Clinical Teaching, Flipped Classroom, Problem Based and Team Based In Nursing Education
Course
Design In Nursing Education
Faculty
have now completed the overarching curriculum structure with the identification
of the organizing framework, outcomes, and competencies. These competencies now
need to be organized, or threaded, through the courses that faculty will
develop.
To begin this process, faculty must consider the antecedents, or
factors, that need to be in place for the outcomes and competencies to be
achieved in each course in the curriculum. Antecedents are defined as the
prerequisite knowledge needed to develop or foster the identified attributes or
characteristics.
It is assumed that each course within the curriculum will make
a unique contribution to the ability of students to meet the identified
competencies at each level of the program.
The key is for faculty as curriculum
developers to consciously consider and design courses and sequences that will
best lead to achieving the desired learning outcomes across the diversity of
students within the population.
Teaching
and Learning Trends in Curriculum Design In Nursing Education
Seismic shifts have occurred in
conceptualizing and designing nursing education programs. Several additional trends of
significance are briefly described here because of their profound and growing
influence on nursing education curricula.
Among the most important are theories
and approaches seeking to promote deeper and more engaged learning while better
reflecting the complexity of teaching nursing, especially but not limited to
prelicensure students.
Four popular trends are overviewed to illustrate the
evolution occurring in nursing education: constructivism, narrative pedagogy,
problem based and team-based learning, and flipping the classroom.
Constructivism
and Narrative Pedagogy for Curriculum Design In Nursing Education
The
influence of constructivism and phenomenological- based approaches to teaching
and learning has led to creation of new pedagogies reflecting this shift in
foundational beliefs about education.
A constructivist perspective embraces
elements of cognitive psychology that suggest knowledge is not simply absorbed
but must be “created” by and within the learner, with faculty serving as a
guide.
Hartle, Baviskar, and Smith (2012) published a field guide to
constructivism for the college level, noting that there are four essential
criteria: prior knowledge assessment, cognitive dissonance creation,
application and feedback, and metacognition.
Metacognition may be simply
defined as students reflecting on what they have learned, how they learned it,
and why it is important.
With
narrative pedagogy, “teachers focus on thinking anew about the experiences they
co-create with students, rather than on the activities common in conventional
pedagogies . . . and work with students to interpret shared experiences of
learning and practicing nursing” (Ironside, 2014, p. 212).
Although narrative
pedagogy may be interpreted and used as an entirely new paradigm for nursing
education, presently it is most often implemented as a strategy and used
concurrently with more traditional approaches to curriculum development.
Considering Benner et al. (2010) seminal work recommending major changes in
nursing education, including contextualizing knowledge, promoting situated
clinical reasoning, linking classroom and clinical information, and focusing on
professional identity formation, narrative pedagogy provides an evidence based
strategy to revolutionize teaching and learning in nursing.
Provides
a comprehensive discussion of constructivism, narrative pedagogy, and other
learning theories.
Problem Based
and Team Based Learning In Nursing Education
Although
some substantive differences exist between the two, problem-based learning and
team-based learning share fundamental characteristics, including the value of
peer learning. A systematic review of peer learning in nursing programs
revealed improvement in either an objective effect or subjective assessment in
16 of 18 included studies (Stone, Cooper, & Cant, 2013).
Additionally, peer
learning in nursing education was shown to develop student communication,
critical thinking, and self confidence. Problem-based learning may be defined
as a “cognitive endeavor whereby the learner constructs mental models relevant
to problems” (Schmidt, Rotgans, & Yew, 2011, p. 792).
Team based
learning is also a learner-centered approach with faculty serving as expert
facilitators (Hrynchak & Batty, 2012; Mennenga & Smyer, 2010). As in
problem-based learning, cases and scenarios are used to promote problem solving
through group interaction and analysis.
One major difference is the more
structured process generally associated with team based learning. A benefit of
team-based learning is the ability to use the technique with a fairly large
group of students; in contrast, problem-based learning is usually conducted in
smaller, independent teams.
The
“Flipped Classroom” In Nursing Education
Last, the concept of “flipping the classroom”
has received significant attention in both K–12 and higher education circles.
Consistent with much of the prior content, the goal of a flipped classroom is
for students to individually prepare for learning with the goal of creating
meaningful and engaging learning activities within groups in the classroom.
Faculty facilitate the classroom discussions to promote active, engaged
learning that results in longer lasting and deeper knowledge gains (Alexandre
& Wright, 2013; Dickerson, Lubejko, McGowan, Balmer, & Chappell, 2014). The concept of interconnectedness in the classroom,
including the “flipped classroom.”
Clinical
Teaching and Learning In Nursing Education
As
a practice discipline, teaching and learning the role of a nurse in a health
care setting is paramount to achieving the desired learning outcomes. The ratio
of clinical instructors to prelicensure students is regulated by state boards
of nursing to ensure public safety when students are practicing.
Clinical
teaching is one of the most time and resource-intensive aspects of nursing
education and is of critical importance at all levels of nursing education and
any practice discipline. Clinical faculty must develop the teaching skills and
strategies to transform their clinical expertise into meaningful experiences
for and with students.
In numerous clinical placements, especially at the
graduate levels, preceptors are used extensively. Thus preceptor identification,
development, and evaluation merits the necessary attention and support.
The
complexity of health care organizations and competition for clinical sites as
schools of nursing increased enrollments to meet health care needs has often
sub optimized student clinical experiences through inconsistent scheduling,
working 12-hour shifts, and being unable to follow a patient’s trajectory of
illness and recovery.
Students frequently do not care for patients with
conditions matching the content being covered in classrooms; may work with
different nurses as opposed to an identified preceptor; and struggle to become
familiar with the necessary structure, systems, and practices of the several
clinical sites they may be assigned to over the course of a semester.
The use
of concepts to showcase similarities and differences across discrete patient
diagnoses is particularly useful given these realities as they help learners to
relate information to multiple situations.
Last, the underlying pedagogy and
role of clinical instructors, who in many cases are not full-time faculty and
may not be familiar with the overall curriculum, is often not clear or
consistent.
Clinical
immersion experiences have waxed and waned in popularity and seem to be
experiencing a new wave of popularity. Immersion may be as short as a week or
two or as long as one or two semesters, depending on curricular design and
clinical site relationships and support.
The benefits of immersion include
sufficient time to learn the setting and its practices and procedures,
opportunities to see the trajectory of patient health and illness patterns over
longer periods, and the ability to form work relationships with a variety of
health disciplines to master the intra and inter professional skills of
teamwork and collaboration.
Although the increasing support for post licensure
residence programs may bridge some of the gaps related to transition into practice,
the importance of clinical practice teaching and learning prior to that time
deserves continued attention.