Challenges in Teaching and Learning



Challenges in Teaching and Learning


Tami H. Wyatt, PhD, RN, CNE





PROFILE IN PRACTICE



Cutting-edge technology is essential in health care delivery, and consequently, nursing education must keep up the pace. In busy outpatient practices, where the primary care goal is improved clinical outcomes and streamlined visits, innovations that enhance clinical decision making and fast-track care provision are essential and welcomed. As a family nurse practitioner with over 20 years in clinical practice, I recognize the need for technology that supports practice. Early on, I was enamored with personal digital assistants (PDAs) and felt certain they would be a valuable resource for health care practitioners’ clinical practice. However, evidence to support how PDAs improve accuracy and efficiency of practice was absent.


My earliest research, “Accuracy and Efficiency as Outcomes of Clinical Scenarios by Novice Nurse Practitioners Using Personal Digital Assistants,” found significant outcomes that helped to validate the use of PDAs in clinical practice. The purpose of this study was to determine whether using PDAs, as compared with textbooks, for the evaluation of clinical scenarios increased accuracy and efficiency of clinical decisions made by novice nurse practitioners. The sample consisted of 40 subjects, and the study examined novice nurse practitioners’ efficiency when making decisions regarding laboratory values, diagnosis, and treatment. This study demonstrated that in all of these areas, the PDA users were more efficient in determining an answer to a clinical question and with a level of accuracy that was at least equal to the textbook users. I routinely use a PDA with drug database applications, medical calculators, and other time-saving resources to quickly locate information during patient visits in the clinical setting.


As a faculty member engaged in the teaching of nurse practitioner students, I am an advocate for the use of technology, not only in clinical practice but also in the classroom and via the Internet to aid student learning. Web-enhanced courses through the use of courseware management systems, such as BlackBoard Learning System, allow students access to all course syllabi, information, class materials, and each other through forums, emails, and chats. This is a valuable component when completing course assignments or preparing for classroom discussions. Another way to enhance classroom teaching is through the use of iPod technology to review podcasts of course lectures and presentations. More recently, my students and I were involved in a research study with the University of Tennessee at Knoxville, evaluating the effectiveness of mobile e-learning among NP students within a multisite environment. All students used PDAs with Skype to communicate with their counterparts in all universities to complete specific assignments. Skype, a free voice-over-Internet protocol application, was found to be useful as a communication tool when costly or inaccessible alternative methods were not available. For example, Skype would be valuable to support global learning and support cost-effective communication between international students.


I fully expect that as technology evolves, it will continue to be at the cutting edge of practice and education. In the future we will be using applications that presently we can only imagine. Keeping up with these advancements is the challenge we all undertake.




imageIntroduction


It can be said that those who practice nursing are not only nurses, but also teachers and students. Nurses engage in teaching and learning while studying to become nurses, in their everyday practice, and as they further their professional development. Clearly, readers of this text are experiencing some form of teaching and learning either through formal (course-required readings) or informal (professional development) methods of learning. Furthermore, readers either have already taught patients and colleagues or they will in the very near future. Most readers have encountered patient-teaching situations similar to the following:



Few nurses have had formal preparation or coursework in teaching and learning, but recognition of the importance of this knowledge for nurses is growing. Nursing programs are integrating teaching and learning content into their curricula, which might very well be the reason you are reading this chapter. Whether you are a hospital nurse, an educator, an administrator, or a student, it is necessary to have basic knowledge of the teaching-learning process and the ways that technology influences teaching, learning, and information seeking. This chapter reviews the more commonly used learning theories in health education, discusses the ways technology influences teaching and learning practices, and presents effective teaching-learning practices with relevant supporting research, including similarities and differences between individual and group teaching-learning experiences.



imageTeaching and Learning Theories


Most commonly and simply stated, teaching is defined as the act or process of imparting knowledge (Merriam-Webster, 2009). This definition implies that those who teach present information and those who learn passively accept the knowledge. However, learning represents a change in meaning for the learner that is based on previous meaningful experiences. More than 200 teaching and learning theories exist, and numerous Internet sites provide information about these theories (e.g., http://tip.psychology.org). Although it is unrealistic to review all of the theories in this chapter, this section will compare and contrast several viewpoints and reflect on the comparisons by presenting learning principles and teaching applications for each of the following theory viewpoints: behaviorism, cognitivism, change, and humanism. This chapter will reference the classical works of theorists to allow the reader the opportunity to explore teaching and learning principles in more depth.



BEHAVIORIST THEORIES


Teaching based on a behaviorist model, known as behaviorism or instructivism, presents objectives and content in a stepwise progression from basic to complex information with minimal learner engagement in the experience. Many of the assumptions of behaviorist models are built on the classic work of Thorndike (1913), Pavlov (1927), Skinner (1953), and Wolpe and Lazarus (1966), as well as some of Bruner’s earliest writings (1966). Table 10-1 summarizes certain learning principles and teaching applications relative to the ideas of behaviorist learning and cognition theorists such as Piaget, Vygotsky, Bruner, and Dewey (Russell, 2002).




COGNITIVE THEORIES


As more scientists focused on teaching and learning, behaviorist theories and their assumptions evolved from teacher focused to learner focused. Theorists such as Piaget (1954), Lewin (1951), Gagne (1974), Bloom (1956), and Johnson, Johnson, and Stanne (2000) examined cognition and the ways that learners process information. By the mid-20th century, a new method of teaching and learning, known as constructivism, appeared in the literature (Bruner, 1966). This method of teaching and learning proposes that learners construct new ideas based on previous knowledge and experiences. Today, many cognitive and behavioral psychologists support this view, which asserts that learners engage or become active in the learning process instead of passively receiving information. In this view, learners actively seek information, problem-solve, collaborate with others, and apply information to realistic problems. Most cognitive and learning experts believe that active learning is superior to passive learning. A summary of cognitive theory and applications is presented in Table 10-2 .




CHANGE THEORIES


The more common teaching-learning methods used by nurses while teaching patients require strategies that empower the patient to exercise healthy behaviors that do not conflict with the patient’s value system. The themes of patient empowerment and patient value systems are based on change models and concepts such as Rosenstock’s health belief model (1974), Bandura’s concept of self-efficacy (1977), Rotter’s locus of control (1990), Festinger’s cognitive dissonance theory (1957), and stages of readiness described by Prochaska and DiClemente, (1982). A summary of learning principles and teaching applications based on change theories are presented in Table 10-3 .




HUMANISTIC THEORIES


In humanistic theory, learning is self-motivated, self-directed, and self-evaluated. The teacher provides information and support to help learners increase their cognitive and affective functioning. Humanistic theories are the oldest classic theories and include andragogy or adult-centered learning (Knowles, 1984), hierarchy of needs (Maslow, 1970), self-directed learning (Rogers, 1969), reality theory of self-awareness learning (Glasser, 1965), perceptual-existential theory or self-determined learning (Combs, 1965), and values clarification learning (Dewey, 1938).


Teachers who use humanistic theories will encourage learners to set their own goals and work toward them. For example, a nurse might ask a client with diabetes, “When do you think you’ll be ready to give your own insulin injection? What activities or steps would help you get ready to do this?” Table 10-4 summarizes teaching applications and learning principles relative to humanistic theories.



Chances are that as a nurse, you have or will use a combination of the above theories in teaching and learning, depending on the type of instruction, the learner, and the desired outcome. Regardless of the theoretical approach of the teaching-learning process, all effective instruction is based on fundamental principles that include matching the instruction with the type of learning that is required and developing a sense of mutuality and trust between teacher and learner.



image Teaching and Learning Principles


Teaching and learning can be formal or informal in nature. Formal teaching-learning is planned instruction with objectives or goals that match the intended learned skills or concepts with the most effective method of delivery. According to the classic cone of learning theory by Edgar Dale (1969), learners remember:



Although reading and listening to information may be the most ineffective method of learning, it is often the most appropriate method, especially if the information or content is abstract in nature and requires few or no motor skills. On the other hand, content that requires motor skills are best learned by actively engaging in the learning such as experiential learning, simulations, or role play (Dale, 1969). Regardless of the level of learning required, the more an individual engages in the content, the more likely the person is to learn the material. Learners, whether they are patients, family care givers, or colleagues, learn best by teaching the information to someone else. Table 10-5 provides examples of types and levels of learning and matching strategies based on Dale’s cone of experience theory.



Informal ways of learning are also effective. Informal learning results from interactions with others through networking, coaching, and mentoring. Learning that occurs in groups or from interactions with others, known as collaborative or cooperative learning, engages the learner in the information (Johnson et al., 2000; Walker & Elberson, 2005). Furthermore, learners who participate in their own learning are able to attach purposeful meaning to the content based on previous experiences. Perhaps this is one reason why the most successful learning often takes place in groups, such as weight loss groups, grief support groups, and parenting groups, where individuals help one another and the teacher is seen more as a guide or a facilitator.


Self-directed learning may also be another form of informal learning. Incidental learning consists of learning from mistakes, assumptions, beliefs, attributions, and internalized meanings and is often a byproduct of another activity. With more and more learners turning to the Internet for information or to complete formal online coursework, emphasis on ways to enhance self-directed learning has increased. Although self-directed learning may be incidental, it can also be purposeful when combined with tutorials, access to resources, and guided lessons.



TRANSFER OF KNOWLEDGE


The key to successful learning is determining how important the information is to the learner’s ability to function effectively in his or her daily life and world. The more the learning environment resembles the actual environment, the more likely learning will be applied (Knowles, 1980). Learning transfer can be enhanced by focusing on behavior rather than knowledge, setting realistic expectations, and establishing rewards. Behavior, however, is not changed by knowledge alone. To influence behavior, a learner must not only have knowledge of the desired behavior but also believe that he or she is able to perform or adopt the new information (self-efficacy) and must value or desire (attitude) the behavior (Bandura, 1977). Factors that inhibit transfer of learning include, but are not limited to, readiness to learn, anxiety level, environmental factors, stress levels, complexity of the content or tasks, ability to learn, and emotional readiness (Bastable, 2006).



MUTUALITY AND TRUST


The most successful teaching-learning experiences involve a process in which an interpersonal relationship of shared mutuality and trust is established between the teacher and the learner. This relationship might be instructor to student nurse, nurse to nurse, or nurse to patient. In such a relationship, the teacher is viewed as the knowledge and information expert, and the learner is seen not only as the individual in need of information and support, but also as the expert on how the information is best suited to his or her life. The emphasis is on the learner actively engaging, discovering, and taking responsibility for new ways of acting and problem solving. Mutuality and trust is prevalent in nurse and patient relationships because the nurse is often considered the expert on health matters and the patient is the information seeker.



imageCharacteristics of Effective Teachers


Most of us teach the way we were taught, imitating the behaviors of the best teachers we have known and minimizing behaviors of those teachers we did not like. To be an effective teacher, however, requires that we develop a sound educational theory and research base, learn the specifics of the teacher-learner roles, find new ways of interrelating, and continually explore new teaching methods that we might use in our various roles (as a nurse, teacher, or peer). In addition, we must be able to critique our own performance and be willing to accept constructive criticism from others.


Many lessons can be learned from classroom teachers, but sometimes learning that occurs in a classroom involves nothing more than obtaining information on a topic. Nurses engaged in patient education often require more advanced teaching skills because patients may need not only to gain information but also to change their health behaviors. Sometimes nurses practice paternalism—that is, they overextend their power of authority over the patient. This method is ineffective; instead, nurses should practice a shared decision-making model with patients.


Regardless of the type of learning required, all teaching should be tailored to be appropriate to the learner’s age, culture, and native language. This is a challenge for nurses who must teach complex medical processes to the lay public; however, numerous websites provide information and learning materials for various populations. For example, EthnoMed (http://ethnomed.org/ethnomed) is a site dedicated to providing material and information for culturally diverse populations. In addition, the National Network of Libraries of Medicine (http://nnlm.gov/outreach/consumer/multi.html) houses patient information in more than 12 different languages. With all educational material, but especially web-based information, nurses must ensure accuracy and reliability of the information obtained.

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Oct 26, 2016 | Posted by in NURSING | Comments Off on Challenges in Teaching and Learning

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