NURSING EDUCATION

1. NURSING CLINIC

Introduction:

          The nursing clinic or patient presentation utilizes the presence of a selected patient as it faces for discussion the purpose is the improvement of nursing care.

          The most effective nursing clinics are those that are planned, which involves

1. Determining the purpose
2. Selecting a patient, for whom students have given nursing care
3. Securing the patients consent and proper legal clearance
4. Providing advance preparation of the student in terms of the names of the patient, the purpose, place, date and time and any specific instructions regarding preparation for the discussion.
5. Selecting the setting to be used the patients bed side or a conference room visited by the patient.

Definition:

          The nursing clinic is a group discussion which utilizes the presence of a selected patient, whereby the nursing aspects are presented and discussed. In nursing clinic the patients medical history and therapy are discussed only briefly but the emphasis is on 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

Preparing The Clinic:

Ø      Determining the purpose of the client

Ø      Selecting a patient for whom students have given the nursing care

Ø      Securing the patients consent

Ø      Selecting the setting to be used, i.e., bedside or conference room

Ø      Providing advance preparation of the students

Conclusion:

          Clinics are valuable as a teaching and learning device because instruction is carried on in direct relation to the patient. It develops the power of observation and stimulates though and consideration of the nursing care of the patients. All the students apply their knowledge, skills, attitude and appreciation to the subject of the clinic. Clinics also help to meet situations presented by the patient.

2. NURSING ROUNDS

Definition:

          Nursing rounds is an excursion into patients area involving the students learning experience. Nursing rounds is one of the teaching rounds.

Purpose of Nursing Rounds:

1. To demonstrate symptoms important in nursing care
2. Clarify terminology studied
3. To compare patients reaction to disease and study the disease condition, actions and reactions of drugs
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 while planning Rounds:

1. To consult students previous clinical experience to avoid repetition and to add to earlier experience.
2. Keep in mind the probable value and availability of clinic material
3. If some demonstration is done, it should 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 part conference for summary and further explanation
8. Record the nursing record in the ward teaching records and with the summary of nursing points stressed.

Advantages of Nursing Rounds:

1. Make classroom discussions more vivid and real and thus improve learning experience
2. Response of the patient is more natural
3. Students can select patients with specific problems and plan proper nursing care

          In nursing records, a small group of staff or students preferably met more than 4 to 5 and a leader or a teacher visit the bed side of the patient.

Methods of conducting Nursing Rounds:

          A brief conference at the side of the patients room/ward has to be held. Necessary data are given. The purpose of the visit to the patient is outlined by head nurse. Special observation to be made or pointed out at this time. 4 to 5 patients are selected for instructions 4-5 minutes are spent. The head nurse herself may present the uses or she may ask students who are assigned to these patients to answer the questions of the group or her questions. The students are as bed to present the cases regarding other particulars. The participants may also be involved such as counting pulse, respiration, examining the conjuctive, pitting oedema, etc. The patients case sheet can also be utilized with presentation thank the patient before leaving and tidy the bed.

3. NURSING CARE CONFERENCE

          The nursing care conference consists of group discussion using problem solving techniques to determine ways of providing care for patients to whom students are assigned as a part of their clinical nursing experience.

          Problem solving discussions arise from three source.

1. The objective of clinical nursing program
2. The patients
3. The students

          The nursing care conference reviewed as a creative act provides a learning environment that festers opportunities for students to think through challenging and worthwhile problems, allowing for their completion and evaluation while simultaneously learning new subject matter.

Nursing Care Conference as a Method of Teaching:

          Nursing care conference is a method of teaching , which provides an opportunity for an informal discussion of a problem and fee exchange of knowledge and experience about the common interest.

v     A nursing care conference is designed around 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.

v     A nursing care conference is a course of action discussion, the focus is on assessing the nursing problem arriving at possible solution helping staff to examine a patients problem from his point of view.

Planning and Preparation:

1. Before presenting the students will have collected all the data regarding the patients. She will have collected information about the signs and symptoms, since how long the patient is sick, what are the laboratory findings? What about his family background etc.
2. The conference should be planned in relation to the objective of the conference and it should be spontaneous in nature.
3. The student be given ample opportunity to work in the ward for quite good amount of time before she is assigned to present in the conference.

Technique:

1. The nursing care conference is used as a consult action tool to help in problem solving.
2. The teacher must be flexible and she will help the students during discussion
3. 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:

          It has got 3 phases

1. Opening phase
2. Working phase
3. Closing phase

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.

Working Phase:

          The task of working phase is to arrive at a consensus on problem identification and solution. It is helpful, the group focus their discussion by asking direct questions, rephrasing what the group has said and summarizing. The problems are identified and the group can often reach its own solution.

Closing Phase:

          Over 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.

Advantages:

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 judgment 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 ascertain to such situation
2. There are chances of using these conferences hours for classroom teaching

4. NURSING DEMONSTRATION

Definition:

          It is can be defined as visualized explanation of facts, concepts and produces.

Advantages:

1. It activates several senses, this learning because the more senses used the better opportunity for learning.
2. It provides an opportunity for observational learning
3. It clarifies the underlying principles by demonstrating the why of a procedure.
4. It commands interest key use of concrete illustrations.
5. It calculates theory with practice
6. It gives teacher an opportunity to evaluate students knowledge of procedure
7. To determine whether reteaching is necessary
8. Used as a stronger motivational force
9. Return demonstration under supervision of the teacher provides an opportunity for well directed practice before the student must use the procedure on the ward.

Uses:

1. To demonstrate procedure in classroom and the ward
2. To demonstrate experiments and its use
3. To teach the patients a procedure or Rx which he must carryout in home.
4. To demonstrate different approaches in establishing rapport with patients so that the most effective nurse patient relationship may be established.

Essential Characteristics of a Good Demonstration:

1. The demonstrator should understand the entire procedure before attempting to perform for others.
2. All equipments should be assembled and pretested.
3. Advance knowledge of the procedure to be followed in the demonstrations.
4. A positive approach should be used
5. Demonstrator should accompany the procedure
6. The setting for demonstration should be true to life as far as possible.
7. A discussion period should always follow the demonstration
8. The student should be given opportunity for prompt practice for better learning.
9. Minigraphed directions should be distributed before demonstrating a nursing procedure.

5. REPORTS AND PROCESS RECORDING

REPORTS

Definition:

          A report summarizes the services of a must and or the agency. Report may be in the form of analysis of some aspect of services.

Types of Report:

1. Oral Report
2. Written Report

Oral Report:

          Oral report are given when the information is for immediate use and not for permanency. In oral report is made by the nurse who is assigned to patient care to another nurse who is planning to relieve her.

Written Reports:

          Reports are written when the information is to be used by several people or is more or less of permanent value. Day and night report include in the written report.

Criteria of Good Report:

Ø      A good report is clear, concise and complete if it is written all pertinent, identifying data are included the data and time and the people concerned.

Ø      It is clearly stated and well organized easy understanding

Ø      No extraneous material is included

Ø      Good oral report are expressed and presented in an interesting manner and important point are emphasized

Ø      A good report is unhurried

Report between the Head Nurse and Her Assistant:

Ø      The assistant head nurse should know everything patient pertinent to the management of the ward

Ø      The well informed assistant head nurse knows the condition of all the patients and the Rx they are receiving

Ø      When the head nurse return to the ward after hours or days of absence the assistant head nurse tells her all changes in the situation including the condition the patients and happening during the absence.

Reports of Staff Members to the Charge Nurse:

          The head nurse or the nurse in charge looks to the bed side nurses to keep her informed throughout the day of changes in patients condition.

Day, Evening and Height Reports:

          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.

PROCESS RECORDING

Definition:

1. The process record as “Verbaturn account of a visit for purpose of bringing out the interplay between and the nurse and the patient in relation to the objectives of the visit”.

- Walker

2. Process recording as an “extract written report of the conversation between the nurse and patient during the time that they were together. It is also record of the nurse feelings about what was going on at that time and of the observations of the patients behaviour during the conservation”.

- Hadson

3. Process recording is a “written report or verbaturn recording of all that transferred 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”.

Purposes and Uses:

          Use the process record in clinical nursing as a tool for developing skills of nurse patient relationship should follow logical pattern of:

1.      Teacher student collaboration in defining the specific objectives to be accomplished through the use of tool.

2.      Discussion of the relationship between the use of the process record and the accomplishment of the established goals.

3.      Careful detailed explanation of the total observation interviewing and recording process

4.      Preparation of the patient for the experience

5.      The students analysis of recordings to serve as dues to self understanding of the patients needs.

6. FIELD TRIPS

Definition:

          An educational trip is defined as an educational procedure by which the students obtain first hand information by observing places, objects, phenomena or activities and process in their natural setting to further learning.

Purposes:

1. To provide real life situations for first hand information
2. To supplement classroom instruction to secure definite information for a specific lesson
3. To verify previous information, class discussion  and conclusion  of individual experiments
4. To serve as a means of arousing specific   interest in materials objects, places or processes
5. To create teaching situations for culturating observations, keenness and discovery
6. To serve as a means to develop positive attitude, values and special skills

Organization and Procedure for Field Trips:

          The essential pre requisite to any successful field trip is a well thought outplan.

1. Knowledge: Teacher has to survey the area to know whether the field trips planned will contribute to the attainment of described objectives.
2. Rapport: The teacher should establish and maintain cordial relations with those incharge of the situations to be visited.
3. Objectives: Objectives should be stated carefully and completely
4. Time and Transportation: Necessary arrangements have to be made with the administrative personnel of the place to be visited regarding the time, place of meeting and length of visit.
5. Preparation of Students: Students should be given an opportunity to list cooperatively the objectives for which the trip is planned.
6. Super Vision: Trip should be supervised carefully the teacher can assist the student by calling attention to potential point.

Values of Field Trips:

1. It breaks monotomy of the classroom and provides real life experiences
2. It furnishes first hand information to supplement  and to enrich the classroom instruction
3. It provide opportunity in learning attitudes and positive values
4. Students develop letter understanding of the eterlogic factor of diseases
5. It helps to create situations which in turn help to develop observation and keenness
6. Offers an opportunity to apply that which has been taught to verify what has been learned
7. They serve as an effective means of correlating the subjects of curriculum.
8. It provides opportunities skills i.e., observation, communication and social skills

Disadvantages of Field Trips:

1. Field trip is time consuming
2. Careful planning is required
3. Many parties to be involved, cooperation, coordination of various agencies required.
4. Transportation may be a problem
5. If the group is too large, effective observation becomes difficult
6. Inability to schedule the trip in time when the unit is taught.
7. It involves cost i.e., sometimes cost involvement is more.