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.

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.

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.