Clinical practice is of outmost significance because this is the site where students can turn theory into practice, students can interact with patients and families, and face the real world of medicine. It is significant and useful to reflect upon assessment practices to evaluate students in clinical setting. For this purpose, this paper analyzes three articles relevant to the clinical practices by the nursing students, and the role they should play outside the classroom, and who should evaluate them in the clinical setting. This paper also features suggestions and recommendations derived from the reflections and analyses made on the articles reviewed. Article one. The ongoing search for best practice in clinical teaching and learning: A model of nursing students’ evolution to proficient novice registered nurses. This article by Edgecombe and Bowden (2009) features current search to implement best practices in clinical teaching and identifies those positive and negative elements as well as the intrinsic and extrinsic factors that make an impact on nursing students’ learning process, and their development and growing process from students to proficient novice nurses Rns. The study was conducted at Flinders University in Adelaide, South Australia, and involved 111 students. A model was created intending to assist students in their transformation from students to RNs, the Dedicated Education Unit (DEU) model was designed as an innovative approach for clinical teaching.
This approach focuses on the specific use of the clinical setting available for learning practices in health settings such as mental health centers, acute medical departments, and surgical wards or community health organizations. The DEU follows the principles of adult learning of modifying, relearning, and replacing knowledge, skills, strategies and values through experience gained, and reflections made (Edgecombe & Bowden, 2009). The DEU foundational philosophy relies on the sound relationships between clinicians and academicists, valuing their contributions aimed at establishing the optimal learning environment for nursing students. Also valuing nursing students’ views. The model described in the article might have influences on the development of future curriculums, upgrading of staff and on different approaches used to place staff in adequate positions. The model can also serve to do research works intended to the teaching and learning process in the realm of nursing education (Edgecombe & Bowden, 2009). Among the elements analyzed in this article, the authors highlighted the emphasis students placed on the importance of belonging to a place, to feeling valued and trusted.
These positive feelings, greatly influence the students’ learning processes. However, when a student feels isolated, neglected from the regular clinical staff or heavily or unfairly critized or scoffed at his/her performance, these actions have a negative impact on the learning stage at this specific clinical setting (Edgecombe & Bowden, 2009). It is important to observe tha bulling, and lateral violence at the workplace exist in some hospitals and health settings, as indicated by Broome and Williams (2011), especially with novice nurses or new nurses when they begin working for the first time in a clinical setting. In this regard, Broome and Williams (2011) state that in some health care settings the problem takes place when some experierenced nurses complaining about novice nurses’ performance, and the lateral violence develops in different ways and causes serious impacts on the victims. Dellasega (2009) considers that lateral violence manifests in cover or overt verbal and non verbal aggression episodes. Reflecting upon these topics among the negative effects that a toxic environment may cause to nursing students as indicated above by Edgecombe and Bowden, (2009), the author of this paper also believe that bullying and lateral violence can also create a harmful atmosphere for the learning process among students who develop their practices in a clinical setting. Article 2. Developing a successful nursing objective structured clinical examination.
This article written by McWilliam and Botwinski (2010) evaluates the basic components for developing relevant and useful nursing objectives in the clinical area for nursing students, but these authors failed to highlight some significant aspects of high-skilled therapeutic work, the importance of interpersonal aptitudes, and blending some key information into practices in clinical settings. The article deals with assessing the clinical skills that students may acquire in different health scenarios. This practice is vital because students can work and learn from different scenarios, patients and diseases (Mcwilliam & Botwinski, 2010). According to Mcwillian & Botwinski (2010), clinical educators should pass on their experience gained to students, and at the same time, should ensure that patients also gain safe nurturing consideration. In achieving these goals, the delivery of clinical instructions should be imbuied of professional ability, proper interpersonal relations, and adequating aspects of temperament.
Educators should have a clear idea on the model that may guide them turning a speficic scenario into a learning experience, and also into an evaluative procedure that will be mutually beneficial for the educator and the nursing students. Nurse’s decision-making abilities derived from critical thinking and evidence-based practice have been analyzed by various analysists who have reflected that choice making is a studied skill that nurse educators should teach, but there are few research intended to investigate the choices made by nursing students. If more information of this topic is available, educators will be capable of designing a more proper curriculum that also covers the developing of this attitude geared to teach students how to make better choices (Mcwillian & Botwinski, 2010). The author of this paper believes that tools to furnish the nursing students to develop critical thinking and choice making are a vital part of the curriculum. It is true that not all topics can be covered in a curriculum as stated by Mcwillian and Botwinski (2010), but decision making process and a good guidance are crucial elements of a proper and adequate nursing training in clinical practice. Article three. Evaluation in clinical practice using an innovative model for clinical teachers The article features the Reflective Interaction Analysis in Nursing Education (RIANE) Model which addresses the problems faced by clinical teachers of how to turn information-rich interactions in clinical practice into objective information using a format that provides valuable feedback and helps evaluation.
The Model facilitates the translation of the interactions for clinical teachers that occurs on a daily basis with nursing students, recorded in notes for their further use in formative and summative evaluations (Zafir & Nissim, 2011). The article discusses the use of this model in the training of a group of nurses that will become clinical teachers. The RIANE model motivates clinical teachers to see the students’ clinical interactions as another way to contribute to the learning process, as an educational opportunity. It provides certain order in an amount of information difficult to manage by clinical teachers who have to find a way to make this information accessible to students (Zafir & Nissim, 2011). The author of this paper considers that allowing the students to learn from their daily experiences, enabling them to provide feedbacks, and being heard, are great positive contributions for educational purposes in the clinical setting, and the clinical instructor can keep track of their students by recording notes while the students also render their clinical collaboration. Zafrir and Nissim (2011) believe that the proper role clinical teachers should play is that of guidance, support, inspiration, and facilitating learning. Also these authors consider that an environment of mutual trust and confidence should prevail in supporting students’ process of learning and growth.
There are several models for clinical instructors and faculty to evaluate students outside the classroom: The clinical instructor can use the modality of preceptor ,one to one relation, in which an experienced nurse serves as a preceptor for a certain period of time. The clinical teaching associate (CTA) model uses a staff nurse collaborating with a faculty to train a given number of students for clinical practices. The paired model features one-student, one patient model, a variation of the preceptor model, and a student begins clinical practice within specific days supervised by a staff nurse for a practicum experience (Billings and Halsted, 2009). Other models for clinical instructors to evaluate students outside the classroom, and on occasions, jointly with the faculty during their clinical practices are the clinical teaching partnership where a form of collaboration is established, the service institution contributes with a clinical nurse specialist and the university constributes with a faculty member. Adjunt faculty is another model in which the faculty is a health care professional hired by a service setting in the modality of part-time.
This professional can serve in several roles as supervisor, mentor, guest lecturer, and preceptor, and can also render a collaboration in research works (Billings and Halsted, 2009). The role that a student should play in the evaluation process should be that of a student that prepares for the clinical experience, establishes good relationships and exhibits proper communication skills, learns and accepts feedbacks and adapts to the assigned clinical setting and advances in his/her performance. The unsuccessful student in the clinical experience is unprepared for this activity, does not establish communication efficiently, breaks legal and ethical practices, uses practices that are not safe, his/her adaptation to the assigned clinical setting is poor (Lewallen and DeBrew, 2012). The students under a clinical practice can act in the following scenarios: labs, homeless shelters, camps, agencies that render social services often
involving interdisciplinary health settings. The clinical teacher-student interaction is a significant part of this practice (Billings & Halsted, 2009).
The author of this paper believes that students should embrace this relation, and take a good advantage of this opportunity to learn at large all what is taught by the instructor and assimilate the experience gained while doing the clinical practice, since the student is exposed to several medical situations. Conclusion The three articles reviewed contribute to make a good analysis of the possibilities of evaluating students in clinical settings. The clinical area is significant in training novice nurses because they are in contact with the real world and can interact, not only with patient but with their families and the professional colleagues and other related staff they will be working with during their professional life. The practice in clinical settings enables students also to be more confident in themselves, because after they can apply theory into practice will feel more capable in their profession, and become more autonomous decision makers. The students will have the possibility to raise their caring abilities, and play more realistic roles based upon their practice.