Journal of Nursing Education

Use of Clinical Logs by Beginning Nursing Students and Faculty to Identify Learning Needs

Carol A Sedlak, MSN, RN, CCRN, ONC

Abstract

ABSTRACT

Students entering a nursing program bring with them an increasing variety of life experiences. This study compares the learning needs of nontraditional and traditional nursing students during the first clinical experience. Twenty sophomore students wrote weekly reactions to their clinical experiences in the form of a log. The logs analyzed each week's clinical experience, assessed attainment of the week's goals, and identified goals for the following week. Descriptive analysis identified the following major themes and patterns of learning needs: learning from negative experiences, awareness of contextual influences, recognition of improved communication skills, identification of locus of motivation, and ability to conduct client teaching. Building on students' prior experiences can provide opportunities for self-reflection and promote the development of self-directed learning.

Abstract

ABSTRACT

Students entering a nursing program bring with them an increasing variety of life experiences. This study compares the learning needs of nontraditional and traditional nursing students during the first clinical experience. Twenty sophomore students wrote weekly reactions to their clinical experiences in the form of a log. The logs analyzed each week's clinical experience, assessed attainment of the week's goals, and identified goals for the following week. Descriptive analysis identified the following major themes and patterns of learning needs: learning from negative experiences, awareness of contextual influences, recognition of improved communication skills, identification of locus of motivation, and ability to conduct client teaching. Building on students' prior experiences can provide opportunities for self-reflection and promote the development of self-directed learning.

Introduction

Across the country, increasing numbers of nontraditional students enter institutions of higher education. Nontraditional nursing students are older than the traditional college student of 17 to 22 years old (Seidl & Sauter, 1990), may be first-time college students or may have a background in another field and perhaps a college degree (Bueche, 1986). The current mix of nontraditional and traditional nursing students challenges nursing faculty to make use of, in their teaching, the variety of life experiences and ways of thinking these students bring to the nursing program. The purpose of this study, therefore, was to identify and to compare learning needs of nontraditional and traditional nursing students during their first clinical nursing experience.

Method

A descriptive study design was used to examine the learning needs of nontraditional and traditional nursing students during their first clinical experience.

Sample

The subjects were sophomore students enrolled in a first-semester clinical nursing course in a baccalaureate nursing program. The course includes a six-hour clinical experience each week in a hospital setting. The sample of 20 students consisted of two clinical groups (10 students per group), each with a mix of nontraditional and traditional students. For analysis, the 20 students were separated into two groups, nontraditional and traditional, with 10 students per group.

Nontraditional students were identified as male and female students over the age of 21. Students were married or single (with or without children), and had not entered nursing school directly from high school. Six students in this group were over the age of 25, the oldest being a 40-year-old male. There were three males and seven females in the group. Six of these students were married with children. Traditional students were defined as single female students, 19 to 21 years old, who had entered nursing school directly from high school.

Data collection

Students wrote weekly reactions to their clinical experiences in the form of a log. The logs, which covered a nineweek period, incorporated an analysis of each week's clinical experience, an analysis of perceived attainment of the week's goals, and goals for the following week. This written form of communicaton served as a means for students to engage in self-reflection and dialogue with the instructor about their clinical experiences. Students turned in their logs the day after the clinical experience, which allowed immediate recall of problems, questions, and experiences.

Data analysis

Each week, the logs were reviewed by the researcher using modified methods of Miles and Huberman (1984) and Spradley (1979) to identify similar and different learning needs of nontraditional and traditional beginning nursing students and to draw meaning from the written clinical reactions, perceived goal attainment, and goal identification.

Results

There were both similar and different themes and patterns of learning needs of nontraditional and traditional beginning nursing students (Figure 1).

Recognition of learning from negative experiences

During the first weeks of clinical experience, the nontraditional students identified their own mistakes and readily admitted to learning from these mistakes and other negative experiences. For example, one student said: "I learned that inspection is so important. The saturated dressing seemed so insignificant until the instructor saw it and became concerned, then I realized this was critical; I looked without seeing." Another student wrote: "It was both enlightening and scary that my patient injured her back in a hospital setting using poor body mechanics with a patient. It was ironic that I was 'caught' doing the same improper technique during this patient's care. Someone is trying to tell me something."

The traditional group of students steadily trailed behind the nontraditional group, but caught up with the nontraditional group by Week 6, at which time they also identified growth from negative experiences. One student wrote: "Seeing the surgery and the smell of the cautery led me to get really hot. As I broke into a sweat I headed for the door and started to black out. Now I know what a client feels like when blacking out."

Table

FIGURE 1Learning Needs Identified by Beginning Nursing Students

FIGURE 1

Learning Needs Identified by Beginning Nursing Students

Self-growth and awareness of contextual influences

Self-growth was identified early by the nontraditional students in caring for challenging clients. One student explained: "The patient was a challenge, but I found that I could actually interact with the client and do A.M. care at the same time." One student, after caring for a client with Alzheimer's disease, wrote: "Even though I was running behind in my patient care for the day, the experience was valuable and rewarding." In addition, the nontraditional students were aware not only of their clients, but also of their clients' surroundings (contextual influences), particularly the hospital staff For example, one student wrote: "The interruptions during morning care by health team members provided a learning experience." At about six weeks, an awareness of contextual influences aside from the client also was identified by traditional students.

Recognition of communication skills

For the traditional group, a recurrent theme throughout the nine weeks was identification of progress with communication skills and basic technical skills. Comments from the traditional students included these: "I am still weak at making beds," "I am doing better at identifying lung and bowel sounds," "I felt uncomfortable obtaining a sexual history from my male patient who was near my age," "I am doing well at hand washing skills," and "Patients open up to me; I am a good listener." The nontraditional group did not focus on their progress with basic communication skills as frequently as the traditional group.

Locus of motivation and self-confidence

By Week 7, the traditional students identified the client's feedback as instrumental in increasing their self-confidence. One student wrote: "It was a great day. I was impressed how my patient remembered my name and would use my name when talking to her roommate and to the instructor." Another student commented: "It made my day when my patient of last week recognized me and was so glad to see me."

Comments from the nontraditional group, on the other hand, pointed toward development of selfconfidence through self-evaluation. Comments from this group included: "I felt good about today, got everything done for the patient due to a more organized plan," "I felt I was good for my patient emotionally; I listened to her and helped her ventilate her feelings about the surgery," and "I work well independently and can adapt well to given situations; my previous work experience helped me attain this strength."

Awareness of teaching ability

Awareness of client teaching was consistently identified by both groups, though the nontraditional group expressed more comfort with teaching. In addition, nontraditional students were more adept at addressing sensitive topics, such as the client's sexuality, and taught clients self-breast and self-testicular examinations. A student in the traditional group wrote, "I just couldn't do teaching on self-testicular examination with him. He also had needle tracks on his arm."

Awareness of emotions

A major theme of the nontraditional group's selfanalysis was increased awareness of their own emotions, particularly empathy. Client advocacy was also identified later by this group. Reactions included: "Viewing surgery was a positive experience; it helps me understand the patient's feeling of fear and pain," "... all the patient needed was some TLC," and "I saw to it that my client was given her pain medication."

Weekly goal identification

Both groups of students demonstrated self-directedness, particularly through goal writing for each week of clinical experience. In fact, the traditional group was much more consistent in writing and evaluating weekly self-goals than the nontraditional group. Both groups identified physiological goals such as "eating breakfast the morning of clinical." The traditional group of students developed goals that addressed basic communication skills and technical skills more frequently than the nontraditional group. The nontraditional group developed goals that addressed higher-level cognitive abilities such as nursing process skills and advanced communication skills (Figure 2).

Discussion

Similarities and differences in learning needs emerged clearly from the weekly log data of the nontraditional and traditional groups of beginning nursing students. Although both groups identified learning from negative experiences and identified an awareness of contextual influences upon the client, the traditional group did so several weeks later than the nontraditional group. This may be attributed to the fact that many of the traditional students may not have been exposed to a hospital setting. Also, initially, they focused on themselves and the client in their efforts to deal with the overwhelming feelings of a first clinical experience. Later in the semester, as the traditional group became more comfortable in the environment, they were able to expand their vision to their surroundings and see others outside the student-client dyad.

The nontraditional group did not focus as frequently on communication as the traditional group, possibly because their previous life experiences enabled them to communicate more appropriately and comfortably with patients. In addition, the traditional students' greater focus on technical skills and the nontraditional group's focus on self-growth from challenges may have been due to differences in previous life experiences.

The source of motivation also was different for the two groups of students. The nontraditional group used internal motivation through self-evaluation of their accomplishments. The traditional students used external motivation in the form of client feedback. Internal motivation is a higher-level characteristic in the promotion of self-directed learning.

The nontraditional students were aware of and comfortable with conducting client teaching about sensitive subjects. Again, their previous life experiences and comfort in the use of communication skills may have been contributing factors. These students' ability to teach areas of sexuality such as self-breast and selftesticular examinations may be attributed to their own sexual development and maturity based on life experiences. The traditional students, who were still in the later stages of adolescence or early adulthood, may have been striving for sexual maturity and thus were uncomfortable not only with their own sexuality but also with the sexuality of others.

Table

FIGURE 2Examples of Goals Identified by Nontraditional and Traditional Beginning Nursing Students

FIGURE 2

Examples of Goals Identified by Nontraditional and Traditional Beginning Nursing Students

The nontraditional students' greater awareness of their own emotions, especially of empathy for the client, may be attributed to their ability to look outside themselves and to focus on the client and contextual influences on the client. Life experiences also may have played a role. Although the traditional students did not voice a noticeable increase in awareness of their own emotions, this may have been the result of continued emphasis, and perhaps anxiety, regarding basic skills.

In the area of weekly goal identification, the traditional students were more consistent than the nontraditional students. This was surprising because the nontraditional group was more self-directed and, based on that finding, they should have been more consistent in writing goals. One can only speculate on the possible reasons for this finding. Perhaps goal identification represented a more concrete type of thinking and nontraditional students may have viewed it as busy work, or the structured nature of writing goals may have been limiting to them, or perhaps they had not had previous experience with this and found it difficult.

Conclusion

With the increase in nontraditional students enrolling in nursing programs and the increasing need for graduate nurses who are independent, critical thinkers able to provide competent professional nursing care, it is imperative that faculty acknowledge individual learning needs and promote self-directed learning. The results of this study indicate that the use of the log in clinical teaching is one method for acknowledging students' previous experiences and ways of thinking.

The clinical log can:

* provide an opportunity for student self-reflection on learning needs;

* facilitate communication/dialogue with students to foster student- teacher relationships;

* place responsibility with the student for active engagement in self-directed learning, thereby empowering the student; and

* increase self-confidence by enabling students to identify their own loci of motivation.

As faculty learn to incorporate alternative pedagogies into the traditional curriculum, they will be more comfortable with the challenge of acknowledging students' life experiences and ways of thinking and will be able to better assist beginning nursing students in identifying learning needs during their first clinical nursing experience.

References

  • Bueche, M. (1986). Re-entry women in the baccalaureate nursing programs: The achievement of selected developmental tasks. Journal of Nursing Education, 25, 15-19.
  • Miles, M., & Huberman, M.A. (1984). Qualitative data analysis. California: Sage.
  • Seidl, A., & Sauter, D. (1990). The new non-traditional student in nursing. Journal of Nursing Education, 29, 13-19.
  • Spradley, J. (1979). The ethnographic interview. New York: Holt, Rinehart & Winston.

FIGURE 1

Learning Needs Identified by Beginning Nursing Students

FIGURE 2

Examples of Goals Identified by Nontraditional and Traditional Beginning Nursing Students

10.3928/0148-4834-19920101-07

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