Exploring the black box of practical skill learning in the clinical skills center

Background: Learning in skills centers has a long tradition in nursing education. Nurse educators struggle to substantiate their opinions on the efficacy of simulation technologies over traditional methods of instruction and it is suggested that they should re-evaluate their methods when teaching psychomotor skills. A necessary step before evaluation is to unravel what the students are actually doing in the skills center. Purpose: The purpose of this study was to explore nursing students’ practical skills training in the skills centre to label and define generic learning actions used during the learning of two specific skills; wound care and dressing, and sterile gloving. Methods: A qualitative observational study of nursing students’ practical skill training in the skills center was developed. Students across three cohorts were video recorded while practicing wound cleaning and dressing, and donning and removing sterile gloves. Verbal interaction on the video recordings was transcribed. The core analytical process was the joint listening to and watching of videos with following discussions of interpretations and development of categories. Results: Seven categories of learning actions were developed: Parallel action and self-instruction, watch and copy, collaborating to find solutions, giving support, seeking support, recontextualising the skill, and humorous enactment with the equipment. The categories are exemplified and discussed in light of learning theory and research on aspects of scaffolding. Conclusions: The learning actions described in this study are a starting point in detailing students learning actions during skills training. Students’ learning in other practical nursing skills should be studied to accumulate more knowledge about students’ learning actions and how peer interaction supports or hampers learning. The relevance of the learning actions should be explored in the clinical setting. A goal is to lay the groundwork for better design of learning in skills centers in nursing education.