At present, there is a persistent shortage of nursing practitioners in Taiwan. According to statistical data, the practice rate of graduate nursing students engaged in nursing care related work is only about 60%, which is due to the great pressure in nursing students ' practice. This then affects the willingness to work and the realistic shock of the workplace after graduation, which leads to the shortage of clinical manpower (Jiang & Yang, 2018). The traditional knowledge and skills are being taught in the classrooms, laboratories and clinical practices, however with younger students and their newer approach to learning, the traditional teaching methods can struggle to satisfy their expectations. In order to teach current clinical practices so that modern students can acquire knowledge and experience, a new way of thinking needs to be applied to nursing education (Wu, Zhou & Li, 2016; Zhang, 2017).
Traditionally nursing students are taken to the clinical units by their teachers to gain practical experience, however the aim of the new role of Nursing Clinical Teacher is to increase the exposure of the nursing students to the clinical environment. The new role will be assigned to the senior staff nurses by the hospital; the aim is to allow the students to see how the hospital systems work, gain working experience with them, grow accustomed to a real hospital environment and learn how the teams should work together. Often the current medical environment pays too much attention to the technical-rational treatments and neglects the focus on the patient as a person rather than being a clinical subject. The Nursing Clinical Teacher can help to bring together real world medical scenarios with the classroom theories and to encourage the students to think about how they would put into practice what they have been taught in the classroom (Yu & Jiang, 2017).
The E-da hospital has commenced cooperation between the hospital and school and is run by the combined Nursing Clinical Teacher. One of the objectives of introducing practical clinical experience to the students’ curriculum has been to reduce the students’ anxieties and any frustrations they may have with a purely classroom approach to learning. Encouraging students to take the initiative and apply critical thinking fosters professionalism and it is hoped that this will improve their retention rate. The combined academic and clinical training model was successfully introduced in October 2017.
Methods:
The selection criteria shall be in accordance with the nursing clinical teacher who is present, has completed more than 10 years of work, and who has received the qualification of teacher development from the Joint Commission of Taiwan, a consortium of hospitals for the evaluation of medical quality. In addition, regular practice with schools will be implemented to open internship education consensus meetings. This will provide the knowledge and expertise of senior nursing practitioners as clinical practice guidance for clinical situations, demonstrate and the use of professional knowledge in the patient context. Participants in this program will be year four Nursing Department students, who completed their fourth year between September 2017 and September 2018.
The participants are fourth grade students with seven to eight students in a group. The duration in every group is fifteen days, and includes group discussion about how improvements could be made and recognition of good performance at the end of the shift. Guided teaching is applied individually according to the student’s characteristic and learning status in order to stimulate their critical thinking and increase their integration with the clinical environment. Giving the nursing students information from the unit to preview beforehand and helping them to select suitable cases through cognition tests helps them to learn what holistic care is. Regarding the care process, the combined hospital and school preceptors have played dual roles which are as teacher and as counselor. By using example scenario and observation followed by discussion, the teachers help the students to assess their own performance with professional guidance. The training and guidance is an ongoing process which continues after the students’ graduation.
Results:
At the internship evaluation symposium the nursing students have been highly positive about the combined hospital and school preceptors. The main reasons are that the combined hospital-school preceptors have created a happy learning atmosphere which has decreased the anxiety about joining the practice and has improved their confidence and motivation in providing patient care and has improved medical team communication. This has reduced the shock that students used to experience when being introduced to the clinical practice. By following up the forth-two graduates’ working status, there were fourteen graduates who stated that where the internship is closer to the medical practice then it has been helpful to their future career.
Conclusion:
The integration of theory with clinical practice in nursing education is at the core of the new teaching method. From interviewing students it was found that traditional teaching methods made it hard to manage situational and technical challenges during the practice (Chien, Liu, Lin, Lin, Lin & Chen, 2014). The emergence of combined hospital and school Nursing Clinical Teachers has brought different views and aspects to the nursing students and introduced valuable working experiences to give them an early introduction to the real clinical practices. With students learning with each other this has fostered an increase in the confidence of the nursing students in an interesting and joyful atmosphere where they are willing to enter to the nursing career.