Thinking from Experience in Psychosocial Practice: Reclaiming and Teaching ‘Use of Self’

A course based on psychosocial theory and students' experiences in practice has been taught in the UK, Norway and Quebec. It departs from the classical social work concept ‘use of self’ and aims to help novices in health and social work to understand how the social world is internalised and re-produced and the value of thinking from experience. International developments such as, competency-based education, New Public Management and evidence-based practice reduce opportunities for experiential learning. This trend has been exacerbated by a focus on anti-oppressive practice without a corresponding understanding of how oppressive relations are internalized and enacted by defended and conflicted subjects. Attempts to rectify a relational deficit through traditions of reflective practice and critical reflection are important developments, but could be further strengthened by psychosocial and psychodynamic perspectives. The course combines critical, contextual and relational thinking for students in caring profession

Developing Clinical Judgment through the Implementation of Information and Communication Technology, such as the Electronic Healthcare Record (EHR)

Graduate nurses are expected to enter a technology-rich workforce with an understanding of the electronic health record (EHR) and how it is used to guide patient care. Limited access to EHRs in clinical settings may result in students entering professional practice with limited ability to understand the full potential of the EHR. Over a seven-week term, students enrolled in the Patient-Centered Care I course, during the 2018 Spring I term, participated in high-fidelity simulation and seminar activities that included an educational electronic healthcare record (EEHR). These activities were integrated into the course to guide students when making clinical decisions regarding patient-centered care. Of the 93 students, 14 participated in the pre-course self-assessment survey, and 10 participated in the post-course self-assessment survey. Only those students who took both the pre and post-course self-assessment were evaluated (11% response rate). This survey was not mandatory, however, the EEHR activities in the course were. Students used Lasater’s Clinical Judgment Rubric to rate themselves in the dimensions of noticing, interpreting, responding, and reflecting. Overall, mean scores increased in three of the four dimensions of clinical judgment (noticing, interpreting, and reflecting). There was a significant difference under the criteria focused observation, for the dimension of noticing. There was marginal significance under the criteria making sense of data, for the dimension of interpreting, as well as marginal significance under the criteria commitment to improvement under the dimension of reflection. Keywords: educational electronic health record (EEHR), electronic health record (EHR), clinical judgment, Lasater’s Clinical Judgment Rubric, simulation, active student learning, experiential learning, and technology

A Simulation to Improve the Clinical Nursing Instructor’s Teaching of Ethics to Students in the Clinical Setting

Ethical knowledge and skill is crucial to the discipline of nursing and is considered foundational knowledge for nursing practice (American Nurses Association [ANA], 2008). Nurses who assume roles in clinical teaching may be clinically competent but may have limited nursing education experience or knowledge in clinical instruction. The purpose of this project was to improve the educational experience of clinical instructors in the teaching of ethics to students in the clinical setting. This DNP capstone was a quality improvement project with a mixed method design using simulation as a teaching strategy. Eight clinical instructors from a university based baccalaureate nursing program in the Northeast were recruited to participate in an educational workshop designed to improve teaching of ethical decision making. Simulation and debriefing methods were utilized to increase the participant’s awareness of their own knowledge and skill in ethics, and provide an opportunity for reflection on useful teaching strategies in applied ethics during clinical instruction. Following the educational intervention, participants experienced an increase in knowledge and confidence in ethics and teaching ethics to students in the clinical setting. The results of this project provided insight to specific gaps in the clinical instructor’s knowledge of ethics and in teaching ethics in practice, as well as what knowledge was needed to apply ethics in clinical instruction. This project has implications for nursing faculty development and may be replicated by other nursing programs who desire to develop their clinical instructors’ teaching of ethics

Nurse Residency Program: Best Practices for Optimizing Organizational Success

A nurse residency program’s best practice recommendations are presented within this article and are organized around three processes: establishing the program infrastructure, creating a multistaged evidence-based program, and sustaining the program through appropriate evaluation and dissemination of results. These recommendations represent lessons learned and key findings derived from a team of academic and nursing professional development educators after 7 years of residency program implementation at multiple rural and urban hospital sites. Organizations, regardless of size and resources, can use these recommendations to increase the likelihood of building a successful residency program

The Impact of High-Fidelity Simulation on Nursing Students’ Flexible and Reflective Thinking in Higher Education

This study evaluated the effect of high-fidelity simulation with both mannequins and live actors on flexible and reflective thinking of nursing students. Students enrolled in an undergraduate nursing program were recruited to participate in this study. Ninety students, all female, completed both pre- and post-surveys. The researchers conducted a paired samples t-test to determine if there is a statistically significant difference in students’ level of flexible thinking before and after they experienced the high-fidelity simulation. Moreover, we conducted multivariate correlational analysis to examine the relationships between flexible thinking and reflective thinking. In general, statistical results in this study provide empirical support for the values of clinical simulation and debriefing on nursing students’ flexible and reflective thinking. High-fidelity simulation can expose students to controlled and dynamic clinical environments, allowing them to attempt the transfer of theory to practice, learn from collaborative and active learning tasks, and be open-minded to multiple perspectives and in diverse situations. We conclude that critical reflection is an important piece of development in flexible thinking and reflective learning. During the time of post-simulation interactions, students are encouraged to reflect objectively on their performance in each scenario. The input from peers and instructors provides students with the opportunity to assess their personal ability to transfer theory to practice and evaluate if the theory design of the course is providing them with the needed information to care for the clients presented in the clinical simulation scenarios

A structured, intentional simulation delivery method: Development of a best practice faculty teaching policy

Executive Summary Consistent, structured, intentional simulation teaching methods for best practice Problem: Observation at two nursing programs indicated inconsistent, simulation faculty teaching methods and absence of training and orientation for faculty development and competency evaluation. Project purpose: Create a structured, consistent faculty development training program utilizing the International Nursing Association for Clinical Simulation Learning standards (INACSL) and using the Debriefing Assessment for Simulation in Healthcare (DASH) measurement instrument for annual competency review. Project Goals: Support positive faculty role modeling, professional development, increased self-efficacy and decreased faculty and student confusion. Project Objectives: Both identified schools will have a system in place for quality improvement in simulation teaching methods through training, mentoring and education. Plan sequence: Plan consisted of a project introduction email, information sheet, pre-survey followed by faculty participation in three simulation teaching sessions with the DNP leader. A 30-minute simulation best practice webinar presentation and posttest followed with a post survey. Outcome and Results: Quantitative paired t-test using ordinal level data from a convenience sample of faculty participants resulted in a reliable positive correlation between the pretreatment and post treatment measurements. Instrument reliability and validity supported recommending consistent structured simulation teaching methods to all faculty teaching in simulation at both schools. Development of confident, knowledgeable faculty teaching and debriefing methods involves instituting INACSL and literature recommendations for best practice outcome

Learning formative skills of nursing practice in an accelerated program

The purpose of this qualitative research study was to describe how students in an accelerated master’s degree entry program experientially learned the practice of nursing. One research question examined in this study was: What formative experiences did students identify as helping them develop and differentiate their clinical practice? Data from clinical observations and a combination of small group and individual interviews were collected and analyzed using interpretive phenomenological methods. Students identified formative skills learned through the independent care of a patient as pivotal in their identity and agency development. By experiencing the responsibility and action from within the body and from within concrete situations, students developed a new understanding that changed their embodied ways of perceiving and orienting to the situation, as well as their skills and sense of agency

Development of a Clinical Nurse Leadership Orientation Program

Nurses are often promoted or hired into leadership positions without the benefit of a formal orientation to their new leadership positions. The challenge of navigating the various expectations of the role of clinical nurse leader (CNL) such as fiscal ownership, staffing patterns, payroll, and disciplinary action process can be overwhelming. The lack of a formalized orientation process and an identified nurse leader to function as a mentor can contribute to the novice CNL feeling unsupported and overwhelmed. The purpose of this project was to identify, develop, and evaluate a CNL orientation manual, outline, and program for newly appointed CNLs. The desired outcome for this doctor of nursing practice project was the education and preparation of CNLs who will navigate the various facets of the role and retain their positions longterm. The Association of Nurse Executives nurse leader model was used to guide the project. A panel of 5 CNL experts evaluated the manual outline and content using a 5-question Likert scale survey. Findings indicated 100% of the participants agreed or strongly agreed with the importance of the topics covered and 80% agreed with the content covered in the manual outline. The project is expected to promote positive social change by preparing new CNLs to meet the requirements of leadership positions

Chaos is Not Rational: Nursing Leadership and Intuition in Disaster Preparedness and Response

Nurses are looked upon as leaders in disaster preparedness and response. Charged with making life-altering decisions, experienced nurse leaders utilize analytical and intuitive strategies to manage crisis situations. Rarely recognized by upper-level management and educational institutions, intuition is our natural ability to know something without any evidence or validation. Intuition allows us to make decisions in ever-changing circumstances when solutions are not obvious. Though difficult to explain, intuition is a powerful skill that gives nurse leaders the confidence needed to make decisions based on their previous experience. Experienced nurse leaders utilize intuition to arrive at a solution without conscious awareness and are capable of quickly processing the situation and producing accurate responses with little information. Intuitive decision-making is incorporated into nursing practice on a daily basis; however, we do not know the depth in which intuition exists within the nursing profession and among nursing leadership. Therefore, the purpose of this study was to examine the lived experiences of nursing leaders using intuition as part of the leadership approach in crisis situations. The qualitative study utilized an interpretative phenomenological approach to illustrate and understand the personal experiences of nurse leaders as they faced uncertain circumstances. The study population included nurses in public health or in the private sector who served in leadership roles in crisis situations. Nurses were recruited via telephone, email, and social media based on their current professional relationship with the researcher. Demographic data was collected through online surveys and one-on-one, semi-structured interviews were conducted via Zoom® with each participant. These interactions between the interviewer and the interviewee revealed the meaning of their lived experiences and understanding of the world from the participant’s point of view (Creswell & Poth, 2018). The findings of this study provide insight and understanding of the functional, real-life application of intuition by nursing leaders when dealing with complex and rapidly fluctuating situations

The Rhetoric of Health and Medicine as a “Teaching Subject”: Lessons from the Medical Humanities and Simulation Pedagogy

The rhetoric of health and medicine has only begun to intervene in health pedagogy. In contrast, the medical humanities has spearheaded curriculum to address dehumanizing trends in medicine. This article argues that rhetorical scholars can align with medical humanities’ initiatives and uniquely contribute to health curriculum. Drawing on the author’s research on clinical simulation, the article discusses rhetorical methodologies, genre theory, and critical lenses as areas for pedagogical collaboration between rhetoricians and health practitioners