Development Psychomotor Skills In Nursing Education
What are Psychomotor Skills
Psychomotor skills are movement oriented activities that involve an overt physical response and mental processes.
Psychomotor Skills Development In Nursing Education
Psychomotor skill development requires understanding the skill and how to perform it, as well as developing the ability to carry out the physical movements accurately, efficiently, and consistently under varying conditions. There are key concepts to understand for teaching psychomotor skills in nursing. First, students should learn the theory and principles underlying the skill prior to practicing it, and assessment of their understanding of those principles should take place outside of the actual performance of the skill.
In initial skill learning, students focus on coordinating their movements. If the teacher asks about principles, the focus shifts from the motor component to the cognitive, and this can impede learning. Second, skills require repetitive practice to refine performance, increase consistency and develop skill automaticity. Considering the need for practice of psychomotor skills, educators should identify the skills that are frequently used in clinical practice, such as intravenous lines maintenance, tracheostomy management, and medication administration. Instruction should focus on those high use skills and ensure that students have opportunities for repetitive practice of them (Oermann, 2011).
This practice is best done in multiple short training sessions, spaced over time, rather than during one long block of time (Spruit, Band, Hamming & Ridderinkhof, 2013). Third, in skill learning students need specific and informational feedback to guide their movements.Simulation, as an instructional method, can mimic real experiences with guided experiences (Gaba, 2004).
Psychomotor skills can be incorporated into simulation experiences to allow nursing students the opportunity to practice in the context of patient care. From the fundamental practice of sterile gloving to the more complex running of an emergency code, nursing students can learn through repetitive practice in a safe environment. Simulation encourages the deliberate practice of psychomotor skills
Phases of Psychomotor Skills In Nursing Education
There are three phases of psychomotor skill learning: cognitive, associative, and autonomous (Schmidt & Lee, 2005). Students move through these phases by practicing. The first phase, cognitive, involves understanding the skill or procedure and how to perform it. Feedback to guide performance is critical in the cognitive phase. In the associative phase, students have learned the most effective way of performing the skill and begin to refine performance until it becomes consistent.
With continued practice, they move into the autonomous phase where the skill performance is automatic (Schmidt & Lee, 2005).Students need deliberate practice of skills to move through these phases of psychomotor skill development (Ericsson, Whyte, & Ward, 2007). In deliberate practice, the skill is practiced repetitively, and students receive specific, informative feedback on their performance (Ericsson et al, 2007; McGaghie, Issenberg, Cohen, Barsuk, & Wayne, 2011).
In identifying skills to teach in nursing programs , faculty should consider the need for deliberate practice to retain skills and develop competence. Skills taught early in a nursing program in a foundation or fundamentals course will probably not be retained without practice. A meta analysis on skill retention found that some skills decay immediately after training and continue to decay over time, if not practiced or used for 1 year, most people perform at less than 92% of their original level (Arthur, Bennett, Stanush, & McNelly, 1998).
There are three domains of learning cognitive, effective, and psychomotor, and taxonomies have been developed for instruction and assessment in each of these domains. A taxonomy of the psychomotor domain provides a framework for understanding the development of skills and deciding on the expected competence level for each skill.
At the lowest level in the taxonomy is imitation learning, in which students observe a demonstration and imitate the performance. With practice, students can follow written instructions rather than having to observe the skill (manipulation level), perform it accurately (precision level) within a reasonable time (articulation level, and finally perform it automatically as a natural part of their patient care (naturalization; Oermann & Gaberson, 2014).
Understanding to Psychomotor Skills In Nursing Education
Nurse educators need to understand the phases of psychomotor skill learning and plan for the instruction of these skills, similar to their planning for knowledge acquisition and development of higher-level cognitive skills. Of the three domains of learning, much emphasis has been given in recent years to clinical reasoning, critical thinking, and other cognitive skills. Hagler and Morris (2015) suggested that in some teaching and learning situations, the psychomotor and effective aspects of learning are ignored or expected to develop without planned instruction.
Faculty should identify psychomotor skills that are frequently used in clinical practice and for which students must develop their expertise: faculty must also ensure that students have opportunities for deliberate practice of these skills. In a study by Liou, Chang, Tsai, and Cheng (2013), skill reviews enabled nursing students to develop their competence.
An understanding of psychomotor skill development is also important for teachers in order to have appropriate expectations of students in the clinical setting. If students have limited practice after their initial learning, they may perform skills accurately but be slow and inconsistent. More research is needed on how best to teach psychomotor skills in nursing and to identify the most appropriate setting for learning and practicing skills.
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