Mesa Community College
MARICOPA COMMUNITY COLLEGES
Simulation Coordinator | Nursing
Every nursing school struggles with helping students transition from memorizing information to analyzing a situation for priority actions. For students to develop an overall patient care concept with assessments, interventions, and goals requires complex critical thinking. When adding the higher level of prioritizing that care, many students and faculty wring their hands in frustration. It can be incredibly frustrating for students when the “right” answer is “wrong” for a certain patient.
As a nursing instructor, I first see this struggle in the skills lab. In the beginning, students are dressed in their crisp new uniforms, eager to show us what they can do. Even though they are nervous, it is a type of learning they understand. Every skill comes with a “skill check-off list”, a video, and even the same equipment for each student. This learning style is similar to the way they grew up. You do the same steps at the same time in the same way and you PASS!
Next, their clinical instructor has them practice the skill in clinical. They use different equipment and demonstrate the skill a little differently. Questions start exploding in the student’s head. How can they learn these new steps? Is my clinical instructor teaching me a wrong way? Is the patient going to be okay? Do I have to buy this different equipment? Who is going to be checking me off? A good student heads to the practice lab and has the lab faculty help them --- and then “Oh no, she does it differently too!”
As a seasoned nurse, I am comfortable with the idea that the same skill can be done any number of ways and still be correct. However, students learning something for the first time often struggle with this ambiguity. The "memorizing student" wants the skill to equal their early step-by-step learning. How do we turn the "memorizing student" into an “analyzing student"?
Building on Previous Knowledge
One of the ways to help students start analyzing is to build on previous learning. Using previous knowledge provides the confidence students need to move to the next learning level, analyzation. This movement can be done in small clinical groups or in larger classroom settings. Faculty can use the teaching of a skill as a learning method that builds up to critical thinking. The step-by-step process of the skill is the first block in learning. The concrete nature of skills allows the student to add the possible alternative steps (the analyzing) slowly before those alternatives become a “struggle”.
The first step is to learn the skill in the lab. You can have students prepare prior to lab in a number of ways. Since there are many different types of learners, it is best to have multiple forms of learning available. It is a priority to have a step-by-step written form for students to refer to during video, audio, or even in-class demonstrations. This method provides the concrete information necessary for step one.
Building on step one, each student must then document the skill performed in the electronic health care chart. Using documentation provides students with concrete information about a patient and requires them to move from a “task” to a patient care intervention. They are not performing a skill in a vacuum, there is a patient who needs consideration during the skill. Documentation allows a student to practice communicating the important information surrounding a concrete skill.
Some of the important information they need to consider:
“Curve Balls” and Patient Individuality
Another step for moving students towards critical thinking is to introduce patient individuality into the scenario. This can be added by including “curve balls” often seen in clinical practice. Organize students around a patient bed for group discussion with the overall goal on how to adjust our “skill” to safely care for this particular patient.
We are all working together to problem solve in a safe learning environment. Any time patient care is at risk, someone has to speak up and offer an idea for how to change it. Those students performing the skill can ask for help at any time.
Curve balls may include:
Our students enjoy problem solving in a safe, skills lab environment. As faculty, we spend many hours helping them perfect these skills. This type of activity does the double-duty of perfecting the skills and role modeling the constant critical thinking nurses do every shift.
Adding these patient conditions into the skill practice can be done with the instructor or as an assignment for submission. It can be done in a skills lab or even as part of a discussion board. This type of student-patient interaction allows the student to develop their own alternative safe practices.
This strategy helps to decrease the anxiety students associate with skill check-offs and helps to eliminate the concern with different practices. By this point, students have moved beyond memorizing the steps to understanding the purpose of each step and how it might be altered.