'I Didn’t Know it was That Serious': Students as Partners - Perspectives on Academic Integrity and Awareness Raising Resources

Abstract

Nursing students are expected to learn to provide safe evidence-based care by deliberately using higher order thinking and clinical reasoning (CR) skills to develop capability to ‘think like a nurse’. This is a challenging task that requires knowledge integration and repetition to articulate actions that are underpinned by reasoning, working towards the end goal of practicing safely in a healthcare environment. Changes in pedagogy require a planned approach, monitoring and support to ensure success. Does the implementation of new active inquiry-based learning interactions and consistent language and thinking scaffolds within a clinical reasoning framework support students’ learning? This was investigated using an action research design that re-framed ‘think like a nurse’ learning within an on-campus tutorial environment in a large first-year Bachelor of Nursing subject. The selection of new learning approaches was based on findings and recommendations from a previous students-as-partners project within Bachelor of Nursing course re-design during 2015-16. Literature – It is well understood that clinical reasoning is complex and a challenge to teach and learn, as each unique practice encounter guides nurses’ actions, reflections and continued learning. It is widely recognised that higher education should encourage students to adopt responsibility for their learning through interaction and engaging activities. Inquiry based learning approaches are credited with having good authenticity with nursing clinical practice; encourage group interaction and self- reflection, and are motivating and enjoyable ways to learn. However there needs to be a structured, facilitative approach engaging learners with a range of information to make sense of a clinical situation. Methods – Researchers observed learning interactions in 32 tutorials with seven tutors and over 600 students across two weeks. Data was generated through researcher field notes and memos were developed. Additionally students and staff completed an online survey regarding satisfaction with experiences. The research was underpinned by a social constructivist theoretical framework. Data analysis was informed by Charmaz’s constructing grounded theory methods. Findings – Two key analytical findings were generated as the learning was reconstructed in the new IBL approach. ‘Driving and reframing’ represented the subtle and overt roles that tutors assumed, reframing from teacher to facilitator of learning, which necessitated a shift in class dynamics and atmosphere. The key finding from student interactions was ‘Opting in and Out’. Students moved in and out of the IBL case based activity, distracted easily and while actively transitioned in and out of learning exchanges, even as an active group member. Survey results identified overall acceptance and strong positivity for continuing use of the IBL and scaffolded CR approach. Conclusions – Introducing a new inquiry based approach to teaching clinical reasoning required careful planning, preparation and an adoption of strategies to support the inclusion and buy in of staff and students. The brief of IBL activities is to offer flexibility, creativity, and discovery oriented learning. This new approach supported learning, embedding clinical reasoning experiences and scaffolds served to support students to develop ‘think like a nurse’ capability