GTN Action Research Project

Sharon F. Verdu, RN, MHS, NBCT

Research Question:How can I improve retention of student knowledge

between learning/practicing the clinical skills and applying them in the clinical setting for the students?

• It is a systematic inquiry conducted by stakeholders (people that matter) to gain insight to effect positive change.

• As teachers, we do this all the time!

What is Action Research?

• Historically Nursing Fundamentals teachers in NC have taught 64 clinical skills, practiced them in the simulated clinical lab setting and THEN took students to a clinical setting to practice on actual patients

• The time between the first skills taught/learned/practiced in the classroom and applied in the clinical setting can be as little as 6 weeks and as much as 10 weeks in a high school setting. 

• Students are having recall issues with skills using this model.

Students in Nursing Fundamentals have memory recall issues with clinical skills due to the time between learning the skills and applying them in the clinical setting

• A relationship exists between the amount of material learned by a student before it is applied in a real world setting and how well it is internalized.

My hypothesis

• This study found that students’ confidence and communication skills play a vital role in order for students to have the optimum learning experience in the clinical setting.

• Why this is Relevant to my Study As a beginning transition from the classroom/clinical setting, I plan to have my students do a social history project with pre-selected patients as their first contact in the clinical setting.

• Reference (APA format): Houghton, C.; Casey, D., Shaw, D., & Murphy, K (2013). Students’ experiences of implementing clinical skills in the real world of practice. Journal of Clinical Nursing, 22(13/14), 1961-1969. Doi:10.1111/jocn.12014

Literature Review Findings

• This study looks at the benefits of providing early clinical exposure to medical students based on their perceptions of their experiences with patients. Most important, “Health care visits allowed them to apply what they had learnt or practiced in the skills laboratory to real life situations, making their learning contextual and relevant.”

• Why this is Relevant to my Study: I am looking at a redesign of the Nursing Fundamentals program for when students start getting clinical experience. I plan to look carefully at what theory and skills will be introduced in the classroom setting and at what interval to plan this.

• Reference (APA format): McLean, M. (2004). Sometimes We Do Get It Right! Early Clinical Contact is a Rewarding Experience. Education For Health: Change in Learning and Practice (Taylor and Francis Ltd), 17(1), 42-52

Literature Review Findings

• This study studied transition from pre-clinical to clinical training and how this may affect performance in the clinical setting as perceived by the students.

• Why this is Relevant to my Study: I am looking at a redesign of Nursing Fundamentals where clinical is integrated between blocks of theory and classroom lab practice to reinforce knowledge and improve content/skills retention.

• Reference (APA format): Van Hell, Kuks, J.M., Schonrock-Adema, J., Van Lohuizen, M.T., & Cohen-Schotanus, J. (2008). Transition to clinical training: influence of pre-clinical knowledge and skills, and consequences for clinical performance. Medical Education, 42(8), 830-837.

Literature Review Findings

• This study tested two different predictions about the chunking theory. There have been differences about how many chunks are held successfully in short term memory when information is being learned. The number of chunks in recall tasks was closer to three than seven.

• Why this is Relevant to my Study I need to understand how memory processing works with chunking steps within a skill as well as how many skills to complete before the students do practical application with them in the clinical setting.

• Reference (APA format): Gobel, F., & Clarkson, G. (2004). Chunks in expert memory: Evidence for the magical number four…or is it two?. Memory, 12(6), 732-747.

Literature Review Findings

• This study looks at the differences in working memory capacity due to differences in the individual’s ability to retrieve information from long-term memory.

• Why this is Relevant to my Study: I have both low and high working memory capacity students in the class at the same time. I have witnessed the lag times when dealing with low capacity memory students (ones that some may think are not paying attention when they are actually trying to recall information) and will be curious if this observation will change once I reorder the skills with clinical time in betweenReference (APA format): Unsworth, N., Brewer, G.A., & Spillers, G. J. (2011). Variation in working memory capacity and forgetting over both the short and the long term: An application of the Population Dilution model. Journal of Cognitive Psychology, 23(2), 243-255.

Literature Review Findings

• This is a theory paper looking at an integrated theory of learning and forgetting. It looks at massed versus distributed practice when learning a new skill.

• Why this is Relevant to my Study:. The time between the declarative/mixed stages (which I see as the classroom/lab practice) and procedural stage (clinical practice) is important to assist with long term memory. So it would be important for me to place theory/classroom practice close to the time we apply the skills in the clinical setting. Also it states that the working memory load can interfere with knowledge performance.

• Reference (APA format): Jong, W. Kim, Frank E. Ritter & Richard J. Koubek (2013) An integrated theory for improved skill acquisition and retention in the three stages of learning, Theoretical Issues in Ergonomics Science, 14:1, 22-37

Literature Review Findings

• This article was not a quantitative study but rather an informative article about student support using a scaffolded method of instruction.

• Why this is Relevant to my Study: I am teaching skills to students of different academic levels. I need to keep the essential parts of scaffolding in mind when using the scaffolding concept to teach the CNA skills.

• Reference (APA format: Larkin, M.J. (2001). Providing Support for Student Independence Through Scaffolded Instruction. Teaching Exceptional Children, 34 (1), 30

Literature Review Findings

• I will look at chunking skills together.• I will determine how often/when clinical

practice will fall among the chunked skills.• I will enlist the support from my clinical

site.• I will determine ways to gather data to

determine if what I am doing is affecting a change.

What Next?