folk theory does not describe the diversity of ways in which guidelines can be used in the selection of methodindividuals learn, neither can we identify one teaching theory teaching appropriate for use in the clinical setting. that describes the range of activities and devices used by Selection of method must be appropriate to objectiw teachers. Creative learning is dependent on some underlying desired behavioral changes. There may be any number 01 scheme leading to self-discovered learning; thus, teaching methods that could be used to meet the specific objecth q| processes cannot always be readily identified. They exist in but there are instances in which certain methods could a variety of shapes and forms and are comprised of a variety accomplish the objective. For example, to learn some of of operations providing for learner involvement in the skills described in the preceding chapter, some type acquisition of knowledge and skill. We are now at a point learning experience involving practice of the skills is nee for teachers to re-examine their teaching approaches, in addition to the use of the lecture method. A ch: .. identifying those methods and instructional strategies that conference could also be utilized to meet the behavi provide for more flexibility in the use of processes leading outcomes by helping student's discuss the problems inner to creative learning in the clinical nursing situation. in the nursing situation and see relationships between d| The procedural aspects of the teaching-learning process theoretical background of knowledge and its application : in nursing consist of a system of communications involving patient-care situations. teachers and others familiar with the use of teaching methods Creativity in the selection of methods is best suited t and audio-visual media. This chapter is limited to the objectives can be accomplished through a co-opet discussion of those teaching methods and devices that, venture whereby students suggest ways of learning w i presumably, the creative teacher can adapt for use in the the framework defined by the teacher. The teacher ho; i clinical nursing situation. Although the teaching of clinical the responsibility for intepreting the educational g nursing can involve a wide range of methods, educational society's needs, and patient's needs; the student holds tin communication media, and multimedia approaches in a responsibility for determining learning experiences that ar variety of combinations, each broad category is described in accord with these stated needs and goals, and with the separately so that the reader can gain information about the individual needs. In this era of technological advancemec use of specific teaching approaches and devices. and k n o w l e d g e e x p l o s i o n the s t u d e n t p o p u l a t i o n i Teaching methods refer to any kind of an orderly, logical becoming increasingly sophisticated and aware that ther course of action taken to accomplish a particular educational seldom exists one perfect, correct solution to a problerr goal. A wide range of methods of teaching has been devised Students need a learning environment that allows them I and used in a variety of combinations depending on the pursue educational goals by proposing and experimei

Teaching Strategies and Methods 3 6 1 new" or "different" methods of problems solving - ed to clinical nursing. Freedom to learn in this dimension <es the student's responsibility for defining the problem . ;escribing the purpose and expected outcomes for the ::ed approach. The teacher is responsible for allowing :aneity that fosters creativity and for providing the rssary support needed by the student regardless of :ess or failure. : .ection of method must be in accord with principles of . : ::ng. Success or failure in the use of selected teaching .ods is also dependent on the teacher's ability to organize - enals, ideas, and people within the social context of the earning environment. The teacher must have a basic :;rstanding of how people learn, variations of individual I learning rates, reinforcement techniques, interpersonal -'.ionships affecting motivation, and active as opposed to issive student involvement in the learning process. Today's world demands that people learn how to think I deeply regarding actions to be taken and the potential .sequences of the actions. Individuals who learn how to i s c o v e r knowledge, how to inquire and examine all issues, ! how to arrive at their own decisions readily learn how so assume responsibility for their own actions and how to . _luate the results. The selection of teaching methods Bering this kind of learning is largely dependent on the . acher's ability to consider the significance these learning I principles have for the individual learner and to translate ese concepts into meaningful approaches to teaching. T h e c r e a t i v e t e a c h e r i n c l i n i c a l n u r s i n g h a s the .sponsibility of selecting methods of teaching that offer freedom to explore unusual concepts, examine many sides : an issue, and express individual ideas. To learn in an environment fostering this individual freedom of expression, students assume the responsibility for inquiry that assists them identifying the philosophical and intellectual basis for making value judgements. Helping students to understand why certain action is taken and to question the consequences of actions in terms of patient's responses should become a part of the routine pattern of professional thought. Selection of method must be in accord with capacity of student. Know your students! The acknowledgement that individual differences are far greater than similarities underlines the need to develop a greater concern for the individual student. Each new group of students must be studied carefully to determine individual variations in intellectual maturity, emotional development, social or e n v i r o n m e n t a l o r i e n t a t i o n t o l e a r n i n g , and p r e v i o u s experience with various kinds of teaching methods. The selection of teaching methods in accord with this basic information suggests the need to employ a flexible plan with a wide variety of methods that can offer the individual student a feeling of security, accomplishment, and selffullfillment. Inherent in this concept is the need for teachers to recognize that they must provide ways of avoiding premature and unreasonable demands on students while seeking to develop them as competent nurse practitioners. The teacher should select those methods that provide an atmosphere of security to assist the learner in gaining mastery of a technical skill, the establishment of satisfying relationships with others, the application of previously learned material to a new setting, or the solving of a complex care problem. The teacher holds the responsibility for assisting students to reach their potential by fostering curiosity, being encouraging of novel or different responses, and being open-minded towards those who do not follow the prescribed patterns. The student is responsible for pursuing learning activities that make wise use of time and self and for d e v e l o p i n g a c o n c e p t u a l framework for understanding and validating the chosen plan of action in patient care. Selection of method must be in accordance with availability of resources. Effectiveness of selected teaching methods is dependent on the availability of the necessary resources. Teaching innovations are being tried, tested, and reported at a rate faster than one dares to imaging, providing teachers with encouragement to vary facilities and methods. The teacher's responsibility lies in carefully evaluating new techniques and devices for practicality in a given situation, making the best use of the available materials to meet the objectives of the program, becoming familiar with the use of new devices, making advance preparations and plans, and preparing the students for their use. Where newer methods and devices are currently not in use, it is imperative that planning for their future use take place, even as the readily available resources are being used in the current teaching program. Students have the opportunity to stretch their minds by learning with new teaching techniques and devices. Their responsibility lies in their willingness to accept change, by becoming involved in working with the new processes and devices and evaluating their effectiveness in contributing to the total learning situation. Selection of method must be in accord with teacher's ability to use it effectively and creatively. Know yourself! As early as 1910 research related to teacher effectiveness gained popularity, and it has continued to gather momentum. Even in the face of this expansive evidence regarding the method or combination of methods the teacher should use in order to facilitate creative, effective learning, it remains

3 6 2 Nursing Education difficult to determine the precise degree of change in student behavior that can be attributed directly to the teacher. Research studies have provided a long list of desirable traits for successful teachers. The very act of teaching involves the individual teacher's feelings, beliefs, interests, psychological reactions, soriocultural orientation, background of knowledge and experience, knowledge of subject matter, and use of teaching methods. It remains for each teacher to adopt and develop that style of teaching that best suits the individual's particular abilities and is appropriate to the given situation. The road to creativity is characterized by a combination of the individual's self-awareness of aptitudes and the courage to experiment with ideas and innovations that could be adapted effectively to the teaching of clinical nursing. Students need the freedom to experience relationships in which the teacher serves as a role model in teaching and as a vital, caring human being. The teacher who is not limited by excessive self-interest or anxieties but can share much of the self in daily relationships with others will experience the joy of helping students feel a freedom for creative expression. Teachers who search for ways of realizing the potentials that lie within each person and find freedom for a creative giving of the self will foster student responsibility for the d e v e l o p m e n t of c o m p a r a b l e a t t i t u d e s in an environment of mutual respect and concern. TEACHING METHODS ADAPTABLE TO CREATIVE TEACHING OF CLINICAL NURSING The methods a given teacher selects for teaching clinical nursing do not guarantee the student's automatic changes. For teaching that is authoritative rather than authoritarian we need creative clinical teachers who use imagination, ability, knowledge, and courage in the selection and use of teaching methods. The discussion of teaching methods is limited to a representative group of those appearing to be the most adaptable for teaching clinical nursing. Laboratory Method According to Webster's New Collegiate Dictionary the laboratory method had its beginnings in the teaching of chemistry, w h e r e b y students went to a w o r k r o o m for purposes of experimental study involving testing, analyzing, and p r e p a r i n g c h e m i c a l s u b s t a n c e s . This c o n c e p t of experimental problem-solving became an integral part of the study of a variety of the science components of nursing curricula. Soon the nursing components of the curricula became a natural media for the use of the laboratory methoj by providing opportunities for students to use a problemsolving approach to the development of techniques in * controlled learning environment. In undergraduate stud\ tht early laboratory experiences are usually performance well-known actions that, when followed correctly, allow : r* student to share in reaching a known goal. At graduate lei i the laboratory is the site for exploration and discov i new knowledge. Explicitly the laboratory method of teaching utilize problem-solving approach to learning that offers stu o p p o r t u n i t i e s for s u p e r v i s e d , i n d i v i d u a l i z e d , di experiences in the testing and appliction of pre\ learned theory and principles and the refinement of specif: skills or complex abilities. The learning experiences ar; planned so that the theory and laboratory experie complement each other. This concept has been expand* include the clinical setting in the hospital, the home, and community health agencies in providing students opportunities for using problem-solving techniques to stu: patients with varying degrees and kinds of nursing and heaia problems. Unlike chemical laboratories, patient care set) can rarely be sufficiently controlled so that the instr... can guarantee the details of the student's findings. E\ beginning undergraduate student must be prepared :; discover something new about human experience with hea and illness. Many schools and colleges of nursing have expanded v ; use of the l a b o r a t o r y m e t h o d to i n c l u d e proh observational studies within the clinical and commm setting. This technique has proved particularly succ in the study of growth and development patterns and of interpersonal relationships to gain an understandin_ b e h a v i o r a l p a t t e r n s of children and adults. A re. experimental study in the use of prolonged observat: hospitalized children as a teaching technique for nun students is described by Schulman and co-workers. As schools and colleges of nursing modernize teaching facilities, they are providing laboratories equipped with one-way viewing devices for observation studies small groups of students. The objectives for the observtic r. study vary according to the subject, such as i. Parent-child interactions; ii. G r o w t h and d e v e l o p m e n t patterns of various q groups; iii. Demonstrations of group therapy; iv. Nurse-patient interaction; and v. Counseling and interviewing patients with s p : problems such as long-term illness, death and dying drug dependency, unwed parents, or other family c:

Teaching Strategies and Methods 3 6 3 ;ations. The purpose for using this technique and its variations is to build observation skills by allowing the interaction to occur in a more natural way than if the observer is seen, and to allow interaction among observers during the event. Alternating observations of specific situations with participation in these settings and later s t u d e n t / t e a c h e r interaction can be very effective. A d e m o n s t r a t i o n of this k i n d n e c e s s i t a t e s e t h i c a l ::-.sideration of the rights of the subjects being viewed. ?nor to the observation session the persons working directly sith the patients should clearly explain the purpose of the irmonstration, describe the viewing audience, and provide sufficient explanation to the subjects to allow each to make in intelligent decision about his willingness to participate at the observation study. Situations involving patients must re evaluated on an individualized basis to determine whether (be demonstration will help or hinder their progress. The demonstration-observation requires careful planning and should be conducted by an expert in the given subject matter w h o already has established a rapport with the subjects. For a productive learning situation, observations should be: 1. conducted at frequent interfals over a sufficient period of time u. evaluated by students in accord with their objectives and their theoretical insights, and in. followed by teacher-observer conferences to validate findings, develop new insights regarding observed responses of patients, discuss observer reactions to the problem, and explore ways that will lead to better patient understanding. Variations of this device are frequently used in medicine. One excellent example is described by M a r s c h a k and Call in observations of parental influence on disturbed children. In another, K n b l e r - R o s s interviewed dying patients to determine their feelings about death and dying, followed by a seminar with the observers representing a wide range of professional disciplines to help them understand their own feelings about the patient and provide the support and understanding needed. Careful study of these techniques furnishes the creative teacher with numerous ideas regarding ways of adapting this method to selected areas of clinical nursing. While both teacher and student have definite responsibilities for the effective use of the laboratory method, its creative use is dependent on the teacher-student milieu. The extent to which the teacher fosters self-direction through co-operative planning, action, and validation of results is directly proportional to the degree of creative action expressed by the student. Table 15.8 is intended for use as a quick reference of the responsibilities of teacher and student in the use of the laboratory method; but its application to actual practice depends on its translation into cooperative teacher-student action. In clinical nursing the use of the laboratory method b e c o m e s p r o c e d u r e for p r o v i d i n g students with wellplanned, supervised experiences in translating principles of nursing into active, problem-solving for nursing problems. The laboratory methods serves as the foundation for building in those combinations of teaching methods best suited for establishing a structural framework to bridge the gap between the theoretical study of nursing and the study of patients. Therefore, the following methods of teaching can be viewed both in terms of their singular uses or their integral contribution to the total laboratory method. As stated earlier the term laboratory method has received various definitions and interpretations and applications in many fields education. Webster used this work to a work room which is used in teaching physical sciences for testing and doing experiments. "Learning by Doing" is the philosophy of Dewey which is applied to all other sciences. Laboratory method, as used in nursing education may be defined as planned learning activity dealing with original data in the solution problems. The term "Original data" includes materials obtained experimentally and any other materials resulting from laboratory procedure. Purposes of Laboratory Method 1. To provide first hand experience with materials or facts in the solution of problem, e.g. Science Laboratory. 2. To provide experiences with actual situation such as Nursing Laboratory and Hospital Wards. 3. To make student to become skillful in manipulation apparatus, practising laboratory technique. 4. It helps student to acquire scientific attitudes and scientific approach in problem-solving. It should be well-organised and well-planned with close coordination, between class and laboratory work. Limitations of Laboratory Work a. Poor planning and lack of direction of teacher may result in wasting student time, use of complicated approaches and consumes time. Poor direction causes blind manual without an conception of the purpose. b. Lack of budget in getting qualitative-laboratory equipment create insecurity in teachers to operate them. Actually simple equipment is far more comprehensive

364

Nursing

Education

Table 15.8: Technique for the Laboratory Method

Teacher responsibilities
Specify o b j e c t i v e s for l a b o r a t o r y e x p e r i e n c e a n d m a k e t h e m k n o w n to s t u d e n t s . O u t l i n e general plan of activities in accord with objectives; p r o v i d e for c o r r e l a t i o n of activities w i t h t h e o r y c o u r s e s .

Student responsibilities
S t u d y n e c e s s a r y b a c k g r o u n d material in a c c o r d wHk m objectives. F o r m u l a t e o w n o b j e c t i v e s for p u r s u i n g a s s i g n m e n t s . O u t l i n e p l a n o f i n v e s t i g a t i o n , u s i n g o w n obje^ o b j e c t i v e s , b a c k g r o u n d k n o w l e d g e , a n d p r e p a r e d i-scmucui be p r e p a r e d to justify plan of action. P u r s u e plan of a c t i o n , u s i n g t e a c h e r as r e s o u r c e fc: -.. c o m p l e t i n g plan.

3. A r r a n g e for n e e d e d facilities in a d v a n c e k n o w p a t i e n t s a n d
p r o j e c t e d area of study.

4. P r o v i d e n e c e s s a r y e q u i p m e n t ; c h e c k for availability and w o r k i n g


condition. 5. P r e p a r e i n s t r u c t i o n s v e r b a l , written, taped, or in m a n u a l f o r m but avoid excessive detail in order to provide for creative thinking.

5 M a k e n e e d s k n o w n to teacher; seek assistance m


data.

iii'cana

Pteff fcr iVtftfeaftk//ezramg expenences; a r r o w p r o g r e s s i o n


a c c o r d i n g t o i n d i v i d u a l abilities.

6.

s t u d y in o r d e r t o u n d e r s t a n d a n d w o r k t h r o u g t

Seek adaTtibnaf t h e o r e t i c a l information b y r e a d * * mi mM jtts


otViey "ncaltVi t e a m m e m b e r s .

1. S u p e r v i s e sUideras \\vcou<2,Y\ c^icsUous a n d cxarnvV, Xvmwva, o \


s. 9. p r o v i d e r e i n f o r c e m e n t a t r e g u l a r intervals; k e e p r e c o r d s o f daijy progress. m a k e self a v a i l a b l e for g r o u p or individual h e l p . collection, organization o f findings, m e t h o d s o f solving p r o b l e m s , c o m m o n p r o b l e m s e n c o u n t e r e d , individual a c c o m p l i s h m e n t s , and i m p l i c a t i o n s for u s e in s o l v i n g o t h e r n u r s i n g p r o b l e m s .

S. S u m m a r i z e d a t a frequently t o k e e p g o a l s clea 9. R e p o r t f i n d i n g s to g r o u p , r e v i e w i n g p r o b l e m , r _
significant data, findings, c o n c l u s i o n s , and reeo-nrnnwSaui

10. S u m m a r i z e t h r o u g h d i s c u s s i o n s and individual c o n f e r e n c e s , d a t a

10. E v a l u a t e self r e g a r d i n g p r o g r e s s m a d e , areas of srmH


w e a k n e s s e s , a n d n e e d e d a r e a s o f h e l p t o ensu (use originally established objectives as m e a n s of s

II. R e p o r t r e s u l t s o f p r o g r e s s t o i n d i v i d u a l s t u d e n t s a n d u s e
i n f o r m a t i o n a s basis for p l a n n i n g future l e a r n i n g e x p e r i e n c e s .

to the student and they are within the bonds of school grant. Teacher should remember that these equipment does not result in effective laboratory work, wise planning and direction of learning activities are more effective means of inservice learning. Technics of the Laboratory M&f/ioa
1

Teacher should plan the entire class for learr.:-. extra-work should be assigned to those who should not be special work, but to get more knew s the same work. E\saJua?/o/7

a r e tiAsrce ritv^x^si-Ei ot

the student to master the subject. to participation of student with his suggestion H planned demonstration by the teacher helps to l e a n 1 procedure accurately. Work period to provides concrete and first hand knowledge of facte 1. It refers to that period when demonstration, experimaterials. mentation or practice for a skill in a nursing procedure. 2. To ensure an effective work period there must be to make provision for purposeful student activity. adequate equipment and facilities including basic tools. ' in training in scientific method and develop scientifii 3. There must be adequate supply of specimens and attitude. materials. to development of laboratory techniques in handhn, 4. There should be sufficient space, light and ventilation. laboratory things. 4. Teachers allow time for maximum use of laboratory work.

JT j ^ C / t e r prepares flfe p/an wtfi cooperation of the student considering objectives not wasting time.

Laboratory method helps:

3 6 4 Nursing Education
Table 15.8: Technique for the Laboratory Method

Teacher

responsibilities

Student
1.

responsibilities
I

1. S p e c i f y o b j e c t i v e s for l a b o r a t o r y e x p e r i e n c e a n d m a k e t h e m known to students. 2. O u t l i n e g e n e r a l p l a n of a c t i v i t i e s in a c c o r d w i t h o b j e c t i v e s ; p r o v i d e for c o r r e l a t i o n of activities with t h e o r y c o u r s e s . 3. 4. A r r a n g e for n e e d e d facilities in a d v a n c e k n o w p a t i e n t s a n d p r o j e c t e d area of study. P r o v i d e n e c e s s a r y e q u i p m e n t ; c h e c k for availability and w o r k i n g condition. 5. P r e p a r e i n s t r u c t i o n s v e r b a l , written, t a p e d , or in m a n u a l f o r m but avoid excessive detail in order to p r o v i d e for creative thinking. 6. P l a n for s e q u e n t i a l l e a r n i n g e x p e r i e n c e s ; a l l o w p r o g r e s s i o n a c c o r d i n g t o i n d i v i d u a l abilities. 7 . S u p e r v i s e s t u d e n t s t h r o u g h q u e s t i o n s and e x a m p l e ; t i m i n g o f g u i d a n c e must be strategically p l a n n e d k n o w w h e n to act, w h e n t o w i t h h o l d action. 8. 9. 10. P r o v i d e r e i n f o r c e m e n t at r e g u l a r intervals; k e e p r e c o r d s of d a i l y progress. m a k e self a v a i l a b l e for g r o u p or individual h e l p . S u m m a r i z e t h r o u g h d i s c u s s i o n s and individual c o n f e r e n c e s , d a t a collection, organization of findings, m e t h o d s of s o l v i n g p r o b l e m s , c o m m o n p r o b l e m s e n c o u n t e r e d , individual a c c o m p l i s h m e n t s , and i m p l i c a t i o n s for u s e in s o l v i n g o t h e r n u r s i n g p r o b l e m s . 11. Report results of progress to individual students and use i n f o r m a t i o n a s basis for p l a n n i n g future l e a r n i n g e x p e r i e n c e s . '

S t u d y n e c e s s a r y b a c k g r o u n d material in a c c o r d with : objectives.

2. F o r m u l a t e o w n o b j e c t i v e s for p u r s u i n g a s s i g n m e n t s . 3. O u t l i n e p l a n o f i n v e s t i g a t i o n , u s i n g o w n o b j e c t i v e s . : . o b j e c t i v e s , b a c k g r o u n d k n o w l e d g e , and p r e p a r e d inst-_. be p r e p a r e d to j u s t i f y plan of a c t i o n . 4. 5. P u r s u e plan of a c t i o n , u s i n g t e a c h e r as r e s o u r c e for gu. c o m p l e t i n g plan. Make needs known to teacher; seek assistance in valid; data. 6 . S e e k a d d i t i o n a l t h e o r e t i c a l i n f o r m a t i o n b y r e a d i n g and study in order to understand and work through prcf.problem. 7. Validate a c t i o n s with c l a s s m a t e s , n u r s i n g s e r v i c e person - . o t h e r health t e a m m e m b e r s . 8. S u m m a r i z e d a t a f r e q u e n t l y to k e e p g o a l s clearly in focus 9. Report findings to g r o u p , r e v i e w i n g p r o b l e m , plan o: ... significant data, f i n d i n g s , c o n c l u s i o n s , and r e c o m m e n d a t i o n 10. E v a l u a t e self r e g a r d i n g p r o g r e s s m a d e , a r e a s o f strcngth w e a k n e s s e s , and n e e d e d areas of h e l p to e n s u r e future ..(use originally established objectives as m e a n s of sell-ex a ...

to the student and they are within the bonds of school grant. Teacher should remember that these equipment does not result in effective laboratory work, wise planning and direction of learning activities are more effective means of inservice learning. Technics of the Laboratory Method There are three phases of laboratory method. Preparation 1. It requires establishment of objectives and plan of work. 2. It motivates the student by presenting problem together with effective method for its solution. 3. Teacher prepares the plan wth cooperation of the student considering objectives not wasting time. 4. Teachers allow time for maximum use of laboratory work. Work period 1. It refers to that period when demonstration, experimentation or practice for a skill in a nursing procedure. 2. To ensure an effective work period there must be adequate equipment and facilities including basic tools. 3. There must be adequate supply of specimens and materials. 4. There should be sufficient space, light and ventilation.

Teacher should plan the entire class for learning actr extra-work should be assigned to those who finish, bui should not be special work, but to get more knowlec B the same work. Evaluation Group discussion, individual reports of findings, wi report of principles learned is the evaluation tool, v. gives more o p p o r t u n i t i e s to the student in mastei knowledge and to put into practice. Values of Laboratory Method Laboratory method helps; the student to master the subject. to participation of student with his suggestion w h i k planned demonstration by the teacher helps to learn the procedure accurately. to provides concrete and first hand knowledge of factual materials. to make provision for purposeful student activity. in training in scientific method and develop scientific attitude. to development of laboratory techniques in handling laboratory things.

Teaching Strategies and Methods 3 6 5 - rr;>vision of concrete materials which help in imaginary experiences. - ID provide opportunity to work out experiments under r-:dance. I f e n Teaching Nursing Arts, which include - velopment of skill through self activity, rrelation of practice and theory, tstery of simple machine of nursing procedure, vision of a situation as real life as possible. - Provision of an opportunity to evaluate the student performance. pes of laboratory required for demonstration, learning, aesearch, treatment. Classroom, clinical, community. Science laboratory. P Nutrition laboratory. \ u r s i n g art laboratory. a. Science laboratory: Used to teach science subjects, w i d e l y used in physiology, physical s c i e n c e , chemistry, microbiology for teaching these subjects. b. Nutrition laboratory: Used to teach the basic knowledge about food and for practice of cooking food for normals as well as invalids. c. Nursing art laboratory of demonstration room: It is used for demonstration of some technics in nursing. Students may practice to become familiar with nursing procedure. (Please see Appendix Sample of Laboratory Manual Sheet). Conclusion {he laboratory method is the part of study in the education c b helps to give proof to the study which is based on . entitle principle. It helps for clear and xomprehensive study which helps acquiring skill in particular study. The success of laboratory period is largely depending upon good planning. It is i rype of instruction in which the student learns by actually doing things by himself. It helps to observe and listen to others doing. Students are made to understand the use of laboratory findings. Nursing Clinic The nursing clinic or patient presentation utilizes the presence of a selected patient as its focus for group discussion. It affords a direct experience in the discussion of principles and practices of nursing care relative to a given patient. The purpose is the improvement of nuring care. Students have the opportunity to sharpen their observation and interviewing skills while simultaneously developing increased ability to see relationships between the patient's concept of his health and nursing problems and his resources for coping with the total problem and the nurse's concept of the patient's problem and how it might be solved. The most effective nursing clinics are those that are planned, which involves (i) determining the purpose, (ii) selecting a patient for whom students have given nursing care, (iii) securing the patient's consent and proper legal clearance, (iv) selecting the setting to be usedthe patient's bedside or a conference room visited by the patient; and (v) providing advance preparation of the student in terms of the name of the patient, the purpose, place, date and time, and any specific instructions regarding preparation for the discussion. The group discussion generally consists of three phases: (i) the introduction, (ii) the patient-centered discussion, and (iii) the evaluation discussion; the patient is present only during phase two. The introductory phase serves to acquaint the students with the patient's background, presenting nursing care situation, the purpose of the discussion, significant observations, types of questions to be asked, and needed information. During the patient-centered discussion, a few simply asked questions directed to the patient are usually sufficient for obtaining the needed information. Ample opportunities should be allowed for patients to verbalize their needs and h o w they see their particular problem. Sometimes demonstrating a particular nursing care measure or allowing the patient to do so is sufficient for meeting the purpose. When the patient appears unresponsive or tired, it is wise to close the discussion, even though the purpose may not have been accomplished. The evaluation discussion offers an excellent opportunity for students to evaluate the patient's behavior, ability to solve his own problems, and various other aspects. The students can be evaluated in terms of their observations and ability to use problem-solving techniques. The discussion should be summarized in terms of application of background knowledge to the given nursing care problem and goals accomplished, with provisions made for follow-up on comparisons between the student's views of the patient's problems and the patient's views of his problems. Such an approach opens the door to many other ways of developing the student's views of the patient's problems and the patient's. This same basic pattern can be adapted easily for use in p l a n n i n g and i m p l e m e n t i n g interdisciplinary patientcentered clinics. The modification would be in terms of identifying kinds of input needed from each team member and seeking appropriate contributions from each. The nursing clinic is a group discussion which utilizes the presence of a selected patient, whereby the nursing aspects are presented and discussed.

3 6 6 Nursing Education In a nursing clinic the patient's medical history and therapy are discussed only briefly, but the emphasis is on the nursing problems, including the physical, mental and social aspects. Purpose 1. To apply theory into actual practice by observing interviewing and studying a patient. 2. To apply knowledge and experience to the real life situation. 3. To understand certain types of apparatus. 4. To improve the nursing care. Size: Small size, approximately 15 students. Preplanning the Clinic 1. Determining the purpose of the clinic. 2. Selecting a patient for whome students have given the nursing care. 3. Securing the patient's consent. 4. Selecting the setting to be used, i.e. bedside or conference room. 5. Provicing advance preparation of the students. Levels of Discussion 1. Introduction. 2. Patient centered discussion. 3. Post-clinic evaluation discussion. Conclusion Clinics are valuable as a teaching and learning device because instruction is carried on in direct relation to the patient. It develops the powers of observation and stimulates thought and consideration of the nursing care of the patients. All the students apply their knowledge, skills, attitudes and appreciation to the subject of the clinic. Clinics also help to meet situations presented by the patient. Bedside Clinic (As a Method of Clinical Teaching) There are numerous methods of teaching employed in nursing education in schools and colleges of nursing. Among them, bedside clinic is also one. As we all know a planned teaching should not be restricted to the classroom only. It is to carry out in the clinical area. It is one of the best methods of teaching. The purpose of the bedside clinic is to portray the nursing problems and to give viva picture of the related nursing care by associating it with a specific individual. Purpose 1. To provide a learning experience for nursing stu;;collect information about the patient with tact and siti] 2. To improve the student's ability to solve nursir. : lems by detailed study and analysis of nursing s::_. 3. To realize the need for understanding each pa; : an individual in order to appreciate his proble outlook. 4. It helps the student to do nursing observatior organised systematic way. 5. To be able to work out a nursing care plan to f needs of individual patient on the basis of his problems. 6. To be able to recognize opportunities for health tea; - ni| in the hospital. 7'. To understand certain types of apparatus being j = . patients. 8. To improve the quality of nursing care.
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Steps Involved in Conducting the Bedside Clinic Planning teachnique

Determine the clinic to whom it is to be c o n d u c t s : date and time of clinic to be held and on what topic rte students have to come prepared. Select a patient for whom students have given the car: Secure the patient's consent as his co-operation is e - . during the clinic.
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Conducting bedside clinic After preplan, the next step is conducting actual clinic The clinic should be conducted in the ward or in a clas: room, which is adjacent to the ward. If such convenier.;;are not there, the clinic should be held apart fro: patients providing him sufficient privacy in a corner of the ward. Physical and mental confort is provided to patients Patient is kept at ease. The clinic usually lasts for 30 minutes. The number of students should not exceed 10-15 ia number. The discussion relative to the nursing clinic cons three phases. 1. Introduction phase 2. Patient centered discussion 3. Postclinic evaluation 1. Introduction phase This phase serves to acquaint tht student with the patient back groung, presenting nursir. g care situation, the purpose of the clinic, significant c vation to be made, type of question to be asked, etc

Teaching Strategies and Methods 3 6 7 'suent centered discussion During this phase a few a m p l e questions are asked to obtain the needed information from patient. No question which hurts the feelings of the patient should be asked. Ample opportunities should be allowed for patient to verbalize his needs and how he perceives his particular problem. n after second phase of clinic patient should be sent to the ward by thanking him for his cooperation. L Post-clinic evaluation It offers an excellent opportues for students to evaluate the patient behaviour, ability to sole his own problems and various other aspects. The student can be evaluated in terms of their ability to meet the stated purposes of clinic through their obserons and ability to meet the stated purposes of clinic through their observations and ability to use problem Iving technique. "Ibe nursing clinic provides an excellent opportunity to symptoms and to show how to use different appliances _".y particular condition and how nursing situations and -'.ems have been met. 5 ntages of Bedside Clinic/Bedside Teaching 3edside teaching puts the student in an active actual .: jation. I Covers a limited group of students. Permits evaluation of degree to which educational objectives have been attained. - Develops qualities of observation and decision taking. Ensures closer contact with reality (Professional-patient health situation of community, colloaguos and teachers). ? Permits comparison between reality and theory. Enables students to develop self-confidence. Increases variability. Z sadvantages of Bedside Clinic Bedside Teaching High personnel costs. Sometimes puts the patient in a difficult situation. Poor standardization. 4. Narrow limits of utilization. The same advantages and disadvantages can be seen in rractical work and field works. Nursing Rounds (As a Method of Clinical Teaching) Nursing rounds is an excursion into patient's area involving the students learning experiences. Nursing r o u n d s (at ...gustinia Hospital School USA) revealed that students responded to this method of teaching with enthusiasm. Their interest in learning increased and they showed ability to are ideas and knowledge with others for the benefit of patients. '. 1
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Nursing round is one of teaching rounds (Except information giving rounds). Nursing rounds are given separate names according to the purpose they serve. 1. Information giving rounds: It is used to acquaint the staff with all patients on the ward or division. 2. Instructional rounds: Here the nurse is expected to read the charts and come to rounds with the basic information in mind. 3. Problem solving rounds: This is to help the nursing staff learn to conduct initial interviews make assessment of patient's needs and identify nursing care problems. Purposes of Nursing Rounds 1. To demonstrate symptoms important in nursing care. 2. Clarify terminology studied. 3. To compare patient's reaction to disease, and study the disease conditions. 4. To demonstrate effects of drugs, i.e., indication, actions and reactions of drugs. 5. To illustrate skillful nursing care. 6. To compare method of meeting nursing needs and to have better understanding and to give more purposeful care to patients. 7. To illustrate successful improvisation and to give opportunity for the use of different applications. Factors to be Kept in Mind When Planning Nursing Rounds 1. To consult student's previous clinical experience to avoid repetition and to add to earlier experience. 2. Keep in mind the probable value and availability of clinical material. 3. If some demonstration is done, it should not have a teleterious effect on the patient. 4. Explain the plan to the patient. 5. Introduce the patient to the group. 6. Make the patient feel important. 7. Have post-conference for summary and further explanation. 8. Record the nursing rounds in the ward teaching records with a summary of nursing points stressed. Advantages of Nursing Rounds Make classroom discussions more vivid and real and thus improve learning experiences. Response of the patient is more natural.

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3 6 8 Nursing Education Students can select patients with specific problems and plan proper nursing care. The ways of conducting nursing rounds are as follows: a. Patients are selected with nursing problems to reinforce their theoretical knowledge. b. The group observes the behavior of the patient at the bedside and make proper comments. The group observes the equipments and articles under use. The students return to the classroom to discuss the nursing diagnosis and n e e d e d nursing care for patients. Some examples and types of nursing rounds: 1. Demonstration of symptoms. 2. To clarify terminology a. Herpes simplex b. Anemic pallor 3. Effects of drug a. Allergic reaction b. Sedative effect 4. Skilful Nursing care a. Progressing improvement of bed sore. b. Maintenance of adequate fluid intake (Oral) 5. Successful improvisation a. Use of a chair as backrest b. Device for support of ice bag 6. Posture and position as indicated for individual patients. a. Neutral position b. Position for surgical shock c. Fowlers position d. Position for CCF In Nursing rounds, a small group of staff or students preferably not more than 4 or 5 and a leader or a teacher visit the bedside of patient. Preparation by the Head Nurse The Head Nurse selects the patients before hand, according to the time available. Rounds not lest longer than an hour. The head nurse needs to read the patient's histories, know the plan for their treatment and its results, the patient's progress and prognosis, their nursing care and its effectiveness. She should post the time for rounds at least a week in advance and indicate the type of proparation the nurse is to make, that in whether she is to know thoroughly the history care and progress of her own patients or briefly that of all patients in the ward. Rounds for staff nurses should be held separately from those of students. Rounds for senior students should be held separately from those of junior students. The central figure in nursing round is the patient. If purpose of the round is instructional or problem-solving patient will be included in the discussion. Method of Conducting Nursing Rounds A brief conference at the side of the patient's room/w . has to be held. Necessary data are given. The purpose the visit to the patient is outlined by the head nurse, spc. observation to be made or pointed out at this time. 4 ti patients are selected for instruction. 4-5 minutes are ap^: The head nurse herself may present the uses or she may ask the students who are assigned to these patients to ansv. a the questions of the group or her questions. The studer.:are asked to present the cases regarding other particu The participants may also be involved such as countit _ p u l s e , respiration, e x a m i n i n g the conjuctive, pitting oedema, etc. The patient's case sheet can also be utilize: with presentation. Thank the patient before leaving and u; up the bed. Post Conference The presentation is summarised and further explanatu any, may be given, questions are invited from the sti, . Nursing Care Study Closely aligned with the nursing care confrence and nurs.r..: clinic is the nursing care study. Although the nursing car; study is generally viewed as an individual learning actr. :r. rather than a group project, the nurseing care conferer... and clinic serve as vehicles for the development, st evaluation, and implementation of the nursing care s t u h as presented by the student. In addition, the clinical teacher and the student work on a tutorial basis in the development of the study and preparation of the report. Thus, it is a gn>ur technique in that the student and teacher are a group of two during its development, and it is frequently presented, formally or informally, to other students in a group meetir.. The nursing care study is a problem-solving a^ w h e r e b y , the s t u d e n t u n d e r t a k e s the c o m p r e h e n s n . assessment of a particular patient's nursing problems lead:-; to the planning, implementing, and evaluating of appropniie nursing care measures. It provides opportunities for the application of previously learned knowledge and skills:: i patient for whom the student is providing daily nursing care. The range of possibilities for problem-solving and making judgments regarding nursing care and health maintenance is as simple or as complex as the particular patient selected for study. Thus, the patient must be within the realm of comprehension and abilities of the individual student The

Teaching Strategies and Methods 3 6 9 .?t have sufficient background information to cope r problems yet have an opportunity to channel _s learning into new avenues of thought with each e study. Students also need sufficient library . and time to pursue the comprehensive study while giving nursing care to the patient. :ugh the use of the nursing care study continues to as a method of teaching in clinical nursing, creativity -se is long overdue. Suggestions for fostering the . use of this tool follow: hen students are exposed to a total program of clinical nursing that builds on a problem-solving, patient. . tered nurisng care approach, the concept becomes n integral part of the pattern of learning they pursue. , do not require x number of clinical conferences, . nmares, or clinics for each student in each clinical area; therefore the nursing care study should the viewed ithin this same context of flexibility in the use of ;thods in the teaching of clinical nursing. .5 a natural corollary, the nursing care study should be used when the need exists at a particular time for a rticular student, because it is the best method to use in accomplishing the objective. If used flexibly, students r :ght apply this teaching method in each clinical area, in some clinical areas, or in none at all. ^.udents who experience the prevailing philosphy is flexibility in the use of teaching methods will not resist or question the use or lack of it any more than any other method, and perhaps less than those who are required to submit a quota of % number of nursing care studies. 1 Flexible use of nursing care studies necessitates preparing and presenting the study as an integral part of the clinical experience. I Guidelines for preparing nursing care studies should be limited to the basic directions regarding the format of the written report, leaving opportunities for the students to organize their materials and approaches to problem-solving according to their own abilities. For example, Helper describes a nursing care study written in free verse by a student who was willing to use a creative approach to a written assignment.
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the early identification of the problem through periodic progress reports and final evaluation and follow-up reports. Within this framework the discussion takes on new meanings for the individual student and for the group conference members. 8. Further investigation should be directed toward creating new combinations or new approaches to the use of the nursing care study or toward determining ways of combining the use of the nursing care study with other methods of teaching such as case analysis or role-playing. The effective use of the nursing care study will flourish in the hands of those who use it creatively; it will perish in the hands of those who cling to it as an end in itself. Nursing Assignment (As a Method of Teaching) Assignment in the clinical field is the nursing educationcum-service. Nursing assignment is a part of organization in the clinical set up. Assignment in the clinical field is a division of labour. Students and staff feel sense of belonginges, importance and it gives opportunity for self expression and individual growth in the professional growth. Meaning The term assignment as used in educational procedure is generally taken to refer to that of the teaching activity where the teacher gives (Assigns) a project, a problem, a reading test, etc. Definition of Assignment (General) The assignment applies to that part of instructional acitivity devoted to the clear recognition and acceptance by the pupil of the next unit of learning to take place and of the processes by which this learning may be achieved most effectively. Definition of Clinical Assignment It is that part of learning experience where the students are assigned with patients or other activities concerning to patients in clinical laboratory. The assignment is one of the top most important phases of teaching because it gives the instructor an opportunity to guide learning activities by c h o o s i n g w o r t h w h i l e o b j e c t i v e s and a t t a i n i n g t h e s e objectives through selection of proper learning activities based on the principles of learning. It is through the assignment that the teacher is enabled to arouse interest, stimulate right mental promotional attitudes and sets forth good study habits.

6. A written nursing care study offers opportunities for students to learn to organize their thinking and writing in logical order and acceptable form; meaningful relationships between theory and its application to actual patient p r o b l e m s are p e r c e i v e d w h e n the student presents the care study orally to the group members. 7. The nursing care conference and clinic serve as useful media for the discussion of the nursing care study from

Teaching Strategies and Methods 3 6 9 - :.".: must have sufficient background information to cope ith the problems yet have an opportunity to channel as learning into new avenues of thought with each Mccessive study. Students also need sufficient library :ies and time to pursue the comprehensive study while jctaally giving nursing care to the patient. A:hough the use of the nursing care study continues to fexmsh as a method of teaching in clinical nursing, creativity its use is long overdue. Suggestions for fostering the e use of this tool follow: 'A"hen students are exposed to a total program of clinical irsing that builds on a problem-solving, patient. .ntered nurisng care approach, the concept becomes an integral part of the pattern of learning they pursue. We do not require x number of clinical conferences, seminares, or clinics for each student in each clinical area; therefore the nursing care study should the viewed within this same context of flexibility in the use of methods in the teaching of clinical nursing. ! As a natural corollary, the nursing care study should be used when the need exists at a particular time for a particular student, because it is the best method to use in accomplishing the objective. If used flexibly, students might apply this teaching method in each clinical area, in some clinical areas, or in none at all. Students who experience the prevailing philosphy is flexibility in the use of teaching methods will not resist or question the use or lack of it any more than any other method, and perhaps less than those who are required to submit a quota of x number of nursing care studies. Flexible use of nursing care studies necessitates preparing and presenting the study as an integral part of the clinical experience. Guidelines for preparing nursing care studies should be limited to the basic directions regarding the format of the written report, leaving opportunities for the students to organize their materials and approaches to problem-solving according to their own abilities. For example, Helper describes a nursing care study written in free verse by a student who was willing to use a creative approach to a written assignment. 6. A written nursing care study offers opportunities for students to learn to organize their thinking and writing in logical order and acceptable form; meaningful relationships between theory and its application to actual patient p r o b l e m s are p e r c e i v e d w h e n the student presents the care study orally to the group members. ". The nursing care conference and clinic serve as useful media for the discussion of the nursing care study from the early identification of the problem through periodic progress reports and final evaluation and follow-up reports. Within this framework the discussion takes on new meanings for the individual student and for the group conference members. 8. Further investigation should be directed toward creating new combinations or new approaches to the use of the nursing care study or toward determining ways of combining the use of the nursing care study with other methods of teaching such as case analysis or role-playing. The effective use of the nursing care study will flourish in the hands of those who use it creatively; it will perish in the hands of those who cling to it as an end in itself. Nursing Assignment (As a Method of Teaching) Assignment in the clinical field is the nursing educationcum-service. Nursing assignment is a part of organization in the clinical set up. Assignment in the clinical field is a division of labour. Students and staff feel sense of belonginges, importance and it gives opportunity for self expression and individual growth in the professional growth. Meaning The term assignment as used in educational procedure is generally taken to refer to that of the teaching activity where the teacher gives (Assigns) a project, a problem, a reading test, etc. Definition of Assignment (General)

The assignment applies to that part of instructional acitivity devoted to the clear recognition and acceptance by the pupil of the next unit of learning to take place and of the processes by which this learning may be achieved most effectively. Definition of Clinical Assignment It is that part of learning experience where the students are assigned with patients or other activities concerning to patients in clinical laboratory. The assignment is one of the top most important phases of teaching because it gives the instructor an opportunity to guide learning activities by c h o o s i n g w o r t h w h i l e o b j e c t i v e s and a t t a i n i n g these objectives through selection of proper learning activities based on the principles of learning. It is through the assignment that the teacher is enabled to arouse interest, stimulate right mental promotional attitudes and sets forth good study habits.

3 7 0 Nursing Education Objectives 1. To provide the patient with the best possible nursing care. 2. To plan assignments which are interesting to nurses and stimulating to their professional growth. 3. To provide a well-rounded educational experience for student nurses. 4. Achieving good ward management. Methods of Assignment 3. When two persons are needed to give a patient cena;: care it is often well for the team leader to be one of the two. When assisting a team member, the leader has i_opportunity to observe the condition of the patient, \ of student and aide and their relationship with the patic:.: and at the same time he can teach them. Criteria For Effective Assignment. i. Students are to be informed of the objectives oi assignment to a particular ward/unit of the area/hospr*i for clinical experience. ii. Students are to be oriented to new clinical area. iii. Students are to be given the learning experiences are outlined in the objectives for particular clinical experiences. iv. Students are to given facilities to practice n u n according to principles taught. v. Only recognized wards of the hospital or commui are to be selected for students to achieve required learning experience. vi. Assignments have to be assigned according to the consistant level of learning that students have rea^ or attained. vii. Proper guidance and supervision has to be provided to the students during their clinical experience. viii. Sufficient time to be provided to carry out the assignment allotted to the students. ix. S t u d e n t ' s p e r f o r m a n c e s h o u l d be e v a l u a t e d a discussed with the students for their improven.. correction, etc. x. Students should be given opportunities for worki: g a team. xi. Students are to be encouraged to develop a pride in the nursing profession. xii. Students are to be watched, that high standard of patient care are being practised by all concerned. Principles of Student's Assignments The rotation of students through departments and wards according to the curriculum plan of their course. Sometimes, reassignments can be arranged accordi;. the students who require the same kind of experience. First year students should be posted where they . receive the maximum supervision and guidance from qualified nursing staff. The departmental and ward sisters or nursing superintendent should be informed in advance regarding the student's assignments in their speciality. The individual s t u d e n t ' s differences should also be informed to the staffs.
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In general there are three methods of assignments in clinical set up. 1. The patient method 2. The functional method 3. The team method Patient method In the patient method of assignment a nurse is expected to give complete nursing care to one or more patients including general nursing measures, treatments, medications, taking temperature, pulse, r e s p i r a t i o n , s e r v i n g n o u r i s h m e n t s and giving health instructions. If she goes on "off duty" her group of patients in taken over by another nurse for the period of her absence in order that the patient may still receive individualized care. The functional method When the functional method is used, nurses are assigned to specific functions in the ward such as giving medications or treatment to all patients, taking the temperature of all or giving general nursing care to a group of individuals. Most hospitals which use the patient method modify it to some extent. The function method may be used at some period of the day such as evenings and nights when a few nurses are on duty. Team method of assignment In this method a group of patients are looked after by a group of hospital staff and students (nursing team). The professional nurses is the leader. The members may be graduate or student professional, nurses aides. Nursing care is given to the patients with team conference by all the members of the team. Nursing leader supervises and guides the team in giving quality nursing care. The principles relative to making assignments within the team will include: 1. In planning the patient care a well qualified team memb e r s are i n v o l v e d in w h i c h a m o u n t and type of responsibility, a student can assume depends upon the stage of her education. 2. All the physical needs and treatments are given by the same nurse but the specific treatment is given by professional nurse.

Teaching Strategies and Methods 3 7 1 ie record should be maintained of the number of hours ent on day, evening, night duty in each block of experience. record of sick leave and other types of leave utilized by e students also be maintained. If needed, reposting or -eassignments my be done. I - a -ners' Responsibility in Assisting Students ' ~neir Assignment . re are two responsibilities in assisting and helping cnts in planning and organizing daily assignments are as follows: Establishing a pattern of sequence for accomplishing assigned tasks in terms of immediately of patient needs discriminating between essential and non-essential in establishing task priorities and preserving economical use of time, energy and equipment. 1 Adjusting plans to meet existing and unanticipated conditions in the clinical setting and merging patient needs, revising in effective plans or pursuing additional experiences to meet the learning needs best. The teacher conducts daily conferences, either group or ldual or both for the purpose of discussing each tent's plan for the day. And he guides the students in m p l e m e n t i n g the plan, revising it w h e r e n e e d e d and naluating. Fa :'ors to Consider While Planning Assignments The previous clinical experience of the students should be considered. I Students must be given sufficient time to study the patient's records. Proximity of patients should be considered. - Assignments should be varied frequently enough to maintain the interest of students. 5 Sociological and the psychological aspects of the patient should be considered. Advantages of patient method of assignment a Patients have security and belongingness. b. The nurse gets job satisfaction. c. Interpersonal relationship is good. d. The maximum learning takes place. Advantages of functional method of assignment a. It is having efficiency in the work, hence the term 'efficiency method'. b. More work is turned out in less given period of time. c. There is less confusion. d. Skill is developed when the work is done repeatedly. Advantages of team method of assignment a. Team spirit is created in the team. b. We can prepare nursing leaders. c. Attitude of co-operation and co-ordination is learnt. d. All the members of the team will give the nursing care under the guidance and supervision of the head nurse. e. No confusion in authority. Disadvantages of patient method a. More nurses are required. b. Economic loss to an agency or to country. Disadvantages of functional method a. Patient does not get any security. b. Nurses do not get satisfaction. c. Individual needs are not considered. d. Interpersonal relationship is very poor. Disadvantages of team method If there is no cooperation within the team members, the work will not be done properly and patient will suffer. It is one of the best methods of teaching, by which, students get more learning experiences and patient gets good care and good ward management. Nursing Care Conference
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The clinical nursing conference has come to be recognized as a pivotal component of the total teaching plan in clinical nursing. The nursing care converence consists of a group discussion using problem-solving teachniques* to determine ways of providing care for patients to w h o m students are assigned as a part of their clinical nursing experience. The use ofproblem-solving techniques constitute the core of the nursingcare conference, with each new patient situation calling for a solution. Problem-solving discussions arise from three source: (i) the objective of the clinical nursing program, (ii) the patients, and (iii) the students. The teacher and the students are responsible for knowing the objectives to be accomplished for a given situation, and to this end they plan for appropriate learning experiences. A danger of this lies in its application to the learning situation to the extent that the patient's needs and often the student's needs are lost in the course objectives. There is evidence to show that the clinical
* Problem-solving in this instance refers to the practice of the same steps o f p r o b l e m - s o l v i n g used in other kinds of learning situations: identifying, defining, and analyzing a problem; collecting data; stating and testing possible solutions; and making conclusions and recommendati ons.

3 7 2 Nursing Education nursing conferences have been used to serve many masters. and see relationships between their findings and how ft Some of these practices must be modified if we truly seek contribute to the immediate problem and to the long rang; to educate today's students beyond the point of perpetuating objectives of the total learning experience. Through : the pastto be open-minded enough to accept new ideas teacher's ability to lead the group discussion from the back and developments activating their own creative potentials ground the objectives are met, but the students have ha^i for coping with today's problems and for understanding the opportunity to be actively involved in discussions of nur> care problems as they perceived them. This ability future. It is time to recognize that dynamic, creative clinical characterized by the teacher who is constantly aware i nursing experiences have no room for such practices as the presenting problems and willingly adjusts the teaching plam use of a master plan of arbitrarily set numbers of scheduled accordingly; raises questions, poses ideas for discuss nursing care conferences per week covering predetermined and suggests related readings; recalls previously lea. nursing care subject areas or the use of the clinical nursing concepts as they relate to the problem under discussion conference time to continue formal theory classes in order and suggests related readings; recalls previously le to "cover" all of the content. Although the care conference concepts as they relate to the problem under discu for students is also touted as preliminary to such conferences utilizes the potential contribution of each student in the mes in practice, teachers should also be honest: in many setings facorable light; and summarizes the problem in terms immediate effect on the patient and its total lea truly creative, problem-solving conferences of nursing staff contribution. are rare. Students may be encouraged to identify the causes While the nursing care conference should be patter:.. of this and to anticipate how they will receive collegial accord with the basic principles of group discuss, assistance in solving problems once in practice. techniques and problem-solving processes, it should a:s There is need for spontaneity in terms of the presenting be aimed at helping students use information in cr. problems, which are reality to the patient and to the student ways. The nursing care conference viewed as a crea: and must be dealt with as such before learning can occur. provides a learning environment that fosters opporta Students need opportunities to learn to cope with and work for studnets to think through challenging and worthwi through the " n e w p r o b l e m s " as they p e r c i e v e or are problems, allowing for their completion and evalual confronted with them in their daily nursing experences. Such while simultaneously learning new subject matter. Hi an approach can be accomplished effectively through the extent to which the clinical nursing conference contnburr use of on-the-spot, problem-solving nursing care conto the development of the student's creative potential i ferences. For example, if the current unit of study and clinical dependent on the teacher's ability to set the stage for ead nursing experience is related to the nursing care of patients learning situation. This freedom to explore problems ar. with chronic respiratory diseases, the clinical nursing seek their solution with imaginative ideas carries with conferences are determined by the problems as they present r e s p o n s i b i l i t y for e v a l u a t i n g t h e m in t e r m s of thei themeselves, either through needs expressed by patients or effectiveness and safety in reaching the desired goals. Or preceived by students. The same techniques for discussion^ , , . ., . , , , " " ^ - e x a m p l e 01 such an approach is that described by H and p r o b l e m - s o l v i n g are used, but the timing of the who initiated and developed her own discussion group b; conferences and the subject of the discussions arise from asking a group of handicapped patients to meet toge the spontaneity of the situation rather than from a fixed discuss their common concerns and needs while ga sequence of topics during a specific course. The nursing understanding and emotional support from one anotfac care conference will contribute to the total objectives, but the problems for the discussion arise from the learning Nursing Care Conference as a Method of Teaching situation itself, with action based on the learner's abilities Nursing care conference is a method of teaching, at the given time. These on-the-spot clinical nursing conferences must be provides an opportunity for an informal discussion of. in an e n v i r o n m e n t of informality and p e r m i s s i v e n e s s problem and free exchange of knowledge and experiea . fostering studnet involvement in problem-solving discus- about the c o m m o n interest and it consists of a grc _: sions. The teacher must be flexible enough to allow sponta- discussion using problem solving techniques or r. neity, yet know how and when to channel the discussion by process. Nursing care conferences are so "old hat" and so identifie helping students to examine their contributions, apply previous learning to the current situation, determine how with basic nursing education that their potential value current information may lead to other areas to be explored, staff d e v e l o p m e n t and c o n t i n u i n g education is : .
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Teaching Strategies and Methods 3 7 3 ."recognised. Within the institution, particularly at the unit ... a nursing care conference can provide a good learning experience for all the staff who share a common nursing problem in providing care to a specific patient. A n u r s i n g care c o n f e r e n c e is d e s i g n e d a r o u n d a consultation visit of a clinical nurse specialist. But more frequently they are designed for the staff of a specific nursing unit, and are planned around some aspect of nursing care or focus on a scientific nursing problem presented by a patient in that unit. A nursing care conference is a "course of action discussion, the focus is on assessing the nursing problem arriving at possible solutions, helping staff to examine a patient's problems from his point of view". - anning and Preparation The organisers should prepare well in advance regarding particular conference. _ Before presenting, the student will have collected all the data regarding the patient. She will have worked with that patient and collected information about the signs and symptoms since how long the patient is sick. What are the laboratory finding? What about his family back grounds, socio-economic conditions, etc.? The conference should be planned in relation to the objective of the conference and it should be spontaneous in nature. - The student should be given ample opportunity to work in the ward for quite a good amount of time before she is assigned to present in the conference. ~echnique Advantages '.. The nursing care conference is used as a consultation tool to help in problem solving. 2. The teacher must be flexible and she will help^t-he students during discussion. \ The conference should involve all the students in discussion. The teacher involves all the students by putting questions, giving guidance and rechanelling, if necessary. 4. Teacher has to draw out the potentials of the students to the maximum in discussion. She will provide ample time for the students to think. Phases The nursing care conference is used as a consultation tool to help in problem solving. It has got three phases. T h e y a r e : (1) O p e n i n g p h a s e , (2) W o r k i n g p h a s e 13) Closing phase. 1. It helps the students to collect the information in creative way, i.e. the students will be able to validate the data pertaining to the situation and appropriateness. 2. It provides real practical learning environment to the students. 3. It fortifies the thinking of students, thereby the creativity and judgement capacity will be increased. 4. It provides free opportunity to think. 5. Each member will be actively participating in the conference. Disadvantages 1. It will be of little use if the students do not accustom to such situation. 2. There are chances of using these conference hours for classroom teaching. Opening phase The opening phase can be defined as the first two minutes of the conference. The task here is to make a commitment to work on a problem relating to a particular patient. What happens during these few minutes often sets the tone for the entire session. Working phase (The task of the working phase is to arrive at a consensus on problem identification and solution. Once the patient is selected we have found that a great deal of time during this phase is spent in delieneating the problem clearly)In some conferences there is a difference of opinion a m o n g the n u r s e s , often the data are inconsistent or incomplete.QJ is helpful the group focus their discussion by asking direct questions, rephrasing what.the group has said and summarising!) Sometimes, when data on the patient are incomplete the group will try to fill in. If the consultant and group yiew the absent data as critical to the solution, time is better spent in getting the facts t h a n in s p e c u l a t i o n . (Conference time can be used to identify just what information is needed. The problems are identified and the group can often reach its own solutionsyOffering concrete solutions to problem behavior allows the staff to feel they are getting something from the group and the consultant who offers alternatives and support to a frustrated staff establishes credibility and does them a great service and she should be careful to ask the group's opinion on the validity of her suggestions.(The Nurses can ventilate their anxiety by expressing their feeling.) Closing phase Once the group has worked through problem-solving and has decided on solutions, the next phase is closure. The task here is to delegate responsibility to one or more of the staff to act on the problems.

3 7 4 Nursing Education Conference is an important method of clinical teaching. The nursing care conference is formed in formal or informal way. It uses problem-solving technique in discussion and the students will have to identify the problems and solutions for these problems. It provides students ample opportunity to think. The learning objectives could be best achieved, when it is used in a well planned way. These will be much adding to the knowledge of students as many students give their contributions. (NB: Fazjwrposes and types of nursing care conference, see Nursing Team Conference). Nursing Team Conference test as students are confronted with this daily resp Concomitant values gained by this type of e x p e r t . related to the ability to share knowledge of patient'^ - . and to work cooperatively with other members of the team and total health team. Such experiences ine\ ita to the improved performance of nursing care actr. the clinical nursing setting. Nursing Team Conference (As a method of Clinical Teaching) Meaning of Team Nursing The team idea as applied in the field of nursing is of : recent origins, but groups of individuals in a loose pattern of organisation with undefined relationship haac existed in our hospital wards almost ever since incep: As nursing has advanced techniques aiming physical and psychological care of patients have ir... infinitely and ultimately it has required a situation in it has become impossible for the professional nurse out all the tasks of nursing for her patient by herself. Team nursing as stated by Miss. Dorathy Finkb in . assignment method should be used which will make posafeir the best nursing care to the patients, provide the b e s : . : ence to staff members, giving them interest and chj and that will keep the unit functioning smooth!;. 2 1 : effectively".

/Application of the basic concept of the clinical nursing conference and the principles of group dynamies is extended to the clinical setting as students pursue clinical nursing experiences within the framework of the nursing team and participate in the nursing team conferences?) Regardless of the structural organization of the nursing team in a given setting^the nursing team conference is used to plan for the daily continuity of nursing care that best meets the patient's needs. The team leader reviews the patients in terms of current objectives of nursing care and ways of altering the nursing care plan to meet the changing needs of the patients. Team members, professional and nonprofessional, discuss their observations and findings regarding the patients and their responses to treatment and nursing care, /problems are identified by the group, and modifications in the nursing care plan are suggested in an attempt to solve Meaning of Conference the problems. Resource persons from other disciplines are A conference is the act of consulting together. The . often utilized in arriving at a satisfactory plan of action/ Where these conferences occur in practice settings, ference is the nucleus of the in-service nursing pro--.students will be expected to participate as team members At the conference there spring up spontaneous':; and team leaders. If students have been provided with teaching opportunities which are invaluable in tenr opportunities to become active, creative participants in- application to specific patient problems. Techniques clinical nursing conferences, transfer of learning should \process and principles of interpersonal relationship are m assist them in participation in the nursing team conferences) integral part of the procedure. Observation made during An article by Melody and Clark described a variation of the nursing team conference offer unique opportunity team conference as "walking-planning rounds". Another guidance of nursing service personnel. article by Hall and Tittle described how a group of students representing several clinical areas worked as a team to Advantages of the Nursing Team Conference systemically evaluate patient care through the use of group dynamics. Creative clinical teachers concerned with the It is used to plan for the daily continuity of nui> that best meets the patient's need. teaching of basic concepts of team nursing to upper division students could pursue these approaches and modify them As a teaching tool, nursing team conference offers valuto meet their particular situation. able opportunities for learning. The nursing team conference as a teaching tool offers It gives an ability to observe, report, and analyse signivaluable opportunities for learning. The ability to observe, ficant findings input to its greatest test as students ar; report, and analyze significant findings is put to its greatest confronted with their daily responsibility.

Teaching Strategies and Methods 3 7 5 : . f s of the Nursing Team Conference accurate information concerning the care of the patients, and to create an environment that encourages collective and cooperative participation. 2. Patient centred conferences are planned meetings to identify problems and evaluate nursing care. These conferences provide a means for all the team who are directly contributing care to a group of patients, have benefit from the experiences of others. The members as a group aim to formulate nursing intervention for one or two patients analyze the nursing care given. The clinical nurse co-ordinator and the supervisor are important members of the patient centered conferences. 3. Nursing service management conferences should be part of the planned scheduled meetings for each unit or s e c t i o n . T h e s u p e r v i s o r a s s i s t e d b y the clinical coordinator is the leader here. The topics presented are distussed may include standards of patient care and policies, procedures, safety measures, infection control, nursing audit evaluation, unit staffing measures and clarifications of new personnel policies. 4. Intershift and interdepartmental conferences are necessary to pass on pertinent information from one individual or group to another. Demands on the Professional Nurse Nine demands were identified by Chao and Wilk's students of Nursing Educations of Columbia University. They are: 1. To identify the patient's nursing problem: The team leader is first of all a listener, so that the leader can be able to assist the group to develop a whole plan out of varied contributions. The leader provides the team members with an opportunity to explore and evaluate the nursing care they have provided the patients. 2. To recognise ability and limitations of various team members: The team leader must exercise professional judgement in evaluating the observations, contributions, and s u g g e s t i o n s m a d e by other m e m b e r s for the development of evaluation of nursing care. The leader must also help the team members to recognise their capabilities and limitations in the areas of skill, knowledge and judgement. 3. To communicate: T h e p r o f e s s i o n a l n u r s e m u s t continually be concerned not only with her own ability to communicate but with the ability of team members as well. It takes two people to communicate - the speaker and the listener. Successful communication in the team depends upon how much understanding the professional nurse may have of the ability and limitation of other team members. The leader must be prepared to employ approaches which will facilitate communication.

_ Team Conference: :r.c:1es the patient nursing problem. gr.izes ability and limitation of v a r i o u s t e a m .ommunicate the ideas, information on related care. - . : :es scientific information to influence the cause of t a r s i n g care ;s generalization from specific information that is i report, interpret, channelize and carry out hospital :ealth care problems. . - . ;es what is required to help team members fulfill r roles. - He.ps to plan nursing care cooperatively with other team members ::gs also maximum creative potential of the team Z*zr'erence Procedure

A r m e is planned each day for the members of the nursing E r r . to meet as a group. During this period, patient's probe_s are identified and explored, and an approach is deveInpecKby the team. The nursing care plans are revised or iartherXeveloped, according to changing needs of patients. Each member of the nursing team has recorded during use of the day and the response of the patient to her rare, questions and comments of the patient and individual ic:es are used as guides in conference. The team leader, using the Kardex as a guide, reads the patient's name and objective of nursing care. The members ho have the contract with that particular patient discuss - response to his care and any additional information from lie patient or his family. Problems are identified by the group, a plan is projected for the solution of the problems. The Kardex is revised and the objective is altered by the leader. The head nurse functions as a resource person and assist :he team leader and the team members in identifying nursing problems and developing nursing care plans. The nursing team conference is the planning stage for the team and assignment of nursing personnel for the following day is developed during and immediately after the conference. The Major Types of Conferences 1. Team leader direction conferences are held at the beginning of a work shift and an hour prior to the ending of the shift. The purpose is to give and receive pertinent,

3 7 6 Nursing Education 4. To use scientific information to influence the course of nursing care: This is the expression of the professional status of nursing. It is this ability which makes it possible to plan for comprehensive or individualised nursing care. Professional knowledge and judgement are reflected in direct protection to the ability of the professional nurse to recognize any valuable clue in the work, attitude or thinking of non-professional member, and to identify and apply those scientific principles which w o u l d be helpful in m a k i n g use of the w o r k e r ' s contribution. 5. To generalise from specific: The leader, in evaluating the contribution of the team members, arranges and presents this information in such a way that it will be useful to the team members at a future date, should a similar situation arise. 6. To report, interpret, channel and carry out hospital policies: Policies are necessary guides and as such are subject to interpretation. In team conferences, questions or problems relating to relating to hospital policies are discussed as they apply to particular patients. One policy which frequently comes up for discussion is visiting hours. 7. To bring out "maximum creativity": The team leader is responsible for creating a working environment which \ is conducive to the full participation of the members of Vthe nursing team. \ She must be aware of the needs of the members of the group and must assist them to meet these needs. Through this process the team leader assists the other members to identify and solve problem and to become more competent within the range of their ability. 8. To teach in conference what is required to help team members fulfill their roles: One of the characteristics of a professional person of a broad scientific background which may be used in a variety of situations. The nonprofessional person is dependent upon routines or techniques. It is important that the professional nurse recognizes which teaching is indicated and whether the teaching will be effective. Detailed teaching is not the responsibility of the team leader in conference. 9. To plan nursing care cooperatively with other team members: This is the primary overall purpose of the nursing team conference. The team leader encourages all team members to participate in the planning, and guides the development of the plan on the basis of scientific principles. Team Conferences in Community Health Nursing The purpose of the team conferences is threefold. The first is to distribute newly referred patients to team members. The team leader describes the referrals and the te members, including the team leader, take the ones for \\: they are best qualified, and interested in, have time for thinks will increase their knowledge or skills. This meth of distributing new cases have proved very satisfactor\ the community also benefits. A second purpose of the team meetings is for case a ferences either spontaneous or planned. The nurse preser. the patient or family situation benefits from group's think:- _ and suggestions. Sometimes, such conferences result . home-visit made jointly by two members, so that another nurse can evaluate the family's situation and help make plan; for service. The final purpose is to give ourselves an opportui. discuss our feelings and reaction to team approach. Real success of team nursing d e p e n d s more on the members willingness to work together, than on one nurse capabilities. Team nursing approach did enable to imp: the continuity, to reduce frustrations in staff within the total community. In addition all nurses develop more skill in ca -. load management, keeping records upto date and lean to work together as a team. Team nursing c o n f e r e e considered as the best method of clinical teaching and can get desirable outcomes with careful planning and leadersh:r to provide comprehensive care to patients. Morning and Evening Reports Probably no other single factor is more vital to good v. m a n a g e m e n t t h a n p r o m p t , c o m p l e t e r e p o r t s , and n ; organizations can function efficiently without a definite system for commnication. The ongoing responsibility of nursing services demands a reporting structure appropr for transmission of important information necessary to c on the nursing care of groups of patients as well as the ministration to and observation of patients individual!; Report is necessary to acheive the goals of nursing. Definition A report summarizes the services of the nurse and or the agency. Reports may be in the form of an analysis of some aspect of a service. Type of Reports 1. Oral report 2. Written report Oral report Oral reports are given when the informatioi for immediate use and not for permanency. They may be

Teaching Strategies and Methods 3 7 7 fctec . material included in a written report. An oral report m xsKie by the nurse who is assigned to patient care to mfoeT nurse who is planning to relieve her. The head nurse ral reports to the supervisor, the nursing office and * t ~ - reports Reports are written when the information used by several people or is more or less or permaB t value. Day and night report census, interdepartmental s p e c s to admitting and business office, are all included in ::en report. Report on accidents to patients. Visitors personnel. Mistakes^in medication, complaints of pKLccts and visitor are other types of written reports. a for a Good Report l e r v r t should be made promptly, if they are to serve their purpose well. \ zi>od report is clear, concise, complete. If it is written nent, identifying data are included, the data and time, pie concerned, the situation, the signature of the n making the report, b is clearly stated and well-organized for easy under- extraneous material is included. Good oral reports are expressed and presented in an ifciesting mariner and important points are emphasized. A good report is unhurried.
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through the doctor's order book together patient, by, patient. This reminds the reporting nurse of information relative to the condition of the patient, treatments which have been completed, and those which are pending or in progress. Reports Between Nurses Who Are Assigned to Bedside Care Contents reports of students and staff nurses to those who are to relieve them include the condition of all patients assigned to her care treatments, and medications which have been given and those which are due, adaptations in method required by each patient, information about the patient as a person and his diagnosis if these are not already known to the relieving nurse. These reports are probably best given if the two nurses together go through the plan for each patient's care. If there is no plan, the doctor's order, treatment and medicine cards or list may be substituted. When nurses read the orders together, no doubt is left about their meaning or whether they have been carried out to date. Questions are asked and answered immediately. Reports of staff members to the charge nurse (During the day) The head nurse or the nurse-in-charge looks to the bedside nurses to keep her informed throughout the day of changes in patient's conditions and results of treatments if they are unusual or significant. She expects them to let her know whether they have insufficient or too much time to carry out their assignments. When reporting off duty When the nurse is ready to go off duty, the head nurse receives a brief concise report on each patient and on unfulfilled assignments. At this time the head nurse has an opportunity to help the nurse. What is important to report and how to do it in a way to avoid an unnecessary expenditure of time. It is an excellent practice to have nurses, particularly students, bring to the head nurse for her review the nurses notes for the day. Charge nurses report to bedside nurses. The information which the charge nurse needs especially to report to the nurses who are caring for patients relates to change in orders. Reports to the Clinical Instructor Reports to the clinical instructor include everything in the ward situation which affects the educational process. Hence the receives the same report relating to patients as that given to the administrative supervisor. Since she is responsible for teaching the instructor especially needs information about concerning new drugs as well as therapeutic .and diagnostic measures which are being used.

r:: ts Between the Head Nurse and Her Assistant

Tie assistant head nurse should know everything pertinent i: e management of the ward even though she may never cemed with parts of the information. The well-informed assistant head nurse knows the condi.<: - of all patients, the treatment they are receiving, obserx::ons which are to he made, changes in the ward and hospital routine, etc. In other words, she has all the informaaon she needs to keep the ward running smoothly without r:erruption of waste of time. When the head nurse returns to the wards after hours or f absence, the assistant head nurse tells her all changes the situation including the condition, the patients and rarpening during her absence. It is advisable for the head nurse and her assistant to keep, rte book or in a note pad memoranda of information ~hich they plan to report. This saves the effort of trying to remember an infinite amount to detail. Prior to giving the report, time is taken to organize the material in logical sequence. It is necessary that each patient be discussed. Probably aplest way in which to do is for the two nurses to go

3 7 8 Nursing Education Report of the Charge Nurse to the Physician The specific information which every doctor expects to receive from the nurse incharge of the ward relates to his patients under her care. He wishes to be told of the symptoms which they show, the results of treatment, inability to carry out his orders and difficulties or mistakes in doing so. Day, Evening and Night Reports The change of shift report is the oldest report in the nursing service. Since^Tts-Jijngevity attests to its importance in carrying forward the goals of the enterprise. Though it has undergone so many changes over the years, it remains essentially a transmission instrument for the care of patients from one set of works to another, using a written report, the nursing care plan as contained in a card file, and patients charts. Some institution include only the sickest patients in the written report. Others include them all. It may help the day nurses to start the day more easily if the night nurse includes in her report a list of the patients on whom new orders have been written. The daily census, or the number of patients in the hospital at midnight, furnishes important source material for hospital statistics. It can be readily understood that census figures must be correct. The accuracy in the total hospital census depends upon accuracy in each ward. The change of shift report has both critics and supporters. The critics hold that the time of the report is not justified that much extraneous malenahafld irrelevant matters creep in; the workers need it only about specific patient to whom they are assigned. The team conference reduce the time thus spent, and that patient's needs are utmost during reporting times. Supporters contend that it is the most important part of the day. Greatest number of workers can be assembled for direct information enhanced by collateral questions and issues and checking on pertinent information relating to nursing care of patients under their collective care. It is vitally important to have well informed workers so that the nursing care they give will be more deliberate and purposeful. They see a teaching potential inherent in the change of shift reports. Team-Teaching Conferences The concept of team-teaching refers to the use of two or more teachers, each having special competencies and knowledge in the co-operative planning, teaching, supervision, and evaluation of a given group of students. This approach has many variations in the utilization of teaching personnel, according to the objectives to be achic involves cooperative planning by the team teachers in . of material to be taught to the total group of students; w hick teacher can best teach each aspect of content; material to b taught by group discussion within the clinical setting; kinds of clinical experiences needed to apply the theorei information; and evaluation of the student's progress in clinical learning, and group discussion. This team appro/.: implies a sharing of knowledge among faculty as w. students. All members of the teaching team work as a groi by attending all formal class sessions. The team teaching conference utilizes each team teacher as a leader of a group discussion, offering students opportunity to discuss the implications of the theorei information for application to selected clinical i experiences and subsequent evaluation of clinical p e r fhance. This approach is the most effective when it flexible enough to provide the students with the tea^ : teachers who can make the most valuable contribution to the particular group discussion session. Thus, considers:: should be given to the utilization of those faculty member; or related personnel who could make the best contributia rather than rigidly adhering to the use of faculty wit] confines of a given clinical area or group. When individual faculty m e m b e r s recognize the contribution a given faculty member can make to the pre ting problem, regardless of the clinical specialty, an en ment fostering freedom to learn, to seek new k n o w h and to develop imaginative ideas is established. This climate fosters faculty c o h e s i v e n e s s , e n a b l i n g it to fu effectively. The clinical teacher who assumes responsib as co-ordinator of the teaching team must posse : qualities desirable of any group leader, and each team teacher must assume those responsibilities desirable for making . operative contributions to the team. The success of I teaching conference depends on the degree to which the team can function as a dynamic, cohesive group that set . as a model for students in the conduct of their . discussions. Health Team Conference as a Clinical Teaching Method Definition "Health Team C o n f e r e n c e " is a group of professional persons involved in accomplishing common goals for the purpose of interchange of ideas and solving problems \\ h; c are centered around the client, provides a useful tool for building and maintaining mutual understanding through which it is possible to attain and maintain optimum m e n u , physical, social healths.

Teaching Strategies and Methods 3 7 9 The members of the health team of the Department of Hedicine. In the hospital, physician will be the leader of . am and followed by the members as follows: The client and his family. 2. The graduate staff nurse, he social worker. 4. The nutritionist. SL The clergy man. * The occupational therapist. I he physical therapist-and 5. Other allied professional workers. Obective of the Health Team Conference ->ess the health needs of the client and to solve these . := through comprehensive approaches by the contricors of all the members of the team. : pies of Health Teams Conference There must be an objective or purpose that is to be -complished. I Adequate preparation by the leader for all conference expedites fulfilment of expectations for the conference. . Prior a n n o u n c e m e n t of time, p l a c e , p u r p o s e and duration of conferences to all concerned promotes _-sembly of a group well prepared and ready to focus attention on the purposes of the conference. j b t a i n i n g the most recent data available prior to conference assures the leader that imparted information is pertinent and accurate. Information to other members and/or client that is paced, systematic and inclusive allows participants time to assimilate the content and provides them with information necessary functions. Multidisciplinary, Interdisciplinary Intradisciplinary Intraction of conference's members on an equal basis encourages active participation and leads to usable solution to the objective. Sharing of feelings through conferences unifies and integrates the membership and allows work to progress. 8. Periodic review conferences held with the members of the team and provide a mechanism for the physician deader) to validate medical care given and maintain quality control. Individual Conference T h e individual conference s o m e t i m e s described as a versation with a p u r p o s e ' , or more simply, as an interview. The two terms 'interview' and 'conference' are used interchangeably. The teacher may introduce the student to new fields of knowledge, impart information to her regarding this field and strive to motivate her in the acquisition. Purposes 1. To guide in teaching. 2. To acquire more knowledge. 3. To discover the interests, needs and the problems of the individual student. 4. To help the student to help herself/himself. Teachnic of the Individual Conference 1. Teacher should establish good rapport with the students. 2. Allow him to talk freely. 3. Teacher should not show any prejudice, emotional reactions or bias. Principles of Individual Conference 1. Establishment of a definite purpose and specific issues to be covered. 2. Knowledge of the student. 3. Provide privacy. 4. Provide sufficient time. 5. Establish good rapport. 6. Good listening. 7. Positive effect. 8. Recording of data. Practical Uses 1. D i a g n o s t i c a n d r e m e d i a l t e a c h i n g in i n d i v i d u a l conference. 2. Supplemental teaching. 3. Discipline. 4. Clinical teaching. a. The nursing cafe study. b. Diagnostic and remedial purposes. c. The nursing care plan. d. Preparation and orientation to new clinical areas. e. Evaluation. Use of the Individual Conference in Nursing Courses 1. It can be used to clarify class material. 2. It helps in supplement instructions. 3. It can also help to explain answers to questions of individuals.

3 8 0 Nursing Education 4. It can be used as a means of assisting the individual w h o is having difficulties in keeping up with the classroom situation. The individual conference can be a means of bringing unity to the entire nursing course, by aiding the student in integrating her previous knowledge and experience in relation to the present learning experience. Process Recording Definitions and Process Record 1. The process record as "a verbatum account of a visit for purpose of bringing out the interplay between and the nurse and the patienHr^relation to the objectives of the visit". Walker 2. Process recording as "an exact written report of the conversation between the nurse and patient during the time that they were together. It is also record of the nurse's feelings about what was going on at that time and of the observations of the patient's behavior during the conversation. Hudson 3. Process recording is a written reports or verbatum recording of all that transpired immediately before, during and immediately following the nurse-patient interaction. It may be written during the interaction or immediately after the one-to-one interaction. Purpose and Uses The aim of process recording is to improve the quality of the interaction of better effect to the patient and as a learning experience for the nurse to continuously i m p r o v e her clinical interaction pattern. W h e n correctly used, it: 1. Assists the nurse Or student to plan structure and evaluate the interaction on a conscious rather than intuitive level. 2. Assists her to gain competency in interpreting and synthesising raw data under supervision. 3. Helps to consciously apply theory to practice. 4. Helps the writer to develop an increased awareness of her habitual, verbal and nonverbal communication pattern and the effect of those patterns on other. 5. Helps the nurse to learn to identity thoughts and feelings in relation to self and others. 6. H e l p s to increase observation skills as there is a conscious process involved in thinking, sorting and classifying the interaction under the various headings. 7. Helps to increase the ability to identify problems ar.: gain skills in solving them. After few exercises these skills will become so much built in her that she will kesr using them automatically even when it is not specifica] h required or when she does not have time to do it. Suggested Outlines for Process Recording A short description of the patient, his name, age, educational level, health problems as much as known and lensft of stay in the hospital. The date, time, place of interac .: o and a short description of the milieu of the ward immediately prior to the interaction will be helpful in understand-i: the thoughts and feelings of the patients. It is also helpfif to record the thoughts and feeling of the nurse just r e : interaction. R e a s o n for c h o o s i n g the patient and the duration of the nurse-patient relationship also should Ik included.
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Process Record in Nursing Like the nursing care study the process record considered an individual learning technique, but fur. it can be considered an effective adjunct to the nursing care study and to the group discussion of specific patients during the nursing care conference. The process record consists of the verbal and non* srsat c o m m u n i c a t i o n s b e t w e e n two individuals, al observations on their meaning, for the purpose o: the interactions to improve understandings and interpcr> ma relationships. Within the context of clinical nurs:: _ cess record can be used to study nurse interaction with pataacs. patient's families, other health team members, and ocier nurses. Some schools of nursing are using the cc r . . . : the process record in requiring students to develop chr diaries. Use of the process record in clinical nursing as a toci sor developing skills of nurse patient relationships should M b a r a logical pattern of: i. teacher-student collaboration in defining the p objectives to be accomplished through the use of He tool; ii. discussion of the relationship between the use of Be process record and the accomplishment of the esacrlished goals; iii. careful, detailed explanation of the total ot -. interviewing, and recording process; iv. preparation of the patient for the experience: v. the student's reporting of the interaction soon a occurrence, including the student's feelings.

Teaching Strategies and Methods 3 8 1 and interpretations of feelings and actions communicated by the patient; the student's analysis of recordings to serve as clues to self-understanding and understanding of the patient's needs; individual student-teacher conferences for purposes of providing immediate feedback regarding the student's growth in self-understanding and understanding of the patients; and the use of clinical nursing conferences for discussion of significant findings by students who are willing to share their experiences with others. While this pattern for using the process record may seem - vely simple, its purpose implies the necessity for certain ~.ing conditions. First and foremost, the teacher must Ex, e an understanding of the dynamics of human behavior, :. tighly skilled in the use of the technique, and knowhow _..ide students through learning to analyze and evaluate .-.munications and i m p r o v e skills in interpersonal -.lonships. The purpose of using process recordings varies * t h e objectives for learning in a given clinical setting ith the level of ability of the students; therefore, each :her must determine the exact purposes that can be mplished realistically. For beginning students, the focus uld be on one purpose, such as dealing with verbal trmunications as they relate to the s t u d e n t ' s self. -landing and understanding of the patient. Subsequent . ement of each purpose is a building process ultimately ::ng to the achievement of related purposes requiring - .rated understanding of the total process of interpersonal itionships. The degree to which the technique effectively ets the intended purposes is in direct proportion to the ree to which the total use of the process record is lerstood by the teacher and the student. The teacher should also>cosnider such timing variables [he total length of time available for accomplishing the jesired purposes in using the process record, the studentfaculty ratio relative to the amount of individual supervision needed for each student, and the provision of time for making rdings immediately after interaction experiences. During . total course of the process recording, students must ::ence a learning milieu that fosters freedom of .-sion in a supportive manner while learning to build sfying interpersonal relationships. In preparationjor-recording interactions, students should have been introduced to the procedural measures used to protect the patient's confidential communications, received .ruction r e g a r d i n g the f u n d a m e n t a l p r i n c i p l e s of observation, interviewing, and recording and received specific information regarding what to record to meet the
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specific purpose. The successful use of the process record as a learning experience is dependent on the cooperative teacher-student analysis of the data. The best results are obtained by those teachers who make themselves available for consultation as needs arise in addition to the regularly scheduled individual conferences. By raising questions the teacher furnishes leads for students to explore in determining the cause-and-effect relationships of given responses with a view toward changing their course of action. Through these individual discussions students grow in self-awareness by recognizing misunderstandings of behavior, glaring omissions of responses to patients and viceversa, and certain emerging patterns of behavior that significantly affect the interaction. When students learn to recognize these recurrent patterns of behavior, the teacher assists them in validating their clues; this leads to sound conclusions regarding self-understanding and ways of improving interactions with others. The selfevaluation process inherent in the use of this technique can be a valuable adjunct to the student's continued growth. The very act of recording and analyzing the data related to interactions can furnish clues to help the studetns look more objectively at themselves and difficult situations. Whether or not this feature is used by the teacher as an additional tool depends on the situation and the ability of those involved to view it objectively, the self-knowledge gained by tiie experience is sacred to the student, cannot be taken away, and need not be shared with anyone unless the student so desires; but it serves as a primary motivating factor in the future effectiveness of that student as a human being. When there is a prevailing climate of permissiveness, g r o u p s h a r i n g of d a t a a n a l y s i s can be a r e w a r d i n g experience. The process recording, properly constructed, exposes the student's feelings in the situation; therefore, the teacher should always seek the student's permission for sharing the process recording analysis with the group. When this is discussed with the g r o u p , students frequently overcome some of their anxieties by knowing that others have experienced similar kinds of feelings or difficulties in dealing with nurse-patient interactions. There has been a tendency for schools of nursing to utilize the process record as an integral and required part of the clinical teaching programs in the areas of psychiatric nursing and public health nursing, but it can be used effectively in any or all of the clinical nursing areas. The criteria for selection of the use of the process record as a method of teaching lie not in the kind of clinical nursing subject to be taught but in the ability of teachers to use it effectively and in the degree to which it meets the objectives and desired outcomes for the given nursing situation. Like the nursing care study, use of the process record as a method

3 8 2 Nursing Education of teaching should be in terms of these criteria rather than in terms of setting rigid requirements for its use within a given clinical nursing situation or within the total curriculum. Process Recording as a Method of Clinical Teaching The art of effective communication is a dynamic process. It comes naturally to some persons, but to others, it is acquired only by hard labour. Many time the student nurses communicate with patients very superficially and stereotyped way rather than being of meaningful therapeutic nature. Thus the nursing student needs to develop more perceptiveness so that the can effect constructive intervention through verbal exchange. 1. Walker defines process recording as A verbatim between nurse and the patient. 2. Hudson defines process recording as An exact written report of the conversation between the nurse and the patient during the time they were together. 3. Conen defines process recording as A teaching-learning tool. Others used the words such as "interpersonal-relations recording". "Patient-nurse interaction interviews, etc. in place of process record. Though this process recording is used in any field of nurse-patient relationship it is widely practiced in the field of psychiatric nursing. Regardless of the area in which the nurse functions she must be aware of the dynamics of human behavior and skill in using her own behavior and communication. Uses of the Process Record There are mainly three uses. 1. As a teaching-learning tool. 2. As an evaluation tool. 3. As a therapeutic tool. Different Phases in Process Recording 1. Preparing the student for process recording. 2. Recording nurse-patient interaction. 3. Evaluating the interactions by nurse teacher and student. Guidelines to Students How to go about process recording (Always use initials in referring patient's name) 1. Your goals for working with assigned patients should be written down before starting the process recoiv 2. Note important factors in patient's persona development (get it from patient's history). 3. Mention about the therapies which patient is getting both past and present. 4. Date of process recording should be mentioned. 5. Amount of time you spent with patient should be recorded. 6. A brief description should be written about the sett and situation before your conversation. 7. Identify the patients needs (as represented by patient behavior). 8. Identify mental mechanisms that you think the patient is using and give examples. 9. After completion of process record, give your comment on how well you were able to meet the goals which you set before starting your work. 10. Evaluate the process record as a learning experience for you at the end of the assignment.

Govt. College of Nursing, Fort Bangalore (Sample Form for Process Recording) 1. 2. 3. 4. 5. 6. Your goals for working with assigned patient Important factors in patient's personality development (from history). Therapies that patient is on. Date of recording. Length of time you spent with patient. Describe briefly the setting and situation.
Student's comments Teacher's comments

Conversation between nurse and patient

In this column write directly the conversation which has transpired. When it is necessary to indicate an activity or action, put this information in a paragraph.

In this column indicate your feelings what you are trying to communicate to the patient and what skill you are using, also your impression of the patient's feelings, what he is trying to communicate and how he is communicating.

The teacher comments focus on the development of nurse-patient relationship (phase, skills, patients behavior, student's ability to examine her own emotional response communication, ear