Clinical Teaching: Concept-Based Curriculum and Exemplars

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Clinical Teaching: Concept-Based Curriculum and Exemplars

Program Description

Nursing students will complete a clinical rotation that will last for two weeks (two clinical days per week) during their campus residency.
A registered and qualified nurse preceptor will supervise and assess the performance of the students based on pre-defined learning outcomes (LO)
This program has been designed for eight nursing students. The students will complete their activities in two groups with each having four participants
Each group will provide care to designated patients in three different units: mental health, intensive care unit (ICU), and the oncology clinic
The students will complete this rotation in a community hospital located an hour away from the University

Primary Objective

The students should understand the various concepts that underpin the four competencies of the Institute of Medicine (IOM). These themes include patient-centered care, interdisciplinary care, evidence-based practice, and quality improvement

Learning Outcomes (LO)

LO1: Know the facts about patient-centered care, interdisciplinary care, evidence-based practice, and quality improvement

LO2: Understand the conceptual frameworks that define patient-centered care, interdisciplinary care, evidence-based practice, and quality improvement

LO3: Incorporate the facts and concepts of patient-centered care, interdisciplinary care, evidence-based practice, and quality improvement into different clinical settings

Evaluation

The learning process will include both group and individual activities and assignments
Students will complete three written assignments (1,500 words each) at the end of every clinical day
The students will also complete a final assignment (3,000 words) in which they apply all the four concepts learned during the two-week clinical rotation
The instructor will use a grading rubric to assess if the students have understood the concepts

Clinical Day 1

Concept: Patient-centered care

Patient-centered care is a novel approach that focuses nursing interventions and cares on the patient rather than the care provider or disease (Lewin, Smith, Coffey, & Olumu, 2012). According to Bastable (2014), the interdisciplinary team (including patients and their families) plays a significant role in the care planning processes. The essence of this approach is to provide comprehensive, integrated, and coordinated care based on the patients preferences and needs.

Exemplars: Clinical assessment, culturally sensitive care, effectual communication, patient safety and quality, patient empowerment, and care coordination

Essential Questions

What components constitute patient-centered care?
What is the significance of patient-centered care in nursing practice?

Pre-Conference Meeting: The instructor will define patient-centered care and provide examples that illustrate its application in the nursing practice. Subsequently, the instructor will assign the students to two patients with similar characteristics but different conditions. The first group will provide care to a Black-American female with breast cancer. The second set of students will care for a Hispanic male patient with a depressive disorder. The principal tasks of the two groups will be to apply the identified concepts while providing care to their respective cases.

Post-Conference Meeting: Each group will provide a PowerPoint presentation (ten minutes). These presentations will aim to outline how the groups incorporated the concepts of patient-centered care into the caring process. In addition, the students will engage explore the similarities between the two cases in a 30-minute discussion. The latter activity will assist the students to understand the application of similar concepts of patient-centered care in different contexts.

Individual Evaluation: The instructor will require the students to complete an individual essay (1,500 words) before the second clinical day. Each student will discuss the application of patient-centered care based on a hypothesized case study formulated by the teacher. The examiner will use a grading rubric to evaluate if the students understood the concepts they learned during the first clinical.

Clinical Day 2

Concept: Interdisciplinary Care

The provision of care is a very complex process that requires input from different health care professionals. As such, interdisciplinary teamwork enhances the quality of care by facilitating effectual cooperation, communication, and coordination (Gaboury, Lapierre, Boon, & Moher, 2011). Keller, Eggenberger, Belkowitz, Sarsekeyeva, and Zito (2013) have asserted that interdisciplinary care emphasizes interprofessional teamwork and the integration of services to improve patient safety and quality.

Essential Questions

What is the role of interprofessional teamwork and communication in clinical practice?
How do interdisciplinary collaboration and communication facilitate the provision of patient-centered care?

Exemplars: Collaboration, communication styles, consensus building, conflict management, clinical leadership, integration, and coordination of care, and professional culture

Pre-Conference Meeting: The principal objective of this forum will be to introduce the students to the concepts of interdisciplinary care. The students will then demonstrate their understanding of these aspects by preparing discharge plans for two different parents. The first group will take part in discharging a patient with dementia from the hospital to institutionalized care. The second set of students will participate in developing a discharge plan for cancer patients being transferred to palliative care. The emphasis of both activities will be the role of interdisciplinary teamwork and communication during the planning process.

Post-Conference Meeting: Each team will provide a detailed discharge plan for their respective patients. The plan should include the functions and tasks completed by every participant. One individual will explain the processes and strategies that each group employed to formulate the discharge plan. The purpose of these activities will be to highlight the significance of interdisciplinary care during the discharge process. Although the patients have different needs, they will all require the coordination and integration of care processes. For instance, both patients will need referral services to enhance the continuity of care.

Individual Evaluation: The objective of this clinical was to highlight the significance of interdisciplinary teamwork and communication during the discharge process. The instructor will ask the students to watch a YouTube video that illustrates a chaotic situation in a pre-discharge conference meeting. The students will then write an individual essay (1,500 words) in which they will discuss the presented problems and make recommendations for best practices. The grading rubric will assess if the students have understood the concepts of coordination, collaboration, and communication.

Clinical Day 3 and 4

Concept: Quality Improvement using Evidence-Based Practice

The evidence-based practice integrates current research findings, clinical reasoning, or expert opinion to influence the care process (Lubejko, 2014). In addition, Bastable (2014) has indicated that this clinical approach enhances patient safety and patient-centered care. The purpose of this care model is to facilitate the standardization of processes based on findings from baseline research.

Essential Questions

How has evidence-based practice enhanced the safety and quality of health care services?
In what ways can nurses advocate for the use of research findings to influence clinical practice?

Exemplars: Nursing theory, nursing research, implications for practice, critique and synthesis of research findings, and dissemination of research findings

Pre-Conference Meeting: The students will learn about the evolution and development of evidence-based practice in the nursing field. The students will also identify how results from various studies have influenced the formulation of clinical guidelines and updates. In addition, the students will give examples of clinical scenarios that mandate the use of the best available evidence. The nurse preceptor will assign each group to a patient and require them to use the current evidence to make rational decisions. The first group will provide care to a patient with reduced cardiac output while the other will deal with an elderly patient presented with septicemia.

Post-Conference Meeting: Students from each group will identify the techniques they used to locate the best available evidence, including the rationale. The students will then discuss their findings to establish recurrent themes. The objective of the latter activity will be to help the students to comprehend the use of the evidence-based practice in different situations. Further, this forum will allow the students to conceptualize how to synthesize information from multiple sources to provide optimal care.

Individual Evaluation: The instructor will assign to the student a case study involving a medication error. The students will use the best available evidence and nursing theories to develop a plan for managing medication incidences in clinical practice. The purpose of this assignment will be to assess the students in three areas: the appraisal of evidence, clinical reasoning, and critical thinking.

The Final Assessment

The students will complete the final assignment (a 3,000-word essay) in which they apply all the four concepts learned during the two-week clinical rotation. Each student will develop a care pathway for a patient with either dementia or breast cancer. The task will entail applying the concepts of patient-centered care, interdisciplinary care, and evidence-based practice from arrival to discharge. The marking criteria will emphasize the systematic incorporation of these concepts into clinical practice.

References

Bastable, S. B. (2014). Nurse as educators: Principles of teaching and learning for nursing practice (4th ed.). Burlington, MA: Jones and Bartlett.

Gaboury, I., Lapierre, L. M., Boon, H., & Moher, D. (2011). Interprofessional collaboration within integrative healthcare clinics through the lens of the relationship-centered care model. Journal of Interprofessional Care, 25, 124-130.

Keller, K. B., Eggenberger, T. L., Belkowitz, J., Sarsekeyeva, M., & Zito, A. R. (2013). Implementing successful interprofessional communication opportunities in health care education: A qualitative analysis. International Journal of Medical Education, 4, 253-259.

Lewin, S., Smith, R. C., Coffey, J., & Olumu, A. (2012). Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database System Review, 12(12), CD003267.

Lubejko, B. G. (2014). Improving the evidence base of nursing education programs. Journal of Continuing Education in Nursing, 45(8), 336-337.

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