Visualization is a teaching methodology that can help nurses learn and perfect psychomotor skills. Great athletes, including Olympic skiers, figure skaters, and gymnasts, use visualization prior to their performance. Visualization is the forming of a mental image in one's mind from outside verbal clues. It can be used in the classroom or on the clinical unit as a teaching technique to improve and to enhance psychomotor skill learning. Venipuncture, catheterization, and nasogastric tube insertion are just a few of the psychomotor skills that can be performed mentally prior to actual performance. Rather than replacing any of the techniques currently in use to teach skills, visualization is suggested as an adjunct to those techniques.
Visualization is effective at many levels of skill learning. The novice will benefit after doing some preparatory work such as handling the equipment, reviewing related principles, and watching a demonstration. The nurse already competent in the skill can use visualizing to practice mentally. The competent nurse will benefit from having the skill presented in its entirety. Visualization helps movement toward proficiency and eventually toward the intuitive grasp needed for "expertise."
INTRODUCING VISUALIZATION AS A TEACHING STRATEGY
Before using visualization, students should be told that a new teaching method is going to be used. Many students remember the athletes in the Olympics visualizing their performance prior to actually performing it. The instructor can explain that the technique will be used to enhance their learning of the particular skill to be taught.
The instructor should thoroughly review the skill to be taught. By being familiar enough with the skill to "see" it, the instructor can relate the steps of the skill verbally as he or she mentally performs them (Figure). Reading the steps is not as effective as relating them, although a general outline may be used as a reference to be sure all aspects are covered.
Students should be comfortable; sitting in a classroom with eyes closed is effective. Outside distractions, including noise, bright lights, and extremes in temperature, should be avoided. Students should be aware of the expected performance outcome. The students also should have knowledge of the principles that underlie a particular skill such as asepsis, anatomy, and physiology. Students should review the steps of the skill and rules prior to the visualization exercise.
THE VISUALIZATION PROCESS
After dimming the lights, the instructor begins, speaking slowly and clearly in a soft, yet audible voice. It may be helpful to begin the visualization process with a progressive relaxation exercise. After students are relaxed, the instructor can begin the visualization process. The skill should be broken down into its component parts with a pause between steps to allow time for mental practice. The entire skill should be performed in the correct sequence.
Words that create a vivid visual image should be used during the process, such as noticing the sharp, shiny silver point of the needle, or sensing the "pop" of the vein wall as the needle passes through it. The instructor should bring the skill to successful completion and allow time for the students to enjoy their individual successful completion of the skills.
When the lights are turned back up, the students are usually quiet, perhaps reflecting on their success. The instructor can ask how the process went for them and ascertain that sttidents were able to perform the skill in their minds.
Encouraging discussion at this time allows feedback on die process itself The instructor can use this feedback to modify the next visualization process and improve die delivery of the process. Debriefing allows the students to solidify die experience and discard any unusual occurrences that may arise. The students should then be given an opportunity to perform the skill.
Every effort should be made to build on what students already know. This provides a frame of reference and context for skill learning. The skill can be demonstrated prior to the visualization strategy by someone who is proficient in die skill so that the student has an opportunity to see the skill performed smoothly and without errors.
The Visualization Process for Venipuncture