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Patricia Benner, R.N., Ph.D., FAAN
Learning a practice discipline is ideal for both simulation and direct experiential learning from practice. But the design of the simulations must be practice-domain specific and pedagogically sound for teaching good practice. Teaching nursing practice requires:
-Experiential learning in high stakes environments
-Expertise Depends on Relational Skills and Clinical Imagination
-Confronting Suffering and Vulnerability
-Students must develop clinical reasoning skills, an analogue for practical reasoning and wisdom: Reasoning across time about the particular through changes in the patient and/or changes in the clinician’s understanding of the patient’ situation. This requires understanding context and sequencing of events.
-Recognize the nature of clinical situations: Develop an experience-based sense of salience in under-determined clinical situations
-When the problem is novel or the current approaches are not working engage in critical thinking
-Thinking-in-action: situated thinking and use of knowledge
-Dealing with life worlds for motivation, meaning and recovery
Most practice disciplines are in their infancy in studying domain specific pedagogies of simulation. Research studies on simulation usually treat simulation as a unified pedagogy that is thought to be roughly equivalent to clinical practice. However like real clinical environments, particular simulations may have radically different learning outcomes for the student. Unless the pedagogies of connection and clinical reasoning are effective, simulations may have unintended negative learning outcomes.
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