In nursing school, I found myself becoming frustrated because after hours of reading and studying, I would still have a difficult time remembering material for the exams. When I talked to my mom (who is a nurse) about this she would explain that I would truly begin learning when I began my career. Basically, I can read textbooks and PowerPoints every day, but I cannot fully understand how these skills are applied and performed on particular patients until I can physically practice these skills myself. I believe this is why many of the USC Bachelor of Science in Nursing courses include a clinical portion. I did not begin to realize how crucial these clinical experiences were to my education until the end of my second semester as a junior.

 

 

After being in clinical at the hospital for almost a whole semester, I finally understood the concept that hands-on experience can enhance your skills taught in lecture. Having five classes in one semester can be overwhelming as there is a lot of information that we must learn. I can study for hours, but am likely to forget a portion of it when it came exam time. However, when I used the skills I learned in class during my clinical day, they become nondeclarative memories. Nondeclarative memories are when you have experience performing skills and they become easier to recall and require less conscious thought. For example, in my Maternal/Newborn Nursing course (NURS 324), I had clinical rotations in Labor and Delivery, Postpartum, and the Neonatal Intensive Care Unit. Being assigned to and following a nurse for eight-hour shifts and physically seeing and performing procedures, such as inserting urinary catheters, helped me better understand why and when procedures are performed. I performed better in my Maternal/Newborn class in regard to grades because when reading exams, I was able to apply my clinical experiences to correctly answer questions. 

 

 

Many theories support the concept of hands-on learning, including those of Piaget, Vygotsky, and Bruner, by stating the basis of learning is through activity and interaction (Miglino, Ponticorvo & Simona-Sica, 2015). I learned about these psychologists in my Nursing of Children and Families (NURS 325) course, but I would particularly like to highlight Jerome Bruner. Bruner, a psychologist, combined both Vygotsky and Piaget’s theories to create his own theory of the process of education. He stated that learning and cognitive development is accomplished through active involvement and social context (or learning in lecture). Bruner stated that active participation can increase intellectual potency so that information is more readily accessible in the memory during problem-solving situations (Miglino, Ponticorvo & Simona-Sica, 2015). This theory is supported in my previous example of nondeclarative memories and a stronger performance on my Maternal/Newborn exams as I was able to recall on clinical experiences in order to answer test questions.

 

 

Another example of Bruner’s concept in practice would be in my Foundations of Nursing Practice (NURS 312) course. During the first four to six weeks of the semester, my clinical group and I had eight hour days in the simulation lab before we entered the hospital. Before simulation, I would be assigned videos to watch and would learn basic nursing care skills in lecture. During simulation, my classmates and I would perform these skills on manikins such as taking proper vital signs, inserting a urinary catheter, inserting IV catheters, bathing patients as well as linen changes with a patient in bed. I also had to practice using assistive devices such as walkers, crutches, and wheelchairs so I understood the correct way of using them. During an actual clinical rotation in the hospital, I could recall parts of the assigned videos and classroom material when teaching patients to transfer from the bed to the bathroom using a walker, but I vividly remember having to practice using the walker myself. As a result, because I was able to physically use a walker myself during simulation, I could clearly recall the correct way to teach this patient how to safely transfer from the bed to the bathroom.

 

 

 

 

Beyond the classroom experiences aid in demonstrating Bruner’s theory as well, including volunteer experiences and community service. For example, the University of South Carolina Lancaster hosted the University of Possibilities on May 15, 2018. One of the rotations for the visiting students was in the simulation lab. The middle school students were able to experience a simulation demonstration of a Code Blue. My classmates and I had to pretend as if our manikin was brought in on a stretcher by EMS, unconscious, began to have a heart attack resulting in cardiac arrest. My classmates and I performed procedures as if we were in a real code situation. We had to take vitals, start an IV bolus, administer medications such as epinephrine, perform emergency compressions and breathing, and use an automated external defibrillator (AED) to shock the heart while loudly communicating with each other at all times. I was thrown into the situation clueless and terrified to perform in front of all my professors and hundreds of students, but I used the knowledge I have learned from class, and listened to the “charge nurse” and performed the procedures that I knew were necessary. The students and professors were in awe and complimented our team for excellent performance. After performing this Code Blue situation ten times I feel more confident in my ability to work in a fast-paced, stressful situation, and performing CPR when needed in a real clinical setting.

 

 

 

In my nursing school career thus far, I have had many clinical and volunteer beyond the class opportunities that have allowed me to practice applying my knowledge. I have just recently begun to understand that these opportunities are crucial in learning how to safely teach and perform medical procedures as well as being confident in yourself as a future medical professional. I came to this conclusion one evening at the Columbia Board of Trustees meeting, where I was an invited speaker. Following the meeting, a trustee came to me with some medical-related questions. I was very proud of myself because I was able to recall caring for some patients in clinical with related conditions and was able to take that applied knowledge and care to confidently answer the trustee’s questions. Additionally, I volunteered at the Lancaster County Fair to take blood pressures for interested participants. I was able to confidently take blood pressures because I have practiced on other patients and my classmates many times. When I was asked questions regarding blood pressure, I was able to assuredly tell them what blood pressure was and what appropriate ranges are in regard to medical context. These are just a few examples of how I have been able to apply the knowledge I learned in the classroom to better grasp the material. I can now feel more prepared in my final year as a BSN student and more confident when I interact with patients.

 

 

It is so pivotal that students, especially those in patient care careers, nursing in particular, have opportunities to physically apply their classroom knowledge. Learning through lecture and PowerPoints is simply not enough to properly teach a student a technical skill. However, it is the student’s responsibility to seek extracurricular opportunities. In nursing school, students are required to participate in clinical rotations but with 8 students in each group, not all students will get the opportunity to practice each skill. Students must be responsible and take action to find volunteer and work experiences to enhance their learning and become the best they can be.