Clinical practice of new nurse graduates in Lebanon: challenges and perspectives through the eyes of preceptors.

New nurse graduates continue to experience difficulty balancing their preparation for practice with the expectations of the workplace. Few studies have explored the transition practices of nurse graduates through the challenges that they experience. This article presents the findings of a research study that explored the perceptions of preceptors regarding the clinical practice of nurse graduates using the qualitative multiple case study design. Twenty preceptors, selected from three recognized hospitals in Beirut, Lebanon, underwent semistructured interviews. Interview questions were based on an extensive literature review and on Tanner's (2006) judgment dimensions to categorize transition practices. An exhaustive discussion of the practices led to the identification of major themes that illustrate the clinical experiences of new nurse graduates: (1) inventory of competencies, (2) learning experience, (3) technical and theoretical mysteries, and (4) challenge of one's potential. The themes provide directives that curriculum leaders and executive nurses can use to plan initiatives that assist in the effective transition of new nurse graduates to the professional role.

Teaching domains of clinical instruction from the experiences of preceptors.

Clinical teaching is vital to prepare nursing students for the role, build learning experiences, and ease transition. This study aimed at exploring the pedagogical principles that guide clinical educators in teaching undergraduate nursing students. The descriptive, qualitative, multiple-case study design, guided by the cognitive task analysis research, helped gain insights into how 18 nurse preceptors provided clinical instruction. The design entailed direct observation of preceptors while teaching students followed by interviews. Observation notes and interview data were analyzed using pattern identification and data thematization. Teaching practices of preceptors were grouped into four domains: (1) partnership, (2) competence-building, (3) nurturing, and (4) meaning-making. The domains represent the pedagogical principles that underpin the preceptors' instructional practice. While the focus of instruction was on competence-building of students, the meaning-making domain was found subordinated by most of preceptors. The findings support prior recommendations that expertise and proficiency must not be the sole agents for selecting preceptors. This study will significantly contribute to the advancement of nursing education through an improved education system that incorporates the four domains in clinical instruction in general, and preceptor preparation in specific. The emergent domains contribute to setting the framework of clinical instruction.

Rethinking clinical instruction through the zone of proximal development.

BACKGROUND: The complexity of the learning environment and intricacy of nursing tasks make it difficult for students to learn without the assistance of an expert. Teaching in the zone of proximal development (ZPD) aims at positioning learners in the zone of what they can do and develop with assistance to reach full potential and independence. ZPD is deemed essential to understand how teaching and learning take place; however, its implications for clinical educators are limited and need further exploration. OBJECTIVES: This research study aimed at exploring the instructional strategies that preceptors use to guide and support the development of undergraduate nursing students, from what they are capable of doing with assistance to what they can become and do independently. DESIGN: The qualitative multiple case study research design was used to gain insights into the teaching experiences of 18 nurse preceptors situated in three recognized hospitals in Lebanon. METHODS: Each preceptor was interviewed face-to-face using questions that were developed from a three-hour observation. Vygotsky's learning principles formed the reference point for this study. Analytic induction and constant comparison of preceptors' responses were applied throughout the study to unravel assisted strategies that target the potential learning zones of the student. RESULTS: Three assumptions emerged from the data to underpin the preceptors' assistive strategies that help move learners from a cannot-do-level to can do independently. The assumptions are: (1) learning from clinical experience, (2) teaching beyond student ability, and (3) teaching for autonomy. In-depth analysis of both assumptions and strategies that focus instruction within each student's ZPD converged on a framework of three constructs: differentiated instruction, instructional scaffolding, and influencing a positive learning environment. CONCLUSION: It is imperative that clinical educators be most receptive to instruction that targets the student's ZPD, as the zone represents a potential phase in student learning. This study provides a ZPD framework for intensifying learning gains from clinical practice.

Context-Based Pedagogy: A Framework From Experience.

BACKGROUND: Attempts to transform teaching practice are inadvertently subjected to several hurdles, mostly attributed to the lack of a guiding framework. This study aimed at unraveling the conceptual underpinnings of the context-based pedagogy, being perceived the pedagogy that prepares professionals for future practice. METHOD: Through focus group interviews, data were collected from 16 nursing students who had case studies as the main instructional format in three major courses. The participants were divided into three focus groups, and interview questions were based on three educational parameters: the learning environment, instructional format, and instructional process. RESULTS: Initial findings revealed an array of classroom activities that characterize each parameter. An in-depth analysis of these activities converged on four concepts: (a) dynamic learning environment, (b) realism, (c) thinking dispositions, and (d) professional formation. CONCLUSION: These concepts improvise a beginning framework for educators and curriculum leaders that can be used to integrate cases in the curriculum and to facilitate the contextualization of knowledge. [J Nurs Educ. 2016;55(7):391-395.].

Case-based learning: What traditional curricula fail to teach.

BACKGROUND: Case-based learning seeks to contextualize learning and to enhance the transition of nurses to practice. This instructional approach is gaining widespread interest in nursing education since the unfolding process emulates the work environment. Case-based learning holds great promise to the development of professional skills. An assumption that was worth researching to determine what those skills are. OBJECTIVES: This study aimed at exploring perceptions of nursing students who had completed two undergraduate nursing courses using case-based learning to be able to identify professional skills that may be gained by this instructional approach. DESIGN: The qualitative focus group research technique was used to explore the perceptions of 16 nursing students who used CBL in two adult health nursing courses in the junior year of an undergraduate nursing program in Beirut, Lebanon. The sample was divided into three groups of four to six students each. METHOD: Thematic analysis using cross-group analysis and inductive constant comparison. FINDINGS: The analyzed data converged on three learning practices that were developed by the case study approach: (a) recognizing the particulars of a clinical situation, (b) making sense of patient data and informing decisions, and (c) reflection. In-depth analysis of these practices helped unravel four professional attributes that form the tenets of case-based learning: (1) a salience of clinical knowledge, (2) multiple ways of thinking, (3) professional self-concept, and (4) professional caring. CONCLUSION: Since professional skills are developmental in nature, educational programs may play an active role in the skill acquisition process. In search of those ineffable skills, four professional attributes emerged from the study findings. Findings support concerns of higher education regarding the ability of the traditional curriculum to meet the expectations of employers at the workplace.

Assessment and instruction to promote higher order thinking in nursing students.

OBJECTIVES: The dearth of data on the role of assessment in higher education formed the two purposes of this study: first, to explore assessment strategies commonly used in nursing education by analyzing the curriculum documents of three baccalaureate nursing programs in Lebanon against Bloom's Taxonomy of learning, and second to unravel issues of instruction and assessment by categorizing data into teacher- and learner-centered strategies. DESIGN: Content analysis research technique applied to analyze the curriculum documents of three baccalaureate nursing programs in Beirut, Lebanon. METHOD: After obtaining IRB approval and consent to access the curriculum documents of the programs, data were analyzed using the content analysis research technique. Data on assessments and instruction were categorized into student-centered and teacher-centered. FINDINGS: Data revealed deficiency in employing learner-centered strategies in the assessment and instruction of the three programs. There was evidence that educators of the programs focus on teaching content and examining retention, thus supporting prior notions on teaching to the test and accusations in earnest on adherence to the traditional and behavioral curriculum perspectives. Such curricula leave little room for the development of higher order thinking in learners. CONCLUSIONS: Although assessments are believed to be indicators of program and teaching effectiveness, there is relatively alarming information on the incompatibility between current assessment practices and demands of the workplace. There is an urgent need for transforming educators' beliefs, knowledge, and skills on testing, since teaching to pass a test could impede knowledge transfer and deter the development of learners' higher order thinking skills.