Experiencing learning: Perspectives from nurse anesthetists

Abstract

This study explored Certified Registered Nurse Anesthetists' (CRNAs) learning and problem solving experiences using a qualitative, case study design. Through interviewing and observation techniques, five informants provided information on learning and problem solving in daily clinical practice.^ CRNAs follow a similar path in their learning process. CRNAs first desire to know the pharmacologic, physiologic, or pathophysiologic ("basic") principles needed to understand clinical situations. Next, CRNAs want to "talk to others" as they expand their knowledge of the basic principles. Once they are comfortable with their grasp of the basic principles, CRNAs will then "try out" the new agent or technique in their clinical practice. During this time, they continue to converse with others, expanding their knowledge of the basics with contextualized information and cues. As experiences accumulate, CRNAs create complex practice structures. Practice structures are an amalgamation of many information pieces obtained through understanding the basics, experiences, and talking to others. The depth and breadth of practice structures possessed by expert CRNAs provide them with the capacity to identify and understand salient, complex environmental cues, anticipate clinical events and physiologic incidents expediently, and provide appropriate and needed interventions before other, less expert, practitioners. Experts are able to handle many clinical situations effortlessly and efficiently. They are confident in their clinical practice; they "know what has to be done" and they "just do it."^ Thus, CRNAs use experiences to enliven, expand, and enhance the scientific principles that guide their practice. CRNAs do not use scientific principles as a list of arbitrary principles and rules to direct their practice; CRNAs instead use scientific principles as a filter or lens through which experiences are interpreted and practice structures are developed. As practice structures develop and accumulate, CRNAs exhibit improved levels of confidence, comfort, and expertise in practice. In understanding how expert nurse anesthetists learn and develop, perhaps educators and students will be more able to identify and design learning activities that prepare students for competent and successful anesthesia practice. ^