Journal of Nursing Education

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Contracting for Clinical

Jeannette L Sasmor, RNC, EdD, FAAN

Abstract

Learning contracts are not a new teaching strategy in nursing education. Described by Rauer and Waring in 1972 as a tool for making classroom learning more meaningful for students, contracting for learning has long added a dimension to the teaching of nursing theory. But, what about nursing practice? Can teaching-learning contracts be used effectively in the practical component of nursing education? The answer is: emphatically yes!

The College of Nursing, University of South Florida, has successfully used contracting for nursing practice since 1974. Initially used for the senior preceptorship experience for generic students, contracts become the vehicle for all the practicum courses taken by registered nurses in the baccalaureate program.

Rationale for Contracting

Contracting for learning is a natural outgrowth of the theories of adult education. The writing of Knowles (1960), emphasizes and re-emphasizes the abilities of adult learners, and the responsibility the adult learners can and will assume for their own learning. Gorman's (1969) fifteen points about learners and learning (Figure) direct educators to consider creative ways of individualizing learning experiences to maximize the adult's past education and present interests. Teacher-learner contracts are one means of providing individualized, relevant to the learner, experiences.

There is further rationale for contracting for clinical experiences. While it does provide the opportunity for exploring individual interest areas, and for specific skill building on a personal basis, contracting also fosters desired behavior and attitude development. If one assumes that professional nurses are responsible for their own professional development, then one assumes that professional behavior includes self-analysis/needs assessment, seeking out ways of meeting identified needs and specifying how the achievement of particular goals will be evaluated. That, in essence, is the contracting experience.

For the generic student, this has occurred in the senior preceptorship experience, which is intended to assist the learner bridge the gap from student role to practicing nurse role. The contract writing experience forces the student to commit to paper personal strengths and weaknesses, and to identify those areas that need more concentrated effort. The student is also forced to place a value on the different areas being pursued.

For the registered nurse (RN) student, contract writing is the basis for all practicum courses. While this may sound as though there are two curricula, that is not the case. There is one baccalaureate curriculum, one set of terminal objectives growing out of one theoretical framework encompassing Man, Health, and Nursing. The difference lies in the approach to education. The generic student needs not only theory, facts, and techniques, the generic student also needs the values and attitudes that are a part of the socialization process. The RN student, on the other hand, while needing some knowledge, has many skills and needs to be resociaUzed into the professional nursing values system while building advanced sküls. The RN students bring a wealth of background and a diversity of experience that makes attempts at individualizing learning a real challenge. Contracting for the practicum allows the maximum individualization within a given course framework.

How to Contract

Learning contracts are treated Uke any other legal binding agreement (Hemelt & Mackert, 1978, pp. 44-46). There must be a meeting of the minds of all parties involved: in this case, the student, the faculty advisor representing the College, and the preceptor representing the clinical agency.

The contract consists of three elements: the objectives, the approaches, and the evaluation.

The Objectives: The main areas outlined by contract objectives are predetermined by the course. Each clinical or practicum course has a set of broad course objectives. The student is expected to take each course objective and relate it to self-analyzed strengths…

Learning contracts are not a new teaching strategy in nursing education. Described by Rauer and Waring in 1972 as a tool for making classroom learning more meaningful for students, contracting for learning has long added a dimension to the teaching of nursing theory. But, what about nursing practice? Can teaching-learning contracts be used effectively in the practical component of nursing education? The answer is: emphatically yes!

The College of Nursing, University of South Florida, has successfully used contracting for nursing practice since 1974. Initially used for the senior preceptorship experience for generic students, contracts become the vehicle for all the practicum courses taken by registered nurses in the baccalaureate program.

Rationale for Contracting

Contracting for learning is a natural outgrowth of the theories of adult education. The writing of Knowles (1960), emphasizes and re-emphasizes the abilities of adult learners, and the responsibility the adult learners can and will assume for their own learning. Gorman's (1969) fifteen points about learners and learning (Figure) direct educators to consider creative ways of individualizing learning experiences to maximize the adult's past education and present interests. Teacher-learner contracts are one means of providing individualized, relevant to the learner, experiences.

There is further rationale for contracting for clinical experiences. While it does provide the opportunity for exploring individual interest areas, and for specific skill building on a personal basis, contracting also fosters desired behavior and attitude development. If one assumes that professional nurses are responsible for their own professional development, then one assumes that professional behavior includes self-analysis/needs assessment, seeking out ways of meeting identified needs and specifying how the achievement of particular goals will be evaluated. That, in essence, is the contracting experience.

FIGUREGORMAN'S FIFTEEN POINTS ABOUT LEARNERS AND LEARNING

FIGURE

GORMAN'S FIFTEEN POINTS ABOUT LEARNERS AND LEARNING

For the generic student, this has occurred in the senior preceptorship experience, which is intended to assist the learner bridge the gap from student role to practicing nurse role. The contract writing experience forces the student to commit to paper personal strengths and weaknesses, and to identify those areas that need more concentrated effort. The student is also forced to place a value on the different areas being pursued.

For the registered nurse (RN) student, contract writing is the basis for all practicum courses. While this may sound as though there are two curricula, that is not the case. There is one baccalaureate curriculum, one set of terminal objectives growing out of one theoretical framework encompassing Man, Health, and Nursing. The difference lies in the approach to education. The generic student needs not only theory, facts, and techniques, the generic student also needs the values and attitudes that are a part of the socialization process. The RN student, on the other hand, while needing some knowledge, has many skills and needs to be resociaUzed into the professional nursing values system while building advanced sküls. The RN students bring a wealth of background and a diversity of experience that makes attempts at individualizing learning a real challenge. Contracting for the practicum allows the maximum individualization within a given course framework.

How to Contract

Learning contracts are treated Uke any other legal binding agreement (Hemelt & Mackert, 1978, pp. 44-46). There must be a meeting of the minds of all parties involved: in this case, the student, the faculty advisor representing the College, and the preceptor representing the clinical agency.

The contract consists of three elements: the objectives, the approaches, and the evaluation.

The Objectives: The main areas outlined by contract objectives are predetermined by the course. Each clinical or practicum course has a set of broad course objectives. The student is expected to take each course objective and relate it to self-analyzed strengths and weaknesses. From that activity, the student develops sub-objectives that are observable and measurable and personal in terms of what that student would like to pursue within the course objectives.

The Approaches: The approaches literaUy speU out what specific activities the student intends to foUow to meet the identified objectives. This might include something as broad as conducting an inservice class on chemotherapy, if the objective is educational in nature, or something as limited as writing for a specific piece of legislation in process if the objective is related to legal forces influencing health care. This is the truly creative part of contracting, and is limited only by the imagination of the student and teachers, and by the resources available.

The Evaluation: As a part of the contract, students must indicate a means of evaluation for each objective/approach including whether the evaluator wiU be the preceptor, the faculty advisor or both. In addition, each evaluation component must be assigned a weight or value, with all of the components equaling 100% of the grade.

Insisting that students assume responsibility for specifying the method of evaluation and the weight or value placed on each component of the evaluation process, promotes a more clearly developed sense of accountabiüty in students.

Responsibilities of Rarties

In addition to the guidelines that students receive explaining the expectations for contracting, there are specific guidelines for preceptors and for faculty advisors which delineate their roles in the contracting operation.

Preceptors are initially identified by their employing agencies as nurses with demonstrated expertise in their area of practice. Faculty match students and preceptors, taking into account student strengths and limitations and the purposes of the course. The only limitation has been on placing students in their normal work situation, since experience has indicated that in the normal work situation students have great difficulty separating their worker role from their student role, and thus may have difficulty meeting contract objectives.

The preceptor is expected to meet with the student and faculty advisor at the beginning of the experience to review the contract and verify the feasibüity of carrying out all approaches within their agency. Once verified, the contract is signed by the preceptor, faculty advisor, and student, thus committing the team to assisting the student to achieve the stated objectives. The preceptor, student and faculty advisor meet again at midquarter to review progress on the contract. Since she is constantly involved in formative evaluation, the preceptor may contact the faculty advisor at any time for clarification or assistance if there are obvious achievement or behavioral problems relative to the student's progress toward meeting the objectives. The midquarter conference is an opportunity to re-assess the contract and, if necessary, renegotiate its terms.

A revised contract must meet all of the conditions of quaUty included in the original contract and be signed by all parties involved - the student, preceptor and faculty advisor. The final conference, although intended as a summative evaluation conference, is primarily a closure meeting and an attempt to obtain preceptor feedback on the overall experience. The student's grade is achieved by meeting the conditions of the contract and, since the student is an active participant in the process, the grade is known and not dependent on disclosure at this conference.

Faculty role in this framework is overtly nontraditional. The primary mover in this experience is the learner. The faculty advisor, rather than being an instructor and giver of wisdom, is a facilitator and mentor. In partnership with the preceptor and the student, the faculty advisor serves to represent the standards of the College while allowing the practice expert, the preceptor, and the learner to seek a variety of learning experiences that will lead to the achievement of course objectives. In this role the faculty advisor is less directly involved, thereby being provided with opportunity for greater objectivity and freedom to assume the role of mediator should problems in contract implementation occur.

OveraU, contracting for clinical experiences is a useful teaching strategy in nursing education. It provides the opportunity for individualizing learning without compromising educational goals and objectives. But, it requires a special faculty person to succeed. It requires an educator instead of a teacher - a person who can perceive the achievement of educational objectives through a variety of activities and who is willing to give up the role of primary knowledge source.

References

  • Gorman, A.H. (1969). Teachers and learners: The interactive process of education. Boston: Allyn & Bacon.
  • Hemelt, M.D., & Mackert, M.E. (1978). Dynamics of law in nursing and health care. Reston, VA: Reston Publishing Company.
  • Knowles, M. (1960). Handbook of adult education in the United States. Washington, DC: Adult Education Association.
  • Rauer, K, & Waring, B. (1972). The teaching contract. Nursing Outlook, 20, 594-596.

10.3928/0148-4834-19840401-14

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