Teaching and Learning in Nursing (2010) 5, 93–94

www.jtln.org

Editorial

Clinical learning: Do faculty teach how to learn?

One of the biggest challenges faculty face is to provideoptimal clinical learning for their students. Faculty expectstudents to have a solid knowledge base; relate rationale forspecific nursing and medical interventions; manage infor-mation; provide safe, empathic, holistic patient care;employ sound clinical reasoning; and use therapeuticcommunication in all interactions. In addition, there is animplicit assumption that students will get better and betterevery day. How does learning come together?

First of all, we must ask ourselves, “What is learning?”Consider the satirical account of “Roast Pig,” taken fromCharles Lamb in his 1822 essay, described by Kanter (1983)in her book, The Change Masters. Lamb told the story ofhow a child set fire to a hut with a pig inside, and thevillagers, poking around in the embers, discovered a newdelicacy. This eventually led to a rash of hut fires. The moralof the story is when you do not understand how the pig getscooked, you have to burn down a whole hut every time youwant a roast pork dinner! Clearly, the Chinese villagersindeed got their roast pig but at the expense of a hut.

There are several philosophic viewpoints about what islearned, that is, knowledge. Aristotle believed that in mattersof scientific inquiry, the senses were the starting point of allknowledge. No knowledge was independent of the senses.However, he did believe that to reach scientific knowledgethe mind and thought process were actively involved.Aristotle's inductive–deductive method and employment ofsyllogism provided the means to attain knowledge of thereasoned fact. Once one grasps a reasoned conclusion,Aristotle said that the primary condition for knowledge wasmet (McKeon, 1973).

Ultimately, it may not matter much to the average learnerjust what Aristotle, Kuhl, Popper, or any of the otherphilosophers have to say about knowledge. What isimportant to the learner is what the “learner” thinks he orshe has “learned.” The future for learners will be determinedby what has been learned before, what has yet to be learned,and what will never be learned. Several factors helpdetermine learning: the learning environment, the perceptionof knowledge, and the nature of self as learner. Learning

1557-3087/$ – see front matter © 2010 National Organization for Associate Degdoi:10.1016/j.teln.2010.04.001

takes place both in and out of a clinical context and atdifferent stages, depending on the development of thestudent (and faculty).

Second, faculty must ask, “What impacts learning?”Students say that they appreciate faculty who establish anonthreatening learning environment, where they not onlyfeel comfortable but also feel encouraged to ask questions.Cook (2005) explored the impact of inviting facultybehaviors on student anxiety states and found that invitingmessages, such as demonstrating respect for students, actingfriendly, and trusting students, resulted in a lower anxietylevel for the student. Students want faculty and staff who willmodel how to think and perform in the role of the registeredprofessional nurse. One of the major benefits of simulation isthe fact that debriefing takes place. Do we debrief or reflectoften enough in traditional clinical settings? In Part 4 of hisbook, Educating the Reflective Practitioner, Schon (1983)posited a reflective practicum, bridging the worlds ofacademia and practice. He challenged us to look at how weview knowledge and its dissemination or attainment. Heasked, could we not depart from traditional rationality andmove instead to a “reflection-in-action” stance? If we are tomerge the two worlds of theory and practice, a reflectivepracticum is essential. In my experience, I have observed thatadults are motivated to learn, value and work diligently toattain knowledge, and are stimulated by topics of interest.Recognition of learning can take place before, during, ormuch later than the actual event in which learning was said tohave taken place. That is, when do we really know what weknow? And, when we know what we know, we also knowwhat we do not know. Therein lies the value of discussion,reflection, critical thinking, sharing, and journaling relevantto clinical learning.

Third, we must ask how the clinical environment isconducive to learning and which teaching methodologieswork well in the face of technological advances that haveaffected the speed and efficiency of documentation andmedication administration, such as electronic medicalrecords and medication verification systems; high patient–low nurse ratios; high patient acuities; a service-oriented

ree Nursing. Published by Elsevier Inc. All rights reserved.

94 Editorial

patient population; and faculty and staff expectations forstudent performance in a clinical setting.

Advances in practice and accordant teaching adjustmentsevoke varying responses. Faculty and staff alike arefrustrated when they try to employ traditional teachingpractices and expectations in light of the current health careenvironment. It is no longer practical or possible to safelyadminister multiple medications to multiple patients withmultiple students. We must examine these practices and seekknowledge that allows students a world view, yet workingview, of what nursing holds. We need to uncover theknowledge embedded in clinical nursing practice: “What'smissing are systematic observations of what nurse clinicianslearn from their clinical practice” (Benner, 2001, p. 1).

Interventional strategies to foster positive clinical learningenvironments include the following:

1. Intentional behaviors to decrease anxiety, such as humor,peer instruction and mentoring, and mindfulness training(Moscaritolo, 2009).

2. Concept-based learning activities, employing Tanner'smodel of clinical judgment (Nielsen, 2009).

3. Establishment of focus groups composed of members fromservice and education whose purpose is to determine teachinggoals and strategies to facilitate graduate outcomes andtransition to practice.

4. Collaboration between education and service to promoteoptimal clinical learning (Palmer, Cox Harmer, CallisterClark, Johnsen, & Matsumura, 2005).

5. Dialogue with students about their teaching and learningneeds and ways to capitalize on student life and workexperiences that lend to success in nursing.

6. A variety of teaching strategies to promote learning andaccommodate a variety of learning styles.

Faculty have the tools and resources to structure positivelearning experiences. We must find a way to make roast pigwithout burning down the hut.

Lynn Engelmann EdD, MSN, RNAssociate Editor

E-mail address: engelman@cod.edu

References

Benner, P. (2001). From novice to expert: Excellence and power in clinicalnursing practice. Upper Saddle River, NJ: Prentice Hall Health.

Cook, L. J. (2005). Inviting teaching behaviors of clinical faculty andnursing student's anxiety. Journal of Nursing Education, 44(4),156−161.

Kanter, R. (1983). The change masters: Innovations for productivity in theAmerican corporation. New York: Simon and Schuster.

McKeon, R. (1973). Introduction to Aristotle, 2nd ed. New York: McGraw-Hill, Inc: Modern Library of Congress.

Moscaritolo, L. (2009). Interventional strategies to decrease nursing studentanxiety in the clinical learning environment. Journal of NursingEducation, 48(1), 17−23.

Nielsen, A. (2009). Concept-based learning activities using the clinicaljudgment model as a foundation for clinical learning. Journal of NursingEducation, 48(6), 350−354.

Palmer, S. P., Cox Harmer, A., Callister Clark, L., Johnsen, V., &Matsumura, G. (2005). Nursing education and service collaboration:Making a difference in the clinical learning environment. Journal ofContinuing Education in Nursing, 36(6), 271−276.

Schon, D. (1983). Educating the reflective practitioner: How professionalsthink in action. New York: Basic Books.