Visual assessment and critical thinking in students: Simple teaching strategies to boost observational skills

In the last post I wrote, I shared a thinking puzzle that involved numbers. The purpose of this problem is to warm up the brains of our learners, and to focus thinking. To be an effective problem solver, we must engage the whole brain, not just the analytical side of it. In this post and the next few to follow, I'd like to share more activities that can foster critical thinking in our learners.

One of the true skills of an expert nurse is the ability to recognize what needs attention in a patient while performing an assessment. This is not a simple skill but a complex one. How do we build this skill from the ground up? I use an activity called, “What do you see?” which is discussed in this blog post. 

I give my learners a challenge, and just 30 seconds to study a picture. Then I move on to the lecture or lesson. After the next break in class, which is more than an hour from the time I showed it to them, I ask them to write down a list of the items they saw on the screen. I spend just 2 minutes debriefing their guesses. The learners think this is a memory test, but it is an observation exercise.

You may be thinking to yourself, “Hey, that's an easy one.” The highly visual people will get this easily. Some do, some don't. But that is not the real point of this. The point is to teach discrimination.

“What?” you may ask. I then show them picture two and give them 15 more seconds, then back the screen. I ask them to write down what has changed from picture one to picture two.

You probably think this is a no brainer. Of course the changes are BB-8 and objects are missing, have changed and have been replaced. Not all your learners will be able to get this 100% right. This awareness creates a need to improve in the learners. Now we must take it to the next level by tying it to assessment on a patient.

Now I introduce picture three, see below. I ask my learners this question, “What do you notice about this patient? You can learn important information from a person's feet.”

Students notice the size, shape, nails, edema, etc. I wait for someone to mention the difference in color of the feet, and then we take a deep dive into, “What does that mean? What could be happening to this patient?” This is where critical thinking is learned, in conjunction with assessment skills. It is of utmost importance to produce nurses who can master safe level of practice, and not just answer NCLEX-style questions correctly.

I know it is impossible to do this with every aspect of assessment and critical thinking, but I have noticed that observational skills have improved with this teaching idea. I have taught the learners to focus, and look for things out of the norm (focused assessment). I know you might also use a similar approach. What are your favorite activities to hone observational skills?

Michele Deck presents nationally and internationally on innovative teaching methods in the field of health care education and training. She is co-founder and chief executive officer of G.A.M.E.S., a company that specializes in seminars on adult learning and interactive training methods, and Tool Thyme for Trainers, a company which supplies innovative and creative presentation tools for educators worldwide. Honors include ANPD's prestigious Belinda E. Puetz Award, election to Sigma Theta Tau National Nursing Honor Society, Business Woman of the Year by the National Business Council, and Best Over All Trainer by Creative Training Techniques Companies. She serves on ANPD's Education committee and was a member of the Editorial board of the Journal for 8 years.