MOCHAKI N.W NURSE EDUCATOR LIMPOPO COLLEGE OF NURSING

CLINICAL ACCOMPANIMENT Outcomes of the presentation Definition of accompaniment Definition of accompaniment Clinical accompaniment, learning and experience in the clinical setting Clinical accompaniment, learning and experience in the clinical setting Relationship between clinical accompaniment and learning Relationship between clinical accompaniment and learning The Limpopo College of Nursing The Limpopo College of Nursing Improving clinical accompaniment Improving clinical accompaniment

Accompaniment is defined as To go with as a companion, escort, attend’ To go with as a companion, escort, attend’ Conscious and purposeful guidance and support of students in clinical areas, an act of adding completeness or symmetry : It Conscious and purposeful guidance and support of students in clinical areas, an act of adding completeness or symmetry : It focuses on students’ needs. creation of learning opportunities, leading to growth, becoming active participants focuses on students’ needs. creation of learning opportunities, leading to growth, becoming active participants Students become critical thinking practitioners Students become critical thinking practitioners

Accompaniment, learning & experience Learning ensures behavioural change Learning ensures behavioural change Experience differentiates change in behaviour of students Experience differentiates change in behaviour of students Change in behaviour is an indication of maturation process Change in behaviour is an indication of maturation process Accompanist/clinical instructor plays critical role in behavioural change towards professional maturity Accompanist/clinical instructor plays critical role in behavioural change towards professional maturity Choose appropriate experiences Choose appropriate experiences Involve students in such choice of experience Involve students in such choice of experience

Students involved in choosing information/skills/procedures to learn Students involved in choosing information/skills/procedures to learn Involvement means: Involvement means: Sharing information with students Sharing information with students Perceptual field for students Perceptual field for students Mutual experience, Mutual experience, Do not dictate skills/procedure Do not dictate skills/procedure Facilitation of learning Facilitation of learning

Facilitation leads to: Curiosity in students Curiosity in students Excitement and discovery of information eg diseases, health profs and their skills, patients profile, family needs Excitement and discovery of information eg diseases, health profs and their skills, patients profile, family needs These serve as opportunities for: knowledge, skill acquisition, use of these for betterment of care and treatment These serve as opportunities for: knowledge, skill acquisition, use of these for betterment of care and treatment Students also learn holistic care Students also learn holistic care

The Limpopo Province Limpopo College of Nursing Structure Limpopo College of Nursing Structure Limpopo College of Nursing Giyane Sovenga Thohoyandou Clinical teaching areas

Accompaniment in Limpopo Contractual obligation between college & clinical settings, contract not followed properly Contractual obligation between college & clinical settings, contract not followed properly Students grouped to these settings Students grouped to these settings Accompaniment done by tutors Accompaniment done by tutors Allocation list, learning outcomes and content sent to these settings Allocation list, learning outcomes and content sent to these settings Clinical settings have varying profiles Clinical settings have varying profiles Some with good facilities, others not Some with good facilities, others not These imply human & physical resources These imply human & physical resources

Challenges in Limpopo Student factor: Student factor: Large numbers Large numbers Poor behaviour Poor behaviour Low motivation Low motivation Students protests Students protests Questionable SRC role Questionable SRC role Selective on subjects to study e g GNS Selective on subjects to study e g GNS

Physical resource factor Inadequate clinical facilities Inadequate clinical facilities Hospitals classified in terms of facilities Hospitals classified in terms of facilities No offices/places for tutors for break during accompaniment No offices/places for tutors for break during accompaniment Lack or inadequate library Lack or inadequate library

Relationship factor Poor cooperation between college & clinical settings Poor cooperation between college & clinical settings Poor communication between college & clinical settings Poor communication between college & clinical settings Students undermining registered nurses Students undermining registered nurses Lack of professional role models Lack of professional role models

Curriculum factor Inadequate integration of theory-practice Inadequate integration of theory-practice Content-based Content-based Curriculum fragmentation Curriculum fragmentation Overloaded curriculum e g four discipline in 4 years Overloaded curriculum e g four discipline in 4 years Some tutors ill-prepared for accompaniment Some tutors ill-prepared for accompaniment Registered nurses not ready/unwillingness Registered nurses not ready/unwillingness

IMPROVED ACCOMPANIMENT Promoting learning in clinical settings: Promoting learning in clinical settings: Consideration of environmental influence Consideration of environmental influence Participation by students in actual observations and treatment of patients Participation by students in actual observations and treatment of patients Emphasise bedside nursing Emphasise bedside nursing Deliberate plan and involvement of students Deliberate plan and involvement of students Proper facilitation of clinical skill learning Proper facilitation of clinical skill learning

Caring attitude displayed by tutor/instructor Formation of humanistic values Formation of humanistic values Instillation of hope Instillation of hope Sensitivity to self & to students Sensitivity to self & to students Develop helping-trusting relationship Develop helping-trusting relationship Systematic problem solving caring process Systematic problem solving caring process Intrapersonal learning promotion Intrapersonal learning promotion Provide supportive and corrective environment Provide supportive and corrective environment Allowance of feelings Allowance of feelings Listen to students Listen to students

Problems experienced by students Not being regarded as emerging R/N by health team members Not being regarded as emerging R/N by health team members Health personnel antagonism towards students Health personnel antagonism towards students Used as workforce Used as workforce Not allowed to ask questions Not allowed to ask questions Their knowledge disregarded Their knowledge disregarded Lack of work ethics in some health personnel Lack of work ethics in some health personnel Negative feedback on performance (Carlson, Kotze & Van Rooyen 2005:70). Negative feedback on performance (Carlson, Kotze & Van Rooyen 2005:70).

Clinical accompaniment: Research-based or based on models Research-based or based on models Engage students & tutors in research Engage students & tutors in research Proper planning Proper planning Use of relevant assessment system Use of relevant assessment system Tutor/instructor to question own teaching approach Tutor/instructor to question own teaching approach Relevant and up-to-date curriculum Relevant and up-to-date curriculum

College-clinical setting relationship: Hold effective, outcomes based bilateral meetings Hold effective, outcomes based bilateral meetings Open communication Open communication Engage R/Ns in meetings Engage R/Ns in meetings Establish clinical instruction responsibility Establish clinical instruction responsibility Inform clinical settings about curriculum changes Inform clinical settings about curriculum changes Enter into contractual obligation Enter into contractual obligation

Registered nurses roles Act as counselors for students in: Act as counselors for students in: recognizing, facing, accepting and resolving challenges in clinical settings recognizing, facing, accepting and resolving challenges in clinical settings Act as leaders in: initiating and maintaining learning goals through interaction Act as leaders in: initiating and maintaining learning goals through interaction Act as technical experts by: displaying clinical skills, operating, understanding and manipulating equipment Act as technical experts by: displaying clinical skills, operating, understanding and manipulating equipment Act as surrogates : supportive, conflicting resolution Act as surrogates : supportive, conflicting resolution

Use of experiential learning: Stage of concrete experiences: Stage of concrete experiences: Accompanist observes behaviour and intervene to turn problems or unique occurrences into learning experiences Accompanist observes behaviour and intervene to turn problems or unique occurrences into learning experiences Stage o reflective observation: Stage o reflective observation: help students grasp meanings of ideas/situations by impartial description. Students reflect on previous occurrences help students grasp meanings of ideas/situations by impartial description. Students reflect on previous occurrences

Use of Experiential Learning Model (Kolb 1984) Stage of abstract conceptualisation: Stage of abstract conceptualisation: involves concept formation where previous information is organised into meaningful conceptual structure, students engaged in more logical thinking in solving problems involves concept formation where previous information is organised into meaningful conceptual structure, students engaged in more logical thinking in solving problems Stage of active experimentation: Stage of active experimentation: students apply concepts learned into new situations, thus serving as a basis or problem- solving and decision making. Students help change or influence decisions made by accompanist (Kolb 1984) students apply concepts learned into new situations, thus serving as a basis or problem- solving and decision making. Students help change or influence decisions made by accompanist (Kolb 1984)

CONCLUSION The field of clinical accompaniment is broad. Nursing college and clinical settings should collaborate meaningfully to attain accompaniment goals Students must be prepared earlier to take active participation during accompaniment Nurse educators should strive to question and improve their methods used during clinical accompaniment Accompaniment should be consistent with contemporary changes in health care system

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