Visual Thinking Strategies: A Mixed Method Study in Bachelor of Science Nursing Students

The development of broad cognitive skills is imperative as nurse educators prepare students for practice in a complex healthcare setting.    Developing and honing these skills in creative ways can be challenging for nurse educators, especially as class sizes increase.  These broad skills include interpersonal communication, critical thinking, problem solving, collaboration, tolerance of ambiguity, and information literacy, which are often referred to as transferable skills.  Visual Thinking Strategies (VTS) is a teaching method that uses art to foster discussions and help students use visual evidence to support their findings.   VTS has been studied in primary education, yet, until recently, has not been studied in nursing education. Only a few recent studies have been conducted with VTS in nursing. This study sought to answer the following questions: How might nursing students use VTS in nursing and caring for patients?  And, Would nursing students who underwent VTS use more descriptive words in a newborn assessment than those who were not exposed to VTS?  This study investigated the use of VTS on two nursing campuses (urban and residential) in a first year nursing course of a 4 year prelicensure curriculum in a large Midwestern university in the United States.  Nearly half of students were exposed to a 1 hour VTS session in the experimental group.  The VTS session was facilitated by a nurse educator in the various clinical sections of the course, using 3 works of art.  All students were asked to type out a newborn assessment of 5 normal newborn conditions in a Microsoft word document. Microsoft word count was used to compare the number of words in descriptions among students exposed to VTS versus those who did not experience a VTS session. The experimental group was then asked to answer, in writing, the following question: How might you use VTS in nursing and caring for patients?  Content analysis was done on these written statements using the computer software, Dedoose. Independent t-tests were used to examine the differences between the experimental and control groups’ Microsoft word count on each campus using SPSS version 23.  No significant differences in t test analysis was noted on the urban campus, while the residential campus neared statistical significance (0.057-0.059).  Differences in timing of administering the newborn assessments yielded different findings. The urban campus had a VTS session, then did the normal newborn assessment exercise 5 weeks after the VTS exposure.  The residential campus did the VTS experience, then did the newborn assessment activity 2 weeks after exposre.  In reflective written statements about their experiences, students identified that VTS would help them work in groups and listen better, as well as expand their ability to be open and use visual evidence for what they observed in a clinical situation.  Students were able to articulate how they might transfer these skills into their clinical practice, even without having been in clinical situations at that specific time of intervention. Students also discussed how important it was to build off of others and listen to make more informed decisions and observations. This innovative teaching strategy has the potential to expand nursing students’ understanding of team work and communication. It also allowed students to practice using skills that would transfer to clinical care of patients.   Future studies should focus on the use of VTS in interprofessional education among healthcare teams.   Also, future studies might include more exposure to VTS and more integrated use of VTS with clinical experience.  VTS studies in the future would be enhanced by having students participate in a VTS experience, then relate it to an actual clinical experience