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A sk F lorence Dear Christina, The concept of reality shock identified by Marlene Kramer is a very useful term for describing students’ reactions to discovering that the work environment of extremely busy and often chaotic clinical settings does not match their expectations about either the working conditions in the hospital or how nursing care should be delivered. Patricia Benner’s writings outlining professional practice development from the novice to expert practitioner explains how nurses develop the practice skills and demeanor necessary to practice skilfully in environments such as you have outlined. The conditions of patient overcrowding, staff shortages and managing/preventing infections are not new and students new to these settings will inevitably be overwhelmed initially. It is particularly important to link theory with experiential learning before students undertake their practicum. You may decide to show the students videos of similar situations which they could watch and then discuss. It would be helpful if the videos show how experienced nurses go about their work in such situations. You could ask the students to closely observe the nurses’ behaviour. When they discuss the videos you may help them to recognise the nurse’s demeanour and approach. You could plan some simulations in which the students focus on prioritising their tasks in a busy setting. It is easy for students to be frustrated with conflict between their values and what they observe happening in the ward. Preceptorship is extremely important in supporting students to be enthusiastic about nursing but also in being realistic about the limitations of what they can achieve. In practicum, students need to be assisted to integrate into the culture and practices of the ward. They need to be offered support and guidance and acknowledgment of how they are feeling. The importance of the work you are doing in supporting students to become proficient new practitloners cannot be overestimated. It is a key factor in the professional socialisation of the student. Keep up the good work. Kind regards, Florence Dear Florence, I have encountered some students with reality shock during the clinical practicum under a busy admission ward e.g. crowded bed allocation, manpower constraint and presence of contact or droplet precaution case. My question is how to better equip the student to adapt to the real clinical situation in practicum in Hong Kong? Thank you! Christina Ask Florence is a column in which students, clinical instructors and nursing teachers can write in with a problem or issue around clinical learning about which they would like advice from ‘Florence’, who is an experienced facilitator of student learning. We expect to receive queries about how to deal with student difficulties in clinical settings, how to give effective feedback to students, the strategies that are helpful for supporting unsafe students, and many other topics including those that students may raise. All questions will be dealt with anonymously. We will not publish your name or any details about you. If necessary we will modify questions slightly to ensure total anonymity. If you have a question for ‘Florence’, please send it to askflorence@hku.hk 5 Issue 42 Nov 2018