Journal of Nursing Education

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Concentrating on the Process of Learning While Teaching Clearly Defined Communication Skills

Marilyn Hyche Johnson, RN, MS; Joan Bricks Zone, RN, MS

Abstract

Grading the clinical experience is accomplished by multiplying the point allotment of each objective on the P.M.O.T. by the rating scale and converting the raw score into a letter grade. Where the authors have established criteria for an objective, the essential steps for safety have been selected, and each student must master this objective at a minimal C-level. Behaviors for achievement beyond this level are identified and students may choose to meet all the criteria for an objective. In goals without criteria, the average number of times achieved is recorded on the continuum of never to always. Two theoretical patient situations, which incorporate both minimal objectives for clinical and commonly observed psychiatric conditions and problems, are utilized for testing to determine the student's ability to apply theory to practice.

Summary

The authors found that students using the composite are more motivated and enthusiastic about learning than before, and claim to have greater confidence in themselves and the skills they possess in relating to others. In addition, the "Level of Response Scale" gives them a concrete framework for choosing the most therapeutic response for a given situation; this has had implications for their performance clinically and theoretically in terms of testing.

The experience of developing this composite of materials and clarifying the teaching-learning process has been growth producing for the authors as well as the students, since it required the authors to be very clear and specific in their expectations and it provided them with more time for counseling individual students.

In conclusion, this experience further demonstrates that communicating effectively is not strictly intuitive but a skill that can be taught and learned in an enjoyable and satisfying manner when a motivating learning environment is provided.

FIGURE III

SUICIDE VULNERABILITY FACTORS*

FIGURE IV

LEVEL OF RESPONSIVE SCALE

FIGURE IV

LEVEL OF RESPONSIVE SCALE…

Introduction

While teaching psychiatric nursing in an ADN program, the authors found it necessary to clearly define the skills needed for safe and effective client care. Several student behaviors made such a need apparent. Initially, students approached the experience with fear of psychological or physical harm to themselves and/or fear of not being able to effect change in psychiatric clients. These fears resulted from misconceptions about psychiatric clients, lack of knowledge and skill with therapeutic techniques and an inability to rely upon previously learned physical skills. The students felt helpless since they had lost their usual pattern of relating to others and jyet were unable to practically apply the abstract therapeutic model. Consequently, they either avoided client situations -or used social chit-chat during patient interactions. Even after several weeks of clinical experience, students were still uncertain of their role and faculty expectations. In view of these reactions, the authors found it necessary to redefine minimal skills, identify the most effective way of teaching these skills and construct the most objective means of evaluating them.

Philosophy of Teaching-Learning

The process of learning is more important than the content of what is learned. Content is continually changing in this technological age, whereas, learning how to learn in a manner that is both enjoyable and satisfying can help make learning a lifetime pursuit. To do this, the educational process must be individualized to meet the particular needs of the learner. Consideration of a student's previous experiences and knowledge as well as his rate and manner of learning is given when he is allowed to participate in establishing goals, selecting methodologies and evaluating achievement.

Inherent in a positive educational experience is a comfortable student-teacher relationship that facilitates growth for each. Such a relationship exists in an atmosphere of openness, honesty and respect characterized by mutual sharing of information, feelings and concerns. When goal directed and therapeutic, this relationship is a microcosm of the student-patient interaction. The client is considered indirectly during the learning process, yet the student remains the primary focus.

A final and equally important element of a positive learning experience is clearly defined minimal behaviors. Most subjectivity is eliminated since these behaviors can be observed and documented by both instructor and student. It has been the authors' experience that each student can meet at least a minimal level of competency given adequate time, teacher input without penalty and some choice in their manner of intervening and meeting of their own learning goals.

Program Characteristics

This program draws students from a wide cross-section of social, racial, ethnic, economic and educational backgrounds with variations in age, sex, marital status and experiences.

Psychiatric nursing is taught during the students' fourth semester along with Nursing of the Physically 111 Adult. Each psychiatric rotation is approximately seven weeks in duration with nine hours of clinical experience each week.

Each student is required to relate therapeutically with at least one client for the duration of the experience. Faculty members accompany students to their clinical agencies; the student faculty ratio is approximately 1:12.

Implementation

To make communication skills as concrete as physical skills, the authors developed a composite of objectives, tools and resource aids. The composite includes a "Psychiatric Minimal Objective Tool" (P.M.O.T.) plus a "Psychiatric Assessment Tool" (P. A. T.), two resource aids - "Level of Response Scale" and "Suicide Vulnerability Factors," - a Psychiatric Nursing Care Plan, and a Psychiatric Interaction Recording (P.I.R.).

The P.M.O.T. (Figure I) identifies minimal behaviors required during the three phases of nursing process and a fourth self-growth phase. Each phase and behavior is weighed according to importance in determining a clinical grade by giving the corresponding point allotment. To meet the objectives of the planning phase, the P.A. T. (Figure II) identifies the essential factors to be examined in planning care for one or more patients. To assess suicide potential, the resource aid, "Suicide Vulnerability Factors," (Figure III) is utilized. The P.A. T. also requires the establishment of patient needs ranked according to priority and short- and long-term goals with a specific nursing care plan. During the implementation phase, the necessary behaviors for effective communication with one or more patients and staff is identified. These behaviors are structured by the stages of relationship therapy from initiation to termination. The resource aid, "Level of Response Scale," (Figure IV) identifies the techniques and processes of communication and uniquely orders them in five levels according to their degree of therapeutic effect.

During the evaluation phase, the student reassesses the priorities of needs and goals and considers modification of the plan of care. The self-growth phase provides a means for the student to objectively examine self, determine direction of growth desired, choose methods to attain this growth and evaluate the extent of growth. The student's previous experience and needs are utilized during this process. When students are successful in relating meaningfully with others in their personal lives, they tend to view communication theory as less abstract and more concrete. Feeling good about the changes in their behaviors and believing in the usability of therapeutic techniques usually allows students to interact more positively with patients. The Nursing Care Plan and P.I. R. (Figures V & VI) help the student and instructor to both focus upon and document the attainment of psychiatric nursing skills.

The above composite of materials is presented to the students during orientation to the psychiatric nursing clinical experience. During this first week, students are kept in the college laboratory where feelings and expectations are explored, misconceptions about mental illness are clarified, the P.M.O.T is reviewed, goal writing is taught, examples of therapeutic techniques are given, films of actual therapy sessions are shown and students role play nurse-patient situations. Information is also given concerning course requirements and student responsibilities for their learning process.

FIGURE 1PSYCHIATRIC OBJECTIVES TOOL (PMOT)

FIGURE 1

PSYCHIATRIC OBJECTIVES TOOL (PMOT)

FIGURE 1PSYCHIATRIC OBJECTIVES TOOL (PMOT)

FIGURE 1

PSYCHIATRIC OBJECTIVES TOOL (PMOT)

FIGURE 1PSYCHIATRIC OBJECTIVES TOOL (PMOT)

FIGURE 1

PSYCHIATRIC OBJECTIVES TOOL (PMOT)

FIGURE IIPAT (PSYCHIATRIC ASSESSMENT TOOL)

FIGURE II

PAT (PSYCHIATRIC ASSESSMENT TOOL)

Table

FIGURE IIISUICIDE VULNERABILITY FACTORS*

FIGURE III

SUICIDE VULNERABILITY FACTORS*

Table

FIGURE IVLEVEL OF RESPONSIVE SCALE

FIGURE IV

LEVEL OF RESPONSIVE SCALE

Table

FIGURE IVLEVEL OF RESPONSIVE SCALE

FIGURE IV

LEVEL OF RESPONSIVE SCALE

FIGURE VPSYCHIATRIC INTERACTION RECORDINGFIGURE VIPSYCHIATRIC NURSING CARE PLAN

FIGURE V

PSYCHIATRIC INTERACTION RECORDING

FIGURE VI

PSYCHIATRIC NURSING CARE PLAN

Grading the clinical experience is accomplished by multiplying the point allotment of each objective on the P.M.O.T. by the rating scale and converting the raw score into a letter grade. Where the authors have established criteria for an objective, the essential steps for safety have been selected, and each student must master this objective at a minimal C-level. Behaviors for achievement beyond this level are identified and students may choose to meet all the criteria for an objective. In goals without criteria, the average number of times achieved is recorded on the continuum of never to always. Two theoretical patient situations, which incorporate both minimal objectives for clinical and commonly observed psychiatric conditions and problems, are utilized for testing to determine the student's ability to apply theory to practice.

Summary

The authors found that students using the composite are more motivated and enthusiastic about learning than before, and claim to have greater confidence in themselves and the skills they possess in relating to others. In addition, the "Level of Response Scale" gives them a concrete framework for choosing the most therapeutic response for a given situation; this has had implications for their performance clinically and theoretically in terms of testing.

The experience of developing this composite of materials and clarifying the teaching-learning process has been growth producing for the authors as well as the students, since it required the authors to be very clear and specific in their expectations and it provided them with more time for counseling individual students.

In conclusion, this experience further demonstrates that communicating effectively is not strictly intuitive but a skill that can be taught and learned in an enjoyable and satisfying manner when a motivating learning environment is provided.

FIGURE III

SUICIDE VULNERABILITY FACTORS*

FIGURE IV

LEVEL OF RESPONSIVE SCALE

FIGURE IV

LEVEL OF RESPONSIVE SCALE

10.3928/0148-4834-19810301-03

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