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Facilitating "Thinking": Cognitive Learning Strategies
Knowledge and its use are basic to all dimensions of nursing practice.
Thinking exists on many levels. The goal for practicing RNs is critical thinking and analysis but those levels can take time to develop. Hopefully in your preceptorship you will begin to see these higher levels emerge in your preceptee. Starting with the more basic foundations:
Basic Knowledge
By spring of their second year, students have studied all body systems and commonly recurring diseases/disorders. That’s not to say the student will be able to recall all of this information immediately. The easiest way to assess the student’s knowledge of a disease/disorder in terms of pertinent information is to ask:
“What assessments do you need to make because the patient has (disease/disorder)”
“What complications can arise because of (disease/disorder) or the ordered treatments”
It is NOT your responsibility to “fill in all the holes”. In fact, the student will learn more by independent review afterwards than by telling them the content. True - you may need to inform them of the needed anticipatory assessments to make that day to ensure patient safety. But let the rest be their “homework”.
If you are concerned by the volume of content the student can’t recall for clinical application please discuss this with your faculty liaison.
Concept Learning
Concept learning encourages a focus on concepts as a way to remember “facts”. It assists the learner in categorizing new events and data in terms of prior knowledge. Examples of ways you could encourage concept learning is asking the student to compare a new situation to that of a similar situation on a previous preceptor day. Ask the student to identify the characteristics of the new situation and how it is similar or different from the previous learning.
“Last week you had a post-cholecystectomy patient. How is the care of this post-cholecystectomy patient with COPD going to be different?”
“Yesterday your post-op patient had a PCA. This one doesn’t. What differences will that make in your care?”
“Two days ago you had a 46-year old with respiratory difficulty. This patient has pneumonia and is 90. How does aging impact the patient’s symptoms and your care?”
Concept learning is an excellent way to help the student transition to medication administration without the preparation they were used to during clinical. When talking over a patient’s medications have the student identify the classification of medication and begin with side effects common to that classification.
Analysis for Decision Makingand Critical Thinking
Experienced nurses do complex problem solving and decision making so automatically that it can become difficult to explain the process. You can help your student by THINKING ALOUD through your decision making as a way to model critical thinking. As the term progresses, let the student take the lead; asking the student to think aloud through their decision making so you can check the clarity of their thought processes. It is vital that the student be allowed to evaluate the situation and formulate a plan - then validate their process with you. It is also important that you assist the student to question the reliability of information. Many of them still think that if another member of the health care team says it – it’s correct. Resist the temptation to provide all the answers. Encourage the student to explore other options or methods if time allows.
The following chart illustrates some common student behaviors related to cognitive learning and some strategies to assist the student. Once you have identified areas needing improvement your faculty liaison can assist with further suggestions.
Possible Student Behaviors |
Strategies to Assist Student |
Feels uncomfortable or lacks understanding if doesn’t prepare for patient care with books and resources. |
Role model worksheet preparation from report and care plan, and rapid access of essential information. |
Seems to understand isolated facts, lacks ability to see relationships between disease, meds, labs. |
Think aloud when role modeling priority setting and problem solving. "How is the care of this CHF patient different because she is diabetic? What complications could likely happen today? What does she need to know before discharge?" |
Lack of ability to prioritize situations such as phone ringing vs CBG of 65. |
Continue to ask throughout the day: "Where are the priority concerns?" Give them guidance if they seem to be getting fixated on a non-issue. On busy days, ask them what could be left for the next shift or delegated, and what can't. |
Lack of experience in usual course of illness/patient responses. |
Require textbook review prior to next clinical. You can and often should direct the student to do some "homework". Help them analyze through guided questions: "What goals would you set for this patient today....tomorrow? How do you think this patient is responding to the current treatment plan? |
Lack of experience and judgment in initiating MD contacts, and follow up activities as patient advocate. |
Ask student when and why they would notify MD. "At what point would you call the MD about this patient's blood glucose?” |