Nursing Student Learning in the Psychomotor Domain

Instructor: Heidi Howerton

Heidi has written education material for a well known hospital's pediatric neurosurgery unit and has her Bachelor's of Science degree in nursing.

In this lesson, we will define the psychomotor domain and learn how it applies to the field of nursing. We'll also examine how teachers can encourage psychomotor domain development in their students and help them translate their nursing knowledge into practical, real life nursing skills.

Introduction to the Psychomotor Domain

Chelsea was a star nursing student. She aced every test, and knew the side effects of every medication. She graduated salutatorian of her program, and was hired onto a hospital's pediatric floor. There was only one problem. On Chelsea's first day of work she couldn't start an IV. She didn't know how to measure any medication and she was horrible at assessments. Chelsea was fired.

What went wrong for Chelsea? Chelsea's fault is that she didn't have any hands on skills. She didn't know how to translate the theoretical knowledge in her brain into her hands. Fortunately for Chelsea, she would never have been allowed to graduate nursing school without completing hands on, psychomotor training.

Psychomotor Domain

Overall, students learn through three methods. The three major domains of learning are affective, cognitive, and psychomotor. In our example, Chelsea had experience in the cognitive domain, or theoretical knowledge. She even had knowledge in the affective domain, which is filtering information through one's values, beliefs, and emotions. Chelsea was enthusiastic about her studies and valued her education. What Chelsea lacked was experience in the psychomotor domain. The psychomotor domain of learning occurs when a person learns new information and gains new skills through physical movement. Chelsea struggled applying her cognitive domain into her psychomotor domain. She had read and memorized about how to start an IV, but had never used her hands to start an IV. Thankfully, a number of ways exist for instructors to engage nursing students' psychomotor domains.

Levels of Learning in the Psychomotor Domain

Hands on, clinical skills are achieved through different levels of learning in the psychomotor domain:

  • Level one is imitation, where students watch teachers perform skills and then imitate their behaviors. If Chelsea's professor were teaching her how to take blood pressure, she might first take Chelsea's blood pressure and then ask Chelsea to take hers.
  • The next level of learning is manipulation, where instructors verbally give directions for a skill and students follow the instructions.
  • Precision is the next level of learning. In this level, students successfully perform skills without any help from their professors.
  • Once Chelsea has mastered a skill with minimal errors and no need for guidance, she is ready to progress to the articulation level. In the articulation level students perform multiple skills together in a timely fashion. One way Chelsea can show that she has mastered the articulation level is to take a patient's heart rate and blood pressure without assistance from her teacher.
  • The last level of psychomotor learning is naturalization. In the naturalization level professors can expect students to perform hands on skills with efficiency and ease. Chelsea will have reached the naturalization phase when her instructor can confidently ask her to go into multiple patient rooms and collect vital signs efficiently and effectively.

A nursing instructor can encourage psychomotor learning by first assessing what level of learning each student's skills fall into and then challenging students to progress up the learning levels as they are ready. Two primary environments exist for professors to assess and engage student's learning the psychomotor domain, simulation labs and supervised clinical hours.

Nursing Simulation Labs

Nursing simulation labs are rooms that are set up to look and function like hospital rooms and include electronic manikin's that talk, produce vital signs, need IV's, and respond to nursing student interventions. In these labs, professors prepare different virtual health problems for the manikin's to have and ask students to act like real nurses.

Simulation labs provide excellent opportunities for teacher's to help transfer their student's theoretical knowledge into the psychomotor domain of learning. In these labs professors can physically show how to do certain skills (like start an IV on a manikin), require students to perform the skills multiple times until each one is achieved with precision, and then observe students use the skills in a critical thinking situation. For example, Chelsea might walk into the lab and find the manikin sweating, pale, and confused. She will need to assess the manikin's health, take the manikin's vital signs, and respond appropriately to the situation.

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