JHPIEGO TrainerNews™ |
Managing Clinical Practice: Clients'
Rights (Part I)
(March 2001)
The following was excerpted from JHPIEGO's newly revised Clinical Training Skills manual. This is the first of three parts on managing clinical practice.
Planning and implementing the clinical experience cannot be done appropriately unless the trainer is well acquainted with the clinical practice sites. Visiting the practice sites before the course begins will allow the trainer to:
develop a relationship with the clinic staff,
find ways to overcome any inadequacies in the situation, and
provide the best possible training experience for the participants while they are in the clinic.
Planning includes designing a schedule that allows participants adequate time to work with clients, and developing assignments and other learning activities for participants to complete in order to provide a positive learning environment in the clinic.
Even the best planning is not always enough to ensure a successful clinical practice experience. In the classroom, the trainer is able to control the schedule and activities to a large extent. In the clinic, however, the trainer must always be alert to unplanned learning opportunities that may arise at any time, and be ready to modify the schedule accordingly.
Situation
As the clinical trainer for a minilaparotomy course, you overhear the participants, who are sitting in the clinic waiting area, discussing the cases they performed that
morning. Several clients are still waiting to be seen and the housekeeping staff is tidying up the area. Clients are being mentioned by name and their behavior and cases described in detail, often in uncomplimentary terms. One participant is furious that a client refused to let him perform the procedure because he is "just learning." How would you intervene in this situation?Write your response on a piece of paper and then compare your response with the one found at the end of this section.
Clients' Rights During Clinical Training
The rights of clients to privacy and confidentiality should be considered at all times during a clinical training course. The following practices will help ensure that clients' rights are routinely protected during clinical training.
The right to bodily privacy must be respected whenever a client is undergoing a physical examination or procedure.
The confidentiality of any client information obtained during counseling, history-taking, physical examinations or procedures must be strictly observed. Clients should be reassured of this confidentiality.
Confidentiality can be difficult to maintain when specific cases are used in learning exercises (e.g., case studies and clinical meetings). Discussions during these types of learning exercises should always take place in a private area where other staff and clients cannot overhear. These kinds of discussions should be conducted without referring to the client by name.
When receiving counseling, undergoing a physical examination or receiving surgical contraceptive services, the client should be informed about the role of each person involved (e.g., clinical trainers, individuals undergoing training, support staff, researchers).
The client's permission should be obtained before having a clinician-in-training observe, assist with or perform any procedures. Understanding the right to refuse care from a clinician-in-training is important for every client. Furthermore, care should not be rescheduled or denied if the client does not permit a clinician-in-training to be present or provide services. In such cases, the clinical trainer or another qualified staff member should perform the procedure.
The clinical trainer should be present during any client contact in a training situation and the client should be made aware of the trainer's role. Furthermore, the clinical trainer should be ready to intervene if the client's safety is in jeopardy or if the client is experiencing severe discomfort.
The trainer must be careful how coaching and feedback are given during practice with clients. Corrective feedback in the presence of a client should be limited to errors that could harm or cause discomfort to the client. Excessive negative feedback can create anxiety for both the client and the clinician-in-training.
Clients should be chosen carefully to ensure that they are appropriate to participate in clinical training. For example, until participants are proficient in performing the procedure, they should not practice with "difficult" clients.
Situation Response
It is important that you step in and stop the conversation right away in a low-key manner. Suggest that you all move to a more private location. Once there, ask the participants why they think you asked them to move. Then discuss the importance of confidentiality and privacy as essential elements of clients' rights and quality care. The participant's anger at being "rejected" by the client should also be explored. Emphasize that the client's preferences are also a key part of clients' rights and should not be taken personally; perhaps that client has had a bad experience with a "new learner" in the past.
For more information about conducting a clinical skills course, contact Learning and Performance Support Director, Rick Sullivan.