The Journal of Continuing Education in Nursing

Original Article 

Effectiveness of Education Courses in Enhancing Clinical Educators' Teaching Ability

Yong-bing Liu, PhD, RN; Ling-ling Xue, RN; Hui-ping Xue, RN; Ping Hou, RN

Abstract

Background:

In China, the nursing discipline has undergone rapid development in recent years, and clinical educators are an important part of the nursing education team. In order to improve their teaching ability and become competent clinical educators, we provided learning opportunities to them.

Method:

To assess the effectiveness of education courses and modules, a cross-sectional study based on questionnaire responses was conducted. Sixty-six part-time clinical nurse educators from six teaching hospitals were included. A standardized four-section questionnaire developed by the authors was used.

Results:

The education curriculum was approved by clinical educators (94%). The specific content in the education courses significantly improved the teaching ability (84%). From a teaching perspective, the confidence was enhanced; the clinical educators were able to control the purpose of teaching and learning objectives via a syllabus (92%).

Conclusion:

Education courses can improve teaching ability, reinforce teaching control, and promote the quality of clinical teaching. [J Contin Educ Nurs. 2019;50(8):367–373.]

Abstract

Background:

In China, the nursing discipline has undergone rapid development in recent years, and clinical educators are an important part of the nursing education team. In order to improve their teaching ability and become competent clinical educators, we provided learning opportunities to them.

Method:

To assess the effectiveness of education courses and modules, a cross-sectional study based on questionnaire responses was conducted. Sixty-six part-time clinical nurse educators from six teaching hospitals were included. A standardized four-section questionnaire developed by the authors was used.

Results:

The education curriculum was approved by clinical educators (94%). The specific content in the education courses significantly improved the teaching ability (84%). From a teaching perspective, the confidence was enhanced; the clinical educators were able to control the purpose of teaching and learning objectives via a syllabus (92%).

Conclusion:

Education courses can improve teaching ability, reinforce teaching control, and promote the quality of clinical teaching. [J Contin Educ Nurs. 2019;50(8):367–373.]

Preparing skilled, safe, and competent nurse graduates is an essential focus of nursing education (Phillips & Vinten, 2010). Clinical educators are a critical determinant of the quality of nursing students' clinical learning experiences (Ludin & Fathullah, 2016). Clinical educators are more directly and personally involved with students in clinical settings than is possible in other nursing learning contexts, such as classroom settings. Clinical educators have immense and diverse responsibilities in ensuring that nursing students receive opportunities to achieve competency, self-confidence, and professional identity, as well as professional attitudes and proficiency (Hand, 2006). Clinical educators thus must anticipate potential learning opportunities, recognize unanticipated learning situations as they arise, and design instruction modes that foster the positive learning events that are critically important to students' professional development. For effective learning to occur, clinical educators must have a sound knowledge of nursing, clinical competence, excellent teaching skills, and positive relationships with students (Hand, 2006).

In contrast to findings reported by Kelly (2007) and Edgecombe and Bowden (2009), the findings of Gignac-Caille and Oermann (2001) indicate that teaching ability is the most highly valued category among the five categories of the Nursing Clinical Teaching Effectiveness Inventory questionnaire. To improve teaching ability, more attention must be paid to how clinical educators are educated in higher education institutions for nursing.

Through rigorous education courses on professional teaching ability, clinical educators can better understand the importance of nursing teaching and can transform their clinical teaching practice and attitudes. Clinical educators must take the initiative to innovate teaching strategies in clinical nursing education and establish an evidence base from which clinical nurse educators can draw as they consider new teaching strategies.

Unfamiliarity with new methods and strategies may decrease the effectiveness of clinical teaching and learning. Therefore, clinical educators should be aware of ongoing changes in nursing education and the health care system, maintain their own learning to keep their professional knowledge current, and ensure that their clinical teaching methods and strategies remain effective. Expert clinical faculty play a vital role in helping students acquire the intellectual knowledge, affective attitudes, and psychomotor skills necessary for professional practice (Gaberson & Oermann, 2007). The improvements resulting from such teaching ability will enable future students to become not only competent nurses but also high-level clinical educators. Clinical educators and their students must adequately prepare to face growing challenges in the nursing education and health care system.

This year, to supplement our clinical teaching strengths, we appointed 66 clinical nurses from teaching hospitals as part-time clinical nurse educators at our nursing school. The clinical educators teach nursing in the medical practice setting. Some clinical educators cover specific areas and specialties, whereas others work with students across specialties (Ioannides, 1999). In China, clinical educators are primarily responsible for teaching clinical education courses, such as the theory of teaching and hospital practices in medical, surgical, obstetrics and gynecological, and pediatric nursing fields. Nursing students attend clinical practice training in a hospital in the final (fourth) year before graduation, where they are taught by clinical educators.

Some differences exist in clinical educators' teaching abilities. Our nursing school should provide learning opportunities to allow teachers to improve their teaching ability and become competent clinical educators. We held the first session of the Clinical Nurses Teaching Ability Improvement class between March 13 and April 14, 2017. We arranged for the education courses to be offered on Monday, Wednesday, and Friday nights every week (3 hours per session).

The education courses included the following seven sections: teaching system and management; knowledge of nursing professional accreditation; acquisition and application of digital teaching resources; teaching design and classroom teaching; research-based teaching; blended teaching mode; and theory and practical teaching reform and evaluation. We brought in experts and scholars from different disciplines who were able to teach the latest advances and knowledge to the clinical educators. We collected data before and after the education courses.

The study was designed to measure how part-time clinical nurse educators perceive and describe the characteristics of innovative teaching modules that are adapted to clinical educators. We hope that an understanding of clinical educators' intent will offer insight into the development of new clinical teaching methods and strategies and possibly be extended to apply to clinical nursing education. The overarching goal of this study was preparing competent, skillful, and caring graduates in the contemporary complex nursing education and health care system.

Method

Sample

This was a cross-sectional study of baseline data. The participants were recruited from six teaching hospitals (two of which were affiliated hospitals) of the nursing school of Yangzhou University. A total of 66 clinical faculty members were included as part-time clinical nurse educators.

The inclusion criteria for the clinical faculty were as follows: age ≤ 55 years; working experience ≥ 10 years and a teacher qualification certificate; bachelor's degree or above; excellent-quality teaching of theory in one or more education courses or of clinical practice to undergraduates or postgraduates; and systematic and solid theoretical foundation, abundant practical experience, and mastery of a foreign language. In addition, the clinical faculty were required to meet one of the following conditions: participation in a teaching or scientific project, receipt of one or more awards or patents, one or more published papers as the first author, or one or more compiled textbooks. The exclusion criteria were as follows: age ≥ 55 years, and not fulfilling teacher duties or an inadequate investment of time in teaching.

Sixty-six faculty members, representing the entire sample pool, were invited to participate in the study. The faculty members who returned the survey constituted the study sample (N = 50), and 75.76% of responses were valid.

Ethical Approval and Questionnaire

The study was approved by the institutional review board of the authors' university. All clinical faculty members who participated in the study were informed of the nature and objectives of the survey. All participants provided written informed consent at the time or responded to an e-mail invitation to participate in the study. Confidentiality and anonymity were maintained through de-identification of the data.

A standardized four-section questionnaire developed by the authors was used for the survey. The questionnaire was designed based on a review of the literature with the goal of understanding the efficacy of education courses. The questionnaire focused on the teaching ability survey. The questionnaire consisted of 40 detailed items, as follows:

  • Sociodemographic characteristics: eight items, which were name, age, gender, years of teaching experience, years of nursing experience, education level, professional title, and administrative experience.
  • Education courses: 10 items, mainly surveying clinical educators' responses to training courses, such as course modules, course learning attitude, teaching perception, and teacher competence.
  • Teaching ability: 10 items, regarding educators' ability to accomplish specific teaching tasks and the core professional abilities. Previous studies have indicated that teaching ability evaluations should include teaching design, executive evaluation, and research abilities (Bi, Ma, & Wan, 2017; Duan, Chen, & Huang, 2018).
  • Teaching control: 12 items, regarding educators' ability to organize and control classroom teaching; this is fundamental to ensuring that teaching tasks are completed, and education goals are realized, which is key to improving classroom teaching quality (Ye & Li, 2012).

In every section, we designed several open-ended items to obtain more information on clinical educators. A 5-point Likert scale was used, with scores ranging from 1 (strongly agree) to 5 (strongly disagree). The Cronbach's alpha coefficient of this questionnaire was .753, thus indicating good reliability.

Data Management and Analysis

Descriptive statistics and nonparametric analysis were calculated for categorical variables, including sociodemographic characteristics, education courses, teaching ability, and teaching control. The reliability of the questionnaire was tested for internal consistency with Cronbach's alpha coefficient. The database was established with EpiData (version 3.1), and all data were coded and double-entered by two independent professional data entry staff. The data were analyzed in SPSS® 18.0 software. Continuous variables are presented as the mean ± standard deviation (SD). Statistical significance was defined at values of p < .05.

Results

Sample Characteristics

The characteristics of the clinical nurse educators are summarized in Table 1. The clinical faculty had a mean age of 44.70 ± 5.13 years; 41 (82%) clinical faculty members were in their 40s. All clinical faculty members were female. The clinical faculty had been involved in clinical teaching for up to 8.76 ± 6.11 years; 30 (60%) clinical faculty members had been teaching more than 3 years. The clinical faculty members had worked as nurses for 25.48 ± 5.39 years, and 43 (86%) had worked as nurses for more than 20 years. All clinical faculty members taught baccalaureate education courses. Only one nurse had a master's degree; the other nurses had bachelor's degrees as their highest level of education. The academic ranks were as follows: 13 (26%) were chief nurses, and the others were co-chief nurses. Among the nurses, 41 (82%) were administrators.

Clinical Nursing Teachers' Characteristics (N = 50)

Table 1:

Clinical Nursing Teachers' Characteristics (N = 50)

In subsequent analyses, the results (numbers of respondents and percentages) were derived by adding the responses to the strongly agree and agree item responses. Importantly, all the questions showed statistically significant differences (p < .001 [two-tailed]).

Education Course Evaluation

The survey results of education courses indicated that most clinical nurses were interested in the following teaching modules: digital teaching resource acquisition and application; teaching design and classroom teaching; research-based teaching; blended teaching mode; and reform and evaluation of theory and practical teaching.

The clinical nurses desired further education courses on teaching techniques, demonstrations, communication skills in the classroom, application and writing of teaching reform projects, integration of humanistic nursing and teaching, practical teaching, and nursing professional accreditation.

The results of the questionnaire are summarized in Table 2. The results demonstrated that the clinical nurse educators were satisfied with the education courses. Forty-seven (94%) clinical nurses thought that the education course module set was suitable. The learning attitude toward education courses was positive for 48 (96%) of the clinical nurses; 47 clinical nurses (94%) thought that the education courses improved their comprehension and recognition of nursing teaching; 42 clinical nurses (84%) thought that the education courses helped to resolve existing teaching confusion; and 44 (88%) thought that the education courses reinforced teaching competence. Finally, 47 (94%) clinical nurses were satisfied with the education courses.

Frequency of Clinical Teacher Responses to Training Courses Questions

Table 2:

Frequency of Clinical Teacher Responses to Training Courses Questions

Teaching Ability Improvement

Most of the clinical educators hoped their teaching ability would improve substantially after attending teaching education courses, such as by adopting various teaching methods freely in the classroom. Moreover, most of the clinical educators were accepted and approved by students in the lectures. Table 3 presents the results of the questionnaire. Among the clinical educators, 24 (48%) indicated that their teaching ability was ordinary, and 35 (70%) did not apply blended teaching into clinical teaching before education courses. After the education courses, 33 clinical educators (66%) expressed interest in using blended teaching, 40 (80%) believed that they had the ability to implement theory teaching reform, 46 (92%) believed that they had the ability to implement practical teaching reform, and 42 (84%) were satisfied with their improvements in teaching ability.

Frequency of Clinical Teacher Responses to Teaching Ability Questions

Table 3:

Frequency of Clinical Teacher Responses to Teaching Ability Questions

Teaching Control

The results of the questionnaire are summarized in Table 4. The clinical nurse educators' teaching control was significantly improved by the education courses: 42 (84%) of the clinical educators understood students' professional thoughts and provided guidance when teaching, 44 (88%) were convinced of the importance of discussing education course objectives, personal expectations, and requirements with students; 46 (92%) approved of combining clinical experience, clinical knowledge, and life values with teaching content; 43 (86%) plan to pay more attention to the student learning process and cultivate their abilities; and 41 (82%) clinical educators grasped the method of assessment of students objectively through a formative evaluation.

Frequency of Clinical Teacher Responses to Teaching Control Questions

Table 4:

Frequency of Clinical Teacher Responses to Teaching Control Questions

Discussion

In recent years, changes in nursing education have accelerated, specifically in teaching and learning of clinical knowledge and skills. In addition, with the development of society and progress in medicine, the roles of other health care professionals have been enhanced and expanded, new patterns in health care have begun to emerge and evolve, and the service demands of patients have increased rapidly; consequently, clinical nursing teaching currently faces substantial challenges.

The behavioral characteristics of clinical educators strongly influence the quality of the learning environment (Katz, 1984). Therefore, it is essential that clinical educators strive to improve their individual teaching abilities to increase the level of student learning (Schwartz, 2001) and to better meet the needs of students.

In China, the nursing discipline has undergone rapid development in recent years, and clinical educators are an important part of the nursing education team. To sustain continued growth, clinical educators will be a powerful means of developing the nursing discipline and improving students' quality of education. Providing professional education courses and support is crucial to improving the comprehensive quality of clinical educators.

To assess the effects of education courses on clinical faculty members' teaching abilities and to prepare for further education courses, we designed a survey and assessed the next steps needed for clinical educators.

Our study showed that the education curriculum was approved by the clinical educators. The clinical educators indicated that the specific education content improved their teaching ability. In addition, the educators' confidence in teaching control was enhanced, including understanding of student learning principles, conducting student evaluations, promoting effective communication, creating positive teacher–learner relationships, and providing constructive feedback.

In the education course evaluation, 94% of the clinical educators were satisfied. They hoped that they could continue with this form of education course. Through the education courses, the clinical educators believed that the teaching system was more integrated, teaching theory was improved, and teaching ideas were upgraded.

In the future, we plan to broaden the education course content to include teaching techniques, demonstration classes, communication skills in the classroom, application and writing of teaching reform projects, integration of humanistic nursing and teaching, and practical teaching and nursing professional accreditation. Then, the education courses can make the leap from teaching foundation to connotation construction.

With respect to improvement in teaching ability, the self-teaching ability assessment of most clinical educators initially was low, but after the education courses, 84% were satisfied with their teaching ability improvement. The clinical educators were more confident in theory and practical teaching reform.

In addition, the clinical educators advised that nursing schools should provide more opportunities to enhance teaching ability. The next step will encourage clinical educators to summarize their theory and practical teaching reform experience and publish articles on teaching. On this basis, clinical educators can then apply for more teaching reform projects and thus complete the process from theory to practice and from practice to theory.

In teaching control, the clinical nurse educators' control ability significantly improved. After education courses, the clinical educators acquired teaching skills and teaching ability, and they developed attitudes and values believed to be essential for entering the education field. Clinical educators must feel comfortable in their teaching environment while performing teaching skills to successfully adapt to the education environment; they must also feel confident in their skills and abilities to meet the challenge of maintaining high teaching quality, while providing students with a good learning experience.

Clinical educators' connotative development should be accelerated, and more attention should be paid to the trilogy of innovating education course content, promoting teaching ability, and enhancing teaching control. Taking these steps should help educators become competent in clinical teaching more quickly.

The current study had some limitations, including the small sample size and single education courses. The results may not be representative of larger samples; however, the findings warrant further research into ways to improve clinical teaching quality. One key point in this study was the suggestion to develop a more suitable education course system and modules for clinical faculty. Indeed, most of the clinical educators indicated a need for further education courses, deeper teaching theory, and broader teaching techniques.

Conclusion

This study demonstrated the effectiveness of education courses and modules in improving clinical educators' teaching ability. In addition, the education course system and modules should be adaptable to, and be able to satisfy, clinical educators' needs. Through education courses, the clinical educators improved their teaching ability, reinforced teaching control, and established a sound foundation for promoting the quality of clinical teaching in the future.

References

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Clinical Nursing Teachers' Characteristics (N = 50)

CharacteristicN (%)Mean ± SD
Age (years)44.70 ± 5.13
Years spent teaching8.76 ± 6.11
  <320 (40)
  3 to 45 (10)
  5 to 96 (12)
  <1019 (38)
Years spent nursing25.48 ± 5.39
  10 to 197 (14)
  ⩾2043 (86)
Education level
  Bachelor's degree49 (98)
  Master's degree1 (2)
Professional title
  Co-chief nurse37 (74)
  Chief nurse13 (26)
Administrator
  Yes41 (82)
  No9 (18)

Frequency of Clinical Teacher Responses to Training Courses Questions

ItemStrongly AgreeAgreeUncertainDisagreeStrongly Disagreeχ2p
Course module35 (70%)12 (24%)3 (6%)0 (0%)0 (0%)64.514< .001
Course learning attitude35 (70%)13 (26%)2 (4%)0 (0%)0 (0%)62.883< .001
Teaching perception33 (66%)14 (28%)3 (6%)0 (0%)0 (0%)67.889< .001
Solve teaching confusion24 (48%)18 (36%)8 (16%)0 (0%)0 (0%)84.739< .001
Teacher competence28 (56%)16 (32%)6 (12%)0 (0%)0 (0%)79.032< .001
Course satisfaction degree29 (58%)18 (36%)3 (6%)0 (0%)0 (0%)85.254< .001

Frequency of Clinical Teacher Responses to Teaching Ability Questions

ItemStrongly AgreeAgreeUncertainDisagreeStrongly Disagreeχ2p
Self-teaching ability assessment before training4 (8%)20 (40%)24 (48%)2 (4%)0 (0%)87.593< .001
Application of blended teaching before training1 (2%)0 (0%)14 (28%)13 (26%)22 (44%)96.896< .001
Interesting for blended teaching after training10 (20%)23 (46%)15 (30%)1 (2%)1 (2%)98.827< .001
Theory teaching reform confidence after training10 (20%)30 (60%)8 (16%)2 (4%)0 (0%)86.116< .001
Practical teaching reform confidence after training14 (28%)32 (64%)4 (8%)0 (0%)0 (0%)71.081< .001
Teaching ability improvement satisfaction degree after training8 (16%)34 (68%)7 (14%)1 (2%)0 (0%)78.364< .001

Frequency of Clinical Teacher Responses to Teaching Control Questions

ItemStrongly AgreeAgreeUncertainDisagreeStrongly Disagreeχ2p
Judge students' learning needs during lecture7 (14%)30 (60%)12 (24%)1 (2%)0 (0%)85.762< .001
Control the teaching purpose and learning objectives via a syllabus14 (28%)32 (64%)4 (8%)0 (0%)0 (0%)82.455< .001
Understand student's professional thought and give guidance when teaching15 (30%)27 (54%)8 (16%)0 (0%)0 (0%)82.444< .001
Discuss course objectives, personal expectations, and requirements with students18 (36%)26 (52%)6 (12%)0 (0%)0 (0%)80.667< .001
Combine clinical experience, clinical harvest, and life value with teaching content30 (60%)16 (32%)4 (8%)0 (0%)0 (0%)73.644< .001
Concerned students' learning process and abilities cultivation20 (40%)23 (46%)7 (14%)0 (0%)0 (0%)83.657< .001
Encourage or praise students' efforts in class30 (60%)17 (34%)3 (6%)0 (0%)0 (0%)71.658< .001
Assessment of students objectively through formative evaluation19 (38%)22 (44%)9 (18%)0 (0%)0 (0%)65.815< .001
Establish good communication with students23 (46%)21 (42%)6 (12%)0 (0%)0 (0%)81.881< .001
Encourage students to think and learn independently30 (60%)16 (32%)4 (8%)0 (0%)0 (0%)73.644< .001
Authors

Dr. Liu is Professor and Vice Dean, Ms. L. Xue is Master's candidate, Ms. H. Xue is Master's candidate, and Ms. Hou is Master's candidate, School of Nursing, Yangzhou University, Yangzhou, Jiangsu, China.

This work was supported by the six teaching hospitals (two of which were affiliated) and 66 clinical teachers.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Yong-bing Liu, PhD, RN, Professor and Vice Dean, School of Nursing, Yangzhou University, No. 88, South Road of University, Yangzhou, Jiangsu, China 225009; e-mail: bing-bing19950806@163.com.

Received: June 15, 2018
Accepted: April 24, 2019

10.3928/00220124-20190717-08

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