Part of the first year of a Basic Nursing three-year degree programme involved a course in communication skills. The course included interviewing and counselling skills and one of its aims was to increase the student nurses' confidence in communicating with others whilst on the 15 weeks of clinical placements which interspersed the first year.
The course drew on students' placement experiences to integrate theory and practice. Almost the only 'communications theory' on the course was developed in an informal way by the students themselves analysing their experiences. The following description of a session illustrates the approach taken.
On the day prior to the session the students had all been out on a community-based clinical placement. The tutor asked the students:
"Think back to yesterday and the experiences you had on placement. I'd like you to identify one incident which you found easy: when you felt comfortable, at ease, a part of what was going on, relaxed. I'd also like you to think of a time which was difficult: when you felt uncomfortable, you wanted to leave, you felt excluded, a spare part, you felt hostility towards you or felt unwelcome."
The students were given ten minutes for this. There were no 'ground rules' requiring students to make notes or not talk to each other (though time for silent reflection prior to discussion can be very useful at this stage). Students then described their experiences to each other. Again there were no ground rules, except to be descriptive rather than trying to leap to solutions. If unstructured sharing like this doesn't work well you can introduce methods such as giving each student in turn five minutes during which the other student in the pair just listens and doesn't comment.
One student from each subgroup was then asked to draw up a table:
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Good situations
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Bad situations
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While the other students contributed to the subgroup by recounting their individual experiences, this student recorded some of the key points on this table.
The role of the tutor in this discussion was to:
The methods used at this stage included taking a specific situation, such as coping with an unhelpful supervisor on placement, and undertaking a role play. The tutor might say: "You play the difficult supervisor and I'll show you what I might do". Instead of offering direct advice this would be demonstrated experientially. Such role plays might involve several students and even props and setting the room or furniture up as in the real situation (see Section 4.4.4 for ideas on using role play). Students would be encouraged to generate ideas for the sorts of strategies which could be used the next time they found themselves in that situation. These would be illustrated with specific examples. The following week some time would be spent exploring how the student coped with the same situations again.
There was an emphasis on specific experience and a deliberate avoidance of theory building and generalisations because the students, especially the 18 year olds, were used to working in academic ways. They preferred to deal with problems in an abstract way rather than through examining their own experience and were not so good at gaining access to their feelings and exploring these.
Charge Nurses reported very positively on students who had experienced this approach to communication skills. For example: "The students show much greater self-confidence. When they come on to the ward, instead of hiding in the office they go straight to the patients and talk to them."
Assessment of students on the communication skills course highlighted one of its problems. Initially assessment involved students writing an essay and doing a classroom test. This was obviously inappropriate and was replaced by a more applied task. Students were asked to make a video of a meeting involving specified roles and were asked to write a report analysing the communications involved. It emerged that there was insufficient briefing for how to undertake this task. Also, in the absence of a clear model of communication, students found it difficult to know what to analyse or how, and the tutors found students' reports difficult to mark in the absence of clear criteria. Subsequently the students were asked to provide an audiotape of themselves undertaking some counselling so that the emphasis was more on their skills than on their ability to analyse.
In terms of the experiential learning cycle, the typical session, exemplified in the example above, started with students reflecting (2) back on experiences prior to the session (1). These reflections sometimes led to experimenting with new ways of behaving in the form of role plays (3) providing new experiences (4), further reflection (5) and plans for future action (6). Sometimes students would carry out these plans (7) and report back the following week (8).
The diagram shows clearly the links made in the course between experimentation and planning, action and reflection. It also shows the way in which conceptualisation was missed out in the learning cycle. It was a lack of conceptual models which caused difficulties with the assessment.
A danger with using the experiential cycle in this way is that learners do not have a basis for generating solutions to new problems, but have to tackle each new situation as if it were unique. The next stage of development of this course will involve searching for and adopting a clear model of the communication process to form a basis for analysis of reflections on experience. This would complete the learning cycle and help students to link their experience to theory in a way which developed an understanding of the communication process as well as developing competence in specific situations requiring communication skills.
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