How, when, and where to teach the psychomotor skills are questions frequently confronted by nursing faculty. How can individual skills be learned, retained, and integrated with other psychomotor and cognitive skills, then transferred to the clinical situation? Safe, efficient, cost-effective teaching strategies must be goals of beginning-level faculty. The introduction of the college laboratorybased "campus clinical" has helped to resolve the problem of teaching psychomotor skills to beginning-level students.
Review of Literature
Several of these questions have been addressed by others (Cowan & Wiens, 1986; Duprey & Patten, 1986; Hallal & Welsh, 1984; Haukenes & Halloran, 1984; Infante, 1981). Duprey and Patton cited limited clinical facilities, patient safety, student anxiety, "limited clinical hours, and demands for cost containment" (p. 348} as the impetus for developing a new strategy for teaching skills which they called "clinical relays" (p. 349). Ten skills were chosen for students to practice over a period of time witb a game-like simulation finale. Various times and places were chosen by faculty for students to practice (Duprey & Patton).
Cowan and Wiens (1986) developed a "Mock Hospital" (p. 30) in the school laboratory using community volunteers as patients. Hallal and Welsh (1984) described a competency laboratory where students could learn psychomotor skills. Students practiced skills at their own rate and the students were responsible for scheduling the testing date.
Haukenes and Halloran (1984) reported a faculty's efforts to identify which psychomotor skills would be taught and in which course these skills would be taught. Skills guides were developed along with modules for teaching each of the skills. A reported outcome of their project was increased use of the college laboratory.
Infante (1981) addressed the desirability of greater use of the college laboratory for beginning students. The college laboratory is defined by Infante as "a place on the college campus that is equipped with simulated materials for the nursing student to practice aspects of care in an artificial instead of a real situation. No clients are available in this setting" (p. 17). Infante further emphasized the importance of differentiating between giving care and learning how to give care.
Lindeman (1989) termed the dilemma between the need for clinical laboratory activities and the difficulty in finding appropriate clinical settings for entry level programs as "nursing's first paradox" (p. 24). Cited among factors contributing to this dilemma are such changes in the acute care setting as increasing acuity level of patients and shorter lengths of stay (Lindeman).
As the Level 1 faculty evaluated course objectives and activities provided to meet these objectives, several problems were identified. Making appropriate assignments for beginning students was difficult because of the acuity level of the patients. Faculty also were concerned about the limited knowledge base of students, since the clinical laboratory practice began early in the semester. Students felt anxious when having to care for such sick patients so early in their program of study. In addition, there was a large, well-equipped college laboratory facility that was underused.
Faculty identified an additional concern about early clinical experiences. Students often performed the same few skills over and over, while the opportunity to perform other skills was either sporadic or nonexistent. A strategy was needed for students to use all the skills that they had learned, to make some decisions, to deal with a large number of stimuli at once, and even to make some mistakes. A simulated clinical activity that involved patient situations was performed in the campus laboratory; a selected psychomotor skill performance for all students was developed. This simulated activity was called campus clinical.
Campus clinicals were designed with the primary objective of allowing the student to use both psychomotor and cognitive skills in a safe, simulated environment. Campus clinicals function as teaching and learning times, not grading times. Each faculty member works with one clinical group, both during campus clinical and later in the clinical agency, thus providing continuity for both student and teacher.
Faculty preparation for campus clinical included the development of several sets of patient situations with separate information for the nurse and the patient in each situation. Information for the nurse included the patient's basic biographical data, signs and symptoms that might be present, and the procedures that must be done for the patient. The patient information includes some directions that the nurse does not have. For example, the patient may be instructed to complain of itching and to scratch the right leg.
Faculty worked with the laboratory coordinator to develop a set of materials for each patient situation. To prevent having to prepare new materials each semester, the patient situations, the corresponding order sheets, the identification bracelets, and the chart tags are laminated. Washable overhead transparency pens are used to write on the order sheets. The sheets can then be washed and reused. Each patient's labeled medication bottle can also be reused.
Room dividers separate the laboratory into individual nursing units. Each unit consists of five beds and all the equipment needed for students to provide nursing care to their patients. A supply cabinet contains supplies such as linen, thermometer covers, sphygmomanometers, and other items that may be needed according to the situation. A table is designated the nurse's station, and the nurse must come there to record vital signs and other necessary information on the patient's chart, since recording is one of the skills that is being practiced. This arrangement reflects the way agencies are arranged and can be adjusted to reflect local agency practice.
Two campus clinicals are scheduled, each consisting of two days. Prior to the designated days for campus clinical, students learn and practice several individual skills such as bed -making, ambulating a client, and bathing a client. Students are expected to be familiar with, although not proficient in, all of the procedures that have been taught. Before the scheduled campus clinical days, the students choose partners within their clinical group and decide which one will be the nurse on the first day and which will be the patient. The roles are reversed the following day.
The routine on a campus clinical day is very much like a regular clinical day. Day 1 begins with a preconference of each faculty member with the "nurses," while the patients are reading their situations and getting into their patient roles. For the first set of campus clinical days, all students have the same patient situation. On Day 2, students reverse roles and work with another patient situation. For example, on Day 1 all the patients in a clinical group would be Mrs. Smith and on Day 2 all patients would be Mrs. Brown. When the student who is the patient is a male, the patient would be Mr. Brown.
The patient situations require that the nurse perform a number of skills that have been learned in class, including such things as communication skills, bathing, vital signs, positioning, transferring, ambulating, and recording. The nurse learns to work with intravenous (IV) tubing and bottles as each patient has the tubing taped to their arm. The nurse also begins to learn to organize tasks within a time frame.
During the time that the students are giving care to their fellow students, faculty are closely available to help, to answer questions, and to provide guidance. The curtains between the bed stations can be closed enough to provide some privacy for the student teams, yet open enough to allow the faculty member to see all five student teams at the same time.
In this safe, simulated situation, the student can be allowed to make mistakes. For example, the student patients are coached to get out of the bed and lie on the floor if their nurse leaves the side rail down when leaving the room. Everyone learns because learning, not grading, is emphasized.
The campus clinical ends with a postconference just as a clinical day in an agency would end. There is discussion from both the patients and the nurses about what was learned, what they would do differently next time, and how it feels to be both the patient and the nurse. Because all the students in the group have had the same patient situation, pre- and postconferences are focused and students can discuss mutual problems and concerns.
A few weeks later in the semester, another two-day campus clinical is scheduled. In this second campus clinical, the day also begins with a preconference and ends with a postconference. The laboratory is arranged as in the first set of campus clinicals. More skills have been taught and are incorporated into the situations for these days. For this campus clinical, no two patient situations are alike within any given clinical group. The nurses are given their situation one week prior to the scheduled campus clinical day. This time they must prepare a basic, singleproblem, nursing care plan and must also plan a brief patient education session on an assigned topic as a part of their patient care. Other new skills include transcribing orders and administering oral medications. The medications are coated chocolate candies that resemble tablets.
Benefits of Campus Clinicals
One benefit of these simulated campus clinical activities is that students can integrate a number of individually learned skills and practice them in a safe environment. They are encouraged to ask questions and to experiment, and are allowed to make mistakes in an environment where they know no harm will come to their patient and where they are not being evaluated for a grade.
Students are asked to write a short anonymous critique after each campus clinical. Faculty have used these critiques to make improvements. Some of the comments have included "my instructor praised us as we succeeded and pointed out our mistakes as we made them," "when you're there with us and watching us perform (and pointing out our mistakes during that time) I learn 10 times more," "It is a learning experience that makes one feel good about himself," and "I know now why it is so important to gather your supplies before performing procedures."
Faculty benefit from these campus clinicals in a number of ways. The faculty member can watch all four or five pairs of students at the same time which is seldom possible in the clinical agency. Strengths and weaknesses of individual students can be identified early so that individual learning activities can be planned around specific needs. Faculty are able to stress learning rather than evaluating. All students can be provided an opportunity to perform certain procedure, such as changing a gown over an IV bottle, in a safe environment. Campus clinicals have helped to assure that "the student enters the clinical laboratory with full ability to carry out the practice expectations there" (Infante, 1981, p. 17).
The week following the second campus clinical, the students begin their first clinical agency rotation in a nursing home. They are then able to perform for the nursing home resident those procedures that they have practiced in the campus laboratory setting. The introduction of campus clinicals permits students to make the transition to the clinical laboratory more rapidly. After a short period of orientation to the new environment, evaluation of the student can be done more realistically.
The introduction of campus clinicals has enabled faculty to better utilize material resources. Two well-equipped, 15-bed laboratories on campus are now used more than ever before.
The learning, practicing, and performing of psychomotor skills is an important part of the beginning-level nursing course. In addition to the performance of the skill, beginning students must learn how to enter the private space of another human being in a caring, professional way. The simulated environment with a peer as the patient is a safe way to begin this learning process.
The use of campus clinicals has proven to be a beneficial and enjoyable teaching strategy for beginning students and faculty. It is a method that can be easily adapted for many situations, and makes optimal use of campus laboratory space.
- Cowan, D., & Wiens, V. ( 1986). Mock hospital: A preclinical laboratory experience. Nurse Educator, 11(5), 30-32.
- Duprey, M.P.C., & Patten, B.C. (1986). Playing for proficiency: A new approach to motivation and psychomotor learning. Journal of Nursing Education, 25, 348-351.
- Halla], J.C., & Welsh, M.D. (1984). Using the competency laboratory to learn psychomotor skills. Nurse Educator, 9(2), 34-38.
- Haukenes, E., & Halloran, M.C.S. (1984). A second look at psychomotor skills. Nurse Educator, 9(3), 9-13.
- Infante, M.S. (1981). Toward effective and efficient use of the clinical laboratory. Nurse Educator, 6(1), 16-19.
- Lindeman, C.A. (1989). Curriculum revolution: Reconceptualizingclinicalnursingeducation. Nursing & Health Care, 10, 23-28.