Clinical Teaching, Flipped Classroom, Problem Based and Team Based In Nursing Education

Clinical Teaching and Learning In Nursing Education, The “Flipped Classroom” In Nursing Education, Problem Based and Team Based Learning In Nursing Education, Constructivism and Narrative Pedagogy for Curriculum Design In Nursing Education, Teaching and Learning Trends in Curriculum Design In Nursing Education, Course Design 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.