New Directions in Teaching and Learning Within Nursing Education

1. New Directions in Teaching and Learning Within Nursing Education New Mexico Statewide Nursing Faculty Conference June 3-4, 2009 Jean Giddens, PhD RN, Professor Interim Senior Associate Dean for Academic Affairs College of Nursing, University of New Mexico

2. Student Centered Learning Decades of educational research have shown that learning is most effective when……. • Students are engaged • Learning incorporates emotion • Learning activities are purposeful and perceived by students as useful

3. Integrative Teaching • Integrative Teaching is practice of minimizing the distance between theory and clinical instruction. • Benner calls integrative teaching a “signature pedagogy” of excellent instructors

4. Emergence of New Paradigms • Conceptual Approaches to Teaching and Learning • Virtual Experiential Communities • Student centered learning • Integrative teaching

5. Teaching and Learning Differently: The Conceptual Approach

6. Example: Concepts as Categories • What concepts do the shapes below represent? • What other concepts can you identify?

7. Example: Concepts as Categories

8. What is Conceptual Teaching and Learning? The difference between concept- and content-focused learning is… “the difference between facts of the Alaska oil spill and an understanding of the importance of environmental sustainability”(Erickson, 1998 p. 50).

9. Conceptual teaching means…. • Focusing on big ideas – students anchor to specifics. • Fostering deep learning, and deep understanding through connections and reflection (as opposed to surface learning). • Developing student-centered learning with a purpose.

10. Concept: Oxygenation and possible exemplars Pulmonary Edema Pnuemothorax Anemia PE RDS AMI Pneumonia COPD Asthma RSV Oxygenation

11. Concept: Oxygenation & selected exemplars Oxygenation Other Exemplars Exemplars RSV Other Concepts Asthma COPD Pneumonia

12. Teaching Conceptually Focus on Concept Exemplars provide content knowledge Application of content to interrelated concepts Application of other content to the concept

13. Concepts for Nursing Education • In nursing education, a concept should be clinically useful to guide student learning and clinical practice. • What are the Concepts for Nursing Practice? • Concepts vs. Exemplars • Concepts vs. Medical Diagnoses

14. Additional Thoughts on Conceptual Teaching • A focus on concepts in itself does not guarantee conceptual learning. • Faculty must adopt activelearning strategies to enhance conceptual learning. • Ideally, concepts are woven throughout the curriculum - incorporated into clinical and didactic courses.

15. Hypertension ASHD Renal Failure Diabetic Retinopathy Peripheral Neuropathy Peripheral Artery Disease Example:Long-term complications of DM How could you teach this so students can understand the underlying concept or concepts could explain this?

16. Example:Skill Acquisition- Securing an IV Catheter What concept(s) apply? How could you apply this to your skills lab teaching? After starting an IV, what steps are necessary to properly secure the IV?

17. What is a concept-based curriculum? • Concepts provide organizational structure for the curriculum and courses. • Concepts represent nursing practice. • Concepts drive content through selection of exemplars.

18. CURRICULM FRAMEWORK

19. Knowledge, Concepts & Theory • Knowledge is represented through concepts • Concepts are building blocks of theory THEORY Concept Concept Concept Concept Concept Concept Concept Knowledge

20. Hallmarks of “Good” Concepts for Curriculum and Teaching? • Represent important spectrum of conditions or situations representing nursing practice • Logical and used consistently • Useful for education • Application across multiple courses and contexts

21. Benefits • Content management • Focus on concepts as opposed to content • Emphasis on learning • Focus is on Nursing • Concepts cut across disease categories and populations • Emphasis on recognition of concepts across populations and practice settings

22. Drawbacks • Resistance to change • Requires a different level of organization • Students may be resistant (at first) • Lack of literature detailing steps • What about NCLEX?

23. Virtual Experiential Communities

24. Mr. Ocampo Mr. Ocampo is short of breath, experiences intermittent chest pain, and is fatigued. He obviously should seek medical attention, but he won’t. Why won’t he seek medical care?

25. Anthony Martin has been arrested for indecent exposure at a local park. He is taken to the ED because he is combative and disoriented. What is causing Anthony to act this way? Anthony Martin

26. Kelsey Young has a new baby sister. What is Kelsey's family like? Does she have adequate support systems? What things trouble her? Kelsey Young

27. What is a Virtual Experiential Community? • Extension of technology-enhanced learning • Representation of individuals in context of community setting – with impact to group and individuals. • In health care, focus on individuals and health related issues and health care providers. • Examples: • The Neighborhood (USA) • Stillwell (UK)

28. Giddens - ODU, 2008

29. Household Characters • 34 characters who live in 11 households within The Neighborhood. • Character stories reflect health-related situations based on incidence and prevalence. • Stories reflect individual and family responses to health-related problems over time. • Stories told from the perspective of the character.

30. Nurse Characters • 6 featured nurse characters that work in 4 health-care agencies • 3 Hospital Nurses, School Nurse, Midwife, Geriatric Nurse in senior center • Stories reflect contemporary issues in nursing practice and issues within the local community. • Stories of household characters interwoven into nurse stories as applicable.

31. Biographical Information • Each character has biographical information that serves as an introduction. • Updated each semester to reflect previous semester story.

32. Weekly Story Each character has a story update each week. Stories unfold weekly over 3 academic semesters.

33. Photos & Video Clips • Stories are extended with photos, and video clips as applicable. • These media enhance understanding beyond text.

34. Medical Record • Abbreviated medical records included to provide an understanding of health care.

35. Newspaper • The newspaper links individual characters to the community • Is reflective of contemporary social, ethical, and health related issues.

36. Benefits of learning with virtual experiential communities

37. Changing the Focus and Context • Focus shifts away from content and toward the characters’ lived experiences • Context is story of individual and relationships within the home, community, and health care settings. • Enhanced understanding of issues associated with vulnerable populations and individuals with complex, chronic conditions. • Enhanced understanding of diversity (i.e. cultural, age, socioeconomic, sexual orientation).

38. Comparisons – Heart Failure Traditional Approach Virtual Experiential Communities Story of individual with HF Story depicts issues associated with disease management and navigating health care system Multimorbidity Changes in status depicted time over weeks; acute exacerbation not primary focus of story – just an event within the story. • A & P • Pathophysiology • Signs/Symptoms • Dx tests • Treatment • Nursing Interventions & patient teaching Context = acute phase; perspective of the nurse Context = daily life; perspective of individual

39. What is the Link to Nursing PHASE OF NURSING CARE • Clinical Judgment Model (Tanner) • Notice (potential for problem) • Recognize (problem has developed or is developing) • Respond (nurse knows what to do) • Reflection-in-action • Reflection-on-action • Health Promotion Model • Primary Prevention • Secondary Prevention • Tertiary Care

40. Common Teaching Strategies Incorporated in Lecture Case Study Role Play Games Care Plan Creative Writing Simulation Compare and Contrast Concept Map Debate Concept Analysis Policy Analysis

41. What Do You Want Students To Do? Learning Activities that are Purposeful Individual Assessment Family Assessment Community Assessment Calculate medication dosages Analyze medication or treatment plan Develop a Care Plan Develop a Teaching Plan Identify Risk Factors Identify Interventions Evaluate Interventions Hold a Team Meeting Analyze a Medical Record Plan a Home Visit Analyze payment structures Develop a Policy or Protocol Propose a Community Health Plan Identify a researchable problem Apply principles of ethics to an ethical dilemma Apply evidence-based standards to situation Develop Discharge Instructions Plan a Health Fair Identify Safety Hazards

43. Future Directions

44. Outcomes and Evidence • Research conducted at pilot sites Fall 08 • Perceived engagement • Perceived benefits (students) • Perceived benefits (faculty) • Future research ??? • Faculty work-life • Enhance cultural competence • Differences in health care delivery

45. Alternative Applications • Population specific virtual communities • Application for multidisciplinary health care education • Application for other disciplines • K-12 • Social Work • Construction Management