Byermoen Kirsten Røland, Eide Tom, Egilsdottir H Ösp, Eide Hilde, Heyn Lena Günterberg, Moen Anne, Brembo Espen Andreas
Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Grønland 58, 3045, Drammen, Norway.
Department of Nursing Science, Faculty of Medicine, University of Oslo, Forskningsveien 2B, 0371, Oslo, Norway.
BMC Nurs. 2022 May 10;21(1):110. doi: 10.1186/s12912-022-00879-1.
The overall aim of this study was to explore third-year bachelor nursing students' stimulated recall reflections on their physical assessment competence development. The choice of learning strategies in nursing education seems to have great impact on nursing students' use of physical assessment skills while in clinical rotation. There is a need to explore nursing students' learning processes related to the use of physical assessments.
Explorative qualitative design using a triangulation of data collection methods. Nine final-year nursing students' physical assessment performances during patient encounters were audio-taped and observed. Shortly after, an individual stimulated recall interview based on the audio-recorded patient encounter and observation notes was conducted. A two-fold analysis was conducted: 1) analysis of students' performed assessments, and 2) phenomenological hermeneutical analysis of the stimulated recall interviews.
Nursing students assessments shifted from a checklist approach to a symptom-based, more holistic and person-centred approach, emphasizing conversation as part of their assessments. The nursing students also reported that a safe and stimulating learning environment was a prominent feature for their continuing development. Learning from skilled role models with expectations to them using physical assessment skills facilitated their continuing skills appliance, interprofessional communication and reflective practice.
This study contribute with a novel, comprehensive and in-depth description of what influenced nursing students' learning processes experiences of using physical assessment skills during clinical rotation. The results reveal the need for targeted course designs by implementing scaffolded learning activities in practical and theoretical courses aimed at strengthening students' learning of physical assessment skills-building upon and emphasizing their prior knowledge and competence, which may lead to more confident registered nurses and promote patient safety in different health care contexts. We propose using stimulated recall systematically as a novel reflective learning activity in nursing education to foster clinical reasoning and metacognition skills and achieve deep learning.
本研究的总体目标是探讨护理学本科三年级学生对其体格检查能力发展的激发性回忆反思。护理教育中学习策略的选择似乎对护理专业学生在临床实习期间体格检查技能的运用有很大影响。有必要探索与体格检查运用相关的护理专业学生的学习过程。
采用探索性定性设计，运用多种数据收集方法。对9名护理学本科最后一年学生在患者诊疗过程中的体格检查表现进行录音和观察。随后，基于录音的患者诊疗过程和观察记录进行了个体激发性回忆访谈。进行了两方面的分析：1）对学生所进行的检查的分析，以及2）对激发性回忆访谈的现象学诠释分析。
护理专业学生的检查从清单式方法转变为基于症状的、更全面且以患者为中心的方法，强调对话是检查的一部分。护理专业学生还报告称，安全且富有启发性的学习环境是他们持续发展的一个突出特点。向熟练的榜样学习并期望他们运用体格检查技能，促进了他们持续运用技能、跨专业交流和反思性实践。
本研究对临床实习期间影响护理专业学生运用体格检查技能的学习过程体验进行了新颖、全面且深入的描述。结果表明，需要通过在实践和理论课程中实施支架式学习活动来进行有针对性课程设计，旨在强化学生对体格检查技能的学习——基于并强调他们的先验知识和能力，这可能会培养出更自信的注册护士，并在不同医疗环境中促进患者安全。我们建议在护理教育中系统地使用激发性回忆作为一种新颖的反思性学习活动，以培养临床推理和元认知技能并实现深度学习。
