Nursing Education and Dealing With Stressed as Strategy
Identification of Stress In Nursing Education
1. How do you know when you’re stressed? What physical and emotional signals let you know you’re stressed?
2. How do you generally manage your stress? Do those strategies work?
3. What interventions would you like to employ to more effectively deal with stress?
4. What lifestyle habits keep you from being stress resistant? What lifestyle habits enhance your stress resistance?
5. What is the role of the nurse in assisting clients to recognize stress and become stress resistant? IV. The final activity has students frame stress management in terms of the nurse’s role. Students write a One-Minute Care Plan for a partner based on a brief Think-Pair-Share about stress assessment and management.
Each student is asked to use the nursing diagnosis of Ineffective individual coping related. Each student develops one long-term goal, two short-term goals, and two interventions for each short-term goal. These One-Minute Care Plans should be individualized for the client using the data collected in the previous conversations.
Implantation of Stress Coping Strategies In Nursing Education
Use a Guided Discussion Group when addressing controversial or difficult issues. Nursing ethics, values clarification, assertiveness skills, professional issues, and therapeutic client relationships may all require more than lecture and discussion. As I’ve shown, this strategy combines several different strategies in a concerted learning package. This approach may prove more effective and enjoyable than one strategy used alone.
One of the greatest assets of Guided Discussion Groups is the repetition of material in several formats. Repetition is a form of mental aerobics, in which the mind practices material and exercises the brain.
Combine several strategies with Guided Discussion Groups to yield the best results: Think-Pair-Share, Admit Ticket, Same Information, Critical Thinking Exercises, and others can augment the learning and the fun.
The final One-Minute Care Plan may be handed in at the end of class, written and handed in later, or submitted electronically as an E-mail Exercise.
Guided Discussion Groups may be adapted to any course content. You’ll meet class objectives simply by collecting several exercises and strategies and developing a schedule for their use. Out of the Hat General Description In this strategy, the instructor creates a pool of topics to be discussed or evaluated.
Students then select one or more topics Out of the Hat and are asked to demonstrate understanding and competency in those areas. This is a common testing strategy when a lot of material must be assessed in a limited amount of time; examples include physical assessment and basic nursing skills. Alternatively, students can create a One-Minute Class, Student-led Seminar, or Ah-hah Journal based on the selected topic.
Preparation and Equipment The equipment you’ll need depends on the skills to be tested. You can use this strategy to test psychomotor skills. Ask students to assemble the supplies needed for the task they’ve just pulled Out of the Hat. Example of the Strategy at Work Traditionally, this strategy has been used to assess psychomotor competency. Health assessment courses teach skills sequentially.
You can use Out of the Hat to test assessment of neurological, respiratory, cardiac, integumentary, gastrointestinal, and other systems. Students come prepared to be tested on any system. They don’t know which one they’ll be tested on until they pick it Out of the Hat. Out of the Hat also works for testing out fundamental skills. We came up with a Total Care Test Out to test basic skills.
Students practiced hygiene, body mechanics, assessing vital signs, making beds, moving clients, and various other basic skills throughout the semester. In the Total Care Test Out, pairs of students demonstrated handwashing, vital signs, giving a bed bath, brushing a client’s teeth, and making an occupied bed. Then they picked two other skills Out of the Hat.
These included putting a client on a bedpan, applying wrist restraints, teaching walker or crutch walking, stretcher transfer, and shaving. They also selected a position (supine, prone, Fowler’s, Sims’, lateral) Out of the Hat. This strategy cut down on the time needed to test each student while ensuring that each one had prepared every skill.
Out of the Hat allows you to evaluate competency in any psychomotor skill. This strategy is appropriate for discussion groups, clinical groups, or small groups in classes with a psychomotor component.
Out of the Hat allows students to demonstrate their knowledge of a topic orally. Evaluate content mastery by having students pick a class concept or topic Out of the Hat and explain it to classmates.
Let students pick out one of the topics for that day’s class. Each Out of the Hat topic is then discussed at length. Students may also pick out discussion questions and potential issues related to a class topic. You’re available to clarify issues, but the students lead the discussion.
For orientation groups and nurses accomplishing mandatory requirements, Out of the Hat makes a good alternative to written post-tests. Each nurse picks a topic Out of the Hat and answers orally or does a Clinical Quick Write. Staff development instructors can use checklists to document these demonstrations.
Out of the Hat may be used for part or all of a class session. It can add flavour to another exercise: students pick the topic for an In-class Debate, a partner for an icebreaker or Think-Pair-Share, or a role in a Teaching Trio.
Students may pick topics for oral presentations Out of the Hat. Legal Cheat Sheets General Description Cheating is a funny thing. If students spent as much time studying as they did prepare eloquent cheat sheets, their test performance would excel. Legal Cheat Sheets let students select priority points in any class and develop them into study sheets with the instructor’s help.
These Legal Cheat Sheets become flash cards for studying material, focusing on most important content, and setting priorities among key issues. Legal Cheat Sheets work well with material that’s often memorized, such as lab values, norms, difficult concepts, and numerical data. This strategy moves such information from one category to another: “need to remember” becomes “need to know where to find it.”
Students find more freedom to think critically and develop prioritization and decision-making skills. Less encumbered with the need to memorize, they can look beyond the facts to the potential contexts that surround those facts and influence nursing practice. Preparation and Equipment Your only preparation for this strategy is to guide students in developing personal Legal Cheat Sheets for later use.
You can help by suggesting a format for the sheets. In addition, you can create a classroom environment in which Legal Cheat Sheets are an accepted aid to learning, studying, and evaluation. Example of the Strategy at Work Students are encouraged to use Legal Cheat Sheets as study guides for test preparation. Often, they spend a significant amount of time selecting which material should go on the sheet.
This prioritization process encourages students to select and study material that’s integral to the test or the course. After the initial reading and class preparation, students revisit the material while selecting integral information, formatting the cheat sheet, writing information in the cheat sheet, reviewing, and finally while studying for the test. This is a good example of the mental aerobics the repetition so important in learning. This strategy works regardless of learning style.
Allow students to bring Legal Cheat Sheets to examinations. They’ll feel more at liberty to use critical thinking and decision-making skills rather than focusing only on memorization. This method replicates many clinical practice settings in which memorization is no longer emphasized. Standard practice emphasizes the ability to find accurate information quickly, especially in emergency situations.
Use this strategy as a means to study and review for final examinations. A semester’s worth of Legal Cheat Sheets provides a compendium of review materials. Keeping up with Legal Cheat Sheets throughout the semester or the course creates a study guide for comprehensive final examinations.
Encourage students to work in pairs, trios, or groups to enhance their Legal Cheat Sheets. Quizzes, Student-led Seminars, Gaming, and E-mail Exercises may all be combined with Legal Cheat Sheets to add to their educational value.
Students may be encouraged to share their Legal Cheat Sheets through Online Discussion Groups or in Group Thought. Students can rotate responsibility for compiling Legal Cheat Sheets in different subjects. Students can help each other by sharing their Legal Cheat Sheets during study groups and review sessions.
Use Legal Cheat Sheets to summarize and reinforce key material from slides and class notes. Mock Trials General Description Mock Trials serve two purposes. They address the legal and ethical conflicts inherent in nursing and health care, and provide practice in organizing and delivering a presentation.
This presentation mimics a courtroom trial. Preparation and Equipment Because this strategy requires a lot of work from students, it’s probably most effective in the academic setting. You will need to determine the evaluation method for the assignment. Example of the Strategy at Work In a continuing education program an attorney was asked to present the legal aspects of nursing documentation.
Knowing that this could be a dry issue, she created a Mock Trial about the hazards of poor documentation. Volunteers from the audience were solicited in advance to take roles and given mini-scripts to follow. The attorney then created a courtroom vignette. A nurse on the witness stand was asked to relate events of several years ago that had ended in a client’s death.
The nurse was provided with the documentation surrounding the incident. Her testimony exposed major lapses such as illegibility, documentation once per shift, undocumented care, spelling errors, the use of correction fluid, and other poor practices. The speaker masterfully met all the class objectives in 1 hour and had the rapt attention of the class the entire time.
A Mock Trial may be incorporated into a continuing education program as an entertaining way to address a legal issue or conflict. Mock Trials are effective ways to reinforce the need for careful documentation at all levels of nursing. Agency ethical rounds can use a Mock Trial as a platform to discuss the needs and roles of the multidisciplinary team in ethically difficult circumstances.
Have students select a legal issue and act as a group to establish roles and scripts. Group members may serve as defendants, lawyers, plaintiffs, a judge, witnesses, and jury members. Plan a discussion group in which the Mock Trial is an impromptu event, allowing students to take roles and wade their way through the dialogue.
In a more formal Mock Trial, you can assign roles and have brief scripts written out on index cards. Students may be encouraged to ad lib as necessary. Mock Trials may be used in a research class to help teach the rights of human subjects. These include autonomy, informed consent, the risk-to-benefit ratio, and beneficence.
You develop a case representing an infringement of these rights, the Mock Trial follows, and the class discusses the issue. Other concepts may include failure to disclose risks, participation under duress or coercion, or unethical research practices.
Use a Mock Trial to approach several legal issues, such as negligence, malpractice, false imprisonment, and fraud. Use case law to develop a realistic subject for the Mock Trial. As in a debate, students should be evaluated on their level of research, knowledge of the topic, ability to present their case within their role, and contribution to the group.
A small group may present the Mock Trial for extra credit. Other students may write their reactions as an E-mail Exercise or a variant on the Clinical Quick Write. Students may witness the Mock Trial and then be asked to apply their knowledge by answering questions related to a different case study.
Encourage groups to share the preparation and dialogue evenly. Students can share roles and assist each other in presenting extensive material. Have an attorney visit the class to discuss major legal concepts and then use them in the Mock Trial.
Use the Mock Trial as a way to reinforce documentation skills in the clinical area. After students complete the Documentation Case Study, create a Mock Trial scenario. Ask students to go back and look at the care they “delivered” in the case and use their documentation to reconstruct that care. Discuss gaps or discrepancies that could be misinterpreted or are difficult to evaluate.
Emphasize that it’s this type of documentation issue that creates legal conflicts. What a great way to reinforce accurate and comprehensive documentation! Learning Carts General Description This strategy works the way it sounds: you place your educational materials on a cart and take it to your students. This cart conveys the message “I am here to teach you” and signals that learning is the order of the day.
Learning Carts allow instructors to bring in all the necessary equipment and to move the learning location as needed. Preparation and Equipment Of course, this strategy requires a cart or a box, carrying case, or whatever allows you to transport teaching materials easily. The size will depend on what you plan to transport.
Some Learning Carts include a laptop computer and a DVD player, a slide projector, or an overhead projector. A blank wall on which to project images eliminates the need for a screen. Other equipment depends on the skills or material being taught and on the needs of the instructor.
You could bring handouts, games, puzzles, prizes, models, pre- and post tests, audio visual equipment, supplies for skills, other materials, and snacks and beverages (these always attract learners). Example of the Strategy at Work Learning Carts are most effective in staff development and agency settings, where unit-to-unit education meets the needs of busy staff nurses.
This strategy communicates your desire to teach and your appreciation of the factors that often keep nurses from participating in educational programs. Learning Carts also keep you ready for repeated teaching sessions.
You just take the cart and go! Agencies have used this strategy to teach staff about a new piece of equipment or a hospital-wide policy change, to help them meet mandatory requirements, to prepare for an accreditation survey, and to assess the competency of nurses in or just ending their orientation.
In academic settings, in which lab or hospital space is at a premium, Learning Carts can bring the setting to the students rather than vice versa. Sometimes labs become so crowded that it’s difficult for every student to see a demonstration. A colleague of mine wheels a hospital bed into a traditional classroom to teach moving the client in bed and positioning.
She packs a Learning Cart with needed supplies, a DVD demonstrating the skills, a short pre- and post-test, and supplies (e.g., draw sheets, pillows, towels). The entire class sees the demonstration at once, and each student has a clear view of the procedure. Students then go to the lab to practice the skills on their own.
Come up with your own Learning Cart contents and use them consistently for every class you teach. Have students or orientees develop a seminar or presentation and set up their own Learning Cart. Role model the use of a Learning Cart during orientation.
Keep Learning Cart teaching sessions short and to the point. Leave handouts or graded post-tests to reinforce the sessions. Allow students to work in pairs, trios, or groups to create a Learning Cart
Do a procedure review by having clinical groups work in pairs and develop a Learning Cart. Encourage them to set up an Active Reading Conference to review the procedural protocol and the necessary equipment and supplies needed for the procedure. Have use active teaching strategies to involve the entire group.
Let students pick the skill to be discussed Out of the Hat. Students may research the skill and use Clinical Area Questioning or Bring on the Evidence to determine the evidence base for the skill or procedure.
Make sure you hand out prizes or small gifts as a way to thank learners and student teachers for their time. Use a variety of Case Studies along with equipment from the Learning Cart to address a learning topic.
When the teaching materials allow, use bins or boxes to carry class supplies from one area to another. Let the bin be the signal that learning is about to occur for units, satellite clinics, or during a clinical rotation! Pass the Stick General Description This quick strategy helps to control a discussion group. Simply, the stick is passed around the group, and whoever has the stick has the floor.
Preparation and Equipment You guessed it you need a stick! You’ll also need to set ground rules for its the use. Parameters may include timing, which way to pass it, the need to observe the rules, and other details specific to the exercise. Example of the Strategy at Work I learned this strategy from a colleague who has taught first grade for a long time. Simple though it is, it meets two important goals.
Discussion groups always have some participants who rarely contribute and others who monopolize the conversation. The stick ensures that those who don’t generally talk are given that opportunity and that those who talk excessively have some limits on their participation. The stick provides parameters for all group members it allows all members to participate. Only those with the stick may talk and you don’t talk unless you have it.
You can use a toy magic wand instead of a stick. You could also use a baton hence the term “pass the baton.” This strategy is an effective way to get everyone in a group to talk. In a discussion of conflicts or sensitive issues, some group members may not disclose their thoughts readily. Pass the Stick requires they participate at least to some small extent.
Pass the Stick may be used with Imagine or Remember When, Reality Check, Mock Trials, In-class Debates, or Case Studies to ensure contributions and equal sharing. In a clinical group, Pass the Stick may be used to facilitate Grand Rounds, V-8 Conferences, Learning from Each Other, and other post-conference topics.
Pass the Stick may be used to assess or test the class. You can Pass the Stick around the group to ask questions, pose issues, or test skills. Put It All Together General Description Put It All Together gives students an opportunity to synthesize material. Students pick a condition or a diagnosis (medical or nursing) that interests them. Alternatively, they may pick a client they’ve cared for in clinical rotation.
Then they augment their past experience or clinical knowledge with continued research in the chosen area. This strategy thoroughly investigates many aspects of nursing or of a particular client. Put It All Together is a good summative assignment for a clinical or senior-level course.
Pared down and used at the end of an agency orientation, it can reinforce knowledge of conditions seen frequently in that facility. Preparation and Equipment You’ll need to come up with the criteria for this strategy. When the exercise involves a particular client, the following topics should be addressed:
• Description of the medical or nursing diagnosis
• Client demographics
• Pathophysiology of the condition
• Physical signs and symptoms
• Assessments
• Diagnostic, lab, and medical imaging data
• Client history and risk factors
• Nursing care––specific to the condition (may include client goals and nursing strategies)
• Nursing care––general (may include client goals and nursing strategies)
• Nutrition and diet therapy
• Medical treatment: medications, hydration, treatments, procedures, surgeries
• Potential complications—both rare and common ones and associated nursing monitoring
• Appropriate precautions (e.g., bleeding, aspiration, seizure, neutropenia, fall)
• Client teaching, discharge, family teaching
• Psych emotional issues In certain conditions, other topics may need to be addressed. Once you decide which information needs to be included, you can choose a variety of formats for this exercise. Possibilities include a conference or seminar, a poster or chart, a report, a nursing care plan, a client profile, and a discussion group.
These are only some of the ways your students can show their ability to Put It All Together. This strategy allows students in discussion groups to develop a capstone assignment at the end of a course.
Using the information previously listed, each of my students created a database, developed and handed out a one-page nursing care plan, and presented a 10-minute seminar in class. It’s critical to tell the class that this assignment is meant to Put It All Together.
After sifting through a wealth of information, students must establish priorities before they can condense it all into a 10-minute presentation. In this exercise, I place a lot of emphasis on laboratory diagnostics. Although students understand the lab abnormalities associated with a diagnosis, they don’t always grasp their dynamic nature.
A change in lab values means a change in the client’s status, and the nurse has a vital role in monitoring these values. My students have presented such topics as pancreatitis, hepatitis, spinal cord injury, different types of cancer, chronic obstructive pulmonary disease, asthma, diabetes, epilepsy, and head injury. These presentations often lead to interesting discussions about which aspects of care are common and which differ according to condition.
• Students may select a client who interests them or one they cared for in a clinical rotation. Alternatively, you can assign a client whose condition ties in with class objectives.
• You can establish guidelines at your discretion. For example, you can gear the assignment toward clinical specialty, course needs, student level, available time, and percentage of the course grade.
• In orientation groups, each participant can present a client and a brief care plan for that client. A new nurse can present a selected client, cared for during orientation, whose condition is commonly encountered on the nursing unit.
• Combine this strategy with Grand Rounds or Learning from Each Other. Students can present the highlights of a case to the group and hand in the comprehensive report.
• Ask students to consider What’s the Big Deal? and the Muddiest Part when selecting information to present to their colleagues.
• Allow students some creativity with this assignment. Group Concept Mapping, Dress-up or Skits, and other creative exercises can enhance their presentation.
• Use a One-Minute Care Plan to establish nursing priorities and allow students to focus on nursing care.
• Put It All Together cultivates presentation skills and assertiveness in addition to building students’ knowledge base and appreciation of their role in client care (Herrman2 ).
• Put It All Together can form the structure for an entire course. Students use readings and course objectives to prepare for class. Rotating presentations feature different prototype conditions at each class session. Finally, the instructor rounds out the information in a summary discussion.
In this form, Put It All Together develops priority-setting skills and confers many of the same benefits as Learning from Each Other. FYI—Classroom Questioning General Description Here, Classroom Questioning is the strategy; FYI (For Your Information) is the purpose.
It’s important to note that “Your” refers to both instructors and students at any educational level. FYI––Classroom Questioning is an effective way for learners to assess their own level of knowledge, find out if they’re on track, determine whether their knowledge base can meet course objectives, or clarify areas of confusion. Instructors can find many uses for Classroom Questioning.
Preparation and Equipment Little preparation is required. FYI––Classroom Questioning is more a teaching philosophy than a distinct strategy. You may find yourself using it in every class to assess your students and create a reciprocal atmosphere. You should consider potential questions while preparing your class.
Classroom questioning can be tough. Students may come unprepared or busy themselves with note taking or other activities. They’ll ask you to repeat your content, spell a word, or clarify a simple concept. This type of questioning is not what FYI––Classroom Questioning refers to. In this strategy, students and instructors ask and answer questions that demonstrate, provoke, and encourage critical thinking.
Both instructors and students must learn to ask “good” questions. This type of questioning is usually on the application or evaluation level. Classroom and staff development instructors should consider reviewing and adapting objective multiple-choice questions before class. When I give a test on venous thrombosis and anticoagulants, I might include the following question:
1. A client you are caring for has thrombophlebitis. The client is receiving heparin. You instruct the client that the action of heparin is to: a. Prolong the clotting time. b. Decrease the clotting time. c. Dissolve the blood clot. d. Inhibit the bleeding time.
This question may be adapted to “What is the action of heparin?” This question and the resulting discussion are at the retention level. We then use the next question to generate continued discussion:
2. A client with a chronic deep vein thrombosis is ordered to receive warfarin (Coumadin) at bedtime every night. The client complains of indigestion and is given an antacid with meals and at bedtime.
Which of the following client statements indicates a need for more teaching? a. “I take the medications together at night with a snack.” b. “I need to stop the Coumadin 2 weeks before I go to the dentist.” c. “I take the Coumadin every day and the antacid as needed.” d. “I need to take my medications with water.”
The following discussion may include such issues as bleeding precautions, discharge instructions for a client on anticoagulant therapy, and interactions with other medications. This classroom discussion has reached the application level.
To take it a step further, you can ask students to apply information about the disorder to teaching, evaluation for complications, nursing implications, and other issues that foster critical thinking. You might ask some of the following questions:
• Your client complains of significant mouth bleeding. What do you do?
• Your client needs to have dental work. What recommendations do you have?
• Your client is switched to warfarin after heparin and tells you he eats spinach every day. What recommendations do you have for this client?
• You client notices dark red blood in his stool. What could this be? What actions are appropriate at this time?
• Anticoagulant therapy is ordered for your client after a cerebrovascular accident. He tells you he doesn’t take any medications and doesn’t want to start now. How do you respond? The key to this strategy is to stimulate thinking. The answers should be longer than the questions; fewer words are needed for the question than are needed to develop a complex and complete answer.
• You don’t need to use written questions in this strategy. Just remember to pause every so often to question and be questioned by the class.
• Be supportive of questions in the classroom. Make sure students who ask questions receive positive reinforcement, such as “That’s a great question,” or “I meant to cover that, thanks for the reminder.”
• While preparing the lecture or presentation, consider what questions you’ll ask and where you’ll place them. Use the Star in your notes and to reinforce key pieces of information from the lecture.
• Oermann5 suggests the One-Minute Question and Answer. Difficult areas of content are examined through a short questioning period. Both instructors and students form pairs or groups to consider potential answers, and a class discussion follows.
• Classroom Questioning should be reflected in tests. Use the Star to signify a study topic for students and a question area for the instructor.
• Watch for those quizzical looks in class. They’re a sure sign that you’ve reached the Muddiest Part and that some points need clarification. Things are also getting muddy when students start shaking their writing hand or ask you to repeat something two or three times, or when you hear a murmur go through the crowd. Be alert to signals that the class is off track and help them get back on. Trudging ahead only leads to frustration and an increased sense of “lostness.”
• See Clinical Questioning to adapt questions for the more intimate setting of the clinical environment.
• Use Pass the Stick to encourage questions that both stimulate the questioner and set off a discourse within the class.
• Try to stimulate students who don’t participate by asking, “Are there any questions from someone I don’t often hear from?” Follow that with eye contact to give the quieter students license to participate in class.
• Pose questions whether or not you plan to discuss them during class time. Ask students to provide answers through E-mail Exercises, Clinical Quick Writes, or Online Discussion Groups. This method generates discussion and rewards class attendance. Give extra credit for the correct answers relating to that day’s content.
• “Round robin” the room, asking questions of each student. Class participation and the level of preparation will certainly increase. However, this technique can discourage class attendance, so it should be used carefully. Never use it to embarrass students who can’t answer their questions.
• Use Gaming to stimulate questioning. In a variant of the 20 Questions game, students ask 20 questions to try to identify an illness or condition. Twenty questions may include:
• Do both men and women get the illness?
• Is it contagious?
• Is it painful? • Can it be treated with antibiotics?
• Does it happen with mostly older clients?
• Does it change the complete blood count?
• Is it visible?
• Is it treated with surgery?
• Does it affect the lungs? Gastrointestinal tract? Nervous system?
• Does it require involved nursing care? Question–Question, described by Schell,6 explores a case scenario by having each student pose a question. Each question is answered with another question. Students rotate throughout the room, asking questions that answer the previous question, being careful not to repeat questions or to speak in statements.
These questions uncover increasing levels of complexity about an illness or condition and foster discussion of nursing priorities. Jeopardy and other game shows can model ways to structure questions and foster questioning skills.
• Respond positively when a student asks or answers a question. It rewards students to hear, “Good question, let me see if I can answer that for you,” or “As we discussed, your question brings up” Responses such as, “We already talked about that,” or “That questions is off track from this class,” discourage participation on a regular basis.
Students who answer questions need the same respect. Rather than saying, “No, that’s wrong,” try “That is an interesting point, but let me clarify by saying .” or “Sometimes what you say may be true, but more often .” Of course, if a student’s conclusions are truly wrong, they need to be corrected. Again, framing that correction in a polite way invites the student to participate in class again.
• Make sure you leave enough time for students to either answer or ask questions. Nursing instructors often feel pressured to fit lessons into the allotted time frame and may not feel free to allow a Classroom Questioning period. When we ask a question, we often pause for 1 or 2 seconds and then answer our own question.
You should allow 30 seconds for students to construct an answer. Although that seems like an eternity, it’s important to impress on the class that you truly want their answers and will wait patiently for them to assemble their thoughts.
• Use FYI––Classroom Questioning to create healthy competition among students in Gaming or just within class discussion. Encourage questioning through Prizes.
Give your opinion if have any.