The Instructional Methods Lucille Martin In Nursing Education and Less Traditional Methods. In nursing Education all education components and theories are same but from the nursing educational point of view.
Less Traditional Methods of Instruction: Instructional Methods Lucille Martin In Nursing Education
The imagination knows no bounds where instructional methods are concerned. More traditional methods may be augmented with new techniques. Novel and creative approaches to teaching are made possible through evolving technology. Whatever seems to work to facilitate learning is worthy of a trial, evaluation, and serious exposure to the research process.
The Jigsaw
Jigsaw is a cooperative strategy that involves group learning. The name “Jigsaw” is given for the structure of the activity within the group. A group is given a task or problem with a packet of information sufficient to allow creative and critical thinking about a solution or mastery of the task. Within the group, each member is given one part of the package (a “piece of a puzzle”) to work with.
Each member then shares what they have learned with other group members—the goal is that all group members eventually learn all the information within the packet, but with the help of each other. The group depends on each individual in order to accomplish the task. In a variation of this first approach, a large class is broken up into small groups.
The same package of materials is given to each group, and parts assigned to individual members. Then, how ever, the students who are responsible for the same section in the various “home” groups join together and form a new, temporary focus group whose purpose is for the students to:
- Master the material in their section. 10 Instructional Methods
- Enrich their thinking and enlarge their perspective through “groupthink.”
- Develop a strategy for teaching what they have learned to the other students in their original “home” learning group. First introduced by Aronson, Blaney, Stephan, Sikes, and Snapp (1978), the jigsaw structure of group discussion promotes positive interdependence and also provides a simple method to ensure individual accountability.
The preparation of group packets is time intensive for the teacher. Sections of the package must be equitable, complete, and contain the best resources. Students may be initially unhappy with this strategy, feeling that they are doing all the work, because this role is traditionally assigned to the teacher. Teachers may be worried about not covering the expected content. These student and teacher assertions are common toward many of the more nontraditional instructional methods.
Debate
Debate is a procedure in which two or more people compete in trying to persuade others to accept or reject a proposition as the foundation for a belief or behavior. Debate was already mentioned as one technique well suited to group discussion. It is included again here to highlight the academic rigor that the technique demands, and the fact that debate is a hybrid, and differs from discussion in several ways: • Debate is a presentation of the result rather than the airing of the process.
- Debate is basically competitive whereas discussion should be cooperative.
- Debate centers on an issue that is already defined, whereas a discussion generally is an attempt to delineate factors and define a position.
One of the major difficulties in structuring debates is the clarification of a good resolution. The subject of the debate must also be controversial in nature. The resolved should always be an affirmative statement presenting an issue that is clear not only to the debate participants, but also to the larger audience. The issue should also be debatable, offering an opportunity for both sides to construct substantive arguments.
When the negative is blatantly wrong, the debate is sacrificed. Speakers should be encouraged to attack the primary issues and not waste the limited time wandering down bypaths. In formal parliamentary debate, it is proper to take a vote from the assembly after the debaters have concluded to see which side won. That is probably not a good technique to use when you are employing the debate as a teaching method.
The object is to get the issues on the floor, not to establish a winner. No doubt there will be a subjective decision formed in the minds of your students as to which side really has presented the better argument. But there seems to be no value in embarrassing any of the participants by taking a win-lose vote.
Journaling
Writing or journaling is a very beneficial technique of instruction that is best applied to the individual, and suitable for learning in both the cognitive and affective domains. Students can write about their knowledge, or their opinions, values, attitudes, and emotions with equal freedom and candor. Later, products generated here can be used with the class, according to student and teacher discretion.
Students may be required to journal periodically about topics assigned by the teacher, or more broadly about a variety of course-related topics, such as: How would you describe the nature of nursing? Describe one incident in your practice during the past week, and the scientific justification for your intervention. What do you have difficulty understanding about this course? Journals may be “stream of consciousness,” reflective, or highly analytical; or may be expected to develop from one to another over time.
An idea generated as an idle thought may later take on significant meaning, and become the cornerstone of serious critical thinking. In any event, journaling should provide an opportunity for creative writing, and the most significant value that this holds should be the exploration into itself. When individuals articulate feelings or ideas about a certain matter on paper, they tend to discipline their minds into orderly thinking about that subject.
That is why teachers so frequently assign term papers and other writing projects that call for the discipline of organized thought processes. This explains three values of this technique: insight into self, discipline, and organization of one’s thinking. A beginning writer may discover keeping a journal to be awkward, clumsy, uncomfortable, and even too revealing (Hodges, Kelley, & Wilkes, 1996).
A major influence on the reactions of students to a journaling assignment is their familiarity with the recording activity. They may have kept a personal diary themselves or read diary-based accounts in literature. Some may have been exposed to the works of scientists, many of whom used diaries in the acquisition of insights and the formation of their theories.
Students may have been required to keep journals in other courses. The quality and quantity of any of these experiences may vary but all provide background on which students can draw, thus predisposing them toward the openness, reflection, and organizational criticality to the journaling activity (Hancock, Mikhail, Santos, Nguyen et al., 1999). And if they bring no history in journaling, and are reticent, require more frequent journaling and shape their entries with sensitive and guiding comments.
Diversity among students in knowledge and attitudes about journals requires faculty to be clear about their journaling expectations. Students need explicit criteria for the form and function of the journal. If it is the expectation that both objective and subjective entries and reflection and analysis be included in journaling, then faculty must emphasize this at the beginning so that students can strive for them from the outset.
If a process of development is expected, say so. The student may be told that their initial journals should support a stream-of-consciousness, with the aim of getting their thoughts down on paper, and subsequently become more organized and analytical.
But the standard must be clear. Thus, observations on the quality or characteristics of a student’s journal may reflect as much upon the faculty’s preparation of the student as on the student themselves. Decisions on journaling are made within the context of the instructional strategy for the course. Faculty members need to ask themselves some salient questions: 10 Instructional Methods
- What are the preconditions for successful journaling?
- When and how does the student learn from it?
- What are its risks and benefits?
- Which aspect of the assignment is more important: the process of writing it, the thinking involved, or the final product?
- Is journaling congruent with the faculty’s philosophy of teaching and learning?
- Will journals be graded?
- Is the evaluation to be formative or summative? Answers to and reflections on these questions can clarify the real reasons for journaling and result in a well-articulated and defensible description of the assignment.
Journaling is particularly effective in shaping the quality of the student’s creativity and critical thinking. Moving students along this road involves careful work for the teacher, patience, and the extensive use of formative evaluation. Summative evaluation is only appropriate at the end of the process. The goal is the same for all students in a course; journaling allows the teacher to personalize the means to that end.
Role Playing and Simulations
Role playing and simulations promote the use of imagination to have students stretch their thinking (Lowenstein & Bradshaw, 2001). Although both simulation and role playing are part of the same category of techniques, there are differences. Role playing “… is a method by which learners participate in an unrehearsed dramatization” (Bastable, 2003, p. 370). Simulation, in contrast to role playing, finds the learner “… rehearsing behaviors or roles that they will need to master and apply in real life” (Bastable, 2003, p. 370).
An experience is created that reflects real-life conditions but without the consequences of failure. Today, with health-care provider requirements for increased productivity and patients who are in the delivery system for very short periods of time, real-life experiences are at a premium. While using simulations and role playing, students may try out behaviors and solutions in the safety of the laboratory before they apply them to the real world. In other words, role play and simulation afford students an opportunity to experiment without risk.
Role Playing
Role playing is particularly effective in the affective domain and in developing decision-making and problem-solving abilities. This instructional method is primarily used to arouse feelings and elicit emotional responses in the learner. It is unscripted and improvised. The learner is not mastering a role with plans to use it, but to develop an understanding of other people in the situation.
The role players respond to each other—not to the audience—as characters in the scenario. Members of the class not involved in the drama are observers and contribute to the analysis after the dramatization (peer review). The teacher role here is passive, facilitating, and gently guiding, rather than directing. Many people have had unpleasant experiences with role playing because the teacher failed to warm up the class. Warm-up is necessary for role play.
Further, those assigned to specific parts of the drama need to be acquainted with their roles. Simply saying, “You’re a dying patient and you are her daughter who is afraid to admit her impending death—go to it!” isn’t enough information, and those thrown into such a situation will feel as if they have been deserted. The teacher as coach needs to talk to each of the players, interview them “in role,” draw out their thoughts regarding the role and role playing, and gently involve them imaginatively in the situation.
Roles need to be explained briefly both to the players and the observers before start of the session. There should be enough explanation to allow their participation but not so much that it affects their role taking or later analysis. Students need to know the objectives of the exercise, the story line, how the characters participate, and the role of the observers. Students report increased learning and better retention using role playing over traditional lecturing (DeNeve & Hepner, 1997).
This is not surprising given the active role of students, both actors and observers, with this technique. This comparison, however, is not entirely fair. Role playing meets different pedagogic needs, being structured primarily for learning in the affective domain, targeting interpersonal behaviors as they reveal attitudes and values. Role playing is particularly useful for practicing therapeutic communication skills and dealing with conflict. But there are dis advantages, too.
Development of appropriate role-playing scenarios can be time intensive. Some students are reluctant to participate because the role playing is done in front of a group of students. Role playing may reinforce stereotypical behavior among students. There are also economic considerations; the method is best accomplished with a small group of students, no more than ten.
Use of Simulation
Simulation allows anticipatory learning (Bastable, 2003). There are a number of types of simulation: written simulation, audio-visual simulation, simulation using models, and computer simulation. Simulation activities involve controlled representations of actual clinical events. This methodology allows the learner to experience “real world” patient situations without risk.
Learners are required to assess and interpret the situation, and make decisions based on information provided. Usually conducted in a laboratory setting, simulation learning allows students to execute a variety of skills, including assessment, psychomotor skills, and decision-making. Simulated cases or problem situations can be used for either teaching or evaluation.
Both psychomotor skills and cognitive decisions can be incorporated into computer simulation. Cases are presented, information given and requested by the student, decisions made, and feedback supplied. Both models and live subjects can be used for simulation. Computers have been combined with lifelike models to provide the ultimate in realism and customization of student experiences.
The most sophisticated of these are called high-fidelity simulators. They are whole-body, computer operator controlled models that reproduce in a lifelike manner the functioning of all body systems, and even have the ability to respond to certain drugs (Bastable, 2003). Mid fidelity does not have the aforementioned capabilities, but permits rapid vital sign and heart/breathe sound changes in response to assessment/interventions.
Low-fidelity includes traditional mannequins, or other non-interactive simulators. These simulators allow students to practice repetitive and high-risk procedures under the supervision of clinical faculty. The use of high fidelity simulators to educate students for the workplace environment is recommended in the Institute of Medicine report “Keeping Patients Safe: Transforming the Work Environment of Nurses” (2003). High-fidelity simulation was first used in nursing anesthesia education (Farnsworth, Egan, Johnson, & Westenskow, 2000).
Since September 11, 2001 these simulators have become the backbone of Air Force Nursing Education at the Joint Trauma Training Center and the Warskills Simulation Laboratory (Bruce, Bridges, & Holcomb, 2003). Recent availability of SimManTM (by Laerdal) now affords undergraduate students opportunities to experience and learn via high fidelity simulation. SimMan scenarios include a teenage asthmatic, middle-age CHF, and multiple-complex critical and anesthesia focused patients.
These situations progress from simple to complex, incorporating a range of complications and crisis events, and expecting nursing management in real-time. High-fidelity simulators allow students to practice repetitive and/or high-risk procedures under the supervision of clinical faculty. Studies have shown that high-fidelity simulation is particularly effective with the adult learner (Yaeger et al., 2004). Simulation, particularly high-fidelity, is expensive, and justification of its use essential.
Ravert conducted a meta-analysis of quantitative studies related to computer-based simulations and their effect on education and learning in the health care disciplines (2002). This review indicates that a significant number of these studies reveal positive effects of simulation on skill and/or knowledge acquisition. The potential of computer-based simulation for educational augmentation is enormous, but more research is needed to determine cost effective and successful uses of high fidelity simulations for nursing education (Ravert, 2002).
A growing trend associated with simulation, especially simulation of the higher order is the learning laboratory. State-of-the-art laboratories are equipped with mannequins; simulators; bed side computers, with Internet access; digitized video; computer-assisted instructional software; and other interactive software. The laboratories are designed to replicate realistic practice settings, including the basic hospital unit, critical care, pediatrics, neonatal nursery, maternity, home care, and the diagnostic laboratory.
Another type of simulation is the simulation game. These games are generally interactive in a problem situation, operated according to set rules, and competitive. Examples of such games are “Mental Hospital,” “Into Aging,” “The Disaster Game,” and “Bafa Bafa.” The first two of these games aim to sensitize students to unique physical disabilities that accompany aging and the social disenfranchisement suffered by the mentally ill. The third simulates citizens’ roles under disaster conditions and encourages players to cooperate, organize, and plan.
“Bafa Bafa” introduces students to the stereotyping experienced by a foreigner in a strange culture. Simulations (whether written, on computer, as a game, practiced on mannequins, high- or low-fidelity) bring clinically related experiences into the school, and are more efficient and safer methods of providing clinical experiences.
It is apparent that many schools of nursing are using simulation teaching and evaluation as a complement to patient-contact experiences. Simulations are being used with a variety of subjects and concepts and with a wide range of student abilities. They have proven to be efficient and effective in these days of tight time schedules, “full” curricula, and crowded clinical facilities.
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