Michele Dowlman, from the University of Tasmania, owns possibly one of the best t-shirts that a bioscience and nursing lecturer can own.
On the front it says, “Why are you seeing what you are seeing?” and on the back it says, “Why are you doing what you are doing?” The t-shirt is fitting.
If you’re a nurse, you would immediately relate to this – it may even make you chuckle. But if you’re a nursing student, these two questions become imperative concepts to what you are learning to do in clinical practice. But before we get ahead of ourselves, let’s take a step back and look at what it means to nurses learning bioscience.
The problem of bioscience is lack of context
Bioscience and nursing students is a problematic mix – it’s an issue recognised by educators like Michele Dowlman, practicing nurse and lecturer in bioscience and nursing at the University of Tasmania. Nursing students have always struggled with the bioscience components of their degree, even though it’s essential to their studies.
Why? As Dowlman explains, nursing students need to be able to contextualised bioscience.
“The fundamental driver of nursing students is the desire to care for patients. So, we need to frame biosciences in this very space – with a patient-centred care approach.” says Dowlman. “Nurses need applied science, not pure science. If we teach nursing students bioscience as a pure theory, students don’t relate and the information doesn’t translate to practice.”
That’s where the Clinical Reasoning Cycle enters the classroom and provides an invaluable case study structure. It’s a framework that can be used to help nursing students put biosciences like anatomy and physiology into context. When students come to the degree with no foundations in bioscience, they need to be given a tool to grasp the concepts and apply them in real patient care situations. The key is to use case studies that follow the nursing process taught in clinical units, such as the Clinical Reasoning Cycle.
What is Clinical Reasoning Cycle (CRC)?
The Clinical Reasoning Cycle is a tool that expands on well-established Nursing Process. The CRC framework was developed by Tracy Levett-Jones and team in 2010 and has become internationally recognised and used in nursing degrees nationally.
It describes clinical reasoning as eight phases of a dynamic nursing process that includes collecting information, making a decision, taking action, and evaluating outcomes. The skill of clinical reasoning itself is a key nursing theme required by The Australian Nursing and Midwifery Accreditation Council (ANMAC), and Levett-Jones’ framework delivers this in spades.
When clinical reasoning and the nursing process come together harmoniously, it teaches students how to ‘think like a nurse’.
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Teaching bioscience with CRC case studies
Nursing students need their bioscience studies framed in a way that aligns with their patient-centred viewpoint, using appropriate case studies. Dowlman, co-author of Principles of Anatomy and Physiology For Nursing and Healthcare Students in Australia, 1st Edition, has brought to life the idea of using CRC case studies in this brand new bioscience textbook specifically designed for nursing courses.
Dowlman reminds us, “we need to tell the story of the patient, and then use the bioscience to explain the patient’s presentation, justify the treatment and provide rationale for therapy.” And this is where the t-shirt re-enters the picture.
Why are you seeing what you are seeing? and Why are you doing what you are doing?
The combination of bioscience theory and a clinical reasoning framework helps nursing students answer both questions. Dowlman and her colleagues are using this method to teach students to ‘think like a nurse’, because a nurse’s actions must be informed by science and driven by process. While experienced nurses do this on a subconscious level, nursing students need this to be transparently embedded in every element of their degree, including bioscience.
The beauty of clinically reasoned case studies is that they are simply guided study tools. Give a student a tool and they will likely pick it up and use it. All nursing degrees teach clinical reasoning and nursing processes.
Dowlman’s students become very familiar with her two favourite phrases: Why are you seeing what you are seeing? and Why are you doing what you are doing?
Therefore case studies written from the Clinical Reasoning Cycle lens can be used with the same end-goal in mind, regardless of what framework is used by nursing academics across different universities.
By integrating clinical reasoning case studies into bioscience courses, universities will produce nursing students that are ready to face clinical practice confidently. Case studies are the gateway to contextualising bioscience in a patient-centred practice.
About Michele Dowlman:
Michele achieved a Bachelor of Nursing in 2005 and a Graduate Certificate in Acute Care in 2011. She has 13 years of experience in acute healthcare. In 2010, she was invited to tutor bioscience for nursing students at the University of Tasmania, and was promoted to Lecturer in Bioscience and Nursing in 2018. Her passion is teaching science to nursing students and doing so within the framework of the Clinical Reasoning Cycle (Levett-Jones 2013). She also works with a nurse practitioner providing free, drop-in healthcare to people in her community who are experiencing homelessness and/or poverty. They partner with a local not-for-profit organisation to deliver this nurse-led care to vulnerable people.
Wiley Australia’s Health Titles that have CRC Case Studies includes:
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| Fundamentals of Applied Pathophysiology, 1st Asia-Pacific Edition | Principles of Anatomy & Physiology for Nursing and Healthcare Students in Australia, 1st Edition | Medical-Surgical Nursing for Australian Students: A Systems Approach, 1st Edition |
| Learn more | Learn more | Learn more |
Source: Levett-Jones, T., Hoffman, K., Dempsey, Y., Jeong, S., Noble, D., Norton, C., Roche, J. and Hickey, N. (2010). The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today. 30(6): 515–20.
