The Science and Art of Nursing

The challenge for nurse training is balancing the historical ‘handmaiden’ viewpoint of the nurse with theoretical concepts and scientific research (evidence based practice). Delivering empathetic holistic care and ensuring evidence based practice is delivered is a quite a challenge. What is the impact of national standardised practice, can one standard really be best practice across so many specialities and be individualised to meet the needs of each patient/client?

As the framework for nurse training, the science aspect is the priority at the start of training with a build up of clinical placements to translate this theory into practice. This is the doing part of nursing, through building therapeutic relationships, empathy and emotional intelligence comes development of interpretation and application in solving healthcare issues. The importance of preceptors and mentors to role model quality care is an essential social learning in nursing.

What about burnout, moral fatigue, bullying and where all this sits in the art of nursing? Are these potential factors to be addressed in nurse training, adding additional focus on the art of nursing, rather than just the science?

Resources

Idczak, S. E. (2007). I am a nurse: Nursing students learn the art and science of nursingNursing Education Perspectives28(2), 66-71.

Jasmine, T. (2009). Art, Science, or Both? Keeping the Care in Nursing. Nursing Clinics of North America. 44(4), 415-4

Doan, W, Fick, D, Hill & Kitko, L. (2018). The Art and Science of Nursing. Journal of Gerontological Nursing. 44(12), 3-5.

Vega, H & Hayes, K. (2019). Blending the art and science of nursing. Nursing2019.

Job roles of the 2025 Medical Educator

Journal Club Article:

Simpson, D., Marcdante, K., Souza, K. H., Anderson, A., & Holmboe, E. (2018). Job roles of the 2025 medical educatorJournal of Graduate Medical Education10(3), 243-246.

Keywords: future ready, adaptability, devices, future systems, curator, role model, medical educator.

Background: Need to understand these changes and design education to be consistent with the roles of physicians in this future system consistent with the roles of physicians in this future system consistent with a true competency-based approach to education.

Job analyses reveal for physicians in 2020 must be:

  • competent health care clinicians for patients and populations,
  • superb communicators,
  • luent with digital data and technology, agile and innovation-driven,
  • capable as leaders and members of interprofessional teams .

Education, changes will be driven by anytime and anywhere adaptive strategies:

  • learning analytics
  • virtual and augmented reality,
  • gamification,
  • mobile/wearable technologies

Future Trends

  • Outsourcing of Education: Textbook publishers have built software platforms where students can do homework exercises and get real-time feedback.8 Education-oriented partnerships between academics, professional societies, and vendors are increasing. Examples include the Surgery Resident Skills Curriculum developed by the American College of Surgeons and Association of Program Directors in Surgery, the AAMC/Kahn Academy for MCAT Prep, the MedU Cases completed by more than 40 000 students each year, and the in-training examinations and prep courses delivered by specialty/professional societies.
  • Technology: Virtual and augmented reality technology, combined with built-in learning analytics, are used to create virtual companions that support trainee learning and new forms of real-time assessment.
  • Learning Analytics/Big Data in Education: The use of big “education” data facilitates personalized learning for individuals and groups, as well as use of assessment data for program evaluation. Examples include the ACGME’s analysis of milestone data and the emergence of conferences highlighting how to analyze and use big data.
  • Learner as Consumer and Co-Designer: Examples include mobile 24/7 anytime/anywhere learning and testing and micro/nano degrees that allow students to take a series of short online courses, finish a capstone project, obtain a certificate, and prepare for a specific role or job.
  • Regulation and Alignment: Increasingly, regulators and accreditors will focus on integrating and aligning education and clinical care outcomes (health care quality, safety, patient experience) as the primary driving force for the design of medical education programs across the continuum. There also is increasing emphasis on team/interprofessional collaborative care and education as decisions and actions will no longer be a solo act. Decision-making will be distributed among the team members based on their license and scope of practice, and supported by artificial intelligence/machine learning (eg, Watson).”

Roles of the Future Medical Educator

  • Diagnostic Assessor: “Use results of big data to identify individual/group performance gaps to individualize training
  • Content Curator: Access, select, sequence, and deliver high-quality content developed by national experts
  • Technology Adopter: Be an early adopter and fluent in selecting and using appropriate technology tool(s)
  • Learner-Centered Navigator and Professional Coach: Guide learners’ use of resources and practice to achieve identified performance targets
  • Clinician Role Model: Exemplar for the various 2025 physician job roles
  • Learning Environment Designer, Engineer, Architect, and Implementer: Designs the “space” to optimize learning informed by sciences (eg, learning).”

Summary

As education evolves, medical educators must embrace these role changes and a new professional identity.

PEARLS Debriefing Tool (Journal Club)

Journal Club Article: Eppich, W., & Cheng, A. (2015). Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefingSimulation in Healthcare10(2), 106-115.

About PEARLS

Promoting Excellence And Reflective Learning in Simulation [PEARLS] is an integrated conceptual framework for a blended approach to debriefing.

The PEARLS framework integrates:

  1. Learner self-assessment,
  2. Facilitating focused discussion, and
  3. Providing information in the form of directive feedback and/or teaching.

The aim of PEARLS debriefing tool is “the use of scripted language to guide the debriefing process in simulation-based education.

“PEARLS offers a structured framework adaptable for debriefing simulations with a variety in goals, including clinical decision making, improving technical skills, teamwork training, and interprofessional collaboration.”

A Rationale for Scripted Debriefing: A cognitive aid to support the debriefing process in clinical contexts and simulation based education.

A Rationale for a Blended Approach to Debriefing: “3 broad categories of learner self-assessment, focused facilitation to promote critical reflection and deeper understanding of events and providing information through directive performance feedback and/or focused teaching.

In merging these 3 broad educational strategies into a blended debriefing framework, we have kept key learning principles in mind, namely, that learning should be active, collaborative, and self-directed and learner-centered” (pg. 2).

PEARLS Debriefing Framework

“Debriefing script supports simulation educators in 3 main areas as follows:

  • Setting the stage for the debriefing;
  • Organizing the debriefing to include initial participant reactions followed by a description of relevant case elements, an analysis of positive and suboptimal areas of performance using the PEARLS framework to select a debriefing approach, and finally a summary of lessons learned; and
  • Formulating questions that empower educators to share clearly their honest point of view about events.”

PEARLS outlines 4 distinct phases of the debriefing process:

  • Reactions phase
  • Description phase
  • Analysis
  • Summary: Learner or Educator guided

Resources

Debrief 2 Learn

Rudolph, J. W., Simon, R., Rivard, P., Dufresne, R. L., & Raemer, D. B. (2007). Debriefing with good judgment: combining rigorous feedback with genuine inquiryAnesthesiology Clinics25(2), 361-376.

Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learningSimulation in healthcare2(2), 115-125.

Q Methodology

Q Methodology is a research method used in psychology and in social sciences to study people’s “subjectivity”—that is, their viewpoint” (Wikipedia, 2019).

“Q-methodology is one approach that can be used to help policy makers and researchers actively engage with those who are important in policy implementation, and anticipate their responses. Q-methodology combines qualitative and quantitative research methods to systematically explore and describe the range of viewpoints about a topic” (Alderson, Bryant, Ahmed & House, 2018) .

Method

This is a 3 stage process (Valenta & Wigger, 1997):

  • Stage one involves developing a set of statements to be sorted;
  • Stage two requires participants to sort the statements along a continuum of preference;
  • Stage three the data are analyzed and interpreted

Aim

“Q-methodology research emphasizes the qualitative how and why people think the way they do; the methodology does not count how many people think a certain way. The goal of Q-methodology is, first and foremost, to uncover different patterns of thought (not their numerical distribution among the larger population” ( Valenta & Wigger, 1997).

Q-method.org: For more information on Q-methodology

Healthcare Resources

Alderson, S., Foy, R., Bryant, L., Ahmed, S., & House, A. (2018). Using Q-methodology to guide the implementation of new healthcare policiesBMJ Qual Saf27(9), 737-742.

Valenta, A. L., & Wigger, U. (1997). Q-methodology: Definition and application in health care informatics. Journal of the American Medical Informatics Association4(6), 501-510.

Check-In Check-Out Process

Journal Club Article: Henderson, A., Harrison, P., Rowe, J., Edwards, S., Barnes, M., & Henderson, S. (2018). Students take the lead for learning in practice: A process for building self-efficacy into undergraduate nursing education. Nurse Education in Practice31, 14-19 [abstract].

Aim: To prepare graduate nurses for practice, the curriculum and pedagogy need to facilitate student engagement, active learning and the development of self-efficacy. Prepare nurses for the range of diverse health settings they will need to deliver care in the future.

Check-in and Check-out process: “aims to engage students as active partners in their learning and teaching in their clinical preparation for practice.”

Three interdependent elements make up the process:

  1. A check-in (briefing) part.
    • What will I be doing today?
    • What are my questions before starting?
    • What are my learning goals?
    • What am I learning about today?
  2. A clinical practice part, which supports students as they engage in their learning and practise clinical skills.
  3. A check-out (debriefing) part.

The Check-In, Check-Out approach to the clinical practical learning experience has been scaffolded for learning development and incorporates classrooms, practice laboratories, simulation clinical placements. Following the Check-In, Check-Out process here are then 4 self-efficacy statements:

  1. I can safely perform the clinical practice (What did I do?)
  2. I can identify positive examples of clinical practice role-modelling (What did I see?)
  3. I can identify feedback received that helped me achieve my learning objective/s (What was I told?)
  4. I have the confidence to initiate and independently perform the clinical practice (How do I feel?)

Then 2 take home self-reflective questions:

  1. Have I learnt what I need to know?
  2. If not, what do I still need to do?

Summary: “The foundation of the CICO process rests on a collaborative partnership between teachers and students. Its benefits are realised by enabling students as active participants and contributors to the fabric of the clinical learning space. Positive learning relationships develop when teaching staff support students in all aspects of their learning experience and students actively engage in the management of their learning.”

Terminology: The authors use the acronym CICO for their Check-In, Check-Out theory. For those of us in critical care settings this may relate more to terminology for the worrying ‘cant intubate, cant oxygenate’ situation.

Thanks to the amazing oracle of nursing education, Associate Professor Deb Massey for discussing this topic. Definitely a nurse academic and influencer to follow.

Nursing Education Network Presentations

Here is the playlist for all presentations to date. Remember its a work in progress so they will increase in number, and hopefully in quality and presenting skills over time. They are based around microlearning so are perfect for on the go learning. If you go to the original post for each recording, the presentation is also available as file version to download.