Understanding of science and scientific problem solving skills are pivotally important for preparing nursing students for competent clinical practice, especially with the explosion of knowledge in the biological sciences leading to more surgical and medical procedures and treatments (de Carvalho, 2003; Courtenay, 1999; Erickson & Ditomassi, 2005; Nyatanga, 2005). In this article, science refers to anatomy, physiology, pathophysiology, and pharmacology. However, there are some commentators who argue that science pedagogy within health education programs has not kept pace with advances in teaching the art of clinical practice (Bynum, 1993; Weatherall, 2006; Wynne, Brand, & Smith, 1997). Indeed, in the 1980s and 1990s, there was ambivalence, or perhaps even reluctance, to emphasize scientific knowledge because it was believed to compete with the need to emphasize humane, compassionate care (Bevis & Watson, 1989). Now that a balanced view that appreciates both the art and science of nursing is restored (Pesut & Herman, 1999), it is important to continue the conversation about what effective teaching and learning in the sciences might mean in a variety of contexts.
Tanner (2003) argued convincingly that simply focusing science courses on technical procedures and processes does not best serve the needs of nursing students primarily because students are best served by developing their own critical thinking skills and drive to explore and inquire. To engage students and deepen understanding, activities that stimulate inquiry and critical thinking are required. In addition, we need to document the effectiveness of such processes to further our own understanding of what a good nurse educator does and how.
Following trends set in McMaster University in Canada, nursing education in many universities in Australia in the 1990s adopted the concept of integrated learning, in which students were encouraged to engage in discovery learning and teach themselves with the support of facilitators, using a problem-based approach (Alavi & Cattoni, 1995). Students were given case studies, taught a systematic approach for analysis, and encouraged to self-identify issues for further inquiry. Science was integrated into this holistic, discovery-based approach, along with humanities, psychosocial and technical skills. This educational practice, although clearly valuable, found students lacking in some fundamental building blocks required for good clinical practice, such as anatomy and physiology (Courtenay, 1991; Williams, 1999). Current emphasis in most Australian universities is placed on the direct importance of an understanding of discrete units of study, including anatomy and physiology as they relate to nursing; that is the importance of anatomy and physiology within a clinical context. This applied approach does not replace the humanistic or skills-based courses, but rather complements them, supporting clinical practice techniques with a sound knowledge base in biological science.
Recently, computer-assisted technology has been used in science education as an alternative to the traditional laboratory learning experience (Jeffries, 2005a, 2005b; Medley & Horne, 2005). Simulations in education are designed to mimic real-life situations, giving students the opportunity to reason through a clinical problem or exercise and make decisions without the potential of harming actual patients or animals (Bond & Spillane, 2002). Simulations also provide the opportunity for repeated practice in a skill, where students can learn and make mistakes in a safe and controlled environment (Wilson, Shepherd, Kelly, & Pitzner, 2005). With limited time and constrained opportunities to experience and practice a range of nursing skills, simulated learning may allow clinical education to maintain rigor and quality. There may also be economic benefits to using simulated environments compared with establishing and maintaining expensive laboratory equipment and personnel. Simulated technologies may add novelty and variety to conventional teaching. They offer the potential for greater student access because eventually, students may be able to access this technology in their own homes according to their own schedules (Jang, Hwang, Park, Kim, & Kim, 2005). Thus, there are increasing calls for simulation use not only in the acquisition of clinical skills, but also in the more fundamental learning experiences of anatomy and physiology (Jeffries, 2005a). Computer or model simulation systems facilitate safe and reliable practice of simple clinical skills (Medley & Horne, 2005). However, there is still little demonstrated evidence or clear understanding of the educational usefulness of simulations in nursing (Jeffries, 2005b).
One significant challenge to the extensive use of teaching simulations is their tendency to lack the emotive and psychological impact of real-life clinical situations and interventions. Researchers have described the value of problem-based learning in the application of clinical knowledge, specifically recognizing increased knowledge retention. This is because problem-based learning is a teaching method thought to engage students and to require applied knowledge, compared with rote memorization (Beers & Bowden, 2005), creating active rather than passive learners. We suspected that laboratory exercises might have a similar effect, as well as applied relevance, and thus inspire students to understand, rather than just learn, anatomical and physiological information.
Traditional laboratory learning continues to offer numerous benefits to the teaching and learning of science, enhancing scientific knowledge but also aesthetic and ethical ways of knowing. For example, use of dissection material in a laboratory situation is an opportunity to emphasize both rationalist and humanist ways of knowing. The instructor can convey knowledge about the relevant organ system and also facilitate learners’ personal feelings about mortality, humanity, objectification, and understanding of how to be a dispassionate yet respectful clinician. Garrison (2003) has written elegantly and persuasively about the importance of student exposure to real organs, real tissues, and real bodies. Hands-on experience of dissection can also be used to enhance students’ ability to apply anatomical information to the clinical context, and thus broaden students’ appreciation of the relevance of scientific knowledge to nursing practice (Fredricks & Wegner, 2003). Although there is research-based recognition that anatomists like to teach using cadaver material or at least animal-based dissection material, the use of computer-based anatomical teaching is increasing (Conway & Sharkey, 2002). There is little understanding of the effects of this educational change on students’ abilities, particularly their ability to engage with and develop from these educational experiences. In addition, little understanding of the effects of this change on nursing students’ perceptions of anatomy and physiology courses exists.
Although most educators recognize the need for nurses to understand science concepts, especially concepts associated with anatomy and physiology (Wilkes, Cooper, Lewin, & Batts, 1999), studies rarely seek student input in student-directed learning, despite industry-based urgings to look at factors that influence students’ understanding of the sciences (Wilkes & Batts, 1998). In addition, rarely have the effects of these factors on nursing students’ recall, understanding, and engagement with the material been examined.
The current evaluation was conducted within this context. The study was designed to examine student perceptions of learning related to anatomy and physiology at a major Australian university.
Students completed two anatomy and physiology courses and two other science courses within a 3-year program consisting of 23 courses. These anatomy and physiology courses were taught conventionally by using a combination of 3 weekly lectures (1 hour each) and a 3-hour practical classes once every 2 weeks. The practical classes consisted of a series of practical laboratory-based dissections, clinical tests (i.e., blood-grouping, blood smears), and model reconstructions.
Formal ethical clearance was not required under the rules set by the National and University Ethics Committee, as the data collected were part of the routine course evaluation conducted during a semester. Students are required to understand that course evaluation data requests and completion are considered consent. All students had the opportunity to anonymously decline participation in the study. The study used a simple 20-statement questionnaire, written by the course convenor and course tutor, evaluating the importance of the hands-on laboratory sessions in the students’ understanding of the concepts and details of the anatomical and physiological knowledge presented in their lecture series. Students were asked whether they agreed or disagreed with statements outlined on a 5-point scale (a = strongly agree, b = agree, c = no opinion, d = disagree, e = strongly disagree). The questions, shown in Table 1, covered the material presented in the laboratories, the importance of that material in their overall conceptual understanding of anatomical and physiological material, and the input of those experiences in their understanding of anatomical and physiological concepts presented in lectures. Questions were designed to cover a range of course areas, including course information, understanding, and perceived value, while not overburdening students’ time. To provide some measure of internal validation and control, the survey included positive and negative statements about laboratory classes. Of note, although laboratory sessions were not compulsory, attendance averaged 96% over the course of the semester.
Table 1: Survey Instrument
Students were asked to note their responses anonymously on computer-mark sheets, which were collected and placed in envelopes by student nominees and returned to support staff. There was no pressure on students to participate in the survey. The lecturer left the room while the survey was completed and collected.
Of a total enrollment of 125 students, 104 completed the evaluation. Results of the survey are presented in Table 2.
Table 2: Survey Results
The overwhelming result was positive support of laboratory sessions in the teaching of anatomy and physiology. The majority of students thought laboratory sessions enabled them to gain information (97%), added to information presented in the traditional lecture sessions (94%), and, perhaps most important, helped them understand the material presented in lectures (97%). Thus, unlike other studies examining the use of simulation or Web-based teaching and learning (Gee, Peterson, Martin, & Reeve, 1998; Jang et al., 2005), this study did not examine one or the other, but rather the importance of integration of the two in students’ perception of their learning experience.
Although a significant part of the laboratory sessions included small group time in which students were invited to ask questions that they could not or would not ask in lectures and to interact with a variety of academics to seek multiple explanations and perspectives, this did not explain all of the satisfaction achieved in laboratory classes. Eighty-five percent of students indicated that they genuinely valued the hands-on time they spent in the laboratories. This reflects the findings of other studies addressing similar issues. Mitchell, McCrorie, and Sedgwick (2004) found that students universally valued time spent in a dissecting room to learn anatomy and that many students wanted more hands-on time to gain knowledge of anatomical structures.
The most significantly valued element identified in the practical sessions was the ability to complete real clinical tests, such as blood grouping and blood smears. These kinds of exercises are gradually moving out of nursing and conventional science laboratory programs, primarily because of the increased safety requirements associated with the use of human tissue, especially human body fluids (even the students’ fluids). Although use of a physical containment level 2 (safety rating of procedures) laboratory facility and carefully supervised techniques does not preclude these as teaching elements, costs and limited access to appropriate facilities do preclude these tests in many nursing programs. It is significant that of all the practical exercises these nursing students performed, they most valued the opportunity to examine and perform the more organizationally challenging assays. Although studies examining the effectiveness of Web-based teaching of clinical skills, such as electrocardiography, indicate high levels of student motivation and satisfaction (Jang et al., 2005), these studies often point to a need to enhance “motivation for more active learning” (p. 38). Results from this study suggest that one of the best motivators may be hands-on interaction with real material, which enables students to engage with, understand, and then apply knowledge acquired in alternative contexts.
Although time spent with models and posters was clearly valued by the students (32% strongly agreed that access to these teaching tools was important), it did not compare to the 53% who strongly agreed that specimen dissection was a valuable part of their laboratory time (compared with 66% positive response for clinical tests). Unsolicited comments on the surveys included several negative comments about the use of videos and DVDs in various laboratory exercises. This study echoed the findings of other studies (Buckley, 2003; Rouse, 2000). Simulations, models, and posters do not replace use of real (i.e., animal) tissue or actual physiological tests related to the students’ positive perceptions of their learning experience.
The importance of contextualization of anatomy and physiology knowledge for student engagement and satisfaction emerged in several areas of the survey. The value placed on clinical tests, together with the very positive response to time spent discussing normal anatomy and physiology with a practicing clinician (91% agreed or strongly agreed that this was a valuable part of their anatomy and physiology laboratories), reinforces the notion that the relevance of knowledge is paramount in students’ perception of its importance.
These data are relatively limited in scope and do not encompass the myriad possible laboratory teaching aids that can be used in anatomy and physiology. They do not specifically address the concerns of students who, for various reasons, may not wish to participate in, or even observe, dissection of animal material or their own biological samples (i.e., blood). However, they do indicate the importance and significance of the laboratory experience to the majority of nursing students enrolled in anatomy and physiology courses. The more relevant and hands-on the experience, the better. Of the students surveyed, 57% thought the laboratory classes should be a compulsory element of anatomy and physiology, and only 10% thought their time would be better spent in private study. A portion of the latter group also thought their time in laboratories was wasted time.
Although the development of the science courses in the bachelor of nursing program continues, these data strongly support the continued inclusion of laboratory classes in the courses, supporting and augmenting more traditional lecture formats. As educators, it is difficult not to support the inclusion of valuable and illuminating hands-on experience in an educational process; this study demonstrates that the majority of this population of students also support this educational framework.
Science elements in nursing degrees have often been viewed, with reasonable cause, with some level of apprehension by students. Unpublished data from within the university reveal that failure rates in initial nursing science-based courses can be up to 30%, outstripping many other first-year nursing courses. This is reflected in the students’ perception of a requirement for laboratory sessions in anatomy and physiology. More than 80% of students surveyed thought they would struggle to learn their anatomy and physiology without the educational support of laboratory sessions, and 63% thought they would fail these courses without the laboratory classes. Because the surveys were completed anonymously, it is not possible to match perception of possible failure with actual academic results; however, given the failure rate with laboratory sessions and the perceived importance of laboratory sessions in gaining and understanding information content, it seems self-evident that laboratory sessions are an essential part of the learning and understanding experience of these first-year nursing students.
This study found that students perceive hands-on laboratory sessions as important to learning. Although these kinds of laboratory exercises are demanding on staff in terms of hours of contact, students clearly appreciate and value these efforts. In contrast, preparation of simulation material can be expensive at first, but it may then become resource-efficient and economical. Nonetheless, effective use of existing, well-researched, conventional techniques remains a valuable method of contributing to the educational preparation of students for contemporary nursing.
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|1||The laboratory sessions are fun.|
|2||I feel I gain information from laboratory sessions.|
|3||The laboratory sessions add to the lecture content.|
|4||Laboratory sessions help me understand lecture material.|
|5||I feel laboratory sessions are an essential part of my anatomy and physiology learning.|
|6||I would struggle to learn anatomy and physiology if I did not have the laboratory sessions.|
|7||I would reconsider enrolling in anatomy and physiology if it had no laboratory sessions.|
|8||I think I would fail anatomy and physiology without the laboratory sessions.|
|9||I value the small group time I get in my laboratory sessions.|
|10||I think laboratory sessions are a waste of time.|
|11||I can ask questions in laboratory classes that I cannot ask in lectures.|
|12||I can ask questions in laboratory classes that I would not ask in lectures.|
|13||I appreciate the hands-on time provided to me in laboratory classes.|
|14||I find the time to explore the human anatomy posters and models an important part of my laboratory time.|
|15||I find the specimen dissections an important part of my laboratory time.|
|16||I value the time to conduct real clinical tests like blood grouping and blood smears.|
|17||I would prefer laboratory sessions to be compulsory.|
|18||I value the time to discuss normal anatomy and physiology with another member of staff (other than my lecturer).|
|19||I value the time to discuss normal anatomy and physiology with a practicing clinician.|
|20||I would rather use laboratory session time to complete my private study.|