An exploration of clinical teaching and learning within a preceptorship model in an acute care hospital in the Republic of Ireland

McSharry, Edel Mary (2013). An exploration of clinical teaching and learning within a preceptorship model in an acute care hospital in the Republic of Ireland. EdD thesis The Open University.



Preceptorship within clinical nurse teaching was introduced in Ireland in 2002. Little is known how this model has impacted upon the pedagogical practices of the preceptor or student learning in clinical practice. An international literature review highlighted the question of what constitutes effective teaching and learning in clinical practice which is the subject of this thesis.

An exploratory qualitative design was used to examine the clinical teaching and learning within the Irish preceptorship model. The sample comprised 13 students and 13 preceptors working together on four clinical areas in one hospital. Data were collected using semi- structured interviews and documentary analysis relating to the teaching and assessment of BNSc (general) students.

Main findings showed preceptors used strategies that fostered performance and understanding such as demonstration, coaching and scaffolding. Participants believed the key to effective learning was interactive dialogue and building the students' confidence within the confines of a consistent mutually respectful relationship where the preceptor had time to teach. Many variations in preceptors teaching practices were illuminated. Some preceptors' utilised teaching methods that had the potential to enhance problem solving and students' self-directed learning ability. However, many did not use or value these cognitive approaches. Yet all preceptors expected students to make appropriate judgements within the unpredictable environment of practice. The student role as learner in many preceptor- students' relationships was not well understood or valued. Some cases of good practice were elucidated where professional education was the focus of students learning. Conversely in many cases the findings suggest that the students' education was driven by service needs and values such as performance, team work and a work ethic. Other professional values such as patient empowerment and critical thinking were not a primary concern.

A best practice clinical teaching and learning model is offered based on the evidence of this study; recommendations as to its further modification and development are discussed. The research demonstrated how concepts such as cognitive apprenticeship (Coli ins 2006), situated teaching and learning in communities of practice (Lave 2009, Wenger 2009), and scaffolding (Vygotsky 1978) can be helpful in understanding the processes entailed in preceptorship. Therefore the research should provide both pragmatic guidance for nurse education in Ireland and more widely, and the development of our understanding about nurse education. The latter will add to the relatively weak theoretical underpinnings of much of the existing literature in nurse education research.

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