The Art of Nursing: Visual Thinking Strategies (With Dr. Meg Moorman)

Using art to teach nursing is not traditional, but it's incredibly effective. UNLV School of Nursing alumna (and newly named Fellow to the National League for Nursing's Academy of Nurse Educators) Meg Moorman explains how she's made nationally regarded breakthroughs employing this strategy. Recorded 9/28/2022

Joe Gaccione 0:02
Welcome to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. Picture this, your nursing students staring at a piece of art. Could be a bowl of fruit, could be a statue. You're asked about what you see, what it means to you. This isn't recreation; this is designed to make you a stronger nurse. But what does art have to do with health science? Actually more than you might think. Joining us to explain this seemingly odd connection today is Dr. Meg Moorman, UNLV Nursing alumna from 2013. She earned her PhD in Nursing Education from UNLV and currently holds a number of roles at Indiana University, including clinical associate professor, MSN coordinator, and director of the faculty innovating Nursing Education Center. In fact, this art related concept and the teaching method behind it is the main reason Dr. Moorman is in town this week. She's going to be officially inducted into the National League for Nursing 2022 Academy of Nurse Educator fellowship at the Education Summit here in Las Vegas. Dr. Moorman, thanks for coming in.

Meg Moorman 1:04
Thanks for having me, Joe.

Joe Gaccione 1:05
So the primary reason for your induction is your work with Visual Thinking Strategies, or VTS. Can you explain what VTS is and how it can relate to nursing?

Meg Moorman 1:13
Sure. So, VTS, or Visual Thinking Strategies, was developed by a developmental psychologist, Abigail Housen, and Philip Yenewine was an art educator. And it was developed to get art museum visitors more engaged with art. So, they asked three questions: what's going on in this painting, what are you seeing that makes you say that, and what more can we find? And it's a teaching strategy that is used to talk about art, but it's based on the educational philosophies of Vygotsky, Lev Vygotsky, who's a Russian educational philosopher, and he really believed that social learning was where it was at, that people really learned better when they took the classroom knowledge and engaged with it in social settings. And that's kind of what we do with VTS, we actually take students out of the classroom, oftentimes, we go to an art museum, although you can do it virtually, you can do it in a classroom and use works of art or pictures in the classroom, but you have discussions about the work of art. And so, it's been pretty well studied in K through 12, but I have been the first person to really do a lot of it in nursing education.

Joe Gaccione 2:22
Can you talk a little more about how it applies to nursing education?

Meg Moorman 2:25
Sure. Well, when I first encountered it, I had, someone said, “Oh, they're doing this at the Indianapolis Museum of Art. Why don't you take your nursing students?” and I didn't really know what to expect, but I had heard that it worked really well with medical students. So, we had a facilitator at the IMA who actually engaged with the students and I just observed. And what I saw was that students who would not engage in the classroom, they didn't answer questions, they didn't participate, they just kind of sat there in their, their desks, they got really involved with this process. And that's what fascinated me about it. And I also noticed that students were noticing things in the painting, small details that I hadn't seen, some of the works of art I had seen before, but they were noticing things that I had never seen, even after repeated exposures to the artwork. So, I was really interested in what's this group dynamic and how are people engaging with the art and what is the facilitator doing to draw these students out who normally wouldn't participate? And so, that's what I did my dissertation in, what meaning does Visual Thinking Strategies have for nursing students and I started using it more frequently in my classrooms. And then I saw this transition: students were using the tools that they learned from the Art Museum to engage with other health care providers in the clinical setting. So, they really had much more keen observational skills. They were much more thorough in their descriptions of disease. They were much more thorough in giving report to other caregivers or the healthcare team and they were much more likely to participate in the classroom. So, I really found it translated in a lot of ways, specifically, observational skills were improved because they were giving visual evidence for what they saw, based on that experience with the artwork and they were much more engaged in the healthcare team. They were, they felt more free to open up and talk because Visual Thinking Strategies is about listening to all of the interpretations and holding all of those as possibilities and having significant meaning. And then you get a more thorough understanding because everyone in the healthcare team really participates in the care of the patient in different ways and they see things that other health care workers may not see.

Joe Gaccione 4:36
And that has to be incredibly insightful when you're dealing with a patient and you pick up on certain nuances or certain visual cues that someone who might be more textbook or maybe just more database driven might not pick up, they might just go, “Well it either fits in this category or that category,” but someone who looks and says, “Oh, the lips, do you know that their lips are a little blue?” like that can mean maybe they're lacking oxygen or something like that

Meg Moorman 5:01
Exactly. And I think we kind of talked about that, those very subtle cues that a patient might be giving. A really seasoned nurse who has a lot of experience will notice those not even consciously, but she will start noticing or he will start noticing some of those subtle changes. So, for example, when someone's in respiratory distress, if we can catch that early, we're going to prevent a lot of bad outcomes. And one of the ways to do that is just to be able to articulate those very subtle changes. So, they're retracting, or they have that circumoral cyanosis, that blueness around their lips. And if we can teach nurses, young nurses, to notice those things early on, and to articulate it and not be afraid to speak out, sometimes nurses are their own worst enemy. They are afraid they don't know it, they don't want to seem stupid. And sometimes that translates in the classroom, we can teach in a way that minimizes students. So, if we ask a question, it's usually a yes or no, or right or wrong, but if we allow and kind of engage with students and ask some follow up questions, it really informs our teaching. So, Visual Thinking Strategies is kind of a vehicle to really explore a lot of experiential learning and active learning in the classroom, and then they can translate that into clinical practice. So, you're right, those subtle changes are what we want them to notice early on and articulate. And it's really important that they say what they see, and they give evidence for it, evidential reasoning.

Joe Gaccione 6:28
And obviously, you don't have to be an expert in art to succeed in this, it has no relevance at all, whether or not you like art or appreciate art.

Meg Moorman 6:36
You know, it's funny, two weeks ago, I was working with some colleagues on our Bloomington campus at Indiana University, and we were looking at a Frida Kahlo work of art, which I've probably looked at this artwork at least seven or eight times. And so, we were having a discussion about whatever you see, what's going on in this painting, and one of the students said it was a, it was a, it was a portrait of Frida Kahlo. One of the students said, “Well, I think she looks sad.” And I said, “Well, what are you seeing that makes you think she looks sad?” And she said, “Well, there's these little tears all around her eyes.” I had never seen that before. And I had looked at this work of art many times and had never noticed it. So, students, I mean, all of us have something to contribute. And if we can get the healthcare team to speak out and notice these things, it gives us a more complete picture, so to speak, of what's going on with the patient. And sometimes I think healthcare workers are afraid to, we have a lot of hierarchy in the health care team. And so, people are afraid to speak out, even if they see something wrong, they may hesitate to speak up because they don't want to feel stupid or irrelevant. But really, if we can kind of get rid of those hierarchies and really work as a team, we are going to give better care to our patients and have better outcomes. And art is just a vehicle to kind of help us learn to do that in a safe way.

Joe Gaccione 7:47
VTS, as we mentioned before, is the main cause for your induction to the fellowship for NLN Academy of Nurse Educators. When did you realize, was there a moment where you thought, “This research is bigger than I expected it would be,” like you're starting to get more attention? Was there a moment or was it more gradual?

Meg Moorman 8:03
I think it was gradual. I mean, the big impact for me was the first time I saw it and I witnessed it in the art museum. I was blown away by it, I knew something was happening there that I wanted to capture. And I still don't know that I can capture it because what I think it's going to do every time is a little bit different. So, it gives students a voice and makes them feel validated. Um, but it also helps them to learn to question things in the healthcare team and I think that that has always been, when I did my dissertation, and I interviewed students, I did in depth interviews with students who had already been doing Visual Thinking Strategies and I was really impressed by how they were using it in their nursing. And then a couple of years ago, I got a call from a nurse at our Children's Hospital, which is right across the sidewalk from our campus, and she said, you know, she was doing a Nurse Residency Program, she was in charge of it and had started and had trained over 700 nurses and helped augment them through their, from graduation in nursing school to their first year of nursing that kind of in between, so we call that a residency, and she said, “I'm using Visual Thinking Strategies, and I wondered if you'd come over and facilitate a conversation,” and I said, “Sure. I'm just curious, how did you hear about Visual Thinking Strategies?” And she said, “I had you in undergraduate and you did it for us in class,” and I had no idea. I mean, I had 140 students in my lecture, but it meant enough to her that she had started doing her own work with it, and working with new nurses in this Children's Hospital. So, I've helped her with some of that and I'm using it kind of statewide, we're actually using it with nurses in hospital settings, which is another big kind of an aha moment. I mean, they really appreciate it's a different way of thinking and of seeing and communicating.

Joe Gaccione 9:42
There's nurse education, there's nurse science, but in previous conversations, you've said that there is a science to nurse education. Can you explain a little more about that?

Meg Moorman 9:50
Sure. So, in clinical practice, we want to use the best evidence to get the best outcomes for patients. We want to do things that have been studied, that are safe, that have science behind it, right? In education, we use the same theory. We want to use educational strategies that have been studied and that we have outcomes that measure, “Are we doing what we say we're doing?” So typically, in medical education in general, or in a lot of educational practices, we have what we call the sage on stage: “I'm the professor, I have all of the knowledge, I will impart it to you, and you will absorb it and use it effectively.” And we know that doesn't really work very well. So, I'm really interested in that dynamic between the professor and the student and how we can work together and we have mutual respect and we learn together. And we expose students to different ways of learning. So, some students will doodle while they learn and we know that that actually synthesizes learning, that people who do it will actually retain more than people who don't, we know that some people are kinesthetic learners, they need to use their hands to actually practice. So, we use simulation and we have practice models that they can practice starting an IV, they really have that muscle memory that they need to develop. Other people are auditory learners and so, they might use a podcast or listen to a lecture over and over. So, I want to really understand what's the science say, it's not that, “Oh, this is a fun activity in class, and it makes it less boring.” Can it really affect your learning and help you retain and develop skills? We're really interested in that in nursing now because as nurses graduate from school, and they come into practice, we want them to have some kind of clinical reasoning. And that's kind of the new catchphrase in nursing education. We want them to be able to use their book smarts, but also use that knowledge from practice and that experiential learning that kind of homes in and helps them to tune in quicker and sooner to things that are going on and help to that transition to practice.

Joe Gaccione 11:48
There are different ways educators can innovate when it comes to teaching their students, we just talked about VTS, there's also gamification, there's virtual reality in clinical simulation. Is there a point though, where this might sound strange, you can't get too innovative, because at the end of the day, you want to show the information in a different way that the students can retain, but do you have to make sure that you don't go so far where it almost you almost missed the point of why you were doing it in the first place?

Meg Moorman 12:14
I think it's great if you have fun and you're learning. There's, I want to augment that as much as possible. But if it's just fun, and you're not retaining any knowledge, and you're not able to apply it to the clinical situation, it's probably not productive and that's what the science of nursing education is. So, we know, and there are a lot of studies coming out about escape rooms and that there's a lot of information about, people are doing research, do escape rooms really help students to retain information? And they do, so you can have fun and learn at the same time. So, there is more and more being studied about gaming in the classroom to help retain information. And that's, that's very important. So, I have no problem with having fun and learning. I think that's great. But we want science that says, does it change our outcomes? And it's not just, can they pass their boards, but are they going to notice those subtle changes? Can we see differences in patient outcomes based on the educational strategies that we use to help teach information? So, experience is a really good way to learn and so, we do clinical learning, but is there something in the classroom that we can do that kind of helps bridge that gap between the classroom and the clinical situation?

Joe Gaccione 13:20
Your nursing path is incredible, professionally and personally, but it almost didn't happen. You came from a family of health professionals. Your mother was a nurse, but she didn't inspire you to become a nurse did she?

Meg Moorman 13:30
Well, you know, I hate to say she didn't inspire me because she inspired me in so many ways. She didn't encourage me to go into nursing. I mean, my dad's a pharmacist, I have a sister who's a physician. I mean, we, there's a lot of health care workers in our family. I just wasn't interested in it at all. And I was, you know, I was gonna go into business, I thought, “Oh, I can, I get to travel that way, I love to travel,” but I had a friend who was a nurse who took me to watch a delivery and that was life changing for me. And even though I didn't like blood, and I didn't like needles, I knew there was something there. I just happened to luck into it that she took me into watch a delivery that got me inspired to become a nurse, and specifically a labor and delivery nurse.

Joe Gaccione 14:14
For the general public, what does it mean to be inducted into the National League for Nursing Academy of Nurse Educator fellowship? How does this rank if we're talking in the world of nursing like for, for an average joe like me?

Meg Moorman 14:25
I, you know, I'm not sure that I understand it clearly. For me, it's huge because the National League for Nursing is our, our body of health care professionals who are teachers, nurse educators across the country. So, there's over 42,000 members. I've been going to the NLN meetings, every year they do an education summit. So, it's faculty and nurses from all over the country who educate nurses, and that's at undergraduate and graduate and doctoral level DNPs. So, we have, we have nurses from, 42,000 nurses. So, I've always come to these meetings because the, the conferences are based on what's the latest research or data show about the best way to teach this or that. And so, it's really hands on knowledge about what might work in the classroom. So, that's the reason I've always come to it. I really honor this organization, I've always, you know, had a lot of mentors who are in this organization, and I knew about the ANEF, it never occurred to me that I would be inducted into it. And then a friend said, “You know, you might think about applying,” and I had a couple of mentors, who, Dr. Diane Billings and Dr. Marilyn Orman, who are kind of the gurus of nursing education, and they actually wrote my letters of nomination for me. So, I am just completely honored and a little, very humbled to be asked to be in it because it's like the epitome of Nursing Education Awards. For me, I think it's, it's just a huge honor.

Joe Gaccione 15:51
If people want to learn more about your work, or just VTS in general, where are the best places they should go look?

Meg Moorman 15:57
Well, there is a website called and it is an organization that teaches and trains educators across the country, especially, especially K through 12, but they also do art education, museum educators. So, they have workshops, where you can be trained in Visual Thinking Strategies. And then of course, on Google Scholar, you can, you can go in and find, or CINAHL, which are some of the nurse repositories, you can find articles about Visual Thinking Strategies. And there are more and more nurse educators who are using it. We've got a couple of studies going on in graduate programs, and, and then again, we're starting to do some work in clinical education in the hospitals. So, I think it's much more prevalent. It's been studied in medicine a little bit. I just read an article that, a research study that some midwives did using Visual Thinking Strategies, so it can be used in a lot of different professions. There's there are more and more articles and more and more science being done to find out exactly what does this VTS do, how does it manifest, and it has potential for a lot.

Joe Gaccione 17:05
Well, Dr. Moorman, thank you very much for coming in. That's all the time we have for today.

Meg Moorman 17:08
Thank you, Joe.

Joe Gaccione 17:09
Congratulations again on your induction. For everyone listening out there. Have a great day.

Creators and Guests

Margaret Moorman
Margaret Moorman
UNLV Nursing alumna; Director of Faculty Innovating for Nursing Education at Indiana University School of Nursing
The Art of Nursing: Visual Thinking Strategies (With Dr. Meg Moorman)
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