UNIT 4: TEACHING IN THE CLINICAL SETTING: TEACHING

METHODS

CLINICAL LEARNING ENVIRONMENT

The CLE is the sum of the internal and external circumstances and influences surrounding
and affecting a person's learning and working: Physical surroundings and structures
Organizational culture (e.g. relationships between staff, patients, and students/trainees;
shared values, norms, and behaviors) Attitudes, norms “how we do things here” The
learner – how s/he perceives the climate, interacts with the environment and its
opportunities note I mentioned the culture, What I mean by this is…

Educational culture
Relates to systems values and common expectations of behaviors within an organization

Educational climate:
Relates to individuals' perception of the environment regarding education

Learning or Working Environment?

 The clinical learning environment = the clinical working environment
 Majority of learning occurs within the workplace environment

Aspects of Environment Affecting Student Learning

• Quality of student preparation
• Characteristics of the instructor
• Characteristics of unit/unit staff
• Peer support
• Past clinical experiences

Clinical Education
• Critical thinking development
• Problem-solving abilities
• Specialized psychomotor & technological skills
• Professional value system
 Expectations of Clinical Placements
• Application of knowledge
• Development of skills
• Development of attitudes & values inherent in the profession of nursing

Clinical Practice
• Opportunity to learn how to learn in a continually changing and complex organization
• Handle ambiguity, complexity, uncertainty, conflict, and instability, to think like
professionals, develop personal responsibility and accountability, problem-solve, and
make decisions.

Expectations of Clinical Teachers

• Monitor students’ needs

• Monitor clients’ needs

• Monitor clinicians’ needs

• Respond to unplanned activities

• Practical teaching

• Assessing students

• Supporting students

• Facilitating students’ learning

• Coach & Guide

• Assisting students in planning care

• Assisting students in delivering care

• Developing relevant nursing skills

• Assessing student understanding of patient status

Good” Clinical Learning Environments

• Non-hierarchical structure

• Teamwork
• Good communication

• Positive atmosphere

• Good team spirit

• Working together

• Motivated staff

• Supportive of students

• High-quality nursing care

FACTORS INFLUENCING SELECTION OF CLINICAL LEARNING

EXPERIENCES

According to Irby and Papadakis,

1. Knowledge and analytical skills and ability.

2. organization and clarity of presentation.
3. Enthusiasm and stimulation of interest.
4. Group interaction skills.
5. Clinical supervision skills.
6. Clinical competence and professionalism.

MODELS OF CLINICAL EDUCATION -TRADITIONAL MODE,

COLLABORATIVE MODEL, PRECEPTOR MODEL, INTEGRATION OF
EDUCATION AND PRACTICE MODEL,

1. Traditional model- The educator provides the instruction and evaluation for a small
group of nursing students onsite during clinical experience.

The benefit of this model is the opportunity to assist students in using the concepts and
theories learned in class through readings and other learning activities in patient care.

The Disadvantages:

•Large number of students for whom faculty members may be responsible

•Not being accessible to students when needed because of the demands of other students in
the group.
 2. Preceptor model- the expert nurse in the clinical setting works with the students on a
one-to-one basis in the clinical setting. Preceptors are staff nurses and other nurses
employed by clinical agencies who, in addition to their ongoing patient care
responsibilities, provide on-site clinical instruction for the assigned students. The
preceptor guides and supports the learner and serves as a role model.
Commonly used for graduating nursing students but it can also used with beginning
nursing students.

The advantages:

• Students can transition into independent practice

• Develop self-efficacy

• Improve critical thinking and decision-making skills.

• Developed the clinical competencies

• Learn new clinical skills under the guidance of the preceptor

• Providing an opportunity for the student to work closely with a role model- promotes
professional socialization and enables them to gain an understanding of how to function
in the role for which they are being prepared.

The Disadvantages:

• Lack of integration of theory, research, and practice

• Lack of flexibility in reassigning students to other preceptors if needed.

3. Partnership Model- nursing education collaborates with:

• clinical agencies and the community to respond to meet the health care needs of the
community.
• Clinical agency and nursing program that involves sharing an advanced practice
nurse(APN) and academic faculty member – the APN teaches students in the clinical
setting and the faculty member serves as course indicator.

• Faculty member teaches 2 groups of students, as in the traditional model.

•
4. Integration of Nursing education and practice

A unique model where the faculty with Master’ degrees in Nursing assumes a dual role,
contributing equally and effectively to Nursing education in the College and Nursing
practice in the Hospital. This model ensures high standards of Nursing practice and
enhances the quality of Nursing education.

CHARACTERISTICS OF EFFECTIVE CLINICAL TEACHER

Interpersonal aspects:

– Role modeling

– Relationship: rapport, genuineness, respect

– Enjoys nursing and teaching

• Competence:

– Theoretical and clinical

– Attitude to the profession

• Teaching ability:

– Knowledge of the philosophy of the school & curriculum

– Evaluation practices

– Supportive Aspects of Clinical Experience

– Strengthen students’ independent professional growth and encourage peer-level

interactions with other healthcare professionals

– Autonomy & recognition

– Role clarity
 – Job satisfaction

– Quality of supervision

– Peer support

– Opportunity for learning

WRITING CLINICAL LEARNING OUTCOMES/PRACTICE COMPETENCIES

Clinical learning outcomes are a crucial aspect of educational programs in nursing. This
concept pertains to the knowledge, skills, behaviour and competencies that you, as
a nursing student, should acquire through clinical practice during your studies.

Clinical Learning Outcomes are measurable abilities, knowledge, proficiencies, or skills

that a student ought to have gained upon completion of specific tasks or activities in a
clinical environment.

Concept of Clinical Learning Outcomes in the Context of Nursing

In the context of nursing, Clinical Learning Outcomes are key areas that provide a clear
understanding of what nursing students might be expected to learn and achieve during the
course of their practical training. These are designed to guide students in aligning their
educational and professional goals and serve as a reference for evaluating their progress
and performance in the field.

EXAMPLE: For instance, one of the Clinical Learning Outcomes could be 'demonstrate
the capacity to perform effective cardiopulmonary resuscitation (CPR)'. Here, the
student's performance in undertaking CPR is observed and evaluated to determine
whether they have achieved this specific clinical learning outcome.

 Demonstrate practical knowledge of nursing principles

 Communicate effectively in a healthcare environment

 Conduct patient assessment and care planning

Importance of Clinical Learning Outcomes for Nursing Students

Understanding and achieving Clinical Learning Outcomes is critical for a nursing

student's educational and professional development journey. They provide a structure to
your learning process, help you keep track of your progress, and ensure your readiness to
effectively operate in a real-world healthcare setting.

Outcome Benefit

Develop practical Enables hands-on patient

skills care ability

Build up decision- Promotes independent

making capacity professional judgement

Inculcate Fosters work ethic and

professional responsibility
behavior

Impact of Clinical Learning Outcomes in Nursing Practices

The Clinical Learning Outcomes directly impact your future nursing practices. Achieving
these outcomes ensures that you have the competency to safely and effectively take care
of patients, communicate with team members, and make informed decisions. It helps in
cultivating a patient-centric approach, thereby improving the overall healthcare
experience.

Furthermore, it promotes evidence-based nursing practices and fosters lifelong learning

which is crucial for continuous professional development and adaptation to changes in the
healthcare field.

For example, a clinical learning outcome-related to infection control will ensure that
you've mastered skills related to hygiene and safety protocols recognizing this area's
significance in patient care and healthcare settings. By accomplishing this outcome,
you'd be playing a vital part in minimizing healthcare-associated infections.

Bloom's Verbs and Clinical Learning Outcomes

Bloom's verbs, originating from Bloom's Taxonomy, are often integral to framing Clinical
Learning Outcomes in nursing education. Understanding these verbs can make a
significant difference in your grasp of the learning outcomes and your overall academic
progression.

Use of Bloom's Verbs in Setting Clinical Learning Outcomes

In education, words matter, and the use of Bloom's verbs is an excellent example of this.
Bloom's verbs, also known as action verbs, pertain to Bloom’s Taxonomy - a
classification of learning objectives within education. These verbs are action-oriented and
are used to define specific, observable, and measurable outcomes.

Bloom's verbs are distinct words that describe the cognitive processes by which thinkers
involve knowledge, according to Bloom's Taxonomy. These include terms such as
'analyze', 'evaluate', 'explain', and 'understand'.

In terms of setting Clinical Learning Outcomes for nursing education, Bloom's verbs play
a vital role. These verbs allow educators to define the learning outcomes in a tangible
manner, making them achievable and assessable. As a result, you can better understand
what is expected of you and set your learning strategies accordingly.

EXAMPLE: If a Clinical Learning Outcome states, 'Analyze the information gathered

from the assessment of a patient’s health status', the verb 'analyze' directs you to examine
and interpret the assessment data rather than simply list it. This can dramatically impact
the depth of your learning and the approach to achieving this outcome.

Role of Assessment Techniques in Measuring Clinical Learning Outcomes

The role of assessment techniques in measuring Clinical Learning Outcomes in nursing is

pivotal. From showing your progress to identifying gaps, guiding learning pathways and
assuring the quality of education, these techniques are at the core of nursing education.

Assessment Technique Role

Written assessments Evaluating theoretical

knowledge and comprehension

Observation & demonstration Assessing competence in

clinical skills

Case studies Examining ability to apply

theory to practice

CLINICAL TEACHING STRATEGIES

Patient assignment

Principles of Patient Care:

 Made by a head nurse for each individual nurse
• Planned weekly and revised daily to ensure continuity of care
• Must be balanced among nursing staff
• Never assign the same task to more than one nurse Based on:
• Nursing needs of each patient
• Skill, experience, and capabilities of each staff
• Job description

Factor Affecting Patient Care:

 Nursing resource
 Patient characteristics
 Organization support
 Type of nursing care delivery system

Challenges in Patient Assignment:

 The problem of personal management
 Shortage of trained manpower
 Lack of adequate training
 No involvement in planning
 No autonomy in nursing activities
 Inadequate number of nursing staff

Methods of Patient assignment:

• Case method nursing or total patient care.
• Functional nursing
• Team nursing or modular nursing
• Primary nursing
• Case management or managed care
• Progressive patient care

Case Method:
• The case method or total patient care method of nursing care delivery is the oldest method
of providing care to a patient.
• In this method, nurses assume total responsibility for meeting all the needs of assigned
patients during their time on duty.
• The premise of the case method is that one nurse provides total care to one patient during
her entire work period of one shift.
• This method was used in the era of Florence Nightingale when patients received total care
in the home. hat time nurses were ‘hired’ and they lived within the family of the patient
and provided 24-hour care to the patient and even family.
• During an 8-12 hour shift the patient receives consistent care from one nurse. The nurse,
Patient, and family share mutual trust and work together toward specific goals.
• Usually the care is patient-centered, comprehensive, holistic, and continuous.

Characteristics:
• Complete care Provides nurses with high autonomy and responsibility.
• Assigning patients is simple and direct.
• Patient theoretically receives holistic and un-fragmented care during the nurse’s time on
duty.
• It is developed and communicated through written sources, its usage remains in
contemporary practice.

Primary Nursing Care:

• It was developed in the 1960s with the aim of placing RNs at the bedside and improving
the professional relationships among staff members.
• It supports a philosophy regarding nurse and patient relationship.
• This method is based on the concept of ‘my patient nurse” In this nursing care delivery
system, each registered nurse is assigned to the care of a group of patients for which she
plans complete 24-hour care and writes the nursing care plan.
• He or she is responsible for coordinating and implementing all the necessary nursing care
that must be given to the patient during the shift.
• If the nurse is not available, the associate nurse responsible for filling in for the nurse‘s
absence will provide hospital care to the patient based on the original plan of care made
by the nurse.
• This type of nursing care can also be used in hospice nursing, or home care nursing.
• Provides total direct care for patients.
• Requires a nursing staff made up of only Nurses.

Characteristics :
• The Primary nurse assumes 24-hour responsibility from admission or start of treatment to
discharge or the treatment’s end.
• During work hours, the primary nurse provides total direct care for that patient. When the
primary nurse is not on duty, care is provided by other junior nurses.
• An integral responsibility of the primary nurse is to establish good communication
• The Primary nurse assumes 24-hour responsibility from admission or start of treatment to
discharge or the treatment’s end.
• During work hours, the primary nurse provides total direct care for that patient.
• When the primary nurse is not on duty, care is provided by other junior nurses.
• An integral responsibility of the primary nurse is to establish good communication

Functional Nursing:

• it is task-focused, not patient-focused.

• In this model, the tasks are divided with one nurse assuming responsibility for specific
tasks. For example, one nurse does the hygiene and dressing changes, whereas another
nurse assumes responsibility for medication administration.

Merits:
• Each person becomes very efficient at specific tasks and a great amount of work can be
done in a short time (time-saving).
• It is easy to organize the work of the unit and staff.
• The best utilization can be of a person‘s aptitudes, experience, and desires.
• The organization benefits financially from this strategy because patient care can be
delivered to a large number of patients by mixing staff with a large number of unlicensed
assistive personnel.
• Nurses become highly competent with tasks that are repeatedly assigned to them.
• Less equipment is needed and what is available is usually better cared for when used only
by a few personnel.

Derits:
• Client Care may become impersonal, compartmentalized, and fragmented.
• Continuity of care may not be possible.
• Staff may become bored and have little motivation to develop themselves and others.
• The staff members are accountable for the task.
• The client may feel insecure.
• Only parts of the nursing care plan are known to personnel.
• Patients get confused as so many nurses attend to them, e.g. head nurse, medicine nurse,
dressing nurse, temperature nurse, etc

Team Nursing
• Team nursing is based on a philosophy in which groups of professional and
nonprofessional personnel work together to identify, plan, implement, and evaluate
comprehensive client-centered care.
• In team nursing an RN leads a team composed of other RNs, LPNs, or LVNs and nurse
assistants or technicians.
• The team members provide direct patient care to a group of patients, under the direction
of the RN team leader in a coordinated effort.
• The charge nurse delegates authority to a team leader who must be a professional nurse.
This nurse leads a team usually of 4 to 6 members in the care of between 15 and 25
patients.
• The team leader assigns tasks, schedules care, and instructs team members in the details
of care.
Advantage

• High-quality comprehensive care can be provided to the patient

• Each member of the team is able to participate in decision-making and problem-solving.
• Each team member is able to contribute his or her own special expertise or skills in caring
for the patient.
• Improved patient satisfaction.
• Feeling of participation and belonging are facilitated by team members.
• Workload can be balanced
• Division of labor allows members the opportunity to develop leadership skills.
• There is a variety in the daily assignment.
• Nursing care hours are usually cost-effective.
• The client is able to identify personnel who are responsible for his care. • Barriers
between professional and non-professional workers can be minimized, and the group
efforts prevail. and shared.

Disadvantages
• Establishing a team concept takes time, effort, and constancy of personnel.
• Unstable staffing patterns make team nursing difficult.
 • All personnel must be client-centered.
• There is less individual responsibility and independence regarding nursing functions.
• The team leader may not have the leadership skills required to effectively direct the team
and create a ―team spirit.
• It is expensive because of the increased number of personnel needed.

Progressive Patient care

• It is a method in which client care areas provide various levels of care. The central theme
is the better utilization of facilities, services, and personnel for better patient care.
• Here the clients are evaluated with respect to all levels (intensity) of care needed.
• As they progress towards increased self-care (as they become less ethically ill or in need
of intensive care or monitoring) they are marred to units/ wards staffed to best provide the
type of care needed.

Principles elements:
i) Intensive care or critical care: Patients who require close monitoring and intensive care
round the clock, e.g. patients with acute MI, or fatal dysrhythmias.
ii) Intermediate care: Critically ill patients are shifted to intermediate care units when their
vital signs and general condition stabilize, e.g. cardiac care ward

Case Management
• The case manager is assigned the responsibility of following a patient‘s care and progress
from the diagnostic phase through hospitalization, rehabilitation, and back-to-home care.
For eg; a case manager for cardiac surgery patients assists them in going through
diagnostic procedures, pre-operative preparations, surgical interventions, family
counseling, post-operative care, and rehabilitation.

Responsibilities of case managers

• Assessing clients and their homes and communities.
• Coordinating and planning client care.
• Collaborating with other health professionals in the provision of care.
• Monitoring client progress and client outcomes.
• Advocating for clients moving through the services needed.
• Serving as a liaison with third-party payers in planning the client‘s care.

Merits
• case management provides a well-coordinated care experience that can improve the care
outcome, decrease the length of stay, and use multiple disciplines and services efficiently.
• Provides comprehensive care for those with complex health problems.
• It seeks the active involvement of the patient, family, and diverse healthcare professionals

Demerits
•Nurses identify major obstacles in the implementation of this service, financial barriers, and
lack of administrative support.
•Expensive
•Nurse is client-focused and outcome-oriented
•Facilitates and promotes co-ordination of cost-effective care
•Nursing case management is a professionally autonomous role that requires expert clinical
knowledge and decision-making skills

Clinical Conference
Definition

“Clinical Conferences are group learning experiences that are an integral part of the
clinical experience.”

• “Provide meaningful learning experiences and opportunities for students to bridge the
gap between theory and practice”

• “Students can develop critical thinking and clinical decision-making skills as well as
confidence in their abilities to express themselves with clarity and logic.”

Benefits of Conference

• Organize/Analyze the day's events

• Review concerns

• Pull information from Theory into Clinical

• Evaluate where the students are

• Clarify expectations for the clinical day

• Socialize /develop rapport between students to student, and faculty to student

Preclinical Conference

• Student:
• Share information about upcoming events

• Ask questions

• Express concerns

• Seek clarification

• Faculty

• Clarify student misconception

• Identify problem areas

• Learn about student thinking

• Identify readiness to implement care

Postclinical Conference

• Discuss clinical experience

• Debrief

• Analyze clinical situations

• Clarify relationship

• Identify problems

• Ventilate feeling

• Develop support systems

Developing cognitive skills

• Focus on problem-solving, decision-making, and critical thinking

• May use a specific case study as an example or general examples

• Consider assigning different aspects of one client’s care (particularly if it is applicable

to current classroom content) to small groups who then report and collaboratively develop
a plan of care

• Consider the list of critical thinking situations and emphasize that there is no ONE right
answer. Students work in pairs to consider nursing approaches. Emphasize the process of
critical thinking, not the outcome.

Debriefing clinical experiences

• Allows students the opportunity to report on clinical learning, describe and analyze the
care they provided

• Allows students to share feelings and perceptions about the experience.

• Students will receive feedback from peers and the instructor.

• Students learn vicariously from these reports

• If a critical incident such as a code or client death, typically the student(s) involved will
present the situation, and the group analyze it

• Consider an “issue” conference such as do not resuscitate or atmosphere on the unit. •

Students discuss and critical thinking can be applied.

Clinical Teacher

• Plans discussion- should consider the curriculum and the learner( student)

• Prepares students for post-conference by offering a brief overview of what may be

accomplished during the conference.

• Sometimes, conferences take on a life of their own and go off in a direction unplanned
by the instructor. It happens!

• Presents problem, issue, and case for analysis

• Develop questions for discussion higher level-to assist student in applying knowledge to
clinical situations

• Facilitates discussion and encourages students to participate, by posing ideas and

questions, providing cues, and leading statements

• Develops and maintains an atmosphere for open discussion of ideas and issues

• Keeps time and avoid side-tracking, keep the discussion focused and moving in a
meaningful way

• Provides feedback in a non-threatening way

Student

• Prepares for discussion

• Participates actively

• Works collaboratively with group members to arrive at solutions and decisions

• Examines and considers different points of view.

General Rules

• At some point, students may be paired for discussion topics.

• Determine that all clinical tasks and documentation have been completed, if possible,
before beginning post-conference.

• Try to facilitate a time of discussion uninterrupted by staff or telephone calls

• Some instructors encourage students to bring lunch or dinner to the conference if time is
an issue

• Assure that client confidentiality is effectively maintained

• Set an atmosphere in which listening, respect for others’ comments and ideas, and
openness to new perspectives are valued.

Practical Post-Conference Activities

• Demonstrate a new piece of equipment or have students practice a skill

• Consider an in-service being offered by the facility if it meets learning objectives.

• Discuss issues that concern students such as weekly written assignments and graded
written assignments.

• Work together on problems such as IV calculations

• An instructor may give a quiz that students grade together.

Clinical Presentation/Bedside Clinic

DEFINITION
Bedside clinic is a process in which a clinical teacher and a group of learners see a
patients, elicit or verifies physical signs, discuss the provisional diagnosis, diagnostic or
therapeutic

PURPOSE
• To provide a learning experience to identify the problems of patients. To collect
information about patients.
• To improve quality nursing care.
• To plan nursing care according to the priority needs of each patient.
• To increase the ability to solve nursing problems by detailed study and analysis.
• To increase the ability to make an organized and systematic observation of the patient.
• To understand certain types of apparatus used for particular patient care.
• To apply knowledge and experience to real-life situations.

PHASES
1. Preparation phase Introduction phase.
2. Discussion phase.
3. Evaluation phase
4. Conducting bedside clinic

1.Preparation phase :
• Select the patient whose condition and the problems should to be discussed. Explain and
take written consent from the patient and relatives. Inform students about the options in
the clinical settings.
- GABERSON
• details of patient and date and time of bed side clinic. & Explain the purposes of bed side
clinic and specific observations to be made to students before visiting the patients.
• Limit the size of the group to 8-10 students. Plan the session for about 30 min.
2. Introduction phase:
A prior permission is sought from the patient and the relatives for conducting bedside
clinic. The information thus collected are kept confidential. The instructor gives a brief
account regarding the name of a patient, venue and other details so as to help the students
to study the case sheet in advance before discussion takes place.

3. Discussion phase:
The discussion is initiated by the instructor or the student who is responsible for the
patient care. No criticism is made over the patients condition such as to humiliate him
The patient may contribute to the discussion group if he chooses depending on his
condition. The students are allowed to interact with the patient for further clarifications.
The discussion phase may take about 30-40 minutes of time.
4. EVALUATION PHASE Once the interaction is over, patient is set free. Further the
students discuss on doubts and can clarify. The bedside clinic ends with a summary,
recapitulation of aspectsmand feedback the students.

 Points to remember while organizing bedside clinic establishment of the rules of conduct:
• Students should be instructed not to whisper in the patient's room. No calls should made
or attended at the bedside. It is not appropriate to laugh at patients or patients' responses.
• The behavior of the learner should be proper and respectful.
• Make a proper introductory interaction between the patient and the learner: It helps to
develop IPR and relieves the anxiety of the patient. The patient develop confidence in
learner and learner also feels comfortable with performing the procedure.
• ENSURE SUITABLE SETTING FOR LEARNING: Maintain privacy for patients,
arrange of an attendant who will wait in the waiting area. Request the patient to stop
activities like reading newspapers, and television.

• DEMONSTRATE APPROPRIATE COMMUNICATION TECHNIQUE: use appropriate

techniques at the time of bedside clinic and also explain to patients that what will going to
be done at the bedside

• AVOID SHOP TALKING: Be well prepared, remain focused to the topic and avoid any
kind of talk out of reference. Find out from team portion of the physical examination if
there is any difficulty then X New lab

ADVANTAGES
 Bedside clinic allows the students to prepare extensively in advance to participate
effectively in patient care.
 It helps the students to develop autonomy.
 It allows students to select patients with disease conditions of common interest. Bedside
clinic allows the students to develop and maintain professional competence.
 It promotes a better understanding among the students in the terms of health, illness and
health care system. Bedside clinic promotes clinical competencies like reasoning,
psychomotor and communication skills among students.
 It develops the ability of the students to evaluate critically and improve own performance.

DISADVANTAGES
 Bedside clinics may be an encumbrance to the patients. It's narrowness limits the
utilization of the process. Bedside clinic is an expensive procedure.
 It may disturb the privacy of the patient.Results in poor standardization.
 It is not suitable clinical teaching method for the large group of students. Sometimes
bedside nursing clinic may disrupt the routine care of patient or vice versa.
 Bedside teaching-learning environment may not be always conducive for students,
teachers, patients and neighbouring patients and health care workers of particular ward.

Case Method/Case Study

CASE METHOD/CASE STUDY

Nursing case study is the blueprint of nursing care rendered by a nursing student to a
selected patient, for a particular period by following nursing process approach, with an
intention to develop comprehen sive nursing care abilities.

PURPOSES OF CASE STUDY

 It provides an opportunity to the student to learn nursing skills using the problem solving
approach.

 Students learn to identify and define a patient's problem. It trains the students to locate,
gather and process the information required to solve the patient's problem.

 It develops a sense of accomplishment from providing individualized comprehensive care

It helps the student solve the patient's problems by critical and reflective thinking.

 It emphasizes the facts that the patient is an individual personality with unique problems.

 It accentuates the health and social aspects of nursing.

 It points out the relationship and cooperation of the various agencies interested in the
patient's prob- lems and welfare such as social service and public health nursing.
 PRINCIPLES OF CASE STUDY

 The students should be able to make their nursing care study on a patient for whose
nursing care they are responsible for.

 The selection of patients can be done by coordination between the clinical instructor and
students.

 With the help of a case study, the student should be able to study the patient's state of
health and self-help abilities, his cultural background, his economic level, hobbies and
interests, as an under standing of all these factors will contribute to the patient's welfare.

 The first part of the study should be concerned with information and facts about the
patient, his disease condition and his social and personal history, and how this knowledge
is applied in providing nursing care to the patient.

 The second part of the nursing study takes in the responsibilities and the activities the
nursing student will be concerned with in giving complete comprehensive nursing care to
the patient.

 It should emphasize on the individual needs of a patient and how they are met.

 Special emphasis should be made on patient learning.

 If outpatient experience and home nursing is included in the study, it helps in better
evaluation of the patient's recovery and his ability to maintain healthy health habits.

 It should serve as an excellent tool to demonstrate nursing skills, scientific knowledge,

and sociological or psychological insight into the problems of the patient. .

 It should encourage critical evaluation of solutions presented by others. The student is

presented with the whole situation so that she may visualize it completely.

FORMS AND PRESENTATION OF CASE STUDY

 Written
 Verbal/oral

Advantages of case study

Written case study

 It provides for individual differences of the student.

 It provides an opportunity for self-expression in writing.

 It provides experience in organizing and writing a paper in a scientific manner.

 It provides a source of material for future reference.

Oral case study

 It provides an opportunity for the instructor to direct student thinking into new channels
and to cor- rect errors of information.

 It serves as a basis for better personal understanding and relationship between the
instructor and the student.

 It is time-saving, and does not require lengthy recopying of the notes to acceptable forms.

 It offers an opportunity for a public-speaking experience.

 If discussion is invited after presentation, the case becomes cooperative and everyone
involved ben- efits from the study. This is a source of motivation to the student because
she shares the benefits of her study with other students.

 The student feels the thrill of achievement in presenting her study to others.

Disadvantages of case study

 Written case study

• It gives no opportunity to branch out and incorporate new ideas once the study is
completed.
 It requires a great deal of time to rewrite to an acceptable form.

Oral case study

• It does not offer an opportunity for writing and other creative expressions, since only
notes are used for the presentation.

• It leaves no records that may be kept for future reference as it is used generally.

NURSING ROUNDS

Nursing rounds an excursion into the patient's area involving the student's learning
experiences. Generally, a small group of nursing professionals such as nursing faculty,
ward nurse manager, bedside nurses and nursing students assemble on the patient's
bedside to discuss the routine nursing care pro- vided to patients so that efficient nursing
care be ensured. Meanwhile, nursing students can also be taught about nursing care.

A nursing round is a tour into the patients' ward to provide the student a learning
experience. In this clinical teaching method, a group of nurses visit all or selected patients
at their bedside in a particular ward with directly or indirectly contributing into clinical
teaching

PURPOSES OF NURSING ROUNDS

 To acquaint the staff and students with all the patients admitted in the ward including
their disease condition, diagnostic test, ongoing treatment and nursing care provided. To
demonstrate the specific clinical features of particular disease condition, which are
important for planning the nursing care interventions.

 To clarify the terminology studied.

 To compare a patient's reaction to disease and study the disease condition.

 To demonstrate effects of the drugs.

 To plan and illustrate skilful nursing care.

 To promote team spirit and professionalism among nurses.

 It also facilitates in building the skills of handing over and taking over of patients by
nurses at change of shift.

 The students develop an ability to categorize patients into high-risk, moderate-risk and
low-risk patients, depending on severity of the disease condition of particular patients.

ADVANTAGESOF NURSING ROUNDS

 This method provides opportunity to learn about the patient's progress through the highly
expern- enced nursing experts.

 Nursing rounds provide an opportunity for students to learn about the effect of different
drugs, treat- ment modalities and nursing interventions and change in the plan of medical
and nursing management based on the progress of patient.
 This method facilitates to learn about more patients in short time through nursing rounds.

DISADVANTAGESOF NURSING ROUNDS

o It is not a suitable method of teaching for a bigger group of students.

o The bedside discussion about patient during nursing rounds may be discomforting and
uncomfortable for patient and it may be a cause of anxiety.

 It may be wastage of time for nurses who are not directly involved in care of particular
patient.

CONCEPT MAPPING
 • Concept mapping is a technique for visualizing the relationships among different
concepts.

• A concept map is a diagram showing the relationships among concepts. Concepts are
connected with labeled arrows. The relationship between concepts is articulated in linking
phrases, e.g., "gives rise to", "results in", "is required by," or "contributes to“.

 It has subsequently been used as a tool to increase meaningful learning in the sciences
and other subjects as well as to represent the expert knowledge of individuals and teams
in education.

Definition:

Concept map is a graphical representation of a person's (student's) knowledge of a

domain. (Alpert & Grueneberg, 2001).  The arrangement of major concepts from a text
or lecture into a visual arrangement. Lines are drawn between associated concepts, and
relationships between the connected concepts are named. These concept maps reveal the
structural pattern in the material and provide the big picture. ( Diane Ehrlich 2006 )

Purpose

Concept Mapping Plotnick (1997) lists five purposes of concept mapping: 

 To generate ideas (brain storming, etc.) 

 To design a complex structure (long texts, hypermedia, large web sites, etc.) 
 To communicate complex ideas 
 To aid learning by explicitly integrating new and old knowledge 
 To assess understanding or diagnose misunderstanding

Concept Mapping in education Rationales for concept mapping in education are

based on several connected ideas:

• General writing-to-learn arguments like writing favors making connections, or writing

in a different genre favors meta-cognitive activities.

• Concept maps can prepare writing, assist in exploration and reading and be used as
planning tools. More precisely: concept maps can be used as a creativity / brainstorming
tool, as note taking tool, as planning tool for writing (in particular hypertexts) or project
(e.g. conjecture map), as tool to express and communicate complex ideas.

• Concept maps could an assessment tool for the teacher and/or could be used as teaching
materials.

TYPES OF CONCEPT MAPS

Four major categories of concept maps

1. "Spider": Organized by placing the central theme or unifying factor in the center of the
map. Outwardly radiating sub-themes surround the center of the map.
2. "Flowchart": Organizes information in a linear format.
3. "Hierarchical": Presents information in a descending order of importance. The most
important information is placed on the top. Distinguishing factors determine the
placement of the information.
4. "Systems": Organizes information in a format which is similar to a flowchart with the
addition of 'INPUTS' and 'OUTPUTS'.

Concept mapping as a student learning tool

 To learn course material

 Students can use concept maps to take class notes.
 Students can use concept maps to organize class notes or course material.  To integrate
course content
 Students can use concept maps to connect material learned throughout the semester.  To
integrate material across different courses
 Concept mapping can foster a student's understanding of how different courses relate if
they map the prominent concepts from different courses that they have taken (e.g.
compose one map of terms from a statistics class and a research design class).
 To assess their own learning. Concept maps can be used to assess changes and growth in
the students' conceptual understanding as a result of instruction received in the course.
 Learning can be evaluated before a course begins (to evaluate students' prior knowledge),
during the semester (to evaluate changes in the students' knowledge), and/or at the end of
the semester (to evaluate the students' knowledge after all course material has been
covered).
 Concept maps can be used to evaluate changes in learning over time and to evaluate end
of course knowledge.  A concept map can provide feedback to the student so that s/he
can check her/his understanding of the material to see if any connections are missing.

How to create a concept map

1. Identify the important terms or concepts that you want to include on your map

2. Arrange concepts in a pattern that best represents the information

3. Use circles or ovals to enclose an important term or concept within the topic

4. Use straight lines with arrows (single or double- headed) to link terms that are related

5. Use a word or phrase of words as labels along the lines to designate the relationship
between two connected terms

1. Identify important terms or concepts that you want to include on your map :
 There are three strategies to identify important concepts to include concepts on a concept
map:

 An instructor-generated list and students are not permitted to add their own concepts
 An instructor-generated list but the students are allowed to add their own concepts to the
list
 An entirely student-generated list of concepts on a particular subject  For novice concept
mappers, it is probably best to have the terms provided.

2. Appange concept in a pattern that best represents the information

 One can choose to use a hierarchical or non-hierarchical structure.  The use of

hierarchical or non-hierarchical maps may have different benefits in terms of pedagogy
and assessment.  Novice mappers may want to create their concept maps using Post-it
notes so that they can easily change the location of any concept before a final version is
constructed.

3. Use of circules or ovals to enclose an important term or concept within the topic 

Each circle or oval should enclose only one term or concept. However, terms can be more
than one word.

4.Use straight lines with arrows (single or double-headed) to link terms that are
related 

Each line should link only two concepts.  However, there is no limit to the number of
links stemming from any one term.  Pay close attention to the direction of the arrowheads
on the linking lines when labeling them.  Each concept is defined by its relation to other
concepts within the topic. Relation included: superset, subset, attribute, part- whole.

5. Use a word or phrase of words as labels along the lines to designate the
relationship between two connected terms 

Each line should have a label that describes the relationship between the two terms it
connects.  Example: Important term Important term Important term Important term
relationship link relationship link mutual relationship link feedback loop link.

STEPS IN CONCEPT MAP CARE PLANNING 

The nursing process is foundational to developing and using the concept map care plan or
any other type of nursing care plan. The nursing process involves assessing, diagnosing,
 planning, implementing, and evaluating nursing care.  These steps of the nursing process
are related to the development of concept map care plans and the use of care plans during
patient care in clinical settings.

Step 1: Develop a Basic Skeleton Diagram 

Step 2: Analyze and Categorize Data 

Step 3: Analyze Nursing Diagnoses Relationships 

Step4: Identifying Goals, Outcomes, and Interventions 

Step 5: Evaluate Patient’s Responses

 Develip a basic skeleton diagram

 Analyze and categorize data
 Analyze nursing diagnoses relationships
 Identifying goals outcomes, and interventions step 5: evaluate patient’s responses

PROJECT METHOD

The project method has been recognized as a teaching technique since many years; it has
its primary inception in the field of agriculture sciences where students carried out some
planned creative activities in a natural environment or a planned work field to produce
certain products. Later it was used in voca tional education programmes. The essential
characteristics of the project method are planned activity of the individual and production
of tangible results.

"This method is a teaching method where students learn to work individually or in a

group to achieve preplanned learning objectives.
Williams H. Kilpartric viewed the project method as a vivid educational activity where
several types of learning activities included enhancing the learning over already learned
behaviour or knowledge. He also emphasized on the importance of the learner's activity
and attitude while working in an environment rather than just considering the educational
objectives to be achieved. Therefore, true creative thinking and true mental activity is
essential to the project method and ulti mately there will be a production of some physical
or mental products and acquisition of the ability to handle real life problems.
 According to Prof. Ballard, a project is a bit of real life that has been imparted into the
school. further in project method, learning by living, this life has spontaneity, purpose,
significance and interest, freedom.

• According to Williams Kilpartrick, 'project method is a whole-hearted, purposeful

activity proceeding

in a social environment'. According to Stevenson, a project method is a problematic act

carried to completion in its natural setting Stevenson also mentioned that to be a project
method, the learning activity must be:

• Problematic in nature.

Aimed at a definite, attainable goal.

Purposeful, natural and lifelike in its procedure to attain the goal.

Directed and planned by the student.

Practical in nature with an emphasis on a single, resulting in a concrete achievement. The

under-taking must be complete in itself and the goal must be definite and objectively
measurable. Project method involves all types of mental and manipulative activities
according to the purpose and objectives by which the learning activities are unified and
shaped.

Characteristics of a good project method

The method aims at teaching the learner to get the best out of life.

• An attempt to use experience, trust and the best master whose lessons are unforgettable.

 The project method gives an opportunity for self-expression.

 The experiments of the project method want to reset the whole curriculum and break all
barriers of the subject matter.
 The project matter proposes the whole sequence of activities involved in complete
understanding.
 A project can be a large unit of appreciational learning or of attitude development that
increases motor skills and technical knowledge.
 A project is a play activity and learners are engaged in carrying out the activity.
 The project method is a complete surrender to the learner's point of view.
 In the project method the procedure of the school is liable to be determined by the
technique of a workshop because the individual learns much better from his own activity
than by constant instruction.
 An attempt is made to establish a positive relation with life.
 The project method lends itself naturally to group work.
 It is a large unit plan of teaching.
 The project method lends itself naturally to group work.
 It is a large unit plan of teaching.
 The method seeks to have individuals see and understand life in its unity.

Types of projects

According to Williams Kilpartrick, project method is classi- fied in the following four
categories

 Projector type: Projects where students are getting to something like building a house or a
garden or planning to execute a model of a textile factory are called projector type
projects.

 Consumer type: Projects where students set and enjoy the direct experience with their
future expected consumers. For example, a master level community health nursing
student may be gives a consumer type project to carry out the home visits and make the
assessment of most common primary health problems of elderly residing in urban
communities and suggest the best possible solution for the identified problems based on
locally available resources. In such a project, nursing student will get direct experience
and will enjoy working with his future expected consumers of his services.

 Problem type: Projects where a solution to a problem is to be found out.

 Drill type: The drill type projects involve an activity that aims at acquiring greater skill.
For example, a nursing student may be given a project to obtain competency skills in
 specific nursing procedures such as mouth care, back care, enema administration,
intramuscular injection, suctioning and so on.

Essentials of a good project

 The project should stress present and future values and experiences that supplement and
extend rather than duplicate learning acquired outside the school.

 The projects must have a bearing on a great number of subjects and the knowledge
acquired through

 it may be applied in a variety of ways.

 The project should be timely.

 The project should be challenging.

 The project should be feasible.

Organizing a project

 The teacher must exercise guidance in the selection of a project.

 Whole-hearted acceptance of the project, almost every student must be secured if the
teacher wants to ensure its success.

 Good planning should be done by the students beforehand. It may be in the form of a
drawing or a list of steps to be followed, materials to be used, a picture to be prepared or
other specific indications of what is to be done.

 The project is an activity to accomplish certain purposes.

 Sufficient preparations must be made to avoid interruptions and delays later. During the
execution of the project, the teacher should carefully supervise the students in
manipulative skills to prevent a waste of materials and to guard against accidents. The
 relation between chalked-out plans and the developing project should be constantly
checked.
 The evaluation of a project should be done by both the students and the teacher.

The role of teacher in the project method

 The teacher has to skilfully guide in the selection.

 The student has to be given help when required.
 The teacher should be good prompter.
 The relations of the teacher and students should be much closer and informal than in
ordinary classroom teaching.
 The teacher is like a friend with rich and mature experience.
 The teacher acts as a director, i.e. the teacher's psychological knowledge must be
thorough and specific.
 The teacher must be a keen observer and a true sympathizer.
 The teacher should be a store house of information and knowledge.

Advantages of the project method

 It follows the psychological laws of learning:

 Law of readiness.

 Law of exercise.

 Law of effect.

 It gives freedom to the students.

 It suited to the psychological concept of maturation.

 It drives social values.

 It trains for social adjustments.

 It saves children from insincerity and superficiality.

 It trains for a democratic way of life.

 It promotes learning through practical problem saving.

 It helps the students and teachers grow. The student stimulated by and encouraged in his
exploration of many materials will ultimately approach other areas of learning in a similar
manner. The teacher will grow in his or her understanding of a child's creative
developments.

• It confers on school work a much needed sense of reality.

• It sets up an intrinsic standard of evaluation.

 It leads to satisfaction of completing the whole task.

 It is economical; the students take more interest and learn in the shortest possible time.

 It is ideal for science work, handicrafts and practical geography and dramatic work
literature.

Disadvantagesof the project method

 The role of communication is subordinated to the glorification of active learning.

 The practical difficulties of covering a syllabus rule out the project method as the basis of
teaching in most schools.
 It is time-consuming and limited by availability and cost of materials. It is most valuable
in students with lesser academic interest, for it provides an opportunity for the practical
enthusiast.
 It leaves gaps in student knowledge.

 It may be too ambitious: beyond a student's capacity.

 Opportunity for the correlation with the academic subjects is extremely limited.

 In this method instructions are more planned; therefore it may disturb the regular
instructional schedule.

 It involves difficulty to ensure any kind of systematic progress in instructions.

 A complete reorganization of the school is needed for a new teacher.

 Children may ignore maxims, working from simple to complex.

 Time-bound projects are introduced artificially and may require more than necessary
help.

 Projects may be adopted or abandoned at will. The project approach often results in an
incomplete mastery of the tools of learning, which are essential to student education later.

DEBATE
 Debate is a creative and collective process of eliciting all related facts of a topic.
 It is a method of presentation especially suitable to controversial themes and developing
certain skill like logical arguments and weighing evidence in students.
 The participating students could be divided in to two groups. One for the proposition and
other against it
 Each group finds a leader
 In a class room teacher can act as moderator

Satges:
1. Topic selection :
2. Selection of panels
3. Selection of moderator
4. Collection of information
5. Conducting debate
6. Conclusion

1. Topic Selection : The Topic should be relevant having potential for different view points.
2. Selection of panels : At least two panel of students may be selected to argue For and
Against the topic.
3. Selection of moderator: A Students representative should be selected to moderate the
session. in the initial stage teacher may act as moderator.
4. Collection of information : The panels of students should be guided by the teacher to
collect as enough information from various sources.
5. Conducting debate :
 The teacher act as overall guide and moderator will facilitate the debate.
 Both the panels can raise their views and arguments on the topic
6. Conclusion:
 Moderator should conclude the debate by expressing his final version based on the views
evolved from the debate.
 The teacher can make his observations comments and suggestions

Merits:
 This develop argumentative abilities
 It promotes leadership qualities.
 Pupil become creative

Demerits:
 Lack of intrest among pupils.
 Difficulty in forming identical groups
 All topic cannot be tackled by this stratergy

Games
Definition :
Educational Games - Individual or group games that have cognitive, social, behavioural,
or emotional dimensions which are related to educational objectives.
An educational game is a game designed to teach humans about a specific subject and to
teach them a skill.

Why Games:
Games so Captivating/ Attractive? - Achievable challenges - Progressive Rewards
Thre Qulities that Games possess - Motivating - Challenging – Engaging

Advantages

 It helps students with their focus, self-esteem, and memory.

 Games basically motivate people to learn

Disadvantages
 Games don’t fit well on a time table.
 Over-use of games.

Types of Gmaes:
1. Team-Building Games : These are games meant for groups and not for individuals.
2. Board Games: A board game is a game played with counters or pieces that are placed on,
removed from, or moved across a "board".
3. Card Games : An educational card game is any game using playing cards, either
traditional or game- specific.
4. Video Games/ Edutainment An educational computer game can be defined as an
electronic medium with all the characteristics of a gaming environment that have
intended educational outcomes targeted at specific groups of learners.

Games in general :
 Games are a form of fun.
 Games are form of play.
 Games have rules.
 Games have goals
 Games are interactive.
 Games have outcomes and feedback.
 Games have win states
 Games have problem solving.
 Games have interaction.
 Games have representation and story.
 Games have conflict/competition/challenge/opposition.

ROLE-PLAY

Role-playing is the spontaneous acting out of a clearly-defined situation by two or more

persons for subsequent discussion by the whole class. Role-playing is a teaching method
where a group of partici- pants act out the assigned role to deliver the content of topic to
be taught to the participants. In a role paying group, the members play the assigned role
the way they think the character would act in reality which helps in arousing feelings and
elicit emotional responses in learners where cognitive and affective domain learning may
be achieved.

According to Karen S. Kesten, role-plays using the SBAR (Situation, Background,

Assessment and Rec- ommendation) technique are helpful to improve observed
communication skills in senior nursing students. Skilled communication and respectful
interaction between the health care team members are critical to achieve optimization of
quality patient care outcomes, Patients in the care of clinically expert professionals suffer
medical errors with alarming frequency. The Joint Commission on National Patient Safety
Goals strives to improve the effectiveness of communication in caregivers by
 recommending the implementation of stan- dardized tools known as SBAR. The findings
suggest that role-play may have a place in teaching communi- cation skills in nursing
schools as well as continuing education and training in hospitals and other health care
settings. Interdisciplinary communication training may provide even more effective
learning.

Role-playing is an educational method in which people spontaneously act out problems of

human relations and analyze the enactment with the help of other role players and
observers.

Role-playing is a discussion technique that makes it possible to get maximum

participation of a group through acting out an example of some problem or idea under
discussion.

Role-play is a spontaneous acting out of roles in the context of human situations. It is a

part of two broad methods: sociodrama and psychodrama. Both sociodrama and
psychodrama require not only players but also an audience that helps the players interpret
their roles.

Sociodrama: It deals with the interactions of people with other individuals or groups like
mother, nurse and leader. It always involves situations of more than one person and deals
with problems related to a majority of the group.

Psychodrama: It is practised in a group setting, mainly concerned with the unique needs
and prob- lems of a particular individual. It should not be attempted except under the
guidance of a trained therapist. The audience identifying with roles in much greater
learning than simply passive watching. role-playing or critical observation brings abou

PURPOSES OF ROLE-PLAY

 To present interpersonal problems.

 To provide emotional and affective stimulus for solving problems.

 To provide awareness about social and psychological issues.

 To develop a situation for an analysis.

 To prevent alternative courses of action.

 To prepare for meeting future situations.

 To develop an understanding of others points of view.

 To convey information to develop specific skills.

PRINCIPLES OF ROLE-PLAY

• As a teaching technique, role-play is based on the philosophy that meanings are in

people and not in words or symbols. If the philosophy is accurate, we must first of all
share the meanings. then clarify our understanding of each other's meanings, and finally,
if necessary, change our meanings.
 In the language of phenomenological psychology, this has to do with changing the self-
concept. The self-concept is best changed through direct involvement in a realistic and
life-related problem situa tion rather than through hearing about such situations from
others.
 Creating teaching situations that can lead to change of self-concept requires a distinct
organizational pattern.
 It should be flexible.
 It should be a stimulant to think and should not be an escape from the discipline of
learning. There is no single best method of selecting the characters; the group may do the
assigning.
 It requires rehearsal as an important feature to produce effective outcome and for
audience to help players interpret their roles.
 It should be done for a brief period so that the attention of audience may be captured
effectively.
 Enough time should be allowed for discussion and analysis of the situation.
 It evaluates the teacher and participants through discussion or follow-up as to specific
individual behaviour or sequence of group actions.

STEPS IN ROLE-PLAY

The following main steps must be followed while carrying out a role-play.

A. Planning phase

During this phase, the following components must be ensured:

 Select a problem for role-play

• The group leader recognizes a problem that can be used effectively and suggests it to the
group

• The group can list problems on the blackboard and decide which problem they want to
work out.

 Set up the role-play scene

 The group should comthun clear agreement on the chief objectives to be realized in role
planning.
 The group working with the leader must determine

 What characters are to be involved.

 The attitudes and personality of the characters.

 The setting of the story.

 The point at which the story should begin.

 The leader may brief the players on the situation they have decided they want to portray.
The leader may arbitrarily assign individuals to take the various roles or members may
volunteer to play the different roles.
 Getting underway in role-play
o The role takers usually go out of the room and are given a few minutes to warm up or to
get a feeling of the roles they are about to play. Specific names, other than their own,
should be used to help them get into their roles.
o The role-players should attempt to express the attitudes the group has assigned to the
various characters as well as achieve the goals decided upon.
o The story grows out of natural reactions of the characters enacted in role-playing. Those
members not involved in the actual role-playing act as observers. They may be assigned
to watch particular role-players or to look for important clues that come out of role-
playing.

 Cutting the content and making role-play comprehensive

o The leader may cut at a point where enough action has already occurred to provide a basis
for discussion.
o The leader may get immediate reaction of role-players. How they felt in their roles and
how they responded to other responses in the scene.
o The leader may use the role name of each person in the discussion so that the player does
not feel he is being evaluated.
o When role-players succeed in really projecting themselves into the roles assigned to them,
they usually give valuable insight into the problem and provide additional material for
discussion.

B. Implementation and evaluation phase

The role-play is carried out to convey particular content to the audience and discussion is
stimulated.

 The audience observers: The comments of the audience observers constitute the heart of
role-playing as a discussion technique. It may consider.
 How did the group think the role was handled?
 What were the good points of the action?
 What were the poor points or omissions?

 Role-playing observers
 • This might be played by different people so that there might be a comparison of the
behaviours o different people.

 Summarize phase
• The leader sums up to the group chief points or principles which have come out in role-
playing and the comments of the observers that follow.
• The comments on specific problems should be taken under consideration.
 Cautions in use of role-playing
 Use role-play only when it will be useful and not just for the sake of doing it.
 Be careful about interpersonal relationships within the group.

 If there is a popular role, give it to a person with enough status in the group to carry it
successfully. If necessary, the leader might play it to spare the feelings of others.
 Avoid uncovering deep seated personal problems that require professional help.

Advantagesof role-play

 Develop real communication skills in leadership, interviewing and social interaction and
obtain constructive feedback from peers. For example, learning how to put another case,
how to listen, how to lead a discussion and how to be a member of the team responsible
for patient care.

 Develop sensitivity to another's feelings by having the opportunity to put oneself in

another's place, by noting there is a difference between what a person says and what a
person does and develop empathy and understanding.

 Develop skills in group problem solving. For example, the group works as a whole to
develop concems for the group, develop the situation, identify critical issues and come to
some mutual agreement.

 Develop an ability to observe and analyze situations. For example, discussion following
role planning provides the opportunity to identify critical issues, suggest alternatives to
deal with a situation and to appraise the actor's concept of role. Practice selected
behaviours in a real-life situation without the stress of making a mistake. A person
 is more appropriate to permit true feelings to be expressed when it is a safe role. For
example, the student is exposed to reaching to and having others react to her pointing up
strengths and weakness with dramatic impact retained, but she is working with others in a
similar situation.

 In a teaching-learning situation, role-play provides the opportunity to:

 Note individual student needs by observing and analysing student needs in a simulated
real life situation.

 Assist the students in meeting their own needs by either giving them or encouraging
group members to give them on the spot suggestions.

 Encourage independent thinking and action by stepping aside or giving indirect guidance
as emphasis is on the students helping themselves.

Disadvantagesof role-play

 Role-playing is a means, not an end.

 It requires expert guidance and leadership.

 Participants may sometimes feel threatened.

 It is used as an education technique, not as a therapeutic one, strongly dependent on

student's imagings are prescime-consuming in developing group readiness one strongly
dependent hen time constraints are

 It is limited only by the teacher's ingenuity and realistic use.

Simulation
Simulation is as old as human beings on earth.It is technique to train young one to adjust
in their physical environment.
 Definition
Simulation has been defined ” as n attempt to give appearance and or to give the effect of
something else” . {Barton 1970}

Purposes :
 It helps students practice decision making and problem solving skills. By means of active
involvement in a simulation exercise , a game , or a role – playing situation , the student
achieves cognitive , affective and psychomotor outcomes.
 Students have a chance to apply principles and theories they have learned and to see how
and when these principles work

Characteristics :
 A good simulation will be: Mirror real situation.
 Provide a safe environment in which learning has priority over patient care or system
demands.
 Provide immediate feed back on performance.
Uses :
 Simulation technique can be used to achieve many learning objectives.
Simulations can help nursing student gain skill in applying the nursing process . Learn to
solve problems efficiently with minimal wasting of time and resources.

Steps:
 Ned Flanders has recommended the following procedural steps in simulated teaching:-
 First of all the teacher must assign letter (A, B, C) designation to all the members of the
group and develop a system of rotating the role assignment by letters so that each
individual has the opportunity to participate and as a chance to be actor and observer.
 It includes planning , preparation and deciding the topic of the skill to be practiced through
simulated technique .
 The teacher should carefully and intelligently select and appropriate topic according to his
knowledge and interest in the subject.
 The teacher should decide in advance as regards the name of the member of the group who
will start conversation.
 A detailed schedule for actors who will start
 The teacher should decide the procedure of evaluation and decide on what kind of data the
observes are record .
 Conduct the first practice session on topic or skills you decide . Provide the actor with feed
back on his performance and be prepared.
 As soon as the practice sessions are working smoothly and each person has opportunity to
be actor , increase the difficulty of the task.
 This is the last step in simulation . Now the teacher should be prepared to alert the
procedure , change topic and move on the next skill so as to prevent a significant
challenge to each actor and to keep interest as high as possible . The task should be
neither high nor too easy for the participants.

Role of Teacher:
 Planning
 Facilitating
 Debriefing

Merits:
 it actively engages learners in the application of knowledge and skills in realistic situations.
 It is useful in promoting the transfer of learning from the classroom to the clinical setting.
 Students can learn without harming the patient.
 By controlling some of the variables, the situation is still close to reality.
 Students can receive feedback on the appropriateness of their actions during simulation.
 It encourages creative and divergent thinking.

Demerits:
 Simulation is costly in terms of both time and money.
 Simulation techniques also consume a lot of classroom time.
 It is possible that emotions may be aroused to an undesirable degree.
 The process and outcomes of simulation methods are not always predictable.
 Models are often easily damaged.
 Never the same as performing technique on a patient.

Key Ponits:

 Thoroughness in preparation for the student.

 Choice of time in the course or unit.
 It should be appropriate for the student's experience.
 Teachers should be always flexible in case it is necessary.
 Simulation what we choose should be nearer to real life.
 Motivation of students.
 Students should get a feedback.

PROBLEM-BASED LEARNING

Problem-based learning is a student-centric instructional strategy where students

collaboratively solve problems and reflect on their experiences. It is an inquiry-based
method of instruction that guides students to solutions of real-world problems through
cooperative group work and builds critical thinking skills.

• According to D.J. Boud (1985), 'the principal idea behind problem-based learning is that
the starting point should be a problem, a query, or a puzzle that the learner wishes to
solve'.

• According to John Dewey (1916), 'a careful inspection of methods which are
permanently successful in formal education. Problem based learning will reveal that they
depend for their efficiency upon the fact that they go back to the type of situation which
causes reflection out of school in ordinary life. They give pupils something to do, not
something to learn; and if the doing is of such a nature as to demand thinking naturally
results'.

USE OF PROBLEM-BASED LEARNING

 Problem-based learning is introduced and continued for many reasons including:

 Acquiring subject matter knowledge.

 Motivating students to learn.

 Helping students with retention.

 Developing students' thinking skills.

 Developing students key skills relevant to employment such as interpersonal
communication skills Fostering professional competence and confidence together with
professional identity.

 Mirroring the interdisciplinary team process graduates will use in work and research.

 Facilitating students how to learn.

 Encouraging students to integrate knowledge from different subjects, disciplines and

sources.

 Linking theory and practice.

 Having a sense of belonging and friendship.

 Having a sense of fun while learning.

 Expressing in operational form a philosophy of learning that is student-centric and

problem focused

COMMON FEATURES OF PROBLEM-BASED LEARNING

 The main features of problem-based learning are:

 Learning is initiated by a problem.
 Problems are based on complex, real-world situations.
 All information needed to solve the problem is not given initially.
 Students identify, find and use appropriate resources.
 Students work in a permanent group.
 Learning is active, integrated, cumulative and connected.

PROCESS OF PROBLEM-BASED LEARNING

The main steps in the process of problem-based learning are

 Presentation of problem.
 Organize ideas and prior knowledge.
 Pose questions.
 Assign responsibilities for questions and discuss resources.
 Research questions, summarize and analyze findings.
 Reconvene and report on research.
 Integrate new information and refine questions.
 Resolution of problem.

THE PROBLEM-BASED LEARNING CYCLE

Problem-based learning consists of the following steps

Kenneth J. Oja conducted a study on using problem-based learning in the clinical setting
to improve nursing students' critical thinking. In today's arena, new graduate nurses are
exposed to increasingly demanding and complex acute care environments that require an
ability to effectively think and reason to provide quality patient care. So there is a need to
demonstrate critical thinking skills to the new graduate students. Problem-based learning
is a method of education designed to encourage critical thinking. The studies reviewed a
positive relationship between problem-based learning and improved critical thinking in
nursing students.
 1. Presentation of problem

2. Organize ideas and prior knowledge (What do you know?)

3. Pose questions (What we need to know?)

4. Assign responsibility for questions, discuss resources

5. Research questions, summarize, analyze findings

6. Reconvene, report on research

7. Integrate new information, refine questions

8. Resolution of the problem (How did we do?)

Fig.4.1 Steps in the process of problem-based learning

Steps of the problem-based learning process.

5.Generalizing 1. Applying
(developing (planning
real- world effective use
principles) of learning)

4.Processing 2.
(discussing Experiencing
patterns and (activity
dynamics) phase)

3. Sharing
(exchanging
reactions and
observations)
 Advantages of problem-based learning

 Relates to real world and motivates students.

 Requires decision-making or judgments.
 A multipage and multi-stage process.
 Designed for group solving.
 Poses open-ended initial questions that encourage the discussion.
 Incorporates course content, objectives, higher-order thinking and other skills.

Questioning

Introduction

Questioning is one of the oldest method of teaching. It is said even a great thinker
Socrates had used this method. From this fact, it is clear that how old this method is.
Question is an essential element in all teaching procedures and it is the key to all
education activity.

The modern theory of teaching still considers questioning as an important part of an

education. In the past, question was an end in itself. But today, it is considered as means
to an end. The old method of questioning did not result in learning. Today, the emphasis
in teaching is based upon the principles of learning, motivation individual differences and
selfactivity. If we view from this angle, questioning should induce motivation, self-
activity, etc. So just questioning alone does not necessarily produce learning. It is a
manner of questioning the timing and the content which result in learning.

Definition

A question is a request for information or for an opinion.

Objective of Questions
1. To measure the student's achievement about knowledge, skill, and attitudes.

2. To rouse interest and challenge attention.

3. To provide for drill.

4. To ensure proper organization and interpretation of materials and experiences.

5. To facilitate interpretation and evaluation of information.

6. To form and develop attitudes and appreciation.

Types of Questions

1. Judgement questions: Judgement questions help the students to develop the ability to
analyse, discriminate and make decision, how, why.

2. Information questions: Information questions help the student to recall facts which
have been read, discussed or learned, when, where, what.

Characteristics of Effective Questions

1. Questions should be based on sound ideas or purposes.

2. Questions should be written the range of students experiences and knowledge.

3. Question should present a challenge which stimulate learning.

4. Question should contain only one idea.

5. Leading questions and cross questions should not be asked.

6. Question should be well worded that means it should be clear, concise, grammatically
correct, expressed in good English and unambiguous.

Skill Essential for the Development of Successful Questions

The teacher should possess personal quality and technical knowledge. The following are
same of the skills considered basic to good questioning:

1. Clear and rapid thinking.

2. Skill in judging relative values

3. Skill in working the questions

4. Self confidence

Technique of Questioning

1. Address the questions to the class in general and then call on someone to answer it. The
teacher should not name the student first and then ask the questions.

2. Distribute questions as evenly as possible to all students. Do not neglect any student.

3. Allow sufficient time for formulation of answer. The student should be given time to
think and answer.
4. Ask questions in a natural, interested, conversational tone.

5. Question as a rule should not be repeated.

6. Student should be given due credit for answering full or part of the answer.

7. Organize questions around the sequence.

Teacher Reaction to Students Questions and Responses

The success of the class depends greatly upon the attitude and the response of the teacher
to student questions and answers. The following points are important in relation to it.

1. Encourage the student's participation.

 2. Student questions should be significant.

3. Both the student and the teacher should be courteous in asking and answering
questions.

4. Grant the student the right to disagree

5. The teacher should admit if she does not know an answer.

Questioning Skills and Techniques in Teaching-Learning

Introduction

1. Skillful use of questions is a priceless ingredient of teaching. Questions and answers

provide a latter in which the learner climbs towards fuller and deeper understanding.

2. Socratec method of teaching relies heavily on series of questions, answers and probing.

3. Questioning, pausing, and responding are important elements of interactive teaching.

4. The chier purposes of questioning are:

o To test understanding of what has been taught or learnt that is to get feedback.
o To stimulate thought and deeper understanding.
o To arouse interest, to involve learner and to increase learner participation in teaching-
learning.

5. Students question:
o To get information.
o To learn and increase understanding.
o To clarify doubts and ambiguous statements.

Types of Questions, Classification

1. Closed, narrow-focus questions

Answers are short, limited, e.g. defining, naming, etc. or no encouraged convergent
thinking
2. Open, broad questions Answers are lower and include a numbe of possibilities.
Encourage divergent thinking.
3. Lower-order questions Factual, descriptive answers based on recall, memoryMiddle order
questions Answers indicate understanding comprehension.Higher-order questions
Answers reflect ability to reason, draw inferences, analyse, solve problems, evaluate
(review Benjamin Bloom's Taxonomy of Educational objectives).
4. Cognitive questions:Answers related to knowledge domain.
Affective questions: Answers related to feelings values and attitudes.
4. Rhetorical questions:These serve no true educational purposes.

Specific questioning skills and techniques

1. Structuring a question: Question should be short, clear focussed.Framing the question

in a way that will serve the purpose.

2. Posing the question:Pose question in a nonthreatening way, in an encouraging manner.

Pose question to the whole group at first then ask for volunteer or nominate someone.

3. Pausing:Give time for answers especially thought-provoking type.Do not answer your
own questions.

4. Distributing questions:Spread questions around.

5. Redirecting questions:Invite others to respond if answer is inadequate without making

the learner feel that her contribution is of little value.If answer is wrong - "let someone
else try".If question is open type widen participation.

6. Prompting technique: Provide hints, clues when question elicits poor or no

response.Prompting techniques may include Rephrasing question to help student
understand the question. Reviewing by going bark over points made so far. Simplifying
by asking simple questions and breaking down concepts and ideas involved to a long
demanding level.

7. Proving technique: Ask further questions to follow up, and to assess degree or depth of
understanding.
Dealing with answers

1. Indicates whether answer is right or wrong. Correct wrong points or help student to
arrive at the correct answer.

2. Commands those who are right especially when a thought-provoking question is asked,
or when responses are adequate.

3. Deal tactfully with wrong answers and inadequate responses.

Common weaknesses in questioning

1. Posing vague questions, or very general questions.

2. Asking multiple questions at the same time.

3. Teacher answers her own questions.

4. Asking rhetorical questions like 'Isn't it? 'Don't you can be improved by analysis and
effort.
"ASKIT" technique of analysing questioning includes evaluation of questions according
to whether. question is narrow or broad recall type or thinking type confused or clear
Question is asked in a Threatening way or neutral or encouraging way.

WRITTEN ASSIGNMENT

Written work provides teachers with an excellent opportunity to assess the student's
ability relative to the thinking process, the communication of ideas, and the values and
beliefs apparent (Some of the written work is more relevant to clinical practice and will
be discussed in the following chapter). Critical analysis of readings, phenomena or
situations, essays, defense of positions, on issues, and reports of studies can follow the
patterns previously illustrated. Many of the suggestions for questions stated in the essay
section are particularly pertinent. Further, illustrative examples will not be given but some
general principles are offered.
 General Principles

1. The behavioral objectives for the assignment be stated clearly.

2. Instructions must be stated clearly and understood by the learner.

3. Provision should be made for individual guidance, as the need is indicated so that the
student can aspire to mastery.

4. Learners should be notified of standards for evaluation and the basis for grading.

5. Faculty should support creative approaches to meeting objectives.

6. Written work deviating from the prescribed format should be assessed. In terms of its
response to the objectives, not to its adherence to an expected form.

PROCESS RECORDING

Process recording refers to as a systemically written formal report of a therapeutic

conversation, oc- curred between patient and healthcare provider. According to Walker,
'the process recording is a verbatim account of a visit for purpose of bringing out the
interplay between nurse and the patient in relation to the common objectives'. In other
words, process recording may be defined as 'a written account or verbalism recording of a
conversation that occurred between a patient and the professional nurse, when they are
working together towards a common therapeutic objective, which is recorded during and
immediately following the nurse-patient interaction'.

Features of process recording

 It is written during and immediately after the therapeutic nurse-patient interaction
 Process recording also can be used as an excellent clinical teaching method. .
 It also has therapeutic purposes, where recorded conversation is used to understand the
patient's behaviour and problem in depth.

Uses of process recording

• As a teaching-learning tool.
 • As an evaluation tool.

• As a therapeutic tool.

Purposes of process recording

 Assists the nurse gain competency in interpreting and synthesising raw data under
supervision.
 Helps to consciously apply theory to practice.
 Helps the students develop an increased awareness of their habitual, verbal and nonverbal
communi- cation pattern.
 Helps the nurse to learn to identify thoughts and feelings in relation to self and others.
 Helps to increase observation skills as there is a conscious process involved in thinking,
sorting and lassifying the interaction under the various headings.

Advantages of process recording

 It is the most suitable method of teaching to develop competency in interpreting and
synthesizing abstract concepts.
 It also provides opportunities for students to develop good communication skills through
the practice of process recording.
 Process recording also helps to develop keen observation skills and critical thinking

Disadvantages of process recording

 The process of recording as a method of teaching is very time-consuming.
 It is not a suitable method of clinical teaching for an average IQ student because it is a
highly complex process.
 The students with poor communication skills cannot be benefited with this method of
clinical teaching.
 Sometimes patients do not offer the cooperation with this complex process of clinical
teaching
REVIEW QUESTIONS

Short Notes:

Write short notes on the following:

1. Role Play

2. Problem-Based Learning (PBL)

3. Clinical Simulation

4. Process recording

Long Answers Questions

1. Briefly explain the concept of mapping

2. Define Problem-Based Learning (PBL) and discuss the steps and Process of Problem-
Based Learning (PBL)

Multiple-choice questions (MCQs)

1. In the clinical setting, what model involves an expert nurse working with students on a
one-to-one basis?
a) Collaborative model
b) Mentorship model
c) Preceptor model
d) Simulation model

2. Which method of nursing care delivery is considered the oldest and involves providing
care to a patient within a single setting?
a) The case method or total patient care
b) Team nursing
c) Functional nursing
d) Primary nursing
 3. What is the term for the educational process in which a clinical teacher and a group of
learners observe patients, confirm physical signs, discuss provisional diagnoses, and make
diagnostic or therapeutic decisions?
a) Ward rounds
b) Grand rounds
c) Bedside clinic
d) Case conference

4. Which of the following involves a systematic approach to nursing care,

encompassing assessment, diagnosis, planning, implementation, and evaluation?
a) Nursing interventions
b) Patient Education
c) Medical diagnosis
d) The nursing process

5. In which nursing model are tasks divided among nurses, with each nurse assuming
responsibility for specific tasks rather than focusing on the patient as a whole?
a) Patient-Centered Nursing
b) Functional Nursing
c) Holistic Nursing
d) Team Nursing

6. What term describes the process in which students have the opportunity to report on
clinical learning, and describe and analyze the care they provided?
a) Reflection
b) Assessment
c) Debriefing
d) Observation

Answer of the Multiple-Choice Questions

Answer:1.(C), 2. (A) 3.(C),4.(D),5.(B),6.(C)

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