The Clinical Awareness Learning Model (CALM) for Undergraduate Nurse Education
Purpose / Aims
- To scaffold a structured approach to clinical education that maximizes the development of clinical judgment, leadership, and advocacy skills, and real-time understanding of evidence-based practice in undergraduate nursing education.
- To expose new undergraduate learners to all aspects of clinical learning in a psychologically safe learning environment through the early use of student dyads to the later integration of individualized learning.
Rationale/Background
Current challenges in undergraduate nursing include creating a safe, meaningful and responsive clinical learning environment where student nurses can develop their awareness of the healthcare environment and develop their critical thinking and clinical reasoning. As the clinical environment gains in complexity, supporting students to develop informed decision-making skills has become necessary for safe and effective practice (Parsonage, 2010). Further, trends in nursing literature suggest the need to safely support students to adapt to dynamic clinical environments while their skills in decision making and clinical judgment develop (Benner, Tanner, & Chesla, 2009). In these dynamic environments, it is essential to develop a safe and structured clinical learning model that can promote real-time understanding at all stages of the undergraduate program.
Brief Description of Project
The Clinical Awareness Learning Model (CALM) purposefully integrates four essential concepts into the clinical day: discovery of evidence, direct patient-centered care, communication with the interprofessional team, and effective use of information technology. Students operate in pairs: one student functions as the “body” with primary responsibility for practice-performance. The other student assumes the role of “brain” using information technology and institutional policies to link best-practice and rationale to the actions of the “body” in real-time. Hourly meetings between the “brain” and “body” maximize communication between the two students and other members of the interprofessional team. Learning is supported by ‘Grand Rounds’ mid-shift at which all students can collectively teach, learn, and reflect with their peers about their patient interactions. Adopting the contingency and fading principles of scaffolded instruction, the CALM is adaptable to real time learning and assessment and the gradual progression from dyads to single student clinical practice as learning progresses across the program.
Outcomes Achieved
The outcomes to date include: (a), creating time and space for students to connect evidence to practice in real-time; (b), starting beginning students in dyads and gradually progressing to individual student practitioners as they progress in their program; and (c), generating interest among community partners and other schools of nursing to address a variety of clinical learning obstacles.
Conclusions/ Recommendations
As the environment of healthcare becomes more complex, clinical learning has not kept pace with the changing environment. The literature suggests that graduate nurses have underdeveloped decision making skills and points to the need for nursing education that minimizes clinical deficits (Tanner, 2010). An intentionally scaffolded Clinical Awareness Learning Model provides an environment for students to progressively adjust to dynamic learning experiences and may be an opportunity to safely and purposefully address many of the challenges in real-time and case-based education. Research to determine this is underway.