Bone marrow transplant teaching rounds: promoting excellence in nursing care.
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Ethics teaching in medical settings usually takes place in the classroom or at specially designated times and places, as in "ethics grand rounds." The authors, an ethicist and an internist, have integrated ethics teaching into regular attending rounds. Three cases illustrated their approach.
1. Teaching at the bedside provides the means for nursing students to begin their professional contacts with patients. 2. Teaching at the bedside should begin with selecting patients who illustrate specific problems and obtaining their consent. 3. Connoisseurship in clinical teaching means knowing and appreciating what is clinically significant at the bedside. 4. After teaching at the bedside, it is important to debrief students.
Clinical rounds are being introduced in the Dudley Group of Hospitals to improve patient care, involve patients and improve communication. There are four types of rounds: matrons' rounds, nurse management rounds, patient comfort rounds and teaching rounds. This article describes nurse management rounds, which involve the nurse in charge of the shift seeing each patient. This gives the nurse manager an overview of the condition and needs of all the patients on the wards and the ability of staff to meet these needs. These rounds have potential benefits for patients, relatives, for the nursing team and for other healthcare professionals.
Clinical rounds are being introduced in the Dudley Group of Hospitals to improve patient care, involve patients and improve communication. There are four types of rounds, matrons' rounds, nurse management rounds, patient comfort rounds and teaching rounds. This article is the third in the series and describes patient comfort rounds (PCRs). PCRs are an important part of maintaining and monitoring the fundamental aspects of individual patient care. They should be carried out at 2-hour intervals whenever possible, commencing after lunchtime and continuing for the rest of the day. At night time, PCRs should be carried out before patients go to sleep and again in the early morning. It may be necessary to carry out more regular care to some patients. This approach should not be confused with the old system of "back rounds" which were often restricted to pressure area care. The purpose of PCRs is to maintain a regular review of the patient nursing needs, support the nursing process and evaluate nursing care.
Teaching in response to case presentations is an essential feature of clinical teaching in medicine. Yet, this form of case-based teaching is often done poorly. Using qualitative methods of interviews, observations, and recordings of teaching rounds, the author describes three different yet exemplary pedagogical strategies for organizing teaching rounds in general internal medicine. These include: (1) case-bedside teaching that involves case discussion in a conference room followed by demonstrations at the bedside, (2) case-lecture teaching that blends quick reviews of cases with more formal presentations on relevant topics, and (3) case-iterative teaching that involves discovery-learning using complex cases. From these three case studies, five general principles of experiential learning in clinical settings are derived: anchoring instruction in cases, actively involving learners, modeling professional thinking and action, providing direction and feedback, and creating a collaborative learning environment. These three approaches to teaching rounds overcome common problems associated with learning in clinical settings.
The inpatient setting is commonly used to teach residents various aspects of the practice of medicine. This paper describes how inpatient teaching rounds can be expanded to teach the biopsychosocial approach to patient care. The background and early development, the structure of the teaching, and specific case examples of behavioral medicine rounds are described.