Journal of Nursing Education

Syllabus Selections: Innovative Learning Activities Free

Reflective Interprofessional Clinical Observation to Promote Clinical Judgment in Second-Degree Prelicensure Students

Bedelia H. Russell, PhD, RN, CPNP-PC, CNE

The American Association of Colleges of Nursing (AACN) identifies interprofessional communication and collaboration for improving patient health outcomes as one of the Essentials listed in Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008). In addition, recent discussions on reenvisioning the AACN Essentials include a proposed domain and descriptor on interprofessional partnerships (domain 6) (AACN, 2019). Therefore, the prelicensure student's understanding of the interprofessional (IP) health care team member roles and relationships should be a key learning outcome of clinical practicum experiences with substantive IP team member engagement. Student clinical placement in IP observation areas can expand awareness of other areas of patient care (Phillips et al., 2012), as well as provide an opportunity to develop clinical judgment skills (Lasater & Neilson, 2009) to reinforce knowledge of nursing practice.

IP Activity Goals

The two primary goals of the IP activity included creation of a structured clinical observation experience focused on IP role delineation and student reflection on IP role delineation in context of clinical judgment concepts (Lasater & Nielson, 2009). In addition, because students were in the second-degree prelicensure program, principles of andragogy and adult learning theory (Knowles, 1970) were necessary underpinnings for activity development.

IP Activity Implementation

During their first clinical course, 37 second-degree prelicensure students self-selected an interprofessional observation (IPO) site for one of their assigned clinical days. The student cohort was reflective of 10 male and 27 female students with ages ranging from 20 to 45 years. IPO sites available at the regional hospital included respiratory therapy, physical therapy, occupational therapy, radiology, social work/case management, speech therapy, clinical nutrition, or laboratory/phlebotomy. Prior to their assigned IPO clinical day, students were provided with placement information and directed to complete the following preclinical activities:

  1. Identify the professional organization most closely associated with the IP health care team member and compare the educational preparation and scope of practice differences.

  2. Develop three individualized, measurable learning objectives.

  3. Review the operational definitions of clinical judgement concepts (Lasater & Nielson, 2009) and the guiding reflection questions.

Following completion of the IPO day, students submitted a written reflection and attended a postclinical conference to discuss the experience. Examples of guiding reflection questions included:

  • How did the health care team member interact directly or indirectly with patient care and provide examples to support your observations?
  • Provide an example of when the health care professional accomplished the areas of noticing, interpreting, responding, and evaluating (Lasater & Nielson, 2009).
  • What appreciation have you gained for this team member, and how does this new understanding impact your professional development as an RN?

Outcomes Discussion

Per course evaluations, students identified this activity as one of their most influential and memorable experiences. One student noted, “I have an extreme amount of respect now for physical therapy. Until today, I had not realized how closely physical therapy works with nurses…. They seem to have a great working relationship.” Another student stated, “I am glad that we incorporated this IPO day….The more I interact with members of one branch of the health care team, the more comfortable I am in using them, communicating with them, and understanding them in the clinical setting.”

In addition, students appreciated the structure of the assignment and the flexibility to address individual learning objectives in context. The structure was provided with creation of a reflection worksheet to prompt and guide thinking but could then be adaptive in response based on the assigned clinical area. Faculty reported that students could articulate well the IP differences between the RN and other IP team members and reflected progressing clinical judgment competencies (Lasater & Nielson, 2009) in the areas of noticing and responding throughout their written reflections and postclinical conferences. In subsequent clinical courses, faculty reported that students were able to collaborate with other IP health care team members more easily regarding comfort with IP referral requests and overall improved IP communication about client interventions and outcomes. Future application of the activity will be adapted for graduate-level students with an emphasis on IP collaboration at the master's and doctoral levels of advanced practice. The activity reflection worksheet can be easily adapted and individualized to meet the needs of other programs of nursing based on their relative availability of local IP clinical sites.

Bedelia H. Russell, PhD, RN, CPNP-PC, CNE
bhrussell@tntech.edu
Whitson-Hester School of Nursing
Tennessee Tech University

References

  • American Association of Colleges of Nursing. (2008). Essentials of baccalaureate education for professional nursing practice. https://www.aacnnursing.org/Portals/42/Publications/BaccEssentials08.pdf
  • American Association of Colleges of Nursing. (2019). Essentials of baccalaureate education and re-envisioning the AACN essentials. https://www.aacnnursing.org/Portals/42/Downloads/Essentials/Essentials-Revision-Domains-Descriptors.pdf.
  • Knowles, M. S. (1970). The modern practice of adult education: andragogy versus pedagogy. Association Press.
  • Lasater, K. & Nielsen, A. (2009). Reflective journaling for development of clinical judgment. Journal of Nursing Education, 48(1), 40–44 doi:10.3928/01484834-20090101-06 [CrossRef] PMID:19227755
  • Phillips, M., Breakwell, S., Kim, M. & Faut-Callahan, M. (2012). Clinical observation reflections from students in an interdisciplinary palliative care course. Journal of Hospice and Palliative Nursing, 14(4), 274–282 doi:10.1097/NJH.0b013e3182491539 [CrossRef]
Authors
bhrussell@tntech.edu

The author has disclosed no potential conflicts of interest, financial or otherwise.

10.3928/01484834-20210120-14

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