EDUCATIONAL PROGRAMS FOR NURSES

Educational Programs for nurses, nurses and educational programs

Introduction

A firm foundation for an educational theory as well as a theory of nursing should guide the development of each educational presentation that an instructor presents.  The theory could be appropriate for just one class or a nursing program as a whole and should be grounded in sound research to ensure the theory is going to meet the needs of not only the students but also the nursing program.  This paper will discuss an educational program that was designed to be presented to students in the school of nursing at Indiana University South.   This paper will include the following information: the mission statement of the school of nursing at Indiana University Southeast; an educational philosophy; a method for identification of the needs of the learner; an instructional design; a goal statement of the presentation; a discussion of the domains and levels chosen; advantages and disadvantages of each chosen instructional method; and a discussion on the chosen evaluation methods.

Mission Statement

The mission of the Indiana University Southeast School of Nursing is to create a community of learning that addresses society's need for caring professionals and that nurtures students, faculty, and staff from diverse backgrounds” ("IUS," 2012, para. 1).

Educational Theory

The educational theory that was chosen for this presentation is the social learning or observational learning described by Albert Bandura.  This theory is grounded in the research that after viewing the positive or negative consequences of the actions of a model, the actions of the observer will then be changed.  The Observational Learning Theory has several principles that guide it.  The first principal guides this theory is that the model possesses characteristics that the observer views as desirable will cause the observer to imitate those same behaviors.  The next principle is reaction and imitation of the observer.  If the behavior of the model is treated positively then the observer will be likely to repeat that same behavior.  Likewise, if the behavior is punished, the observer usually does not produce the same behavior (Educational Theories, n.d.).

            Attention, retention, production, and motivation are the four processes by which learning by observation takes place.  By paying attention to what is going on around them and being influenced by the level of emotional arousal of the observer is the requirement for attention.  Recognizing the observed behavior and remembering it later are the requirements for retention.  This happens when the observer codes the information through physical or mental rehearsal for easier recall at a later time.  Physically and intellectually producing the act is required for production.  The necessary response might be produced by the observer, but the observer might need to learn other skills necessary to produce the actions of the model.  Typically motivation includes the observer only reproducing the observed behavior if they have an incentive to do so.  Reinforcement or punishment is an integral part of this process (Educational Theories, n.d.).

Curriculum, instruction, and assessment are all impacted by observational learning.  Allowing for the reproduction of the observed behavior in which positive reinforcement happens is how curriculum design is impacted.  Because learning typically happens within environmental and social contexts, collaborative learning must be utilized during instruction.  Lastly the right environment to perform the behaviors must happen during the assessment phase (Educational Theories, n.d.).

This can be utilized in the didactic setting by offering prizes for answering questions correctly during class.  The prizes do not have to be anything major.  Some examples of prizes might include free items obtained when attending conferences, candy, or possibly extra credit points.  At the beginning of the semester, the name of every student would be placed in an envelope.  When the instructor was ready to ask a question, they would then pull a name out of the envelope and ask that student.  If the question was answered correctly that student would then in turn receive a prize.  However if that student did not answer correctly they would not receive a prize and a second name would then be drawn.  After several opportunities for the class to observe that if an incorrect answer was given no prizes were awarded, the students would then be persuaded to try harder or study more.

Identification of learner needs

The way that the instructor can identify the needs of the learner is quite easy.  Upon admission to the nursing program the students are required to take an entrance exam which not only gives feed back to the students but the school of nursing on certain aspects of the students.  The information that is given includes the baseline knowledge of the students and what type of learning style they benefit from.  This information can be interpreted by the faculty to help develop and facilitate the educational presentations.  More information could be obtained during orientation to the school of nursing and the nursing program.  A questionnaire would be passed out to the students asking for what types of instructional methods they prefer or what types of methods help them learn.

Description of the learner

The learners are second semester Bachelors of Science in Nursing students at Indiana University Southeast.  The total number of students is 50, of that seven are male and the remaining 43 are female.  There are a total of five African American students, three Asian American Students, and the remaining 40 students are Caucasian.  The median age of the students is approximately 25 so this class is a mix of both traditional and non-traditional students.

Instructional Design

The instructional design chosen for this presentation is the Dick and Carey model.  This model has several steps.  The first step is to identify the goals instruction.  Next, an instructor would conduct an instructional analysis and identify entry behaviors.  The third step is to write performance objectives then to develop criterion referenced tests.  Steps five and six are to develop instructional strategies and develop and select instructional materials.  The last two steps include development and conduction formative evaluation as well as summative evaluations.  According to Akbulut (2007) this model “is rigid and cumbersome for the real-life instructional design situation” (p. 63).  This author also goes on to suggest that this model is helpful to first time instructors as well as instructors who teach online classes but mentions that this model does not leave room for much flexibility.

Goal of presentation

The goal of this presentation is to ensure that second semester Bachelor of Science in Nursing students can properly administer medications that affect the cardiovascular system.

Objectives

There are a total of seven objectives included in this presentation.  Six of the objectives are taught in the cognitive domain and the seventh objective is taught in the psychomotor domain.  The levels of the cognitive domain that are included in this presentation are: application, analysis, comprehension and synthesis.  These levels were chosen because it is the goal of the nursing program to ensure the students are learning at high levels.  If the knowledge or comprehension level had been chosen for all of the objectives, the students would not challenged to critically think.  The basis for the types of questions asked on the National Clinical Licensure Examination – Registered Nurse (NCLEX-RN) are geared at higher levels.  Since the NCLEX-RN is the culmination of the learning experience it is important to ensure the students are introduced to the types of questions that will be asked on that examination very early in the nursing program.

Content

The content chosen in this presentation is pertaining to medications that affect the cardiovascular system.  This information is important for the students to know because according to the Center for Disease Control and Prevention (CDC), heart disease is the number one killer of people in the United States.  In 2010 approximately 600,000 people died as a result of heart disease and in 2011 11.5 percent of the population of the United States was living with heart disease (Center for Disease Control and Prevention [CDC], 2013).  It is apparent from these statistics that in the future these students will encounter a client living with heart disease and these students will need to know how to properly and safely administer the medications these clients are taking.

Instructional Methods

The instructional methods were chosen to cover a variety of ways to engage the learners.  Not every learner learns the information the same way so the method of instruction needs to be varied.  The methods of instruction that were chosen for this presentation include: gaming; group discussion; lecture; self-instruction; and demonstration and return demonstration.  These varied methods are important to the student because it allows the student to learn in different ways thus allowing the student to engage more which benefits them from receiving a richer education.  Each method will be discussed individually with the major advantages and disadvantages for each method.

The first method chosen to help engage the learner is gaming. Bastable (2008) “gaming is an instructional method requiring the learner to participate in a competitive activity with preset rules” ( p. 443).  Winning the game by applying knowledge and rehearsing previously learned skills is the goal with this method.  The advantages to utilizing gaming as an instructional method include the fact that gaming is considered fun with a purpose; by stimulating the learner in an enthusiastic way and increasing the involvement of the learner games promote retention of the information; games are easy to create or change to be used with both individuals and groups; gaming adds variety to the experience of the learner; and when the information is dull or repetitious games provide an excellent way for the information to be presented (Bastable, 2008).  Yolageldili and Arikan (2010) point out that the benefits of using gaming as an instructional method help reduce anxiety and they are also student focused.  The major disadvantages to gaming include the fact that due to the competitive environment it may create, some learners may consider it threatening; in order to ensure active participation by all learners the group size may need to be kept to a minimum; due to the requirements of a flexible space and need for teamwork, they may not be able to be conducted in the classroom; they have the potential to be nosier than other methods of instruction;  depending on the requirements of the game, it may be too physically demanding for some students; and if the learner is restricted by a disability, they may not participate in the gaming activity (Bastable, 2008). 

The second method chosen to help engage the learner is group discussion.  Bastable (2008) defines group discussion “as a method of teaching whereby learners get together to exchange information, feelings, and opinions with one another and with the teacher” (p. 434).  Bastable also points out that this method can be used in both the cognitive as well as affective domains of learning.  The major advantages of group discussion include the fact that because it can be taught in the cognitive and affective domains, it enhances learning; it is centered around both the subject and the learner; learners are stimulated to think about issues and problems; exchange of the experiences of the members is encouraged which makes the learning more active; opportunities for sharing ideas and concerns are provided; feelings of belonging and positive peer support are fostered; and previous learning is reinforced (Bastable, 2008).  Baglione and Nastanski (2007) point out those student contributions may be just as important as the contributions of the facilitator, students learn from each other, greater responsibility is placed upon the student to learn the material, and it fosters memory retention and greater understanding of the material.  The disadvantages to using this method of instruction include the fact the one or more members may dominate the discussion; digression from the topic is easy which may affect achievement of the objectives; learners that are shy may not participate or could require a great deal of encouragement; the instructor needs to require skills that can tactfully redirect the discussion; novice instructors find this method very challenging if the members do not interact easily; the time spent disseminating the information is longer than with other methods, and the presence of the teacher to act as the facilitator and resource person is required at all times.

The third method chosen is lecture.  Bastable (2008) defines lecture as a highly structured method by which the teacher verbally transmits information directly to groups of learners for the purpose of instruction” (p. 431).  The major advantages of lecture include the fact that the instructor can transmit the information to a large number of people in an efficient, cost effective manor within a reasonable time frame at the same time; it is useful in demonstrating patterns, main ideas, data summarization, and presentation of ways to view unique information; it is effective in the cognitive domain at lower levels; is useful to disseminate information prior to a group discussion; and can be supplemented with handouts or other audiovisual aids easily which helps enhance learning.  The major disadvantages to lecture are that influencing the affective and psychomotor domains is largely ineffective; lecture is not very stimulating for the learners; it centers on the instructor which can lead to little participation of the students; individual differences such as background, attention span, and learning style are not accounted for; regardless of the cognitive abilities of the learner, the needs of the learner, or the stages of coping of the learner, all learners are exposed to the information at the same time; and the teacher might not be able to reach all the learners equally due to the diverse makeup of the group being presented to.

The fourth method chosen for this presentation is self-instruction.  Bastable (2008) defines self-instruction as “a method used by the teacher to provide or design instructional activities that guide the learner in independently achieving the objectives of learning” (p. 451).   The major advantages to using self-instruction include the fact that it is self-paced; learning is stimulated actively; an opportunity to review and reflect on information is provided; feedback is frequently built in;  mastery of materials is accomplished in a designated time frame (Bastable, 2008).  Cook, Gardise, Levinson, Dupras, and Montori (2010) point out that with this form on instructional method creates a creative application for the delivery of objectives and context.  The major disadvantages to using self-instruction include the fact that learning is limited in learners with a low rate of literacy; this is not an appropriate method if the learner has a visual or hearing impairment; motivation needs to be high for learning to be achieved; procrastination makes using this method challenging; boredom may occur if this method is utilized repetitively with no change in the design of the instruction.

The fifth and final instructional method chosen for this presentation is demonstration and return demonstration.  The teacher demonstrated how to perform a particular skill and the learner attempts to reproduce the skill through a return demonstration (Bastable, 2008).  The major advantages to using this method include it is very effective for achieving learning in the psychomotor domain; active engagement of learning takes place through the stimulation of visual, auditory, and tactile senses; confidence, competence, and skill retention are reinforced through repetition of movement; an opportunity for overlearning is provided to achieve the goal. The disadvantages to using this method include that plenty of time be set aside for teaching and learning to occur; the size of the audience must be kept small to allow for close supervision and an opportunity to practice; purchase or replacement of the equipment needed may be expensive; to practice the skill, extra space and materials are needed; and to evaluate competency one to one student to instructor ratio is required.

Materials

The materials needed for this presentation the text book, a computer, projector, projector screen, a classroom where the lights can be dimmed, a computer lab, a sterile needle, a sterile 10 milliliter syringe, a vial of labetalol, a vile of sterile normal saline; a bag of intravenous fluids primed through an intravenous line, and a mannequin arm.  The text book is needed to supplement the instruction.  The computer, projector, and projector screen is needed to allow for the use presenting material.  The room where lights can be dimmed allows the students to easily see the material that is on the projector screen.  A computer lab large enough to accommodate the students is needed for the online module they need to complete during the self-instruction portion of the teaching session.  The sterile needle, sterile 10 milliliter syringe, vile of labetalol, vile of sterile normal saline, bag of intravenous fluids primed through an intravenous line, and the mannequin arm are required for the demonstration of the proper technique to administer labetalol using the intravenous push method.

Evaluation

The methods of evaluation chosen for this teaching session include active participation of the learners, a short answer or essay, students presenting information to their classmates, a post test, development of care plans, and a return demonstration in the form of a skills check off.  Paying attention to the participation of the students during the group discussion section will be the easiest way to evaluate the learning of the students.  The two short answer or essays that the students have to turn in will be used to evaluate the critical thinking skills as well as mastery of the material presented.  When the students have to present to their classmates, active participation by each student in the groups as well as the information presented will be used to evaluate the effectiveness of the presentation.  The development of the care plans will be used to help determine the critical thinking skills of the students.  Finally the return demonstration portion of the evaluation will be used to determine if the students learned the concept presented or if remediation is needed.

Conclusion

Presenting an educational program where learning takes place is a very dynamic process that involves many steps.  After the instructor chooses an instructional design to help guide the presentation, the instructor must then develop objectives that are measureable.  The instructional methods have to be chosen carefully enough to not only add variety to the teaching session but to ensure that the teaching is effective for all students in the class room.  The same principal that applied to the instructional method also applies to the materials used for instruction.  Lastly the instructor needs to ensure that the evaluation methods chosen allow the instructor to determine if the objectives were met.  It is the hope of this author that this paper served that very purpose.

 

Author: Jason Hawkins RN, BSN, MSN

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