Running head: DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
Dedicated Education Units compared to Traditional Clinical Units in Undergraduate Nursing
Programs
Samantha Soto BSN, RN-BC, MSN Candidate
University of Central Florida
1
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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Abstract
Background: The nursing shortage is complicated by an aging population of nurses, inability to
accept all qualifying applicants to programs, rising stress levels for practicing nurses, high
turnover rates, and a shortage of faculty. (American Association of Colleges of Nursing, 2014)
Aim of the study: This integrated literature review (ILR) examined whether dedicated education
units compared to traditional nursing programs improves nursing student education
Method: Multiple databases were examined with criteria including: studies published from 2004
to present day; studies must be of the nursing discipline, and nursing studies utilizing the DEU
with both quantitative and qualitative results.
Findings: Three themes emerged: environment, clinical skill development, and QSEN
Competencies. The DEU not only provides an optimal environment for nursing students to learn
in the clinical setting, but also improves student education by helping students forge professional
relationships; it establishes professionalism and accountability; increases student satisfaction;
may segue in to shorter orientation periods once student nurses become licensed; provides a
platform conducive to learning assessment skills; and can easily incorporate QSEN
competencies.
Conclusions: It is certain that the DEU provides an improved clinical environment for nursing
students to practice and learn; yet there remains speculation regarding how the DEU correlates to
NCLEX performance and cost benefit
Keywords: dedicated education unit, dedicated learning unit, clinical
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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Table of contents
Introduction………………………………………………………………………………………p4
Significance and Background…………………………………………………………...……….p4
Research Question……………………………………………………………………………….p6
Methods…………………………………………………………………………………………..p6
Findings………………………………………………………………………………………….p9
Environment……………………………………………………………………………...p9
Clinical skill development……………………………………………………………...p10
QSEN Competencies…………………………………………………………………...p12
Recommendations………………………………………………………………………………p15
Conclusions……………………………………………………………………………………..p18
References………………………………………………………………………………………p20
Figure 1…………………………………………………………………………………………p23
Appendix A……………………………………………………………………………………..p24
Appendix B……………………………………………………………………………………..p29
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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Dedicated Education Units compared to Traditional Clinical Units in Undergraduate Nursing
Programs
By 2022 the estimated need for nurses will reach 1.05 million according to Employment
Projections 2012-2022 from the Bureau of Labor Statistics. According to the National Council of
State Boards of Nursing (2013, 2012, 2011, &2010) 210,550 prospective registered nurses (RN)
passed their National Council Licensure Examination (NCLEX) boards in 2013; 194,898 in
2012; 204,482 in 2011; and 197,775 in 2010. From 2014 to 2022 the discipline of nursing has 8
years to satisfy this growing need and appeal for 1,050,000 RNs or even more staggering
840,000 nurses per year that we need to produce for US alone. Inability to meet these demands
are further complicated by an aging population of nurses, inability to accept all qualifying
applicants to programs, rising stress levels for practicing nurses, high turnover rates, and a
shortage of faculty. (American Association of Colleges of Nursing, 2014).
Significance and Background
The American Association of Colleges of Nursing’s (AACN) (2014) 2013-2014
Enrollment and Graduate in Baccalaureate and Graduate Programs in Nursing presents the
startling statistic that 78,089 qualified applicants were turned away from baccalaureate nursing
schools related to a lack of faculty, clinical sites, classroom space, clinical preceptors, and budget
restrictions. Within this survey two-thirds of the nursing schools that replied with faculty
shortage as reason for not accepting baccalaureate applicants. Furthermore, The AACN’s
Special Survey on Vacant Faculty Positions states that currently there are 1,358 faculty
vacancies. As a multi-faceted issue, realistically there is no easy solution. Solutions must arise
via different venues from macro to micro levels working cohesively with similar objectives.
Ironside and McNelis (2010) in Clinical Education in Prelicensure Nursing Programs
discuss ratio of faculty to students, restrictions on number of students in clinical, lack of
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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qualified clinicians to serve as preceptors, and unwillingness of qualified clinicians to serve as
preceptors as part of barriers to improving clinical learning experiences. Utilizing an
interdisciplinary design, hospital and university administrators, nursing faculty, nurse managers,
and hospital staff RNs are making strides to ameliorate the nursing shortage via the dedicated
education unit (DEU). Commenced in Australia by Flinders University in 1999 by Edgecombe,
Wotton, Gonda, & Mason, the DEU is capable of relieving faculty shortages around the world.
Acquiring this influence, the University of Portland was first to construct a DEU along with its
clinical partners within the US in 2003. (University of Portland, 2007)
The infrastructure of the DEU design focuses on academic and clinical relationships, unit
selection, faculty role, staff nurse role, communication, and quality assurance. Within the
academic and clinical relationship, a traditional clinical unit (TCU) requires relationships that are
cooperative in nature, and clinical placements are scheduled. The DEU sustains its pledge to its
mission, and overall quality of clinical education. It supervises construction and processes of
quality and its relationships are built on trust and collaboration. The unit selection process differs
with the (TCU) acquiring clinical units with variation of quality and commitment to teaching is
inconsistent amongst mentors. A clinical unit voluntarily commits to becoming a DEU where
high quality and efficiency are priority; along with its commitment to teaching. The faculty role
is of significant difference between the DEU and TCU. Traditionally the faculty role manages a
maximum of 8-10 nursing students; is in charge of scheduling patient assignments, evaluations,
and educating students one to one. Faculty in the DEU manage 8-16 nursing students, offers
coaching and professional development for the staff nurse, known here as the clinical instructor.
The staff nurse, mentor and clinical instructor within the DEU, must express their desire to teach,
can teach 1-2 students, and is committed for the entire rotation to those 1-2 students. In the TCU
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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mentor qualifications vary, students may not be consistently assigned to the same staff nurse, and
the staff nurse can be assigned 1-2 students. Communication for DEU is formal and informal,
whereas the TCU lacks formal communication altogether and informal communication varies.
Quality assurance in the TCU lacks evaluation and within the DEU evaluation is utilized to
monitor fidelity. For an illustrative description of the DEU please refer to figure 1. (University of
Portland, 2007)
Research Question
The purpose of this integrated literature review (ILR) is to investigate and determine if in
nursing students, how do designated education units, compared to traditional clinical units,
improve student education? The DEU is a relatively new format of clinical education that
several high ranking nursing schools have begun to utilize, bringing attention to it and making it
worthy of further investigation.
Methods
Search Terms and Definitions
Moscatto and colleagues (2007) define the DEU as clinical units with an optimal learning
experience where staff nurses are clinical instructors and mentors to students. The faculty
member works in conjunction with clinical instructors and nurse managers to enhance clinical
teaching and definitively assisting the transformation of didactic information to the clinical
setting. Finally, the DEU ameliorates the nursing shortage by increasing the capacity of nursing
students per faculty member. This ILR was conducted by first determining search terms and
definitions, assessing inclusion and exclusion criteria, evaluating validity and findings, and
finally determining presenting themes. A total of 22 searches were conducted with singular and
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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combination key words to produce an exhaustive search for pertinent items. Key words used
were: dedicated education unit, dedicated learning unit, and clinical. Queries used the following
terms: dedicated education unit*, dedicated learning unit*, dedicated module, nurs*, student*,
clinical, program, initiative, PT research, AB study, SU research, SU studies, and PT clinical
trial*.
Inclusion and Exclusion Criteria
Criteria for inclusion were: studies published from 2004 to present day; studies must be
of the nursing discipline, and nursing studies utilizing the DEU with both quantitative and
qualitative results. Exclusion criteria were articles of other health professions, any nursing study
articles that did not describe enhancement of learning via the DEU, and online programs.
The first search yielded 987 results including academic journals, journals, magazines,
reports, and books from the following databases: CINAHL Plus with Full Text, Alt Health
Watch, Biological Abstracts 1969 - Present, Cochrane Central Register of Controlled Trials,
Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Database of
Abstracts of Reviews of Effects, ERIC, Health and Psychosocial Instruments, Health Source Consumer Edition, Health Source: Nursing/Academic Edition, Health Technology Assessments,
MEDLINE, PsycARTICLES, PsycBOOKS, PsycINFO, SPORTDiscus, and Academic Search
Premier. Searches continued eliminating magazines, books, and reports. The 22nd and final
search utilized CINAHL Plus with Full Text, ERIC, Health Technology Assessments,
MEDLINE, PsycINFO, and Academic Search Premier. This search yielded 38 articles that were
further reviewed for the ILR table. For full disclosure of databases, keywords used in each
search, and results please refer to Appendix A.
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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Validity of Findings
To improve validity of findings several searches were conducted, criteria for levels of
evidence and validity were graded utilizing Melnyk and Fineout-Overholt’s (2011) Evidencebased practice in nursing and healthcare: A guide to best practice, as many random control trials
available were included, results were consistent across multiple data, and search strategies have
been described.
Themes
Emerging themes from the exhaustive review of literature indicate: environment, clinical
skill development, Quality Safety Education for Nurses (QSEN) competencies, student
satisfaction, development of the clinical instructor, confidence and independence in practice, and
forging of professional relationships. Please refer to Appendix B for Table 2, a complete table of
evidence.
Findings
A total of 38 articles were yielded from the final search, of these 23 were excluded
because they did not meet the set inclusion criteria for the ILR. Finally 15 published studies
were included in the ILR table. All 15 published studies are from nursing journals. There are six
level 6 case reports, four level 4 cohort studies, three level 3 controlled trials, and two level 2
random control trials (RCT). The entire sample size was 2052 participants consisting of 1673
nursing students, 277 staff nurses/clinical instructors, 43 clinical faculty, 12 nurse administrators,
35 nurse managers, and 12 university faculty administrators. Nursing students were junior and
senior level with the exception of one study from Australia reporting first through third year
students in their study. Three studies report two or more years of clinical experience by the
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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clinical instructor or staff nurse. One study revealed criteria for the CI as having participated in a
preceptor program prior to engaging in the DEU.
Environment
Environment is described as those conditions that surround someone or something and
influence its growth, health, and progress (Merriam-Webster’s online dictionary, 2014).
Familiarity, acceptance, trust, support, respect and recognition of their contribution, emotional
and clinical support, education based on current evidence, and opportunities to practice are all
elements that nursing students place great value on (Chan, 2004). Nursing students often report
unsatisfactory experiences with placement and expect hostility in the clinical environment. They
require an environment where they can practice clinical skills and are offered opportunities to
learn new skills and link theory to practice. Education in the clinical environment is contingent
upon the quality of mentorship (Emanuel & Pryce-Miller, 2013).
Six of the studies entered in this ILR discussed or proposed discussion regarding the
learning environment. Phrases such as, “impact on ward,” “learning environment,” “learning
atmosphere of the unit,” “environment of the DEU” were mentioned. The impression of the
learning environment for the student nurse on the DEU was welcoming and open. One student
stated “you actually forgot you were a student because you felt so welcome.” Another student
nurse voiced this comment, “there was a lot of respect given to you even though you were a
student nurse they didn’t actually see you as a student nurse, you were a nurse in the process of
learning. You were respected and made part of the team.” One study stated the clinical setting
should foster experiences that promote student learning and development and that staff members
carry the responsibility of being supportive, working together to communicate effectively as a
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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team and individually (Gaberson & Oermann, 2010). Another study reported statistics for
clinical instructors and student nurses for “learning atmosphere of the unit” between the DEU
and traditional clinical unit with the following data from nursing students: DEU n=518, M(SD)
5.09(0.72) and traditional clinical unit (n=525 4.55[0.91]). Results from clinical instructors
were: DEU n=69, M(SD) 5.18(0.56) and traditional clinical unit n=53, M(SD) 4.67(0.78) with
SE=0.428(0.198) and z=2.17, P<.03 and g=0.645. (Nashioka, Coe, Hanita, & Moscato, 2014)
These results indicate a strong presumption against the null hypothesis, interpreted as the DEU
does provide a “learning atmosphere.” Both DEU responses have a smaller standard deviation
indicating lesser variance in responses than traditional clinical units. According to Benner,
Sutphen, Leonard, and Day (2010) nurses are educated and practice in suboptimal environments.
This study reports that nurses learn to perform under tumultuous circumstances and present
health care establishments are not well-planned for good nursing and medical practice or
education. The DEU not only provides an optimal environment for nursing students to learn in
the clinical setting, but also improves student education by helping students forge professional
relationships, it establishes professionalism and accountability, increases student satisfaction, and
may segue in to shorter orientation periods once student nurses become licensed.
Clinical skill development
Assessment skills
Eight studies in this ILR address clinical skill development as a predominant theme.
Assessment, one of the essential components in the nursing process, includes collecting data for
physiological, psychological, sociocultural, spiritual, economic, and life-style factors (ANA,
2014). As a fundamental pedagogy in the profession of nursing, it is stated by the Florida Board
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of Nursing in the Nurse Practice Act: Rules of the Board of Nursing (2007) that to prepare
competent nurses a program must consist of 50% clinical experiences. Within the studies
identified in this ILR, physical assessment, documentation, use of tools in the clinical setting,
and clinical judgment are discussed. Mulready-Shick, Flanagan, Banister, Mylott, and Curtin
(2013) utilize an instrument titled Growth in Clinical Learning where students from both the
DEU and traditional clinical setting were both surveyed for: growth in nursing knowledge;
growth in clinical skills development, including clinical judgment; and growth in ethical and
professional behavior development. For the first item, “growth in clinical knowledge” DEU
students perceived greater growth (DEU M=4.78, traditional students M=4.30; F=18.72; p<0.01
on a scale ranging from 1=no growth to 5= a great deal of growth). For the second item,
“growth in clinical skills development, including clinical judgment,” DEU students observed
greater growth than traditional clinical unit nursing students (DEU M=4.76, traditional students
M=4.13; F=26.95; p<0.01). For the third item surveyed, “growth in ethical and professional
behavior development” again, DEU students perceived greater growth (DEU M=4.66, traditional
students M=4.22; F=12.11; p<0.01). The DEU improves student education by providing an
enhanced forum conducive to learning assessment skills.
Development of social skills in clinical environment
Four articles emerge with the theme of how nursing students develop social skills in the
clinical environment. According to Newhouse, Hoffman, Suflita, and Hairston (2007) the first
year of practice for new graduates is often met with strife and distress. Fifty percent of nurse
turnover in some hospitals consists of new graduates. Within their first year of practice, 35%60% of new graduates will change their place of employment. Also, 30% of new graduates will
leave their first job within one year, and 57% within 2 years. Found in this ILR were studies
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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highlighting the development of social skills such as the Nurse-to-Nurse Collaboration Scale
(NNCS) used by Moore and Nahigian (2013) when results for “shared processes,”
“communication,” “coordination,” and “conflict management” were tested. Each one of these
subdomains was scored as a 4 point Likert-type scale with 1=strongly disagree to 4=strongly
agree. For “shared processes” DEU students rated this domain higher than nursing students in
the traditional clinical setting (p=0.01). In the subdomain of “conflict management” DEU
students perceived that best possible solutions were achieved (p=0.01). In the “communication”
subdomain researchers state that there was only a significant difference in one item titled “I can
think of times when I received incorrect information from nurses on this unit” where nursing
students from the traditional units scored higher (p=0.01). Finally, for the subdomain
“coordination” DEU students scored higher for “there are written evidence-based treatment
protocols” than nursing students in the traditional clinical setting. The DEU enhances nursing
education by setting the foundation for socialization and removing barriers between nursing
students and preceptors. Moscato, Miller, Logsdon, Weinberg, and Chorpenning (2007) report
statements such as, “it is nice that the layer between you and the student is removed,” and “I like
watching my students grow.”
QSEN Competencies
Three studies in this ILR researched the DEU with incorporation of QSEN competencies.
The Health Professions Education Summit conducted on June 17 and 18, 2002 was a landmark
gathering consisting of over 150 health professionals. A major report titled Health Professions
Education: A Bridge to Quality by the Institute of Medicine of National Academies presented
findings concluding that health professionals were not being effectively equipped to deliver the
highest and safest care and that competencies had inadequate follow up. The summation of this
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meeting concluded in the establishment of five core principles. They are: patient-centered care,
working as part of an interdisciplinary team, practicing evidence-based medicine, focusing on
quality improvement, and using information technology. (IOM, 2003) Funded by the Robert
Wood Johnson Foundation, the Quality and Safety Education for Nurses (QSEN) Initiative was
established in 2005 with a purpose of achieving all five of the IOM’s competencies in nursing
along with one for safety.
In a study conducted by Mulready-Shick et al. (2013) the DEU nursing students stated
significantly more opportunities to develop four of the six competencies; teamwork and
collaboration, informatics, quality improvement, and safety. Utilizing a QSEN Competency
Development Scale, Mulready-Shick et al (2013) report on a rating scale: 1 = never to 4 = very
often, that for teamwork and collaboration, the DEU average scores were 4.78 and for TCU
students 4.53 (F=6.68; p<0.01). For informatics DEU students reported average score of 4.56
and TCU students 4.00 (F=21.82; p<0.01). Quality Improvement resulted with DEU averaging
4.59 and TCU students 4.22 (F=10.44; p<0.01). Finally Safety results for the DEU were 4.95
and TCU students 4.82 (F=3.15, p<0.01).
In a study by McKown, McKown, and Webb (2011) DEU students were to describe
examples of the QSEN domains. One hundred forty-eight students’ log entries collaboratively
reported the following efforts towards QSEN competencies. For teamwork and collaboration, 44
students stated that they consulted physicians; 32 students clinical teachers; 19 medical social
workers, 17 physical therapists, 14 case managers, 13 clinical specialists, and 11 speech
therapists. For evidence based practice (EBP) 99 students utilized Mosby’s RN Drug Book; 52
students used Taber’s Cyclopedic Medical Dictionary; 42 used Mosby’s Diagnostic & Lab; and
8 utilized hospital intranet or internet. In the competency of patient-centered care, 76 students
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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responded that they were involved with scheduling of care; 51 students were involved with
comfort measures; and 11 students were involved with discharge. Quality Improvement was
indicated by 29 students in fall prevention; 28 students reported using patient protocols; and 20
medication safety. Finally for the competency of Safety, again 30 students reported fall
prevention and 21 reported medication administration as the most common safety issues reported
by DEU students. QSEN competencies are now being incorporated in the creation and curricula
of dedicated education units further enhancing nursing student education.
Gaps and Limitations
Gaps are evident in cost analysis and funding of the DEU therefore the future
construction of DEUs should be approached with caution. Many questions exist for future
investigation such as: “what type of investment is required?” “does the DEU increase profits to a
hospital?” “should the investment be viewed as short term or long term?” Limitations of sample
size within individual studies were noted. In order for a study to accurately represent population
sample size must be ample to display its characteristics appropriately. For adequate comparison
there was a lack of randomization in the student sample, lack of control group, and lack of
historical data. Some studies indicated and interview process for selection of clinical instructors
while others were hand-picked by their nursing directors. There was inconsistent information as
to whether relationships had already been established between hospitals and nursing schools.
Some DEUs had already been established for several semesters while others being tested were
new. Finally, QSEN logs displayed redundancies in some domains, psychometric testing of the
QSEN log in the future may help to prevent this (McKown, McKown, & Webb, 2010)
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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Recommendations
The DEU improves nursing student education in its entirety. It not only provides an
enhanced clinical environment its benefits are three fold. Nursing students learn in a welcoming
and consistent clinical environment, current staff nurses have the opportunity to assist in the
formation of incoming colleagues, and it ameliorates the nursing shortage. Recommendations
regarding evident themes were graded with Strength of Recommendation Taxonomy (SORT)
and described below.
Recommendation #1, Level A: Enhancement of Clinical Environment
A nurse’s ability to provide sound, safe, and quality care depends largely on environment.
To obtain and maintain an excellent standard of education and to enhance the clinical
environment, it is recommended certification, accreditation, and regulation be conducted of each
DEU through an applicable board. This process would facilitate standardization across all DEUs
in the US and ensure that all nursing students participating are receiving similar experiences.
Regulation would specify criteria for eligibility of an institution, application process, and how
and when certification can occur. It provides continuous monitoring for the safety of all parties
involved (DeNisco & Barker, 2013).
Conveying nursing’s obligation to society is imperative in the enhancement of the clinical
environment. A nursing student must understand their duty to the public. Understanding the
Code of Ethics for Nursing established by the American Nurses Association (ANA) is a
foundational document in nursing that discusses how nurses practice; commitment to people
whether individual or an entire community; promotion and advocacy of safety, health, and rights
of patients; responsibilities and accountability; duty self and professional growth; establishing,
maintaining, and improving health care environments; participation in advancement of the
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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profession; collaboration with other health professionals to accomplish health goals; and finally
the obligation of helping shape social policy and maintain our values and integrity. (ANA, 2010)
Student nurses need to know and understand the Nurses’ Bill of Rights also established by
the ANA (2014). This document discuses core values for what it is to be nurse and would
introduce a potential nurse to the ideals of how a nurse should practice. For example, “nurses
have the right to work in an environment that is safe for themselves and for their patients.” The
document would encourage a nursing student to speak up regarding dangerous circumstances for
the patient or the nursing student. “Nurses have the right to freely and openly advocate for
themselves and their patients, without fear of retribution.” This declaration educates the student
nurse regarding the importance of speaking for patients with ease.
Recommendation #2, Level A: Enhance DEU curriculum
To enhance current DEU curriculum several strategies can be employed. Development
of a routine for daily practice is a concern voiced within the literature. Although a nurse’s day
can be chaotic in nature some may argue that it is “organized chaos.” The ability of a nurse to
continuously prioritize is imperative to the safety of their patients. Establishing a routine, time
management, prioritization, organization, delegation, and team work all go hand in hand.
Nursing students must be taught to begin their work day with a plan and anticipated routine. All
of this together assists the student in becoming an independent practitioner.
The DEU curriculum should include assessment, diagnosis, outcomes and planning,
implementation and evaluation (ANA, 2014).
Going beyond skills check-list is necessary for a
student to truly appreciate a satisfactory clinical assessment. Satisfactory demonstration with a
side by side clinical instructor that questions and teaches the nursing student regarding
assessment within its context offers an improvement to the TCU. Nursing diagnoses are often
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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preventative in nature and planning go hand-in hand. Identification of potential hazards is
crucial to the protection of the patient. It is recommended that the DEU contain this form of
documentation and that student nurses be educated on its significance. Implementation of patient
objectives can be further examined in outcomes. Evaluation within the clinical setting at interval
timing such as monthly would improve and ensure nursing students are on track to meeting
objectives. Whether formative or summative, evaluations can provide evidence to facilitate
curricular changes in this setting.
Recommendation #3, Level A: Development of DEU Instructors
The DEU model decreases the amount of face to face time between faculty and nursing
students considerably as the student to faculty ratio increases. Students spend most of their day
with clinical instructors and gain a greater amount of knowledge from working with them as
opposed to the faculty member. Development of DEU instructors can only improve the DEU
experience. DEU instructors should be encouraged to certify once available, learn teaching
strategies for the clinical environment, and advocate for a differential in salary.
Certification would offer standardization and assumes a level of knowledge. It promotes
the values of the DEU and guarantees safety to the nursing students and patient population being
worked with. Continuing education for certification also assumes the clinical instructor’s
knowledge base is kept relevant. Certification also validates the clinical instructor as a nursing
professional. The clinical instructor can be proud of accomplishing a goal and assisting in the
development of new colleagues.
To ensure clinical instructors assist in meeting clinical objectives they too should be
educated on teaching strategies and methods of integration for nursing students and new nurse
graduates. Benner, Sutphen, Leonard, & Day’s (2010) Four Essential Shifts for Integration
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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should be incorporated in the development of clinical instructors. For example, “shift from focus
on covering decontextualized knowledge to an emphasis on teaching for a sense of salience,
situated cognition, and action in particular situations” discusses how the educator, in this case the
clinical instructor, teaches nursing students how to select the most important details from and
array of information. Learning to determine what is most important in a particular situation can
prevent dangerous situations. The second shift, “shift from a sharp separation of clinical and
classroom teaching to integration of classroom and clinical teaching,” This is where clinical
instructor and faculty must collaborate to facilitate transfer of didactic information to the clinical
environment. The DEU clinical instructor’s awareness is imperative. The third shift, “shift from
an emphasis on critical thinking to an emphasis on clinical reasoning and multiple ways of
thinking that include critical thinking,” is most likely not the way most clinical instructors were
taught themselves, however the clinical instructor learning that many forms of thinking are
correct will assist them in identifying the learner’s method of thinking. Lastly, the fourth shift,
“shift from an emphasis on socialization and role taking to an emphasis on formation,” is crucial
in the transformation of the profession of nursing. `It implies that founded in meanings, content,
intent, and practice rather than being socialized externally. We develop senses, aesthetics,
perceptual acuities, relational skills, knowledge, and dispositions that all help form nursing
identify. (Benner, Sutphen, Leonard, & Day, 2010)
Conclusions
The DEU provides an improved clinical environment for nursing students to practice and
learn; yet there remains speculation regarding how the DEU correlates to NCLEX performance
and as to how cost efficient it is. Nursing students in the DEU setting make positive reports on
many levels, however the differences in how well DEU students assimilate data compared to
DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
19
TCU nursing students would require further quantitative research. On a positive note, the DEU
increases the capability for a clinical faculty member to address up to 18 nursing students, more
than double the current standard in a TCU. It also encourages bedside nurses to be part of the
formation of new colleagues, including them in the process of integration, increasing their value
to the profession of nursing and self.
Nurse educators should advocate for the development of future DEUs and continue
evaluation of its design, implementation, curriculum, and effectiveness. The DEU may be novel,
but it is encouraging. It pioneers professional relationships between nurses at all levels and from
different arenas. It connects nurse administrators, faculty, nurse managers, bedside nurses, and
student nurses all with different levels of education promoting education of our next generation.
The DEU enables nursing students to provide best practice safe and quality care in the near
future.
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DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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DEUs COMPARED TO TRADITIONAL CLINICAL UNITS
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Figure 1. Model of Clinical Instruction-DEU
Note. The Model of Clinical Instruction-DEU is from Moscato et. al. (2007). The model of the
DEU includes a Nurse Manager and Clinical Faculty Coordinator whom then delegate to clinical
instructors that teach nursing students.