The Instructional Methods Lucille Martin In Nursing Education Its Case Method, Concept Map and Problem Based Learning. In nursing Education all education components and theories are same but from the nursing educational point of view.
Case Method and Problem-Based Learning: Instructional Methods Lucille Martin In Nursing Education
Case method and problem-based learning (PBL) are variations on a theme. Both use case material or problem scenarios as a vehicle for analysis and/or decision-making. In case method, these scenarios demonstrate how previously acquired knowledge applies to clinical practice. The knowledge precedes the problem. Often a step-by-step analysis by the teacher models the critical thinking process, followed by student discussion.
In contrast, PBL is not dependent on earlier learning; the problem comes first. The problem is posed so that the students discover that they need to acquire some new knowledge before they can understand or solve the problem. Information necessary to devise a solution is not included in the case, and the scenario is open-ended and purposefully “ill structured.”
Problem-Based Learning
An essential component of problem-based learning (PBL) is that content is introduced in the con text of complex real-world problems. PBL uses an inquiry model. In PBL, students work in small groups (ideally five or six) or independently; must identify what they know; and most importantly, what they don’t know. After asking critical questions and searching for the relevant information, the goal is to solve the problem or at least shed some light on an unclear situation.
Posing the problem before learning the associated content tends to motivate students. They know why they are learning the new knowledge. Learning in the context of the need-to-solve-or-understand a-problem also tends to store the knowledge in memory patterns that facilitate later recall. Before entering PBL, students should be skilled problem solvers. PBL does not develop problem solving skills without explicit interventions on the part of the teacher. In some academic situations, a workshop on problem solving precedes the use of PBL.
PBL teaching materials are designed to be “ill-structured” and to mimic the complexity of real-life situations. There is never a simple answer. PBL assignments vary widely in scope and sophistication, and one case may provide the focus for many weeks of inquiry. Students must go beyond their textbooks to pursue knowledge in other resources in between their group meetings. One such resource may be expert opinion. They then reconvene to share and summarize their new knowledge. Students may present their conclusions, and there may or may not be an end product.
Again, students ideally have adequate time for reflection and self-evaluation. All problem-based learning approaches rely on a problem as their driving forces, but may focus on the solution to varying degrees. Some PBL approaches intend for students to clearly define the problem, develop hypotheses, gather information, and arrive at clearly stated solutions. Others engage students with problems that have no solution, but are meant for learning and information gathering (Burch, 1997).
The primary role of the instructor is to facilitate group process and learning, not to provide easy answers. The model for PBL was developed more than 25 years ago at McMaster University in Canada. PBL has since become a preferred methodology in business, law, and several medical schools. Interest grew from questions about how well traditional courses educated students to be problem-solvers and lifelong learners.
Information-dense lectures, presented by a series of experts to large student audiences, seemed disconnected from the application of content to real life, which requires integration of knowledge, decision-making, and working and communicating with others.
Case Method
The case method differs somewhat from PBL. The materials used in the case method are more extensive and complete, assuming that previous learning is integrated into the scenario. Case method and the problem-based method both use narratives, situations, select data samples, or statements that present unresolved or provocative issues, situations, or questions. As a teaching/learning tool, this material challenges participants to analyze critique, make judgments, speculate, and express reasoned opinions.
Above all, although information can be real or invented, the situations presented must be realistic and believable. The information included must be rich enough to make the situation credible, but not as complete as to close off discussion or exploration. Material may be short for brief classroom discussions, or long and elaborate for semester long projects. The intent is to bring real world problems into the safe and secure world of the classroom. They are “rehearsal for life” (Herreid, 1994).
Both of these techniques place the student in the role of decision-maker, and provide a story or scenario that needs to be made sense of, solved, or resolved. The faculty role is to guide students to resources and information, help them to frame the questions to ask, formulate the problems in clear language, explore alternatives, and make decisions. Students confront these problems in small groups, and pool their knowledge for successful solutions. These strategies give students the opportunity to use previous learning or evolving knowledge depending on the method used.
As in other group strategies, students should be allowed to work without instructor interference, and optimally within a group of three to eight participants. The instructor must be comfortable with ambiguity and with adopting the nontraditional roles of witness and resource, rather than authority. The instructor may provide the structure of a series of questions to guide group exploration and discussion. It is probably wise to reveal these questions slowly over time, rather than chance that students will rush to premature closure. Pay careful attention to the sequencing of the questions suggested.
In case method, the materials may be an in-depth description, including present problems and background information. The case may demonstrate how concepts and theories learned in class are applied to clinical practice. Shorter cases, a few sentences to a paragraph, may only present essential information, and focus through questions on assessment, missing data, alternative decisions, and consequences.
Case studies also may be developed to represent the unfolding of clinical situations over time. These are referred to as unfolding cases. After the student has answered questions about the current part, the scenario is modified. This can continue indefinitely (Oermann, 2004). The format for cases or problem situations can take several forms. They can include the solution, allowing merely for analysis or suggested alternative solutions.
Unfinished cases have the results withheld, either by design or reality. Situations may be fictional or real. In the situation where the teacher authors such material, care should be taken that the material is complex enough to challenge the student, yet not so obscure as to make solution impossible. The time involved in developing or securing these materials is a major obstacle to use of these techniques.
Grand rounds are another instructional method focusing on case material. The case material may be either real or fictitious, current or retrospective, one case or several. Presenting a case at grand rounds assumes some sophistication in presentation and knowledge. Faculty or senior students are often the presenters of case material and the facilitators of discussion.
Grand rounds may be conducted in the clinical area or the classroom. In some settings, they are videotaped for future review (Oermann, 2004). Grand rounds should include staff nurses, who are the appropriate role models for students.
Concept Mapping
A concept map is a visual (graphic) representation used to illustrate and facilitate understanding of relationships between one or more concepts, thus directly enhancing critical thinking. In addition, concept maps facilitate communication between students and faculty. Many nurse educators have in recent years adopted this teaching strategy, originating from the educational discipline.
Mapping has been well documented in the literature and given various labels, depending on the field and its intended use. It has been called cognitive mapping, idea mapping, patterned mapping, patterned note taking, and flow charting (Koehler, 2001). There is no one right way to design a concept map. The learner should be oriented to map ping and to the logic behind the methodology, but then encouraged to be creative in the map design while still including all of the appropriate data.
Ideally, the learner creates the map and the teacher can gain great insight into the nature and extent of the student understands of content by reviewing the maps. No two concept maps will ever be the same. Four main styles of concept maps are possible, yet there may be more. These are the spider map, hierarchical or chronological map, flow chart, and systems map. Proposals have been made to use some form of concept mapping in lieu of traditional nursing care plans, but for our purpose we will be considering mapping as a strategy for learning. The benefits of concept mapping include the following: (Hanson, 2005).
- Improves the student’s ability to organize a body of knowledge
- Allows the student to assimilate previously learned knowledge with newly acquired knowledge
- Demands critical thinking skills
- Provides a visual aid that may promote learning
- Allows the student to identify what they know about a topic and also what they must still learn
One person alone may construct concept maps or a group may collaborate in this work. In fact, the greater the number of students who participate in the map development, the more meaningful the discussion. These maps may be used in any content area, but the most common application is in the clinical setting. Mapping can be a successful tool in leading discussions during post-conference: the student(s) draws a map showing patient problems and how these problems are interrelated.
The map illustrates relationships between one or more medical diagnoses, nursing assessment data, diagnostic test results, nursing diagnoses and collaborative problems, and interventions and treatments. Students can be introduced to the idea of concept maps by the instructor’s use of such tools. Use a blackboard, transparencies, or the computer to visualize lecture content in this format, without labeling it as such. Once students have been intrigued or found it useful to their understanding, invite them to participate in using this format.
Conclusion Or Summary
The teaching strategies that have been presented here are just a start. These techniques will grow and multiply by combining them and making minor and major modifications. The secret is to trust your intuition and continuously assess your students and the pace at which they are growing in their learning. Remember that as a teacher of students preparing for professional practice, your goal is to develop critical thinking skills adequate to support evidence-based practice.
The student who thinks critically can ask appropriate questions, gather relevant information, efficiently and creatively sort through this information, reason logically from this information, and come to reliable and trustworthy conclusions about their practice. Any of the strategies detailed here can facilitate the development of these skills. Lecture brings the perspective of an expert and models critical thinking.
Group discussion, in all of its forms, when properly facilitated by the teacher, moves students to challenge one another, while sharpening their thinking skills. The jigsaw builds responsibility and independence through a group within group experience. Debates allow us to find new meaning and consider the opposing views of our arguments. Journaling provides the time to examine yourself and to process concepts.
Role playing and simulation allow us to experience new situations without the inherent risk that reality would hold. Case studies offer an opportunity to apply concepts to novel situations, extrapolating from the familiar. Problem-based learning promotes a spirit of inquiry, con fronting what we don’t know as opposed to what we do know. The teacher’s only restriction is her own creativity.
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