The impact of the nursing process on the role and function of the clinical teacher

The impact of the nursing process on the role and function of the clinical teacher Erica Lowry

This

article

teacher

examines

over

the effect

the last decade.

of the nursing

It takes

process

the changing

practised as a starting point. The rationale behind process is considered as are some of the difficulties complex

skills required

onus on the clinical patterns.

Some

potential

for creative

During

the

context

within

celerated:

their

this

somewhat

has

expectations

are discussed

in

the

have

ac-

have altered,

escalated,

It

approach had

the clinical herselfr

teacher

was given

formal

have

moving the curriculum

Against nurses

for a professional

identity

the effectiveness

of

to the

total

care

and creativity

Change

of pa-

to enhance

to nurs-

in a rather

engenders

must be prepared

stan-

anxiety; for this in

and others.

the

process

is

in

1977

and

was seen

for the study of patient

Committee

ing Council become: adaptation Clinical

varying

in order

by the Nurse General

that nursing

‘a dynamic process and improvement.’ teaching

as a care,

away from task orienta-

of the EEC

(1982)

It

by the General

tion. It has also been supported Training

at

over the country.

recognition

thread

the potential

period.

nursing

Council

ing, yet it was one more variable bewildering

the

stages of implementation

unifying

changed.

dards and add vitality

Today

but

the

working

is welcomed.

Nursing

the service they provide. In the mid 1970s the nursing process was introduced as a logical, tients.

are acknowledged needs

of care

background,

is

highlights

and different

working

and have been re-examining

systematic

process

changing

nursing

and this article methods

the consumers

turbulent

have been searching

work

structures

decreased,

and

developments nurses

technology have

to meet

in which

implementation of the nursing encountered with it. The

new teaching

of the nursing

teaching

decade which

today

to adopt

limitations

management

medical hours

last

by nurses

teacher

on the role of the clinical

context

lending

Nursmay

itself

began in this country

to

some

20 years ago to promote more consistent support and instruction for learners in the clinical situation

and

to

bridge

the

theory-practice

gap. If the clinical teacher embraces ing process, learners may appreciate of integrating

theory and practice,

the nursthe value

and identify

actual or potential problems in order to meet their patients’ needs. Initially, the monitoring E Lowry BA SRN RCNT, Clinical Teacher, The Sheffield School of Nursing *For the sake of simplicity, I have used the feminine pronoun for both the clinical teacher and the nurse, and the masculine pronoun for the patient.

60

of the learner by a clinical teacher and ward sister revolved largely around the practical syllabus. involved

Today the in helping

clinical teacher is more the learner to achieve

NURSE

learning

objectives

feedback

and guidance

to

be

flexible,

individual ical

in the ward.

to

ent settings,

the

nurse

accountability nursing fully

nurse

which

vention.

care

within

differ-

which

than

the philosophy

evaluate

nurse assessments.

provide needs.

periences

THE NEED FOR TEAMWORK The

nursing

process is a method

ting

the traditional

activities

framework

which

objectively

analytical.

completeness process work Royal that

the

College the

nursing

proc(~s nursing

system.

A major

agree

has staff

teacher

in providing discussing

the nursing that

all who

in

been used

adopting

the

experienced

by

to a task-oriented

investment

was suggested.

in some

has an important

information,

injecting

implementation

areas.

Attention

The

skills

and learning.

evaluation

within

ment. Just

as the nursing

nurse to appreciate patient, (1970)

identified

task

mechanism

learner

is being encouraged

against

other

ship will change.

The

effective practice. Reaction

a

of medical

duction

in

strategies

has demonstrated

and

years

misunderstanding

fessionals.

Where

the nursing teacher sional

recent

colleagues

may rivalry

of

to the intronew

can

arise between

anxiety.

Where

the

to have more reac-

patient

contact, teacher

levels should

to extend her

the period of train-

aspects clinical

facilitator

of the relationteacher as

takes over responsibility

becomes

the

learner

for her own

learning.

to help

pro-

discussion

process can take place developing

gradually

and

Menzies

how easily hostility

inter-disciplinary

be able

nursing

co-worker

and needs as a helpful

clinical

role throughout

the

needs of the

be aware of this and be prepared ing. In addition,

in

requires

attributes

defenre

of

ward

to

environ-

process

allocation

tive and more sustained

day-to-day

and

begun

must also be evaluated.

to

issues

We have

so the individual

of stress may rise. The

if she is to assist realistically

interpretation

the individual

counselling

pressing

not only technical

a non-threatening

she must be sensitive

the

ex-

stage of

appreciate that a student-centred approach reemphasis on participation and selfquires

review sessions. However, management

of

and

learning

to the learner’s

enthusiasm, in

his problems

to select

role to play

and participating

and in a

care plan can

must be given to the right climate

for teaching

of the learner

in staff develop-

education

also

skills

and need to

with an up-to-date

in order to develop but

skillinter-

communication.

and

( 1981) acknowledged

has yet to be made

clinical

a

to its use. The

diffculty

ment and continuing This

For

it is important

of‘ Nursing

trained

predictive

care.

patient

greatest

skills

into

This makes for unity and

in patient

to work, with

of nurses

her

care

gradually

patient,

appropriate

training

of incorpora-

is appraisive,

enables

make

complex

nursing

teacher

of each

It

are

The

to

of her

by chance

The

the clinical

assessment

success

to the learner

fashion.

nurse

set objectives, these

However,

structured

the

the

do not develop

be introduced

do the equivalent

requires

assessments,

and

61

TODAY

for the service she provides.

process

accurate

pract-

pupil

patient

process

and

Currently,

more closely reflect

of the nursing student

of

individual

the learner

problems

effectively.

assessments

examine

solve

patients

She can give

encouraging

EDUCATION

prevent

between

of

the clinical profes-

medical

and

nursing staff.

COMPLEX SKILLS AND NEW TEACHING METHODS The

nursing

nursing

skills

process does not make obsolete:

these

will

essential and need to be well taught.

traditional always Helping

be a

A NEW KIND OF NURSE

patient to eat while maintaining his dignity and giving an injection correctly with skill and

We are now essentially involved in educating a new kind of nurse who will ultimately render

sensitivity require careful teaching and monitoring. However, it is no longer acceptable for

NURSE

62

EDUCATION

the learner questioning

to ‘do’ without understanding and and the clinical teacher must be

prepared cess

TODAY

for this.

does

not

Moreover,

divert

the

attention

logical

sciences;

for informed

such

knowledge

may

nursing from

pro-

A fundamental

bio-

process

in relation

clinical

teachers.

the

decision-making,

well

need

to

be

strengthened. interpersonal a

range

interviewing,

of

skills

assessing,

onus is on the clinical

suitable

teaching

methods,

to experiment

self-awareness develop good In

the

and

the

territory.

the learner

to identify

goals the

of care.

Not

precision teacher

scoring

scales

that

of frequency

of her

learner.

The

clinical

a thread her

not

This

teacher

to date.

She may

clinical

leagues,

may

not have

framework

of the

needs

need clinical

for

teacher

with

techniques.

may

more

staff

education need

have

to both

is

to

limited

she

limitations sense

as much The her

knowledge and participate the like to extend her famcreative,

dynamic

at

that

clinical

one

ward

teacher

programme

that

could

would

to the next

ments

have

been

posts. a

as a clinical

tive

teaching

the ward. impetus teaching

plans

are

being of con-

a time

might

of the ward develop

be

team,

a teaching after

she had would

and

counselling

with

exciting to joint

nursing

of’ recent ward

(1981),

appoint-

appointed

to

functioning

reported

more

no longer

process

be stu-

sister/clinical

previously

teacher,

the

starts

Afternoons

as she was

The

07.30

ward.

after

only

to

given

continue

Walden

position

(1981)

be

possibility

at

of a

nursing

& Bridge

if care The

is

the nurse

the care

of work:

time.

the

change

effec-

a guest

can provide

on the

for teachers to seek for less fragmented patterns which enhance ellectiveness.

col-

within

deepen

be appropriate

reviewed

herself

of primary

should

hours

(Thom-

so that

that

retain

Thomson

attention

teacher’s

teacher

to keep up

as others.

that

such

minority

and

in operation.

dents elswhere. Perhaps the most

research

process

were advise

might

de-

clinical

effect

suggests

if a system

left free for tutorials

research

to feel a misplaced

Teaching

continuing

specialist clinical in workshops and iliarity

nursing

of the future of patients

The

endeavour

of her

teacher

care

team

and

(1980),

group

moved

in the

nursing

to innovate

the

with

many

of the caring

McFarlane

and

responsible

to establish

use

This

her own skills and

It is easy

of inadequacy.

like

it difficult

of’ that

peripatetic

As a full member

assist learners

practised

opportunity

The

on

theory

a

find

suggested

of nursing

1981).

nursing

patterns

maintained

considered.

‘why?‘.

on

can

the

are personally

delivery

as a full member lost.

been

centrating

of

and

who

& Bridge

teacher

has

for

be

that

research

teacher,

to appraise

realistically.

so

It

by

working

the

clinical

nursing

son

is raised

to the

skills are only

for the direct

might

tools

1981).

the teacher

own

scale. The the

own

should

on occasions

their

the

of enquiry

of relevant

challenges

but

issue

in those

clinical to

develop

Barnett

a spirit

in

encourage

literature

as a peripheral

concern.

patient

measurable

her

will

teaching

merely

undertake

to

her

herself

encourage

integration

develops

throughout

the

Wilson

and

use of

themselves

perhaps

teaching

the

and

lend

be

help

expression

and

practice

seen

realistic

relevant

assists

to weave

to

do exist,

(see, e.g.

keynote both

needs

explore

scores

of measurement speciality

find

all goals

can

must

The

may

of numerical

clinical

she

to evaluate

She

be

to select

play will skills.

teacher

unfamiliar

teacher

innovate.

learner

clinical

to

involved in and teach-

and

games, role communication

assisting

care,

need

which are counselling

ing. The willing

appropriate veloped

Certainly stressed,

WORKING PAlTERNS

teaching

CONCLUSION The clinical teacher must acknowledge that the nursing process is no panacea and that there are aspects the

of nursing

problem

aware

that

the

nursing, since problem-solving as sound person

that

solving

cannot

steps.

She

approach

is

be fitted must not

also

unique

into be to

many other disciplines employ a format. Any care plan is only

as the constructing

skills and

and

knowledge

implementing

of the it.

To

NURSE

have meaning, within

the nursing

a philosophical

process must he set

framework

concerning

the nature of nursing. Facilitator, are

just

a

counsellor, few

interpreter,

descriptions

of

by

nursing

changes Social

that have occurred and technological

continue

and

considerable challenges. learners

the

clinical

By creative

the

are likely

teaching

to

will

need

to meet

these

she can enable

new ideas and increase so becoming

reponsibility

other

in the last decade. teacher

and sensitivity,

to assume

by

changes

skill and flexibility

to explore

effectiveness able

and

for the care

their nurses they

give. Acknowledgement

I

wish

to

record

my

thanks

to

Lynwen

Margaret the

Smethers

clinical

for valuable

teaching

course

ideas at

con-

Sheffield

clinical

role as her scope has been extended process

and

tributed during City Polytrchnic.

63

TODAY

innovator the

teacher’s the

Needham

EDUCATION

Evans.

Helen

References General Nursing Council 1977 Paper on educational policy Gcueral Nursing Council 1982 The EEC Advisory Committee on Training in Nursing Training for Nurses Responsible for General Care (R 82/5) ~McFarlane J 1980 Essays on nursing. Project Paper-Kings Fund, London Menzies 1 1970 The functioning of social systems as a defence against anxiety. Tavistork Institute of Human Relations, London Royal College of Nursing 1981 Towards standards. A discussion document Thomson B, Bridge W 1981 ‘l‘raching patient care H M and M, London Walden E 1981 Sharing the pleasure and the pain. Nursing Times 78: 20: 833.-835. Wilson Barnett J 1981 Sizing 153: 9: 31-33

up the scores.

Nursing

‘limes