Many schools of nursing require students to prepare in advance for their clinical experience. The amount of information available to the student for advance preparation may depend to a large extent upon the method utilized by the instructor in making student clinical assignments. Methods of assignment identified include instructor-made/student-gat here d, instructor-made/instructor-gathered, student-made, staff-made, and a combination of these methods.
Students and faculty from the 15 National League for Nursing (NLN) accredited associate degree programs of nursing in Tennessee were surveyed to determine the methods of assignment they utilized and the methods of assignment they preferred for making clinical assignments. Advantages and disadvantages of the methods were also examined.
The majority of respondents stated that the preferred method, as well as the predominant method utilized, was the instructor-made/student-gathered method. The major benefits listed were researching medical diagnoses, anticipating actual nursing diagnoses, and researching medications. The major disadvantage cited was the time-consuming factor.
Many nursing educators believe that preplanning for the clinical experience by obtaining data about the patient(s), researching nursing literature, and developing an individualized plan of care is a valuable learning experience. Therefore, students are frequently required to preplan.
Five possible methods were identified by which students are assigned to patients and by which students gather information. In the first method, the clinical instructor assigns the student to a particular patient. The student, after obtaining the assignment, visits the clinical facility, gathers information from the patient's record, and perhaps talks with the patient.
In the second method of assignment, the instructor visits the clinical facility, makes the assignment, gathers information from the patient's record and possibly from the patient and/or staff, and later gives this information to the student by oral or written means. In the second method, the student neither visits the clinical facility nor talks with the patient prior to developing a plan of care. In the third method, the student may make his/her own patient assignment and gather the needed information. In the fourth method, the staff of the clinical facility may be responsible for the student's clinical assignment, with the student directly gathering the patient data. The fifth and last method of assignment refers to any combination of the four previously identified methods.
The purpose of this study was to ascertain the methods of patient assignment utilized by the 15 National League for Nursing accredited associate degree programs of nursing in Tennessee. Advantages and disadvantages of these methods were also examined.
Review of Literature
Virginia Henderson did not directly develop the concept of preplanning, but she did support the development of a written, individualized nursing plan of care as early as the 1930s (Henderson, 1973). Such support for the individualization of patient care helped to provide the basis for the concept of preplanning. Development of the nursing process, with the emphasis on the assessment of the individual patient's needs, thus provided impetus for the utilization of preplanning activities in nursing education.
Mullins (1965) stated that the day prior to the clinical experience, her students were provided with an individual clinical assignment sheet containing information about their patient(s). Students were to use this information in preparing for the clinical experience by "looking up drugs, treatments and diets, and reviewing nursing principles" (p. 49).
In 1981, Carpenito and Duespohl supported the need for students to obtain their assignments the day before the clinical experience. They advocated requiring the student to visit the clinical facility, talk with the assigned patient, and gather a nursing history and health assessment data. In the event it was not feasible for the students to visit the clinical facility, the instructor would gather the pertinent information and give this information to the student the day prior to the clinical experience.
Mitchell and Krainovich (1982) advocated giving students their patient assignments prior to the clinical experience. They observed that benefits from advance assignments and preparation included increased group discussion in the preconference activities and decreased direct teaching by the instructor. Mitchell and Krainovich, however, stated that advance assignments were not appropriate for all students, particularly students nearing graduation.
Questionnaires were mailed to the nursing director of the 15 NLN accredited associate degree programs in Tennessee. The nursing director was asked to randomly select four to five faculty members to complete the faculty questionnaire. Fifty second-year nursing students from five randomly selected programs were also asked to complete the student questionnaire. Student and faculty questionnaires were identical, except that the faculty questionnaire contained three more questions.
Research Questions - Results and Discussion
1. What methods of preplanning do the associate degree programs in Tennessee utilize?
Results: Faculty reported that they utilized the instructor-assigned/student-gathered method 82% of the time; students reported 62%. The instructor-assigned/instructorgathered method was the second choice. There were no responses for the studentmade or staff-made categories.
Discussion: Faculty and students may have had limited experience with types of preplanning other than the type they utilized, and these limitations should be considered in the evaluation of the findings. Prior to changes in nursing education in the 1950s, clinical assignments were controlled by staff. The study implies a lack of staff involvement in students' assignments at the present time, as there were no responses in this category.
INFORMATION CITED AS NECESSARY UNDER THE INSTRUCTOR-ASSIGNED/INSTRUCTOR-GATHERED METHOD BY FACULTY AND STUDENTS
Although the research involved associate degree nursing programs, the implications are also applicable to diploma and baccalaureate nursing programs. Admittedly, the emphasis of the preplanning activities may vary with the type of programs. In a baccalaureate program for example, more attention may be directed toward physical assessment during preplanning activities.
2. What do faculty members and students believe the benefits of preplanning to be?
Results: The results of the faculty and student questionnaires from the different assignment methods revealed a consensus as to the perceived major benefits of preplanning - researching medical diagnoses, anticipating actual nursing diagnoses, researching medications, researching nursing interventions, and anticipating potential nursing diagnoses. Researching principles, researching lab values, learning to read the chart, motivating the student, decreasing student anxiety, assessing the patient, and becoming familiar with equipment were additional benefits ranked by faculty from highest to lowest responses. There was a discrepancy between faculty and students regarding the perceived benefit of decreasing student anxiety.
Discussion: The findings regarding the anxiety experienced by students with the instructor-made/student-gatheredand instructor-made/instructor-gathered methods of assignment need further study. Faculty respondents cited the instructorassigned/student-gathered method as decreasing student anxiety 70% of the time, whereas student respondents reported only 52%. All of the student respondents reported that the instructorassigned/instructor-gathered method decreased student anxiety, but only 50% of faculty indicated a decrease. Possibly, the lack of travel required and the elimination of the need for the student to gather vast amounts of information (inherent in the instructor-assigned/instructor-gathered method) was perceived by the students as being less stressful.
3. What do faculty members and students believe the disadvantages of preplanning to be?
Results: The time-consuming factor, followed by cost of travel/distance, choosing relevant information, and focusing on problems were the perceived disadvantages noted by both faculty and students.
Discussion: Researchers had no available data to indicate the average length of time required for a student to gather patient information, but reported personal experiences indicate that preplanning requires approximately 1 to 1¼ hours per assignment. This does not include time spent in commuting, researching, and developing a patient plan of care. Carpenito and Duespohl (1981) supported allowing clinical credit hours for the preplanning activities, and perhaps nursing faculty should consider this proposal. However, one faculty respondent employed at an institution where credit was granted for preplanning time, stated that such credit "decreased the hands-on clinical experience."
The time-consuming factor for faculty was not explored in this study. All faculty members probably gather some patient information when making assignments, but the instructor utilizing the instructorgathered method must gather more information. Carpenito and Duespohl (1981) suggested using a carbon copy of the assignment, alleviating the need to recopy the information for the student, thereby saving time for the instructor.
Preplanning from the nursing staff viewpoint was not examined in this study. However, a number of students arriving together on a nursing unit to preplan could present significant problems. According to one faculty respondent, the "staff became frustrated by so many different people underfoot, so many people asking questions, and students tying up charts when they were needed, requiring the staff members to hunt the chart." Perhaps staff viewpoint should be elicited in preplanning activities.
4. When should preplanning take place?
Results: The majority of students and faculty agreed that preplanning should take place the day before the clinical experience.
Discussion: The benefits of advance preparation might occur in preconference activities. The instructor would be able to elicit how well the student(s) prepared by having them give an oral or written presentation of the researched assignment. This information could also benefit other students when contrasts and comparisons of planned patient care are made. Degree of student preparation might also be utilized as part of the student clinical evaluation.
5. What type of information does the instructor need to give to the student in the instructor-assigned/instructorgathered method of preplanning?
Results: Patient identification information, medical diagnoses, and surgery were indicated by both faculty and students as major data (Table 1).
Discussion: Omission of important details is a potential problem in preplanning. Perhaps a written outline could be developed to help avoid omissions.
One factor not emphasized as a major item by responses was social data. In this era of cost containment resulting in shorter hospital stays, social data may become more important than ever before. For instance, discharge teaching must be started earlier; social data, such as living arrangements and significant others, are becoming increasingly important.
Researchers believe that the utilization of preplanning as a precursor to the writing of a nursing care plan incorporating the nursing process facilitates optimal use of clinical laboratory experience. The ultimate purpose of preplanning is to provide a better learning experience for the student, as well as to improve patient care.
The amount of information available to the student as he/she prepares in advance for the clinical experience is influenced by the method of assignment utilized. Therefore, the researchers suggest that nursing educators make informed decisions about the best method of assigning student clinical experiences for each program/ course by examining the advantages and disadvantages of each available method before making clinical assignments.
- Carpenito, L., & Duespohl, T.A. (1981). A guide for effective clinical instruction. Wakefield, MA: Nursing Resources.
- Henderson, V. (1973). On care plans and their history. Nursing Outlook, 21, 378-379.
- Mitchell, C.A., & Krainovich, B. (1982). Conducting pre- and post- conferences. American Journal of Nursing, 82, 823-825.
- Mullins, A.P. (1965). First clinical assignments. Nursing Outlook, 13, 47-50.
INFORMATION CITED AS NECESSARY UNDER THE INSTRUCTOR-ASSIGNED/INSTRUCTOR-GATHERED METHOD BY FACULTY AND STUDENTS