Probe into teaching effect of the two arrangement patterns of the theoretical learning and clinicalpractice in nursing curriculum

Wang Yan，Yin Lei（School of Health Science，Macao Polytechnic Institute，Macao，China）

·英文稿專欄·

Probe into teaching effect of the two arrangement patterns of the theoretical learning and clinical
practice in nursing curriculum

Wang Yan，Yin Lei（School of Health Science，Macao Polytechnic Institute，Macao，China）

Objective：To compare the effects of two models in different combination of theoretical learning and clinical.Methods：Undergraduate students in our school began their clinical placement from the first year.Every grade has two classes.In semester I，class A takes ModelⅠand class B takes ModelⅡ.In semesterⅡ，class A takes ModelⅡand class B takes ModelⅠ.Model I：Students have a compact theoretical learning in about 1 to 2 months.Then they begin clinical placement in hospitals.After finishing the clinical placement，students come back to school and continue the theoretical study.ModelⅡ：Students have theoretical study at school until the modelⅠcomplete clinical placement.Then they begin their clinical placement.The teaching contents，teaching hours，teachers，clinical units and clinical preceptors are all the same for two models.The performances of the clinical placement were assessed at the end of the clinical placement.All the students take part in the final exam at the school in the end of every semester.This article statistically analysis the scores of students with independent samplet-test.Opinions from teachers and students were analyzed.Results：There is no significant difference of the average scores between two models in both theoretical exam and the clinical exam（allP＞0.05）.Two models each have its advantages from the views of students and teachers.Conclusion：In limited clinical units we get the same learning outcomes from the two different models，and students gain different learning experience.

arrangement；theoretical learning；clinical placement；nursing education

1 Background of Macao nursing education

In recent years，with increasing and aging population，the requirement for high quality health care service is raised in Macao.In 2009，the population is 542 thousand and every thousand people only have 2.8 nurses［1］.There are two nursing schools in Macao.Two nursing schools are required by the government to increase the number of nursing students.Macao has 3 hospitals，whose total number of beds is about 1 100，so the clinical units are very limited.For using the clinical unit utmost，our school develops two models in the different combination of theoretical learning and clinical placement in nursing curriculum.This article is going to compare the learning effects of the two models.

2 Theoretical learning and clinical placement in nursing curriculum

Nursing is a practical science.Clinical placement can help the students put the theoretical knowledge into practice，understand the knowledge thoroughly and improve the clinical think-ing［2］.Nursing curriculum can be classified into three kinds：①the Apprentice ship-based model，which mainly composed of clinical placement，inserted by a little theoretical learning［3］.②the Theory and practice model，which mainly composed by theoretical study followed by the clinical placement in the last whole year.③the Sandwich model，every stage is composed of theoretical learning and clinical placement.Different course may select different model for the best learning outcomes［4］.

Because of the urgent lacking nurses in Macao，our school wishes its nursing students can be adequate to the nursing work right after graduation.So we take the sandwich model，letting students begin their clinical practice from the first year.Clinical practice is corresponding with the theoretic learning.In the first year，students study basic course and practice fundamental nursing in the hospital.They can be familiar with the clinical situation and the work range of the nurse.So they have the chances to reconsider about their choice of selecting nursing as their career and make a decision whether they should go on studying in nursing or just quit［5］.In the second and the first half of the third year，students begin to learn med-surgical nursing，so the focus of the clinical placement is to make the students be familiar with the background of common diseases and the regular work of the nursing.In the second half of the third and fourth year，students mainly practice some special care in the clinical.

Theoretical learning and clinical placement will give the students different pressure.Because of the combination of theoretical learning and clinical placement in one semester，and also because of the different theoretical learning and clinical placement arrangement in the same grade，the pressure on the students is the considerations of teachers.

3 The characteristics of ESS nursing curriculim

3.1 Nursing curriculum Bachelor training began in our school from 1999，every year having only one class.From 2008，be required by the government，we began to have two classes every year.Nursing curriculum is composed of theoretical learning and clinical placement from the first year.From year 1 to 4，the ratio of theoretical learning hour to clinical placement hour is decreasing.With the increase of students’number，the problem of lacking clinical units is more obviously.So we developed two kinds of arrangement for theoretical learning and clinical placement（table 1）.

Table 1 The arrangement of theoretical learning and clinical placement

In the same grade，ModelⅠ：students have compact theoretical learning in 1-2 months at school from the beginning of the semester，and then have the clinical placement in the hospital，and finally come back to school for theoretical learning.ModelⅡ，students have theoretical learning in the school till model 1 students’almost finishing clinical placement，then go to clinical placement，and finally regain the theoretical learning.Thus there is only one class of every grade in the hospital，solving the problem of lacking clinical units.The assessment of clinical placement is carried out at the end of clinical placement.The finally exam is carried out at the end of every semester.

Form 2008，every year has two classes：class 1 and class 2.If class 1 takes modelⅠwhile class 2 takes modelⅡin semesterⅠ，and then class 1 take modelⅡwhile class 2 take modelⅠin semesterⅡ.

3.2 Arrangement of theoretical learning and clinical placement（table 2）

Table 2 The percentage of completion of theoretical learning at the beginning of clinical placement

Table 2 shows，in the first two years，when ModelⅠbegan the clinical placement，the students almost finished half of the theoretical learning.Because of complaints from the students about the compact arrangement（hours per weeks is up to 12），so our curriculum have made some adjustment：The theoretical hours per week for ModelⅠbefore the clinical placement was decreased slightly.

4 Learning outcomes of two models

4.1 Opinions from the students The most common complaints from modelⅠstudents is about the compact theoretical learning timetable.But they also feel good about that there is al

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ays a long time for them to calm down to the theoretical learn-ing and have a long time to review the knowledge before the final exam.They find the great help from their clinical experience for theoretical learning.The other dissatisfaction is that the students have learned only a part of the theoretic knowledge，so they feel some unfamiliar with the disease background when they begin working in the hospital.Most students from model 2 are satisfied with the most completion of the theoretical learning before the clinical placement.But they feel uneasy because there is only a little time left after their coming back to school before the final exam.They also feel there are always pressures in the long waiting time for clinical placement.

4.2 Opinions from the clinical teachers Clinical teachers feel there is no obviously difference between the two models except students from modelⅡmaybe a little familiar with the theoretical knowledge.

4.3 Opinions from the school teachers School teachers most-ly feel worried about the effects of modelⅠstudents in the compact theoretical learning.

4.4 Score compare（table 3 and table 4） score

Table 3 Compare of the theoretical score and clinical score

Table 4 Compare of the score of the total performance

Total performance score is composed of theoretic school（50%）and clinical score（50%）.

5 Discussion

5.1 The baseline of the two models our school has regulated that if class A take the ModelⅠwhile class B take ModelⅡin semesterⅠ，and then class A take ModelⅡwhile class B take ModelⅠin semesterⅡ.All the theoretical teachers，teaching hours，teaching content，and the final exam paper are all the same for the two models.All the clinical departments and the clinical teachers are all the same for the two models.

5.2 The learning effects of the two models The average score of the theoretical leaning and clinical placement shows no statistical significance.The score of the total performance of the students shows no statistical significance.So we can get the preliminary conclusion there is no differences in the learning effects between the two models.Because the arrangement has solved our problem about the lacking clinical units，so our school will continue to carry on the two models.

There are still three means have statistical significant difference.Two means are about the higher in the clinical score of Model I.Recalling the reflecting notes from students；we found the differences may be caused by the reason that some students have improved their performance based on the suggestions from the past experiences.

Till now，there is no obvious explanation about the statistical significant difference in the theoretical score of med-surgical nursing.Theoretical learning and clinical placement can give students different pressure.Students are easier to feel tired in the period of clinical placement.Pressures may come from the persistent clinical working，the relatively unfamiliar condition，and the sickness of the patients.Most students may only review the problem facing in the practice，so systematic review on the theoretical knowledge is rare［6－8］.Student have relative simple situation in school，and they would like to spend more time on review the books.

We think different arrangements can give students different learning experience：knowledge first or practice first.It is also a good challenge to students.

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護理課程理論學習與臨床實踐兩種安排模式教學效果的探討

王 艷，殷 磊（澳門理工學院高等衛生學校）

［目的］比較兩種護理課程理論學習與臨床實踐模式的學習效果。［方法］我校護理本科生從第一學年開始進入臨床實習。將每年招收的兩個護理班分為A班、B班，第1學期A班采取模式Ⅰ，B班采取模式Ⅱ。第2學期A班采取模式Ⅱ，B班采取模式Ⅰ。模式Ⅰ：在每一學期開始的1個月～2個月進行比較密集的理論學習，然后進入臨床實習，最后回學校完成理論學習；模式Ⅱ：進行理論學習，直至模式Ⅰ完成臨床實習后再進入臨床。臨床實習的評價在實習結束時完成，每學期期末學生接受學校的期末考試。兩個模式的教學內容、總學時數、理論教學老師、臨床實習科室、臨床帶教老師全部相同。采用t檢驗對兩種模式學生的學習成績進行比較，分析學生和老師的意見。［結果］兩種模式學生的臨床實習成績、理論考試成績差異無統計學意義（P＞0.05），學生與老師均認為兩種模式各有優勢。［結論］兩種理論學習與臨床實習安排模式，可以盡可能地充分利用有限的臨床實習基地，讓學生經歷兩種不同的學習模式，并且教學效果無差異。

安排模式；理論學習；臨床實踐；護理教育

G642.0

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10.3969／j.issn.1009-6493.2011.31.001

1009-6493（2011）11A-2828-03

2011－01－24；

2011－10－12）

Author introduction Wang Yan（1976—），Lecturer，Master in Nnursing，Doctor Candidate in Public Health，Research aspects in clude ethical nursing and evidence-based nursing.She was from School of High Science，Macao Polytechnic Institute；Yin Lei was from Macao Polytechnic Institute.

（本文編輯 李亞琴）