On reflection,

thinking? by galo/*, on Flickr
Creative Commons Attribution-Noncommercial-No Derivative Works 2.0 Generic License  by  galo/* 

As I am reading the ECI 831 class blogs (such as Judy’s) and reflecting on last week’s discussion rhyzomatic learning, I find myself considering how we are educating our future nurses.

I am a nursing clinical instructor and have been working with nursing students in a variety of clinical areas for over 10 years. Out of curiosity, I read a book written by a nursing clinical instructor in the early 1900s and was amazed that the book was a carbon copy of what we do today. In this small book, the author stated that a nursing instructor supervised 7-8 nursing students who attended classes, students were able to relate theoretical concepts with patients they were assigned to that week by completing research and submitting written assignments, and listed observational experiences for the students as an off unit experience for part of the shift where they may be able to watch a surgery. This mirrors what we do with nursing students in our current educational program.

This brings me back to last week’s class in which Dave Cormier discussed three different outcomes for our educational system: the workers who show up on time, accept tasks and complete the tasks without understanding them; the soldier who establishes what things we currently need to know and how we will measure this learning and the nomad who is a creative thinker and carves their own path. Each outcome has served a role/function in our learning. For nursing students, they do need to be a worker and show up on time for clinical, accept and complete the tasks they are assigned. This is important for several reasons as patients require care and we need to learn what tasks we need to do in order to do our jobs. Soldiers will always be ever present as they defenders of the status quo established by the SRNA. These soldiers could be me, as the clinical instructor for I am determining what you know and what you need to know. I assume this role as I have learned more through experience and education so that I can monitor you  nursing students for compliance and determine their grade for the course.Despite this role, I strive to encourage the nomad or creative thinker by allowing students to carve out their own path and learn things because they need to learn them. How do I do this? I have the student identify their own learning goals by choosing patients they want to work with, by focusing their written assignments on those areas that they may be weak in such as lab and diagnostic test interpretation or reading ECGs. However no matter how much the nursing student can creatively think about a patient assignment, they are still restrained by the status quo as we still require specific measurable outcomes for each graduate nurse. I believe that nursing can only move towards the rhizomatic learning model by changing how nursing education is done. We do need to move towards more of an open syllabus such as in problem-based learning to continue to further outcomes in health care.

I have included a video on ECGs. I thought it was a good example of the nomad that creative thinker who carves out their own path. The person in this video did not follow the traditional manner in which we teach ECGs and those students who have viewed this do understand the heart better.

If anyone has any ideas on how we can further improve clinical education please let me know. We do bring in technology such as simulation which can be used to teach the worker to understand and obey the system. We use concept maps as a form of measurement to show what research has been done by the student to understand how well prepared they are for the shift so my question would be how can we encourage more nomad learners (please note we do see this and it really does happen at different times as the nursing student will have that light bulb moment and begin to explore things because they want to and feel they need to know them).


3 thoughts on “On reflection,

  1. I think you’re right with your views on problem based learning as it requires students to evaluate information in context which requires a higher order of thinking. PBL is group work and allows for collaboration and peer learning.

    I enjoyed the video. This guy would have been a hoot as a teacher, and for those of you who are wondering, his arms are representing right and left upper chambers or atria, and legs the right and left ventricles, lower chambers. In a normal healthy heart the ventricular (both sides) contraction should follow atrial (both sides) contraction.

  2. I like how you see all three visions for learners as interrelated. There is clear need for standards in nursing that are worker/soldier type activities. In some sense, they are the creation of a context… of agreed upon usages of terms and processes, so that everyone knows what everyone else is talking about. Fill out form X like this so that everyone can glance at the form and figure out what other people mean. These things are important shorthands for people working in busy places. To use an example from a different context, imagine trying to count up how many burgers were sold at a macdonalds in a week if all the receipts were written by hand in random places in the store. Printed, formatted receipts just make more sense. But they aren’t true, or important… they’re just the basic language of the store. Same for nursing.

    I’m not an expert in any sense of the word, but having spent alot of time around new nurses the last few years (series of non-tragic family hospital visits) i saw alot of nurses who were trying to remember the steps they needed to follow. They had some ‘memories’ of things they should do… but not what i would call knowing. Now… some of that is just experience and will come with time. But i have heard that nursing education used to include putting needles into other nurses… and that that has been stopped in some cases (certainly for the poor new nurse who tried to put a needle in my partner). She had practiced on sophisticated technological dummies. Turns out that putting a needle into something that doesn’t feel pain and putting one into a woman who is hallucinating due to an allergic reaction is not the same thing. at all.

    A simple (and stereotypical) example, maybe. but to the point. Putting a needle in an arm is not a ‘step by step’ procedure. It’s subtle and probably requires a rhizomatic approach.

    • Thank you for your reply. I really do see these as interrelated. At the beginning we teach nursing students to be the workers, with experience and additional information they may move up to a different designation (and this is what we strive for). I agree ultimately we want that rhizomatic approach taken by all nurses (students and grads alike) but sometimes due to factors such as determination/ focus on completing all necessary steps in a skill, you can only obtain the worker level of knowledge at that particular point in time.

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