The Clinical Conference

1. The Clinical Conference

2. Compiled by: Donna Cooke RN BSN Dorothy Dooley BN RN, IBCLC Patricia Meyer RN BSN

3. This presentation will include the following content on the pre clinical conference, the post clinical conference and the pre/post clinical conference. • Definitions • Teaching Approaches/Advantages • Additional Advantages • Disadvantages • Activities

4. Definitions

5. Pre Clinical Conference • “Preclinical conferences are small group discussions that precede clinical learning activities” (p.181) that can be conducted in a group setting or one to one; and is a time for students to prepare for their experience, seek clarification, think through plans of care and examine client’s information and problems (Gaberson and Oermann, 1999).

6. Post Clinical Conference “Postclinical conferences are held at the conclusion of clinical learning activities” (p.182) and is a time for discussion, sharing experiences and emotions, peer support and critique, looking over the day and analyzing experiences (Gaberson and Oermann, 1999).

7. Teaching Approaches and Advantages

8. Pre Clinical Conference Teaching Approaches/Advantages • Teacher directed discussion in a conference room primarily aimed at student planning activities in advance of their clinical assignment to ensure discussion of their plans of care based on their review of the literature, specific to their client’s care. Students learn how to apply theory to practice, how to defend their critical thinking skills and client care decisions, how to express feelings, and how to explore the role of the nurse (Mitchell and Krainovich, 1982).

9. Student centered on the unit where the focus is on client centered care in immediate assessment of clients by the student and reprioritization of care based on client’s present status as well as discussion with instructor regarding re-evaluation of care (Mitchell and Krainovich,1982).

10. Post Clinical Conference Teaching Approaches/Advantages • Circle format: promotes a feeling of collegiality, augments the group process • Instructor as a facilitator: portrays the instructor as a role model, reinforces learning as a lifelong process, and ensures productive use of time • Build self confidence by focusing and stressing the positive aspects of the day, creating a positive atmosphere, encouraging specificity and promoting peer feedback (Copeland, 1990).

11. Instructor as a facilitator encourages student participation, facilitates the investigation of commonalities and differences in care, examine the role of the practicing nurse, and share their affective experiences (Matheney as cited in Mitchell and Krainovich, 1982). • Grounded on specific objectives which ensure coverage of clinical objectives (DeYoung as cited in Letizia, 1998). • Use of an informal atmosphere is conducive to learning (Werner-McCullough and L’Orange as cited in Letizia, 1998).

12. Using a variety of techniques and approaches such as creativity and student - centered approaches can enhance the learning experience, improve student and group problem-solving, promote team building and encourage maximum use of the post conference experience (Werner-McCullough and L’Orange, 1985).

13. Student centered approach encourages dialogue where students share experiences, work through problems and assign meaning to complex interactions (Rossignol, 2000). Student participation and student – to – student participation in this approach helps foster critical thinking skills (Collins, Brown and Newman as cited in Rossignol, 1997).

14. Use of high levels of discourse (teacher centered: high level questions from instructors, elaboration of student ideas by instructor, instructor probing questions; and student centered: student participation and student to student participation) (Rossignol, 1997). Previous studies (Barnes; Craig and Page; Scholdra and Quiring; Wink as cited in Rossignol, 1997) provide evidence that both teacher and student – centered activities may foster the use of more high cognitive level questions and in turn, critical thinking skills.

15. An environment that moves beyond low cognitive level questions to that of high level cognitive questions (teacher centered) may foster the development of cognitive skill: critical thinking skills, decision - making skills, and problem - solving skills in students (student centered) (Gaberson and Oermann, 1999; Oermann, 1997; Oermann, 1999; Rossignol, 2000; Sellappah, Hussey, Blackmore and McMurray, 1998), facilitate the consolidation of clinical experiences (Sellappah et al.,) and development of clinical competence (Wink, 1993). Higher level questioning by instructors may encourage higher level questioning among students (Wink, 1993).

16. Instructor as a facilitator asks high level questions to help students with in depth reflection and to constructively critique each other’s interpretation of events (Matheney as cited in Mitchell and Krainovich,1982). • Fosters problem solving (DiRenzo; Mitchell and Krainovich; Reilly and Oermann; Werner-McCullough and L’Orange as cited in Letizia, 1998).

17. Use of imagery may enhance discussions and learning (Skurski as cited in Letizia, 1998). • Education imagery where the instructor takes the student through a process of quiet relaxation to discuss feelings, perspectives of the situation, and make decisions to improve client care. It allows students freedom to discuss what they feel is important and actively includes students in learning (Skurski, 1985).

18. Computer conferencing serves as an environment in which students can “exchange ideas, solve problems, explore alternatives, and create new meanings along a connected journey” ( Andrusyszyn and Billings as cited in Babenko-Mould, Andrusyszyn and Goldenberg, 2004, p.149).

19. Computer conferencing provides a connection between students and faculty who are otherwise isolated geographically, support through encouragement from others in the group, learning from discussion of experiences, and sharing by giving and receiving each others perspectives and insights (Babenko-Mould, Andrusyszyn and Goldenberg, 2004).

20. Computer conferencing may contribute to students sense of connection and self confidence, sense of control/power over learning and augmentation of group process skills (Babenko-Mould, Andrusyszyn and Goldenberg, 2004), and enable students to access global links by extending enquiry beyond local links and issues (Colling and Rogers as cited in Babenko-Mould, Andrusyszyn and Goldenberg, 2004).

21. Pre and Post Clinical Conference Teaching Approaches/Advantages • The use of narrative pedagogy, a deductive approach to teaching and learning where students and instructors as well as clinicians share and interpret their experiences in the context of nursing education. The facilitator encourages students to share the significance and the meaning of their learning to enhance their ability to be reflective practitioners. Use of attentive behaviors creates an open environment for thinking about the meaning of the clinical experience (Andrews et al., 2001).

22. May involve the use of instructors who are initially “leaders, facilitators, and ‘energizers’ who promote participation and encourage questioning and analysis by all members of the group” (p.29) but then as the group advances, the students assume the instructors role “thus learning the group interaction of nursing professionals.”( Wink, 1995, p.30). Group discussions and analytic questioning advance to higher levels as the experience evolves (Wink, 1995).

23. Discussions where the instructor promotes critical thinking and problem - solving skills as well as provides a supportive educational environment which involves the use and progression from low level to high level questioning (Gaberson and Oermann, 1999; Oermann, 1997; Oermann, 1999). • Socratic Method of questioning, comparing and synthesizing where students are asked open-ended questions, allowing students to work through difficult concepts, examine different points of view and seek clarification (Gaberson and Oermann, 1999; Oermann, 1997).

24. Instructors though the use of their own critical thinking skills and awareness of learning styles, course objectives and evaluations; can influence student learning by using a deeper approach to learning. Students draw meaning from past experiences, develop higher level assessments, students are engaged in learning and are encouraged to comprehend complex topics (Oermann, 1997; University of Technology Sydney, 2004).

25. Achieving approach encourages students to strive and compete for high grades and therefore help them understand the effort required to do well in assessments. Here students are well organized, good time managers, act as role models and select students with similar goals for education. The instructor should take the role to influence the student to function in both a deeper and achieving approach (University of Technology Sydney, 2004).

26. A group effort that contributes to the attainment of course/clinical objectives such as theory review, critical thinking, problem solving, and fine-tuning of psychomotor skills. Students begin to apply research, examine ethical issues and evaluate the effectiveness of their own and their peers’ application to the nursing process, and is an environment where students explore their personal feelings and attitudes related to the care of the client (Oermann, 1997;Wink, 1995).

27. Experiential learning through a simulated setting to foster improved problem solving and decision making. Faculty control the teaching environment, learning is reinforced through peers and educator, use of good tools to promote affective learning (emotions, values, perspectives), increases communication skills, develops leadership, and complex issues can be worked through (Gaberson and Oermann, 1999).

28. Additional Advantages

29. Pre Clinical Conference Advantages • Foster critical thinking and clinical decision making skills development as well as enhances the clinical learning experience (Wink, 1995). • Enhance analysis of theory concepts, conceptualize the role of nurses, and use the “nursing process to think logically and make decisions” (Mitchell and Krainovich, 1982, p.824).

30. Post Clinical Conference Advantages • Provides an opportunity for empirical study of approaches and activities to student learning processes and outcomes (Letizia, 1998; Letizia and Jennrich, 1998). • Contributes to the attainment of the course and the clinical objectives (Wink as cited in Letizia, 1998). • An opportunity to enhance clinical learning (Lister as cited in Letizia, 1998).

31. May provide a method to apply theory to practice (DiRenzo as cited in Letizia, 1998). • Opportunity for students and faculty to interact and learn from each other (Rossignol, 2000).

32. Enhances the capacity for clinical decision making • Increases self confidence • Improves group process skills (Reilly and Oermann as cited in Letizia, 1998).

33. Students can “evaluate and critique care, … explore … the basis of problems encountered during the clinical laboratory [and] alternative ways to accomplish … objectives” (Wink, 1995, p. 29). • Is an important environment in the development of cognitive, affective and behavioral learning of nursing students (Letizia and Jennrich, 1998; Reilly and Oermann as cited in Letizia, 1998).

34. Educators can create an informal tone to enable nursing students to feel free to openly discuss topics without being evaluated (Gaberson and Oermann, 1999; Oermann, 1997; Mitchell and Krainovich, 1982; Werner-McCullough and L’Orange, 1985). • Encourages student learning from other students, improves communication and group dynamics within a small group (Werner-McCullough and L’Orange, 1985). • Can be flexible. Example: Nursing rounds can be carried out in a conference room to decrease student and instructor fatigue and allow for limited discussion (Werner-McCullough and L’Orange, 1985).

35. Pre/Post Clinical Conference Advantages • Meet planned goals and maximize the use of time • Students apply research, examine ethical issues, and evaluate the effectiveness of their own and their peers’ application of the nursing process • Attends to affective issues for the students: stress, apprehension, values, beliefs, and incident debriefing (Wink, 1995).

36. The structure and timing of conferences are flexible to ensure quality is enhanced. That is, they do not have to happen at the beginning or end of a day, and may be cancelled if students are fatigued; they do not have to happen in the agency or on the same day as clinical; can be forfeited in favor of accomplishment of objectives elsewhere; may vary in length, shorter at the beginning of the course because of the increased time students need to perform learning activities, and longer toward the end of the course as students become more proficient and are able to reflect more meaningfully (Wink, 1995).

37. Disadvantages

38. Pre Clinical Conference Disadvantage • May be rushed due to the demands of the unit and client care.

39. Post Clinical Conference Disadvantages • May be unstructured in discussions leading to boredom in students • Since it typically occurs at the end of the day, energy levels may be low (DeYoung as cited in Letizia, 1998).

40. Computer conferencing may impose barriers such as connection through internet access and time availability (Babenko-Mould, Andrusyszyn and Goldenberg, 2004). • If using educational imagery, the instructor needs to feel comfortable and confident with the technique to foster discussion and improve decision-making (Skurski, 1985).

41. Pre/Post Clinical Conference Disadvantages • Can be used as a substitution or distraction for other learning activities (Wink, 1995). • If a surface level of learning approach is used, it promotes only memorization of information (University of Technology Sydney, 2004). • They take up time; up to 30% of the clinical day (Wink, 1995).

42. Conference Activities

43. Pre Clinical Conference Activities • Student planning activities and discussion of plans of care for their clinical assignment based on their review of the literature specific to their client’s health status • Teacher centered using mock reports, discussion, role playing and demonstration (Mitchell and Krainovich, 1982).

44. Nursing rounds where students gain an opportunity to speak in front of peers’, improve decision making skills, meet other clients, apply theory to practice, generate enthusiasm, promote ideas for research, learn pathophysiology, compare diagnosis and client response to care, and faculty see where priorities in the supervision of students are needed (Skurski, 1985).

45. Post Clinical Conference Activities • Individual and group reflection • Student evaluation by instructor • Debate (Reilly and Oermann as cited in Letizia, 1998).

46. Sharing of clinical experiences • Review and critique of clinical activities • Examination of behaviors used in clinical decision making (Mitchell and Krainovich as cited in Letizia, 1998).

47. Discussion of clinical concerns and issues (Mitchell and Krainovich; Reilly and Oermann as cited in Letizia, 1998). • Exploration of feelings and attitudes of students related to patient care (Wink as cited in Letizia, 1998). • Discussion of learning objectives realized during the day and how they fit into the curriculum (Matheney as cited in Mitchell and Krainovich, 1982).

48. Discussion of clinical experiences, case studies, coverage of theoretical content, nursing ethics, student presentations, guest speakers, nursing research, audiovisual presentations, psychomotor skill presentation, quizzes or tests, group lunch, tour of other units, patient rounds (Letzia, 1998). • Questioning, ethical debates and use of multimedia (Mitchell and Krainovich, 1982).

49. Group problem solving, nursing rounds, clinical testing and role playing, all to enhance student learning and problem-solving. Clinical testing assists students to look at areas of strengths and areas for improvement. Role playing can improve communication skills, assertiveness skills, examine personal perspectives, attitudes and encourage accountability. Instructors can promote group collaboration and a safe environment which provides opportunities for positive and negative feedback from peers and instructor (Werner-McCullough and L’Orange, 1985).

50. Nursing rounds, an approach to promote problem solving where students practice “verbal presentation of organized and pertinent data” (p.34), involves preparation of client information, understanding of the plan of care and allows the instructor to ask questions to develop a deeper level of understanding. This approach “helps students fit the pieces of the puzzle together and to have a more in-depth understanding of the patients” (Werner-McCullough and L’Orange, 1985, p.34).