Aim: This study aimed to describe preceptors’ perceptions of clinical education strategies to create an optimal clinical learning environment (CLE) for undergraduate nursing students.
Background: Staff nurses who take a role of preceptor take an important role for student learning in clinical as a part of the clinical learning environment (CLE). CLEs have been complicated by constant changes due to changes in healthcare system and new technologies. Understanding preceptors’ perceptions of clinical education strategies to create an optimal CLE is crucial to improve students’ learning and clinical nursing education.
Methods: Qualitative descriptive design with maximum variation, purposive sampling, was used. After obtaining IRB approval, 13 participants who had completed a preceptor training were identified as experts by clinical faculties were recruited from a tertiary teaching Magnet hospital. The age of participants ranged from 24 to 56 years, with a mean age of 40.5 years. Participants had worked as nurses between 1.5 and 32 years, and had been preceptors between 5 months and 25 years. Participants worked and precepted students in a variety of specialty settings. All of them were baccalaureate prepared. Using semi-structured interviews, participants were asked about their teaching strategies for student learning as a part of the CLE. Data were analyzed with thematic coding. The data were collected from July 2015 to March 2016.
Outcomes: Five categories extracted from the data under the theme, Strategy. Those categories are Modeling,Coaching, Scaffolding, Articulation and Reflection. Through the data analysis, with an exception of Exploration, it became evident that the theme, Strategy, aligned with the categories developed in the Cognitive Apprenticeship Model that has a long history of application to professional education.
In this study, Modeling was defined as establishing self as a role model and demonstrating expertise. Coaching was defined as observing a student providing clinical care and offering hints, feedback, and reminders to improve learner competency. The definition of Scaffolding was supporting students according to their developmental level, organizing activities to assist them to progress to the next level, and eventually fostering their independence. Articulation was described as fostering students’ knowledge, reasoning, or problem-solving processes by asking students to make explicit what they are doing or observing and why. Lastly, Reflection was defined as supporting students to think critically about their own performance and problem-solving processes and to compare these with those of experts.
There was no code or category identified for Exploration. Exploration is an approach to foster students’ independence and ability to perform problem solving. It usually takes time for students as novices to integrate all of their knowledge, skills and experiences enough to gain their independence during their clinical practicum. Even new nurses need certain precepting time to be independent and solve problems without guidance. This may be why there was no code or category for Exploration was appeared this time.
The clinical education strategies described by preceptors in this study fit well with ways to promote students’ development of expertise through cognitive apprenticeship and thus to optimize the CLE for their learning.
Implications:It is indicated that preceptors were fully capable of using a number of varied and complex clinical teaching strategies and had the capacity of widely enhance student learning in the CLE. Given the increasing reliance on preceptors as part of the CLE, their ability to make this contribution should be recognized. Also, they should be included in planning and evaluating the CLE. Providing a training including the use of the cognitive apprenticeship model as useful clinical teaching skills to new preceptors and clinical faculties is also recommended.