A critical examination of clinical teaching in undergraduate nurse education
Lisa McKenna, PhD, MBA, MEdSt, BEdSt, RN, Midwife
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Clinical education is an integral part of undergraduate nurse education. Whilst extensive research has explored roles of clinical teachers and clinical teaching, largely through perceptions of their effectiveness, little is known from clinical teachers about how they perceive their work, factors that shape their work, and what clinical teachers themselves shape. It is the development of clinical teaching both from historical and current perspectives that formed the basis for this unique study which adds new understandings to existing knowledge around this important area of nurse education.
This study was undertaken in two phases. The limited, first phase involved an exploration of the evolution of clinical teaching models prior to, and following, the transfer of nurse education into the tertiary education sector in Victoria, Australia. Data were collected through interviews with individuals who were involved in nurse education around the time of the transfer, as well as sourced from an array of documentary sources. The analysis provided a foundational understanding of the evolution of clinical teaching models developed which informed the second and larger phase of this study. In phase two, nine clinical teachers were interviewed about their clinical teaching work to explore the discourses impacting on that work. Participants included clinical teachers from the three predominant models of clinical teaching in current Victorian practice.
Foucault’s ideas on discourse, power-knowledge and genealogy were used to inform data analysis of clinical teaching work revealing aspects and issues that have not previously been reported. Findings revealed how clinical teachers use their own personal curricula to inform their teaching work. Additionally findings demonstrate a complex interplay of power-knowledge relations between clinical teachers and students, between universities and clinical settings, as well as the influence of time and other factors on disciplining clinical teaching work.
This study concludes that personal curricula operating during clinical teaching reflect realities of clinical practice and whilst not necessarily negative, they also compete with theoretical aspects of courses. Increased awareness of personal curricula is needed to ensure that they are used effectively with without negative impact on student learning. Questions are raised about the suitability of current teaching models in achieving their intended outcomes as the impact of such factors as personal curricula and nursing practice discourses widen the theory-practice gap. These findings challenge schools of nursing to develop new, more appropriate clinical teaching models. The study also concludes that relationships between clinical teachers and students have changed dramatically since the transfer of nurse education into the higher sector. The emergence of maternal-child relationships warrant care and support if educational expectations are to be met and potential for conflict is minimised. Overall, the study adds significantly to current understandings of clinical nursing education and provides a basis for future developments in the area.
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