Tell an instructor how to teach better.

[tulip5]

I tell my students that PROFESSIONAL nursing is what goes on between the ears. And I put a lot of emphasis on teaching students how to reason about patient care. Here are my questions for you...

1) How much of nursing school should be spent teaching you skills and how much of your education should be devoted to clinical reasoning? (%-wise.)

2) Can you think of anything in your career as a student that has posed an obstacle to learning clinical reasoning?

3) Tell me one thing that really helped you "get" clinical reasoning.

[SoldierNurse22, BSN, RN]

That's a really good set of questions. I'd argue that it varies by student.

Some students intuitively "get" critical thinking. Some need to learn it over time. But of course, a solid base in theory and medical knowledge (lab values, disease process, etc) are also critical. While I wouldn't venture a percentage of time I think should be devoted ot either, I can tell you that I don't think that most students get enough clinical time.

I had a preceptor at one point in my student nursing experience who didn't expect much from us. She was very nice, but she gave us all the answers. Then, the next semester, I had a preceptor who was incredibly smart and expected a lot from us. Outside of our theory classes, we were expected to learn certain values and research disease processes on our own. We presented case studies based on our patients. She not only reviewed the case studies, but she'd take the time to go around to us in clinicals and discuss the pathophys of our patients' conditions and the possible consequences. Other times, she'd take the symptoms and work backwards, then ask us to think ahead for what the patients might need. She was an astute, extremely intelligent nurse. I wanted to be just like her.

She was one of the reasons I started to "get" clinical reasoning. I learned to mimic her thought processes and think beyond, "OK, my patient is desatting and I'm not sure why. Let's give them oxygen" and think into "OK, my patient is desatting with changes in position. She said she has an inhaler that she usually takes, but it hasn't been ordered by the physician for in-hospital use. I need to get her that med, consult RT, and look at her lab values". Huge, crazy difference.

[EP, RN]

I agree with Soldier Nurse 22 that those things vary between students. I am a "big-picture, visual learner" (if that makes sense), so I am not going to get much out of just reading a chapter in a textbook. The teachers that I have learned the most from use/used a lot of case studies because it helps me to "see" a scenario and then break it apart and discover the details. I think that also feeds into the importance of our first year on the job...so much of it is just seeing different things and building a foundation of knowledge. As for skills vs. critical thinking, they are both equally important, imo, if for no other reason than to have confidence in your ability whenever it is time to perform a task.