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Guest Editorial 

From Random Access Opportunity to a Clinical Education Curriculum


Nurse educators have been initiating multiple strategies in response to the current and projected nursing shortage. Increasing the enrollment of nursing students is one such immediate strategy to address the complexity of this problem. However, this strategy alone is simply not sustainable unless substantial changes are made in how nursing schools integrate clinical learning to prepare students. The traditional clinical education model is taxing faculty, facilities, students, and staff, and increasingly relies on the availability of clinical placements. This makes it difficult to ensure that students get a planned experience with a variety of patients. Students need experience with patients across the lifespan, and ample learning experience with patients with prevalent illness and disease should be included (Tanner, 2006). Students also need to understand the trajectory of chronic illness and management of end-of-life care. But the current model of clinical education is increasingly driven by availability of clinical placements, not by experience that correlates with course outcomes or competency development. The traditional model of clinical education has been referred to as “education by random opportunity” (LeFlore, Anderson, Michael, Engle, & Anderson, 2007, p. 170).

The Oregon Consortium for Nursing Education (OCNE) is developing new clinical education practices to complement a shared competency based curriculum that is being delivered throughout Oregon. A group of educators and practice partners associated with OCNE schools was formed with the charge to study current clinical education practices and develop a comprehensive clinical education model that spans the OCNE curriculum.

Curriculum connotes the planned staging of learning activities to accomplish course outcomes. In the case of clinical education, the desired outcome is the students’ ability to apply course competencies in the practice arena and in so doing, to take on the practice of nursing. The term learning model signifies that each model is an integrated set of activities. There are five learning models in the proposed OCNE clinical education curriculum. Learning models build on one another, adding complexity appropriate to the level of the student. The five models are described below.

Focused direct client care experience enables the student to gain progressive experience in the delivery of client care, where the client may be an individual or family in the acute care, long term care, or community care arena. A focused direct client care experience is differentiated from the total patient care experience by carefully identifying the nursing activity or practice to be studied during the clinical time.

Concept-based experience is focused on the outcome of learning, which is associated with an identified concept. In this model, the student is studying the patient regarding the concept to be learned and is not responsible for care outcomes. Students are accountable for all aspects of care provided as a consequence of studying the patient and for patient safety, as well as communication of changes in client condition to the client’s care provider.

Case-based experience provides for practice of clinical judgment and nursing performance through client care exemplars. It encompasses seminar discussion of cases, as well as a variety of simulations, including use of high and low technology manikins, standardized patients, and role-playing. The OCNE curriculum includes a number of “mega-cases” that are designed as exemplars of highly prevalent health care situations.

Intervention skill-based experience has the primary purpose of building proficiency in the “know-how” and “know-why” of nursing practice for those skills best learned through repetition. Common intervention skill-based experiences focus on psychomotor, communication, teaching, and advocacy skills, among others. As the student’s skill level increases, complexity can be added through the integration of the skills into case-based experiences so the student has the opportunity to practice the…


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