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Welcome to this episode of NLN podcast Nursing Edge Unscripted. I'm your host, Dr. Steven Palazzo, a member of the editorial board for Nursing Education Perspectives. In this episode, we will discuss how to foster clinical judgment through active learning strategies. My guests today are Dr. Ashley York, associate professor, and Laura Wynn, an instructor, both at the Moffett and Sanders School of Nursing at Sanford
University in Birmingham, Alabama. We will discuss their article, Fostering Clinical Judgment and Promoting Transition into First Clinical Rotation through Active Learning. This article can be found in the July-August issue of Nursing Education Perspectives. Welcome Ashley and Laura. Hi, thanks for having us. You're very welcome and thank you for joining us. First I'll just ask you, what common barrier hinders the transfer of clinical
knowledge to practice? I think that's a question most of us ask ourselves when we're figuring out how to take something from the literature and bring it into clinical practice. I think there's lots of different things that affect students. Many students struggle with applying classroom learning to their real life situations. This seems to be a major struggle with students across every type of undergraduate program as well as even
some in master's programs as well. There's a major disconnect between the theory that we're teaching them in the classroom and then the practice of actually thinking like a nurse, which is a term we talk a lot about and mention to our students, but they don't really understand how to think like a nurse or what it means to think like a nurse.
So first semester students they the ones that we speak about in this article they really lack interpreting patient cues or making decision making skills based off of real patient data. So a lot of it is because they don't have the real experience. They might not have had a job as a patient care tech. They may never worked or done anything in a health care setting. They may have never even cared for children in general or older adults. So did anybody any type of
care experience. So with what we kind of looked at, that's one of the major things we see. They also need to develop clinical judgment, which is one of the big things that we're needing to work on. And they might not see from the lab setting or class as a connection to the actual clinical. And then our goal was to try to really help foster that connection because of the lack of the connection that we've seen with our students.
So when I read your article, obviously what stood out was a strategy you used called the seven stations simulation. How did that seven stations simulation promote active learning through content reinforcement, experiential learning, and reflection that was mentioned in the article? Focusing on the content reinforcement, our stations that we had, they really aligned with our course objectives. This was a health assessment
course. We were really focused on getting them to do focused assessments, documentation, and health promotion. And that's the things they've been learning didactically and in the lab setting already. So, our goal was really trying to get them to put all of these pieces together because a lot of it had been done segmented throughout the program or they might not have seen that
full-blown connection. And also, we tried to help them in the experimental learning area by using realistic manikins as well as scenarios for our mannequins. It just wasn't a piece of plastic laying there. We wanted them to be real people for them. And we also did partner-based vital sign checks. So they're actually using a real
person, not a mannequin for that. So there can be real variables and they might not have ever checked that person's vital signs before because that might not be the partner that they were working with throughout the entire semester. We also had safety walkthroughs where we were really just letting them do and not just learn. So, this was really trying to put hands-on experience and as much real life experience as we could give them without physically taking them to the hospital
setting. I'm going to let Laura answer a little bit more about the reflection portion of it. Yes. So, not only did we engage them with hands, but we also let them reflect on what they were doing. And we had them do that through guided reflection. We had a station six especially they had to look at different charts and pick out the normals and the abnormals and they picked out normals and abnormals based on physical findings.
It wasn't until they looked at our answer key and they saw that we had picked out some things that were social determinants of health like somebody living alone is not going to be able to care for themselves as well when they're getting better. And so they saw that and it made them realize, oh, this is a whole person and helped them to begin to think from a different perspective, which is what helps them to grow clinically is to be able to start to think in a more holistic
manner. So the reflection piece, we guided them just a couple of questions and that was really engaging in helping them to learn. Great. Would you walk us through like so I'm a student coming in and going through this seven station simulation just kind of what would I experience or what would
I expect when I come into the environment? So when you we had stations set up and we had a piece of paper or on their learning system telling them what the different stations were and we told them they could choose which station to go to so they got to pick and we did a little brief survey. This station we're going to do be do vital signs. If you see that this station is open, you can go and do your physical assessment and this station you can document. So they had to hit all the
different ones. They had a bingo card so that they made sure they hit all the different ones. And when they were done with the station, we would sign that station so that when they were finished, they knew they were finished. And each station had explanations for it at that station. And if they also needed us, we were there to walk around to the different stations and give them more guidance if they were unsure of what to do. What kind of
feedback did you receive from the students? So, we did receive feedback that it helped them to feel more confident. it pulled the whole semester together and that they realize, oh, documentation is rather important when I'm doing an assessment and so is looking at the person as a real person and not just their vital signs or their assessment findings. So, we did get some really good feedback that they learned a lot and they enjoyed
doing it hands-on, right? And did they offer any suggestions for improvements or did you all have any suggestions for improvements moving forward? I'm assuming you're still using this strategy. We are using this strategy and we have kind of made it even more realistic by combining a few of
the stations. So that we noticed that they were still very anxious the next semester when they went into the actual clinical setting, which is to be understood, but we wanted to give them a little more practice. So we actually have part of the stations now in a little pretend hospital room.
So the safety is combined with the assessment and they can practice more realistically what they're going to be doing the next semester and that has helped them to become a little more confident because we're trying to build confidence and decrease anxiety when they actually go into the hospital. Any plans in the future about measuring change or measuring your outcomes? Yes, we have been talking to the people in the next semester. So we have five semesters in our
program. We've been talking to the second semester teachers and we're going to be doing some surveys in the first semester and second semester and try to gauge how they transitioned. That's great. Wonderful. Any other things you want to mention about your strategy used for active learning? I do want to mention that even though we have just this one, the students get to do a lot of active learning throughout the semester. So, it's
not their first time. This is just really their first kind of put it all together opportunity. They've had an opportunity to use standardized patients. So they have a little bit of opportunity with simulation there. So, it helps make this opportunity a little less stressful. I do feel like they get really shocked when they actually have to go in and actually act like a nurse. Kind of a deconditioning is what I feel like we've
been doing with them. We're kind of, you know, getting them ready for that hospital by giving them those little small exposures throughout the entire semester. And I feel like most of them by the end of it, they're having a good time. They really enjoyed it. They know it's not high stakes.
They know they have to complete things to get their grades and their credit for it, but I feel like they really kind of enjoy the overall experience and getting the opportunity to do things like a focused assessment because they're so used to doing something in order, the exact same order, and now they're having to trim it down instead of do all 12 cranial nerves that they learned. Well, I want to thank you both
for joining us. It's great that you're able to and willing to share some of your information on your experiences with translating active learning in the classroom. I appreciate your time and expertise and I know our our listeners will too. To our listeners, if you have not had the opportunity, please look for the author's work, Fostering Clinical Judgment and Promoting Transition in the First Clinical Rotation
Through Active Learning. The article can be found in the July-August issue of Nursing Education Perspectives. And thank you all the listeners and thank you both to our authors for joining us for this conversation. Much appreciated. Thank you. [Music]