Traditions, Existing Paradigms, and Sacred Cows in nursing and nursing education

SusanJean · Jan 3, 2005

Since I have not attended nursing school, I can not comment yet.

I have attended PA school and I would say the problems listed above for nursing are glaring in the program I was enrolled in.

Altra, BSN, RN · Jan 3, 2005

From a student's perspective ...

Many of the statements seem true - curricula geared to NLN standards, focus on covering content & preparation for NCLEX, etc. But is this necessarily a bad thing? Nursing education must prepare a student to begin clinical practice - a considerable amount of knowledge of theory and procedure has to be "crammed into" a nursing student within the time allotted.

While that may not leave much time for exploration of individual areas of interest, is it feasible to expect that within an undergraduate program? Is it significantly different from undergraduate programs of study in other fields which require licensure to begin practice - i.e. accounting, architecture, pharmacy, etc.?

I'd be curious to read the responses of experienced nurses and nursing faculty ...

purplemania, BSN, RN · Jan 3, 2005

The list sounds very negative, but does not offer any solutions for change. Educators are obligated to many governing bodies (State, School & others). Trying to fit in all the "must haves" is challenging. Another challenge is meeting the expectations of the students and future employers of those students. Nursing is so much more than learning theory or facts, and the skills can be learned quickly on the job. What takes time, and energy from both the educator and the student, is learning to become a nurse. How do you teach that?

VickyRN, MSN, DNP, RN · Jan 3, 2005

Thank you for bringing this up, Karen. This is an excellent article, which we discussed at length last semester in our nursing curriculum class (for those who don't know, I'm in the Nurse Educator concentration of a MSN program).

Here are some of my thoughts on the matter:

As educators, we most often teach as we were taught. We tend to emulate our favorite teachers or role models. Change is always very difficult because we get out of our comfort zone. That said, it is imperative that nurse educators stay current with not only the latest evidence-based theories in instruction, but also the current practice environments, and latest political and legal trends in nursing.

There seem to be few pedagogical changes in the basic structure of nursing school curriculum in the past 20 years. (Pedagogy is a fancy word which means activities of educating, instructing, or teaching.) Traditional pedagogy embodies teacher-focused education. In the traditional pedagogic model, teachers assume responsibility for making decisions about what will be learned, and when it will be learned. Teachers direct learning. Learning is passive.

Passive learning occurs when students use their senses to take in information from a lecture, reading assignment, or audiovisual. This is the "traditional" mode of learning most commonly present in nursing classrooms. It is used to acquire ideas and information that is available for recall (regurgitate information).

Advantages of passive learning include:

1. Can present a great deal of information in a short period of time.

2. Lecture notes, handouts, and audiovisual media can be selected and prepared in advance.

3. Controlled environment (faculty more comfortable).

4. Good for new faculty member or one who is teaching new content.

5. Students most often prefer this approach (they are used to this method of teaching).

6. Important concepts and content identified in a concrete, organized, and meaningful manner.

7. Students have lower anxiety levels and feel more secure with this method.

Disadvantages of passive learning include:

1. Little opportunity to assess how well students are learning the content.

2. Little time for questions, clarification, or discussion.

3. Students may not feel comfortable letting faculty know that they do not understand key concepts, they are reluctant to ask questions in class, or they may not ask enough questions to clarify their misunderstandings.

4. Does not require consistent use of higher-level cognitive skills (no opportunity for application).

5. May become tedious and boring.

Current theories of pedagogy operate from an entirely different paradigm: learner-focused, instead of teacher-focused. The focus is now on the student: active or student-based learning.

Active learning: Involves the student through participation and investment of energy in all three phases of the learning process (input, operation, and feedback phase). This type of learning is more apt to stimulate higher cognitive processes and critical thinking.

Advantages:

1. May increase critical thinking skills in students.

2. Enables students to show initiative.

3. Involves students by stimulating them to talk more.

4. Incorporates more student input and ideas.

5. Easier to assess student learning.

6. Better meets the needs of students with varying learning styles.

Disadvantages:

1. Faculty need to be expert in the content area.

2. May be difficult to organize active learning experiences.

3. Requires more time and energy and may be stressful for faculty.

4. Faculty may receive less favorable evaluations from students.

5. Students may be stressed because of the necessity to adapt to new ways of learning.

While attending the North Carolina Community College System 2004 Conference in Greensboro last October, I was privileged to participate in a fascinating presentation by three non-nursing educators from Craven Community College entitled "A Recipe for Introducing Student-Based Learning into Your Classroom." They talked about their journey from a teacher-based (passive learning) curricular framework to a student-based (active learning) curricular framework in their respective departments and courses at Craven.

Within the new paradigm of student-based learning, students take responsibility and students become the teachers. Faculty and students become equal partners in the learning environment. It is the faculty's responsibility to construct the best learning environment possible. The Craven educators emphasized that teamwork among instructors in a department and faculty agreement are essential in order to successfully implement student-based learning in the classroom. They warned that students will be upset and even angry at first, but "will thank you at the end of the semester." Fellow educators may not accept this as a collegiate method and there will be instructor insecurity with "letting go" of the lecture format. And, the current environment in most undergraduate classrooms and block scheduling (the set-up of most nursing curriculums) does not lend itself to this change very easily. These educators emphasized that much time for planning and development up front is essential and that the majority of the time spent with this new learning paradigm is on the "front end." Students will be assigned to teams and trained to work in teams. Students must learn how to find and use information to make decisions. They must use ideas and information instead of just memorizing information for a test. The students must learn to evaluate their own work. There must be a willingness on the part of faculty to accept the idea that students can find the important material themselves. One of the teachers (a mathematics instructor at Craven) is using this new paradigm to teach algebra and other upper level mathematics courses with astounding results! They contrasted the "familiar recipe" (the teaching paradigm) with the "new recipe" (learning paradigm).

The Familiar Recipe: Lecture/ deliver instruction, taking the right notes, rote memorization, instructor only assessment, grading competition among peers, one right answer, thinking like the instructor, independent disciplines and departments.

The New Recipe (students as coproducers of learning): Brain-based learning, multiple intelligences, quality learning, learner center instruction, collaborative learning, problem-based learning, incorporation of individual learning styles. The end product of student-based learning is that the student takes responsibility for his or her learning, there is increased retention of the most important points, and students learn to work in teams and solve problems cooperatively. Valuable workplace skills and critical thinking are developed.

Five critical need issues be considered and addressed in active learning. They include:

1) letting learners know WHY something is important to learn;

2) showing learners how to direct themselves through information;

3) relating the topic to the learners' experiences;

4) people will not learn until they are ready and motivated to learn; and

5) this requires helping them overcome inhibitions, behaviors, and beliefs about learning.

Twenty-first century nursing curriculum must change from an emphasis on teaching to an emphasis on learning. Within the learning paradigm, faculty are responsible for creating environments and experiences that bring students to discover and construct knowledge for themselves (the "guide to the side"). The teaching paradigm positions the faulty as the chief controlling agent providing instruction with the expectation of transferring knowledge to the students (the "sage on the stage"). Students are seen as passive receivers (rather than active learners), taking in information and then regurgitating it during examinations.

In the new learning paradigm, student responsibility is key to all development and learning. I find this concept of personal responsibility very refreshing in that it goes against the grain of the "victim" culture in which we live (in our "learned helplessness" cultural milieu, taking personal accountability for one's actions or the outcomes of one's life is deemphasized).

In order to achieve curricular change, the article that Karen cited made some recommendations, including that the nursing curriculum should be:

a) learner focused, with faculty serving as facilitators of learning

b) structured so that courses are not rigid or offered sequentially

c) students should be held accountable for their own learning

d) students should care for patients in a varienty of settings and along the entire continuum of care

e) assessment skills, critical thinking, and diagnostic reasoning are key concepts that should have a focus throughout the program

f) adjunct and part time faculty should have a greater role in curriculum design

g) faculty should use innovative, learner-centered pedagologies based on actual research to facilitate learning

g) simulation/virtual patients should be used extensively to enhance student learning and decision making skills

h) students should have an opportunity to connect with a professional nurse who could provide mentorship on various nursing issues

i) students should have more choices in the learning strategies adnd opportunities throughout the program.

I know this is lengthy, but this is a very relevant discussion. Anybody else with any comments or ideas? What do students think about these proposed changes in teaching style?

rach_nc_03 · Jan 12, 2005

while reading
think tank on perioperative learning experiences in the nursing curriculum came across the interesting section regarding nursing education.
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thought i'd share and get your reactions.
karen

this is right on the money, in my experience. i'm starting the last semester of an adn program right now, and i've completely lost my love of learning- all i want is to get the hell out of there! as someone who challenges convention and always looks for new, better ways to do things, i've been forced to back-burner my preferred, integrative mode of learning, and instead, spend countless hours analyzing instructors and textbook authors, in an effort to crack the code of their test-making.

nursing is my third career, and i absolutely love most of what i've been able to do thus far; however, when i think about the rigidity of the education i've received, and wonder if it will persist in the workplace....let's just say i'm *highly* concerned!

SmilingBluEyes · Jan 12, 2005

Right-on! this is why the RN-BSN program I was enrolled in was so unpalatable, and why I could not wait to graduate my ADN program when I was in....I was sick, sick, sick of the boredom of it all......that and.......I hate indocrination and one-size-fits-all teaching and learning. Tons of "busy work" does NOT equate to quality education! :angryfire