Development of perceptual aptitude is a critical yet complex skill that requires the effective organization and interpretation of data using visual and auditory clinical observation. Educators face challenges in creating pedagogy that consistently demonstrates reliability and validity in fostering clinical skills. We have dependably used the arts as a means to improve students’ auditory and visual skills, and this article will describe replication of our work with accelerated nursing students in a bachelor’s program in their last semester of nursing school (n = 23).
Our results reveal that auscultative and observational abilities of soon-to-be registered nurses are in need of improvement. The use of art in a museum improves observational and assessment abilities, and music training increases auscultative interpretive skills significantly. (Index words: Nursing education; Art; Music pedagogy) J Prof Nurs 32:S30–S36, 2016. © 2016 Elsevier Inc. All rights reserved. Background Clinical observation is an essential skill for nursing practice. Students are tasked with developing this capability throughout their career and, with practice, can improve over time. As the health care environment becomes more complex, it is ever more important for providers to be holistically minded and creative problem solvers, with keen perceptual and communication skills. Previous study of the use of art and music in graduate nursing education demonstrated marked improvement in perceptual skills of observational and auscultative abilities (Pellico, Duffy, Fennie, & Swan, 2012; Pellico, Friedlaender, & Fennie, 2009; Pellico et al., 2013). The question of the pedagogy’s portability prompted this replication study in an accelerated bachelors of nursing (BSN) student population.
The humanities are recognized as a valuable element of nursing education. The Essentials of Baccalaureate Education for Professional Nursing Practice (2008) acknowledges “a solid base in liberal education provides the cornerstone for the practice and education of nurses” (p. 11). Although art and music are liberal study disciplines that have not traditionally been part of nursing education, they bring a new lens through which students can learn valuable skills. In addition to skill acquisition, the nontraditional format may provide avenues to think critically, opening the mind to alternative ways of seeing and hearing (McKie, 2012). Yet, tradition has a firm grip on nursing education. A faculty survey in 2006 found that nursing programs are highly structured, faculty feel pressure to cover content, and lecture is the prevailing classroom instructional strategy (Pardue, 2006). The question is how to advance a new pedagogical climate that includes creativity, risk taking, curiosity, and cooperation between students and faculty.
Guided listening to music is less commonly found in the literature as a tool to improve students’ abilities. Our previous work with auditory skill training successfully increased skill and sensitivity in hearing and interpreting sounds relevant to diagnostic auscultation (Pellico et al., 2012). Specifically, the ability to label normal and abnormal heart sounds doubled; interpretation of normal and abnormal lung sounds improved by 50%; and bowel sounds interpretation improved threefold, confirming the positive effect of an adult-oriented, creative, and practical method for teaching auscultation. This study examined whether the fine art and music pedagogy used previously for accelerated master’s nursing students could be applied to accelerated bachelor’s nursing students and whether it significantly improved their physical assessment and auscultative skills. Research Approach and Methodology Participants A pretest–posttest design was used to evaluate the effectiveness of the art and music program. The sample consisted of 23 students in their third and final semester of an accelerated BSN program for nonnursing college graduates.
The entire cohort (43 students) was offered the opportunity to participate in the study. The intervention was scheduled at a time that did not interfere with class and clinical schedules. Students were free to participate or not. There was no penalty for not participating or incentive to participate other than the experience itself. The museum covered the cost for parking and entrance to the museum. Because the data collection was anonymous and this was an optional and nongraded experience, there was little possibility of retribution. Twenty-three students elected to participate. Auscultation of normal heart, lung, and bowel sounds is taught in the first semester of nursing school. At the time of the “looking” or observational and “listening” or auscultative pretest, students had completed over 800 hours of direct clinical experience and were in their final 6 weeks of nursing school. Students were pretested on their observational skills using two images of patients with specific disease processes. Each picture was individually sealed in an envelope and labeled as photograph one (deep vein thrombosis [DVT]) and two (chronic obstructive pulmonary disease [COPD]). Students were allowed 5 minutes to observe the patient photograph and 5 minutes to record all observations in the Socrative® cloud-based student response system; at the end of 5 minutes of recording details, the students were given 3 minutes to type their interpretations of the clinical issue represented in the picture.
All students progressed in unison from photograph one and two. Auscultative ability was evaluated by correctly identifying the organ sound they were hearing (either lung, heart, bowel) and interpreting 25 specific sounds. Scores were calculated by adding the number of correctly identified organs (i.e., heart) and specific sounds (i.e., S3 gallop). For example, if a student correctly identified 8 out of 10 sounds correctly, then they would have a score of 8. The mean score is for the entire group and represents the mean number of correctly identified organs or specific sounds. Further details on the auscultative pre- and posttest are described below. The study was approved as expedited by the Human Subjects Research Review Committee of Mount Saint Mary’s University. The Looking Intervention Students spent 3 hours with a gallery expert and nurse educator at the Los Angeles County Museum of Art. The professional art educators were trained in the technique of looking by the fifth author. Students were placed in groups of four where each student was assigned a painting to view alone. Each painting was narrative in nature, rich in detail, and had a degree of ambiguity. Under the direction of a gallery instructor, students were gathered together, and the student who was assigned the painting was asked to objectively describe what they observed in their painting.
The gallery instructor challenged subjective statements because only objective observations were allowed in this phase. After a visual inventory was completed, the student then described their interpretation of what was happening in the painting. In this phase, students made inferences based upon their observations; however, their conclusions had to be grounded in visual evidence. After this phase, the gallery experts opened up the discussion to the other nursing students to consider any additional observations or inferences. Finally, the gallery expert reviewed the historical information about the art. The art museum experience was a single event lasting approximately 90 minutes per group of four students. Immediately after the activity, nursing students were given a variety of photographs of patients with disease processes and asked to replicate the skills used in the art exercise to distinguish aspects of a particular disease or condition under the direction of the first author.