Does Student Learning Ever Supersede Patients' Rights?

Jorge L. Corchad, RN, MSN, DNSC(c)
Assistant Professor, University of Puerto Rico at Arecibo School of Nursing

Today, patients are expected to play an active role in seeking, implementing, and evaluating their care. Patients need adequate information if they are to perform those functions successfully. Learning is not a spectator sport, and nursing learning is active and continuous. Students do not learn much sitting in classes, only listening to lectures. They must have a dynamic force that encourages them to learn, and they must want their learning to be part of themselves. They need to take care of real patients, and that relationship is important in achieving the ultimate goal of nursing. But does student learning ever supersede patients' rights?

To a nurse, learning is a complex interaction of affective, practical, and cognitive factors. The quality of the clinical environment and the quantity of student-client interaction is influential in promoting the integration of all of these. Students spend the majority of their time in a clinical setting and are dependent on their mentor or teacher to engage them in increasingly sophisticated professional activities. Such activities should challenge students' intellects and promote their development of professional knowledge.

I believe that although this development is potentially valuable to students and clients, major philosophical issues need to be addressed. The use of people as a means rather than an end is morally wrong. However, professionals, to some extent, have probably always used clients: Case studies and skill development are legitimized by the intention to improve training and practice. Patients legitimately play a central role in healthcare education. If we start from the premise that all clients benefit from being cared for by highly experienced nurses, then nursing student participation in patient care is wrong. Clinical education without patients is like learning to ride a bike without one. Good learning is a collaborative and social experience. Students need opportunities to perform at various points during their clinical practice and chances to reflect on what they have learned while still taking good and responsible care of patients.

With recent changes in the relationship between education and clinical practice, students are entering the clinical environment with limited clinical and judgment skills, which contribute to client care. Exposure to clinical practice promotes integration between theory and practice through the participation and supervision of a qualified, experienced faculty. It is wrong if the faculty restricts this right from students. The complexity of learning in practice is a challenge to nursing educators and creates a stressful environment for students and the clients. Learning to nurses requires collaborative patient care and sophisticated nursing knowledge. Enhancing students' intellect and encouraging them to apply it to patient care establishes the basis for high-performance nursing practice.

To educate is to cultivate the intellect, to develop it until it reaches a higher level. It is not only to obtain knowledge but also to form character. We must discover the reality of our conscience and use it to develop the good things that are in us. Is it not our duty to use good reasoning, to be in balance, to harmonize, and to avoid extremes? We started from the premise that the truth is universal and we can arrive at it with good reasoning. It is necessary that a student learn the whole, because if not, that student's imperfect knowledge can be harmful and dangerous and may jeopardize patients' lives. There is meaning in the whole. If we know a single part of the absolute, we know the truth in fractions. How can we make fundamental decisions that can save lives if we only know part of the truth? We must know the whole to have true knowledge. Educating has a fundamental intention, that the student discovers the truth that surrounds him, based on rationale. We look for true reality through acquired knowledge. Learning is a process of searching for truth. It is a continuous search, to walk toward the inconceivable, to the strange and unimaginable things. It is to discover the unknown world and to make it a reality.

Health is a continuum; therefore, learning is constant. The premise that the patient has rights and that the student must learn is a conflicting, complex, and reflective situation. Does student learning ever supersede patients' rights? We must observe the situation from different angles-from the patient, the student, and the educator. The premise that we learn from experiences is legitimate, but if there are no experiences, does it mean that there is no learning? This assertion is not completely correct; we learn, but we learn partly and not as a whole. Not only must students listen to lectures on taking care of patients, but they also must have "real-life" training. Learning is enhanced when there is collaborative involvement between students and patients. It is not simply learning to take care of the patient but rather being part of that care that improves learning.

Training a student is not a haphazard process. It is a transaction between three parties: the educator, student, and patient. It must have an order in the formation of the student, an order that facilitates the understanding and acquisition of knowledge. Students have high expectations of the clinical area, and those expectations provide motivation to perform well in patients' interest. The voluntary participation of clients is vital in this knowledge acquisition. Students' engagement in learning is predicated not only on interest but also on the perception of relevance to their needs. Students look for opportunities to become active participants in their learning. When we provide students with real experiences, we are offering them the necessary instruments for the construction of firm bases on which they can base their practice. We teach them that patients have rights to receive high quality care and to select who will provide that care to them. If we act arbitrarily toward patients, without protecting their rights, we will be sending students a conflicting, erroneous, and dangerous message. We want to form good nurses, conscious of their duties and ready to exert a change in the care of the patient.

Patients are our reason for being. This means that what we do must have patients as a pivotal axis. Patients are most important, and everything happens for their benefit. Patients are free human beings capable of making choices concerning their health care. Patients seek to obtain safe, responsible, and adequate health care. The faculty protects this right and provides an enriched caring experience for patients and students. A social commitment exists in the care of patients that is over the individual commitment, but we have the responsibility to protect patients. Let us remember that to take care of patients is more than the acquisition of knowledge; it is the living reflection of caring.

Increased student-faculty contact helps students' motivation and involvement. The faculty shows students the art of caring through commitment to their education and helping students get through long hours of clinical practice and lecture work. Creating an atmosphere of mutual respect provides students with tools that they can use to explore new ideas, thoughts, and reflections. Students want their teachers to be resources, motivators, promoters of patient care, and patient advocates, not only evaluators of the learning process of theory and practice but facilitators of nursing care. Roles of the nurse educator include the establishment of strategies that influence students to provide patients with the best care they can get. Nursing educators have the responsibility, with society, to direct the preparation of future professional practitioners who recognize the meaning of caring.

When students finish their formal education, they must have acquired the intellectual, social, and moral skills to be involved successfully in society and to contribute to its improvement. Teachers must be an example of their lessons, teaching with words and their lives. Providing patients the opportunity to decide if a student should take care of them teaches the student the values of the democratic right of giving care to patients in all its dimensions and sends a message to patients that they are important. We form good citizens, conscious of their rights and duties and ready to provide high-quality patient care. This is a philosophy of care that defines patients' needs as the primary and paramount factor in shaping care-delivery practice.