Every parent can describe a memory that stands out in their mind when their child demonstrated true and uninhibited curiosity. Some of my greatest memories of my kids' curiosities have come at the most unexpected times. We can all recall our children asking multiple questions throughout the day. Their innate curiosity propelled them to better understand concepts and fill in the gaps of knowledge. As a parent, I hope I helped to develop habits of curiosity and wonder in my children. The skill of questioning can help us identify and solve problems (Legare, Mills, Souza, Plummer, & Yasskin, 2013). What happens to us as adults and why is our questioning not as frequent? Why are we reluctant to ask questions?
As a nursing professional development (NPD) practitioner, I have found that not all new graduate nurses ask questions that might help them better understand what is going on with their patient. I feel that sometimes they are so overwhelmed about completing the tasks that need to be done that they don't see the importance of understanding the complete picture of what is happening to the patient. It is so important that both NPD practitioners and preceptors assist in developing the new graduate nurse to understand the importance of asking questions (Nickitas, 2012). We also need to teach our preceptors to model the skill of questioning behavior.
This questioning behavior develops a more reflective practice. By asking the right questions, nurses will develop both the critical thinking and clinical reasoning skills (Nickitas, 2012). The complexity of the healthcare environment has definitely increased. Patients and their healthcare concerns are more complex. The novice nurse needs to be able to prioritize care, to provide the necessary treatments, but also to anticipate possible outcomes. It is important for the novice nurse to understand why certain tasks are being done and when they are to be done. The preceptor can help the new nurse develop a more questioning behavior. There is a need to increase curiosity and bring back the natural wonder in our nurses.
The ability to ask and answer questions is central to learning. As an NPD practitioner, when I develop new presentations for the nurses, I carefully plan my content by thinking through possible questions, which would guide the nurses toward further investigation and a deeper understanding of the concepts being emphasized. My objective-the nurse will discover that the question is a very valuable learning tool. By asking questions, the learner will identify the deficits in the concept and gain the knowledge needed to have a better understanding of the concept. Most importantly, the learner will be actively engaged in the learning process (Nickitas, 2012). Therefore, preceptors who are training new nurses need to understand that asking questions is a valuable teaching strategy.
What happens to our tendency to actually wonder about something and be curious? I believe that preceptors need to stress the importance of wonder. The preceptor needs to show the new graduate that asking questions can fill in the gaps and help obtain a complete picture of what is occurring with the patient. The preceptor can help develop the sense of wonder in the new graduate by going back to the basics of asking who, what, where, and why while training the new nurse. By doing this, the new graduate will see that he or she needs to ask questions to understand why certain decisions are made.
These basic questioning points are not new to us. We have learned the basic sequence of questioning when we were in grade school. Harper and Maloney (2016) used these questioning words to describe our scope of practice. Nursing Professional Development: Scope & Standards of Practice (Harper & Maloney, 2016) describes the who, what, where, when, why, and how of NPD practice. The Nursing Professional Development Practice Model, Standards of NPD Practice, and Standards of Professional Performance for NPD (Harper & Maloney, 2016) define the scope of our practice.
The sequence of questioning needs to follow Bloom's taxonomy. The framework covers the learning objectives in cognitive, affective, and psychomotor domains (Anderson & Krathwohl, 2001). Preceptors need to build on the new nurse's knowledge, test their understanding of the concept, and ensure the new graduate applies the knowledge to practice. Throughout the orientation, the preceptor needs to apply the skill of higher-level thinking. By questioning the new nurse, improved attention to detail, increased comprehension, and expanded problem-solving skills can develop (Nickitas, 2012). Realize that taking the time to model a questioning behavior will influence and strengthen the practice of the novice nurse.
There are times during nursing handoff when I see curiosity and wonder being demonstrated. I recently observed a nurse receiving report and asking the other nurse some basic questions, "why is the patient on that specific drug when there is nothing in the patient's history that warrants the medication?" After reading the doctor's admission note, the other nurse shared why that drug was warranted. This, in turn, caused the nurse to be curious and go back to talk to the patient about their specific history and fill in gaps in the admission history form.
I remember being a new nurse on a medical-surgical unit, and when the doctor came onto the unit and went into the patients' room, I would always follow. I would listen to the conversation between the doctor and the patient. I would listen to the doctor talking about the surgical procedure explaining the prep needed, what was going to be removed during surgery, and what the patient was to expect postoperatively. That 10-minute conversation enabled me to follow my sense of curiosity in understanding the patient's plan of care. It also provided me the benefit of anticipating what would be ordered for the day. Last, it filled in any knowledge gaps that I might have had about the patient's illness. As the doctor explained things to the patient, I was able to fill in gaps and build the connections to why things were being ordered and the overall plan.
Realize that taking time to model a questioning behavior will influence and strengthen the practice of the novice nurse. Preceptors need to model the following behaviors:
1. Take time to model questioning behavior will influence and strengthen the practice of the novice nurse.
2. Use Bloom's taxonomy to move to higher-level questioning. Using higher-level questioning will develop enhanced critical thinking skills.
3. Continue to allow time for questions as the new graduate is progressing through the orientation, completing assessments, and completing tasks. The new nurse may complete all the tasks, but are they able to put together the plan for the patient?
4. Encourage the new graduate to go into the patient's room with a provider.
5. Model questioning behaviors back to basics: who, what, when, where, how, and why.
6. Discuss with the new nurse that it is OK not to know something, but it is not OK to avoid finding out.
As stated by Albert Einstein (Life Magazine, 1955), "The important thing is not to stop questioning[horizontal ellipsis]. Never lose holy curiosity."
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