The profession of nursing strives to prepare safe and competent future nurses as it functions within a dynamic and rapidly changing healthcare environment. As the National League of Nursing (NLN) (2003) position statement declared, and more recently affirmed by Caputi (2017), nursing education needs to endorse innovation and utilize pedagogies that are more effective in guiding students to learn efficiently in rapidly changing environments. A type of learning theory used to frame competent practice inclusive of modern pedagogical strategies is transformative learning (Cabaniss, 2014). As Mezirow (1991) explains, transformative learning is a multidimensional social process that engages learners to better understand self, perspective, and meaning through communication in real situations with mindful actions. The purpose of this abstract is to discuss a qualitative study on a prenatal-to-postpartum transformative continuum of care learning experience.
Methods:
Originating from the faculty desire to afford each student the opportunity to experience a comprehensive obstetrical experience, the prenatal-to-postpartum transformative continuum of care learning experience, referred to here after as the OB Family assignment, was developed. This study uses a convenience sample of all senior level nursing students in their third semester obstetrical course in a Midwestern, rural university during the fall 2017 and spring 2018 semesters. Institutional Review Board approval for this study was obtained. The aim of this study was to describe baccalaureate nursing students’ selected learning outcomes and clients’ satisfaction in an OB Family transformative continuum of care learning experience. Three questions guided this study utilizing the OB Family assignment: 1) are students actively engaged in the transformative learning process; 2) are students gaining a sense of confidence to provide competent obstetrical nursing cares; and, 3) are students able to validate new meanings in real situations using the course designated social mediums.
The faculty role in the OB Family assignment was to facilitate student self-directed, socially engaging, collaborative learning experiences (White & Nitkin, 2014) designed to formulate obstetrical competency. Faculty participated in interactive classroom theoretical discussions supplemented with high fidelity labor and delivery postpartum and newborn simulation case scenarios over the course of the semester. Adhering to transformative learning theory, student content knowledge was reinforced.
The OB Family assignment was comprehensive, occurring at random times throughout the semester for each student. To begin the transformative learning experience, each student actively sought and attained a non-relative, pregnant family in their last trimester of pregnancy willing to consent to this course assignment. Upon finding this OB Family the student developed a therapeutic relationship, including attending prenatal office visits with the family. To help educate the family on their journey through the reproductive process, students developed and shared, specific to their OB family, Pinterest boards. Information from pregnancy through the first year of life was pinned to this collaborative site. This information reinforced classroom learning for the student as well as provided valuable education for the family.
When the OB family presented to the hospital in labor or for a scheduled cesarean section the student joined the family. The student participated alongside the nurse in the birth process and during the first four hours postpartum. To conclude the clinical experience, students arranged a two-week postpartum follow-up visit with the family. The focus and timing of this visit is crucial due to potential health concerns that the student evaluates’ such as postpartum depression, breast milk jaundice, and late postpartum hemorrhage.
The OB Family assignment is documented in three essential forums. As previously mentioned, students collaborate with families using Pinterest. In a second forum, secure blog journaling unfolds. The blog encompasses the entire transformative learning experience for each student. The intent of the blog is to promote true knowledge shifting (Cabaniss, 2014), meaning obstetrical competency using an asynchronous, collaborative learning medium (Marrocco, Kazer & Neal-Boylan, 2014). Using the design of critical conversations (Forneris & Fey, 2017; NLN, 2016), students are guided to identify with the patient’s story, understand context, and discuss how this experience might influence practice. In the blog students are also engaged in reading and evaluating peer posts being mindful of content, process, and assumptions presented from real situations. Summatively, students develop a course assignment notebook documenting the comprehensive OB Family transformative continuum of care learning experience including theoretical models and research articles selected and analyzed relative to the OB Family. This notebook is the concluding forum that provides an opportunity for each student to question assumptions and conduct a critical reflection (Marrocco, Kazer & Neal-Boylan, 2014) of the OB Family experience.
Results:
Qualitative data for this descriptive study was analyzed using a naturalistic inquiry, iterative process to find patterns and themes after final course grades were submitted for the participants. Rich data was analyzed from the course blog, Pinterest, standard student evaluation forms, five question survey emailed to the students following final grade submissions, and the assignment notebook. As one OB family described, “She [the student] helped a lot during my labor. My husband has said multiple times how much he also noticed that she helped me and the staff!”
In analyzing the aims of this study, the research is supportive. In the first aim, students described how they were actively engaged in transformative OB Family learning experiences. As one student explained in the post course survey, “This experience really verified my learning in the course. I got to experience first-hand some of the high-risk situations we learned in class”. In response to the second aim, students reported an increase in their level of confidence to provide competent obstetrical nursing care. As reported, “If it weren’t for this experience, I don’t think I would feel as confident in OB as I do. It really solidified my learning.” A second student remarked, “When I was in the labor and delivery room with my family I understood the fetal strips, the fetal heart rate, the frequency and duration of contractions. I was able to talk to my mom and calm her down because I knew the answers to her questions.”
And lastly, the qualitative data gathered supports the studies third aim. Students described being able to portray new meanings from the OB Family experiences. One student blogged, “Overall I really enjoyed this assignment . . . I would never wish this experience on someone, but I would never take it back the exposure I received. This was the first time in my nursing school career that I felt like an actual nurse . . . I offered knowledge, support, and emotional stability that I did not know I was capable of … no other nurse on the floor that morning could have offered her the same amount of support as I did and that is because I was with her through the last [half] of her pregnancy. . . So I am happy that since my OB mom had to go through this experience that I was able to be there and offer her additional support . . . they are incredibly strong individuals that I will never forget. Rest in peace Miss A, you will always be loved and never forgotten.”
Conclusion:
Families commended the students for enriching their momentous birthing experiences and advocated that this learning experience be maintained for the families in our global communities as evidenced on the returned student evaluation forms by families. As for student perceptions of this OB Family transformative continuum of care learning experience, this quote speaks for itself: “If I retook this class, and had the option to complete this experience or not (without any effect on my grade) I would still find another family to follow and do this all over again. It was very influential in my decision to be an OB nurse.”
While the goal of learning is for the student to grow academically and socially, the goal of teaching is to inspire and guide students (Rosebrough and Leverett, 2011). In this OB Family transformative continuum of care learning experience, students were self-motivated to seek out a family and make this obstetrical experience what they desired. This study supports transformative learning in nursing education as an innovative approach to promote student safe and competent obstetrical clinical practices in a rapidly changing healthcare environment.