Innovative Teaching
Strategies in Nursing and
Related Health Professions
Fifth Edition
Edited by
Martha J. Bradshaw, PhD, RN
Professor
Louise Herrington School of Nursing
Baylor University
Dallas, Texas
Arlene J. Lowenstein, PhD, RN
Professor and Director
Health Professions Education Doctorate Program
Simmons College
Boston, Massachusetts
Professor Emeritus
MGH Institute of Health Professions
Boston, Massachusetts
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Library of Congress Cataloging-in-Publication Data
Innovative teaching strategies in nursing and related health professions /
[edited by] Martha J. Bradshaw and Arlene J. Lowenstein.—5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7637-6344-2 (alk. paper)
ISBN-10: 0-7637-6344-6 (alk. paper)
1. Nursing—Study and teaching. I. Bradshaw, Martha J.
II. Lowenstein, Arlene J.
[DNLM: 1. Education, Nursing—methods. 2. Teaching—methods. WY 18
I589 2011]
RT71.F84 2011
610.73071—dc22
2009038851
6048
Printed in the United States of America
14 13 12 11 10 10 9 8 7 6 5 4 3 2 1
Dedication
To teachers—past, present, future.
May you always inspire, uplift, and transform.
iii
Contents
Preface
Contributors
SECTION I: FOUNDATIONAL APPROACHES TO
TEACHING AND LEARNING
Chapter 1. Effective Learning: What Teachers Need to Know
Martha J. Bradshaw
Chapter 2. Diversity in the Classroom
Arlene J. Lowenstein
Chapter 3. Strategies for Innovation
Arlene J. Lowenstein
Chapter 4. Critical Thinking in the Health Professions
Patricia R. Cook
Chapter 5. The Teaching–Learning Experience from a Generational Perspective
Lynda Pesta
Chapter 6. Esthetic Action: Creativity as a Collaborative Process
Ellen M. Landis
Chapter 7. Lighten Up Your Classroom
Mariana D’Amico and Lynn Jaffe
v
vi CONTENTS
Section ii: teaching in Structured SettingS
Chapter 8. Lecture: Reclaiming a Place in Pedagogy
Barbara C. Woodring and Richard C. Woodring
Chapter 9. Problem-Based Learning
Patricia Solomon
Chapter 10. In-Class and Electronic Communication Strategies to Enhance Reflective Practice
Lisa A. Davis, Traci D. Taylor, and Deborah Casida
Chapter 11. Debate as a Teaching Strategy
Martha J. Bradshaw and Arlene J. Lowenstein
Section iii: Simulation and imagination
Chapter 12. Games Are Multidimensional in Educational Situations
Lynn Jaffe
Chapter 13. Role Play
Arlene J. Lowenstein (Example by Shawna Patrick)
Chapter 14. High-Fidelity Patient Simulation
Catherine Bailey, Judy Johnson-Russell, and Alfred Lupien Chapter 15. The New Skills Laboratory: Application of Theory, Teaching, and Technology
Deborah Tapler and Judy Johnson-Russell
Chapter 16. Innovation in Facilitating Learning Using Simulation
Kimberly Leighton and Judy Johnson-Russell
Chapter 17. Interprofessional Education
Jeannine Salfi and Patricia Solomon
Section iV: educational uSe oF technology
Chapter 18. The Use of Video in Health Profession Education
Clive Grainger and Alex Griswold
Chapter 19. Multimedia in the Classroom: Creating Learning Experiences with Technology
Karen H. Teeley
Contents vii
Chapter 20. Electric Communication Strategies
Gail Matthews-DeNatale and Arlene J. Lowenstein
Chapter 21. Web 2.0 and Beyond: Emerging Technologies That Enhance Teaching and Learning
Gail Matthews-DeNatale
Chapter 22. Blended Learning
Arlene J. Lowenstein
Chapter 23. Distance Education: Successful Teaching–Learning Strategies 353
Kathy P. Bradley and Sharon M. Cosper
Chapter 24. Web-Based Instruction
Judith Schurr Salzer
Section V: teaching in unStructured SettingS
Chapter 25. Philosophical Approaches to Clinical Instruction
Martha J. Bradshaw
Chapter 26. Crafting the Clinical Experience: A Toolbox for Healthcare Professionals
Stephanie S. Allen and Llewellyn S. Prater
Chapter 27. Nursing Process Mapping
Suzanne Sutton and Charlotte J. Koehler
Chapter 28. The Preceptored Clinical Experience
Brian M. French and Miriam Greenspan
Chapter 29. Student Learning in a Faculty–Student Practice Clinic
Jennifer E. Mackey, Marjorie Nicholas, and Lesley Maxwell Chapter 30. Service Learning
Hendrika Maltby
Chapter 31. Study Abroad as a Strategy for Nursing Education: A Case Study
Carol Holtz and Richard L. Sowell
viii Contents
Section Vi: eValuation
Chapter 32. Programmatic Evaluation
Jill M. Hayes
Chapter 33. Assessment of Learning and Evaluation Strategies
Eric Oestmann and Joanna Oestmann
Chapter 34. Student Evaluation of Teaching
Jill M. Hayes
Chapter 35. The Clinical Pathway: A Tool to Evaluate Clinical Learning
Martha J. Bradshaw
Chapter 36. Evaluation of Teaching Resources
Jill M. Hayes
Index
Preface
This edition of Innovative Teaching Strategies in Nursing and Related Health Professions continues the theme of interdisciplinary collaboration in health professions education. The need to capitalize on the contributions of numerous healthcare professionals is increasingly more important in light of the current, complex healthcare system. Education has a knowledge base that crosses over disciplinary lines and is one we need to understand in order to be effective in our work.
This book incorporates educational principles and techniques suitable for students in all higher education settings, at the graduate or undergraduate levels.
More attention has been given to use of various forms of technology, although it is never possible to present all methods and versions that are available. What needs to be remembered by educators is that technology is the means, not the ends, to teaching effectiveness. It is the individual teacher who makes decisions based upon best educational principles, about what strategy or form of technology to use in order to meet goals in the learners. The diversity of learners has increased on all levels of higher education. A new chapter in this book covers generational diversity in both learners and faculty, and provides approaches for greater accord in the teaching–learning process among age groups.
It is our intent that this book will be a useful resource for educational programs in all health professions.
Martha J. Bradshaw
Arlene J. Lowenstein
ix
Contributors
Stephanie S. Allen, RN, MSN
Patricia R. Cook, PhD, RN
Louise Herrington School of Nursing
University of South Carolina–Aiken
Baylor University
School of Nursing
Dallas, Texas
Aiken, South Carolina
Catherine Bailey, PhD, RN
Sharon M. Cosper, MHS, OTR/L
College of Nursing
Medical College of Georgia
Texas Woman’s University
SAHS, Department of Occupational
Dallas, Texas
Therapy
Augusta, Georgia
Kathy P. Bradley, EdD, OTR/L, FAOTA
Mariana D’Amico, EdD, OTR/L
Medical College of Georgia
Medical College of Georgia
Professor and Chairperson
SAHS, Department of Occupational
Department of Occupational Therapy
Therapy
Augusta, Georgia
Augusta, Georgia
Martha J. Bradshaw, PhD, RN
Lisa A. Davis, PhD, RN
Louise Herrington School of Nursing
West Texas A & M University
Baylor University
Canyon, Texas
Dallas, Texas
Brian M. French, RN, MS, BC
Deborah Casida, MSN, RN
The Institute for Patient Care
West Texas A & M University
Massachusetts General Hospital
Canyon, Texas
Boston, Massachusetts
xi
xii Contributors
Clive Grainger
Judy Johnson-Russell, EdD, RN
Harvard-Smithsonian Center for
Clinical Educator, Medical Education
Astrophysics
Technologies, Inc.
Cambridge, Massachusetts
Professor Emerita, Texas Woman’s
University, Dallas
Sarasota, Florida
Miriam Greenspan, RN, MS
Brigham and Women’s Hospital
Boston, Massachusetts
Charlotte J. Koehler, RN, MSN
Mary Black School of Nursing
University Center Greenville
University of South Carolina,
Alex Griswold, AB
Upstate
Harvard-Smithsonian Center for
Spartanburg, South Carolina
Astrophysics
Cambridge, Massachusetts
Ellen M. Landis, PhD, ADTR
Adjunct Faculty Lesley University
Jill M. Hayes, PhD, RN
Division of Expressive Therapies
Professor Emeritus
Clinical Director, Sharevision Inc.
School of Nursing
Family Counseling and Consulting
North Georgia College and State
Group
University
Amherst, Massachusetts
Dahlonega, Georgia
Kimberly Leighton
Carol Holtz, PhD, RN
Bryan LGH College of Health Sciences
Kennesaw State University
Lincoln, Nebraska
Kennesaw, Georgia
Arlene J. Lowenstein, PhD, RN
Lynn Jaffe, ScD, OTR/L
Professor and Director, Health
Medical College of Georgia
Professions Education Doctoral
SAHS, Department of Occupational
Program
Therapy
Simmons College
Augusta, Georgia
Professor Emeritus
MGH Institute of Health Professions
Boston, Massachusetts
Contributors xiii
Jennifer E. Mackey, MA, CCC-SLP
Eric Oestmann, PhD, PT
MGH Institute of Health Professions
OEI Consulting
Department of Communication
Bradenton, Florida
Sciences and Disorders
Boston, Massachusetts
Dr. Joanna Oestmann, LMHC, LPC,
LPCS
Hendrika Maltby, PhD, RN, FRCNA
OEI Consulting
College of Nursing and Health
Bradenton, Florida
Sciences
University of Vermont
Burlington, Vermont
Shawna Patrick, RN, MS
Nurses for Nursing
Snowmass, Colorado
Gail Matthews-DeNatale, PhD
Associate Dean, Graduate and
Lynda M. Pesta, RN, MSN
Professional Programs
Louise Herrington School of Nursing
Emmanuel College
Baylor University
Formerly Interim Director
Dallas, Texas
Academic Technology
Simmons College
Boston, Massachusetts
Llewellyn S. Prater, RN, MSN
Louise Herrington School of Nursing
Baylor University
Lesley Maxwell
Dallas, Texas
MGH Institute of Health Professions
Department of Communication
Sciences and Disorders
Jeannie Salfi, PhD, RN
Boston, Massachusetts
McMaster University
School of Nursing
Faculty of Health Sciences
Marjorie Nicholas, PhD
Hamilton, Ontario, Canada
MGH Institute of Health Professions
Department of Communication
Sciences and Disorders
Judith Schurr Salzer, PhD, MBA, RN,
School of Health and Rehabilitation
CPNP
Sciences
Medical College of Georgia
Boston, Massachusetts
School of Nursing
Augusta, Georgia
xiv Contributors
Patricia Solomon, PhD, PT
Traci D. Taylor, RN, MSN
McMaster University
West Texas A & M University
Faculty of Health Sciences
Canyon, Texas
School of Rehabilitation Science
Hamilton, Ontario, Canada
Karen H. Teeley, MS, RN, AHC-BC, CNE
Simmons College
Richard L. Sowell, PhD, RN, FAAN
Boston, Massachusetts
Kennesaw State University
WellStar College of Health and Human
Services
Barbara C. Woodring, EdD, RN
Kennesaw, Georgia
Georgia State University
Byrdine F. Lewis School of Nursing
Atlanta, Georgia
Suzanne Sutton, RN, MSN
Mary Black School of Nursing
University Center Greenville
Richard C. Woodring, BA, MDiv, DMin
University of South Carolina,
Medical College of Georgia
Upstate
Division of Continuing Education
Spartanburg, South Carolina
Augusta, Georgia
Deborah Tapler, PhD, RN, CNE
College of Nursing
Texas Woman’s University
Dallas, Texas
SECTION I
Founda tional appr oaches t o
teaching and l earning
Creating an effective learning environment is not an easy task in today’s world, and it is even more complex in education programs for the health professions.
Students entering the field of health care are extremely diverse. Traditional undergraduates, entering college directly from high school, interact with a vast variety of nontraditional students returning to school after experiences in the workplace and/or having completed previous college degrees. There is a wide range of ages and experiences within the student body. Educators are challenged to recognize different learning needs and respect and utilize the knowledge and experiences that students bring to the learning settings. The teaching strategies and examples throughout this book may be adapted for use in a variety of situations, at undergraduate and graduate levels, taking into account the diversity of learning needs.
The chapters in Section I provide a foundation for understanding, selecting, and adapting specific teaching strategies to the educator’s setting and student body. The contributors provide a theory base for learning and critical thinking and bring in various dimensions of effective learning that include creativity, humor, and exploration of diverse viewpoints and ways of processing information.
1
CHAPTER 1
Effective Learning:
What Teachers Need to Know
Martha J. Bradshaw
Knowing is a process, not a product.
—Jerome Bruner (1966)
What brings about effective learning in nursing students? Is it insight on the part of the student? A powerful clinical experience? Perhaps it is the dynamic, creative manner in which the nurse educator presents information or structures the learning experience. Effective learning likely is the culmination of all of these factors, in addition to others. In this chapter, dimensions of effective learning will be explored as a foundation for use of the innovative teaching strategies presented in subsequent chapters. The monumental growth in the use of technology has definitely changed the teaching–learning environment. Learners also have changed in the ways they access and use information and their expectations regarding feedback. The field of health professions education is experiencing a growth in the variety of students, yet how individuals learn is essentially unchanged.
THEORIES OF LEARNING
We approach learning individually, based largely on cognitive style (awareness of and taking in of relevant information) and preferred approaches to learning, or learning style. Some students are aware of their style and preference, some gain insight into these patterns as they become more sophisticated learners, and some students have never been guided to determine how they learn best.
Theoretical underpinnings classify learning as behavioristic or cognitive. Behavioristic learning was the earliest pattern identified through research. Psychologists, such as Skinner and Thorndike, described learning as a change in behavior and used stimulus response actions as an example. Subsequent theorists have described more complex forms of behaviorist learning. Bandura’s (977) theory of social learning describes human learning as coming from others through observation, imitation, and reinforcement. We learn from society, and we learn to be social.
This type of learning is evident when we describe the need to “socialize” students to the profession of nursing.
CHAPTER 1 • EFFECTIVE LEARNING: WHAT TEACHERS NEED TO KNOW
Robert Gagne (968) formulated suggestions for the sequencing of instruction, conditions by which learning takes place, and outcomes of learning, or categories in which human learning occurs. These learning categories are based on a hierarchical arrangement of learning theories, moving from simple to complex learning, and include intellectual and motor skills, verbal information, cognitive strategies, and attitudes. For example, within the category of intellectual skills are the following stages:
• Discrimination learning: distinguishing differences in order to respond appropriately
• Concept learning: detecting similarities in order to understand common characteristics
• Rule learning: combination of two or more concepts, as a basis for action in new situations
Gagne’s ideas seem to combine behaviorism and cognitive theories. Use of behaviorism in nursing education was especially popular in the 970s and early
980s through the use of concrete, measurable, specific behavioral objectives.
Even though nursing education has moved away from the concrete methods of learning and evaluation, use of the hierarchical arrangement is seen in curriculum development and learning outcomes.
Cognitive theories address the perceptual aspect of learning. Cognitive learning results in the development of perceptions and insight, also called gestalt, that brings about a change in thought patterns (causing one to think,
“Aha”) and related actions. Jerome Bruner (966) described cognitive learning as processes of conceptualization and categorization. He contended that intellectual development includes awareness of one’s own thinking, the ability to recognize and deal with several alternatives and sequences, and the ability to prioritize. Bruner also saw the benefit of discovery learning to bring about insights. Ausubel’s (968) assimilation theory focuses on meaningful learning, in which the individual develops a more complex cognitive structure by associating new meanings with old ones that already exist within the learner’s frame of reference. Ausubel’s theory relies heavily on the acquisition of previous knowledge. These principles are useful for introducing the new student to the healthcare environment by relating information to what the student knows about health and illness. The same principles are fundamental to curriculum development based on transition from simple to complex situations.
Gardner’s theory of multiple intelligences recognizes cognition as more than knowledge acquisition. Based on his definition of intelligence as “the ability to solve problems or fashion products that are valued in more than one Approaches to Learning
setting” (Gardner & Hatch, 990, p. ), Gardner has described seven forms of intelligence:
. Linguistic: related to written and spoken words and language, and use and meaning of language(s)
2. Musical/rhythmic: based on sensitivity to rhythm and beat, recognition of tonal patterns and pitch, and appreciation of musical expression
. Logical/mathematical: related to inductive and deductive reasoning, abstractions, and discernment of numerical patterns
. Visual/spatial: ability to visualize an object or to create internal (mental) images, thus able to transform or re-create
. Bodily kinesthetic: the taking in and processing of knowledge through use of bodily sensations; learning is accomplished through physical movement or use of body language
6. Interpersonal: emphasizes communication and interpersonal relationships, recognition of mood, temperament, and other behaviors
7. Intrapersonal: related to inner thought processes, such as reflection and metacognition; includes spiritual awareness and self-knowledge (Gardner
& Hatch, 990)
Cognitive theories that address learning stages appropriate for college students include Perry’s (970) model of intellectual and ethical development. This model recognizes four nonstatic stages in which students progress: () dualism (black vs white), (2) multiplicity (diversity and tolerance), () relativism (decision made by reasoned support), and () commitment to relativism (recognition of value set for decision making). Perry’s ideas can serve to explain how critical thinking is developed over time.
APPROACHES TO LEARNING
Emerging from learning theories are descriptions of preferred styles or approaches to learning. Categorized as cognitive styles and learning styles, these approaches to learning are the ways that individuals acquire knowledge, which are concerned more with form or process than content (Miller & Babcock, 996).
Cognitive style deals with information process, the natural, unconscious internal process concerned with thinking and memory. It is the consistent way in which individuals organize and handle information (DeYoung, 2009). The most common example of cognitive style is Witkin and colleagues’ field dependent–field independent style (Witkin, Moore, Goodenough, & Cox, 977). The field dependent–field independent style describes one’s field of perception, or how one 6 Chapter 1 • effeCtive Learning: What teaChers need to KnoW
takes in information or data. Whereas one style generally predominates, people possess the capacity for both styles. Field-dependent individuals are more global, are open to external sources of information, are influenced by their surroundings, and therefore see the situation as a whole, rather than identifying and focusing on the separate aspects of it. Field-dependent people tend to be social, people oriented, and sensitive to social cues. Learners in which the field-dependent style predominates may be externally motivated and therefore take a more spectator or passive role in the learning process, preferring to be taught rather than to actively participate. Field-independent individuals are less sensitive to the social environment and thus take on a more analytical approach to information. By identifying aspects of the situation separately, they are able to restructure information and develop their own system of classification. Field-independent learners enjoy concepts, challenges, and hypotheses, and are task oriented (Miller & Babcock, 996).
An aspect of learning style related to student behavior is response style. Kagan (96) pioneered work, with school-age children, on the concepts of reflection and impulsiveness. These dimensions of cognitive response style describe personal tendencies regarding possibilities to solutions and choice selection.
Individuals who have the impulsivity tendency prefer the quick, obvious answer, especially in highly uncertain problems, thus selecting the nearly correct answer as first choice. Reflective individuals identify and carefully consider alternatives before making a decision or choice. The implications for nursing education are apparent and will be discussed further. One problem that emerges with individuals who have a strong tendency in one of these dimensions is that the impulsive individual acts too quickly, based on an instant decision. On the other hand, the reflective individual may be immobilized in decision making, which has outcomes implications.
Reflection, as associated with learning, was described as early as 96 by John Dewey as being a process of inquiry (Miller & Babcock, 996). To reflect on a situation, experience, or collection of information is to absorb, consider, weigh, speculate, contemplate, and deliberate. Such reflection serves either as a basis for reasoned action or to gain understanding or attach meaning to an experience.
The most notable descriptions of reflection, especially as related to nursing, have been presented by Schön (98). In his work, Schön related reflection to problem solving. He pointed out that traditional means of teaching and learning result in structured problem solving where the ends are clear and fixed. In the reality of health care, such ends are not always so concrete.
Schön also believes that professionals in practice demonstrate a unique proficiency of thinking, and he has described three aspects of this thinking: () knowing-in-action (use of a personally constructed knowledge base), (2) reflection-in-action (conscious thinking about what one is doing, awareness of use of Approaches to Learning 7
knowledge), and () reflection-on-action (a retrospective look at thoughts and actions, to conduct self-evaluation and make decisions for future events). Reflection results in synthesis. This outcome is evident when the individual carries over thoughts, feelings, and conclusions to other situations. Teaching includes reflection-in-action, in which the teacher spontaneously adapts to learner reactions.
Thus, reflection is the foundation for growth through experience. Reflection, as a form of thinking and learning, can be cultivated. Educators improve their teaching when they reflect on episodes of teaching that were successful, as well as those that were failures (Pinsky, Monson, & Irby, 998).
One of the best known descriptions of learning styles is Kolb’s, which emerged from Dewey’s seminal theory on experiential learning (Kolb, 98). Dewey pioneered educational thinking regarding the relationship between learning and experience. The relationship between the learning environment and personal factors such as motivation and goals can lead the learner through a stream of experiences that, once connected, bring about meaningful learning (Kelly & Young,
996). Using these ideas, Kolb went on to describe learning as occurring in stages: concrete experiences, observation and reflection on the experience, conceptualization and generalization, then theoretical testing in new and more complex situations. Learning is cyclical, with new learning coming from new experiences.
Consequently, learning occurs in a comprehensive means, beginning with performance (concrete experience) and ending with educational growth. Kolb further explained that individuals go about this learning along two basic dimensions: grasping experiences (prehension) with abstract-concrete poles and transforming, with action-reflection poles (Kelly & Young, 996). Applying his experiential learning theory to his dimensions, Kolb identified four basic learning styles:
. Convergers prefer abstract conceptualization and active experimentation.
These individuals are more detached and work better with objects than people. They are problem solvers and apply ideas in a practical manner.
2. Divergers prefer concrete experience and reflective observation. Individuals with this tendency are good at generating ideas and displaying emotionalism and interest in others. Divergers are imaginative and can see the big picture.
. Assimilators prefer abstract conceptualization and reflective observation.
Assimilators easily bring together diverse items into an integrated entity, sometimes overlooking practical aspects or input from others. Theoreticians likely are assimilators.
. Accommodators prefer concrete experience and active experimentation.
These individuals, while intuitive, are risk takers and engage in trial-and-error problem solving. Accommodators are willing to carry out plans, and they like and adapt to new circumstances (Miller & Babcock, 996).
8 Chapter 1 • effeCtive Learning: What teaChers need to KnoW
Gregorc’s (979) categorization of learning styles is similar to Kolb’s, except that Gregorc believes that an individual’s style is static, even in light of the changing educational setting. Thus, even through maturity and further learning, an individual still approaches learning in the same way. Gregorc uses the learning style categories of concrete sequential, concrete random, abstract sequential, and abstract random. In his research, Gregorc determined that individuals have preferences in one or two categories. In studying both first-year and fourth-year baccalaureate nursing students, Wells and Higgs (990) discovered that these students have preferences in the concrete sequential and abstract random categories (total 8% of first-year students, 7% of fourth-year students).
USE OF LEARNING STYLES AND PREFERENCES:
APPLICATION OF RESEARCH
Theoretical foundations regarding learning and descriptive studies of cognitive and learning styles provide insight and understanding of self. It would be difficult to address research on all modes of learning in this one chapter. A summary application of information from the vast field of knowledge about learning theory and cognitive and learning styles has been developed by Svinicki (99) as six operating principles:
. If information is to be learned, it must first be recognized.
2. During learning, learners act on information in ways that make it more meaningful.
. Learners store information in long-term memory in an organized fashion related to their existing understanding of the world.
. Learners continually check understanding, which results in refinement and revision of what is retained.
. Transfer to new contexts is not automatic but results from exposure to multiple applications.
6. Learning is facilitated when learners are aware of their learning strategies and monitor their use (Svinicki, 99, p. 27).
To understand one’s own learning styles helps understand one’s own thinking, to be aware of a fit between style and strategies for learning, and thus to select the most effective and efficient means to go about learning. Some students are aware of how they learn best and gravitate toward that strategy. Instructors see this process in students who choose to sit in the front row of the class, take many notes, and feel involved with the topic, or students who prefer online learning, choose to not come to class but instead read course material, watch Effective Teaching for Effective Learning 9
Internet clips or videos, and acquire information as it pertains to a clinical assignment. Some students adhere to tradition-bound forms of learning, such as lecture and reading, yet do not maximize their learning. This result explains why these students benefit more from direct clinical experiences. Many students find learning to be more powerful when they experience something new or significant in a clinical environment, then explore information and reflect on the experience. Learning experiences can be adapted to the environment and are influenced by the environment in which they occur. Awareness and comprehension of one’s style of learning enables one to tailor the learning environment for optimal outcomes. A simple test that will guide the student in discovering his or her learning style(s) is presented in the teaching example at the end of this chapter.
Feedback from an observer, such as the instructor, can heighten awareness of personal styles. The knowledgeable educator also can guide the student in enhancing predominant styles or in cultivating additional dimensions of thinking and responding. For example, a student who is predominantly impulsive in decision making should be guided to explore outcomes of decisions and encouraged to increase reflection time, as appropriate. Conversely, the student who is highly reflective may need to explore reasons that bring about hesitancy or prolonged deliberation and the outcomes of such behaviors.
EFFECTIVE TEACHING FOR EFFECTIVE LEARNING
A knowledgeable and insightful educator is the key to effective learning in many situations. Consequently, the educator should have a knowledge base in learning and teaching as well as an extensive repertoire of useful strategies to reach learning goals. Faculty in health professions education are challenged to be directive in their teaching, addressing measurable learning outcomes that are directly linked to professional standards. This is juxtaposed with the importance of freeing the student from linear thinking and encouraging broader approaches to learning that are accomplished through dialogue, expression, and attribution of meaning. Instructors must determine best use of time, both for themselves and for students. So, difficult decisions must be made regarding what to leave in and what to omit from teaching episodes. In the health professions, faculty have to choose between teaching for practical judgment or for disciplinary knowledge.
Specialized knowledge from within the discipline can clarify issues involved in practical situations, but it cannot determine judgment or a course of action (Sullivan & Rosin, 2008). This is where the role of the instructor, as a seasoned practitioner, is indispensible.
0 Chapter 1 • effeCtive Learning: What teaChers need to KnoW
In their research to discover attributes of successful teachers at the rank of full professor, Rossetti and Fox (2009) developed four categories this teaching success:
Presence of the teacher: “being there” or available for the students, becoming acquainted with students, and cultivating mutual respect and trust
Promotion of learning: interested in students’ learning and finding meaning in their education
Teachers as learners: staying current in the discipline and teaching strategies, and continually updating and refreshing courses
Enthusiasm: conveying an interest in the subject and passion for the work Regardless of setting—traditional classroom, clinical care, synchronous or asynchronous electronic instruction—these principles of teaching success are applicable.
As students advance in their education, their established, comfortable ways of knowing, thinking, and reflecting are challenged. This is especially true in the health professions, where students explore value systems that differ from their own and identify ethical dilemmas in practice, circumstances in which there is more than one right answer or no clear choice. In situations in which the research evidence diverges from existing paradigms that are known to students, and thus cause conflict in thinking, the instructor should be prepared to adapt and modify teaching to address this conflict (Fryer, 2008). Therefore, the instructor needs to be patently aware of their own teaching styles and how to amend style for the circumstances.
Underlying assumptions regarding the nature of professional education are derived, in part, from principles on adult learning, as formulated by Knowles (978). Key principles include assuming responsibility for one’s own learning and recognizing the meaning or usefulness of information to be learned. Students in health professions are career oriented and need to see practical value in their educational endeavors. As consumers, adult students need to believe that they are receiving the maximum benefit from learning experiences. Furthermore, taking charge of one’s own learning is empowering. Students who gain a sense of self-responsibility can feel empowered in other areas of their lives, such as professional practice. Faculty, in turn, have the responsibility to cultivate empowerment and to affect learning outcomes.
The teaching–learning experience, whether it is in a classroom environment or online, should be fresh and challenging each time the class convenes. Faculty should endeavor to provide variety in the manner in which they teach, rather than the same, predictable, albeit comfortable method of telling rather than teaching. As providers of information, instructors need to remember that learning is best brought about by a combination of motivation and stimulation. The Effective Teaching for Effective Learning
effective instructor should be the facilitator of learning in the students. In professional education, motivation is gained when the relationship to the well-being of the client is pointed out. The value of faculty experience is evident when the nurse-teacher shares from his or her own professional experiences and uses these anecdotes as examples for client outcomes. Nursing students and faculty agree that nontraditional strategies such as collaborative or cooperative learning, active involvement, and participation in the learning experience are desirable for effective learning. Students in professional education programs do respond positively to opportunities to choose or structure some of their learning experiences (Melrose, 200). This approach should be used frequently by the teacher to not only promote active learning but to instill in students a sense of empowerment, which is an important attribute for the clinical setting. Technology-based learning activities direct the student to engage in independent learning, research, and use visual cues, such as video, to enhance comprehension.
Students are more likely to remember information with which they can agree or relate, and if they can attach meaning to the item or information (DeYoung, 2009). Disagreement or disharmony should be explored in an objective fashion.
Viewpoints can then be strengthened or altered. Questioning and discussion should be based on the diversity that exists among the students. An instructor who is able to establish a sense of trust and confidence with the students can promote the expression of different perspectives likely to be found in the group. Professional educators should support students who are at various levels of cognitive growth, looking upon students from a criterion framework rather than a normative one. Faculty should show that various viewpoints are welcome, legitimate, and worthy of discussion.
Effective educators guide students to see how their thought processes occur.
They ask “what do you know about . . . ?” and “how did you arrive at that answer/
conclusion?” Teachers cultivate further development in individual learners by demonstrating how to critique a theory, develop a rationale, or work through the steps of problem solving. These strategies will facilitate growth in students who are in an early cognitive stage such as dualism, or will challenge more advanced students to a commitment to realism (Perry, 970).
Delivery of information should be based on instructional theory in addition to content expertise. Using Ausubel’s (968) principles of advanced organizer, the teacher can develop inductive discovery by which students can build on previously acquired, simplistic knowledge to develop new or broader concepts. This strategy operationalizes some of Svinicki and Dixon’s (987) cognitive principles.
Effective learning experiences that emerge from identified styles should be developed and used in both classroom and clinical settings. Information from Kolb’s four dimensions serves as an excellent example. Students who are convergers readily become bored with straight lecture, especially with topics that
2 Chapter 1 • effeCtive Learning: What teaChers need to KnoW
are abstract in nature. These individuals work better by themselves, so they are less likely to participate well in group projects. Learners with the diverger style learn from case studies and will actively participate in discussion, but they may have difficulty detaching personal values from the issue. These students often are visionary group leaders. Individuals with the assimilator style manipulate ideas well, so they will participate well in discussion or write comprehensive papers; however, these students may be less practical and have difficulty with some of the realism of clinical practice. Accommodators usually enjoy case studies, new or unusual teaching strategies, skills lab, and tinkering with new equipment.
These learners will be most responsive to a challenging, complex client. With the multitude of learning opportunities available through electronic resources and patient simulation, teachers can readily craft a learning experience that meets most learning styles and preferences.
Skiba, Connors, and Jeffries (2008) cite nursing education as the field considered by many to be the pioneer in the use of educational technology. Nursing, along with the other health professions, must face the challenges of incorporating core competencies, using emerging technologies, and practicing in informatics-in-tensive healthcare environments. However, one-way learning, such as Web-based instruction, will not fully replace competency-based instruction and verification that is needed in the applied disciplines of health care (Knapp, 200).
In the clinical setting, the instructor may wish to provide introductory motivation through discovery learning. One way to accomplish this goal is to have each student observe or follow an individual in the clinical setting to gain exposure to the myriad tasks and responsibilities of a professional healthcare provider.
Whereas students may have some rudimentary ideas of what healthcare providers do, they discover the depth and demands required in day-to-day work by observing actual practice. This strategy should broaden their perspectives and set the stage for meaningful learning, which includes increased retention of material and greater inquiry.
As students develop clinical written summaries about their clients, instructors should be flexible with the type of written work submitted. Traditionally, nursing students develop some form of a care plan based on the nursing process. The structured, linear method has taken criticism as the only way to look at clients.
As a concrete, methodical strategy, the nursing process care plan is effective for students who are field independent and who can readily discern the data and related information needed for each step.
Additional methods of client summary or analysis should be introduced, and students should be encouraged to try each method. In doing so, students may broaden their ways of seeing clients and nursing problems, thus setting the stage for increased insight, analysis, and confidence. For example, use of the concept Future Considerations
map is a way in which a student can envision the client or care situation in a holistic manner. Concept maps provide a fluidity that enhances the ability to determine relationships and make connections. Therefore, this strategy likely will be used positively by students who demonstrate Gardner’s categories of visual/spatial or interpersonal intelligence. Learners who are field dependent also should do well with the concept map strategy because of their tendency to see the situation as a whole. Concept mapping should be effective for learners with all of Kolb’s styles, but for different reasons and with different outcomes.
Guided reflection, especially reflection-on-action, helps the student bring closure to the clinical experience, as well as conduct self-evaluation and gain from the experience. Journal writing is one of the most effective means by which the student can capture thoughts and responses and preserve these ideas in writing for subsequent consideration. This strategy is particularly useful as a means by which students can identify and modify impulsive-reflective tendencies. Journal writing will have the best results with divergers and assimilators, and some students may benefit from open discussion about the experiences entered into their journals. Again, feedback from the faculty is crucial and should be as thoughtful as the entries provided by the student. Faculty reading journals should guide the student in growth of insight and patterns of reflection.
Effective teachers in the health professions are those who possess content expertise, create an active learning environment, and use carefully selected teaching strategies (Wolf, Bender, Beitz, Wieland, & Vito, 200). One of the greatest challenges for faculty is in developing the blend of strategies to bring about effective learning in all students. Part of the challenge is the fit between the faculty’s styles and learning preferences and that of each of the learners. Faculty especially should be on guard against favoritism to students who possess the same attributes as the instructor. Conversely, the congruency between styles of the teacher and of the student may enhance a relationship that is especially meaningful and may evolve into professional mentoring.
FUTURE CONSIDERATIONS
The majority of research on cognitive styles, learning style, and learning preferences was conducted in the 970s and 980s. This was before the widespread accepted use of electronic technology. The use of technology in teaching and learning may be influenced by learning preferences, such as in visual and kinesthetic learners. Have some students learned to modify their preferences in order to become more comfortable with technology? Online education is widely accepted, and the role of the instructor is changing. The extent to which learn-
Chapter 1 • effeCtive Learning: What teaChers need to KnoW
ers continue to value the presence of the instructor for spontaneous teaching is worthy of investigation. Currently, there is a shift in education toward student-centered, active learning for the development of critical thinking, coupled with generations of students who are used to immediate feedback and a variety of stimulation. Educators must determine if selected strategies are useful for genuine learning or, if not used properly, merely providing entertainment.
CONCLUSION
Effective learning is more than merely the result of good teaching. It is enhanced by a learning environment that includes active interactions among faculty, students, and student peers. Effective learning is achieved through the use of creative strategies designed not to entertain but to inform and stimulate. The best ways faculty can bring about effective learning are by recognizing students as individuals, with unique, personal ways of knowing and learning, by creating learning situations that recognize diversity, and by providing empowering experiences in which students are challenged to think.
TEACHING EXAMPLE
How Do I Learn Best?
This instrument typical y takes 4 to 6 minutes to complete and can be self-scored. The style categories are visual, aural, read/write, and kinesthetic, which correspond with categories found in Gardner’s multiple forms of intelligence. Students are directed to answer the brief questions, then are shown the learning modalities that best fit predominant styles.
HOW DO I LEARN BEST?
This test is to find out something about your preferred learning method. Research on left brain/right brain differences and on learning and personality differences suggests that each person has preferred ways to receive and communicate information.
Choose the answer that best explains your preference and put the key letter in the box. If a single answer does not match your perception, please enter two or more choices in the box. Leave blank any question that does not apply. Once you have completed the test, find the totals for each of the letters (V, A, R, K) that correspond with a learning preference. Then look at the table of learning modalities (Table 1-1) to see what strategies best support your learning preference.
1. You are about to give directions to a person. She is staying in a hotel in town and wants to visit your house. She has a rental car. Would you:
(V) draw a map on paper?
(R) write down the directions (without a map)?
(A) tell her the directions by phone?
(K) collect her from the hotel in your car?
Conclusion
2. You are staying in a hotel and have a rental car. You would like to visit a friend whose address/location you do not know. Would you like him to:
(V) draw you a map on paper?
(R) write down the directions (without a map)?
(A) tell you the directions by phone?
(K) collect you from the hotel in his car?
3. You have just received a copy of your itinerary for a world trip. This is of interest to a friend.
Would you:
(A) call her immediately and tell her about it?
(R) send her a copy of the printed itinerary?
(V) show her the itinerary on a map of the world?
4. You are going to cook a dessert as a special treat for your family. Do you:
(K) cook something familiar without need for instructions?
(V) thumb through the cookbook looking for ideas from the pictures?
(R) refer to a specific cookbook where there is a good recipe?
(A) ask for advice from others?
5. A group of tourists has been assigned to you to find out about national parks. Would you:
(K) drive them to a national park?
(R) give them a book on national parks?
(V) show them slides and photographs?
(A) give them a talk on national parks?
6. You are about to purchase a new stereo. Other than price, what would most influence your decision?
(A) A friend talking about it.
(K) Listening to it.
(R) Reading the details about it.
(V) Its distinctive, upscale appearance.
7. Recal a time in your life when you learned how to do something like playing a new board game.
Try to avoid choosing a very physical skil (e.g., riding a bike). How did you learn best? By:
(V) visual clues—pictures, diagrams, charts?
(A) listening to somebody explaining it?
(R) written instructions?
(K) doing it?
8. Which of these games do you prefer?
(V) Pictionary
(R) Scrabble
(K) Charades
9. You are about to learn to use a new program on a computer. Would you:
(K) ask a friend to show you?
(R) read the manual that comes with the program?
(A) telephone a friend and ask questions about it?
10. You are not sure whether a word should be spelled dependent or dependant. Do you:
(R) look it up in the dictionary?
(V) see the word in your mind and choose the best way it looks?
(A) sound it out in your mind?
(K) write both versions down?
6 Chapter 1 • effeCtive Learning: What teaChers need to KnoW
11. Apart from price, what would most influence your decision to buy a particular textbook?
(K) Using a friend’s copy.
(R) Skimming parts of it.
(A) A friend talking about it.
(V) It looks okay.
12. A new movie has arrived in town. What would most influence your decision to go or not go?
(A) Friends talked about it.
(R) You read a review about it.
(V) You saw a preview of it.
13. Do you prefer a lecturer/teacher who likes to use:
(R) handouts and/or a textbook?
(V) flow diagrams, charts, slides?
(K) field trips, labs, practical sessions?
(A) discussion, guest speakers?
Source: Gardner, H., & Hatch, T. (1990). Multiple intelligences go to school: Educational implications of the theory of multiple intelligences (Technical Report No. 4). New York: Center for Technology in Education.
Conclusion 7
our
ve
ou
hoice
here appropriate
wers to an old
wers
ams w
wers/tutorials
ams into statements
aphs, beginnings, endings
agr
our ans
actice ans
y the exam situation in y
, use diagraw
ords
actice writing ans
exam
someone read them to y
actice with multiple-c
questions
head
For Exams
Recall the pictures on the pages
Dr
Practice turning visuals back into
w
Speak y
Pr
Read questions to self or ha
Pr
Write par
Organize diagr
Write pr
Role-pla
ysa
ate
bols and initials
ords
y talking out ideas
oices
ith sym
ords
ying
ords w
our notes b
aw pages from memory
hen Stud
y take poor notes because of
preference for v
another kinesthetic person
W
Recall visual aspects of presentation
Reconstruct images in different w
Redr
Replace w
Ma
Expand y
Explain new ideas to another student
Read assignments out loud
Write out the w
Reread notes silently
Rewrite ideas in other w
Use lecture notes/read
Put examples in note summaries
Talk about notes, especially with
Use pictures and photos to illustr
ant
harts,
y
verheads, pictures,
odalit
angements on a pagearr
and other visual aids
ve space in notes for later
recall
y take notes poorly because
topics do not seem relev
In Class
Underline
Use different colors
Use symbols, c
Attend lectures and listen
Discuss topics with students
Use a tape recorder
Discuss o
Lea
Use lists, headings
Write out lists and definitions
Use handouts and textbooks
Ma
Go to lab, take field trips
Use trial-and-error method
Listen to real-life examples
Learning M
All
al
isual
ur
Writing
Use
Your
Senses
V
A
Reading/
Kinesthetic:
Table 1-1
8 Chapter 1 • effeCtive Learning: What teaChers need to KnoW
REFERENCES
Ausubel, D. P. (968). Educational psychology: A cognitive view. New York: Holt, Rinehart and Winston.
Bandura, A. (977). Social learning theory. Morristown, NJ: General Learning Press.
Bruner, J. (966). Toward a theory of instruction. New York: W. W. Norton & Co.
DeYoung, S. (2009). Teaching strategies for nurse educators (2nd ed.). Upper Saddle River, NJ: Prentice-Hall.
Fryer, G. (2008). Teaching critical thinking in osteopathy: Integrating craft knowledge and evidence-informed approaches. International Journal of Osteopathic Medicine, 11(2), 6–6.
Gagne, R. M. (968). Learning hierarchies. Educational Psychologist, 6, –9.
Gardner, H., & Hatch, T. (990). Multiple intelligences go to school: Educational implications of the theory of multiple intelligences (Technical Report No. ). New York: Center for Technology in Education.
Gregorc, A. F. (979). Learning/teaching styles: Their nature and effects. In Student learning styles (pp.
9–26). Reston, VA: National Association of Secondary Principals.
Kagan, J. (96). Reflection-impulsivity and reading ability in primary grade children. Child Development, 36, 609–628.
Kelly, E., & Young, A. (996). Models of nursing education for the 2st century. In K. Stevens (Eds.), Review of research in nursing education (pp. –9). New York: National League for Nursing.
Knapp, B. (200). Competency: An essential component of caring in nursing. Nursing Administration Quarterly, 28, 28–287.
Knowles, M. A. (978). The adult learner: A neglected species (2nd ed.). Houston, TX: Gulf Publishing.
Kolb, D. A. (98). Experiential learning theory. Englewood Cliffs, NJ: Prentice-Hall.
Melrose, S. (200). What works? A personal account of clinical teaching strategies in nursing. Education for Health, 17, 26–29.
Miller, M. A., & Babcock, D. E. (996). Critical thinking applied to nursing. St. Louis, MO: Mosby.
Perry, W. G. (970). Forms of intellectual and ethical development in the college years: A scheme.
New York: Holt, Rinehart and Winston.
Pinsky, L. E., Monson, D., & Irby, D. M. (998). How excellent teachers are made: Reflecting on success to improve teaching. Advances in Health Sciences Education, 3, 207–2.
Rossetti, J., & Fox, P.G. (2009). Factors related to successful teaching by outstanding professors: An interpretive study. Journal of Nursing Education, 48() –6.
Schon, D. A. (98). The reflective practitioner: How professionals think in action. New York: Basic Books.
Skiba, D. J., Connors, H. R., & Jeffries, P. R. (2008). Information technologies and the transformation of nursing education. Nursing Outlook, 56(), 22–20.
Sullivan, W. M., & Rosin, M. S. (2008). A life on the mind for practice: Bridging liberal and professional education. Change, 40(2), –7.
Svinicki, M. D. (99). Practical implications of cognitive theories. In K. A. Feldman, & M. B. Paulsen (Eds.), Teaching and learning in the college classroom (pp. 27–28). Needham Heights, MA: Ginn Press.
Svinicki, M. D., & Dixon, D. M. (987). The Kolb model modified for classroom activities. College Teaching, 35, –6.
References 9
Wells, D., & Higgs, Z. R. (990). Learning and learning preferences of first and fourth semester baccalaureate degree nursing students. Journal of Nursing Education, 29, 8–90.
Witkin, H. A., Moore, C. A., Goodenough, D. R., & Cox, P. W. (977). Field-dependent and field-independent cognitive styles and their implications. Review of Educational Research, 47, –6.
Wolf, Z. R., Bender, P. J., Beitz, J. M., Wieland, D. M., & Vito, K. O. (200). Strengths and weaknesses of faculty teaching performance reported by undergraduate and graduate nursing students: A descriptive study. Journal of Professional Nursing, 20, 8–28.
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