Traditional Clinical Pre-Planning: Is There a Better Practice in Undergraduate Nursing Clinical Education?

Clinical preparation for undergraduate nursing students is viewed as an arduous experience. Traditional clinical preparation often requires nursing students to report to clinical units the day before clinical experiences, learn his or her patient assignment through a posted list, collect pertinent patient data, develop a plan of care using a prescribed format, and outline a proposed plan of care to faculty before providing direct patient care. Anecdotal reports from students suggest traditional pre-planning interferes with studying, work-school-life balance, and sleep patterns. Furthermore, faculty found assigned patients were often transferred to other units, discharged to home, or refused care from a student nurse.

There is little evidence to support best practices of clinical pre-planning among nursing students. Much of the evidence for pre-planning was conducted over 20 years ago (McCoin & Jenkins, 1988; Kermode, 1987). A recent study reported students spending approximately five hours on pre-planning activities (Turner & Keeler, 2015). The long process of pre-planning, often occurring the same day as long lectures, other clinical experiences, and/or employment, was noted to interfere with sleep quantity and quality. A high percentage of the students in this study reported pre-planning activities caused elevated stress and decreased the ability to sleep the night before clinical experiences (Turner & Keeler). Loss of sleep is not inconsequential. Evidence supports short-term sleep deprivation has a significant effect on cognitive functioning, especially in the area of simple attention (Lim & Dinges, 2010). Thus, sleep deprivation among nursing students may create lapses and omissions in patient care. Although students reported detrimental effects of pre-planning, an overwhelming proportion identified benefits to pre-planning. The benefits included: increasing safety, enhancing critical thinking, improving the ability to collect pertinent data, and developing a solid plan of care (Turner & Keeler). Some educators have urged traditional clinical instructional models and methods be re-evaluated, and real-world practice of nursing be adopted into clinical nursing education (Hickey, 2010). This suggestion aligns with a call for action to transform nursing education to better prepare graduates to work effectively in an ever-changing complex health care system (Institute of Medicine, 2001, p. 164).

Faculty implemented same-day clinical preparation in a bi-weekly, five-week pediatric clinical course rotation to address this problem. Before providing care in the pediatric unit, students enrolled in the course receive a thorough explanation of clinical objectives and expectations, orientation to the clinical unit, unlimited access to a clinical folder containing important clinical information within a learning management system, and lectures related to pediatric variations and pediatric assessment. On the second clinical day, students arrive at the unit at 6:15 AM and receive patient assignment(s). Students have approximately one-hour to plan care using a faculty developed worksheet. Physical and online resources are available to all students. A faculty member is readily available to assist students in answering questions, clarifying concepts, and assisting students to use clinical judgment and reasoning to develop a plan of care.

Objective: The objective of this descriptive study is to gain undergraduate nursing students’ satisfaction and perception of preparedness of same day clinical preparation in a five-week pediatric clinical experience.

Method: This study was approved by the Institution Review Board. Data collection began during fall 2018 semester and will continue through spring 2019. All students enrolled in a Child and Adolescent Health nursing course during fall 2018 and spring 2019 semesters are eligible to participate. It is estimated 42-56 will participate in the study using a projected 30-40% response rate. Participants are recruited through the Child and Adolescent Health portal on Student, Observe, Learn, Engage (SOLE) learning management system. The study is advertised through email and an announcement to all students enrolled in the course. The link to the anonymous electronic survey is embedded in the advertising. The survey consists of demographic information and the following questions.

1. How would you rate your overall experience of same day clinical preparation?
   Very positive, somewhat positive, neither positive or negative, somewhat negative, very negative
2. How well did same day clinical preparation prepare you to care for your pediatric patients and families?
   Extremely well, Very well, somewhat well, Not so well, not well at all
3. How would you rate your preparedness with same day clinical preparation compared to traditional pre-planning?
   more prepared with same day clinical preparation, slightly more prepared with same day clinical preparation, about the same with same day clinical preparation, slightly unprepared with same day clinical preparation, not prepared at all with same day clinical preparation
4. In the following space, please provide additional comments related to your experience with same day clinical preparation.

Findings: Statistical Package for the Social Sciences (SPSS) will be used to manage and analyze data. Data are categorical. Thus, descriptive statistics will be used to analyze data.

Discussion: Findings from this study will add to nursing education research by building evidence to support best methods of clinical pre-planning for undergraduate nursing students. There is a considerable knowledge gap related to the best methods of pre-planning to ensure quality learning, student health, and patient safety.