A puzzling approach to lab skill instruction

Issue:

Not enough lab time.

Students struggled with organization.

Lapse in aseptic technique strategies.

What are some issues you encounter when teaching concepts of back table set-up?

Intention: Demonstrate how assisting students with organizational skills to maximize lab time can be implemented by utilizing puzzle drills during classroom instruction.

› In 2009 an article was published in the Journal of Nursing Education titled “Looking Is Not Seeing: Using Art to Improve Observational Skills”.

Using original works of art, students participated in focused observational experiences to visually itemize everything noted in the art piece, discriminate visual qualities, recognize patterns, and cluster observations. After organizing observed information, they drew conclusions to construct the object’s meaning.

› Sixty-six first semester nursing students in an accelerated program leading to a master’s degree were chosen for the study. Thirty-two students were placed in the control group, which received traditional classroom instruction and did not visit the museum. Thirty-four of these students were placed in the treatment group, which participated in the Looking is Not Seeing program at the art museum.

› Students in the Looking Not Seeing program spent 90 minutes in small groups of five or six looking at a work of art and participating in a facilitated discussion with a museum docent that moved from observation to interpretation. The paintings that the students looked at were selected for their rich visual detail. The students participated in a single 90-minute session.

›After receiving their respective forms of instruction, the researchers asked all sixty-six nursing students in the study to observe six patient photographs and make written notes on what they noticed. Students spent five minutes observing the photos and five minutes recording their comments. They were then give three minutes to use their written observations to make clinical interpretations.

› Participants in the museum program, a total of 34 students, made significantly more written observations while observing six patient photographs for five of the six photographs—a range of 51 to 68 median observations as opposed to the range of 36 to 55 for the control group. The observations were in the forms of signs or symptoms derived from looking at the patient photographs.

› Participants in the museum program also noted a significantly higher number of possible objective clinical findings for the same five patient photographs than the students in the control group.

› Participants in the museum program also offered more alternative diagnoses when performing a differential diagnosis, a systematic procedure for identifying the most probable diagnosis among many, while observing the patient photographs than students in the control group.

›Observation is to Nursing what Organization is Surgical Technology

›How do we develop organization skills if we are not practicing in the lab?

› Surgical technology is a hands-on learning environment that utilizes performance and authentic assessment to check concept comprehension. Skills must be measured and evaluated prior to clinical rotations.

› If observation is the necessary proficiency to develop nursing skills, than organization would be a comparable ability in the realm of surgical technology.

› A common frustration amongst students in the beginning of clinical originates at the point of setting up a procedure when they must establish a sterile field with an overwhelming pile of supplies on a back table.

› Easy solution: Practice in the lab but make it count!

› 2 labs: 18 students

› Flashcard puzzle drill was developed.

› Pictures were taken, enlarged, and laminated to form a puzzle.

› Students do daily drills to organize supplies they will see in clinicals.

› Skills are checked through timed back table set-up with a fluid knowledge of aseptic technique.

› Speed + Precision = Efficiency!!!!!!

› 1. Start with basic back table set up

›2. Cut out all elements of back table set up that you would like students to organize….

›3. Place cut pieces with original picture into an envelope

› 4. Distribute one envelope to each student in the class.

› 5. Demonstrate drill by having students pull out completed picture and assembling all items to resemble original set up.

…….First couple of times will be S-L-O-W……………

› 6. Begin another project/lecture/etc…and have students concentrate on another task. Yell out “Puzzle Time” and have students interrupt their process to assemble puzzle pieces.

› 7. Walk around class to check accuracy of placement.

› 8. As students become faster with the drill, take away the original picture and have them put together the pieces from memory.

› 9. To make it more challenging and fun, add a timed element to it and have students race!

› I had a couple of favorites I would do over and over.

› I would organize them by edges and colors 1st.

› They got more difficult, and I would get overwhelmed.

› I would go back to a favorite puzzle that I could do quickly to build some confidence, and return to finish the challenging one.

›A basic back table set up is similar to a familiar puzzle.

› Even if the instruments and supplies vary, students can begin with the drill that was learned in school to establish a foundation for organization.

Before Puzzle Drills – Class size 18 students

Average Back Table Set up Time

(Opening supplies to Initial Count)

19 mins

Average Contaminations per assessment 4

Average Class Grade on assessment 73

After puzzle drills

Average Back Table Set up Time

(Opening supplies to Initial Count)

11 mins

Average Contaminations per assessment 1

Average Class Grade on assessment 91

› More skills assessments with a variety of procedures can be performed due to students’ abilities to be more efficient with basic set-up techniques.

› Timed component added to skills assessments to ensure students are moving with accuracy and precision in set-up process.

› Ability to add in details for assessments and integral set-up techniques based on procedure Ex: Cholangiogram set up with Lap Chole and C-arm draping procedures.

› $$$$ - Saved money on lab expenses due to dramatic decrease in supplies needed for retest assessments.

› Improved lab availability due to faster practice sessions. Students are confident with the procedure and utilize the lab to develop their skills instead of learn organization.

› Instructors are able to give essential feedback to improve performance of strategy and aseptic principles.

›Confidence in the clinical setting pertaining to back table organization.

›A faster basic set up will allow preceptors to focus teachable moments on case details instead of a fundamental skill set that should already be present.

› Preceptors have been impressed with student skill set and have made comments like:

“Are you sure this is your first O.R. rotation?”

“Go ahead and set this up, you don’t need my help.”

“Can I have one of your students in my room today? I need someone who can scrub.”

“It’s very easy to train a student when I don’t have to show them the basics.”

I found a missing piece to the puzzle that has had a dramatic impact on student learning in the lab setting.

I hope you enjoyed the presentation.

Pellico, L., Friedlaender, L., & Fennie, K.. (2009). Looking is not

seeing: Using art to improve observational skills. Journal of Nursing

Education, 48(11), 648-53. Retrieved from Career and Technical

Education Journals.