Teaching and learning are interactive processes. The roots of the paradigm shift away from an emphasis on the teacher and teaching to the learner and learning can be traced back to the works of Carl Rogers (1969), Malcolm Knowles (1980), and Jack Mezirow (1975), among others. This shift places the purpose of the educational enterprise on the outcomes of the learning process and is of particular interest in nursing, which relies on this process for effective practice. The learning paradigm, as opposed to the instructional paradigm, “frames learning holistically, recognizing that the chief agent in the process is the learner” (Barr & Tagg, 1995, p. 21). Within this process, faculty are responsible for “creating environments and experiences that bring students to discover and construct knowledge for themselves” (Barr & Tagg, 1995, p. 15). In the learning paradigm, the learning environment and learning experiences are learner centered and learner mediated. Learning is a two-way process of teacher as senior learner and student as junior learner (Rogers, 1969), resulting in both being transformed (Diekelmann, 1989). It is viewed as a fundamental social activity by Chan and Pang (2006), who emphasize the co-construction of ideas and development of learning communities. In contrast, the instructional paradigm positions the faculty as knowledge disseminator and student as passive recipient whose primary responsibility is to take in this knowledge and recall it during activities and examinations. Teaching is a complex and abstract concept that has several definitions. Teaching is a system of directed and deliberate actions that are intended to induce learning through a series of directed activities (Heidgerken, 1953; Hyman, 1974). Bevis (1989a) defined teaching as an art and science in which the content is structured and the processes used enable student learning. For Bevis (1989a), teaching includes determining the objectives, arranging the instructional materials, creating the learning activities, and evaluating student learning. However, Bevis (1989c) addressed the need for teachers to restructure their perception of teaching from a focus on establishing the climate, structure, and teaching role to a focus on establishing the climate, structure, and dialogues that engage students’ intellectual processes. This redirected focus is necessary so that students will be able to find patterns that can eventually be used as their prototypes for clinical practice. Intellectual engagement is promoted through the use of questions that direct students to read, observe, analyze, and reflect on the care of patients. The new pedagogies with a focus on teaching and learning thinking rather than increasing and impossible demands on memorization produce adaptive students with the capacity to solve problems (Ironside, 2005). Within this context, teachers are also involved in nurturing students, ethical ideals, caring, creativity, curiosity, assertiveness, and dialogue. The journey to this restructure requires that the teacher think about how their own thinking changes with the adoption of new paradigms and strategies (Diekelmann & Lampe, 2004). Davis (1993) also viewed teaching as a science and an art. In nursing education, the science aspect of teaching is based in a body of knowledge derived from the theories and research from natural and social science disciplines, such as microbiology, anatomy, physiology, anthropology, psychology, sociology, and speech communication. In addressing the art aspect of teaching, Eisner (1983) used the analogy of an orchestra conductor for the teacher because conductors and teachers must use a wide variety of skills while making judgments about complex issues that arise while conducting or teaching. The teacher and conductor must be prepared to deal creatively with unexpected events. For example, although the conductor and teacher are knowledgeable about the musical score and content for a given session, both persons must provide appropriate guidance, attend to the responses from the participating members, maintain and adjust the desired pace, make every effort to evoke the best responses, and be flexible and creative when the members have problems producing the desired effect. The concept of teaching has evolved from what and how content is taught and evaluated. Current thinking also includes what Duffa (2005) calls the “who I am” as a teacher. Style significantly influences learners and the learning environment. The personality of the teacher is reflected in the style in which he or she teaches. This makes it important for teachers to reflect on thoughts and feelings regarding educational philosophy, life biography, and class and clinical practices as a part of the complex concept of teaching (Demetriou, Wilson, & Winterbottom, 2009; Niyozov, 2008). In general, learning is considered a change in a person that has been caused by experience (Slavin, 1988). Learning is a process of understanding, clarifying, and applying the meanings of the knowledge acquired. Furthermore, learning is the exploration, discovery, refinement, and extension of the learner’s meanings of the knowledge (Heidgerken, 1953). Learning occurs when an individual’s behavior or knowledge changes. Learning has also been defined from the perspectives of two major bodies of learning theory: behaviorism and cognitivism. The behavioristic perspective views learning as a change in observable behavior or performance resulting from some external reinforcers that stimulate the change. To be considered learning, a change in performance must come about as a result of the learner’s interaction with the environment (Driscoll, 1994). In contrast, the cognitive perspective views learning as occurring when a new experience alters some unobservable mental processes that may or may not be manifested by a change in behavior or performance. Bevis (1988) proposed that the distinction between training and education is essential for the development of curriculum and indicated six types of learning (Box 13-1). The first three types of learning are associated with technical aspects and may be observed. The last three are associated with mental processes that may or may not produce an observable change. Learning is self-active; it can be accomplished only by the learner. The use of multiple theories to guide educational practice is evident in the following sentence. Learning is influenced by a person’s profile of intelligences (Gardner, 1983), background, and experience; by the type of learning activities and the degrees of participation in the teaching–learning situation (Barr & Tagg, 1995); and by the power structure that dictates what knowledge is valid (Freire, 1993/1971). Learning is explained by Alexander, Schallert, and Reynolds (2009) as a complex set of principles and dimensions. They set out nine principles, including the process of learning as change, interaction, possible resistance, and process and product. The what, who, where, and when of learning dimensions provide a framework through which the principles can be understood. The teaching–learning process or transaction is a complex cooperative and personal relationship between faculty and students. When viewed from the perspective of the “learning paradigm” rather than the “instructional paradigm,” the teaching–learning process is a personal interactive relationship that extends beyond the subject matter. Within the interactive relationship, faculty relate to students with dignity and respect, with the expectation that students will be supported and stimulated to develop intellectual integrity and independent judgment (Hyman, 1974). The roles of the teacher are facilitator, learner, guide, coach, and mentor acting in partnership with students. The student roles become those of learner-inquirer and seeker of knowledge within an active participative student–faculty relationship. In a humanistic model both the faculty, as senior learner, and the student, as junior learner, are engaged in the teaching–learning process (Rogers, 1969). According to Diekelmann (1989), both teacher and learner engage in a transformed relationship as a result of meaningful dialogue with one another. Shared responsibility and an egalitarian relationship between student and teacher are also key components of feminist pedagogy (Wheeler & Chinn, 1989). Bevis (1988) identified the purpose of nursing education as twofold: to ensure safety and to provide the climate, structure, and dialogue that promote praxis (the application of a skill as opposed to its theory). The roles associated with these purposes include raising questions; nurturing creative drive, caring, assertiveness, and ethics; designing ways to engage mental processes; and interacting with students as persons of worth, dignity, intelligence, and high scholarly standards. Data about students’ personal attributes can be obtained from various sources. Students’ entry knowledge and skills can be obtained from a brief review of the course materials and texts used for prerequisite courses; this helps establish reasonable expectations of the students. Informal discussions with faculty and students are another excellent source of entry-level information. During the first or second class meeting, students’ interest in the course and content and their perception of the class’s relationship with previous and concurrent courses can be elicited through class discussion. Students can also be asked about individual skills, abilities, and personal gifts that have not been directly associated with their formal education in a nursing program. This type of discussion often stimulates a lively interaction and helps students become aware of faculty interest in the student as a whole person. Individual learning styles and preferences can also be elicited. See Chapter 2 for further discussion of assessment of student learning styles. Instructional planning includes selecting and organizing the appropriate and essential concepts and content in a logical and meaningful sequence, with attention given to the appropriate delineation of the important relationships between facts, concepts, and principles. Planning also includes selecting the instructional strategies and designing learning activities. Developing a map of all of the lesson plans before the course begins is beneficial because it helps ensure that the content will be adequately addressed and allows faculty to examine the variety of instructional strategies and learning activities to be used throughout the course. See Chapter 10 for further discussion of planning learning experiences and developing instructional plans. Evaluation is the final step in an iterative teaching–learning model. Formative and summative evaluations are two common forms of evaluation used during instruction. Formative evaluation is used to determine student progress throughout the course and is often used during a class session. It is helpful to teachers in assessing what students understand and in providing feedback to them that can be used for improvement (Nicol, 2009). Informal strategies such as questions, discussion, and feedback about student participation and success in attaining the objectives of the learning activities provide faculty with valuable information about student comprehension and achievement during the lesson. Having students participate at the end of class in constructing a summary of the key points of the lesson also provides valuable information. Formative evaluation strategies can be considered diagnostic tools in that they help faculty focus on difficulties students are having in attaining the learning outcomes and provide opportunities for corrective interventions designed to further facilitate learning (see Chapter 24). The formative and summative evaluation strategies selected to determine student learning need to be consistent with the approaches used during the instructional strategies and learning activities. For additional information on evaluation and evaluation strategies, see Unit V. Learning theories focus on how people learn, whereas educational frameworks and philosophies focus on identifying the methods that will provide students with the conditions that are most likely to facilitate attainment of the learning outcomes (Reigeluth, 1983). As faculty shift the emphasis from teaching to learning, educational frameworks may be used to enhance the faculty-facilitated learning environment (Barr & Tagg, 1995). Discussion of learning theories and educational frameworks and philosophies is organized in the following manner. After a brief overview of each theory or framework, additional information is presented from the perspectives of the basic premise, the setting or climate in which the theory or framework may be used, the role of the faculty, the role of the student, some of the advantages and disadvantages associated with the theory or framework, and application. Summaries of the premises for the learning theories and educational frameworks and philosophies are presented in Box 13-2 and Table 13-1, respectively. Table 13-1 Premises of Educational Frameworks and Philosophies Learning theories and frameworks are descriptive in that they focus on and describe the processes used to bring about changes in either the way in which students perform or the way in which they understand or organize elements in their environment. Theories of learning include sets of concepts of psychological variables that are presented as laws or principles about learning. Theories of learning can be used as prescriptions that provide a focus for creating an environment and conditions in which the instruction will occur (Driscoll, 1994). Psychologists have developed two principal types of learning theory—behavioral and cognitive—to explain how people learn. In addition to the cognitive theories, educators and counselors are using cognitive development theories because they focus on the ways in which thought processes develop over time and the influence those processes have on other dimensions of personality development (Widick & Simpson, 1978). Adult education and humanistic theories are also commonly used in educational programs. There is no single behavioral, cognitive, cognitive development, adult education, or humanistic theory; variations exist for each type of theory. Ivan Pavlov and Edward Thorndike established the roots for behaviorism in the late nineteenth century with their systematic scientific investigation of how animals and human beings learn (Hilgard & Bower, 1966). This work provided the basis for what became known as behaviorist psychology. Pavlov and Thorndike associated behavior with physical reflexes (Hilgard & Bower, 1966). However, Thorndike believed that the behavior was in response to rewards or reinforcements; he called this the law of effect. The focus of their research later became known as stimulus–response theory. Skinner’s (1953) principles of operant conditioning focus on arranging consequences for learner behavior (Slavin, 1988). Skinner suggested a different type of behavior associated with learning that he named operant behaviors. Operant behaviors are a person’s responses that act on the environment as an immediate response to the consequence resulting from the behavior. A behavior is strengthened or weakened in response to positive or negative consequences. Positive consequences are referred to as reinforcers because they strengthen or increase the frequency of behaviors, whereas negative consequences weaken the behavior by not reinforcing it (Skinner, 1953; Slavin, 1988). Although all behaviorists do not have the same framework for their theories, there are some fundamental similarities in that they all look for behavioral change in the learner and define learning as permanent change in behavior. In addition, they all place great importance on the external environment as a main element in controlling what people learn (Dembo, 1988). Since the 1950s, the principles of behaviorism have been incorporated into the widely promulgated work of several renowned educators. Tyler (1949) addressed the psychology of learning, the learning setting, and learning conditions and presented a model for writing behavioral objectives. Bloom, Englehart, Furst, Hill, and Krawthwhol (1956) compiled a taxonomy of the cognitive domain incorporating the use of action verbs to differentiate levels of cognition. Mager (1962) developed a model for writing highly prescriptive behavioral objectives that consist of three components: specification of the behavior to be acquired, conditions under which the behavior is to be demonstrated, and the criteria for how well the behavior is to be performed. The prominent nurse educators of the 1970s and 1980s who adopted the behavioristic paradigm into their works include Bevis (1973, 1978, 1982, 1989a), deTornyay (1971, 1982), deTornyay & Thompson (1987), Reilly (1975, 1980), and Reilly and Oermann (1990). As a result of these publications, programs in nursing education once made extensive use of the principles of behaviorism. The organization of instruction is dominated and directed by behavioral objectives and learning outcomes that can be specified, observed, and measured. Common criticisms of the behavioristic model for instruction are that it is mechanistic and decreases or minimizes student involvement in learning. Less visible and unobservable processes involved in complex mental processes, such as concept formation, problem solving, and critical thinking, are not deemed appropriate in the behavioristic paradigm. Romyn (2001) challenges such criticism with the claim that a professional shift in value orientation from one of learning outcomes based on a behaviorist paradigm to social change based on an emancipatory paradigm is the foundation of this criticism. In the emancipatory or interpretive pedagogies, the egalitarian, shared responsibility for learning replaces fixed, directive outcome objectives with meaningful dialogue (Tanner, 1990). Romyn (2001) suggests an inclusive approach in which both emancipatory and behaviorist paradigms are available to nursing education and practice is the solution to this criticism. The initial focus on the cognitive aspects of learning is attributed to the work of the Gestalt psychologists during the early 1900s. Gestalt, a German word, means “patterns” or “configurations.” Gestalt psychologists emphasized perception, and learning was interpreted in terms of perceptual principles of organization. Gestalt psychologists believe that people respond to whole situations or patterns rather than to parts (Shuell, 1986). Insight is an important concept in Gestalt psychology. Insight is often referred to as the “a-ha” phenomenon. Insight is primarily a matter of perception that is explained as a procedure of mental trial and error that results in a solution. When a person’s perceptual field is disorganized, order is imposed by restructuring problems into a better gestalt (pattern); the restructuring may occur through a process of trial and error (Dembo, 1988). Lewin (1951) believed that because human beings have a basic need to bring order to the situation, the motivation to learn is stimulated by the ambiguity perceived in the situation. During the 1960s, criticism of the limitations of behaviorism as a system for explaining learning led to the development of other theoretical formulations in cognitive and developmental psychology that focused on how people learn. Cognitive psychology has several perspectives and approaches that try to explain particular aspects of human behavior (Weinstein & Meyer, 1991). Cognitive theorists focus on and emphasize the mental processes and knowledge structure that can be inferred from behavioral indices. Cognitive learning theorists are concerned with the mental processes and activities that mediate the relationship between stimulus and response; the learner selects from stimuli in the environment according to his or her own internal structures (Grippin & Peters, 1984; Slavin, 1988). Cognitive theories define learning as an active, cumulative, constructive process that is goal oriented and dependent on the learner’s mental activities (Shuell, 1986; Wittrock, 1992). Learning is an internal event in which modification of the existing internal representations of knowledge occurs. Learning is processing information; it is experiential and formed by a person’s experience of the consequences. In cognitive models of learning, students have active rather than passive roles in the instruction and a new responsibility for learning. A transfer of information from faculty to student does not automatically result in learning; students must discover meaning by using information processing strategies, memories, and attentional and motivational mechanisms to organize and understand it (Wittrock, 1992). Some authors associated with cognitive learning theory are Anderson (1980, 1985); Ausubel (1960, 1978); Ausubel, Novak, and Hanesian (1968); Ausubel and Robinson (1969); Piaget (1970a, 1970b, 1973); Rumelhart and Ortony (1977); Shuell (1986); Tulving (1972, 1985); and Wittrock (1977, 1978, 1986). Information processing theories emerged during the 1970s; they focus on describing the way in which information is tracked, the sequences of mental operations, and the results of the operations (Anderson, 1980). A computer model provides the basis on which the theories were developed. The primary focus of information processing investigations is the various ways in which individuals perceive, organize, and remember large amounts of information. In the information processing theory, memory is viewed as a complex organized system. Memory selects the sensory data to be processed and transforms the data into meaningful information before storing it for later use. Information is processed through three components of the memory system: the sensory register, short-term memory, and long-term memory. The sensory register receives stimuli from visual and auditory information from the physical environment; only some of these data are retained for further processing. Information that is retained then enters the short-term (working) memory, where it is either forgotten or encoded into some meaningful form. Short-term memory is believed to be brief (a few seconds) and to have a limited capacity of six to seven items (the capacity can be enlarged by chunking related items). Some of the information may be quickly used and not further processed for transfer to the third component, long-term memory. Rehearsal of the information is important for retention in short-term memory and helps it persist long enough to move to long-term memory (Atkinson & Shiffrin, 1968; Norman, 1989; Simon, 1979). Long-term memory has at least three parts—episodic, semantic, and procedural—all of which are organized differently (Tulving, 1972, 1985). Episodic memory contains the memories of personal experiences. Semantic memory is organized into networks that have connected ideas or relationships that are referred to as schemata (Anderson, 1985), which hold meaningful information. Schemata are packages of knowledge that include different concepts that are organized into larger groups in an outline form (Rumelhart, 1981). Procedural memory is where the ability to do a task or skill resides. Graff (2003) contends that memorization reflects only recall and not how students think about or make sense of the content. This covering of the context to which thinking occurs is a result of confusing memorization with thinking. The problem in nursing education occurs when memorization is rewarded in the didactic portion of the curriculum and expected knowledge is not applied in the practice setting. Recognizing that these are two different expected outcomes can redirect learning strategy design. Cognitive load theory was first advanced in the 1980s to better understand the nature of short-term or “working” memory and subsequent instructional design (Ozcelik & Yildirim, 2005; van Merrienboer & Sweller, 2010). Information capacity is limited in terms of amount and duration in the working memory so information is quickly either chunked into an existing long-term memory schema (thereby expanding and transforming the schema) or lost unless reinforced with rehearsal (de Jong, 2010; Merrienboer & Sweller, 2010). In order to promote transfer to long-term memory, teachers need to avoid nonessential content, align new content with previous learning, and promote learning through student engagement (de Jong, 2010). Constructivism, a psychology of learning theory, is based on the work of Piaget (1970a, 1970b, 1973) and Vygotsky (1986/1962). Constructivism theory holds that learning is development (Fosnot, 1996) and that assimilation, accommodation, and construction are the basic operating processes in learning. A learner constructs new knowledge by building on an internal representation of existing knowledge through a personal interpretation of experience. Constructivists assume that learners build knowledge in an attempt to make sense of their experiences and that those learners are active in seeking meaning. Constructive processes operate in all types of learning; learners form, elaborate, and test their mental structures until they get one that is satisfactory to them. In the constructivist paradigm, knowledge representation is open to change as new knowledge structures are added to the existing foundational structure and connections (Reigeluth, 1983; Walton, 1996). Piaget’s (1970a, 1970b, 1973) theory of cognitive development introduced the notion of knowledge construction. Wittrock’s (1977, 1986, 1992) generative learning theory and the works of Ausubel and colleagues (Ausubel, 1978; Ausubel & Robinson, 1969; Ausubel et al., 1968) also fit within the constructivist paradigm. The concepts of self-efficacy, self-regulation, and metacognition have underpinnings in constructivism (McInerney, 2005). Mezirow (1975, 1981), describing learning as transformation, studied women participating in reentry college programs and discovered 10 elements associated with perspective transformation. This transformation process began with a disorienting dilemma, progressing to self-examination and critical assessment, then connecting the discontent to similar experiences shared by others, resulting in a building process and construction of new knowledge. Components of the building process included acquiring knowledge and skills, planning a course of action, trying new roles, and finally reintegrating into society with a new perspective. Ausubel and colleagues (Ausubel, 1978; Ausubel & Robinson, 1969; Ausubel et al., 1968) developed assimilation theory to describe meaningful learning processes involved in assimilating old meanings with the new meanings that form a more highly differentiated cognitive structure. Cognitive structure refers to a person’s store of information. Cognitive structure provides an overall framework that incorporates new knowledge, and it is a prerequisite to meaningful learning. Ausubel (1978) held that prior knowledge is the most significant factor in determining the occurrence of new learning. Ausubel and Robinson (1969) and Ausubel (1978) held that a learner may incorporate received information by either a meaningful or a rote approach and that the information can be learned by one of two methods: reception or discovery. In the rote reception method learning is acquired by memorization, whereas in the meaningful reception method learning results from information that is logically organized and presented to the learner in a final form. This information is then integrated into the learner’s own existing cognitive structure. Meaningful learning can be attained only if (1) the learner has a mental set to learn the task in a meaningful way, (2) the task has a logical meaning, and (3) specific and relevant concepts in the learner’s cognitive structures can interact with the new material (Ausubel, 1978). Ausubel (1960) and Ausubel and Robinson (1969) proposed the use of different aids to facilitate students’ learning processes. Aids help students fit new material into existing cognitive or affective structures. One aid is prompting learners about what they already know by questioning, giving, and asking for examples and recalling their existing knowledge for them and showing how it relates to points presented in an explicit introductory example. Another aid is the use of advanced organizers. Advanced organizers are process-oriented introductory presentations that emphasize the context for the content; they are developed at a higher level of abstraction and are presented before students engage in the learning task. Advanced organizers provide a broad conceptual framework that students can use to gain clarity about the subsequent material. Advanced organizers may consist of verbal or written prose or a visual presentation (Ausubel & Robinson, 1969; Hartley, 1976; Mayer, 1979). Cognitive theories can be applied in any formal or informal academic setting and in continuing education classes. The climate must allow for time and flexibility so that the learner can experience and make meaning of that which is to be learned. Twomey (2004) suggests constructionist theory as supportive of online education with emphasis on Vygotsky’s theory (Learning Theories Knowledgebase, 2011) to add the social element and “scaffolding” as a technique to structure learning activities. Emphasis is on designing an active, constructive, and goal-directed learning environment appropriate for the students’ cognitive abilities. Faculty relinquish some control of the learning situation to the students and actively involve students in reflective thinking, examination of assumptions, and assessing what they have learned (King & Kitchener, 2004). Creating a rich, real-world context in the classroom facilitates students’ learning constructive processes that can be applied outside the classroom. It is important for students to have the opportunity to construct knowledge for themselves; group discussions of topics that involve a number of different variables enhance knowledge construction. A primary focus is on changing the learners by modeling and encouraging the use of appropriate teaching strategies. Understanding how students process information helps faculty in selecting and implementing teaching strategies. Using think-aloud protocols, which is the process of having students verbalize their thinking while they are thinking, helps faculty gain some understanding of how students are processing information (Corcoran, Narayan, & Moreland, 1988; Muth, Britton, Glynn, & Graves, 1988). Using an introduction with an advanced organizer before actually beginning a lesson helps faculty prepare students for the subsequent learning experience (Ausubel, 1960). An advanced organizer includes only broad concepts presented in a hierarchical order; following this presentation with some discussion of the interrelationships between the topics helps students see linkages and patterns. An advanced organizer does not contain specific content material that is to be learned. Faculty selecting other appropriate instructional strategies and learning activities will assist students in assimilating and accommodating new information. For example, concept mapping, sometimes referred to as mind mapping, is a strategy based on Ausubel’s assimilation theory (Ausubel & Robinson, 1969; Ausubel et al., 1968). Concept mapping has been shown to be effective in helping students assimilate and accommodate the concepts (Novak, Gowin, & Johansen, 1983; Rooda, 1994). McKeachie (1980) recommended that faculty relate new information to students’ existing cognitive structure. Faculty often discover that students know more than they think they do; students may need some prompting and cues to recognize that the new information being presented is a variation or extension of something they have previously learned and applied. Auditory and visual cues help students activate and connect what has been previously learned to the new knowledge. Faculty can create an organizational structure for the content, such as cause and effect, time sequence, parallel organization, phenomenon to theory to evidence, problem to solution, pros versus cons to resolution, familiar to unfamiliar, and concepts to application. Faculty should also present a prototype model and make every effort to ensure that students understand it before progressing to new concepts (Norman, 1989). Limiting the number of elements presented at one time to the six or seven that can be contained in short-term memory and helping students rehearse the information is beneficial; this tactic facilitates learning and retention. Providing examples of concepts and asking students for additional examples from their own perspective encourage concept development and learning. Presenting a prototype model and making every effort to ensure that students understand it before progressing to new concepts are important. The use of periodic summaries and reiteration of the relationships between the concepts is also beneficial. In addition, faculty can provide some suggestions to students about ways to improve their learning strategies. For example, using mental elaboration, attending to verbal and visual cues, and drawing pictures and diagrams can help stimulate imagery of old and new information (Wittrock, 1992). Passively receiving information from faculty or instructional materials does not automatically result in learning; students must discover the meaning by using information processing strategies, memories, and attentional and motivational mechanisms to organize and understand information (Wittrock, 1992). Students may discover the meaning of information by presenting analogies, using and describing prior knowledge and experiences, and having dialogues with faculty and peers about real-life situations that require application of the content. With faculty and peer support, students can acquire an increased self-awareness about what is known and become aware of how the new knowledge fits into their existing knowledge structure. Reflection, an intentional retrospective process focused on the meaning of the content and the learning experiences, is a process students can use to enhance and extend their learning. The key to learning in the cognitivists’ paradigm is the use of cognitive apprenticeship, reflection on the collaboration required in real-life problem solving, and the use of tools available in the problem situation. In the learning paradigm, faculty create the learning environments and experiences that assist students to move toward discovering and constructing knowledge for and of themselves (Barr & Tagg, 1995; Bevis, 1989c). The use of the perspective transformation theory (Mezirow, 1975, 1981) has direct application in nursing programs seeking to advance from basic to higher degrees or to role change instruction. Such programs (RN to BSN, APN, and ADN to MSN programs) can structure didactic material in consideration of the 10 elements associated with reentry to couple professional advancement with an expected need for psychosocial transformation. Concept mapping (Rooda, 1994) and problem-based learning (Heliker, 1994; van Niekerk & van Aswegen, 1993) are examples of instructional approaches that incorporate principles derived from cognitive theories. The use of journals for didactic and clinical courses enables students to take time to reflect on and describe their own learning and meaning making; journals also provide faculty with opportunities to communicate with students through writing. Fay, Johnson, and Selz (2006) apply constructionist theory to the online learning environment to develop an action-based model with the acronym ALINE (A = action based, students are actively engaged; L = learner centered, action shifts from teacher to student; I = interactive, students interact to gain competency; N = nursing competency oriented, skill building over time; E = evaluative, students are continuously involved in performance assessment). Azzarello and Wood (2006) suggest an approach to encourage well-developed situational mental models by unfolding case studies. Through selective release of case information the student has the opportunity to actively engage in a problem related to a specific situation. As the case unfolds, the context changes and the mental exercise becomes more complex, offering a series of discoveries. Cognitive development theories provide a practical model of the student and present ways in which the organization and structure of instruction can be designed to accommodate the students’ readiness to learn (Widick & Simpson, 1978). Cognitive development occurs in sequential, predictable stages; in each stage aspects of the previous stage are expanded. Perry’s (1970) model of intellectual and ethical development of college students is presented here because it has received increased attention in the nursing education literature. Perry (1970) and his associates developed the model based on the results of a study of undergraduate students who volunteered to report on their college experiences. The study sample included men at Harvard and women at Radcliffe; the students were interviewed at the end of each academic year for a period of four years during the late 1950s and early 1960s (Perry, 1970). Analysis of the interview data revealed dominant themes with regard to students’ orientation to authority; the nature of knowledge; and other themes such as simplicity versus complexity, good versus bad, right versus wrong, orientation to responsibility, reasoning, open versus closed mental perspective, rationale for differences of views, and concreteness versus abstractness (Perry, 1970, 1981; Valiga, 1988). Perry organized the phenomenological themes into nine positions that were further categorized into four broad categories: dualism, multiplicity, relativism, and commitment. Students progress through the positions in each of these categories in a sequential manner, demonstrating specific intellectual skills and values. At any point in time, however, further development may be halted or suspended. Growth is usually not linear and usually occurs in fluctuating surges (Perry, 1970, 1981). In the two positions of dualism, students view knowledge and values with the assumption that all knowledge can be either right or wrong; learning consists of finding and knowing the right answers. Progress to the category is indicated by students having some ability to accept the legitimacy of diversity and uncertainty with their own explanations that the authority has not yet found the answers. Perry (1970, 1981) referred to this latter stage as multiplicity. The two positions of relativism begin with movement to accept that views of right and wrong and good and bad are not sufficient to deal with real-life situations. Continued progress in development is demonstrated by the recognition that knowledge is contextual, uncertain, and relative. Students develop the ability to abstract and weigh information to problem-solve in specific situations. Perry considered that the progression of cognitive development that occurs between the stages of the legitimacy of uncertainty and the acceptance that knowledge is contextual is a revolutionary change in cognitive restructuring. This stage is necessary for students to fully engage in critical thinking activities (McGovern & Valiga, 1997). The last category in this model is marked by the students’ understanding that making a commitment is necessary to become oriented to a world of relativism. At this stage “commitment is foreseen as the resolution of the problems of relativism, but it has not yet been experienced” (Perry, 1970, p. 137). In commitment, continued cognitive development focuses on the affective domain. Responsibility is the theme in this phase of development. Progression is through phases of initial commitment, orientation in implications of commitment, and developing commitment. Students reveal the ability to take a risk by making an initial commitment in some particular area. Movement to this phase involves realization of the implications of what the experience of commitment means in terms of responsibility. Here students affirm their identity and accept the reality that commitment is a continuing experience that is revealed through a personal lifestyle. Baxter Magolda (2004) traces the evolution of her qualitative research and development of the epistemological reflection model over 20 years and contributes important concepts leading to the consideration of learning and gender reasoning patterns, development, types of knowing, and managing uncertainty. She traces participants’ journeys as well as her own, acknowledging contextual knowing, meaning that knowledge exists in a context. In her study, 70% of freshman college students assumed that knowledge was certain and demonstrated this reasoning as absolute knowing. Transitional knowing (assuming knowledge to be more uncertain) was evidenced in 30% of freshman and in 80% of those in the senior year. Contextual knowledge, characterized by the belief that knowledge exists in context, was found in only 2 of the 80 participants in the senior year. She also found that postcollege environments prompted movement toward independent and contextual knowing faster than the college environment. Gender-related reasoning patterns associated with absolute knowing included the receiving pattern, used more often by women, and the mastery pattern, evidenced more in men. In transitional knowing, women were found to use an interpersonal pattern (connecting to others) and men an impersonal pattern (focus on self). Research findings from studies in which Perry’s model (1970) was used have particular relevance for nursing education because of the responsibility that faculty have for preparing graduates who need highly developed critical thinking skills and the ability to deal with uncertainty if they are to provide care in an increasingly complex society and health care system. Baxter Magolda (2004) contributes evidence of an expected developmental sequence during the college years and evidence that use of contextual knowledge is more common in the postgraduate years. Valiga (1988) summarized several variables identified through research with Perry’s (1970) model that relate to cognitive development. Variables that pertain to the student include age, sex, socioeconomic status, verbal fluency, student’s hometown population, educational motivation, and learning style preference. Variables related to the development and implementation of the curriculum and courses include the subject matter discipline of the curriculum, the amount of structure and flexibility, the degree of challenge and support given, the types of course assignments, the nature of student–peer interactions, the openness of student–faculty relationships, and the degree of fit between the students’ positions in the Perry (1970) model and the learning environment. Frisch (1990) reported on the results of Collins’ (1981) study that revealed that baccalaureate nursing students functioned in the dualistic stage. Frisch’s (1987) study of junior baccalaureate nursing students revealed that most students operated at the end of the dualistic stage, whereas only one had attained multiplicity, which occurs at the beginning of the relativism stage. Frisch (1990) noted that these findings are consistent with studies conducted on other college students. Valiga (1988) reported her study results on a sample of 123 nursing students. At the beginning and at the end of the academic year, most of the students were at the dualistic stage. Although some showed no change, a few gained almost two positions, moving them into the relativism stage. Positive gains in cognitive development were found by Zorn (1995) and Frisch (1990) with some students who had an international learning experience in Mexico. Perry’s (1970) model of intellectual and ethical development and Baxter Magolda’s (2004) model of epistemological reflection are appropriate for generic undergraduate and RN to BSN and RN to MSN mobility students enrolled in undergraduate programs. The climate is one in which the student’s cognitive development is considered. Baxter Magolda offers additional assistance in understanding the greater potential for contextual learning in the second degree student who comes to nursing education with postbaccalaureate experience. Implementing a cognitive development model requires that faculty give attention to the cognitive and interpersonal characteristics of the students who will actually be in the classes rather than focus only on increasing the subject matter content. Guardo (1986) contended that faculty design curriculum for imaginary students, with little or no regard for their cognitive and interpersonal characteristics. Information about the students may be collected at the time of entry into the program or at the beginning of a semester or course. Data such as age, sex, socioeconomic status, verbal fluency, the type and composition of a student’s hometown, educational motivation, learning style preference, and life experiences can be elicited through informal conversation. These conversations also facilitate development of a closer student–faculty relationship and begin the trust-building process. Valiga (1988) recommended that faculty design curricula that require students to have organized experiences with other students who have alternative ways of thinking, reasoning, and viewing the world. These experiences should be introduced during the freshman year. In addition, requiring courses in different disciplines that provide gradual degrees of complexity should be part of the curricular design. Other instructional and evaluation strategies suggested include instructional strategies that minimize the use of lecture and promote faculty–student interactions and student-to-student interactions. Role play, debate, discussion, frequent use of questioning, and use of materials that present opposing opinions and positions are appropriate. Evaluation strategies should include essay examinations, position and reaction papers, projects, and journals, with less frequent use of multiple-choice examinations. Allowing students choices in some content areas and assignments facilitates development (Valiga, 1988). Hodges (1996) described how she developed a model for journal writing for RN to BSN students. The model incorporated concepts from Knowles’ model of adult education, Perry’s model of intellectual development, and qualitative research on women’s ways of knowing. The model progresses through four levels: dualism, multiplicity, relativism, and commitment. Colucciello (1988) also recommended the use of Perry’s model as a way to create a powerful learning environment after she found students operating at the dualistic stage of conceptualization. Colucciello (1988) identified several instructional strategies and learning activities that are consistent with those already described. She concluded that powerful learning environments are essential if faculties are to prepare graduates to achieve a professional career rather than function at the technical level. McGovern and Valiga (1997), using Perry’s model, report the use of developmental instructional strategies to promote cognitive change in freshman nursing students. They used interactive teaching strategies in the classroom to provide diversity in learning experiences, integrate previously learned information, and encourage the use of active learning strategies such as group projects. Although students were at lower levels of cognitive development, they did show cognitive growth. Lessons about implementing Perry’s model can be found in other disciplines. For example, Thoma (1993) has described how he developed instructional strategies in an economics course that specifically focus transitions from dualism through relativism. Ward (1992) used the Perry model as a framework for developing writing exercises in a legal environmental course.
From teaching to learning: theoretical foundations
Teaching
Learning
Teaching–learning process
Assessment
Planning
Evaluation
Learning theories and educational frameworks and philosophies
Framework
Premise
Adult education
Adults are self-directed and problem centered and need to learn useful information.
Authentic learning
Focuses on real-world situations as the context for students to develop skills that are important in nursing practice.
Brain-based learning
Emphasizes the maximization of learning by enhancing the conditions under which the brain learns best: relaxed alertness; orchestrated immersion; and active, regular processing of experiences.
Caring
Education consists of an integration of humanistic-existential, phenomenological, feminist, and caring ideologies.
Critical
The liberation of thought occurs through analysis of power and relationships within social structure information.
Deep learning
An intentional, intrinsically motivated strategy that integrates previous knowledge to what is being learned in order to create new meaning and actions.
Feminism
Intellectual growth, activism, and empowerment can change injustice and inequity for all persons.
Humanism
Education motivates the development of human potential.
Narrative pedagogy
A practical discourse using nine themes allows knowledge gained through experiences of teachers, students, and clinicians to direct nursing education.
Patterns of knowing
Patterns of knowing (empiric, aesthetic, personal, and ethics) provide the nursing professional in practice, education, and research with new means to understand meaning within situational contexts.
Phenomenology
Understanding the hows and ways in which humans experience and perceive events that result in learning.
Postmodern discourse
Truth is related to specific context and is constantly being constructed.
Behavioral learning theories
Disadvantages
Cognitive learning theories
Information processing theories
Constructivism
Assimilation theory
Setting and climate
Role of faculty
Role of student
Application
Cognitive development theories
Setting and climate
Role of faculty
Application
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
From teaching to learning: theoretical foundations
