The Psychomotor Domain
Psychomotor learning is one of the three domains, or broad categories, of educational behaviors. It is based on manual or physical skills, and includes fine and gross motor dexterity, coordination, and movement.
The focus is on physical and kinesthetic forms of learning. This domain can also involve communication skills, such as public speaking or computer charting abilities.
Skill acquisition is an important part of nursing education. Unfortunately, learning skills often takes the "back seat" in nursing curricula to the more dominant cognitive learning activities.
Examples of essential nursing psychomotor skills include taking blood pressures, performing head-to-toe assessments, putting in intravenous lines, mixing insulins in the same syringe, and administering subcutaneous or intramuscular injections.
Becoming competent in essential nursing skills is fundamental to safe, effective nursing praxis. It requires training, commitment, and practice. Performance is measured by adherence to basic principles of safe technique, correct sequencing, accuracy, precision, and efficiency. In order to successfully advance in psychomotor areas, the nursing student must devote much time and effort.
Taxonomies identify developmental stages of learners' growth within a certain domain. There are several taxonomies, or classifications, of psychomotor skill sets. The taxonomy created by dave (1970) is the one used most frequently, as it is simple to understand and easy to follow. It consists of five advancing levels that progress from basic observation and imitation to complete mastery of a physical skill:
- Imitation (copy): observing and return demonstrating (under close supervision of instructor)
- Manipulation: following instructions and practicing
- Precision: performing the skill independently in a competent manner; few errors present
- Articulation: coordinating and modifying the skill; combining and resequencing
- Naturalization: performing the skill automatically with ease, on a consistently high level
Basic skill performance starts at a low level and progressively builds to more intricate skills found on higher levels. The student must demonstrate mastery of one stage before progressing on to the next stage. There are no shortcuts.
In presenting a new skill to students, the educator should first present the knowledge content. The skill should be broken down into small steps, with the instructor taking the time to demonstrate each step in proper sequence. After a maximum of 15 minutes' instruction, learners should be required to return demonstrate the skill under the educator's watchful eye.
The educator should not interrupt a participant's train of thought while performing the psychomotor skill by quizzing him or her about theoretical matters. The student should be allowed to concentrate and focus on the skill alone. The "critical thinking" type questions can be elicited either before or after performance of the skill, but not during.
Teaching skills is very labor intensive and expensive for schools of nursing, as student performance of psychomotor skills needs close supervision in the learning lab or in the clinical environment. A significant investment by in educators, support staff, equipment, supplies, and tools is required for learners to adequately perform nursing skills.
Simulation labs are an excellent strategy to facilitate the acquisition of psychomotor skills. Within the lab, participants can practice essential nursing skills in a non-threatening environment. My college of nursing has eight simulation labs with state-of-the-art mannequins and the latest medical equipment.
The principle of "see one," "do one," and then "teach one" helps establish the skill into the learner's repertoire of experience. In accordance with this principle, more proficient students can be recruited to help mentor weaker students who are struggling with skill performance.
In conclusion, psychomotor skills are essential to nursing practice and should be strongly emphasized in nursing education.
Dave, R. (1970). Psychomotor levels. in r. j. armstrong (ed.). Developing and Writing Behavioral Objectives. Tucson, AZ: educational innovators press.
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VickyRN has '16' year(s) of experience and specializes in 'Gerontological, cardiac, med-surg, peds'. From 'Under the shadow of His wings...'; Joined Mar '01; Posts: 12,046; Likes: 6,483.Jun 10, '09Hi Vicky,
I can't agree with you more on how important learning in the psychomotor domain really is. I even believe it needs to be expanded above and beyond how you describe.
I believe that learning in the psychomotor domain is incredibly important for self use as well. We have no programs in our brains that tell us how to move - how to sit, stand, lift, walk, talk, etc.... You get the picture. We have to learn everything!
However, we as human beings learn just well enough to get an outcome, and once that point is reached, the overwhelming majority cease the refinement process in the movement domain. There is a reason that over 85% of people will experience back pain at some point in their lives - they haven't learned how to move correctly. Nurses are hit even harder: the incidence of back pain is almost twice the national average in the nursing profession.
It is not enough to simply try and impose a ergonomic protocol on someone - i.e. "lift with your legs". We can't impose anything on anyone and have it be effective. People need to feel what efficient movement is.
As soon as movement and attentional training for self use are implemented on a wide scale, these statistics aren't going to change much. Those that do implement them will have healthier, happier, more productive nurses that will be incredibly loyal to their jobs and organization.
Thank you again, Vicky, for such a great article.