Innovative Approaches to Clinical Teaching and Learning: Caring for Clients Undergoing Perioperative Surgical Experiences by Nursing Students

Purpose: Clinical Instructors are constantly challenged to optimize clinical teaching and learning opportunities for students, to master technical skills while providing patient care through critical thinking and reflecting on their performance. Method: Students in the Nursing Program at Nunavut Arctic College are oriented to client assignments a day before clinical placement, visit the Unit and, utilizing the nursing process, develop a client-specific care plan for implementation and ensure optimal outcomes during client care. In 2013 academic year, the third-year students’ clinical placement included Day Surgery and Operating Room (OR) – to acquire skills in caring for clients undergoing peri-operative surgical experience. Using Kurt Lewin’s force-field analysis model of change, a holistic approach to client care and, in collaboration with the Day Surgery/OR multidisciplinary team, students initiated a care plan based on their knowledge of the specialist surgery of the day only. They then met with clients on the morning of surgery, gathered data and developed a plan of care, detailing their understanding of client needs through pre-operative, intra-operative, and post-operative stages of care. They observed client responses on a continuum, the effect of surgery on client ability to meet self-care needs, and conducted discharge planning and teaching. Results: Students described this experiential learning as innovative, challenging, holistic, comprehensive, patient-centered, and team-oriented. They learned to unfreeze and move, overcoming their own individual anxieties and/or apprehensions about surgery and nursing care-plan development without prior access to clients or their charts. They felt enlightened to see the clients smile and in high spirits, as they recovered from anesthesia and actively participated in their discharge process. This change brought feelings of achievement and pride as was demonstrated in the students' critical thinking abilities, evaluation of care outcomes, reflections during clinical conferences, and in their written reflective journals. Conclusion: The outcome of students taking their own initiatives in client-care planning, and working closely with the multidisciplinary perioperative team, was evidently re-energizing and empowering, while client care encompassed all aspects of primary health care, continuity of care, cultural diversity, and preferences. The learning environment offered the students a medium for positive growth and development as they went through the refreezing phase of change. It further generated rewarding benefits to both academic and clinical sectors, promoted therapeutic communication among the team members, including clients and their families, and accorded opportunities for subsequent student placement in the Day Surgery and Operating Room settings.