Good Teaching -ENCOURAGES- Critical Thinking -DEVELOPING- Active Learning
Active Learning is an educational process or an instructional method which involves the active participation of the student in the learning process; students are actively involved in activities such as reading, writing, active discussions, promotion of analysis through problem solving, and the synthesis and evaluation of classroom content (CRLT, 2014). Billings and Halstead noted that there are several benefits of active learning including: Increased attentiveness to learning, greater interest in learning, desire to use multiple ways of learning, increased retention of information, increased critical thinking skills, and enhanced team work to name a few (Billings & Halstead, 2012). Active learning is in contrast to the typical lecture of students. Active learning can be applied to the area of undergrad nursing education especially in the clinical area. Clinical competency in undergraduate nursing students is an area identified by some researchers as requiring some improvements, as many were found to be poorly prepared in relation to understanding and implementation of the nursing process; the study suggests that an active learning environment proved to be most beneficial to the undergraduate students nursing students in relation to adequate clinical competency (Shin et al., 2015).
Critical Thinking is a mode of thinking with regards to any particular subject, the content of a topic, or a problem; it is self-guided, and self-disciplined; it involves effective communication, and effective problem solving abilities (CTC, 2013). Critical thinking is a process that is learned; it is the art of analyzing and evaluating thinking with the forethought of improving the situation (ISNA,2014). Critical thinking in the profession of nursing is essential, and the characteristics of these nurses exhibit the following habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance and reflection (Shoulders et al, 2014). Implementation of case studies and simulation labs provide nursing students with the opportunity to develop necessary critical thinking skills in a controlled setting before entering into the profession; once these nurses enter into the workplace environment, they need to seek areas that will be conducive to the development and continued support of critical thinking such as: team support, staffing patterns that will allow continuity of care, and exposure to a variety of patient care situations – this creates an environment where the nurses efforts are valued, feelings of respect, and the nurses feel comfortable with asking questions which enhances the development of valuable critical thinking skills (Shoulders et al, 2014).
Active Learning can support the student nurse in developing his/her critical thinking/clinical judgment/clinical reasoning skills. Through active participation in course work and clinical work, the nursing student develops knowledge and skills related to nursing theories and models, application of research based practice (EBP), use of clinical judgment and decision making skills, self-reflection regarding professional practice, evaluation of nursing care outcomes by way of questioning inconsistencies, and engaging in creative problem solving (Benner et al, 2008).
Two examples of teaching/learning strategies that represent active learning and will lead to the strengthening of critical thinking/critical judgment/clinical reasoning skills:
Critical Thinking is a mode of thinking with regards to any particular subject, the content of a topic, or a problem; it is self-guided, and self-disciplined; it involves effective communication, and effective problem solving abilities (CTC, 2013). Critical thinking is a process that is learned; it is the art of analyzing and evaluating thinking with the forethought of improving the situation (ISNA,2014). Critical thinking in the profession of nursing is essential, and the characteristics of these nurses exhibit the following habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance and reflection (Shoulders et al, 2014). Implementation of case studies and simulation labs provide nursing students with the opportunity to develop necessary critical thinking skills in a controlled setting before entering into the profession; once these nurses enter into the workplace environment, they need to seek areas that will be conducive to the development and continued support of critical thinking such as: team support, staffing patterns that will allow continuity of care, and exposure to a variety of patient care situations – this creates an environment where the nurses efforts are valued, feelings of respect, and the nurses feel comfortable with asking questions which enhances the development of valuable critical thinking skills (Shoulders et al, 2014).
Active Learning can support the student nurse in developing his/her critical thinking/clinical judgment/clinical reasoning skills. Through active participation in course work and clinical work, the nursing student develops knowledge and skills related to nursing theories and models, application of research based practice (EBP), use of clinical judgment and decision making skills, self-reflection regarding professional practice, evaluation of nursing care outcomes by way of questioning inconsistencies, and engaging in creative problem solving (Benner et al, 2008).
Two examples of teaching/learning strategies that represent active learning and will lead to the strengthening of critical thinking/critical judgment/clinical reasoning skills:
- Team based learning – an opportunity for large classes to break down into smaller groups to participate in class assignments such as case studies, etc. This allows for each student to participate and provide valuable input into discussions developing their own thoughts and processing others input through active discussion. Students are able to strengthen their critical thinking/clinical judgment/clinical reasoning by working through clinical issues through case study, thinking through critical situations in a safe environment, and reasoning through implementations with thoughts from other individuals, and class.
- Simulation labs – allows students to participate in the implementation and development of critical thinking skills in a controlled environment which also strengthens the students critical thinking/clinical judgment/clinical reasoning.
Application of Student-Centered Learning Objectives
Program outcomes are the knowledge, skills, and/or behaviors that are expected of the students at the completion of a program (Billings & Halstead, 2012). Course outcomes refers to learning and behaviors that has been achieved and demonstrated by the student at the end of the program (Iwasiw & Goldenberg, 2015). Student-centered unit learner outcomes are based on expectations that are student focused that states what the student will be able to demonstrate at the completion of a unit (Iwasiw & Goldenberg, 2015).
Medical Surgical Content at BSN level: Critical Care Nursing
Upon completion of the course, students will:
Upon completion of the unit, the student will:
At a BSN level students are provided with a strong foundation in acute and critical care nursing that is developed through a variety of activities and critical care application. Students demonstrate their knowledge and skills by performance in clinical settings, evaluation by exams, class participation (group discussion, presentations), and simulation. Students benefit from self-reflection by journaling; and developing critical thinking skills through case study and discussion.
Medical Surgical Content at BSN level: Critical Care Nursing
Upon completion of the course, students will:
- Synthesize and applies the knowledge of physical sciences and behavioral sciences as it relates to medical/surgical nursing and the care of patients with acute and critical alterations in their health.
- Applies critical thinking and applicable other nursing theories to the patient and their families in the critical care environment.
- Demonstrate professional values, attitudes and actions that are mindful of the nursing standards of care as it relates in the critical care environment.
- Demonstrates the use of technology and information to the complex health care needs of the critically ill patient.
- Integrate culturally and religious sensitive care for clients and their families in the critical care environment.
- Provide safe, quality, and patient/family centered care to patients/family experiencing complex emergent life-threating health care and spiritual needs in the critical care environment.
Upon completion of the unit, the student will:
- Identify appropriate nursing interventions to manage the care and needs of critically ill patients (Remembering, Understanding, Applying) (1).
- Describe how critical care units meet the needs of the acutely/critically ill patients (Analyzing, Evaluating, Creating) (2).
- Identify common treatments and care involved in the care of the critically ill patient including acute issues such as hemodynamic monitoring (ABG, PAC, CVP, IABP, VAD, and mechanical ventilation) (Applying, Analyzing, Evaluating, Creating) (1, 4).
- Identify ethical issues that may arise and impact the care of the critically ill patient (Analyzing, Evaluating, Creating) (6).
- Recognize policies in health care related to financial regulation, resuscitation, and end of life care, organ donation, and introduction to the Critical care environment (Remembering, Understanding, Analyzing) (5, 6).
- Describe the commonly used treatments in the Critical care environment (monitoring, intubation) (Understanding, Applying, Analyzing) (1).
At a BSN level students are provided with a strong foundation in acute and critical care nursing that is developed through a variety of activities and critical care application. Students demonstrate their knowledge and skills by performance in clinical settings, evaluation by exams, class participation (group discussion, presentations), and simulation. Students benefit from self-reflection by journaling; and developing critical thinking skills through case study and discussion.
Large & Small Classroom Teaching/Learning Strategies
There are several challenges of teaching nursing in both the large and small classroom. There is a common assumption that smaller classrooms are more conducive to learning than larger classrooms, and students in larger classrooms feel as though they are anonymous to the instructor. Research has indicated that students in larger classrooms have demonstrated reduced levels of active involvement in the learning process as it relates to class involvement and interaction (Kerr, 2011). As one could imagine, instructors quality of instruction is impacted by the size of the classroom; the larger the classroom the greater the disconnect, therefore, negatively impacting the quality of the instruction (Bedard & Kuhn, 2008). Smaller classroom settings provide a form of intimacy for students where they feel as if they are an important addition to the classroom, and their input is valuable. The student has an opportunity to interact in discussions, ask questions, and get assistance when needed. I attended a large college with a saturated classroom, and a college which had small classrooms and I personally found that I did far better in the smaller classroom institution than in the class where I was typically a number.
As educators, we should focus on our skill and competence, our teaching methods that we choose to use and the design of the course that will ultimately affect the learning of the students and not necessarily the size of the class (Atkinson, 2010). For the large classroom, I would have the group count off by numbers from 1-10 for a classroom size of 80-100, and divide the group up into teams (Team 1-10) assigning each of them a disorder related to a system or disorders (ex. Digestive system or Abdominal disorders), give each a poster board or sheet of poster paper with a sharpie, and have each group research and report on disease, common signs and symptoms, and treatments; this activity will be time limited to 10-15 minutes; once the time is up, I would have a spokesperson from each group present what they have found. The smaller classroom of 15-40 students allows for group discussion, as well as an opportunity to play a group game such as jeopardy; this would be done by having a previously prepared game board (done on power point) with questions specific to a unit being taught; each question, just as jeopardy will cascade from 500-100 points and correct answers will be formatted in a question; this encourages group participation and provides a review for that unit.
Nursing programs have seen a steady incline in admission in the recent years, and nursing classes are being impacted by an increase in class sizes, thereby affecting the learner to educator ratio, ultimately putting the educator in a place where they are forced to develop inexpensive, creative, and effective learning alternative tools to engage the students. As I examine my own strengths and challenges which I will bring to the nursing classroom, I believe I am better suited to teach in a smaller classroom. I want to have an opportunity to get to know my students while I am teaching and I don’t feel I can do this in a large class. I am creative, organized and can switch gears when needed so I recognize this as my strength; my weakness would be not wanting to fail an individual who I know is trying but may be just barely not passing (74 GPA), I recognize that this may come with time. I don’t feel I am ready for either just yet, but I am prepared to work as a clinical instructor, and I guess I would recognize this setting as a small classroom as the groups are typically no more than 10 students ideally.
As educators, we should focus on our skill and competence, our teaching methods that we choose to use and the design of the course that will ultimately affect the learning of the students and not necessarily the size of the class (Atkinson, 2010). For the large classroom, I would have the group count off by numbers from 1-10 for a classroom size of 80-100, and divide the group up into teams (Team 1-10) assigning each of them a disorder related to a system or disorders (ex. Digestive system or Abdominal disorders), give each a poster board or sheet of poster paper with a sharpie, and have each group research and report on disease, common signs and symptoms, and treatments; this activity will be time limited to 10-15 minutes; once the time is up, I would have a spokesperson from each group present what they have found. The smaller classroom of 15-40 students allows for group discussion, as well as an opportunity to play a group game such as jeopardy; this would be done by having a previously prepared game board (done on power point) with questions specific to a unit being taught; each question, just as jeopardy will cascade from 500-100 points and correct answers will be formatted in a question; this encourages group participation and provides a review for that unit.
Nursing programs have seen a steady incline in admission in the recent years, and nursing classes are being impacted by an increase in class sizes, thereby affecting the learner to educator ratio, ultimately putting the educator in a place where they are forced to develop inexpensive, creative, and effective learning alternative tools to engage the students. As I examine my own strengths and challenges which I will bring to the nursing classroom, I believe I am better suited to teach in a smaller classroom. I want to have an opportunity to get to know my students while I am teaching and I don’t feel I can do this in a large class. I am creative, organized and can switch gears when needed so I recognize this as my strength; my weakness would be not wanting to fail an individual who I know is trying but may be just barely not passing (74 GPA), I recognize that this may come with time. I don’t feel I am ready for either just yet, but I am prepared to work as a clinical instructor, and I guess I would recognize this setting as a small classroom as the groups are typically no more than 10 students ideally.
Student Learning in the Clinical Environment
Long-term care is more than just caring for the elderly
in a nursing home, it is a rewarding specialty area that requires the nurse to
poses and exercise an extraordinary level of patience and compassion, in
addition to analytical thinking, knowledge and implementation of nursing
interventions. This clinical area of focus is relevant and useful for the
clinical learning of the pre-licensure nursing student.
In long-term care nurses provide medical, psychosocial, nursing, and personal care on an ongoing basis to patients who have chronic physical disabilities and illnesses, as well as mental disorders that require extended care. The extended care environment often consists of nursing homes, skilled nursing facilities, assisted living facilities, long-term acute care hospitals, adult day care centers, and retirement communities. The long-term care environment can be less chaotic than the acute care setting, however, in recent year’s patient acuity has increased as well as the use of technology such as IV pumps, and ventilators (Nurse.com, 2015). The nurses in long-term care collaborate with other members of the interdisciplinary team including physicians, social workers, dieticians, therapist (respiratory, physical, occupational, and speech), case managers, and pharmacists (The Commuter, 2012). Long-term care facilities employ nurses who have completed an accredited nursing program and attained state licensure either as a Licensed Practical Nurse (LPN), and/or Registered Nurse (RN). These nurses function as bedside nurses, nursing supervisors, unit managers, staff educators, directors of nursing services, infection control nurses, wound care nurses, minimum data set coordinators (MDS), and wellness directors. Nurses are able to attain professional certification in long-term care offered by the National Association for Practical Nursing and Education Service (NAPNES) who provides the LPN with their certification, and the American Association for Long Term Care Nursing (AALTCN) who offers certification for RNs (NAPNES, 2015; AALTCN, 2015).
Two innovative and creative student-centered teaching/learning strategies that would be appropriate to the clinical setting offering clarity in relation to clinical knowledge, skills, and attitudes are the Day in the Life of a Client with…., and Pass the Problem (Herrman, 2008).
Day in the Life of a Client – students are assigned a condition that residents (patients) in long-term care suffer from (Alzheimer’s, CVA with affected extremities and/or speech/swallow, Huntington’s disease, Arthritis, pulmonary disease with oxygen use, etc.), and the student will be given the day prior to for research, and planning associated with the assigned condition. The next day in clinical, the students will demonstrate some ADL’s (feeding, dressing, ambulating), and later document the difficulties they have noted as it relates to the condition, nursing diagnosis, and interventions in order to prepare for a reaction paper based on their research, experience, and nursing diagnosis with interventions applicable to the patient. Students will develop cognitive assessment, proper application of nursing assessment, nursing diagnosis, and nursing interventions, in addition to providing ADL care that is compassionate and empathetic of the patient’s needs.
Pass the Problem – students will take out a sheet of paper at the start of the clinical day, and on that sheet of paper they will write down the client’s age, sex, medical diagnosis, and a brief background/description. Next, the students will pass the paper around to each member of the clinical group, and each one will write down one nursing diagnosis and a clinical goal (brainstorming) for the patient taking about 5 minutes all together. After, each student will be given about 5 minutes to discuss their patient and the applicable nursing diagnosis, and goals. This activity fosters team work, developing care planning skills, assessments, and prioritization.
Multiple and varied clinical sites, experiences, and learning activities addressing the long-term healthcare environment needs are vital and necessary for nursing skills of the 21st century, as the aging population continues to grow and an increased need for qualified nurses in this clinical area grows as well. Long-term care nurses and facilities have recognized the need to foster healthy relationships and role models for clinical nursing educational experiences. Nurses in long-term care recognize a need for qualified clinical education liaisons, and have developed mentorships through partnering with educational institutions in order to provide nursing students with the necessary clinical curriculum to help focus their learning activities in relation to gerontological nursing (White et al, 2012).
In long-term care nurses provide medical, psychosocial, nursing, and personal care on an ongoing basis to patients who have chronic physical disabilities and illnesses, as well as mental disorders that require extended care. The extended care environment often consists of nursing homes, skilled nursing facilities, assisted living facilities, long-term acute care hospitals, adult day care centers, and retirement communities. The long-term care environment can be less chaotic than the acute care setting, however, in recent year’s patient acuity has increased as well as the use of technology such as IV pumps, and ventilators (Nurse.com, 2015). The nurses in long-term care collaborate with other members of the interdisciplinary team including physicians, social workers, dieticians, therapist (respiratory, physical, occupational, and speech), case managers, and pharmacists (The Commuter, 2012). Long-term care facilities employ nurses who have completed an accredited nursing program and attained state licensure either as a Licensed Practical Nurse (LPN), and/or Registered Nurse (RN). These nurses function as bedside nurses, nursing supervisors, unit managers, staff educators, directors of nursing services, infection control nurses, wound care nurses, minimum data set coordinators (MDS), and wellness directors. Nurses are able to attain professional certification in long-term care offered by the National Association for Practical Nursing and Education Service (NAPNES) who provides the LPN with their certification, and the American Association for Long Term Care Nursing (AALTCN) who offers certification for RNs (NAPNES, 2015; AALTCN, 2015).
Two innovative and creative student-centered teaching/learning strategies that would be appropriate to the clinical setting offering clarity in relation to clinical knowledge, skills, and attitudes are the Day in the Life of a Client with…., and Pass the Problem (Herrman, 2008).
Day in the Life of a Client – students are assigned a condition that residents (patients) in long-term care suffer from (Alzheimer’s, CVA with affected extremities and/or speech/swallow, Huntington’s disease, Arthritis, pulmonary disease with oxygen use, etc.), and the student will be given the day prior to for research, and planning associated with the assigned condition. The next day in clinical, the students will demonstrate some ADL’s (feeding, dressing, ambulating), and later document the difficulties they have noted as it relates to the condition, nursing diagnosis, and interventions in order to prepare for a reaction paper based on their research, experience, and nursing diagnosis with interventions applicable to the patient. Students will develop cognitive assessment, proper application of nursing assessment, nursing diagnosis, and nursing interventions, in addition to providing ADL care that is compassionate and empathetic of the patient’s needs.
Pass the Problem – students will take out a sheet of paper at the start of the clinical day, and on that sheet of paper they will write down the client’s age, sex, medical diagnosis, and a brief background/description. Next, the students will pass the paper around to each member of the clinical group, and each one will write down one nursing diagnosis and a clinical goal (brainstorming) for the patient taking about 5 minutes all together. After, each student will be given about 5 minutes to discuss their patient and the applicable nursing diagnosis, and goals. This activity fosters team work, developing care planning skills, assessments, and prioritization.
Multiple and varied clinical sites, experiences, and learning activities addressing the long-term healthcare environment needs are vital and necessary for nursing skills of the 21st century, as the aging population continues to grow and an increased need for qualified nurses in this clinical area grows as well. Long-term care nurses and facilities have recognized the need to foster healthy relationships and role models for clinical nursing educational experiences. Nurses in long-term care recognize a need for qualified clinical education liaisons, and have developed mentorships through partnering with educational institutions in order to provide nursing students with the necessary clinical curriculum to help focus their learning activities in relation to gerontological nursing (White et al, 2012).
Future of Nursing Education
The future of nursing education is rapidly changing along with the health care system. The focus of nursing education is no longer what it was in past years. There is greater focus on making improvements in relation to patient safety, quality of care, greater focus on patient centered care, accessibility, and affordability, in addition to the role that nurses play in relation to these improvements (IOM, 2010). A report issued by the Robert Wood Johnson Foundation (RWJF) provided recommendations related to the improvement and future of nursing which stated that nurses should achieve higher levels of education at an approved higher education system that promotes and encourages academic progression (ISNA Bulletin, 2011). In response to these demands, nursing programs are working on improving their programs to include the diversity of the changing health care environment to better prepare nurses to meet the needs of the changing population. With the new millennium, a blast of new technological changes came with it diversifying the world we live in even more, and impacting our society and culture making it imperative to shift towards a student centered view to meet the needs of students and society. For me, emerging technologies open the doors to unlimited possibilities, new discoveries, and developments which will enhance the world we live in, and improve the health care system as we currently know it. A recent report looked at the technological changes we face today, and discussed embracing the technology to ultimately strengthen the nursing profession such as EHRs (electronic health records), the use of smartphones in the clinical setting, and genetics and genomics; the full article and report can be accessed at Embrace Technology.
As I reflect on the needs of the 21st century learner and consumer, I determine that I am prepared to meet their needs, as I too am a life-long learner; learning, developing, and growing with the changes. The nurse educator interviews taught me that to be an effective educator I need to be prepared to watch, listen, ask questions, and not be afraid to admit that I don’t know something, because the real knowledge is in knowing your resources and how to get to the information and answers that you need. Approaching technology and changes in nursing education with an open mind and understanding that I too am learning is the best way to become efficient so that I can be an effective educator. Emerging changes and challenges in nursing education in the 21st century should be embraced by the educator, providing students with opportunities to utilize their skill and critical thinking in the health care setting (Glasgow, Dunphy, & Mainous, 2010). Over the course of the last 5 weeks, I have had an opportunity to look at the role of the nurse educator, and develop my nursing philosophy related to that role. I am certain that with the tools I have been equipped with and resources, I am prepared to be a nurse educator meeting the needs of the 21st century nursing student and health care consumer.
As I reflect on the needs of the 21st century learner and consumer, I determine that I am prepared to meet their needs, as I too am a life-long learner; learning, developing, and growing with the changes. The nurse educator interviews taught me that to be an effective educator I need to be prepared to watch, listen, ask questions, and not be afraid to admit that I don’t know something, because the real knowledge is in knowing your resources and how to get to the information and answers that you need. Approaching technology and changes in nursing education with an open mind and understanding that I too am learning is the best way to become efficient so that I can be an effective educator. Emerging changes and challenges in nursing education in the 21st century should be embraced by the educator, providing students with opportunities to utilize their skill and critical thinking in the health care setting (Glasgow, Dunphy, & Mainous, 2010). Over the course of the last 5 weeks, I have had an opportunity to look at the role of the nurse educator, and develop my nursing philosophy related to that role. I am certain that with the tools I have been equipped with and resources, I am prepared to be a nurse educator meeting the needs of the 21st century nursing student and health care consumer.