An Adapted Clinical Teaching Model: Shifting from Traditional to Targeted

Health systems and care environments are faced with increasing complexity as a result of advancing knowledge and technology.  At the same time, many agencies are experiencing financial resource and human resource constraints. These factors come together to generate a wide array of ethical and safety challenges for both health care and health care education.

Nursing programs, similar to several other health education programs, have struggled to provide graduates with the knowledge, skills, and abilities needed to enter such complex health care environments. The natural temptation is to add more content, assessment, and practice to already dense curricula. The result can create the perfect academic crisis; mounting stress and overload for both the student and the teacher. Further, nursing programs encounter increasing inability to meet their determined demands for safe, quality practice placements in the overtaxed care environments that are also often saturated beyond capacity with the volume of practice placements required from multiple health care programs.

In an effort to address these multiple challenges, our School of Nursing engaged in a curriculum review which included an extensive environmental scan. The environmental scan revealed several pieces of evidence that informed the development of an integrative curriculum for the development of entry level competencies for the graduate nurse.  The newly developed curriculum includes an innovative clinical education model adapted from the Oregon Clinical Education Model developed by the Oregon Consortium of Nursing (Nielsen, Noone, & Voss, 2013).  Our clinical education model shifts the early practice learning from random chance practice learning to targeted, focused practice learning experiences through the usage of Intentional Learning (IL) activities (Gubrud-Howe & Schoessler, 2008; Taylor Huber & Hutchings, N.D). The threading of concepts and learning outcomes across suites of courses, and the use of (IL) activities within several practice courses, are the hallmarks of the revised curriculum. Intentional Learning activities integrate knowledge, lab learning, and practice, thereby supporting the student to develop deep thinking and strong reasoning abilities (Benner, 2010; Taylor Huber & Hutchings, N.D; Tanner, 2006).  As the student gains knowledge, skills, and abilities in an integrative manner, their level of responsibility for complex, holistic patient care is steadily increased.

An integrative curriculum with the adapted innovative clinical education model balances targeted learning with quality experiential learning to produce strong graduates who provide safe, competent, ethical professional nursing care. Integration and intentional learning are pedagogical approaches that could be adapted and infused into the curriculum of other courses and other disciplines.