Nursing educators have used the learning laboratory for years to teach basic nursing skills before students actually give "hands-on" care. In these days of consumer rights, a client does have a right to a knowledgeable student providing safe, efficient care. The learning laboratory helps by bridging the gap between the classroom and the clinical setting, thereby improving client care and reducing the students' anxiety. We knew this but did not utilize it as effectively as we could have until 1976.
Need for Change
In 1976 the faculty-student ratio in our course was 1:12 - one faculty member to 12 beginning baccalaureate students. In addition, our five-semester-hour course was designed so that all students were in the clinical area at the same time.
This was an instructor's nightmare. There were 12 students to instruct, evaluate and supervise; 12 care plans to grade every week; and 12 evaluations to complete along with 12 student conferences. In addition to being responsible for the students, there were 12 clients who were expecting safe, quality, supervised care. For the students to finish care and leave the unit on time was a dream. It rarely happened.
Many students felt frustrated because of the necessary delay in receiving assistance from their instructor. They believed they were not getting the individual attention they deserved. They also expressed a need for more experience with psychomotor skills. They realized, however, that under present circumstances, the instructor was doing her best. Additionally, faculty were extremely frustrated by these heavy demands and realized that something had to be done.
We voiced our concerns to administration and were challenged to be creative in working with our large numbers of students. The faculty-student ratio would not change so other alternatives would have to be explored. We put problem solving into action, giving much thought to our beliefs about students, nursing and the teachinglearning process. We knew there had to be a more efficient, effective teaching strategy.
Since our course, Nursing Process in the Secondary Setting, is our sophomore students' first hospital course, basic concepts of safety, elimination, nutrition, oxygenation, hygiene, mobility, asepsis, heat and cold, and intravenous therapy are covered. These concepts and related psychomotor skills are taught using the framework of the nursing process. Concepts and skills previously learned in the students' first clinical course (community health), such as vital signs and medication administration, continue to be emphasized as these apply to the secondary setting.
As we looked at our course we realized that each concept area could easily have a related learning lab. For example, in addition to the class lecture on oxygenation, students would attend a learning lab which would provide an opportunity to manipulate various oxygen equipment, practice postural drainage, vibropercussion, coughing and deep breathing.
Students were expected to learn these and other skills on their own. We provided the theory and it was their responsibility to be self-directive in learning these skills prior to their next clinical experience. For a variety of reasons, many times students would not be self-directive, therefore, they would not be adequately prepared to give client care. As we reviewed our present use of the lab, we realized we focused most of our attention on the teaching of principles without adequate emphasis on integrating technical skills (Wisser, 1974). Having scheduled learning labs would guarantee skills practice. It would provide structure that beginning students need and give them more opportunities to develop what Lewis (1971) called "professional craftsmanship."
We already had a large learning lab facility containing 16 beds and most of the equipment and supplies we would need. Our course's present use of this facility was minimal due to the current method of instruction. We were excited about using the learning lab more effectively.
After much deliberation we decided the only effective way to reduce frustrations of students and faculty was to work with half of our students at a time in the clinical area. Based on this, we devised a plan and began its implementation the following quarter.
While one group of students was in the hospital, another group rotated through various learning lab sessions. Students rotated on a weekly basis throughout the nine week quarter - one week of hospital experience then one week of learning lab experience. The 60 students were divided into Group A and Group B. These were further divided (Group A-I, A-2, B-I, B-2 ) if a smaller ratio was needed, such as with the intravenous therapy lab. It was difficult to observe 30 students (e.g. Group B) practice with IV equipment, therefore half of the group (Group B-I or B-2 ) attended each session (Table).
Ample independent study time was provided. Not only was this time to be spent in preparing for lab sessions, students were encouraged to spend time meeting self- and instructor-identified learning needs related to the clinical area, such as reviewing intramuscular injection sites.
EXAMPLE OF LEARNING LAB-CLINICAL ROTATION
Because the first lab introduced was on hygiene, students could actually implement these skills in the clinical area early in the quarter. We felt this was important as students like to be "part of the action." We also wanted students to assist clients with their most basic needs then move to more complex skills as the quarter progressed.
We decided each faculty member involved in our course would serve as the laboratory instructor one or two quarters until each person had served her rotation. Not only did this provide a break from the clinical area, it gave each faculty member an opportunity to know exactly what was being taught in the learning lab.
Most major concept classes were scheduled on Thursdays, with the related learning lab(s) scheduled the following week when possible. Specific class, laboratory and clinical objectives guided the students' learning. Not all learning labs were based on a previous class. For example, the mobility and hygiene labs were based on reading assignments and audio-visuals housed in our learning resources center. The first portion of these particular lab sessions involved a demonstration by the instructor, after which students practiced the appropriate skills.
Because we wanted the students to take the learning labs seriously, "pop quizzes" were incorporated to encourage study and preparation. We envisioned that some students might see the lab sessions primarily as a rest period from the hectic clinical pace and not give them their best. Since learning is a self-active process, students took an active role in order to promote transfer of learning (Wong, 1979). They participated in learning "action" labs in non-stressful, simulated client situations and practiced with equipment without being graded on their psychomotor performance (except for aseptic technique which we considered a critical skill). Grading occurred as the skills were implemented in the clinical setting. In addition, theory and underlying principles were tested in our regularly scheduled examinations.
Students were encouraged not to perform a particular skill just for the sake of learning a skill, but rather to view the skill as a means by which the nursing process could be implemeted. Take the skill of inserting a rectal suppository, for example. Many things are involved before the skill is performed. The nurse must first assess her/his own knowledge of the action and desired effects of the suppository. Assessment of the client's need for the suppository, planning appropriate nursing prescriptions, implementing these prescriptions, and evaluating the effectiveness of the plan are all an integral part of performing this basic skill.
Students were also asked to share situations in which they utilized a certain skill and to seek out experiences in the clinical area to implement learned skills. This helped them to better see the relationship of the learning lab with the "real world" of nursing.
Evaluating The Plan
We implemented the plan being optimistic that our detailed planning would bring positive results - and we were right. There were several advantages to the new plan. With fewer students in the clinical area each week, instructors were better able to meet the individual student's needs. Additionally, we were able to be more effective because we had more time to instruct, evaluate and supervise the students. There was a better choice of client assignments since there were fewer students. Although the change resulted in less clinical days for students, we believed there was a definite improvement in the quality of instruction. Instructor job satisfaction increased as a direct result of implementing the new plan.
Students were pleased with the plan as they gave positive comments on their lab evaluations. They were glad to have the learning lab experiences, because in most instances they were able to practice the skills before performing them for a real live client! By having had an opportunity to practice skills, the students were less anxious when they had to perform skills in the clinial area. Sure the students needed support and encouragement but the skills did not overwhelm them to the point that the client's other needs could not be seen.
As soon as we started our "action" labs, former students stopped by to tell us they had heard about the changes and to express their positive feelings about the rotation system. These students had been instrumental in bringing about the change, as it was their constructive suggestions that also motivated us to devise a different plan on instruction.
We continue to utilize the learning laboratory as described. The learning labs are valuable in meeting the learning needs of students; they feel more secure when performing skills in the clinical area. We encourage other faculty to use their learning laboratory facility to its potential. Put the learning laboratory to work for you. It has been - and is - one of our greatest assets.
- Lewis, E.P. (1971). Secure in her skills. Nursing Outlook, 19, 519.
- Wisser, S. H. (1974). Those darned principles. Nursing Forum, 13, 386-392.
- Wong, J. (1979). The inability to transfer classroom learning to clinical nursing practice: A learning problem and its remedial plan. Journal of Advanced Nursing, 4, 161-168.
EXAMPLE OF LEARNING LAB-CLINICAL ROTATION