Dissertations / Theses on the topic 'Clinical education'

Simulation has been used in nursing education for many years in order to show students complex patients, allow practice of new skills without allowing actual harm to come to the patient, as well as being able to build up student confidence in abilities. The primary focus for this qualitative study was associate degree nursing faculty perceptions of their students transferability of knowledge gained through participating in simulation activities in the clinical setting and, may assist in planning future educational activities. The nursing faculty provided insight to what they felt the students needed to know and reflected on what they actually saw students do in actual clinical situations. The research question addressed in this study was the following: What are associate degree nursing faculty perceptions on student transferability of knowledge to an actual clinical setting after having experience in simulation activities? There was also a research sub question addressed, which was, What do associate degree nursing faculty perceive as barriers to becoming successful in clinical performance and knowledge retention? The study used a basic qualitative design. A basic qualitative design was appropriate for this study because it examined simulation use by nursing faculty at multiple chosen schools and their experiences with knowledge transferability. The study sample consisted of associate degree nursing faculty from the East South Central and West South Central regions of the United States. The study participants ranged in age from 30–66 years of age, and they all have been teaching for at least one year. The guided face-to-face interviews by the participants revealed the following themes, providing a safe environment, clinical experiences/nursing skills, simulation integration in course content, and faculty development and training regarding simulation use. The purpose of the study was to examine transferability of knowledge gained through simulation activities on student clinical performance, and this was actually not addressed in any of the participants’ answers. The researcher found that all the faculty participants are able to work together in all areas where simulation is utilized, in order to produce competent graduates who will be able to enter the workforce as nurses. Recommendations for further research include using a larger sample size and from other geographical regions in order to have a more diverse sample of nursing faculty.

Background: Practice knowledge exists as a complex relationship between questions and answers in a context of meaning that is often intuitive and hidden from the novice practitioner. Physiotherapy education, which aims to develop patterns of thinking, reflection and reasoning as part of practice knowledge, is often based on didactic teaching methods that emphasise the learning of facts without highlighting the relationships between them. In order to improve health outcomes for patients, clinical educators must 
consider redesigning the curriculum to take into account the changing and complex nature of physiotherapy education. There is some evidence that a blended approach to 
teaching and learning may facilitate the development of graduates who are more capable of reflection, reasoning and critical thinking, and who can adapt and respond to the 
complex clinical environment. The purpose of this study was to develop principles that could be used to guide the design of blended learning environments that aim to develop 
capability in undergraduate physiotherapy students. Method: The study took place in a university physiotherapy department in the Western Cape in South Africa, among 
undergraduate students. Design research was used as a framework to guide the study, and included a range of research methods as part of that process. The problem was 
identified using a systematic review of the literature and a survey of students. The design of the blended intervention that aimed to address the problem was informed by a 
narrative review of theoretical frameworks, two pilot studies that evaluated different aspects of blended learning, and a Delphi study. This process led to the development of a set 
of design principles which were used to inform the blended intervention, which was implemented and evaluated during 2012. Results: The final results showed that students had undergone a transformation in how they thought about the process and practice of learning as part of physiotherapy education, demonstrating critical approaches towards 
knowledge, the profession and authority. These changes were brought about by changing teaching and learning practices that were informed by the design principles in the 
preliminary phases of the project. These principles emphasised the use of technology to interact, articulate understanding, build relationships, embrace complexity, encourage 
creativity, stimulate reflection, acknowledge emotion, enhance flexibility and immerse students in the learning space. Discussion: While clinical education is a complex undertaking with many challenges, evidence presented in this study demonstrates that the development of clinical reasoning, critical thinking and reflection can be enhanced through the intentional use of technology as part of a blended approach to teaching and learning. The design principles offer clinical educators a framework upon which to construct learning environments where the affordances of technology can be mapped to the principles, which are based on a sound pedagogical foundation. In this way, the use of technology in the learning environment is constructed around principles that are informed by theory. However, clinical educators who are considering the integration of 
innovative strategies in the curriculum should be aware that students may initially be reluctant to engage in self-directed learning activities, and that resistance from colleagues 
may obstruct the process. Conclusion: The development of clinical reasoning, critical thinking and reflection in undergraduate physiotherapy students may be enhanced through 
the intentional use of appropriate technology that aims to fundamentally change teaching and learning practices. Design research offers a practical approach to conducting 
research in clinical education, leading to the development of principles of learning that are based on theory.
iii

The hospital setting provides an environment for patients to receive medical care, for medical professionals to provide treatment, and for medical students and residents to learn the practice of medicine through supervised patient encounters. Education provided at the point of care allows students and residents to apply knowledge and develop clinical skills needed for medical practice. The hospital environment is also a confluence of learning and work, where applied learning takes place in an integrated and simultaneous manner with work duties. This setting, referred to as the clinical learning environment (CLE), is a focus for educators, scholars, administrators, regulators and accrediting agencies to understand, measure and improve it. While several instruments have been developed to measure the CLE, they suffer from great variation in subscales and content. The purpose of this study is to deconstruct the CLE, apply theories from related fields, and frame those theories in the context of the hospital setting to develop a conceptual framework for the CLE. A systematic review of the literature and thematic synthesis of existing research about the CLE provided evidence to inform and test a learning environment framework in the clinical setting. Data from qualitative CLE assessments, the ACGME Clinical Learning Environment Review (CLER) Pathways to Excellence, and existing CLE measurement instruments informed these results. Findings showed that a CLE framework consists of three mediating factors: learning, people, and change. As the clinical setting is a unique environment for learning, the people dimension (as a community of practice) was found to be the most influential on learning outcomes for students. The dimension of change was found to be most influential from the perspective of improving organizational or work outcomes, including patient care, clinical quality and patient safety. Findings from this study provide researchers and scholars with a framework to for developing measures of clinical learning environment effectiveness, and informing practitioners of CLE components and relationships that impact both learning and organizational outcomes.

Clinical reasoning is the cognitive process and strategies used to understand the significant patient data to identify and diagnose actual or potential problems in order to make competent clinical decisions that will affect patient outcomes (Fonteyn & Ritter, 2000). The purpose of the study was to determine if implementing the Outcome-Present State Test Model of Clinical Reasoning with guided reflection activities was an effective method to improve clinical reasoning skills in senior nursing students at a large southeastern university. The overall research questions involve comparing participants Health Sciences Reasoning Test scores before and after implementation of the OPT Model as clinical paperwork, secondly the experimental group was given a guided reflection activity to complete in conjunction with use of the OPT Model during clinical experience.

Kolb’s Experiential Learning Theory is the theoretical framework used throughout this study. Nursing education has historically blended didactic learning with clinical experiences to transfer knowledge. The OPT offers a frame to organize thoughts and guides the learner to decide what data is important to each patient situation.

This study reports the findings for 62 senior nursing students that completed the HSRT prior to implementation of the OPT Model and a guided reflection activity. Clinical instructor’s scored participants using the Lasater’s Clinical Judgment Rubric each week. There were no statistically significant differences between the experimental group and the control group. The only statistically significant difference that was identified was in the Lasater’s Clinical Judgment Rubric scores between week one and week 2, and week 3 and week 4.

Graduate students in Communication Disorders were found to become enculturated in the use of a specific literacy strategy to help struggling young readers. Supervisors used four transmission modes: modeling, feedback, collaboration and humor as symbolic channels to transmit knowledge and actions (defined as mechanisms) that were needed for the enculturation process. Mechanisms included negotiating power, linking classroom to the clinic, employing reflection, planning, extending thinking, using contrastiveness, verification, affiliating, making positive acknowledgements, employing cognitive dissonance, highlighting, using recurrency, explicit contextualizing, and employing independence. Situated learning experience was also identified as a necessary aspect of enculturation. Powerful mechanisms for struggling students were identified as reflection, employing cognitive dissonance and peer sharing (employing independence).