Strategies to Engage Learners in Nursing Decision Making and the Clinical Reasoning Process

Geist, Melissa J.

Wednesday, July 13, 2011: 10:50 AM

Melissa J. Geist, EdD, MSN, RN
Bedelia H. Russell, RN, MSN, CNE
Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, TN

Learning Objective 1: The learner will utilize tools based on findings from “How People Learn: Brain, Mind, Experience, and School,” to design interactive learning environments.

Learning Objective 2: The learner will be able to design and implement Legacy Cycles to engage students in the clinical reasoning process.

Schools of nursing are under pressure to produce graduate nurses who think critically and adapt to multiple complex scenarios with fewer resources and dwindling quality clinical placement sites. It is no longer appropriate for nursing faculty to focus strictly on imparting knowledge to students. There is urgency for nursing faculty to model clinical reasoning and to design activities that provide students opportunities to practice complex decision making. One school’s response to these demands was an initiative by faculty to restructure the Medical Surgical II Nursing, and Pharmacology courses to emphasize learning for long-term information recall, clinical reasoning, and collaboration.

This initiative was guided by the National Research Council publication How People Learn: Brain, Mind, Experience and School (2000), and by the VaNTH-ERC multi-institutional biomedical engineering education initiative funded by the National Science Foundation (NSF). “How People Learn” (HPL) is a comprehensive investigation into the best practices for guiding learners as they develop enduring and flexible knowledge. A strong research foundation for the application of HPL principles using Legacy Cycles exists in another discipline. The authors have demonstrated the approach to be highly applicable to educating nursing students as they develop critical thinking, collaboration, and communication skills. To our knowledge this use of the Legacy Cycle is a unique approach to instructional design in nursing education. HPL frames a method of teaching that is conceptual and challenged-based in approach as compared to standard methods of teaching that are pure content-delivery. HPL embeds opportunities for ongoing formative assessment, reflection, and metacognition. Incorporation of the Legacy Cycle into the school of nursing curriculum has resulted in NCLEX pass rates above the national average, consistent positive comments on graduate surveys, and high ratings for program graduates. The concepts presented may be applied to other educational settings such as staff development and re-entry programs.

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