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Improvisation as an Adaptive Strategy for Occupational Therapy Practice

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Abstract

ABSTRACT As health care environments become increasingly complex, practitioners must develop new adaptive skills to master practice. The idea of using theatrical improvisation (improv) in health care is relatively new. Occupational therapy students were taught a module of improvisational techniques as part of an academic seminar, learning improvisation rules, and enacting solutions to typical daily professional challenges. The purpose of this article is to recommend improvisational techniques as an adaptive skill to effectively blend art and science for occupational therapy practice in fast-paced and unpredictable health care environments.

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... 2,3 These courses have shown great promise in enhancing students' communication skills as well as providing an enjoyable environment for learners. 4,5 Our institution launched its inaugural medical improv elective in 2019, inspired by Katie Watson's work. 6 Our elective was crafted after training with Watson and adopting many aspects of her curriculum for medical students. ...
... The benefits of improv are immense, and its application in medical education has shown promise in improving student communication, empathy, and teamwork. 4,5 We have seen this firsthand at our institution, with many students thoroughly enjoying their experience and confirming personal benefit gained from participation. The challenges faced due to COVID-19 provided a unique environment to practice the principles of improv and attune, adapt, and commit to the situation at hand. ...
... Therefore, the specific framework of improv may be a crucial component of the training of healthcare providers, and this role needs to be clarified. Recently, an increasing number of publications on this topic have emerged (4,5,(10)(11)(12)(13)(14)(15)(16)(17)(18). This has led us to bring together health, psychology, and art in an unexpected but harmonious mix. ...
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From practising a procedure, such as a lumbar puncture to explaining the aim and method and listening to concerns, the practice of health professionals requires a range of skills, often classified into technical and non-technical skills. Gestures and procedures can be taught, and as can empathy and communication skills. This article introduces an innovative approach to unite both necessary skills.The specific framework of improvisational theatre (improv) has widespread application, including the training of health professionals (health training improv). By sharing close context and skills, health training improv provides a valuable, safe and effective learning environment, which allows practitioners to practice exercises and situations that align with objectives.We created a transdisciplinary team to develop Health Professional Training Improv (HPTI), bringing together the fields of health, psychology, simulation and arts. Since 2019, various health student groups (nurses, midwives, medical doctors, speech therapists) participated in a 16-hour applied improv training under the supervision of a professional improv facilitator. Additionally, drama students completed applied improv for health courses to act as simulated patients, with a view to transdisciplinary improv simulation sessions at SimUSanté (a multidisciplinary health simulation facility located in France).Students' feedback emphasized their interest in HPTI, the realism of the simulation session and the skills they felt had improved. This feedback needs supplementation with quantitative data from standard assessments. This rich pedagogical and research framework development, based on a transdisciplinary approach, has brought together different fields to prepare students for real patients encounters. It is essential to sustain this training and conduct research to evaluate the curricula.
... The idea of 'applied improv' takes the principles of improv (deep listening, disciplined acceptance, selfawareness, spontaneity, and teamwork) and uses them in various contexts. Applied improv has been widely used in business and other fields over the past few decades with varying degrees of success [10,11]. In more recent years, applied improv has gained popularity in medical education. ...
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Medical students experience rising rates of burnout throughout their training. Efforts have been made to not only mitigate its negative effects, but also prevent its development. Medical improv takes the basic ideas of improvisational theatre and applies them to clinical situations. Given improv’s focus on self-awareness and reflection, in addition to its spontaneous nature, we hypothesized it had the potential to serve as a creative outlet, a way to prevent and/or mitigate the negative effects of stress, burnout, and fatigue, and provide a learning environment to develop skills necessary to succeed as a physician. University of California (UC) San Diego School of Medicine developed a medical improv elective for pre-clinical students and assessed its effects on student development and wellbeing. Students enrolled in the elective between Fall 2019 and Fall 2020 at UC San Diego School of Medicine were surveyed pre- and post- course completion using both qualitative and quantitative methods. Students noted significant improvement in domains related to proactivity in their professional career (3.15 to 4.00, p = 0.02), wellbeing (3.0 to 4.4, p < 0.001), engagement with their studies (3.85 to 4.52, p = 0.02), and communication (3.75 to 4.3, p = 0.04) after completion of the medical improv elective. We describe a pilot-study demonstrating the positive effects of improv on medical student wellbeing and professional development, laying the groundwork for both future study of improv on student wellness and its implementation in the pre-clinical curriculum.
... Within the competencies course, students discussed the purpose and format of OSCE, scenario prompts, contingency plans, timing, station formatting, etc. In preparation for OSCE, students practiced improvisational skills for unexpected events (Krusen, 2012). Students also performed sample OSCE scenarios in various roles as patient, family member, practitioner, supervisor or rater. ...
Article
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Objective Structured Clinical Examinations (OSCE) are commonly used across health professions educational programs to evaluate student clinical competencies. OSCE are multiple, brief stations representing common practice scenarios. The purpose of the study was to evaluate student perceptions of OSCE. The researchers implemented 17 OSCE stations with 40 second year occupational therapy students to assess clinical competencies prior to fieldwork. Applying a qualitative descriptive methodologic approach, researchers analyzed station rating data, Qualtrics survey Likert-type items, and Qualtrics survey open-ended responses. Number of station rating responses varied widely, due to perceived time press. Station rating responses confirmed the more robust 80% response to Qualtrics survey. Analysis of Likert-type items revealed perceptions of OSCE as comprehensive, mixed eustress and distress, confirming of competence, and supportive of growth. Four dimensions of learning emerged from analysis of open-ended items: temporal, real world, bottlenecks to learning, and being open to the process. Findings affirmed student perceptions of OSCE to be valuable as summative and formative assessment of clinical competence. Existing literature supports three of the four dimensions of learning. The researchers advocate additional research to examine bottlenecks to learning, psychometrics of OSCE, the use of OSCE in program evaluation, and longitudinal study of student performance related to OSCE.
... Four papers applied an occupational adaptation framework to occupational therapists adapting to specific workplace stressors such as cost containment or managed care [41,78,114], or to challenges to practice [115]. Ten papers discussed the use of occupational adaptation as a framework taught in occupational therapy curriculum including practice education, with Galvis, Ishee [40] highlighting how it could bridge the gap between theory and practice. ...
Article
Background: Occupational adaptation is a key occupational therapy concept, yet lacks clarity and consensus, impacting on its application in practice, theory and research. Concept analysis is a rigorous methodology which enables identification of unique features, gaps in knowledge, and the need for further concept refinement. Aim: This study aimed to determine the conceptual maturity of occupational adaptation, and identify steps needed to understand and use occupational adaptation. Methods: Four databases were searched using the term ‘occupational adaptation’ and a principle-based concept analysis was conducted from epistemological, pragmatic, linguistic, and logical perspectives. A mapping of the concept’s evolution and analysis of the maturity of its structural features also occurred. Results: Seven hundred and fourty-eight papers were identified, which reduced to 161 after abstract and full-text review. A diverse range of applications and two primary theoretical frames of reference were identified. The definition, attributes, preconditions, outcomes, and boundaries of the concept lacked maturity, limiting clinical utility. Conclusions and significance: Occupational adaptation is a concept applied across many practice and research contexts, yet the concept is not fully mature. Concept refinement is required before further applied research is conducted. A shared understanding of occupational adaptation through refinement and research may consolidate its importance and future utility.
... Students engaged in improvisation scenarios supporting development of critical thinking as an adaptive skill. The authors encouraged students to generate potential solutions for unpredictable daily practice (Krusen, 2012). Course participants also reviewed standard professional behaviors needed for any client interaction, and therefore for each OSCE station. ...
Article
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Objective structured clinical examinations (OSCEs) are a series of controlled, timed stations in which students demonstrate clinical skills. OSCEs are commonly used within health professions education to demonstrate competence, prepare for clinical education, and conduct program evaluation. The body of literature addressing the use of OSCEs in occupational therapy (OT) is growing; however, there are no available guidelines for developing an OSCE specific to the profession. The purpose of this paper is to describe the design of an OSCE for OT students prior to fieldwork placement. Twelve OT practitioners participated in a modified-Delphi method to generate possible OSCE scenarios. The authors developed a blueprint, designed items, implemented an OSCE, and collected data. Quantitative analysis suggests OSCEs to be valid assessment of clinical skills. Qualitative analysis suggests students perceive OSCEs to be stressful but valuable learning experiences. The authors are conducting additional analysis of outcome data, exploring the utility of OSCEs as a strategy to assess clinical competence in OT. Stakeholders concurred with the need to investigate the experience of learning through doing. The authors believe OSCEs could address universal professional rather than program specific clinical competencies.
... In fact, student scores on the standardized patient examination used to assess communication skills learned during the course were markedly higher in the three years after the addition of the improv module than in prior years. After participating in an improv seminar, occupational therapy students reported that skills they learned were valuable for providing a foundation on which to improve professional communication and patient interactions (Krusen, 2012). Additionally, the Center for Communicating Science has theorized that improv workshops offered at the Center will improve scientists' ability to distill their messages for better access to laypeople (Center for Communicating Science, n.d.). ...
Article
Background: Improvisational theater exercises (improv) are used in various settings to improve mental health and medical outcomes. However, there is little documented evidence of the effectiveness of these interventions. Aims: We developed a short-term, group intervention that used improv exercises in a therapeutic manner to treat psychiatric patients. Methods: We evaluated the feasibility, acceptability and five clinical outcomes (depressive symptoms, anxious symptoms, self-esteem, perfectionism and satisfaction with social roles) of this intervention in an outpatient setting. Participants were 32 patients with symptoms of anxiety and depression and who had variable exposure to psychiatric treatment. Results: In paired samples t-tests, participants demonstrated reduced symptoms of anxiety (t(31) = 4.67, p < 0.001) and depression (t(31) = 3.78, p = 0.001), and improved self-esteem (t(31)= −3.31, p = 0.002) following the intervention. There was a trend towards reduction of perfectionism (t(31) = 1.77, p = 0.087), but no substantial change in rated satisfaction with social roles. Effect sizes were medium for reduction in symptoms of depression and anxiety. Conclusions: The results of this study indicate that a brief intervention based on improv exercises may provide a strong and efficient treatment for patients with anxiety and depression.
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Importance: The application of interpersonal skills is considered therapeutic use of self, a pillar of occupational therapy practice, and a required competency for occupational therapy education (American Occupational Therapy Association [AOTA], 2020). Medical improvisation (medical improv) uses the principles of improvisational theater to enhance professional competencies and shows promising results in health professions education (Gao et al., 2019). Objective: To understand the effect of medical improv on occupational therapy students’ therapeutic use of self. Design: A 6-wk randomized controlled waitlist trial. Setting: Occupational therapy education. Participants: A cohort of 36 occupational therapy students. Intervention: Two 2-hr sessions of medical improvisation. Outcomes and Measures: Standardized patients rated students’ therapeutic use of self with the Empathy and Clarity Rating Scale (Terregino et al., 2019), and students completed the Self-Efficacy for Therapeutic Use of Self (SETUS; Yazdani et al., 2021). Data were analyzed using independent samples t tests and multivariate mixed-methods models. Results: There was a significant difference between the intervention and waitlist control group in three SETUS subtests (modes, p = .004; traits, p = .04; total score, p = .03) and a significant interaction effect in SETUS modes (p = .03). The waitlist control group responded with comparable increases, and all participants demonstrated a significant increase in self-efficacy of therapeutic use of self after the medical improv intervention (p < .001). Conclusions and Relevance: These findings provide the first evidence for the positive effects of medical improv in building self-efficacy of therapeutic use of self in occupational therapy students. Plain-Language Summary: Medical improvisation (medical improv) in health professions education uses the principles of theatrical improvisation to build the interpersonal skills of students. This study’s application of medical improv to occupational therapy education found significant change in students’ self-efficacy of therapeutic use of self. The inclusion of medical improv in occupational therapy education can better prepare students to build and maintain therapeutic relationships.
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This article explores the parallels between improvisational theater, commonly known as improv, and active teaching. Specifically, it focuses in the impact of improv techniques on instructor and teaching assistant professional development. The implementation of an active teaching seminar is analyzed, where improv techniques were used in developing the teaching quality of teaching assistants in the mathematics department at the University of California, Santa Cruz.
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Improvisational theater (improv) is a form of theater where dialog, characters, and story are created spontaneously by its actors on stage. In the last years, different improv techniques have gained increasing popularity and spread into fields beyond comedy and performing art, e.g., business organizations and educational programs. However, the beneficial impact of improv on psychological variables has barely been investigated. In this study, we aim to fill this gap and contribute to a scientific investigation of improvisational theater on various variables that measure creativity, acceptance, and psychological well-being. In a controlled trial, 30 participants in the intervention group and 28 in the waiting control group completed six different tests and questionnaires prior and post to a 6-week improv intervention or waiting time, respectively. We found significant improvement in participants’ creativity and psychological well-being due to the intervention but no evidence for enhanced acceptance.
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As children with autism spectrum disorder become adults, social participation continues to be an area of need. Within creative arts, there is a growing body of literature about the use of theatre arts, improvisational theatre, and improvisational techniques as a way to address social participation for individuals with autism spectrum disorder. The purpose of this article is to discuss current literature related to the use of improvisation for individuals with ASD and how improvisation techniques can address social participation within occupational therapy practice. Recommendations for research-based strategies using improvisational theatre are described for occupational therapy practice in various contexts, as well as future areas of research.
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Issue: The practice of medicine is intrinsically unpredictable. Clinicians must respond skillfully to this uncertainty; therefore, medical educators are using improvisational theater training methods to teach improvisational ability in areas such as communication and professionalism. This teaching approach is called “medical improv.” Although early reports of medical improv suggest promise, the collective descriptions of curricular content lack consistency. This ambiguity creates impediments for further implementation and research of this new educational technique. To address this challenge, the author presents two unifying conceptual frameworks for medical improv curricula. Evidence: Medical improv evolved from previous work done in improvisational (improv) theater and “applied improv,” which is the broader category of improv-based training in nontheater environments. The author synthesized curricular elements from all three fields of improv into two conceptual frameworks: core curricular components (skills, principles, and exercises) and core skill groups (attunement, affirmation, and advancement). The curricular component framework simplifies terminology and clarifies a previously vague distinction between skills and principles. The skill group framework harnesses a redundant and wide-ranging list of improv skills into three categories. Together, the frameworks provide a simple structure that encompasses and organizes the core concepts of medical improv. Implications: These curricular frameworks enable educators and learners to more easily understand the scope and depth of medical improv concepts and to identify areas where medical improv could enhance existing medical education strategies. For example, there is substantial overlap between improvisation skills and current curricular objectives for communication skills, as outlined by Accreditation Council for Graduate Medical Education benchmarks (e.g., Milestones, Competencies, Entrustable Professional Activities). Medical improv courses could be an efficient way to achieve many of these objectives. In addition, improv-based exercises represent an experiential learning modality that is underutilized in communication skills training; therefore, exercises could be integrated into existing coursework to bridge the learning pathway between texts and simulation. Furthermore, the deliberate cultivation of affirmation skills could enhance resilience and wellness in clinical and learning environments. In summary, through their conceptual simplicity, these curricular frameworks for medical improv can help educators understand, study, and optimize teaching of improvisation in medical education.
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Background: The use of improvizational theater ("improv") in health professional education ("medical improv") is an emerging field. However, optimal curricular design features and learning outcomes have not yet been systematically described. Objective: To synthesize evidence on learning outcomes and curricular design elements of improvizational theater training in health professions education. Methods: A literature search with keywords "Improv" and "Improvisational Theatre" was undertaken in January 2016 in Ovid MEDLINE, CINHAL, EMBASE, SCOPUS, Web of Science, and ERIC, with an accompanying gray literature search. Four authors coded and achieved consensus on themes relating to curricular design elements and learning outcomes, which were mapped onto the CanMEDS framework. Results: Seven articles met inclusion criteria. Key curricular design features included (i) facilitators with dual clinical and theater expertise; (ii) creating a low-stakes environment; and (iii) engaging in debrief to highlight clinical relevance. Improv curricula were found to impact most CanMEDS roles, including: Medical Expert (comfort with uncertainty); Leader (team management); Scholar (feedback, self-reflection); Communicator (empathy, active listening, non-verbal communication); Collaborator (culture of trust); and Professional (resiliency and confidence). Mechanisms by which improv may promote acquisition of these professional competencies, and the utility of improv in areas such as interprofessional team development, leadership, and wellness and resiliency are discussed.
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What the hell is improvisation? / Do I take the long road or the short road? / I'll take the short one—who has time? / Improvisation is getting on a stage and making stuff up as you go along. Please, sit. Relax. Grab a beverage. I know improv usually starts with standing, and that improv is about doing things—building characters, developing narrative, you know—but this is a little different. As students of improvisation, we sometimes forget to wonder exactly what we're doing, so today, instead of practicing it, I'd like to ask: What must we do to make improv happen, and what can we do with it—what are its necessities and possibilities? After concisely defining improvisational theatre, Mick Napier treats its nature as given and concentrates on method—in other words, how do we get a "better" performance product? Napier's approach is typical of most praxis writings on improv (e.g., Halpern, Close, and Johnson; Hazenfield; Johnstone; Libera; Spolin). In contrast, this article focuses on elaborating his elegant definition and elucidating the structure of improvisational theatre within which particular acts of "improvisation" occur. Via this "long road," I assess improvisational theatre's unique characteristics and analyze both its formally necessary and optionally deployable elements. I hope to offer conceptual tools and a nomenclature for describing rules and performance organization across the spectrum of possible improv shows. By using them, we can better understand the dimensions comprising the predetermined aspects of improv, creating a system for us to invent new exercises, games, and show formats, and to modify existing ones to meet new goals or explore new territory in our work. Improvisation as a category of actions is different from improvisation as a method for action. Improvisation as a category covers any activity involving "inventiveness within limitations" (Seham xx), including our ever-present need to react to the changing circumstances of life. Improvisational theatre, instead, is a method; performers purposefully choose not to plan aspects of their performance. If actors in a scripted play forget their lines and make up new ones, or decide to ad-lib without warning other actors, this would not be "improvisational theatre," though it certainly is theatre that is invented on the spot! Improv is deliberate and agreed-upon by its performers as a pre-given structure, not a fallback position enacted when a prescribed performance fails. Improvisational theatre also needs to be distinguished from other forms of artistic improvisation. Two considerations are relevant: first, improvised art, such as expressionistic painting, automatic writing, or dancing to the radio while home alone, does not involve an audience at the time of creation; and second, the performer's body (including voice) is itself the experienced site of performance content. Improvised instrumental performances, while relying on the presence of musicians' bodies to occur, can typically be experienced as being distinct from their performers' bodies; in these cases, you usually need not give attention to the musicians themselves to fully appreciate their music. Distinguished from these cases, I define improv as the deliberate use of improvisational methods in a performance that manifests in the context of a dual matrix of immanence—that of the audience's gaze to the performers and of the performers' bodies to the audience. I call practitioners of this craft "improviers" (a term coined by fellow performer Elaine Kibodeaux). The "best" or "correct" terminology for improv performers is a matter of significant contention within the community. A lengthy forum on from late 2007 (apparently since purged in a site upgrade with the rest of that period's archives) proposes arguments for five terms specific to improv performers: "improviser," "improver," "improvisor," "improvisatore," and "improvisateur," as well as for the primacy of the more general terms "actor" and "player." I have elsewhere encountered "improvist." Given the lack of standardization, I feel it appropriate to use "improvier"—my own preferred terminology for many years. The term is a relatively simple and euphonic word referring specifically to improv performers (instead of, more generally, to "one who engages in improvised action"), which also offers a phonetic nod to both English speakers in the United States...
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Thesis--Columbia University. Bibliography : leaves 189-150. Photocopy. Ann Arbor, Mich. : University Microfilms, 1978. -- 21 cm.
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Research and development at the nanoscale requires a large degree of integration, from convergence of research disciplines in new fields of enquiry to new linkages between start-ups, regional actors and research facilities. Based on the analysis of two clusters in nanotechnologies (MESA+ (Twente) and other centres in The Netherlands and Minatec in Grenoble in France), the paper discusses the phenomenon of technological agglomeration: co-located scientific and technological fields associated to coordinated technology platforms to some extent actively shaped by institutional entrepreneurs. Such co-location and coordination are probably a prerequisite for the emergence of strong nanoclusters
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A theoretical perspective designed for clinical application and based on fundamental occupational therapy principles is offered. This perspective, the occupational adaptation frame of reference, is presented as an articulation of (a) a normal developmental process leading to competence in occupational functioning; (b) the process through which the benefits of occupational therapy occur; and (c) a perspective that promotes holistic practice. The person is viewed as operating occupationally through an idiosyncratic configuration of sensorimotor, cognitive, and psychosocial systems, all of which are inevitably involved in each occupational response. This occupational functioning is described as occurring through interaction of the person with a work, play and leisure, or selfcare context that has distinctive physical, social, and cultural properties (i.e., the occupational environment). Occupational adaptation is a perspective that can influence practice, education, and research.
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The purpose of this study was to test the validity of a model of professional development that was based on occupational adaptation. This model proposes that students have three classes of adaptive response behaviors available for use: primitive, transitional, and mature. Eight Level II fieldwork students were assigned to the Department of Veterans Affairs Medical Center, Dallas, Texas, for 12 weeks. Experienced fieldwork supervisors at the medical center developed a taxonomy of behavioral statements consistent with the developmental model's three classes of adaptive response behaviors. This taxonomy was converted to a student log in which supervisors rated the frequency with which the Level II fieldwork students exhibited these behaviors. The patterns of behaviors, which were represented graphically for each of the students, generally supported the predictions of the model. Students demonstrated all three classes of behaviors. Primitive and transitional behaviors emerged when the students experienced increased or unusual demands, even when the students' model behavior was mature. Students temporarily reverted to lower level behaviors when faced with situations that they perceived as too difficult or as too unfamiliar. This model of professional development facilitates an understanding of students' development during their transition from classroom to practice setting. Generalization to other settings will require validation of the student log.
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This article examines the intersection of professionalism and complexity science as a source of new insights for improving the health care industry from both a clinical and business point of view. Viewing health care organizations as professional complex adaptive systems suggests eight leadership tasks for addressing the circumstances that engulf health care. Managers who adopt this view will be able to create new levers for positive movement in their organizations.
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In this paper Gadow's philosophical themes are developed considering the pedagogical relation--the relation of teacher and student, nurse and patient, self and world. Relational pedagogy is discussed through exploration of embodiment (being the teaching), improvisation (doing the teaching), and interdependence (locating the teaching in a reciprocal world as home). The pedagogical relation explores the lived space between teacher and learner, nurse and patient, where new knowledge is constructed. Such knowledge 'resounds bodily' and is always under construction.
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Improvisation has long been considered a function of music, dance, and the theatre arts. An exploration of the definitions and characteristics of this concept in relation to the art and practice of nursing provide an opportunity to illuminate related qualities within the field of nursing. Nursing has always demonstrated improvisation because it is often required to meet the needs of patients in a rapidly changing environment. However, little has been done to identify improvisation in the practice of nursing or to teach improvisation as a nursing knowledge-based skill. This article strives to explore the concept of improvisation in nursing, to describe the characteristics of improvisation as applied to nursing, and to utilize case studies to illustrate various manifestations of improvisation in nursing practice.
Position paper graduate medical education in rural practice. National Rural Health Association and American Academy of Family Physicians from http://www.aafp.org/online/en/home/policy/policies/r/fammedruralpractice
  • R Longenecker
  • T Rosenthal
  • J Stearns
  • M Woods
  • R Longenecker
  • T Rosenthal
  • J Stearns
  • M Woods
Peripheral visions: Learning along the way
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Bateson, M. C. (1994). Peripheral visions: Learning along the way. New York: Harper Collins.
Position paper graduate medical education in rural practice. National Rural Health Association and American Academy of Family Physicians A class at the imrov: Using improv as a health education teaching technique
  • R Longenecker
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