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Requiring design thinking in nursing curriculum

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By: Marion Leary, MPH, MSN, RN and Abby Burger

I am a firm believer that exposure to innovation methods and processes leads to innovation itself. I teach a course at the University of Pennsylvania’s School of Nursing called Innovation in Health: Foundations of Design Thinking. This is an active-learning course that is open to all students across the University (upper-level undergraduates and graduate level students). Over the three and a half years I’ve run this course I have seen students, faculty, and clinicians take the knowledge and resources gained in this class and use them in other ways – whether in hackathons, accelerators, or in-practice. Over and over they are successfully applying what they have learned in the classroom in the other areas of their education and practice.

One such student, Abby Burger, took the Innovation in Health course in the Spring of 2021 and was the teaching assistant for the Fall 2021 course – helping other students learn the innovative process and methodology. She shares her thoughts on why she believes design thinking should be a required part of the undergraduate nursing curriculum. This is a belief I share and one that has recently been recommended by in the National Academy of Medicine’s Future of Nursing 2020-2030 report, which recommended including human-centered design and an innovation mindset as a competency for nursing education.

Last semester, during my junior year in nursing school, I signed up for a course titled “Case Study: Design Thinking”. I chose this course for two reasons. First, I needed to complete my case study requirement. Second, the course was rated well on my school’s course review website. I had not heard of design thinking and did not know what to expect. After having taken the course, I believe this should be a requirement of every nursing program.

The design thinking process is human-centered and has five main stages: Empathy, Define, Ideate, Prototype, and Test. These five stages tie in closely with the five stages of the nursing process, Assess, Diagnose, Plan, Implement, and Evaluate. This process is also human-centered, so we are already trained to be thinking this way. Additionally, each of the stages of the design thinking process helps to develop skills relevant to both nursing and to any career one could choose to pursue with a nursing degree.

The Empathy stage involves interviewing stakeholders about a problem they may be experiencing. The interviews are an incredible way for students to gain exposure in their community of interest and practice interviewing for the purpose of data collection and understanding. The key concept is discovering what your stakeholders know their problem to be instead of designing based on what you think their problem is. Discovering another party’s true interests is helpful in negotiations, professional relationships, and patient care, to name only a few examples. From the Empathy stage, you are then able to Define the problem. This stage helps students to develop skills in identifying, analyzing, and finally defining the problem in a way that the stakeholders’ true interests can be addressed in a cohesive way. Defining the problem also helps students practice clear communication skills within a team.

After the problem has been accurately identified to the satisfaction of the population students are serving, the Ideate stage begins. This is where teams brainstorm possible solutions. It is an incredible way to practice problem-solving skills, collaboration, and confidence in one’s own creativity. This exercise reinforces not only the importance of a team but also the voice of each member of that team. It is a great way for students to learn how to speak their minds and how to listen to others. Once the team decides on their favorite idea, one that best meets the needs of their stakeholders, they then must brainstorm how to Prototype it. They need to be creative with available materials and resources. This stage, like all of the others in the design thinking process, involves hands-on learning. Students appreciate the opportunity to learn through doing, and they learn better when they are having fun. This stage, again, involves a large amount of collaboration through the many challenges teams face in designing a working Prototype.

While the final stage, Testing, involves many of the themes already discussed, the most important skill I practiced during the Testing stage of the design class was being able to actively seek criticism and to truly not be offended by it. In the Testing stage, criticism and feedback from the target population is what will make the Prototyped solution better. As young people and as college students, this class can serve as an early experience for some in going out of their way to seek criticism for something they have spent an entire semester on, and it happens in a safe environment where every single other student in the class is doing the same.

A final skill students may be practicing for one of the first times is delivering a formal presentation to a board of experts. At the end of the semester, we created a formal pitch involving a storyboard, an animated video, and presentation of relevant data and presented the pitch to a board of experts in design thinking and innovation and received their feedback. I had never and still have not ever had an experience like this during my time as an undergraduate.

Design thinking courses are an incredible way to practice cohesively explaining the ideas of a team, selling those ideas, telling a story, presenting, teamwork, negotiating, receiving criticism, and creative problem-solving skills. Just like foreign language requirements, they give students the opportunity to gain confidence going outside of their comfort zone in a safe environment. These courses can offer students early practice with valuable skills. I believe there should be a design thinking requirement for any undergraduate program; however, design thinking courses are essential for nursing students. Nurses are at the bedside and are therefore uniquely positioned between the world of healthcare and that of the patient. They are an important part of every design team and are in an incredible position to be leading design projects. However, many nurses do not think of themselves as “innovators”. Nurses should enter the workforce with confidence in all these skills and realize their power to be leading innovators – including design thinking courses in the undergraduate curriculum will go a long way in providing that confidence.

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