NR 535 Week 7 Clinical Teaching Plan Example

Clinical Teaching Plan: An Eleven-Minute Chest Drainage Round for Two New Graduates on a Busy Step-Down Unit, Built in Three Pieces That Each Survive an Interruption

Student Name

College of Nursing, Chamberlain University

NR 535: Theoretical Foundations and Instructional Strategies for the Nurse Educator

Instructor Name

Month Day, Year

Clinical Teaching Plan: An Eleven-Minute Chest Drainage Round for Two New Graduates on a Busy Step-Down Unit, Built in Three Pieces That Each Survive an Interruption

The Setting

Classroom plans assume a projector, a fixed hour and a quiet room. The unit where I teach, which takes thoracic surgery and pulmonary patients after intensive care, offers none of these. When two new graduate nurses are on shift, the time I can have with both of them together is usually between the morning medication pass and the first discharges, about 1000, and it is rarely longer than eleven minutes before a call light, a family question or a transfer interrupts one of us. The teaching must happen at a real patient's bedside or in the corridor outside the room, with the patient's consent and without delaying care.

This plan describes a short chest drainage round for two new graduates in their second month on the unit, two weeks after their skills lab session. Its purpose is to move what they learned on a task trainer onto real patients, and to find out whether they can check a system aloud without prompting.

Objective

Each nurse will check a real patient's chest drainage system aloud, in the order on the unit's reference card, state what each finding means for that patient and name one thing to watch for during the rest of the shift. The objective combines several from the skills session into one bedside performance. It is deliberately modest. Eleven minutes with two learners at one or two bedsides cannot cover troubleshooting or emergencies; those are practiced in the lab.

Design Principle: Pieces That Survive Interruption

Because interruption is likely, the round is built in three pieces of three to four minutes each. Each piece is complete on its own, so that if the round ends after the first piece, one nurse has still performed and received feedback. The pieces do not depend on each other, and the educator keeps a note of which pieces each nurse has completed across the week, so that an interrupted round can resume the next day where it stopped.

The round uses a brief teaching sequence often used in clinical settings, in which the learner commits to an interpretation before the teacher speaks, the teacher asks for the evidence behind it, and feedback follows at once. Feedback given immediately after direct observation of a specific performance is more useful to learners than general comments given later, and structured observation tools in clinical education are built around that principle (Holmboe et al., 2004).

The Round

Piece 1: First nurse at the bedside, about four minutes. At the bedside of a patient with a chest tube, with the patient's agreement, the first nurse checks the system aloud: position below the chest, tubing without kinks or dependent loops, the water seal for tidaling and bubbling, the suction setting against the order, and drainage since the last mark. The educator says nothing until the nurse finishes. Then the educator asks one question: "What does that tell you about this patient?" The nurse commits to an interpretation. The educator asks, "What made you think so?" and then gives one point of feedback on what was done well and one on what to change.

Piece 2: Second nurse, a different patient if possible, about four minutes. The second nurse repeats the check on another patient, or the same patient if only one is available, with the first nurse watching. The same sequence of questions follows. If the patients differ, for example one on suction with intermittent bubbling and one on water seal with no bubbling, the difference itself becomes the teaching point.

Piece 3: In the corridor, about three minutes. Outside the rooms, each nurse names one thing to watch for in their patient during the shift and what they would do if it happened. The educator adds a general rule that applies beyond these patients, for example that tidaling which stops suddenly needs the tubing checked before anything else is assumed. The educator then records on the tracking sheet what each nurse completed.

Why This Structure

At this point in their development, the nurses are advanced beginners who notice the recurring parts of a situation when someone points them out, yet cannot yet hold the whole situation in view alone (Benner, 1982). The round gives them a real patient, where the whole picture exists, while the reference card and the educator's single question supply the guidance. Asking them to commit to an interpretation before the educator speaks keeps the thinking with the learner. Keeping feedback to one point done well and one to change prevents overload in a setting that already demands attention.

The round also serves as a short form of deliberate practice: a specific task, performed with immediate feedback and repeated over several days until it is reliable (Ericsson, 2004). One round will not make the check automatic. It also helps that the rounds happen on the nurses' own patients. A nurse who has just explained a patient's water seal to the educator at 1000 is more likely to check it carefully again at 1400, and more likely to notice if it changes. The teaching becomes part of the care rather than a pause in it. Four or five rounds across the first weeks, each lasting minutes, will do more than one long session.

When the Round Is Interrupted

If an interruption comes during piece 1, the educator gives the feedback in one sentence and records that piece 1 was completed. If it comes during piece 2, the second nurse is first on the next day's round. If a patient's condition changes during the round, the round stops and patient care takes over; the event becomes material for the next round's discussion. The educator never finishes a piece by taking over the nurse's check, because that would turn the round back into a demonstration.

Evaluation

The tracking sheet shows, for each nurse, how many rounds they have completed, which findings they interpreted correctly and what feedback they received. A nurse who checks three systems correctly without prompting on three different days is signed off on the bedside chest drainage check. The same record lets the educator see whether particular findings, such as bubbling on water seal, are misread more often than others, and adjust the skills session for the next cohort.

References

Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407. https://doi.org/10.1097/00000446-198282030-00004

Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79(10, Suppl.), S70-S81. https://doi.org/10.1097/00001888-200410001-00022

Holmboe, E. S., Yepes, M., Williams, F., & Huot, S. J. (2004). Feedback and the mini clinical evaluation exercise. Journal of General Internal Medicine, 19(5), 558-561. https://doi.org/10.1111/j.1525-1497.2004.30134.x