New Directions in Teaching and Learning Within Nursing

EducationNew Mexico Statewide Nursing Faculty Conference

June 3-4, 2009

Jean Giddens, PhD RN, ProfessorInterim Senior Associate Dean for Academic Affairs

College of Nursing, University of New Mexico

Student Centered LearningDecades of educational research have shown

that learning is most effective when…….• Students are engaged• Learning incorporates emotion• Learning activities are purposeful and

perceived by students as useful

Integrative Teaching

• Integrative Teaching is practice of minimizing the distance between theory and clinical instruction.

• Benner calls integrative teaching a “signature pedagogy” of excellent instructors

Emergence of New Paradigms

• Conceptual Approaches to Teaching and Learning

• Virtual Experiential Communities

• Student centered learning

• Integrative teaching

TEACHING AND LEARNING DIFFERENTLY: THE CONCEPTUAL APPROACH

Example: Concepts as Categories

What concepts do the shapes below represent?

What other concepts can you identify?

Example: Concepts as Categories

What is Conceptual Teaching and Learning?

The difference between concept- and content-focused learning is… “the difference between facts of the Alaska oil spill and an understanding of the importance of environmental sustainability” (Erickson, 1998 p. 50).

Conceptual teaching means….Focusing on big ideas – students anchor to specifics.

Fostering deep learning, and deep understanding through connections and reflection (as opposed to surface learning).

Developing student-centered learning with a purpose.

Pneumonia COPD

Anemia Pulmonary Edema

Pnuemothorax

Oxygenation

PE

RSV

RDSAMI

Asthma

Concept: Oxygenation and possible exemplars

Pneumonia

COPD

Oxygenation

RSV

Asthma

Concept: Oxygenation & selected exemplars

OtherConcepts

OtherExemplars

Exemplars

Teaching ConceptuallyFocus on Concept

Exemplars provide content knowledge

Application of content to interrelated concepts

Application of other content to the concept

Concepts for Nursing Education

• In nursing education, a concept should be clinically useful to guide student learning and clinical practice.

• What are the Concepts for Nursing Practice?• Concepts vs. Exemplars• Concepts vs. Medical Diagnoses

Additional Thoughts on Conceptual Teaching

A focus on concepts in itself does not guarantee conceptual learning.

Faculty must adopt active learning strategies to enhance conceptual learning.

Ideally, concepts are woven throughout the curriculum - incorporated into clinical and didactic courses.

• Hypertension• ASHD• Renal Failure• Diabetic

Retinopathy• Peripheral

Neuropathy• Peripheral Artery

Disease

Example:Long-term complications of DM

• How could you teach this so students can understand the underlying concept or concepts could explain this?

Example:Skill Acquisition-

Securing an IV Catheter

• What concept(s) apply?• How could you apply this

to your skills lab teaching?

• After starting an IV, what steps are necessary to properly secure the IV?

What is a concept-based curriculum?

Concepts provide organizational structure for the curriculum and courses.

Concepts represent nursing practice.Concepts drive content through selection

of exemplars.

Courses and Course Objectives

Class Sessions Class Session Objectives Class Learning Activities

Level Objectives/Competencies

NURSING PROGRAMMission Statement Goals Philosophy

INSTITUTION

Mission Statement Goals Philosophy

CURRICULM FRAMEWORK

Knowledge, Concepts & Theory

• Knowledge is represented through concepts• Concepts are building blocks of theory

THEORY

Concept Concept Concept Concept

Concept ConceptConcept

Knowledge

Hallmarks of “Good” Concepts for Curriculum and Teaching?

• Represent important spectrum of conditions or situations representing nursing practice

• Logical and used consistently• Useful for education• Application across multiple courses and

contexts

Benefits

• Content management• Focus on concepts as opposed to content• Emphasis on learning• Focus is on Nursing• Concepts cut across disease

categories and populations• Emphasis on recognition of concepts across

populations and practice settings

Drawbacks• Resistance to change• Requires a different level of

organization• Students may be resistant (at first)• Lack of literature detailing steps• What about NCLEX?

VIRTUAL EXPERIENTIAL COMMUNITIES

Mr. Ocampo

• Mr. Ocampo is short of breath, experiences intermittent chest pain, and is fatigued.

• He obviously should seek medical attention, but he won’t.

• Why won’t he seek medical care?

Anthony Martin

• Anthony Martin has been arrested for indecent exposure at a local park.

• He is taken to the ED because he is combative and disoriented.

• What is causing Anthony to act this way?

Kelsey Young

• Kelsey Young has a new baby sister.

• What is Kelsey's family like? Does she have adequate support systems?

• What things trouble her?

What is a Virtual Experiential Community?

• Extension of technology-enhanced learning• Representation of individuals in context of

community setting – with impact to group and individuals.

• In health care, focus on individuals and health related issues and health care providers.

• Examples: • The Neighborhood (USA)• Stillwell (UK)

Giddens - ODU, 2008

Household Characters

– 34 characters who live in 11 households within The Neighborhood.

– Character stories reflect health-related situations based on incidence and prevalence.

– Stories reflect individual and family responses to health-related problems over time.

– Stories told from the perspective of the character.

Nurse Characters

• 6 featured nurse characters that work in 4 health-care agencies– 3 Hospital Nurses, School Nurse, Midwife, Geriatric Nurse

in senior center • Stories reflect contemporary issues in nursing

practice and issues within the local community.• Stories of household characters interwoven into

nurse stories as applicable.

Biographical Information

Each character has biographical information that serves as an introduction.

Updated each semester to reflect previous semester story.

Weekly Story

Each character has a story update each week.

Stories unfold weekly over 3 academic semesters.

Photos & Video Clips

Stories are extended with photos, and video clips as applicable.

These media enhance understanding beyond text.

Medical Record

• Abbreviated medical records included to provide an understanding of health care.

Newspaper

• The newspaper links individual characters to the community

• Is reflective of contemporary social, ethical, and health related issues.

BENEFITS OF LEARNING WITH VIRTUAL EXPERIENTIAL COMMUNITIES

Changing the Focus and Context• Focus shifts away from content and toward the

characters’ lived experiences• Context is story of individual and relationships within

the home, community, and health care settings.• Enhanced understanding of issues associated with

vulnerable populations and individuals with complex, chronic conditions.

• Enhanced understanding of diversity (i.e. cultural, age, socioeconomic, sexual orientation).

Comparisons – Heart FailureTraditional Approach

- A & P- Pathophysiology- Signs/Symptoms- Dx tests- Treatment- Nursing Interventions &

patient teaching

Virtual Experiential Communities

- Story of individual with HF- Story depicts issues associated

with disease management and navigating health care system

- Multimorbidity- Changes in status depicted time

over weeks; acute exacerbation not primary focus of story – just an event within the story.

Context = acute phase; perspective of the nurse

Context = daily life; perspective of individual

What is the Link to Nursing

• Clinical Judgment Model (Tanner)– Notice (potential for problem)– Recognize (problem has developed or is developing)– Respond (nurse knows what to do)– Reflection-in-action– Reflection-on-action

• Health Promotion Model– Primary Prevention– Secondary Prevention– Tertiary Care

PHASE OF NURSING CARE

Common Teaching Strategies

• Incorporated in Lecture• Case Study• Role Play• Games• Care Plan• Creative Writing

• Simulation• Compare and Contrast• Concept Map• Debate• Concept Analysis• Policy Analysis

What Do You Want Students To Do?

• Individual Assessment• Family Assessment• Community Assessment• Calculate medication dosages• Analyze medication or treatment plan• Develop a Care Plan• Develop a Teaching Plan• Identify Risk Factors• Identify Interventions• Evaluate Interventions• Hold a Team Meeting• Analyze a Medical Record

• Plan a Home Visit• Analyze payment structures • Develop a Policy or Protocol• Propose a Community Health Plan• Identify a researchable problem• Apply principles of ethics to an

ethical dilemma• Apply evidence-based standards to

situation• Develop Discharge Instructions• Plan a Health Fair• Identify Safety Hazards

Learning Activities that are Purposeful

FUTURE DIRECTIONS

Outcomes and Evidence

• Research conducted at pilot sites Fall 08– Perceived engagement– Perceived benefits (students)– Perceived benefits (faculty)

• Future research ???– Faculty work-life– Enhance cultural competence– Differences in health care delivery

Alternative Applications

• Population specific virtual communities• Application for multidisciplinary health care

education• Application for other disciplines

– K-12– Social Work– Construction Management