Nursing schools today are striving to increase the competency of their students, and to help them obtain the ability to deal with the role of the nurse they will assume upon graduation. One of the new methods of instruction is incorporating independent study into the undergraduate nursing curriculum. Independent study can be defined in different ways. In this paper it refers to a unique experience, designed by both the student and instructor, to meet the requirements to gain credit and to fulfill the special needs of each student. It is a course through which reality experience, selfmotivation, and teacher-student relationships are fostered. Usually incorporated into this course is the establishment of requirements, objectives, and how evaluation will be accomplished.
Independent study fits in well with the curriculum of study at the University of Maryland. The junior year emphasizes approaching health care from a wellness orientation involving clients with a low stress state. It focuses on assessment skills and the development of fundamentals necessary for senior year. By the end of the junior year students have also been exposed to chronic illness, and the increasing level of stress that accompanies this type of illness. Senior year incorporates the last two phases of health care, which are the acute phase in the hospital (the high stress state) and community health nursing. Independent study courses are offered as an elective with the medical-surgical semester (the acute phase) and/or in between semesters of the senior year during the minimester.
I was able to take independent study both during the minimester and during the last semester at nursing school. The school had established basic guidelines and certain due dates for topic selection and course ending dates. They also described basic student and faculty mentor responsibilities which I found very helpful in setting up this course. The first step in the process was to find a faculty mentor willing to work with the student, preferably experienced in the area in which the student was interested. Since I was interested in doing an experience in neonatal intensive care, I checked with many pediatric and obstetric instructors and found many willing to work with me. One of my junior year instructors had had experience in the NlCU, so we sat down to plan the course together. The Baltimore area hospitals offered many locations in which to learn. We decided to use Johns Hopkins Hospital because of its large NICU and its reputation as a teaching hospital. My instructor-mentor contacted the agency to discuss the feasibility of such an experience and with tentative approval I wrote a letter to the Director of Nursing Education at the hospital describing the proposed length of my course (a total of 90 hours over four weeks), the need for a nurse-preceptor to supervise my learning experience, and a copy of the objectives I hoped to accomplish by the end of the minimester.
The objectives were developed by me and were then checked by my instructor who offered suggestions. This was important because I did not know what would be possible to accomplish and what would be interesting to learn, having never worked in an NICU. The objectives for the clinical portion of the experience included identifying the role of the nurse in an NICU setting from a multidisciplinary point of view, special neonatal nursing skills, and working with parents of a high risk neonate. The theory portion of the course was to be carried out in the library, studying the various diseases of the neonate, current research in neonatal health care, and writing a log of the information I learned along with a day-to-day record of my experience in the hospital.
My mentor and I decided to meet once a week at school to discuss how the independent study was going along, and how well I was meeting the objectives I had set. I found this meeting valuable to air my feelings about this new experience. It gave me a chance to discuss my problems with being overwhelmed in this new area, and how we were able to make progress on what I wanted to accomplish. This portion of the course was very important because it gave the instructor and me a chance to learn new things about neonatal ICU nursing, and yet provided an atmosphere for guidance necessary to insure the safety of the project. We used this time to develop an ongoing evaluation of the experience. At the end of the minimester it allowed us time to discuss the written evaluation I turned in. The evaluation covered the accomplishment of the objectives I had established by the characteristics of adequacy, appropriateness, effectiveness, and efficiency (AAEE). These characteristics are the basis of the tool used at the University of Maryland to evaluate students' work.
My evaluation of the experience was positive to say the least. All of the Hopkins staff members whom I met were extremely cooperative and willing to answer any questions. I was able to develop a very close relationship with Ms. Krieg, an NICU nurse at Hopkins who acted as my preceptor there. She took me under her wing and introduced me to this challenging type of nursing. While I struggled to develop the skills and knowledge necessary to take care of such small infants, her patience and enthusiasm really encouraged me. I followed her and assisted her with her assignment which usually consisted of two stable infants on respirators or three children who just needed to gain weight. While the development of skills was stressed, she also incorporated basic pathophysiology and pharmacology to give me a very solid knowledge base of neonatal nursing care.
I began by being awkward at such things as handling these small infants and taking too long to do their vital signs. I progressed to developing confidence in these basic nursing skills. I was then able to learn suctioning of an ET tube and other skills involved with a child on a respirator and various monitors. I was never expected to do anything I felt uncomfortable doing, and soon I developed enough confidence to care for a stable child on a respirator with supervision by my preceptor. As a student I was never able to give medications but we discussed their indications and side effects.
On days when Ms. Krieg was assigned to be team leader for the unit I was able to work with her to learn basic management skills. Some things I was able to assist her with included making out the next day's assignment, checking narcotics, doing an environmental safety check of the unit (ambu bags, suction equipment, oxygen outlets, and bulb syringes at every bedsi de ), and assisting any of the staff nurses with their assignments to enable the unit to run smoothly. Ms. Krieg was always looking for opportunities for me to learn new things, and I was able to watch many deliveries of high-risk infants, admitting infants from the helicopter transport team, and surgery on the neonates from the unit.
I felt this experience to be such a valuable one that I used my elective during medical-surgical semester to continue my independent study at Johns Hopkins Hospital. Since this experience would be for a longer period of time and for only one day a week, my objectives included following a case study and writing a longterm care plan that I revised as I followed this baby throughout the semester. This gave me the opportunity to develop a discharge teaching plan and to use the information I had gained to do more parent teaching. The evaluation of this semester included writing this paper on my experience there as well as a summation of the accomplishment of my objectives.
In summary, a brief look at how independent study is incorporated into the curriculum at the University of Maryland was presented. The value of the experience to the student as well as the instructor was emphasized to present this as an enriching form of study for all involved. A brief description of my individual experience was presented to give an example of a type of independent study that worked for me.
Independent study and the one-to-one student-nurse relationship it provides is a valuable learning experience for students who are motivated enough to accomplish the work and feel comfortable with flexible guidelines. It is not for everyone. I feel that independent study should be offered as an elective course for nursing students as it is at the University of Maryland. This is because I feel that some students learn more with the formal student-teacher experience. For me, however, I felt that this independent study has given me a chance to develop the skills, management experience, and confidence I will need when I enter the nursing field after graduation.