Nursing Education and Developing Learning Style Preferences, Cognitive Skills, Critical Thinking and Clinical Reasoning
Nursing Education and Implications of Learning Style Preferences
Currently, obtaining knowledge of the learner and his or her characteristics is a vastly underused but complex approach to improving teaching and learning strategies.
To address this concern, faculty should be encouraged to assess student learning style preferences using one of the many instruments available to help students develop an awareness of their preferred learning styles (Fleming, Mckee, & Huntley Moore, 2011; Hallin, 2014; Robinson , Scollan Koliopoulos, Kamienski, & Burke, 2012).
The results would also enhance faculty ability
to select and design learning activities that appeal to a broad range of
student learner preferences, rather than to narrow teaching strategies to
specific learning styles.
Of further concern are achievement gaps that continue to exist for diverse students. In programs with high numbers of adult students, there may be a larger number of students who leave the program because of family problems or job-related issues (Sauter, Johnson, & Gillespie, 2009).
There are lower graduation rates among institutions serving high proportions of minority, low-income, and first generation college students. Current students are striving to reduce achievement gaps, and it is important that educators augment their efforts (Brown & Marshall, 2008). Students are diverse in their experiences, cultural backgrounds, and traditional versus nontraditional and at risk status.
A one-size-fits-all educational accommodation is likely to stress and discomfort many students who might otherwise perform well if their individual uniqueness were recognized and responded to instructionally (Li, Yu, Liu, Shieh, & Yang, 2014).
As a result of this diversity, it is unlikely that any single teaching style would be effective for all or most students in a class of 25 or more. Students may experience a difficult transition caused by the loss of individuality in large classes in which personal recognition is absent.
Faculty must employ a variety of creative teaching approaches to engage
the diversity of learners in larger classes, such as personal response systems
(“clickers”) (Bachman & Bachman, 2011), short writing assignments (Boyd,
2010), and interactive assignments ( Hourigan, 2013).
Faculty should assist individual students to identify their learning style preferences, help them to improve study habits, and aid them in the selection of courses or work environments that are compatible with their learning styles (Fleming et al., 2011).
Students of varying generations might benefit substantially from
knowledge on how to accommodate their own learning style (Robinson et al.,
2012). In class and clinical settings, faculty can use learning style
preferences to create a learning environment where different types of learner
preferences are valued.
Developing Cognitive Skills in Students In Nursing Education
The increased complexity of the health care system requires nurses to problem solve and collaborate across the disciplines. The nursing student is challenged to develop cognitive skills that foster reasoning, remembering, and deep learning, and that ultimately leads to the development of clinical reasoning skills.
Designing curricula that foster critical thinking in students has long been a
desired program outcome in nursing programs. In more recent years, emphasis has
been placed on clinical judgment, decision making, and reasoning, which are the
desired outcomes of critical thinking applied to nursing.
Because of this changing emphasis in nursing education, critical thinking is often associated with problem solving, clinical decision making, and clinical reasoning. Problem solving focuses on identification and resolution, whereas critical thinking incorporates questioning and critiquing solutions.
Clinical
reasoning is critical thinking applied to the decision-making process related
to patients and their diagnoses (Alfaro Le Fevre, 2012). Students vary in the
way they approach thinking and problem solving. The ability to think critically
and make individualized but safe clinical judgments is a significant outcome in
nursing programs.
Benner,
Sutphen, Leonard, and Day (2010) recommend that students develop a variety of
thinking skills, including critical thinking, clinical reasoning, and clinical
imagination. Faculty can assess students' cognitive development as well as
their dispositions and abilities to think critically and make clinical
decisions to guide students to think like a nurse.
Developing Critical Thinking In Nursing Students
Professional nursing practice requires using multiple ways of thinking and problem solving abilities. The emphasis of nursing curriculum has shifted toward guiding students to become lifelong, independent critical thinkers (Kalisch & Begeny, 2010; Oliver, 2010).
Nurse educators remain accountable for creating
and implementing curricula that produce graduate nurses who are able to use
critical thinking as a component of clinical reasoning to formulate appropriate
clinical judgments (Mann, 2012).
Despite many years of discussing critical thinking in the nursing education literature, experts on critical thinking cannot agree on a definition for it, nor is there any effective way to measure critical thinking and the effect it has on patient care.
Some research suggests a link between critical thinking and learning style preferences; however, the evidence lacks rigor and is not generalizable (Andreou, Papastavrou, & Merkouris, 2013). Critical thinking underlies independent and interdependent decision making.
The critical thinker must have
the attitude or desire to approach the problem and to accept that the problem
needs to be solved. The critical thinker must also have knowledge of the
problem's subject matter and the necessary skills to use and manipulate this
knowledge in the problem-solving process (Bradshaw & Lowenstein, 2011).
Despite the difficulty of defining critical thinking, several critical thinking inventories have been developed and are frequently used to assess critical thinking skills in nursing students.
These inventories include the
Watson Glaser Critical Thinking Appraisal (Watson & Glaser, 1980), the
California Critical Thinking Skills Test (Facione, Blohm, Howard, &
Giancarlo, 1998); and the California Critical Thinking Disposition Inventory
(Facione, Facione, & Sanchez, 1994).
How Provoke Clinical Reasoning
Clinical reasoning is the process of gathering and thinking about patient information, analyzing the options, and evaluating alternatives. This cognitive process precedes the decision to act. Reasoning is a cyclical process that depends on results of prior experience, and is the hallmark of the experienced nurse (Simmons, 2010).
In one systematic review of 24 studies of educational
interventions to improve nurses' clinical reasoning, there was a lack of
consistency in defining successful interventions because of a general lack of
study quality (Thompson & Stapley, 2011).
Strategies to Develop Cognitive Skills
Developing
cognitive skills in students requires nursing faculty to implement a variety of
teaching strategies appropriate to content, setting, learner needs, learning
style, and desired learner outcomes (NLN, 2005). The following are examples of
teaching strategies that have been associated with fostering the development of
cognitive skills and clinical decision making.
Reflection Writing and Critical Thinking In Nursing Students
In
the nursing literature, there is an emphasis on the use of reflection to
develop and engage in critical thinking. Critical thinking is on attributes
that enhance one's skill in problem solving and decision-making making (Romeo,
2010). Critical thinking is not a single way of thinking but rather a complex
process. Moore (2013) identified seven concepts among the various process
descriptions of critical thinking.
These seven concepts include self-reflexivity, judgment, skepticism, simple originality, engagement with knowledge, rationality, and sensitive readings. As nursing educators seek to assess their students' knowledge and critical thinking abilities, providing opportunities for reflective learning on evidence-based practice can be an effective strategy.
A systematic review of literature including eight simulation studies found that simulation improved critical thinking, skills performance, and knowledge of subject matter, although evidence of improved clinical reasoning was inconclusive (Lapkin, Levett Jones, Bellchambers, & Fernandez, 2010).
Researchers found that providing nursing students with practice scenarios using
a human patient simulator increased their critical thinking skills, and that
those who were assigned more simulated scenarios demonstrated a greater
increase in critical thinking (Sullivan Mann, Perron, & Fellner, 2009).
Recently, the National Council State Board of Nursing published the first national simulation study with results suggesting that well designed simulation experiences could be substituted for up to half of traditional clinical hours with comparable end of program outcomes (Hayden, Smiley, Alexander, Kardong Edgren, & Jeffries, 2014).
The effective use of simulation in
nursing education continues to be researched; However, early findings suggest
that when faculty are prepared and resources are available to design and
deliver high-quality simulation, the critical thinking skills, clinical
reasoning, and knowledge of students are enhanced.
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