Adult Nursing Cycle 2

The pedagogical focus(es) of Cycle 2 and its/their rationale(s):

The observations for cycle 2 were completed during the second year of the community nursing module. This Year 2 / Level 5 module introduces students to community nursing and builds upon existing knowledge to that of more autonomous practice. This module challenges students to assess and manage the care of patients outside of the hospital setting; dealing with issues such as sexual health and health promotion. The overall focus of this cycle was to explore how different teaching techniques can engaging students in thinking about they are best able to apply theory to clinical practice.

Observation 1:

The first approach utilised simulation opportunities to allow the students to practice scenarios requiring health promotion. It is recognised that health promotion is a fundamental element of nursing practice, promoted by the NMC and National Guidance (MECC).

This session was delivered by Stephanie Reynolds (SR), who was keen to identify if the learning experience was valuable when observing as well as actively engaging in the simulation within a large classroom setting.

Three scenarios were included within the session, each with a different health focus: sexual health, mental health, nutrition in elderly care. Students were asked to volunteer to converse with an actor who responded realistically.

Observation 2:

The focus of this session was to identify whether problem based learning (PBL) within a mixed field group (adult and paediatric student nurses) was effective in encouraging students to apply theory to practice, and explore their role as accountable practitioners within sexual health and wider contexts such as legal and ethic considerations.

This session was developed by Lee Roberts (LR), who hoped to explore student engagement and learning of their problem based scenario, but also the feedback from others groups and consolidated by the lecturer.

Four problem based scenarios were created for this session, each with a different nursing field focus. Students were allocated to large interfiled groups, and were asked to consider their nursing roles and responsibilities within the following cases: HIV exposure, sexual assault, under 16’s and sexual health, and individuals with learning disabilities and sexual relationships.

Cycle 2 summary:

  • Whilst significant benefits were seen from the practical results of simulation, it was important for SR to ensure learners contributed voluntarily and were not selected; this was promoted as their learning opportunity given the option for those who prefer to learn by doing. In this particular circumstance however, it was noted that the voluntary contribution was limited, leading to uncomfortable silence at times. It was recognised that a safe learning environment was key to ensuring students felt comfortable to engage with the simulation experience, and clear boundaries were essential in establishing this environment.
  • Although humour was encouraged to facilitate the creation of a relaxed learning environment, it was important to stress the humour should not be directed at student contributions. This was successfully achieved during the observation, and allowed for a significant number of students to contribute to scenarios, but also receive positive feedback about their approach with the patient.
  • The observed sessions allowed for opportunities for student beliefs / preconceptions to be challenged. Both simulation and PBL promoted critical thinking, and encouraged learners to question their role, accountability, and professional responsibilities. Learners appeared to engage well with both approaches, and brought forward interesting discussions and feedback.
  • During the observations it was noted that learners were drawing upon previous experience and knowledge from other modules within the programme in order to manage both the simulation and PBL case studies. It was clear that knowledge regarding sexual health developed during the PBL session was actively translated into the health promotion simulation.
  • Observees were conscious of the need to refocus learners back to the learning outcomes as at times discussions / role-plays could quickly go off topic or dominate the content delivery. For example, during the PBL session, there was a large amount of theory that was needed to underpin group discussions; as such, feedback needed to be succinct. During the simulation experience, learners circulated around assessment and nursing actions, but would occasionally overlook patient empowerment particularly when supporting elderly patients’ nutrition.

Summary of Cycle 2 joint learning between staff and students:

  • Student observes both reported to enjoy the learning experiences of simulation and problem based learning, and felt the experiences were beneficial for their professional development. It was noted that these two learners will both always actively engage in lectures however, and so it was difficult to conclude if the learning environment had facilitated them in contributing in sessions, or whether this was as a result of their own internal motivation to participate.
  • Both simulation and PBL reportedly challenged the thinking of both students. They explained how the opportunity to work alongside other fields of nursing (in this case, child student nurses) allowed for new learning, different viewpoints, and tested preconceptions. They both spoke positively of the opportunity to work across fields, and how valuable this was to their learning experience.
  • It was interesting to note that when discussing the simulation experience, students would continue to refer to the lecturers’ character, but not the lecturer herself. They reported to appreciate the experience these scenarios offered, and appeared to refer back to the learning experience like they would when discussing a clinical experience with a patient; focusing on the patient in the scenario, and not the lecturer who portrayed them in a classroom.
  • Previous learning from other lectures and modules were utilised effectively by the learners in order to lead a simulation experience, and holistically manage a PBL scenario. Additionally, one student discussed how his previous person experiences and clinical practice had been drawn upon when leading the sexual health simulation experience.

Implications on learning and teaching for staff members:

  • It has been clearly identified that in order to effectively facilitate simulation and PBL experiences, a safe learning environment must always be considered. It was clear the use of humour, clear boundaries, and effective use of silence would be beneficial in establishing such an environment. For simulation, allowing voluntary contributions remains a significant component of this. To further facilitate this experience, SR hopes to include a lecturer demonstration of simulation before asking students to participate. The aim being to ensure learners have clearer expectations of simulation, and their role within it.
  • Having never utilised PBL before, LR has developed confidence within this teaching technique as a result of the feedback from student researchers, and is hoping to utilise this for future sessions. He has acknowledged however that few cases would prevent a temptation to include too much theoretical content, and would allow for more time for feedback, discussion and debate.
  • Within their teaching styles, both SR and LR have considered the use of silence during teaching, and have recognised its value in student participation and engagement.

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