The first new course I developed for RNs returning to earn a BSN was a powerful learning experience for me; teaching from a traditional critical care perspective did not make sense for nurses from diverse work settings and clinical specialties. In order to apply ideas about improving care for complex patients, each of these nurses needed a unique learning experience with meaningful connections to his or her workplace and patients.
Based on the course objectives, outcomes evaluation data and a review of best evidence for teaching/learning practices, I redesigned the learning activities to help meet diverse individual learning goals. My focus changed to emphasize processes that apply across nursing specialties and work settings. Nurses reflected and shared their own complex patient experiences from the framework of the AACN Synergy Model using aspects of critical thinking: supporting judgments about patient characteristics and nurse competencies with assessment data, recognizing what was taken for granted, prioritizing nurse competencies for each patient and the unit's usual patient mix, providing care based on best evidence along with patient preferences and available clinical expertise, planning to enhance nurse competencies, and identifying optimal outcomes from many perspectives.
Nurses told me that reflecting on their patients in new ways changed their thinking about other patients and situations. Some started asking patients and families about what an optimal outcome would be. Others described being more appreciative of their co-workers' expertise. One nurse explained that hospital administrators seemed more responsive to the language of the Synergy Model in describing patient characteristics and required nurse competencies for appropriate staffing. "Understanding patient characteristics like vulnerability, complexity and resilience - and knowing how to back those words up with evidence - gives me a clear voice to advocate for my patients getting the care they need."
