The purpose of the curriculum is to present students with a cohesive body of knowledge, attitudes, and skills that are necessary for professional nursing practice. A curriculum provides the means of delivering a course of study designed to support the achievement of intended outcomes (Ellis, 2004). The curriculum is implemented for both faculty and students through teaching strategies and learning activities. This chapter focuses on designing and selecting learning activities for effective implementation of the teaching–learning process. The rationale that guides the design and selection of learning activities is reflected in the understanding that students should be educated for self-development and various nursing roles in society. Selecting experiences that enable meeting curriculum outcomes cannot be accomplished through a casual, hit-or-miss approach; learning activities must be thoughtfully designed to offer students the opportunities necessary to achieve the intended curriculum outcomes. In recent years, there has been an increased emphasis on learning and learner-centered instruction, shifting the focus in education away from teacher-centered instruction. Learning activities that are learner-centered focus on students becoming empowered to participate in designing learning tasks, which facilitates their responsibility for acquiring the knowledge and abilities specified by curriculum outcomes (Greer, Pokorny, Clay, Brown, & Steele, 2010). When faculty design an instructional strategy to provide specific kinds of student learning experiences, the instructional strategy is then referred to as a learning activity or a learning experience. Conversely, teaching strategies, teaching methods, and teaching techniques are teacher-centered strategies that are used to describe the kinds of activities faculty engage in when teaching. Faculty need to select instructional strategies that match the outcomes, competencies, and objectives of the curriculum (see Chapters 9 and 10) so that students have the opportunity for maximum learning. In contemporary education, for optimal learning, teacher-centered strategies must be counterbalanced with learner-centered strategies. Faculty are responsible for arranging the learning activities and conditions necessary to ensure that learning occurs. It is essential that faculty understand that learning activities are an integral part of the curriculum and courses and, as such, they must be purposeful, planned, and organized. Learning activities are designed to engage students in listening to and interacting with others, observing, thinking, and doing in a manner that highlights the knowledge, attitudes, competencies, and skills to be acquired. For example, activities situated in narrative pedagogies promote clinical reasoning across time by allowing students to analyze illness trajectories within actual life contexts (Benner, Sutphen, Leonard, & Day, 2010, p. 225). There are many theories that explain the learning process. Many of these theories are behaviorally, cognitively, or socially based (Jarvis, Holford, & Griffin, 2003) and include, but are not limited to, constructivism, brain-based learning, experiential learning, and adult learning. There are other learning theories that are situated in critical and feminist theory, phenomenology, and postmodernism (Diekelmann & Diekelmann, 2009). Common to each of these theories is the idea that learning may be a passive or an active process. Students typically experience both types of learning throughout their educational career. Passive learning, a mode of learning commonly present in many classrooms, occurs when students use their senses to take in information from a lecture, reading assignment, or some form of audiovisual media. Passive learning is commonly used to acquire ideas and information that are subsequently available through recall (Wingfield & Black, 2005). Active learning involves the student through participation and an investment in exploring content knowledge in all phases of the learning process (Wolf, Bender, Beitz, Wieland, & Vito, 2004). It requires educational activities that provide students with the opportunity to actively engage in courses and respond to the learning situation (Price & Nelson, 2007). The benefits of active learning reported by many authors (Clark, 2007; Price & Nelson, 2007; Snelgrove, 2004) include, but are not limited to: 1. Increased attentiveness to learning 2. Greater interest in learning 3. Desire to use multiple ways of learning 4. Increased retention of information 5. Greater assimilation of learning 6. Deeper understandings of course material 7. Increased critical thinking skills 8. Increased problem-solving skills It is not always possible to determine whether students are actively involved in learning because their responses during a learning activity may be reticent. Reticence does not necessarily mean students are not learning. However, there are active learning activities that can make it easier for faculty to assess the degree of active learning. For instance, team-based learning, in which small groups of students work together independently within large classes, allows teachers to observe the extent of student preparation for class, students’ use of materials related to the course, and their level of participation in class sessions (Clark, Nguyen, Bray, & Levine, 2008). Peer active learning is an approach in which students make apparent their critical thinking skills through think/pair/share, case-based learning, role playing, interactive presentations, and discussions (Stevens & Brenner, 2009). Virtual learning, while still in its early development, allows teachers to assess deep learning verses surface learning (Sand-Jecklin, 2007). The Neighborhood is one example where students experience deep learning through scenarios that unfold over time and that are situated in storytelling, case-based learning, and interpretive pedagogies (Giddens, 2007). Fostering active learning in the classroom is a faculty goal, and some evidence exists to support the view that active learning is preferred by some students (Harton, Richardson, Barreras, Rockloff, & Latané, 2002). Faculty need to be aware of content areas and relationships among concepts that usually pose difficulty for students. Organizing learning experiences so that students are engaged in active learning requires faculty to educate themselves about and design teaching strategies that are learner-centered rather than strictly teacher-centered. Examples of such strategies were related above, but can also include activities such as think-write-preview, in which students begin to think about topics by writing everything they know about them in 2 to 3 minutes; board workers, in which students work together to address pertinent questions; and bookends, in which students meet before an oral presentation to share what they know about a particular topic and generate questions to ask during and after the presentation (Price & Nelson, 2007). Regardless of the active learning strategy employed, the shift to active learning paradigms may be stressful for faculty, particularly when trying these approaches with large groups of students. Furthermore, faculty may have concerns about receiving less favorable evaluations of instruction. Additionally, students are often resistant to changes in the way in which they receive instruction because understanding new ways of learning is stressful. They may be impatient with the process and averse to putting forth the effort needed to alter their learning style. In fact, Sand-Jecklin (2007) suggests that, despite recent evidence supporting active learning and teachers’ use of it, nursing students still prefer to learn through memorization and recall. Support from faculty, administration, and peers is important if active learning strategies are to be incorporated into teaching practice. To determine the match of learning activities with the desired course outcomes, faculty can create a matrix to examine the relationships between the means (learning activities) and the ends (outcomes). Advance planning for how the learning activities relate to the course objectives facilitates the selection of a variety of activities for the course. Faculty and students enjoy and benefit from a variety of learning experiences. Variety helps prevent faculty and students from becoming bored and makes it more likely that faculty can accommodate different learning style preferences. Faculty should use a systematic approach in designing and selecting the learning activities for a course before actually teaching the course. The learning activity plan shown in Box 11-1 provides a useful approach for planning and evaluating learning activities for each of the course’s class sessions. Several principles and how to achieve them can guide faculty in planning learning activities (Davis, 2009). 1. Promote intellectual development by: 2. Help students contextualize information by: a. using real-world situations b. emphasizing deep learning through manageable work schedules, use of conceptual frameworks, and avoiding recall of meaningless details 3. Help students retain and apply information by: a. encouraging repeated review of materials b. making activities active rather than passive c. encouraging cooperation and group work 4. Facilitate self-regulated learning by: Informing students of the purpose and goals for learning allows teachers and students to use instructional activities to help students understand why they need to know the materials, fosters appreciation for learning, and invites them to learn new content in the future (Blumberg, 2009). It is advantageous to include the learning activities in the materials students receive at the beginning of the course. Placing learning activities in the same logical order as the content, in the sequence in which they will be used, and in proximity to the appropriate objectives or competencies enables students to have a holistic sense of how the learning activities relate to the course objectives and content. Students should be able to determine from the course materials the sequence and patterns of the course. Learning activities may be structured or unstructured. Structured learning activities are frequently used and are important in assisting students to address and pose questions, solve problems, create solutions, and consider alternatives (Pascarella & Terenzini, 2005). Although unstructured learning activities may be used at the undergraduate level, they are more likely to be used in honors or honors option courses, independent study courses, and capstone courses. Faculty may also allow students to use unstructured learning activities for bonus credit. 1. Complete an answer sheet that will be evaluated by peers, faculty, or both. 2. Write a general or specific summary report that addresses the content or processes and submit it to faculty. 3. Present a report to the class. 4. Discuss the experience with another student or small group of students. 5. Initiate a small group or class discussion of the major points, issues, or problems that arise during their work. Unstructured learning activities are designed to allow students to acquire knowledge and skill with much less specific direction from faculty. This form of activity is derived from Bruner’s discovery learning (Bruner, 1977) and, in recent times, has been called inquiry-based learning (Levy, Aiyegbayot, & Little, 2009). Discovery learning is believed to do the following: 1. Promote a disposition toward inquiry. 2. Promote independent thinking and enhanced problem solving. 3. Stimulate student motivation and interest. 4. Improve knowledge retention. 5. Facilitate transfer of learning by stimulating the student to seek and find relationships between information and the situation at hand. A major limitation associated with discovery learning is the need for students to adapt to self-directed learning that is student-centered rather than teacher-centered (Bebb & Pittam, 2004). Example 1. Students are required to make a series of visits over a period of weeks to a family in any community setting, such as their home, a day care center, a senior center, an extended care facility, a homeless shelter, or a church function. Over the course of the visits, students use the nursing process to develop a plan of care with the family and provide verbal or written reports to faculty, peers, and agency staff on the visits and the progress they are making. On completion of the visits, students will have completed a family nursing care plan. Faculty may choose to have students share their care plan with others in any one of a variety of ways. For example, students may present their completed care plan either verbally or in writing, either in clinical conference or as a case study, to faculty, peers, and agency staff. When a student develops a case study, faculty may want to obtain the student’s permission to use it as a teaching tool with future students. Example 2. As an alternative to family visits, faculty may offer students the opportunity to use case studies, simulations, or virtual excursions that present a scenario representative of the type of experience in which the students would engage in actual practice. These alternative activities could be used by a small group of clinical students, and care plans could be shared in the manner described in Example 1. A simulation is an event or situation constructed to reflect clinical practice as closely as possible to teach procedures and critical thinking (Jeffries, 2005). Unlike the traditional classroom setting, a simulation allows the learner to function in an environment that is as close as possible to a real-life situation and provides the opportunity for the learner to think spontaneously and actively rather than passively. Simulations should present realistic situations, require active involvement in problem solving, provide feedback on the process, and require the learner to act on the effects of the harmful actions. When faculty decide to use simulation in the classroom or in clinical teaching, simulations should be developed at an appropriate level for the beginner or advanced beginner. Simulations should provide opportunities for students to select relevant assessment data, infer patient problems, and take appropriate actions (Jeffries, 2006). Ideally simulations present clinical situations that vary in complexity depending on the number of decisions that must be made, the clarity or ambiguity of the possible choices, and the urgency of the underlying problem. The complexity of each case has to be appropriate for the targeted learners. Simulations can help enrich an environment by promoting interaction with students’ minds, the content, and the equipment. Good educators attempt to make learning meaningful so that students can make connections, problem-solve, and think critically, and simulations are one way of doing that. Faculty should consider both the advantages and the challenges and barriers to simulation when deciding whether to develop and incorporate it into the learning environment (Table 11-1) (Hovancsek, 2007). Table 11-1 Advantages and Challenges/Barriers in Using Simulation within the Curriculum From Hovancsek, M. T. (2007). Using simulations in nursing education. In P. R. Jeffries (Ed.), Simulation in nursing education: From conceptualization to evaluation (pp. 5–6). New York, NY: National League for Nursing. (Included with permission.)
Selecting learning experiences to achieve curriculum outcomes
Defining learning activities and teaching strategies
Student learning activities
Passive and active learning
Passive learning
Active learning
Advantages
Disadvantages
Matching learning activities to desired outcomes
Principles for selecting learning experiences
Structuring course materials
Structured and unstructured learning activities
Structured learning activities
Unstructured learning activities
Critical learning experiences
Learning experiences with technology
Simulation
Advantages
Challenges/Barriers
Mistakes can be made without patient harm
More faculty preparation time to develop and conduct simulations
Can provide clinical experiences rarely seen
Only a small number of students per session
Experiences can be repeated to enhance learning
Simulation sessions must be offered repeatedly
Can promote critical reflective analysis of skill sets
Expense (maintaining equipment; fixing equipment; faculty workload; create new positions to maintain labs)
Immediate feedback from peers, teachers, and/or sophisticated equipment
Physical space limitations for equipment, teachers, and students in each simulation
Promotes active learning
Technical support for computer-based simulations
Decreases performance anxiety
Faculty development to ensure computer literacy
Increases critical thinking skills
Is learner-centered, requiring a paradigm shift for students (students need to become active learners)
Increases confidence
Faculty time to validate learning outcomes
Promotes team work
Research needed to ensure is financially and educationally sound
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