Reflective practice is a teaching strategy for improving teaching and learning which emphasizes learning as a personal, internal process of making meaning. Through reflective practice learners adopt the acquired knowledge, then use that knowledge to modify their thinking, revise, integrate, and accommodate new knowledge. Another learning situation where students can be guided using RP is in understanding and connecting concepts of using aseptic and sterile techniques. Aseptic and sterile techniques are necessary for many nursing interventions such as removal, insertion and routine Foley catheter care, as well as interventions involving intravenous catheter, peripherally inserted catheter and implanted vascular access devices.
The student will demonstrate comprehension, application principles, and rules of inserting a Foley catheter using sterile techniques while maintaining a sterile field and supplies in a simulated learning environment.
Kolb’s Learning Theory
Kolb’s experiential learning theory (ELT) will be used for this learning exercise. As previously noted in Part 2 of this series, in the ELT framework, knowledge creation is portrayed as a four-mode cycle where the learner responds to new knowledge through experiencing, reflecting, thinking, and acting in response to the learning situation and what is being learned. In the experience stage, the student nurse physically inserts a Foley catheter. The experience of doing the action forms the foundation for observation and reflection and the learner has the opportunity to consider what is working or failing in the process. The student now has the chance to think about ways to improve on the next attempt made inserting a Foley catheter which is the thinking phase of the cycle. Every new attempt to place a Foley catheter is informed by a cyclical pattern of previous experience, thought and reflection or active experimentation. The instructor will highlight points in the training connecting concepts of theory to practice.
Subject area will cover insertion of a Foley catheter.
Demonstrate competency using sterile technique while maintaining sterile field and supplies in the prevention and control of infection in patients.
A high fidelity simulated patient, Foley catheter kit, and other appropriate materials needed to complete the task of inserting a Foley catheter.
The setting will be a realistic simulated medical-surgical setting.
During the simulation practice, the facilitator will provide cues to help students progress through the activity by providing information of the step the student is on or is approaching.
Learner support will be provided throughout the simulation and the debriefing that concludes the experience. During the debriefing session, learners will discuss their feelings and roles during various stages in the scenario. The facilitator will ask questions during the reflective period that will help students anchor positive lessons learned from the training and in connecting theory to practice.
The instructor will act as a facilitator and will stand at the head of the bed allowing students to focus on the high fidelity simulated patient. The instructor will focus on several key areas which include:
- Reviewing the checklist.
- Reviewing the expectations of the case with the students.
- Watching and reviewing a Foley catheter video with the students.
- The instructor will allow students to perform hands-on practice with the Foley kit, any additional materials that will be involved with the training, and to answer questions students have before the start of training.
Remarks and notes
Since these tasks involve techniques that are critical to the prevention and control of infection in patients, the instructor will ensure students understand the process, know inherent risk factors, and are closely supervised during the evaluation. The instructor will stop the evaluation immediately and correct a student if performance may compromise sterility or safety. The instructor will also ensure the student dons all personal protective equipment (PPE) required by current standards and precautions.
- This competency of inserting a Foley catheter using sterile technique while maintaining a sterile field and supplies will be evaluated during simulated performance in a patient scenario.
- After the learner has received instructions and sufficient practice on each principle or rule of maintaining sterility, their performance will be evaluated on the rules and principles throughout the simulated procedure. Students should decide on the appropriate position and action that will allow them to learn from mistakes and act on their own judgment as they care for the patient. In order to pass the student must satisfactorily perform in all areas without assistance.
- A checklist will be used when evaluating performance to ensure all areas are evaluated properly.
- Immediate feedback will be provided using a checklist as a source of information to discuss performance, indicate strengths and weaknesses, and to suggest improvements. Feedback on students’ performance is a vital component of simulation and is highly valued by students as it assists them to ensure they take away from the lesson what was expected for them to learn.
- The instructor will ask students to take a moment to reflect on their experience of the simulated training then write a paragraph or two answering the following question:
- Describe a peak moment during the training which you felt most confident and a time you felt not so confident.
- The instructor will go around the table and ask students to share the highlights of their story and values on the training. By using real-life nursing stories, learners have a better chance of being able to recall what was learned and transfer this learning to new patient care situations; thus, enhancing their critical thinking and judgment in practice.
- Upon conclusion of the training, the instructor will collect student responses to the question. The responses will be used, in conjunction with student’s overall performance on the checklist, to make recommendations to help the current student and future students to identify areas of strengths and weaknesses and also to make further improvements in the class. Students, in turn, can share the information with their nurse mentor who can help them to map out resources and information to enhance their learning.
Note: Follow facility guide and manufacturers instructions of inserting a Foley catheter.
This series concludes next week looking at how data can support reflective practice.