The trigger film in nurse education

NuruEducalion T&y (1994) 14,34~330 0 Longman Group Ltd 1994

WORK The trigger film in nurse education Julia Nichols

The use of video in education is now common place. Most Colleges of Nursing and Midwifery have access to the equipment for making and/or showing their own films. Video cannot be used indiscriminately and assumed to be effective. Many educational videos are entertaining but encourage a passive audience. As a result the materials may be enjoyable but the learning achieved, disappointing. An application of video that involves the student in active learning is the trigger film. This is a short piece of film, generally only a few minutes long whose aim is to stimulate and provoke learning. It is a unique form of film possessing special characteristics. The use of the trigger film in other areas of education is documented but its application to nurse education not widely explored. A trigger film has been produced by the author and used with nursing students (RN/Dip HE) to explore professional issues. The trigger film has been found to be an excellent stimulus for discussion and particularly effective for analysis of complex issues. Evaluation by students has been overwhelmingly positive. The trigger film lends itself to exploitation within nurse education. It is particularly useful for learning within the Affective Domain (Baud & Pearson 19’79). This paper will discuss the use of video in nurse education, the concept of the trigger film and the use and evaluation of the authors own film.

the use of this potentially powerful medium is lim-

INTRODUCTION

ited and unimaginative.

The use of the moving image as a teaching aid is well documented

in the educational

literature

and its value as a medium for communication undisputed.

Most

Colleges

of

Nursing

is and

Midwifery have invested large sums of money in the purchase

of equipment

for recording

and

a recent

This view is supported by

review of the use of video within one

College of Nursing (Fowler 1993). This paper describes the use of the video camera within one College of Nursing to produce trigger film for use with nursing explore professional issues.

students

a to

showing film, however in my personal experience,

THE VALUE OF THE MOVING IMAGE AS A TEACHING AID

Julia Nichols BSc(Hons) PGCEA RGN, Nurse Teacher, Sir Gordon Roberts College of Nursing and Midwifery, Kettering General Hospital, Rothwell Road, Northants, UK

The essence of teaching

(Requests for offprints to JN) Manuscript accepted 16 February 1994

teacher’s aim must be to meet the needs of the learner by the clearest exposition of the subject

is communication.

The

NURSE EDUCATION

matter. We all learn through

our senses: hearing,

sight, taste, touch and smell. Of these the most powerful is said to be sight (Groombridge Sless

(1981)

tradition

argues

that classical

1987).

philosophical

separated vision from thinking,

treating

each as a discrete process. Vision was seen as the province

of the eyes, a purely

sensory

process

327

TODAY

THE USE OF VIDEO IN NURSE AND MEDICAL EDUCATION Video has been used in a variety of ways in nurse and medical education: 1. As an infmnation source. Pre-recorded

videos

while thought was an entirely mental process, the

provide a source that may be used repeatedly and

two being biologically

shown to a large number of students, thereby pro-

however,

and logically distinct. Kant

writing in 1781,

vision and

viding

a cost-effective

thinking to be one process, with vision as the insti-

(1988)

describes

gator of thought,

conceived

not the handmaiden,

the seat of the intellect’

‘Vision is

(Sless 1981).

All teachers are aware that the thoughtful a variety of media will enhance

conferencing’ programme

use of

communication

between themselves and the learner, providing an ‘assault on the senses’ (C,urzon 1990) and enlivening a session:

teaching

medium.

the Canadian

where

Kerr

system of ‘video

an entire

post-RN degree

is carried out through distance learn-

ing. Lectures

are transmitted

by satellite to thou-

sands of students and the system is described

as

highly successful. 2. As a demonstration method. Video can be used effectively to demonstrate

procedures,

detail can

be seen in close up and the film stopped at strateOne can never justify because

that

singularly

teaching

is a mode

under

by talk alone

of teaching

which

uses the sensory capabilities

of the learner.

The eye for the teacher

most powerful

in road to the brain,

only verbally therefore under

use

the

(Groombridge

is the

gic points or repeated (1987)

describes

is to under value and

describe

the use of video

principle

sense.

purposes.

teach communication

the video film,

would appear to be an appropriate method to exploit in the effort to create the ideal learning (1987)

however,

suggests

be used indiscriminately

assumed to be effective. Research lish what aspects of training

moving images are

many video training programmes ducers have, in imitating

rials

have

the same passive audience been

for

is that the pro-

their presentation

counterparts.

and

has yet to estab

best suited for. He states that the problem

entertainment

style,

as their

As a result, the mate-

enjoyable

but

the

learning

achieved disappointing. Adult learners need to be involved in discovery learning, to be active, not passive recipients

(Rogers

um that has great resource;

the resource of instruction

1986).

potential

the problem

taped

modelling

to

skills to nurses in a coro-

nary care unit. Films were made of experienced staff

encouraged

for surgical teaching

He evaluated it as a simple and inexmethod. Wallace and Joshi (1987)

learners

Fawbert

was used to

record operative techniques pensive

1987).

that video cannot

areas. Young

to teach

The use of the moving image,

environment.

for problem

how a camcorder

Film is a medi-

as an educational

is how to exploit it without

itself determining (Baud & Pearson

methods and style 1979).

films

communication

demonstrating

through

the simulation

were

shown

skills

of real life situations. The

to other

nursing

staff and

stopped at intervals to discuss the skills. 3. As personalfeedbackon pe$nnance.

Video may be

used to film students performance as interviewing, teaching

inter-personal

etc. Hoyt et al (1988)

recording could

describe

of every resuscitation

place in their hospital critique

them

in such areas

communication, the video

effort that took

so that the trauma and learn

from

team

reviewing

their actions. As a result, they report that resuscitations

have become

more

efficient

ence to assigned responsibilities

and adher-

better.

4. The recording or re@oduction of events that occur infrequently or would be unethical to set up. The recording

of resuscitation

efforts

above or of operative techniques

as described

allow students to

benefit from otherwise inaccessible experiences.

or infrequent

328

NURSE EDUCATION TODAY

Video has been used in many different

formats

Powell (1982)

describes

the use of trigger films

to achieve various objectives.

It is clear that its use

to

must be carefully

and considered

Departments in tertiary education. They found it to be effective for stimulating the pooling of ideas

effective learning

planned

to take place. Successful

ing from this medium

still requires

for learn-

some inter-

action between the learner and the content. application

of video which

involvement presented

of the learner

requires

One

the active

in the material being

is the trigger film.

stimulate

discussion

and sharing of concerns. for 2-3 minutes realistic

amongst

a simulated

exemplifying

aspect of staff management. approaches.

The films were open-

They found

being a useful learning

THE TRIGGER FILM

but

a problematic

ended so that viewers could consider possible

of

Each film episode lasted

and portrayed

situation

Heads

a variety of

that as well as

exercise,

the discussions

helped to break down the sense of isolation felt by some Heads.

A trigger film is a short piece of video, generally only a few minutes long, whose aim is to stimulate and provoke learning. possessing

special

not a learning provide

experience

a means

reflection

It is a unique form of film

characteristics.

The

films are

in their own right but

of stimulating

students

and analysis of incidents

into

within a safe

environment. Typically,

(1991) describe the method

ing for adolescents trigger

in Israel. Nurses were shown

films depicting

and behaviour

various types of lifestyle

in adolescents

and sexual habits).

(smoking,

At critical moments

incomplete.

eating the pic-

ture faded and the nurses were invited to say what they would do in this situation.

trigger films are short, 3-4 minutes

long and portray an event that is left unresolved or

Eshed and Epstein

used as a research tool to assess primary care nurs-

They found the

films to be a useful way of stimulating

a response

to a simulated real life situation.

The viewer is asked to put them-

selves in the position

of one of the characters

in

the film and to state what they would do in the situation portrayed. Baud and Pearson (1979) offer further guidelines and state that the film must

PROFESSIONAL DECISION MAKING IN NURSING

appear to be a real life situation for the viewer, it must finish relatively abruptly and the profession-

Nurses are required

al must not appear committed

sions on a daily basis. Moral and ethical dilemmas

to any particular

The origin of the trigger film is attributed ment

psychologist and

Department

the

to the

and its develop-

the Film Board

University

of Gerontology

its development, explore

Seat-Cohen

to the US Air Force,

Canada

deci-

arise that require the nurse to use her knowledge,

course of action. French

to make professional

of

(Fisch

Michigan

1972).

Since

it has been used in education

how professionals

a particular situation. Ahoy and Ber (1984)

of

to

would choose to act in describe

the use of this

skill and judgement course of action. carry

out

this

to decide

an appropriate

The skills that are required level

of decision

to

making

may

develop over many years as the practitioner

pro-

gresses along the path from novice to expert. practice,

however, junior

staff nurses

In

may find

that they are required to use these skills early in their career. If such issues have not been addressed

during

their education

argue

watch trigger films lasting from 5-9 minutes. They

reality of practice. The ideal place to explore such dilemmas in the first instance is within the safety

were asked to state what they would do if they were in the same situation. They found the trigger films highly successful in stimulating lively discussion and reported an overwhelmingly (92%) positive result from students when asked if they had benefited.

that they have been

they may well

medium with medical students who were asked to

ill prepared

for the

of the college classroom. The difficulty lies in being able to reproduce a complex situation in a format that retains realism. It was decided that a trigger film could provide the medium through which a realistic real life sit-

NURSE EDUCATION

uation could be presented in nursing

practice

lysed. Individuals

to students. A dilemma

could be explored

and ana-

would be able to experiment

with ideas and actions within a safe environment.

l

Professional

l

The nurse as patient’s advocate.

l

Dealing with ‘difficult’ situations. The Code of Professional

College

using

of Nursing.

Teachers)

camera

Three

of the Code of Professional

within

volunteers

and the author

spent

a

(Nurse

several

hours

filming a scenario of events which occur in a ward area.

A short

ground

introduction

explains

the

back-

to the events: the patient is a 69-year-old

gentleman

who had been admitted

for a routine

operation.

Unexpectedly,

tumour

been found

a large

in his abdomen,

therefore

had

the sur-

geon had merely closed the wound. The patient is unaware

of this development

the operation

and assumes

that

took place as planned and unevent-

fully. Scene 1 shows the medical team and staff nurse coming

to the patients bedside. After a brief dia-

logue with the patient, home

that afternoon

patient appointment

used and evaluated Conduct

with

to provide

guidance as to possible and appropriate of action in uncertain situations.

and 15 seconds

a portable

film has been

Conduct.

groups of students to examine and discuss the use

THE USE OF THE TRIGGER FILM WITH NURSING STUDENTS was made

329

relationships.

l

The

A trigger film lasting 3 minutes

TODAY

The

aim of the session

group, it is emphasised

courses

is explained

to the

that there are no right or

wrong answers to the question

that they are to be

asked, the aim being to identify and discuss the issues and implications.

Students

view the film

twice so that they have fully understood

the events

and are then asked to identify the main concerns of each of the individuals involved in the incident allowing groups Conduct

the dynamics of students

to be identified.

(3-4))

for reference,

using

the

Small

Code

of

discuss and decide appro-

priate courses of action,

being prepared

to sup-

port the rationale

for action with the Code. The

large group

re-forms

then

to discuss and chal-

lenge the various ideas and proposals.

he is told that he may go and to return

for an out-

in 10 days time.

Scene 2 shows the staff nurse in discussion with the junior

doctor in the ward office. She is com-

municating

her unease at the lack of information

STUDENT EVALUATION OF THE TRIGGER FILM LED DISCUSSION The trigger film method

has been found by the

given to the patient and family. The doctor insists

author to be an effective method of presenting

that the surgeons

complex situation to a group of students. On each

orders

must be followed

that the patient will be informed

and

of his diagnosis

at his out patient appointment. Scene patient. collect

that it has been

3 shows the staff nurse talking with the

nent

ence, a written description

before

his daughter

him, he suddenly

picture

is due to

asks her to explain

to

during his operation.

fades with the words ‘What would

YOU do? ’ The film was produced

issues and details.

study approach, the simulation

has

for use with nursing stu-

dents on the Adult branch of the RN/Dip HE course. It was anticipated that the film may be in a number

of

areas: l

Ethical issues (withholding

l

a patient. The patient’s right to know etc.). Inter personal and communication skills.

information

from

In the author’s

experi-

of an event, or the case

usually leads to comments

that

is not realistic or comprehensive.

This has not been experienced On the contrary,

used as a trigger for discussion

used, the group

been able to identify quickly and discuss the perti-

Shortly

him exuctly what happened The

occasion

a

with this method.

students appear to identify very

quickly with the characters in the film and argue their points with conviction. In addition, the discussion

often

includes

comments

on the non-

verbal communication used by the characters, thus making the situation more realistic and opening

up areas for debate and discussion.

In each session a lively discussion has followed the sharing of ideas and proposals for action. The

330

NURSE EDUCATION TODAY

role of the teacher

is that of facilitator,

out key issues from

the students’

drawing

debates.

main issues that are raised and debated group may be followed up in subsequent

The

by the sessions

ment with ideas within the safe environment the classroom.

own interpersonal real life situations constraints

and are likely to be different for each group. The use of this trigger film has been evaluated

Students are able to explore and intrapersonal without

of a complex

(Baud & Pearson

1979). Students

by each student (n =90) using a written evaluation

trigger film-led discussion

form.

and is enjoyable.

Students

principal session

were asked to comment

points learned had been

on the

from the session; if the

enjoyable

and why/why not;

whether

they felt this was an appropriate

present

this

information

and

way to

suggestions

for

has been

encouraging

evaluating the session as enjoyable.

Reasons given

others ideas and debating the issues. The principal

points learned

how to cope/recognise/deal tions; the meaning

were said to be:

with difficult

situa-

of the Code of Professional

Conduct and the importance

of good interprofes

sional relationships. None of the students

had seen a trigger film

before although all felt that it was a suitable way to present this type of information.

CONCLUSION films can be used flexibly within nurse

education,

particularly

Affective Domain.

for learning

within

They are an excellent

the

stimulus

for discussion and through simulating real life situations can be used to allow students to explore and examine

issues that they might not otherwise

have the opportunity

to experience.

The author

has found the trigger film to be particularly effective for analysis of dilemmas

that may arise in

practice and are difficult to simulate through case study approach.

the

The trigger film style places the student in the position of active learner by presenting that demands to become

report that the aids learning

Despite the availability of literature this technique

explaining

to support

its use,

there appears to be very little exploitation

of this

potentially

and research

powerful and effective method within

with 100%

were: the creation of a ‘real life’ situation; hearing

Trigger

method

and

environment

nurse eduction.

improvement. Feedback

responses to

the distractions external

of their

a response.

Learners

a situation

are required

involved, to draw on their own experi-

ences, to make decisions and to consider the views of others. The unresolved ‘real life’ situation opens up many avenues of exploration.

The situa-

tion in which there are no right or wrong answers and no solutions.

allows the student

to exneri1

References Ahoy G, Ber R 1984 Doctor-patient relationship and the medical student. The use of trigger films. Journal of Medical Education 57: 334-336 Baud D, Pearson M 1979 The trigger film: a stimulus for affective learning. Programmed Learning and Educational Technology 16: 52-56 Curzon LB 1990 Teaching in Further Education: An Outline of Principles and Practice, 4th ed. Cassell Education, London, ~246 Eshed H, Epstein L 1991 Assessment of primary care nursing in relation to adolescent health behaviour by means of trigger films. Journal of Advanced Nursing 16: 24-29 Fawbert F 1987 Using video in training technology. Training technology programme, Vol. 11. Parthenon Publishing Fisch A L 1972 The trigger film technique. Improving College and University Teaching 20(4) Fowler J 1993 The use of video cameras in one college of nursing. Nurse Education Today 13: 66-68 Groombridge J (ed) 1987 Resources for teachers of adults. N.I.A.C.E. Hoyt D Ret al 1988 Video recording trauma resuscitations, an effective teaching technique. Journal of Trauma (April) 28 (4) : 435-440 Kerr J R 1988 Nurse education at a distance using technology to advantage in undergraduate and graduate degree programmes in Alberta, Canada. International Journal of Nursing Studies 25(4): 301-306 Paegle R D, Wilkinson F J, Donnelly M R 1980 Video taped versus traditional lecturers for medical students. Medical Education (Nov) 14(6): 387-393 Powell I P 1982 Enhancing the managerial effectiveness of heads of departments through trigger film workshops. lournal of Tertialv Educational Administration 4(l): 39-81 Rogers A 1986 Teaching Adults. OU Press, Milton Keynes Sless D 1981 Learning and Visual Communication. Croom Helm. London Wallace L M, Joshi M 1987 Video tape modelling of communication skills in a coronary care unit. Intensive Care Nursing 2: 107-l 11 Young H 1.1987 Low cost video equipment for surgical teaching. Medical Education (Nov) 21(6): 490-492