- Email: [email protected]
Clinical learning: Do faculty teach how to learn?
Teaching and Learning in Nursing (2010) 5, 93–94
www.jtln.org
Editorial
Clinical learning: Do faculty teach how to learn? One of the biggest challenges faculty face is to provide optimal clinical learning for their students. Faculty expect students to have a solid knowledge base; relate rationale for specific nursing and medical interventions; manage information; provide safe, empathic, holistic patient care; employ sound clinical reasoning; and use therapeutic communication in all interactions. In addition, there is an implicit assumption that students will get better and better every day. How does learning come together? First of all, we must ask ourselves, “What is learning?” Consider the satirical account of “Roast Pig,” taken from Charles Lamb in his 1822 essay, described by Kanter (1983) in her book, The Change Masters. Lamb told the story of how a child set fire to a hut with a pig inside, and the villagers, poking around in the embers, discovered a new delicacy. This eventually led to a rash of hut fires. The moral of the story is when you do not understand how the pig gets cooked, you have to burn down a whole hut every time you want a roast pork dinner! Clearly, the Chinese villagers indeed got their roast pig but at the expense of a hut. There are several philosophic viewpoints about what is learned, that is, knowledge. Aristotle believed that in matters of scientific inquiry, the senses were the starting point of all knowledge. No knowledge was independent of the senses. However, he did believe that to reach scientific knowledge the mind and thought process were actively involved. Aristotle's inductive–deductive method and employment of syllogism provided the means to attain knowledge of the reasoned fact. Once one grasps a reasoned conclusion, Aristotle said that the primary condition for knowledge was met (McKeon, 1973). Ultimately, it may not matter much to the average learner just what Aristotle, Kuhl, Popper, or any of the other philosophers have to say about knowledge. What is important to the learner is what the “learner” thinks he or she has “learned.” The future for learners will be determined by what has been learned before, what has yet to be learned, and what will never be learned. Several factors help determine learning: the learning environment, the perception of knowledge, and the nature of self as learner. Learning
takes place both in and out of a clinical context and at different stages, depending on the development of the student (and faculty). Second, faculty must ask, “What impacts learning?” Students say that they appreciate faculty who establish a nonthreatening learning environment, where they not only feel comfortable but also feel encouraged to ask questions. Cook (2005) explored the impact of inviting faculty behaviors on student anxiety states and found that inviting messages, such as demonstrating respect for students, acting friendly, and trusting students, resulted in a lower anxiety level for the student. Students want faculty and staff who will model how to think and perform in the role of the registered professional nurse. One of the major benefits of simulation is the fact that debriefing takes place. Do we debrief or reflect often enough in traditional clinical settings? In Part 4 of his book, Educating the Reflective Practitioner, Schon (1983) posited a reflective practicum, bridging the worlds of academia and practice. He challenged us to look at how we view knowledge and its dissemination or attainment. He asked, could we not depart from traditional rationality and move instead to a “reflection-in-action” stance? If we are to merge the two worlds of theory and practice, a reflective practicum is essential. In my experience, I have observed that adults are motivated to learn, value and work diligently to attain knowledge, and are stimulated by topics of interest. Recognition of learning can take place before, during, or much later than the actual event in which learning was said to have taken place. That is, when do we really know what we know? And, when we know what we know, we also know what we do not know. Therein lies the value of discussion, reflection, critical thinking, sharing, and journaling relevant to clinical learning. Third, we must ask how the clinical environment is conducive to learning and which teaching methodologies work well in the face of technological advances that have affected the speed and efficiency of documentation and medication administration, such as electronic medical records and medication verification systems; high patient– low nurse ratios; high patient acuities; a service-oriented
1557-3087/$ – see front matter © 2010 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.teln.2010.04.001
94
Editorial
patient population; and faculty and staff expectations for student performance in a clinical setting. Advances in practice and accordant teaching adjustments evoke varying responses. Faculty and staff alike are frustrated when they try to employ traditional teaching practices and expectations in light of the current health care environment. It is no longer practical or possible to safely administer multiple medications to multiple patients with multiple students. We must examine these practices and seek knowledge that allows students a world view, yet working view, of what nursing holds. We need to uncover the knowledge embedded in clinical nursing practice: “What's missing are systematic observations of what nurse clinicians learn from their clinical practice” (Benner, 2001, p. 1). Interventional strategies to foster positive clinical learning environments include the following: 1. Intentional behaviors to decrease anxiety, such as humor, peer instruction and mentoring, and mindfulness training (Moscaritolo, 2009). 2. Concept-based learning activities, employing Tanner's model of clinical judgment (Nielsen, 2009). 3. Establishment of focus groups composed of members from service and education whose purpose is to determine teaching goals and strategies to facilitate graduate outcomes and transition to practice. 4. Collaboration between education and service to promote optimal clinical learning (Palmer, Cox Harmer, Callister Clark, Johnsen, & Matsumura, 2005). 5. Dialogue with students about their teaching and learning needs and ways to capitalize on student life and work experiences that lend to success in nursing.
6. A variety of teaching strategies to promote learning and accommodate a variety of learning styles.
Faculty have the tools and resources to structure positive learning experiences. We must find a way to make roast pig without burning down the hut. Lynn Engelmann EdD, MSN, RN Associate Editor E-mail address: [email protected]
References Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. Upper Saddle River, NJ: Prentice Hall Health. Cook, L. J. (2005). Inviting teaching behaviors of clinical faculty and nursing student's anxiety. Journal of Nursing Education, 44(4), 156−161. Kanter, R. (1983). The change masters: Innovations for productivity in the American corporation. New York: Simon and Schuster. McKeon, R. (1973). Introduction to Aristotle, 2nd ed. New York: McGrawHill, Inc: Modern Library of Congress. Moscaritolo, L. (2009). Interventional strategies to decrease nursing student anxiety in the clinical learning environment. Journal of Nursing Education, 48(1), 17−23. Nielsen, A. (2009). Concept-based learning activities using the clinical judgment model as a foundation for clinical learning. Journal of Nursing Education, 48(6), 350−354. Palmer, S. P., Cox Harmer, A., Callister Clark, L., Johnsen, V., & Matsumura, G. (2005). Nursing education and service collaboration: Making a difference in the clinical learning environment. Journal of Continuing Education in Nursing, 36(6), 271−276. Schon, D. (1983). Educating the reflective practitioner: How professionals think in action. New York: Basic Books.
www.jtln.org
Editorial
Clinical learning: Do faculty teach how to learn? One of the biggest challenges faculty face is to provide optimal clinical learning for their students. Faculty expect students to have a solid knowledge base; relate rationale for specific nursing and medical interventions; manage information; provide safe, empathic, holistic patient care; employ sound clinical reasoning; and use therapeutic communication in all interactions. In addition, there is an implicit assumption that students will get better and better every day. How does learning come together? First of all, we must ask ourselves, “What is learning?” Consider the satirical account of “Roast Pig,” taken from Charles Lamb in his 1822 essay, described by Kanter (1983) in her book, The Change Masters. Lamb told the story of how a child set fire to a hut with a pig inside, and the villagers, poking around in the embers, discovered a new delicacy. This eventually led to a rash of hut fires. The moral of the story is when you do not understand how the pig gets cooked, you have to burn down a whole hut every time you want a roast pork dinner! Clearly, the Chinese villagers indeed got their roast pig but at the expense of a hut. There are several philosophic viewpoints about what is learned, that is, knowledge. Aristotle believed that in matters of scientific inquiry, the senses were the starting point of all knowledge. No knowledge was independent of the senses. However, he did believe that to reach scientific knowledge the mind and thought process were actively involved. Aristotle's inductive–deductive method and employment of syllogism provided the means to attain knowledge of the reasoned fact. Once one grasps a reasoned conclusion, Aristotle said that the primary condition for knowledge was met (McKeon, 1973). Ultimately, it may not matter much to the average learner just what Aristotle, Kuhl, Popper, or any of the other philosophers have to say about knowledge. What is important to the learner is what the “learner” thinks he or she has “learned.” The future for learners will be determined by what has been learned before, what has yet to be learned, and what will never be learned. Several factors help determine learning: the learning environment, the perception of knowledge, and the nature of self as learner. Learning
takes place both in and out of a clinical context and at different stages, depending on the development of the student (and faculty). Second, faculty must ask, “What impacts learning?” Students say that they appreciate faculty who establish a nonthreatening learning environment, where they not only feel comfortable but also feel encouraged to ask questions. Cook (2005) explored the impact of inviting faculty behaviors on student anxiety states and found that inviting messages, such as demonstrating respect for students, acting friendly, and trusting students, resulted in a lower anxiety level for the student. Students want faculty and staff who will model how to think and perform in the role of the registered professional nurse. One of the major benefits of simulation is the fact that debriefing takes place. Do we debrief or reflect often enough in traditional clinical settings? In Part 4 of his book, Educating the Reflective Practitioner, Schon (1983) posited a reflective practicum, bridging the worlds of academia and practice. He challenged us to look at how we view knowledge and its dissemination or attainment. He asked, could we not depart from traditional rationality and move instead to a “reflection-in-action” stance? If we are to merge the two worlds of theory and practice, a reflective practicum is essential. In my experience, I have observed that adults are motivated to learn, value and work diligently to attain knowledge, and are stimulated by topics of interest. Recognition of learning can take place before, during, or much later than the actual event in which learning was said to have taken place. That is, when do we really know what we know? And, when we know what we know, we also know what we do not know. Therein lies the value of discussion, reflection, critical thinking, sharing, and journaling relevant to clinical learning. Third, we must ask how the clinical environment is conducive to learning and which teaching methodologies work well in the face of technological advances that have affected the speed and efficiency of documentation and medication administration, such as electronic medical records and medication verification systems; high patient– low nurse ratios; high patient acuities; a service-oriented
1557-3087/$ – see front matter © 2010 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.teln.2010.04.001
94
Editorial
patient population; and faculty and staff expectations for student performance in a clinical setting. Advances in practice and accordant teaching adjustments evoke varying responses. Faculty and staff alike are frustrated when they try to employ traditional teaching practices and expectations in light of the current health care environment. It is no longer practical or possible to safely administer multiple medications to multiple patients with multiple students. We must examine these practices and seek knowledge that allows students a world view, yet working view, of what nursing holds. We need to uncover the knowledge embedded in clinical nursing practice: “What's missing are systematic observations of what nurse clinicians learn from their clinical practice” (Benner, 2001, p. 1). Interventional strategies to foster positive clinical learning environments include the following: 1. Intentional behaviors to decrease anxiety, such as humor, peer instruction and mentoring, and mindfulness training (Moscaritolo, 2009). 2. Concept-based learning activities, employing Tanner's model of clinical judgment (Nielsen, 2009). 3. Establishment of focus groups composed of members from service and education whose purpose is to determine teaching goals and strategies to facilitate graduate outcomes and transition to practice. 4. Collaboration between education and service to promote optimal clinical learning (Palmer, Cox Harmer, Callister Clark, Johnsen, & Matsumura, 2005). 5. Dialogue with students about their teaching and learning needs and ways to capitalize on student life and work experiences that lend to success in nursing.
6. A variety of teaching strategies to promote learning and accommodate a variety of learning styles.
Faculty have the tools and resources to structure positive learning experiences. We must find a way to make roast pig without burning down the hut. Lynn Engelmann EdD, MSN, RN Associate Editor E-mail address: [email protected]
References Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. Upper Saddle River, NJ: Prentice Hall Health. Cook, L. J. (2005). Inviting teaching behaviors of clinical faculty and nursing student's anxiety. Journal of Nursing Education, 44(4), 156−161. Kanter, R. (1983). The change masters: Innovations for productivity in the American corporation. New York: Simon and Schuster. McKeon, R. (1973). Introduction to Aristotle, 2nd ed. New York: McGrawHill, Inc: Modern Library of Congress. Moscaritolo, L. (2009). Interventional strategies to decrease nursing student anxiety in the clinical learning environment. Journal of Nursing Education, 48(1), 17−23. Nielsen, A. (2009). Concept-based learning activities using the clinical judgment model as a foundation for clinical learning. Journal of Nursing Education, 48(6), 350−354. Palmer, S. P., Cox Harmer, A., Callister Clark, L., Johnsen, V., & Matsumura, G. (2005). Nursing education and service collaboration: Making a difference in the clinical learning environment. Journal of Continuing Education in Nursing, 36(6), 271−276. Schon, D. (1983). Educating the reflective practitioner: How professionals think in action. New York: Basic Books.