1. Modic, Mary Beth DNP, RN, CDE

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Think about the following three words-triplicate, trifecta, and triad. Consider another three-trilogy, tertiary, and triumvirate. Have you ever reflected on the way that the number 3 dominates our thinking, actions, and writings (Newman, 2008)? The Pythagoreans believed that the number 3 was the first true number. Thousands of years later, the creators of School House Rock proposed that "three is a magic number" (Dorough et al., 2002). We all learned in grade school that 3 is the first odd prime number. We give no thought to counting to three when a group of people wish to perform an action in synchrony. We often mutter unconsciously, "Third time's the charm," when we have been unsuccessful in previous endeavors or wish to offer encouragement to another who has experienced two previous failures (Bunch, 2000, p. 39).


Throughout history and across professions, the number 3 has been used to engage, entertain, and educate. This rhetorical strategy is known as a tricolon. It is a series of three parallel words, phrases, or concepts that resonate with the listener by creating a rhythmic message (Forsyth, 2013, p. 97). This clustering concept is also known as the "rule of three" (Gallo, 2014, p. 191). One of the earliest uses of the rule of three has been attributed (although not substantiated) to St. Patrick of Ireland, in 432, when he used a shamrock to illustrate the concept of the Trinity to the people of Ireland.


The rule of three is used in joke telling, speech writing, and storytelling. It is an important component of marketing, everyday language, and music (see Table 1). Dale Carnegie, the American writer and lecturer, is known for this speech giving directive, "Tell them what you are going to tell them, tell them, then tell them what you just told them" (Carnegie, 1936).

Table 1 - Click to enlarge in new windowTABLE 1 Examples of the Golden Rule of Three

Maria Montessori appreciated the significance of the number 3 when she introduced her revolutionary pedagogy in 1907. Montessori believed that the first 5 years of life were sensitive periods in which children acquire vocabulary. She wanted children to have precise terminology for describing the world and, as a result, created the three-period lesson (Lillard, 2007, p. 179). The three-period lesson, a hallmark of Montessori education, includes three distinct activities: naming, recognizing, and remembering. The directress does not move to the third teaching activity until he or she is confident that the child will be successful. The underlying philosophy of the Montessori approach is mastery.


As preceptors and professional development practitioners, our concern is that we facilitate mastery in our learners. How do we take complex skills, behaviors, and concepts and break them down into manageable "chunks"? Harvard professor George Miller (1956) published a seminal article on the concept of chunking and, after robust analysis, suggested that the maximum amount of information an individual could store in his or her short-term memory was actually 7+/-2. This is the rationale for the American telephone numbers consisting of seven digits excluding the area code. Given the explosion of research examining brain activity and resilience, more compelling evidence is needed to state that, empirically, there is a preferred "number" by the brain for easy information storage and retrieval.


However, in our efforts to guide, engage, and support our learners, the novelty of three as a teaching technique cannot be overlooked. Our goal as preceptors and educators is to help our learners assimilate knowledge, skills, and attitudes into memorable patterns. Consider the handoff process when the oncoming nurse is attempting to prioritize the care using the information that is shared. The rule of three that can be used by the preceptor here is "How is the patient the same, better, or worse than yesterday?". What is the evidence that the nurse needs to know to answer that question? The rule of three can be used to delineate roles and responsibilities in a patient's plan of care. A preceptor can pose this question: "When we reflect on all the care needs of our patients and the three types of nursing interventions: dependent, independent, and interdependent, what are examples of interventions that you believe nursing owns for these patients?". The rule of three provides a "hook" for patients and their families, who are being bombarded with an overwhelming amount of information before discharge. The nurse can introduce patient education by offering "3 survival skills you can use to be safe at home." The overarching survival skills are managing symptoms, taking medications correctly, and preventing complications. The specific topics for each skill can include the checklists that are presented to patients. However, the content is organized or clustered in a way that engages the patients. The survival skill for symptom management includes symptoms that are to be expected: fatigue, pain, loss of appetite, and strategies for minimizing or controlling symptoms. This skill would also include the criteria to determine when to call a physician or advanced care provider or a visit to the emergency department is warranted. The survival skill of medications would be knowing the name, dosage, frequency, purpose, and potential side effects. It also addresses actions to take if a dose was missed or intolerable side effects occur. The survival skill of preventing complications addresses behaviors to prevent infection, injury, and fatigue. It also includes recommended activities, diet, fluid intake, pain management techniques, and so on. The rule of three can be used at the conclusion of a formal educational session. The facilitator can ask the group to share three things they learned because of their participation in the class session.


The use of the rule of three as a deliberate teaching technique is only limited by our imagination. Think about the marketing outcomes for nursing orientation and professional development programs across the country: They came. They learned. They flourished!




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