Are nursing students allowed to develop independence and accountability in their decision making about patient care? How do schools of nursing facilitate the development of this type of behavior in their students? Many times the perfection of skills is overemphasized in that students are shown step by step just how to do something rather than allowed the freedom to explore various ways to do the same task. This approach influences the development of dependence and convergent thinking. Then when students enter the work world and observe the large contrast in theoretical concepts they were taught and what is being practiced, they tend to follow instead of lead.
Following, however, is becoming a behavior of the past. Nurses today are being asked to assess, implement, and evaluate patient plan of care. This approach to patient care requires divergent thinking and creativity from the nurse. Divergent thinking may be defined as a mode of thinking that uses directions, searching and seeking a variety of approaches to the same situation (Wallach & Kogan, 1965). When an individual thinks divergently in an approach to problem solving, the solutions to the problem tend to be creative. A creative individual will intentionally relate previously unrelated experiences to produce something new that is satisfying and useful to the individual (Schweer & Gebbie, 1976).
Students need to be encouraged to think divergently in order to creatively formulate patient caz« plans. The nursing educator can promote divergent thinking in students by giving them freedom to explore, experiment, question, and try out a variety of approaches to the same situation To be effective, the educator must not only show support and confidence in the students' ability to master situations they encounter but also avoid giving excessive directions, which stifle the students' creativity (Smith, 1977). With this kind of learning environment, the students can become creative in their nursing care.
Providing experiences for this type of learning does not take extra time in the curriculum but rather requires structuring the learning experience in such a way that provides opportunity for the development of creativity. We found that a creative teaching project incorporated into our clinical teaching in pediatrics was ideal for transferring the theoretical concepts of patient teaching into an active teaching program, thereby promoting divergent thinking.
After teaching pediatrics for several years and working on different pediatric units, we had observed that many children were not prepared by staff or students for what happened to them during hospitalization. We noted that the students had received theory on the need for preparing children for their hospital experience to promote optimum adjustment to illness and/or hospitalization and to prevent deleterious effects, but many students were not transferring the theoretical concepts into clinical practice. It appeared that students were not seeing the value of patient education since staff nurses did not always carry it out, and these students were not thinking and acting creatively to develop something they had not had an opportunity to observe in operation.
Within the course requirement for their pediatric rotation during the second semester of their nursing program, the students must complete a faculty preference project assignment. Tb fulfill this requirement, we asked students to create a small teaching booklet that could be used in preparing the child for some hospital experience for the age level of their own choosing. We gave no further instructions regarding format, topics, or materials to be used nor showed them examples of booklets. Two students paired up according to their own preference unless there was an odd number, which required an occasional group of three. The students had five weeks to produce the booklet, which they presented to their fellow classmates at post-conference in the sixth week of clinical.
After implementing this assignment with three groups of students, we have received a variety of booklets, of which the following are some samples. One group of students did a booklet on preparing the child for insertion of intravenous needles. They used a sketch book and added drawings cía doctor, a nurse, and a pair of hands along with a simple story telling why the child needs the IV, how the IV will be inserted, how the nurse takes care of the IV, and when the IV will be taken out. The booklet discussed the importance of the child keeping bis or her hands off the IV, and of the child's calling the nurse if the IV becomes disconnected or has blood in the tubing. The students individualized this booklet by putting hard plastic on the part where the child's, the doctor's, and the nurse's names appear so that the child could write the names in the booklet with an erasable wax pencil. The students also glued alcohol wipes, a tourniquet, an empty intravenous bag with tubing, and a Band-Aid in the booklet at appropriate places in the story. Such equipment encouraged the child to feel and see the various items and ask questions.
Another group of students constructed a coloring booklet on Tonsillectomy and Adenoidectomy, in which Charlie Brown and Snoopy were telling the child how it was when Charlie Brown had his T&A
Other topics the students covered were Asthma, Allergy, Diabetes Mellitus, Isolation, and Upper GI X-Ray. Some used photo albums, poster board covered with clear contact paper, or construction paper to provide the background of the booklet. The booklets were illustrated with personal colored drawings, cut-out pictures, and actual supplies. The content was presented by puppets, animals, and children in the form of games, cartoons, or script.
The reactions of the students to the projects were positive. One student could not wait until the sixth week to present her project. Several students cared for children who were going to have the same procedure for which they had prepared a booklet, so they tried it out. After one student had used her booklet in preparing a 4-year-old for his T&A the child said, "Do you have any more pictures I could look at?" Several studente, who stated that they did not feel that they would be able to complete such an assignment, were really surprised with their end product. Other students stated that they had appreciated the freedom to explore and that they had experienced real feelings of accomplishment.
Throughout this assignment several principles were followed to facilitate the development of divergent thinking and creativity. First, students were given a project and asked to formulate an approach. Tb do so, they drew upon previous, unrelated experiences and pertinent concepts which had been presented to them, a process which stimulated divergent thinking in that they had to derive their approach from a variety of possibilities. Second, the assignment was not an additional one but merely a structuring of one of the student's present requirements in such a way that they had freedom to explore. Third, the booklet was not evaluated as to whether the approach was right or wrong but whether the student had completed a booklet. Such evaluation is consistent with Schweers statement that in order to allow creativity to develop the nurse educator must assist students through the problem, guiding them to problem solve by utilizing their knowledge without fear of being evaluated as to right or wrong (Schweer & Gebbie, 1976). Fourth, the environment was set for learning, but the students were allowed to assume the responsibility for their own learning according to their capabilities and needs. This freedom circumvented the tendency, according to Infante, for faculty to assume responsibility for student learning, which only interferes with student creativity (Infante, 1975).
We believe that the students benefited from this experience in that they were able to experiment with a variety of approaches to patient teaching and observe the effectiveness of these approaches. They were able to experience the feeling of satisfaction that comes from developing something of their own and also to see the value of patient education. In the future, these students will be more eager to be self-directed and to experiment with other creative approaches in applying theoretical concepts in patient care.
Finally, this project demonstrates that the concept of using divergent thinking to promote creativity can be an effective teaching-learning experience. The benefits that students can acquire from this type of experience are: learning how to analyze alternatives, utilizing previously learned theoretical concepts in order to develop a creative plan of action, as well as being less inhibited in implementing their plan. In doing this project, the students experience feelings of satisfaction in accomplishment and recognize that there can be more than one effective approach - all of which stimulate the nurse to be more self-directed and accountable in patient care. Creativity is indeed a necessary aspect of clinical nursing.
- Infante, H.S. (1975) The clinical laboratory in nursing education. New York: John Wiley & Sons.
- Schweer, J.E., & Gebbie K.M. (1976) Creative teaching in clinical nursing (3rd ed.). St. Louis: The CV. Moeby Co.
- Smith, D.W. (1977), Perspectives on clinical teaching (2nd ed.). New York: Springer Publishing Co.
- Wallach, M.A., & Kogan, N. (1965). Modes of thinking in young children - intelligence distinction. New York: Holt, Rinehart, and Winston, Inc.