Printer-friendly versionIntroduction to the Case
Professor Lisa Day, of the University of California San Francisco, teaches an advanced Medical-Surgical course in which she seamlessly integrates the three apprenticeships.
- 1. Intellectual training to learn the academic knowledge base and the capacity to think in ways important to the profession.
- 2. A skill-based apprenticeship of practice, including clinical judgment.
- 3. An apprenticeship to the ethical standards, ethical comportment, social roles, and responsibilities of the profession, through which the novice is introduced to the meaning of an integrated practice of all dimensions of the profession, grounded in the profession's fundamental purposes.
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Integrating the Apprenticeships
In an interview we conducted with Lisa Day on February 7, 2005, she explained how she integrates the apprenticeships to help her students develop their professional roles.
Click arrow to listen to the interview:
Interview transcript:
CF: And how does this class assist the student in their professional role and character development?
LD: Character development, wow, yeah. That's another thing that I'm shifting my focus toward. I mean I think that from me, learning the practice is all about values and, you know, I've said this from when I first started teaching. We can teach content but what I prefer to teach, is to teach appropriate approach to a person, to a patient. And the way I sort of differentiate that is that we can talk about the specific technical skills that we need and what we need to look for and watch out for but I'm sort of more trying to show them what's at stake and then ask them, what do you think we should be paying attention to? And that I think that sort of gets at the character development but these are the questions that you should be asking and these are the concerns that you should have, and getting them to be – and this is the response that that should generate, that that should develop in you, this response. And I think that's what that is … says to me is that this is sort of trying to develop a habit of thinking in them that's patient focused and focused on what's at stake.
Analysis: Using Case Studies to Integrate the Apprenticeships
Lisa Day's answer shows how she integrates the apprenticeships, putting "the content" of nursing—what is covered in the first apprenticeship—in service of patients. She devotes an entire class to the case of a patient with sepsis, Ms. G, whom the students have met in previous classes.
She structures her class around the following questions:
- What are your concerns about the patient?
- What is the cause of the concern?
- What are you going to do about it?
- What is the patient experiencing?
Throughout the class she:
- Demonstrates reasoning through patient transitions
- Models concern for the patient
- Returns to changes the patient is experiencing over time
Students Talk about Learning to Become a Nurse
Lisa Day's students praised her use of cases and the questions she asked. They spoke about how valuable her approach to the cases and to teaching were to their formation as nurses. Listen to the following excerpt of one interview, which was re-recorded by members of the Carnegie Foundation staff.
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Interview transcript:
CF: Are there essential, the most important skills that you think you need as a nurse?
STUDENT 1: I think critical thinking skills. I think that needs to be there, being able to evaluate your patient and how they present physically and anticipating the next step in their care. I think that's very important.
CF: In what courses have you found were most helpful in developing those?
STUDENT 2: In Lisa Day's course that we are in right now.
CF: In what way? What is it about what she does that helps you with your critical thinking?
STUDENT 3: She presents us - the nice thing is, she presents us with a case study, she mimics what you would see in an acute care setting and then she'll question you. What do you see here, what's concerning, what steps would you do, how would you address, you know, those things that are critical to you at the moment?
STUDENT 2: And we have to draw upon what we learned in the first quarter in order to answer those questions, in addition to what we're learning now and our own clinical experiences.
Later in the interview, we asked students about learning in the cognitive apprenticeship. The following excerpt of the same interview was re-recorded by members of the Carnegie Foundation staff.
Click arrow to listen to the interview:
Interview transcript:
CF: How important do you think it is to have an understanding of the science?
STUDENT 3: We had that discussion last week with Lisa. We were talking about how much information is now expected of a nurse versus well back when there wasn't all that information available or known. And that sometimes it can be especially for a new nurse, it can be overwhelming to think that you'd have to know all that. But for some reason, it also—I find comfort in knowing some of the things and that when I get to the floor that I actually know what they're talking about versus a doctor coming in and saying, well, what are you doing? And it just makes me feel better if I have a good knowledge base.
Analysis: Bringing Practice into the Classroom
Professor Day presented the case as it would unfold over time, and when she asked about the causes of concern for the patient, she opened a discussion of the pathophysiology of sepsis, which she enriched with graphs, pictures, explanations, and references to the most recent medical or nursing literature. She taught pathophysiology, pharmacology, diagnosis, signs and symptoms, and interventions in detail as they are related to the case. After presenting content on pathophysiology, or what is covered in any of the other apprenticeships, she always returned to the patient, guiding her students back to a shared concern for what the patient is experiencing.
In her classroom, students are:
- Placed in a collaborative nursing role with the instructor
- Presented with a case in terms of patient-nurse concerns
- Asked to consider what the patient is experiencing
- Asked to respond to the patient's situation
- Asked what actions the nurse must take on behalf of the patient as the patient's condition changes
