NURS 764 Week 6 Project: Clinical Teaching Plan Example

Clinical Teaching Plan: Reinforcing the Golden Minute on the Labor Unit Through Warmer Checks, Brief In Situ Practice and Debriefing After Real Resuscitations

The Clinical Problem

Junior students in the maternal-newborn course spend six clinical days on a labor and delivery unit at one of two community hospitals, each with about 1,800 births a year. Even on a busy unit, a student may attend several births in a rotation and see none in which a baby needs ventilation. The skill they learned in the lab is therefore rarely used, and when a resuscitation does occur, students who have not practiced since the lab may freeze or be sent out of the room. The retention evidence makes the problem plain. Sendo et al. (2025) found that midwives who completed Helping Babies Breathe in their final pre-service year scored a median of 98% on knowledge just after training but 74% a year later, and the share proficient on the skills examination fell from 62% to 36%. Billings and Halstead (2016) describe clinical teaching as reinforcing classroom learning in practice, and for this skill reinforcement must be planned, not left to chance.

Setting, Learners and Roles

The clinical group is eight junior students with one clinical instructor. Each student is paired each day with a staff nurse who has current neonatal resuscitation certification. The unit's nurse educator has agreed to keep a newborn manikin, a bag and masks and a stopwatch in a supply room on the unit for the student group. Students may dry, warm and stimulate a newborn under the direct supervision of their staff nurse and may assist with ventilation only if the staff nurse directs it and remains hands-on. Students do not lead a resuscitation. These limits are explained on the first clinical day and on a card students carry.

Four Clinical Activities

Activity One: The Warmer Check

At the start of each shift, every student checks one radiant warmer with the staff nurse, using the unit's equipment checklist: warmer on and heating, dry towels and hat ready, suction working, bag and term and preterm masks present and tested and the pulse oximeter and probe available. The check takes about five minutes and teaches preparation, the first step of the golden minute, where it actually happens. It also introduces students to the unit's equipment, which may differ from the lab's.

Activity Two: Five-Minute In Situ Practice

Once each clinical day, at a quiet moment chosen by the instructor, each student performs the golden minute on the unit manikin in an empty labor room, using the room's own warmer. A partner times the attempt and reads the checklist. The practice takes about five minutes per pair and repeats every clinical day, so each student completes six or more practices over the rotation in addition to the lab. Kalabamu et al. (2026) studied providers in twelve Tanzanian facilities who had access to brief, self-directed in situ practice on simulators after Helping Babies Breathe training; a year later, 77% retained their skills, although the average checklist result dropped by about ten percentage points. Their findings suggest that short, frequent practice in the workplace sustains skills that would otherwise fade, while showing that it does not stop all loss.

Activity Three: An Assigned Role at Every Birth

When a student attends a birth, the staff nurse and student agree before delivery on the student's role should the baby need help: usually bringing towels and drying, starting the clock and calling out times, or placing the pulse oximeter on the right hand. The student states the role aloud in the room before delivery. Priyanti et al. (2026) found that nursing students who witnessed neonatal resuscitation often described role uncertainty and feeling overwhelmed, and a role agreed in advance gives the student a task and a place to stand if the baby is born limp.

Activity Four: Debriefing After a Real Resuscitation

If a student witnesses or assists in a resuscitation, the instructor holds a private debriefing with that student, and with others present if they wish, the same day. The debriefing follows the PEARLS structure described by Eppich and Cheng (2015): a reactions phase that lets the student express feelings first, a description phase that establishes what happened, an analysis phase that explores what went well and what could be done differently, using the instructor's choice of learner self-assessment, focused facilitation or direct teaching, and a summary of take-home lessons. The instructor also tells the student where to find counseling services and checks in by message two days later. Students interviewed by Priyanti et al. (2026) described an emotional burden that stayed with them after resuscitation and a stigma around asking for help, so the debriefing treats emotional response as expected, not as weakness.

Schedule Across the Rotation

Debriefings after real events happen whenever needed and are not scheduled. The schedule builds the skill in layers, one element each day, so that by the sixth day the student is combining preparation, initial steps, ventilation and correction in one timed attempt. Any student who misses a clinical day makes up the practice on the next day they attend, and a student who does not meet the target time on day six repeats the checkoff on the following clinical day after a coached practice with the instructor.

Preparing Students Before the Rotation

Students arrive on the unit a week or more after the lab, and some will not have touched a bag and mask since. In the week before the rotation, each student watches the seven-minute teaching video from the classroom plan again and completes a ten-question online quiz on the golden minute, with immediate feedback. The clinical orientation on day one includes a tour of the warmers and the location of the unit manikin, a review of the student role card and a frank conversation about what a resuscitation looks and sounds like on a real unit, including the possibility that a baby will not survive. This preparation is meant to narrow the gap between simulation and reality that students describe, so that the first real event is not also the first time they have thought about what it would feel like.

When a Real Resuscitation Occurs

When a baby needs resuscitation while a student is in the room, the student carries out the agreed role or, if the team is complete, steps to a place against the wall where the student can see without being in the way. The staff nurse decides which. The instructor is called to the unit if not already present but does not enter the resuscitation unless asked. Afterward the instructor finds the student, offers a few minutes away from the unit and arranges the debriefing for later that shift, after the student's patient care is covered. The instructor records the event in a log kept for the course without any patient identifiers. If the baby dies or is transferred in critical condition, the instructor tells the course coordinator, who contacts the student the next day and offers a meeting with counseling services. Students are never asked to describe the event in a written assignment unless they choose to.

Adapting for Diverse Learners

The supports built into the classroom plan carry over to the unit. The pictorial action plan used in the lab is posted, with the unit educator's permission, beside the manikin in the supply room. The ten spoken phrases appear on the back of each student's role card, which lets a student whose first language is not English announce a role before a birth in the same words they practiced. The student with hearing loss is paired with staff nurses who agree to face the student when speaking and is given the role of timekeeper or pulse oximeter placement, which depends less on hearing calls across the room. Students with high anxiety are offered an extra in situ practice with only the instructor present before practicing with a partner.

Barriers and How They Will Be Managed

Three barriers are likely. First, busy days may leave no quiet moment for practice; on those days the instructor moves the practice to the end of the shift or to the next day, and the schedule allows for one missed session without loss. Second, staff nurses may differ in how much they let students do at births; the orientation for staff and the agreed role card reduce, though they cannot remove, that variation. Third, the manikin and supplies kept on the unit may be borrowed or lost; the instructor checks them at the start of each clinical day, and the course budget includes a replacement mask set and a spare bag.

Patient Safety and the Role of Staff

The plan adds nothing to the care of real newborns that the staff nurse does not direct. Practice takes place in empty rooms with a manikin, and the unit's equipment used for practice is returned and rechecked by the staff nurse. If the room is needed, practice stops at once. Staff nurses were consulted through the unit educator, and their concern that practice could take students away from patients is met by keeping each session to five minutes and leaving the timing to the instructor. A short orientation for staff nurses explains the students' assigned roles at births, so that a nurse who hears a student say "I will dry and start the clock" knows what has been agreed.

Evaluation Against the Objectives

The clinical plan supports four of the five project objectives. Objectives two and three are measured on clinical day six by a timed checkoff using the same checklist as the lab. Objective four is measured by asking each student, during the day six checkoff, to state their role and first three actions. Results of the week fourteen recheck for objective five will be compared with the previous cohort, who had no in situ practice, to see whether the clinical activities slow skill loss. The instructor will also log each real resuscitation students witnessed and whether a debriefing occurred within the day. If the plan works, students will leave the rotation having practiced the golden minute more often on the unit than they ever practiced it in the lab.

References

Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). Elsevier.

Eppich, W., & Cheng, A. (2015). Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and rationale for a blended approach to health care simulation debriefing. Simulation in Healthcare, 10(2), 106-115. https://doi.org/10.1097/SIH.0000000000000072

Kalabamu, F. S., Daudi, V., Moshiro, R., Kamala, B., Mdoe, P., Bishanga, D., Kvaløy, J. T., Ersdal, H., & Mpembeni, R. (2026). Neonatal resuscitation skills retention among healthcare providers one year after implementation of in situ low-dose high-frequency simulations using innovative tools across two regions in Tanzania. Global Health Action, 19(1), Article 2639774. https://doi.org/10.1080/16549716.2026.2639774

Priyanti, R. P., Hidayah, N., Asri, A., Dianita, E. M., Lin, S. C., & Tonapa, S. I. (2026). The lived experience of nursing students witnessing neonatal resuscitation in Indonesia: A phenomenological study. Journal of Hospice & Palliative Nursing. Advance online publication. https://doi.org/10.1097/NJH.0000000000001255

Sendo, E. G., Aga, F., & Gebrewold, L. A. (2025). Retention of knowledge and skills among midwives one year after completing helping babies breathe pre-service training in Ethiopia: A non-randomized quasi-experimental study. Maternal Health, Neonatology and Perinatology, 11(1), Article 15. https://doi.org/10.1186/s40748-025-00201-2