In the fast Technological growth Learning Resource Center In Nursing Education Its Skills and Competencies has become the main focus of nursing discussions main pints are discussed in this blog post. Testing and Skills specifically psychomotor skills are discussed.
Skill Competencies for Learning Resource Center In Nursing Education
The primary reasons that LRCs exist are for nursing students to have a setting where they can develop and master proficiency in the implementation of client care. Whether isolated, or combined in a scenario, there needs to be a decision as to specifics regarding skill competencies.
Skill competencies are a listing of all the required skills or procedures that a student needs to acquire over the course of his education. The skills may be listed in a variety of ways:
(1) in alphabetical order
(2) by course requirements
(3) by level of student (sophomore to senior)
A variety of elements are required to be completed for the student to pass the skill competencies successfully. These elements include the theoretical information necessary to understand the skill or procedure; critical elements or those things that need to be performed so that no injury or harm occurs to the clients (example: maintaining sterile technique); and time frames when it affects the outcome of the skill/procedure that is performed (example: CPR).
Other components that may be found on a skill competency checklist are validation areas for skill performance in the lab or clinical area, with areas for documentation by the faculty. Those creating the LRC need to decide which skill competencies will be developed in the LRC, how they will be developed, and which skills competencies will be considered necessary to include for proficient performance of a particular skill.
A curriculum committee meeting is an ideal place for this planning process to begin, as skill competencies cross the curriculum, and all courses and learning objectives need to be considered. The curriculum committee, considering the objectives of the program, then decides what portion of the program requires LRC components, and which skills, and skill competencies, need to be included in each course.
Once it has been determined which competencies need to be introduced, the committee determines which skills need to be mastered. These can be detailed in a Competencies Master Plan. Not all skills involve intense instruction and time investment to achieve mastery. The LRC can be used to focus on those skills that are best learned and mastered in that environment.
For example, therapeutic communication techniques can be introduced and practiced in an LRC setting, particularly if there is emphasis on using these techniques in interactions with clients in health-care settings, but they can be just as easily introduced and mastered in a setting other than the LRC. Time constraints also guide which competencies need to be mastered in the laboratory session, as the time spent in the LRC competes with student time spent in theory-building activities, as well as in the clinical setting.
After the faculty has made a decision about which competencies will be introduced and mastered in the LRC setting, planning on how best to implement the process begins. Instructors should carefully delineate the specific objectives that are to be met in each laboratory session. Again, there should be a planning session in which this information is decided by a dedicated group of people.
A curriculum committee may be charged with this task, or a task force set up for this purpose. Further decisions need to be made about how the skills will be introduced, mastered, and evaluated. Generally, it is necessary for each program to have internal consistency. Policies regarding skill competencies need to be established throughout the entire program.
Every course does not need to be cookie-cutter identical, but there does need to be congruency in what is presented in the LRC, and how it will be evaluated throughout the program. The activities that take place in the LRC can vary greatly from course to course and program to program. Many programs choose to introduce selected skills in a formal manner, with identified objectives and skill checklists.
A nursing faculty member in the course is assigned to present the content to the students, and the students practice with supervision and guidance. This may be the extent to which some skills are introduced, or there may be a requirement to complete a formal testing process to determine competency.
Testing for Learning Resource Center In Nursing Education
There is also the question of how to decide if an individual, or group of students, has achieved competency in a particular skill or skills. This decision has many prongs. The amount of time that will be spent learning the skill will need to increase if there is going to be testing for competency achievement. How will the testing be carried out? Who will do the testing?
And it is possible that skill competency could be evaluated in various ways. It depends on the skill, the curriculum, the faculty, and the philosophy. This testing process could be accomplished in a variety of ways. In some cases, the course instructor may be able to validate that the students are competent following a return demonstration of a newly introduced skill. In other cases, the students separate LRC learning sessions from testing sessions.
Testing is completed in a formal manner, with a student using the laboratory specifically for a testing scenario, and needing to be evaluated according to preset criteria. Students may be prepared to test on a specific, predetermined skill, or they may be presented with an unknown scenario upon arrival, which requires them to identify and correctly perform one or several skills.
These decisions are usually determined by the faculty to best meet the educational objectives of the particular program. Teaching and testing can be accomplished in a variety of creative ways of which simulation scenarios are just one. In addition to determining what needs to be taught and tested, the faculty needs to come to an agreement on the method of evaluation to use in the LRC, if evaluation is to be done. Grades can be assigned to the performance of a skill, with grading from “Pass/Fail” to any of a variety of number or letter grades.
As is usually the case, this area is one of concern for students and faculty alike. On one hand, students who feel that they are very good at the psychomotor domain and wish to have that reflected in a numerical grade, conflict with those students who feel that a numerical ranking system increases the level of anxiety over the performance to a greater degree than would a pass/fail grade.
Testing faculty members understand the subjectivity inherent in assigning a grade to a return demonstration session, and may prefer to reduce that subjectivity by using a pass/fail grading system. This subjectivity is readily apparent when decisions are being made as to what behaviors are needed to perform a task in a competent manner.
Some faculty members feel strongly that certain steps need to be performed in a certain order, whereas others argue that those particular steps could be accomplished in a variety of approaches. Faculty members have to come to an agreement on the development of the testing and grading methods used, and need to be as specific as possible in the grading criteria.
Some schools have chosen a proficiency system, where a grade of “P” is given when a student is proficient in a skill, followed by a number, or series of numbers, which indicates a degree of proficiency. For example “P.4” may be the most proficient, and “P.3.1” may indicate that a student was proficient enough to be considered competent, but did not perform the procedure during the test as proficiently as possible.
There is a cut off, determined by the faculty, below which the student cannot be considered competent or proficient, and therefore is not considered safe in the performance of that particular skill. Again, philosophy faculty, creativity, and objectives dictate the manner in which the evaluation is graded. After that decision has been made, it needs to be followed by a consequence for not achieving a passing grade in a testing situation.
The least punitive consequence is that a student continues to practice and repeat the performance of the skill in a subsequent testing situation. The most punitive consequence is receiving a failing grade, either in a number grade that is factored into their course average or in a “Pass/Fail” grading system in which a failure in a laboratory testing situation is known in advance to the student to result in a failure in the particular course.
And there are an infinite number of variations in between—from a student being able to repeat a test only a certain number of times without penalty, to a student who will receive an LRC warning that may result in a grading penalty if repeated within a certain designated time frame.
Consequences may also affect a student’s ability to implement client care during a clinical component of a course. Policies may dictate that students not be allowed to perform any skills that require LRC testing on clients in the clinical area, until those tests have been completed successfully.
Psychomotor Skill Development for Learning Resource Center In Nursing Education
“I hear and I forget. I see and I remember. “I do and I understand.” In his quotation, Confucius captures the essence of the value of the LRC. Promoting psychomotor skill development in students is one of the many essential functions of the laboratory setting. The LRC provides an excellent venue for students to conceptualize and put into practice, skills that they have read about or seen demonstrated in audio-visual materials.
Many nursing students state that their preferred mode of learning is centered in the psychomotor domain, and the LRC is the perfect match for students who learn best in that manner. Allowing students to view and handle the equipment; watch demonstrations, either live or audio-visual; and practice on nonthreatening models or mannequins until they feel comfortable with the procedure proves invaluable.
Having personnel available to guide and answer questions and to cue the student further encourages the development of psychomotor skills. There is a long tradition in nursing that practicing skills in this manner leads to mastery over time. The variable that changes when implementing the procedure for the first time on a live client is the client response. While the mannequins are quite happy to go along with any procedure the nursing student has planned, clients are not always as cooperative.
Actual clients have differences in anatomical structures, responses to stimuli, mobility, vital signs, and pathological conditions. These are all variables that can come up in the laboratory setting. Students are expected to apply on-the-spot decision-making, and alter procedures according to variables they have assessed.
Client scenarios, frequently resembling actual client charts and flow sheets, are prepared before the learning experience, and a student may find it necessary to change the traditional way a procedure is performed in order to fit the situation.
Whether the client has a condition that makes him unable to assume the traditional posture that is the norm for implementing a certain procedure, or the client is allergic to a material that is usually used, it is possible to manipulate the circumstances to mimic real-life situations, requiring students to plan, consider alternatives, and make decisions to alter traditional implementations in skill performance.
Instructors have been working on creative ways to simulate reality closely, even while working with static mannequins and equipment. Mannequins have become more and more realistic. They come supplied with interchangeable parts that contain, for example, realistic, deep wounds, as well as gangrenous toes and amputated limbs. These mannequins allow students to practice wound care that simulates a client’s real wounds.
Instead of enabling students to practice just the procedure of performing wound care, the use of these mannequins allows students to measure, assess, and describe the wound. The latest generations of mannequins are simulators that can breathe, have heart rhythms, and show response to interventions by having those changes become apparent on a monitor, through computer programming.
These mannequins can allow for scenarios that simulate trauma, burns, and even active hemorrhage. Students not only have the opportunity to implement all types of hands-on psychomotor skills, they have to develop strategies to perfect assessment skills, set priorities, and act—all in a matter of minutes. Failure to do so can actually result in the “death” of the simulated client. These simulators challenge instructors to develop realistic scenarios that will reflect actual client situations.
The LRC, therefore, becomes not only a domain where psychomotor skills are learned, practiced, and tested, but it becomes one in which critical thinking, prioritizing, and decision making can also be practiced and refined. The direction in which the LRC is heading is one in which clinical assessment skills, integration of theory and evidence-based research; critical thinking, decision-making, and prioritizing are all combined in scenario-based testing.
At this time, students are given a set of data, the simulated model is programmed with certain variables, and students respond to these variables in the assessment of the model, by making decisions about the required interventions, and implementing care for the client. Following the implementation and documentation of care, instructors meet with students in debriefing sessions, to review the salient points that have been learned through this experience.
This technology can be applied to all levels of learning—beginning students can assess a preprogrammed blood pressure in a model’s technological logical arm, decide if the level of blood pressure is within normal limits to proceed with medication administration, and go on to carry out those procedures, for example.
This situation can be adapted in many ways—it can be used as an initial learning experience in which students are introduced to skills, and expected to bring some theoretical knowledge to apply to the situation; it can be used for competency testing—either directly observed or videotaped for review; or it can be a practice situation in which students come to learn skills independently that they may not encounter in the clinical area or may not have time to have practiced in a traditional laboratory classroom time block.
It will be possible to create entire simulated clinical experiences for client conditions that a student would not normally encounter in live clinical settings—clients who are in the middle of hypoxic episodes, myocardial ischemic events, or trauma situations, such as burns and hemorrhages. This is especially important at a time when clinical rotation experiences may be difficult to find.
Changes in available regional clinical experiences, including increases in acuity level of hospitalized patients, specialized care, shortened hospital stays, and an increase in the number of outpatient facilities, have decreased the availability of in-patient experiences for nursing education. Clinical simulations provide an acceptable alternative for a variety of hands-on client scenarios that were previously offered only in the clinical setting.
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https://nurseseducator.com/learning-resource-center-in-nursing-education-its-self-directed-learning
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