Or, the story of how a nursing clinical instructor is
attempting to teach the art of nursing
I’m relatively new to clinical teaching. I attended the Colorado
Center for Nursing Excellence’s Faculty Development Seminar in
July of 2007 and began teaching first semester nursing students for
UNC the Fall of 2007. A last minute addition to the faculty because
they had an unexpected resignation, their crisis was my
opportunity. I had the greatest group of nursing students ever
assembled. They didn’t judge me as I bumbled along learning my
new role. We learned together and I will forever be in their debt.
Since then I have had more amazing students and am becoming
much more focused on how I’m using my clinical conference time
with them. In this teaching unit I’m sharing my personal
philosophy of teaching and what has worked well for me in the
hopes that you may join me in my passion for teaching nursing
students the art of nursing.
Gaberson and Oermann (1999) open their book Clinical
Teaching Strategies in Nursing with this astute
observation:
Every clinical teacher has a philosophy of clinical teaching,
whether or not the teacher realizes it. That philosophy
determines the teacher’s understanding of his or her role,
approaches to clinical teaching, selection of teaching and
learning activities, use of evaluation processes and
relationships with learners and others in the clinical
environment” (p. 1).
As a new clinical instructor I didn’t know that I had a “philosophy”
but I “knew” this: that nursing schools were great at turning out
graduate nurses whose heads were full of knowledge and who knew
they needed to be critical thinkers. But many of these new grads
didn’t know how to establish a caring, therapeutic relationship with
a patient.
I wondered, “Where did I learn to do this?” It wasn’t in school – I
learned it from a valued colleague. She told me to slow down, look
my patient in the eye and ask, “How are you doing?” as a start. It’s
made all the difference in my practice and so this business of
building caring relationships into nursing practice has become
what I want to pass along to my students.
So, yes, as even as a new clinical instructor I guess I had a
philosophy and a mission…
I’m an oddball, I’ll admit it – I love nursing theory. A
staff nurse colleague of mine recently came out of
meeting complaining, “Geez! That was the most boring
meeting I’ve ever been too! Teri, you would’ve loved it!”
(It was about theory).
I have many theories that support my practice and
teaching. I won’t bore you with all of them but Carper’s
is one I really can’t get by without. I know you all have
been introduced to Carper’s ideas in Nursing Theory.
You remember… the theory that nursing knowledge has
four discrete patterns.
 Empirics, the science of nursing;
 Aesthetics, the art of nursing;
 Personal knowledge of self as a nurse; and
 Ethics, or moral knowledge, in nursing.
 Nursing science is not enough… even though its
tough and messy we have to help nursing students
achieve “knowing” in all the areas described by
Carper (1979).
In it’s report Health Professions Education and
Relationship-centered Care the Pew-Fetzer Task Force on
Advancing Psychosocial Health Education called for
practitioner education programs to include instruction
in the knowledge, skills, and values necessary for quality
practitioner-patient relationships:
 self-awareness
 understanding of the patient experience of health and
illness
 an ability to develop and maintain caring relationships
 effective communication
Lindeman (1989) says clinical teaching should
emphasize the use of self as a major component of the
care process and the use of a post-experience reflective
seminar or group reflective opportunity to enrich
personal perspective.
(I can hear you say, “Sure, no problem… I’ll get right on
that…”)
So here I was… passionate that nurses should learn how
to develop and maintain caring relationships with their
patients but I had no idea how to teach it…
Thank goodness I’m an “intuitive-feeler” Myer-Briggs
type (INFP) with an accommodator Kolb learning style!
Thanks to a University of Pennsylvania website I know
my leading strength is creativity and per a numerology
reading my purpose in life to “show people new
approaches” (Millman 1993, p.217). All that lead me to
depend on my usual strategy: Develop my own method!
All thinking-judging Myers-Briggs types beware. While I
really have attempted to choose learning exercises that
are sensible this is not something I can really claim
confidence in judging. The only evaluation process my
method has been through is a crude thumbs-up or down
evaluation by my students to the question of whether
they found an exercise valuable.
And while they gave a thumbs-up to everything I’ve put
them through I doubt this evaluation is sound since my
students probably have guessed I find criticism hard to
take…
Clinical
Conferences
Reflection for
Affective Learning
Caring Student-Instructor
Relationships Grounded in
Attachment Theory
 With a foundation of a caring relationship with the
instructor, the nursing student will engage in reflective
writing and clinical conference activities that are
directed at achieving affective outcomes in the clinical
setting.
 Starting with the foundation we’ll go through each
layer of the pyramid…
Sitzman and Leners (2006) report traits students
identify with caring teachers:
 “being non-judgmental, respectful, patient, available,
dependable, flexible, supportive, open, warm, and
genuine, etc.” (p. 255).
 “genuinely caring about what happens to others,
sensitivity to the uniqueness of each student,
promoting awareness of self in each student,
cultivating acceptance of differences in others, sharing
genuine life/professional experiences, and provision of
a supportive emotional, sociocultural, and spiritual
environment” (p. 255).
Okay, so I couldn’t resist another theory! My thanks for
this one goes out to fellow student Mary Beth Wenger.
We enjoyed a great time together a few months ago and
she shared her notes from a conference on attachment
theory. Originally a theory based on research of
children, psychologists have expanded it to adults. I have
found it useful in helping me support nursing students.
Basically the theory says we all want someone to support
us as we go out and explore new experiences and, if and
when we get scared, we want the support of someone
that we perceive to be bigger, stronger, wiser and kind.
I conceptualize my teaching based in an instructor–
student relationship no different than my nursing
practice is based in the nurse-patient relationship. I
strive to establish a caring, supportive relationship with
each student. I tell my students I will do all I can to help
them become the best nurse they can be. I also tell them
I will do all I can to protect them from harm. When they
make a mistake or experience what they perceive is
disapproval or abandonment I make myself available to
“run to”. I try to be the “secure base” and “safe haven” as
conceptualized in the Circle of Security.
Wagner (1998) notes how many nursing students “get
lost in the day-to-day technical ‘doing’ for patients and
lose the sense of ‘self’” (p.3). Wagner (1998) promotes
reflection as how nursing students may become “unlost”.
Johns (1994) states, “Caring is emotional work and as
such, the reflection aims to enable the practitioner to
recognize and value her own feelings” (p. 115).
I require reflective writing following each clinical
encounter to encourage students to consider/recognize/
evaluate the impact of caring actions of self or others on
the patient. The writing is required as an adjunct to
traditional care plans in the clinical setting. A list of
questions for reflection pertinent to the affective domain
is provided in the course syllabus along with simple
instructions. The written work is not graded but is
required and support for their reflective process is
attempted by returning feedback specific to the
student’s “story” or the affective components of their
papers.
I have tried several clinical conference activities over the last
year aimed at achieving affective learning outcomes. I am
amazed at how open and receptive students can be if you let
them know there is no way to fail. Here’s the list so far…
 Share their stories for why they chose nursing
 Values clarification exercise
 Role Model reflection exercise
 Myers-Briggs Type identification exercise
 Learning style identification exercise
 Professional interests exercise
 What makes me happy? exercise
 Strengths identification exercise
 Artistic expression of a memorable caring experience
 I have been working on a new project this semester for
my students. Envisioned as a way to pull together
information from all the clinical conference exercises I
call it “My Nursing Book” and it is a scrapbook of sorts.
I have attached a copy of it as a Microsoft Word
document for your review and it will provide the basis
of the learning activity for this unit.
 I am also in the midst of developing a collection of the
clinical conference materials I use – an instructor
guide of sorts. A few of the pages I am working on will
be posted as well.
Gaberson & Oermann (1999) are so right when they say,
“Clinical learning also produces important outcomes in affect
– beliefs, values, attitudes, and dispositions that are essential
elements of professional practice… Students are socialized into
the role of professional nurse in the clinical setting, where
accountability is demanded and the consequences of choices
and actions are readily apparent” (p. 16,17).
As clinical instructors we have an obligation to provide
learning opportunities that support our students in achieving
these outcomes. I hope my intuitive model may provide “food
for thought” for you as you consider your personal philosophy
of teaching and develop your own personal model.
Thinking back over the last year and remembering the
students that I have had the privilege to teach, I am
struck at the richness of the journey and I realize how
blessed I have been. I have a sense of motherly pride for
all my former students and I can’t help but think that the
reason I feel this way is because I sense in each the value
of caring. I hope that each student will reach their
potential in developing caring patient relationships
because I believe this is what will provide them with the
deep satisfaction that nursing has to offer. As I have told
many of them, they are not guaranteed a rewarding
practice but they will find it if they seek it…