Transcript OHSU Presentation Template

Joanne Noone, PhD, RN, CNE
April 20-21, 2015
From Random to Targeted Clinical Learning:
The Oregon Clinical Education Model
OHSU School of Nursing
www.ohsu.edu/son
Oregon Consortium for Nursing Education
(OCNE)
• Shared
competency-based
curriculum to
prepare nurses to
work in the 21st
century
• 5 OHSU and 9 CC
partners
• 3 year nursing
curriculum
Clinical Education Redesign
Key Questions
• What are the purposes of clinical education?
• Is total patient care the best approach to achieve these
goals?
• What are the problems with the conventional approach
to clinical education?
• NLN Prelicensure Survey (2008) – many of the
strategies identified by faculty to overcome barriers to
clinical learning perpetuated total patient care model
Clinical Education Redesign Group
• 32 academic and practice partners across
the state
• Identified assumptions for learner centered
clinical education
• Developed model
– Expectations of students, clinical partners and
faculty
– Intentional design of learning activities
– Linked to developmental needs of learner
Clinical Education Model
From random access
design
to purposeful
Concept Based
• What are some
important concepts
to use as building
blocks?
• Focus is on
developing pattern
recognition
• Fluid/Electrolyte
Balance
• Diabetes
Diabetes CBLA
• Instructors: Find 2 or 3 diabetic patients.
Look for patients with scheduled medication
for their diabetes. There may be differing
intensity of treatment from correction bolus
insulin or daily dosing. Look for patients with
differing causes for their diabetes. Students
may work together in small groups of 2 to 3.
Work should be completed within the clinical
day so that debrief can occur in post
conference. Bring monofilaments for use in
assessments.
Diabetes CBLA - Patterns
•
•
•
•
•
Medication regimen
Predisposing factors – history
Complications
Blood sugar patterns
Other lab values – HgbA1C, Cholesterol,
estimated GRF, microalbuminemia
• Focused assessment
• Lived experience
• Learning needs
Case Based Simulation
• Involves authentic
clinical problems
• Highly prevalent
nursing practice
situations
• Includes simulated
learning experiences
• “Mega-cases”
exemplars of prevalent
health care situations
Bringing MegaCases to Life
• Follow-up to in-class
case work
• Faculty/theater student
can play Mega Case
role
• Gives students a
chance to follow
through on what more
they would like to know
• Script out some
possible responses
Adolescent Standardized Patients
• Adolescents recruited by
community Health
Educator
• They create their
character
• Student nurses become
intake nurses
• Complete sexual health
history and assessment
• Students both observe
and do an interview
• Debriefing occurs with
patient
Simulations that Focus on Vulnerable
Populations
Schizophrenia Simulation
Poverty Simulation
Veteran Simulations
Intervention Skill Based
• Beyond technical
skills
• Includes developing
skill with
communication and
assessment
• Linked with
preparatory and
reflective
assignments
A person at the flu clinic tells you he got
a flu shot in September and is getting a
second one today “for insurance”. How
should you respond?
Another client at the flu clinic asks you,
“Why do I need to get a flu shot every
year?” How should you answer?
Focused Direct Client Care
Essential Characteristics
• Student applies
knowledge and skill base
• “Client” includes
individual, families and
communities
• Student incorporate into
the workflow of the
agency
• Students learn to engage
in constant organization
and prioritization
Integrative Experience
• Pulls all elements of prior
learning into an authentic
clinical situation
• Begins the transition into
practice
• Student assigned to
Clinical Teaching
Associate
Early Clinical Learning Experiences
Concept Based
Case Based
Intervention-Skill
Based
DirectFocused
Care
Mid-Program Learning
Experiences
Case Based
Focused Direct
Patient Care
Concept
Based
InterventionSkill Based
End of Program Learning
Experiences
Integrative Experience
ConceptBased
InterventionSkill Based
II
Case-Based
Working with Clinical Partners
• Goal cards/Handouts
• “They think now and
just don’t perform
tasks” (Staff
Development
Educator)
“Assignments impact the real world of nursing and are not just an
exercise for students to do” (Nursing administrator at local clinic)
“What impact has OCNE had on the way
you teach?”
1) increased use of case studies;
2) increased use of simulation;
3) focus on deep learning/change in content
coverage;
4) team teaching;
5) interactive learning activities for students.
Oregon Consortium for Nursing Education (OCNE). Do not replicate without permission.
Faculty Survey - 2010
Oregon Consortium for Nursing Education (OCNE). Do not replicate without permission.
Student/Faculty Interaction
• “I am not running around the whole shift
wondering what my students are doing
unobserved when they have the
responsibility for care and I am not in the
room”
• “While I am still busy, it is focused on the
learning of the student and not keeping the
patient safe”
Best Things Observed
• Win-win situations – students learning and
contributing to agencies
• Key learning and reflection
• Students are really thinking and grasping
concepts • “CBLA’s and high fidelity simulation – 2
pieces of learning I never want to be
without” (CC nursing director)
Thank you
Questions?
Joanne Noone
[email protected]
OHSU School of Nursing
www.ohsu.edu/son