MOCHAKI N.WMOCHAKI N.W

NURSE EDUCATORNURSE EDUCATOR

LIMPOPO COLLEGE OF NURSINGLIMPOPO COLLEGE OF NURSING

CLINICAL ACCOMPANIMENTCLINICAL ACCOMPANIMENT

Outcomes of the presentationOutcomes of the presentation• Definition of accompanimentDefinition of accompaniment• Clinical accompaniment, learning and Clinical accompaniment, learning and

experience in the clinical settingexperience in the clinical setting• Relationship between clinical Relationship between clinical

accompaniment and learningaccompaniment and learning• The Limpopo College of NursingThe Limpopo College of Nursing• Improving clinical accompanimentImproving clinical accompaniment

Accompaniment is defined Accompaniment is defined asas• To go with as a companion, escort, attend’To go with as a companion, escort, attend’• Conscious and purposeful guidance and Conscious and purposeful guidance and

support of students in clinical areas, an support of students in clinical areas, an act of adding completeness or symmetry : act of adding completeness or symmetry : ItIt

• focuses on students’ needs. creation of focuses on students’ needs. creation of learning opportunities, leading to growth, learning opportunities, leading to growth, becoming active participantsbecoming active participants

• Students become critical thinking Students become critical thinking practitionerspractitioners

Accompaniment, learning & Accompaniment, learning & experienceexperience• Learning ensures behavioural changeLearning ensures behavioural change• Experience differentiates change in Experience differentiates change in

behaviour of studentsbehaviour of students• Change in behaviour is an indication of Change in behaviour is an indication of

maturation processmaturation process• Accompanist/clinical instructor plays critical Accompanist/clinical instructor plays critical

role in behavioural change towards role in behavioural change towards professional maturityprofessional maturity

• Choose appropriate experiencesChoose appropriate experiences• Involve students in such choice of Involve students in such choice of

experience experience

• Students involved in choosing Students involved in choosing information/skills/procedures to learninformation/skills/procedures to learn

• Involvement means:Involvement means:

• Sharing information with studentsSharing information with students

• Perceptual field for studentsPerceptual field for students

• Mutual experience,Mutual experience,

• Do not dictate skills/procedureDo not dictate skills/procedure

• Facilitation of learningFacilitation of learning

Facilitation leads to:Facilitation leads to:

• Curiosity in studentsCuriosity in students• Excitement and discovery of information Excitement and discovery of information

eg diseases, health profs and their skills, eg diseases, health profs and their skills, patients profile, family needspatients profile, family needs

• These serve as opportunities for: These serve as opportunities for: knowledge, skill acquisition, use of knowledge, skill acquisition, use of these for betterment of care and these for betterment of care and treatmenttreatment

• Students also learn holistic care Students also learn holistic care

The Limpopo ProvinceThe Limpopo Province• Limpopo College of Nursing StructureLimpopo College of Nursing Structure

Limpopo College of Nursing

Giyane Sovenga Thohoyandou

Clinical teaching areas

Accompaniment in LimpopoAccompaniment in Limpopo

• Contractual obligation between college & Contractual obligation between college & clinical settings, contract not followed properlyclinical settings, contract not followed properly

• Students grouped to these settingsStudents grouped to these settings

• Accompaniment done by tutorsAccompaniment done by tutors

• Allocation list, learning outcomes and content Allocation list, learning outcomes and content sent to these settingssent to these settings

• Clinical settings have varying profilesClinical settings have varying profiles

• Some with good facilities, others not Some with good facilities, others not

• These imply human & physical resourcesThese imply human & physical resources

Challenges in LimpopoChallenges in Limpopo

• Student factor:Student factor:

• Large numbersLarge numbers

• Poor behaviourPoor behaviour

• Low motivationLow motivation

• Students protestsStudents protests

• Questionable SRC roleQuestionable SRC role

• Selective on subjects to study e g GNSSelective on subjects to study e g GNS

Physical resource factorPhysical resource factor

• Inadequate clinical facilitiesInadequate clinical facilities

• Hospitals classified in terms of Hospitals classified in terms of facilitiesfacilities

• No offices/places for tutors for break No offices/places for tutors for break during accompanimentduring accompaniment

• Lack or inadequate libraryLack or inadequate library

Relationship factorRelationship factor

• Poor cooperation between college & Poor cooperation between college & clinical settingsclinical settings

• Poor communication between college Poor communication between college & clinical settings& clinical settings

• Students undermining registered Students undermining registered nursesnurses

• Lack of professional role modelsLack of professional role models

Curriculum factorCurriculum factor

• Inadequate integration of theory-practiceInadequate integration of theory-practice• Content-basedContent-based• Curriculum fragmentationCurriculum fragmentation• Overloaded curriculum e g four discipline Overloaded curriculum e g four discipline

in 4 yearsin 4 years• Some tutors ill-prepared for Some tutors ill-prepared for

accompanimentaccompaniment• Registered nurses not Registered nurses not

ready/unwillingnessready/unwillingness

IMPROVED ACCOMPANIMENTIMPROVED ACCOMPANIMENT

• Promoting learning in clinical settings:Promoting learning in clinical settings:

• Consideration of environmental influenceConsideration of environmental influence

• Participation by students in actual Participation by students in actual observations and treatment of patientsobservations and treatment of patients

• Emphasise bedside nursingEmphasise bedside nursing

• Deliberate plan and involvement of Deliberate plan and involvement of studentsstudents

• Proper facilitation of clinical skill learning Proper facilitation of clinical skill learning

Caring attitude displayed by Caring attitude displayed by tutor/instructortutor/instructor

• Formation of humanistic valuesFormation of humanistic values• Instillation of hopeInstillation of hope• Sensitivity to self & to studentsSensitivity to self & to students• Develop helping-trusting relationshipDevelop helping-trusting relationship• Systematic problem solving caring processSystematic problem solving caring process• Intrapersonal learning promotionIntrapersonal learning promotion• Provide supportive and corrective environmentProvide supportive and corrective environment• Allowance of feelingsAllowance of feelings• Listen to studentsListen to students

Problems experienced by Problems experienced by studentsstudents

• Not being regarded as emerging R/N by health Not being regarded as emerging R/N by health team membersteam members

• Health personnel antagonism towards studentsHealth personnel antagonism towards students

• Used as workforceUsed as workforce

• Not allowed to ask questionsNot allowed to ask questions

• Their knowledge disregardedTheir knowledge disregarded

• Lack of work ethics in some health personnelLack of work ethics in some health personnel

• Negative feedback on performance (Carlson, Negative feedback on performance (Carlson, Kotze & Van Rooyen 2005:70).Kotze & Van Rooyen 2005:70).

Clinical accompaniment:Clinical accompaniment:

• Research-based or based on modelsResearch-based or based on models

• Engage students & tutors in researchEngage students & tutors in research

• Proper planning Proper planning

• Use of relevant assessment systemUse of relevant assessment system

• Tutor/instructor to question own Tutor/instructor to question own teaching approachteaching approach

• Relevant and up-to-date curriculumRelevant and up-to-date curriculum

College-clinical setting College-clinical setting relationship:relationship:

• Hold effective, outcomes based bilateral Hold effective, outcomes based bilateral meetingsmeetings

• Open communicationOpen communication

• Engage R/Ns in meetingsEngage R/Ns in meetings

• Establish clinical instruction responsibilityEstablish clinical instruction responsibility

• Inform clinical settings about curriculum Inform clinical settings about curriculum changeschanges

• Enter into contractual obligationEnter into contractual obligation

Registered nurses rolesRegistered nurses roles• Act as Act as counselorscounselors for students in: for students in: recognizing, facing, accepting and resolving recognizing, facing, accepting and resolving

challenges in clinical settingschallenges in clinical settings

• Act as Act as leaders leaders in: initiating and maintaining in: initiating and maintaining learning goals through interactionlearning goals through interaction

• Act as Act as technical expertstechnical experts by: displaying clinical by: displaying clinical skills, operating, understanding and manipulating skills, operating, understanding and manipulating equipmentequipment

• Act as Act as surrogates surrogates : supportive, conflicting : supportive, conflicting resolution resolution

Use of experiential learning: Use of experiential learning:

• Stage of Stage of concrete experiencesconcrete experiences: :

• Accompanist observes behaviour and Accompanist observes behaviour and intervene to turn problems or unique intervene to turn problems or unique occurrences into learning experiencesoccurrences into learning experiences

• Stage o Stage o reflective observation:reflective observation:

help students grasp meanings of help students grasp meanings of ideas/situations by impartial ideas/situations by impartial description. Students reflect on description. Students reflect on previous occurrencesprevious occurrences

Use of Experiential Learning Model (Kolb Use of Experiential Learning Model (Kolb 1984)1984)• Stage of Stage of abstract conceptualisation: abstract conceptualisation: involves concept formation where previous involves concept formation where previous

information is organised into meaningful information is organised into meaningful conceptual structure, students engaged in conceptual structure, students engaged in more logical thinking in solving problemsmore logical thinking in solving problems

• Stage of Stage of active experimentationactive experimentation:: students apply concepts learned into new students apply concepts learned into new

situations, thus serving as a basis or situations, thus serving as a basis or problem-solving and decision making. problem-solving and decision making. Students help change or influence decisions Students help change or influence decisions made by accompanist (Kolb 1984)made by accompanist (Kolb 1984)

CONCLUSIONCONCLUSIONThe field of clinical accompaniment is broad. The field of clinical accompaniment is broad.

Nursing college and clinical settings should Nursing college and clinical settings should collaborate meaningfully to attain collaborate meaningfully to attain accompaniment goalsaccompaniment goals

Students must be prepared earlier to take Students must be prepared earlier to take active participation during accompanimentactive participation during accompaniment

Nurse educators should strive to question Nurse educators should strive to question and improve their methods used during and improve their methods used during clinical accompanimentclinical accompaniment

Accompaniment should be consistent with Accompaniment should be consistent with contemporary changes in health care contemporary changes in health care system system

THANK YOUTHANK YOU