Author: Linda Macera-DiClemente, DNP, BA, RN
Title: Assistant Director of Educational Excellence and Coordination – Clinical Instructor – Undergraduate Program
Institution: University of Michigan – Ann Arbor, MI
Coauthors: Peggy Ann Ursuy PhD, RN PPCNP-BC, Clinical Assistant Professor
The learner will
• Recognize patient is the center in the delivery of care and the coordination of care.
• Identify a trust relationship between patient, family, and nurse to effectively coordinate
• Practice in reflecting on a patient’s point of view in relation to the nurse-patient
• Demonstrate awareness of personal strengths and limitations as a team member while
recognizing the therapeutic relationship that exists between patient and nurse. (Skill).
• Describe own strengths, limitations, and values in functioning as a member of a team
• Acknowledge own potential to contribute to effective team functioning (Attitude).
• Appreciate the importance of intra- and inter-professional collaboration (Attitude).
TouchPoint is an innovative approach to the face-to-face clinical post-conference for pre-licensure BSN nursing students in an immersion experience. The design and purpose of these faculty-moderated sessions are to engage students in an elevated, deep, and meaningful
reflection. Unlike a traditional faculty-student clinical conference, which is the typical standard for faculty and students to meet and engage at the end of a clinical day or experience, TouchPoint elevates the experience to deep reflection. TouchPoint builds relationships between
faculty and students by connecting and exploring feelings, emotions, fears, and anxieties in this unscripted method of deep reflective sharing.
By aligning the QSEN competencies of Patient-Centered Care and Teamwork and Collaboration, the sessions build a sense of safety in reflective sharing and transparency, with the outcome of building resilience and strengthening resiliency practices. Touchpoint’s aim is to explore the deep levels of students’ experiences in relation to clinical reasoning and critical thinking thought processes. TouchPoint creates a safe and enriching environment where the sharing of student experiences builds on a community reflection technique to support students during intense immersion experiences. Macera-DiClemente and Smith’s (2018) work on mentoring noted a supportive environment is crucial to deep reflections that produce deep thought. It is imperative to contend that with an intense degree of deep thought and disclosure, vulnerability exists. Ursuy(2015) demonstrated the dimensions of trust, support, and respect were the most important
factors in understanding progress toward independent nursing practice. Hudson (2016) further supports the trust relationship as the center of any supportive and close relationship.
Koole, Christiaens, Cosyn, and Bruyn (2016) identify deep reflection in terms of single-loop, double-loop, and triple-loop learning by the use of mentor groups, to explore deep reflection for dental students. TouchPoint digs deeper into reflection by using triple loop learning which
includes the practice of how the structure relates to the problem, in that students connect experiences to clinical reasoning practices through examples and experiences. In this deep reflective state, students recognize the patient as the center point in the delivery of care, and that
effective delivery and coordination of care happen through teamwork and collaboration. Using the QSEN competencies of Patient Centered Care and Teamwork and Collaboration, Touchpoint’s reflective learning practices and deep exploration of student experiences frames
discussion on the importance of formulating a holistic approach to healing and a building a trust relationship for patients and families. This deep reflective state aligns with Patient Centered Care as students relate examples of sensitivity, diversity, and respect for the human experience as it relates to the particular unit experience. Emphasizing the importance of Teamwork and Collaboration, students begin to realize the importance of quality patient care as role transition takes place from the perspective of a student individual to a functioning member of the inter- and intra-professional healthcare team member.
TouchPoint is a two-part experience: (1) The focus of Session One is Patient Centered Care and the immediate and professional relationship between patient, nurse, and family; and (2) Session Two addresses Teamwork and Collaboration, the importance of inter- and intra-professional relationships for the institution of quality care. The method for both sessions includes a faculty moderator meeting with a small group of students, 10-12 students maximum. The sessions last 1-1/2 hours to 2-hours, depending on the number of students, in either a face-to-face format or synchronous online format. Session One content on Patient Centered Care is a reflective question card clinical game (TouchPoint Session One: Clinical Game, see attachment). There is no preparation necessary for students or faculty, as the initial first response generates deep reflective thought. A randomly selected student begins by drawing a card. The student shares a response aloud to the group related to the clinical experience. After the sharing, all students can reflect on the experience or discuss their own experience elicited by the discussion. After this deep dialogue, the next student draws a card and the same process occurs. This can continue until all students have the opportunity to participate in the game with an original question drawn by a card. Be prepared for deep reflective thought about death, dying, the good and bad of a clinical experience, fears, struggles, shared tough moments, and the support and comfort in knowing that others have the same feeling and emotions.
TouchPoint Session Two content on Teamwork and Collaboration occurs approximately four-to-six weeks after the TouchPoint Session One. The focus of Session Two is the professional socialization and role identity transition of senior students nearing graduation. The preparation necessary for this TouchPoint is that the students receive and complete, after reflective thought, the TouchPoint Behavioral Questions (TouchPoint Session Two: Behavioral Questions, see attachment) prior to the face-to-face meeting. The behavioral questions include the following topics: a) teamwork/collaboration, b) leadership, c) problem solving, d) communication/handling conflict, and e) initiative “self-starter” (https://www.indeed.com/career-advice/interviewing/most-common-behavioral-interview-questions-and-answers). Each of these topics have four-to-six sub-statements or questions for follow-up. The sub-statements are randomly distributed and assigned to an initial student, and then moving in a round-robin fashion as students reflect on one to two questions in each group, in a simulated interview panel experience. At the end of each student share, the moderator summarizes the share by an affirming statement for the student that states, “Your story is inspiring and you inspire me by the way you….”
The TouchPoint senior immersion activity is a synthesis of moving stories presented by nursing students following a reflective question prompt. TouchPoint sessions are valuable for students as they share about witnessing death, experiencing independence and autonomy, practicing anticipation, and applying new knowledge acquisition with critical thinking at the bedside.
Hudson, P. (2016). Forming the mentor-mentee relationship. Mentoring and Tutoring: Partnership in Learning. 24(1), 30-43. http://doi.org/10.1080/13611267.2016.1163637
Koole, S., Christianens, V., Cosyn, J., & De Bruyn, H. (2016). Facilitating dental student
reflections: Using mentor groups to discuss clinical experiences and personal development.
Journal of Dental Education, 80(10), 1212-1218.
Macera-DiClemente, L. M. & Smith, C. (2018). The Impact of Nurse-to-Nurse Mentoring In
Leadership Skills Development – RNMentor2Mentor. Virginia Henderson Global Nursing e-
QSEN competencies. (n.d.). QSEN Institute. https://qsen.org/competencies/pre-licensure-ksas/
Ursuy, P. A. (2015). The journey within: Discovering the sense of becoming (Order No.
3728897). Available from ProQuest Dissertations & Theses Global. (1733970259).
The design and purpose of these faculty-moderated sessions are to engage students in an elevated, deep, and meaningful reflection. Student participants complete an evaluation of TouchPoint after each session. The student responses assist faculty in evaluating the deep reflection that is taking place individually. The TouchPoint evaluation is an important gauge for faculty to assess student engagement in this deep reflective experience. Did the exploration of the students’ experiences create a deeper level of discussion in relation to clinical reasoning and critical thinking?
The evaluation questions addressed after each session include:
– As a participant in TouchPoint, share your thoughts/feelings on the session you recently attended.
– How did TouchPoint help you reflect on your experiences in the clinical unit?
– Any other comments or feedback you would like to share. What would you change?
The magic of TouchPoint is the creation of a safe space that optimizes a structured learning activity that opens a discussion of sensitive topics such as death, dying, gossip, loss, unsupportive nursing staff, joy and happiness as the patient goes home, and the supportive nature of nurse mentors throughout these positive and negative experiences. It is an opportunity for nursing students to learn about their peers’ clinical experiences, especially those in high-risk specialty areas. In experiencing TouchPoint, students feel safe in a confidential environment that is necessary for deep reflection. The trusting relationship built allows for an exchange that talks about challenges seek support, and shares advice. These essentials will help faculty ensure TouchPoint sessions adhere to the foundations of trust, respect, and support.
In summary, the keys to success for TouchPoint include the following:
– Keep the student groups’ small, no more than 12 students per session is recommended.
– Provide a safe and confidential environment. This is critical to the project’s success.
– Clearly stating the ground rules prior to starting TouchPoint, with emphasis on confidentiality. Confidentiality is imperative for reflective practice.
The essentials noted above will help faculty ensure their TouchPoint sessions adhere to the foundations of trust, respect, and support