Characteristics of a Clinical Learning Environment
Clinical learning environments (CLE) provide students with invaluable opportunities for applied learning and real-world practice in a guided learning environment, but the flip-side to a CLE is that these very same benefits pose additional challenges to both instructors and students.
For the instructor.
The challenges inherent in teaching in a clinical setting are complex and dynamic in ways that are very different from teaching in classroom, online or simulated environments. They are unpredictable, impossible to control and are largely choreographed by the interplay of a wide range of human interactions. Decisions must often be made quickly, under duress and with limited information available to make clinical judgments. The skills that are necessary for students to learn are difficult to teach and evaluate. Teaching students in clinical areas is a high risk, high responsibility undertaking. Ensuring competent graduate nurses is not an easy task.
For the learner.
The clinical environment is exceedingly stressful and frightening. The fear of the unknown and of causing injury to a patient is embedded into each clinical day to say nothing of feeling incompetent and burdensome (Elliott 2002). It is critical that learners are supported in developing strategies to not only manage clinical stress as a student but coping skills to deal with clinical stress as a graduate. It has been suggested that student nurses have minimal coping skills to manage clinical stress (Evans & Kelly 2004; Lindon 1999) and that clinical instructors play a pivotal role in how students’ progress through the clinical experience (Valiee et al 2015). In a review of a number of different studies done exploring the sources of stress in the clinical practice environment, the behavior of the clinical instructor was consistently identified as one of the most significant stressors for student nurses at all levels (Elliott 2002). In order to reduce the adverse effects of this stress on students as they learn and into the future, it is essential that clinical educators focus on the positive rather than negative, create a supportive learning environment and have a high tolerance for less than perfect behaviours. (Elliott 2002; Beck 1999).
DeBrew and Lewallen (2014) revealed that the skills that nursing faculty considered to be essential for competent nursing practice were not necessarily taught in nursing school. These frequently included effective communication skills and professional comportment, skills that were expected from students but inherently difficult to measure as well as to teach. Allan et all. (2011) referred to this as the hidden curriculum of skills that are expected of students, but not taught.