from random to targeted clinical learning: the oregon clinical education model ohsu school of...
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From Random to Targeted Clinical Learning: The Oregon Clinical Education Model
OHSU School of Nursingwww.ohsu.edu/son
Joanne Noone, PhD, RN, CNEApril 20-21, 2015
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 RedesignKey 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 to purposeful design
• What are some important concepts to use as building blocks?
• Focus is on developing pattern recognition
• Fluid/Electrolyte Balance
• Diabetes
Concept Based
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
• Involves authentic clinical problems
• Highly prevalent nursing practice situations
• Includes simulated learning experiences
• “Mega-cases” exemplars of prevalent health care situations
Case Based Simulation
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
Poverty Simulation
Schizophrenia 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
Intervention-SkillBased
Case BasedConcept Based
Direct-Focused
Care
Mid-Program Learning Experiences
Concept Based
Case Based
Intervention-Skill Based
Focused DirectPatient Care
End of Program Learning Experiences
II
Concept-Based
Case-Based
Intervention-Skill Based
Integrative Experience
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)
