Nursing Education and Practice
Nursing Education and Practice
Nursing Education and Practice
key issues of nurse education and practice today. Covering all nursing education including teaching
patients, clients and their families, it combines theoretical principles and practical application to appeal
to nurse educators, students and clinicians in practice.
This updated text has been reorganised into four parts to reect the main threads of nurse education:
Part One The Psychological Basis of Teaching and Learning: focuses on adult learning theory
and the varying approaches to learning teaching.
Part Two Learning, Teaching and Assessment: focuses on the skills and preparation necessary
to ensure effective teaching and learning with NEW! material on the hidden curriculum, teaching
and learning resources, the use of interactive whiteboards, blackboards and virtual learning
environments and time management.
Part Three Specic Teaching Contexts: offers guidance on teaching in the clinical setting and
teaching patients, clients and their families with a NEW! chapter on Teaching Support Mechanisms.
Part Four Continuing Professional Development: explains the importance of lifelong learning
with a NEW! chapter on Preparation for an Education Post and NEW! material on reection,
research governance, maintaining clinical credibility, joint clinical/educational roles, self-assessment
and training needs analysis.
Francis M. Quinn was formerly Director of Healthcare Education in the School of Post Compulsory
Education and Training at the University of Greenwich, London, UK.
Suzanne J. Hughes is a Lecturer in Adult Nursing Studies, Cardiff University, Cardiff, UK.
Australia Brazil Japan Korea Mexico Singapore Spain United Kingdom United States
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Contents
Foreword
ix
Acknowledgements
xi
Dedication
xii
1
1
2
8
10
12
12
13
psychological basis of
teaching and learning
17
17
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27
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36
36
41
45
51
52
56
Memory
Perception
Thinking
Critical thinking
Intuition
Problem-solving and decision-making
Motor skills
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Contents
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Contents
Using flipcharts
Using an overhead projector
Designing and using handout material
Using the slide projector, audio-cassettes and
video-recording in teaching
Using Microsoft PowerPoint for presentations
Computer-assisted learning
The Internet and World Wide Web
Intranets and online campus
Summary
References
6. Teaching strategies
The lecture method
Commentary on the guidelines for planning and
delivering lectures
Variants of the lecture
Small-group teaching and experiential learning
Group dynamics
Reflection in small-group and experiential learning
Planning and implementing small-group and
experiential learning
Techniques for fostering relationships in small groups
Basic classification of small-group teaching
Techniques for teaching small groups and
experiential learning
Common difficulties in small-group and
experiential learning
Summary
References
7. Assessment of learning
Purposes and aims of assessment
The terminology and dimensions of assessment
Cardinal criteria for assessment
Planning assessments
Assessing knowledge and understanding using essays
Examples of types of essays
Marking and grading of essay tests
Variants of essays
Using objective tests
Guidelines for writing objective tests
Analysis of objective-test items
Assessment of group projects
Student self-assessment
Peer assessment
Assessment and evaluation of small-group processes
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Contents
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304
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313
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322
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teaching contexts
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Contents
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412
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415
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professional development
421
421
422
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427
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430
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Contents
Index
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Foreword
The Principles and Practice of Nurse Education, now in its 27th year
of publication, has established itself as an indispensable text for nurses
and other health professionals engaged in the business of teaching and
learning. The books popularity remains undiminished both at home
and abroad, and this new edition retains the balance between theoretical
issues and practical application that is so important to the practising
teacher. The text has been revised and updated to take account of new
developments, and we have included new chapters on teaching support
mechanisms, preparation for an educational post, and lifelong learning.
The previous editions of this textbook were written by me as sole
author but, whereas this model is excellent for consistency and coherence,
the increasing scope and complexity of modern nurse education are more
challenging for a single author to encompass. With this in mind, I felt that
it was time to adopt a collaborative approach and am therefore delighted
to welcome Suzanne Hughes from Cardiff University as co-author of the
fifth edition.
An exciting innovation for this new edition is a Web site linked to
the book, which will enable information to be updated as new material
becomes available. We have also included a summary at the end of each
chapter to provide further clarity for the reader.
I would like to express my sincere thanks to Suzanne Hughes for her
contribution to the new edition, and also to Lisa Fraley, freelance editor
at Nelson Thornes, whose administrative skills have brought the project
to fruition.
This preface would be incomplete without an acknowledgement of
the unstinting help and support that I have received from my wife Carole
and my children Hamnet and Tara, not just for this new edition but
throughout the years since the first edition was published in 1980.
Francis M. Quinn
Ventnor, Isle of Wight, UK
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Preface
Teaching and learning is a subject that involves all qualified nurses and
midwives; they work in a constantly learning profession where the
teaching and supervision of students feature greatly in their daily lives.
The different learning experiences that I have encountered throughout
my nursing career have proved invaluable and have greatly influenced
my ways of teaching. To be able to develop and implement a range
of teaching and learning strategies that are effective across a variety of
educational settings, and to be able to create and develop opportunities
for students to identify and undertake experiences to meet their learning
needs, are objectives that many seek to achieve to meet the requirements
of qualified teacher status.
This book has been in existence for the last 27 years and is one that
has guided me through my career in both the clinical and educational
setting. I was honoured and delighted to be offered the opportunity to coauthor the fifth edition of such a reputable text, and the encouragement
and support that Francis Quinn has provided have been exceptional.
The book is primarily aimed at lecturers who are new to nursing and
midwifery education, practice educators and students undertaking a
postgraduate certificate in education, and teaching and assessing and
mentorship programmes.
The overall structure of the book remains relatively unchanged,
although a few new chapters have been introduced. These include
Teaching support mechanisms, Preparation for an education post,
and Lifelong learning. Summaries have also been included, listing the
important points in each chapter.
A Web site accompanies the new edition (www.nelsonthornes.com/
nursing), providing further information and guidance for readers and
links to regulatory bodies and relevant organizations.
The fifth edition is divided into four parts. Part One focuses on
adult learning theory and perspectives on teaching and learning; Part
Two focuses on learning, teaching and assessment; Part Three addresses
specific teaching contexts, and Part Four explores the spectrum of
professional development within the university and clinical practice
environment.
Suzanne J. Hughes
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Acknowledgements
This book has been a tremendous learning curve for me and would not
have happened if it wasnt for the support of all the individuals below.
I would like to express my sincere gratitude to Francis Quinn for
allowing me to impinge on his seminal work and for his continuing
support, encouragement and constructive feedback during the past few
years.
I would like to thank Helen Broadfield, Commissioning Editor at
Nelson Thornes, for inviting me to co-author the fifth edition.
Special thanks to Lisa Fraley, freelance editor at Nelson Thornes, whose
endless support, encouragement and motivation has been exemplary and
very much appreciated.
My thanks to Professor Philip Burnard; you know what for. I owe
a great deal to my friends and colleagues for their support and to the
students that I have both taught and supervised and who have provided
much inspiration for my work.
To Greg Dix, thank you very much for allowing me to reproduce our
work.
I also wish to thank and formally acknowledge the editors of the
following journals and organizations for permission to reproduce their
material in this book:
Nursing Standard;
Nurse Education in Practice;
British Journal of Perioperative Nursing;
Cardiff University;
Nursing and Midwifery Council; and
Quality Assurance Agency.
Thank you to my parents-in-law for their childminding expertise when I
was struggling with deadlines.
To Gemma, who saw me start this work but didnt see me finish it I
miss you; and thank you to Mitzi, who didnt see me start this work but
did see me finish it.
Special thanks to my husband and best friend, Charlie, and to my son,
Oliver, for their unconditional support and patience. I love you both.
Finally, I would like to thank my Mum and Dad, Anne and Brian
Griffiths, who have always been so proud of my achievements and who
have made me the person I am today; love you!
Suzanne J. Hughes
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Dedication
To Oliver
This is my story
Love, Mummy x
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Introduction: Nurse
education in the
university and the clinical setting
The
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Chapter 1Introduction
principle. This is not to say that nursing curricula omit the wider aspects
of education such as the needs, aspirations and personal growth of the
individual, but these considerations are secondary to the main purpose.
Nurse education takes place within two major contexts, the National
Health Service (NHS) and the university sector within the UK, and each
of these is subject to continuing development and change. There are also
important developments in professional nursing that have a major impact
on the design and delivery of nurse education. The following sections
will highlight some of these current developments, and reference will be
made to the appropriate chapters of this book in which further discussion
of some of these issues can be found.
Developments
There are now three parts to the NMC register for nurses, midwives and
specialist community public health nurses, with only three recordable
post-registration qualifications:
specialist practice;
teaching;
nurse prescribing.
However, a number of other important developments relating to the
NMC are also included here.
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Developments
The Fitness for Practice (FfP) curriculum is now fairly well established,
and a number of key issues have now been addressed:
Fit for Practice (professional legal and ethical outcomes) can fulfil the
needs of registration;
Fit for Award (meeting academic standards) have the breadth and
depth of learning to be awarded a diploma or degree.
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Chapter 1Introduction
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Developments
evaluation;
creating a learning environment;
context of education;
professional development; and
curriculum development.
Standards for the preparation of practice educators
Practice educators are experienced practitioners who make a significant
contribution to education of students and practitioners, and lead practice
developments within their setting. Practice educators must have effective
NMC registration, and at least 3 years full-time experience (or part-time
equivalent) within the last 10 years. The NMC (2004a) identifies the
core components that must be achieved within the programme. These
include:
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Chapter 1Introduction
Manage and practise in accordance with the NMC code of professional conduct and an ethical
and legal framework.
Practise in a fair and anti-discriminatory way and promote the health and well-being of patients.
Engage in, develop and disengage from therapeutic relationships through appropriate use of
communication and interpersonal skills.
Assess the physical, psychological, social and spiritual needs of patients.
Plan nursing care in partnership with patients, carers and their family.
Engage in safe nursing practice that is based on the best available evidence.
Demonstrate sound clinical judgement across a range of professional and care-delivery contexts.
Create and maintain a safe environment of care through quality assurance and risk-management
strategies.
Demonstrate a commitment to continuing professional development.
Enhance the professional development and safe practice of others through peer support,
leadership, supervision and teaching.
Adapted from NMC (2004b)
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Developments
To provide sound family planning information and advice.
To diagnose pregnancies and monitor normal pregnancies.
To care for and assist the mother during labour and to monitor the condition of the foetus in
utero.
To conduct spontaneous deliveries where required including an episiotomy and, in urgent cases,
a breech delivery.
To care for and monitor the progress of the mother in the post-natal period.
Supervision and care of at least 40 women in labour.
The student should personally carry out at least 40 deliveries.
Supervision and care of 40 women at risk in pregnancy, or labour or the post-natal period.
Observation and care of the new-born requiring special care including those born pre-term,
post-term, underweight or ill.
Care of women with pathological conditions in the fields of gynaecology and obstetrics.
Table 1.2
Summary of the standards of
proficiency for pre-registration
midwifery programmes of
education
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Chapter 1Introduction
Analyse, interpret and communicate data and information on the health and well-being and
related needs of a defined population.
Identify individuals, families and groups who are at risk and in need of further support.
Develop, sustain and evaluate collaborative work.
Communicate with individuals, groups and communities about promoting their health and wellbeing.
Work with others to protect the publics health and well-being from specific risks.
Identify and evaluate service provision and support networks for individuals, families and groups in
the local area.
Interpret and apply health and safety legislation and approved codes of practice with regard for
the environment, well-being and protection of those who work with the wider community.
Contribute to policy documents and influence policies affecting health.
Prevent, identify and minimize risk of interpersonal abuse or violence, safeguarding children and
other vulnerable people.
Manage teams, individuals and resources ethically and effectively.
Adapted from NMC (2004d)
Developments
in the
NHS
sector
The NHS has made significant steps in providing faster, more convenient
access to care through increases in capacity and changes in ways of
working (DoH, 2005). Whilst it has always been very patient centred
and delivered excellent care, the NHS Improvement Plan (DoH, 2004a)
set out ways in which the NHS needed to change in order to become
patient led. It stated that the NHS needs a change of culture to become
truly patient led so that it is as concerned with health promotion as it is
with sickness and injury.
The NHS and local government have taken the lead together in
promoting health by helping individuals make informed, healthy lifestyle
choices and giving them the practical support and motivation to achieve
this in a way that reflects the reality of their lives (DoH, 2005). This
commitment is emphasized in the White Paper Choosing Health (DoH,
2004b) and means that patients will increasingly receive advice on
improving their health as part of routine care. White Papers are further
discussed in Chapter 11.
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Developments
practice;
education, training and development;
quality and service development; and
leadership, management and supervision.
The DoH (2006) identifies four key priority areas that must be
addressed in order to create modern nursing careers that are fit for
purpose. These are:
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Chapter 1Introduction
identify the knowledge and skills that individuals need to apply in their
post;
Developments
in higher education
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Developments
in higher education
completion rate from first degree courses is the fourth highest in the
world.
In research, British universities punch well above their weight on the
normal measures of output and impact, with only the US ahead of us
(DfES, 2004).
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Chapter 1Introduction
Research
assessment exercise
Summary
Nurse education comes under the overall umbrella of post-compulsory
education and training.
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References
There are now three parts to the NMC register for nurses, midwives
References
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Chapter 1Introduction
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Part One
The
psychological
basis of learning
and teaching
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Adult
learning theory
Human
Table 2.1
General characteristics of adult
learners
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Chapter 2Adult
learning theory
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Human
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Chapter 2Adult
learning theory
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Human
Physiological ageing
The ageing process involves a decline in the effectiveness of many bodily
functions, including breathing, circulation, digestion and elimination
but the most obvious deterioration is in eyesight and hearing. The main
eyesight problem in the elderly is concerned with the ability to focus
correctly, leading to long-sightedness or, more seriously, loss of acuity
or sharpness of vision. Hearing loss of varying degrees is common in the
elderly and can be attributed to a range of factors such as wax blocking
the auditory canal, degeneration of the small bones that conduct sound
in the middle ear, and degeneration of the nerves of the inner ear.
Perception of high-frequency sounds sustains greater loss than that for
low-frequency sounds, and the ability to discriminate pitch may be
affected (Stuart-Hamilton, 1996).
Psychological ageing
In considering the effects of ageing upon psychological functioning, it
is useful to distinguish between two types of intelligence: crystallized
intelligence, which indicates the knowledge acquired by an individual
throughout the lifespan, and fluid intelligence, which is concerned with
information-processing and problem-solving, and which is much less
dependent upon acquired knowledge. Crystallized intelligence is often
equated with wisdom, i.e. the accumulated knowledge gained over a
lifetime, whereas fluid intelligence equates with wit, i.e. the ability to deal
with novel or abstract problems. Research studies indicate that there is
a decline in fluid intelligence in old age, but that crystallized intelligence
is largely unaffected. Many elderly people feel that their memory has
declined as they have grown older, and research findings support the fact
that memory does indeed decline with ageing.
Implications for teaching and learning
From the foregoing outline of ageing, it is apparent that no significant
deterioration in intellectual abilities is likely to be present in those adult
learners in nursing, midwifery and specialist community public health
nursing who are below the age of 6065. However, the teacher may be
able to assist the adult learner to compensate for the gradual decline in
some aspects of functioning that occurs progressively during adulthood.
With regard to eyesight problems, the teacher can ensure that adequate
lighting is provided by simply switching on the classroom lights at the
commencement of the lesson and can advise older students to sit closer
to the front of the classroom so that visual materials can be more easily
seen. It may also be helpful to furnish such students with photocopies
of any transparencies or slides used in the lesson. The teacher can help
students with hearing problems by suggesting that such students sit at the
front of the class, and by ensuring that the volume of his or her voice
is sufficiently audible and the speed of delivery is not too fast. Also,
particular attention needs to be given to the volume and tone settings of
audiotape and video presentations.
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Chapter 2Adult
learning theory
The
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The
the ability of adult students to plan and manage their own learning;
a personal characteristic of adult learners associated with personal
autonomy;
The basic underlying concept in each of these is the belief that adults are
naturally self-directing and autonomous with regard to learning, if given
the opportunity to be so. Autonomy is one of the basic values of Western
society; its literal meaning is self-governing, which implies independence
and a sense of control over external forces. Hence, learner autonomy is
really about the re-distribution of power; self-directed learning aims to
shift the power base away from the educational organization (teachers,
curriculum, etc.) and towards the adult learners themselves. Autonomy
is not an all-or-nothing phenomenon, but a continuum from lesser
to greater autonomy; it is also a characteristic that can be developed
(McNair, 1996).
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Chapter 2Adult
learning theory
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The
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Chapter 2Adult
learning theory
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Andragogy:
Andragogy:
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Chapter 2Adult
learning theory
Assumptions
Pedagogy
Andragogy
Learners self-concept
Learners readiness is
dependent upon what the
teacher wants the learner
to learn
Students orientation to
learning
Students motivation
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Andragogy:
both may be appropriate for children and adults depending upon the given
circumstances. For example, it might be that a pedagogical or dependent
approach involving didactic teaching would be more appropriate when
the learner first encounters new or unusual learning situations, provided
that an andragogical approach is used overall. Similarly, Knowles believes
that andragogy can be appropriate for children, with its emphasis on a
classroom climate conducive to learning and the concept of increasing
self-direction and autonomy.
Two aspects of Knowless work have had a particularly strong
influence on nurse education curricula: his process model for human
resources development, and the use of learning contracts.
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Chapter 2Adult
learning theory
Learning contracts
As Knowles points out, individuals have a need to be self-directing in
their learning, yet traditional curricula were largely controlled by the
educational institution. Learning contracts are a means of reconciling the
learning needs of the student and those of other interested parties such as
educators and employers. The focus of nurse education is the promotion
and maintenance of professional competence; what constitutes such
competence is decided not only by the individual nurse but also by
employers and professional bodies. The needs of each of these key
players may well conflict on occasions, and learning contracts provide a
useful way of negotiating an acceptable compromise. Knowles offers the
following steps for developing a learning contract.
Step 1: Diagnosis of learning needs
This involves the students in assessing the difference between their
present state of knowledge or skill in relation to an area of learning and
the state they aim to achieve in that area. In nursing, this often requires
the help of tutors and clinical colleagues.
Step 2: Specifying learning objectives
The learning needs, identified in Step 1, are then written as learning
objectives such as acquisition of certain knowledge or skills.
Step 3: Specifying learning resources and strategies
In this step, the students take each learning objective and identify how
they are planning to achieve it, for example by reviewing the relevant
literature.
Step 4: Specifying evidence of accomplishment
For each learning objective, the students describe the evidence which they
will produce to indicate their achievement; for example, an essay can
provide evidence about knowledge of a topic.
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Andragogy:
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Chapter 2Adult
learning theory
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The
students;
teachers; and
programme.
The
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Chapter 2Adult
learning theory
Figure 2.1
Experiential learning model
(Kolb, 1984)
Testing implications
of concepts in new
situations
Observations and
reflections
Formation of abstract
concepts and generalizations
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The
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Chapter 2Adult
learning theory
Non-learning
Jarvis points out that individuals do not necessarily learn from any given
experience, and he identifies three types of non-learning. The first is
presumption, i.e. the tendency for individuals to rely uncritically on
their past experiences as a basis for their behaviour. The second is an
individuals failure to respond to a potential learning situation, which
Jarvis terms non-consideration. The third type is rejection, where the
individual rejects the possibility of learning from the experience; bigots
would come under this category.
Non-reflective learning
As the name implies, this is learning that does not involve a reflective
process; it includes memorization, skills learning, and preconscious
learning. The latter is also called incidental learning, i.e. the learning that
occurs without the individual being aware of it.
Reflective learning
In contrast to the two previous forms of learning, this involves a process of
reflection. Jarviss research identified different types within this category:
contemplation, reflective skills learning, and experimental learning.
Implications for teaching and learning
Jarviss typology is useful in that it expands our view of what constitutes
learning; it also emphasizes the importance of the reflective process in
learning.
Reflection
Human
motivation
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Human
motivation
Motivation as instinct
Instincts are aspects of animal behaviour that are innate and untaught,
and which govern much of their total repertoire of behaviour.
Ethology
Ethology is a branch of psychology concerned with the study of animals
in their natural settings rather than in the artificial surroundings of the
laboratory. One of the founders of this school was Konrad Lorenz; he
demonstrated that animals possess instinctive behaviours called fixedaction patterns (FAPs), which can be triggered off by innate releasing
mechanisms (IRMs). Nikko Tinbergen (1951) has described these in
relation to the male stickleback; fixed-action patterns of attack or
courtship are released by the red underside of another male, or the
swollen abdomen of the female respectively. Another example of a fixedaction pattern, according to Lorenz, is imprinting (Lorenz, 1958). This
occurs in young animals within two days of birth or hatching and consists
of the animal following the first moving object that it encounters. This
is normally the parent, and the process has survival value to the species,
in that the young animal follows and remains close to the parent. Lorenz
showed that imprinting will occur on the first moving object, even if
this is a human being or an inanimate object, but that it is difficult or
impossible after two days, when fear of strange objects has developed.
Some psychologists believe that certain aspects of human behaviour
are instinctual; Eibl-Eibesfeldt has summarized the innate releasing
mechanisms in man, citing examples such as the cues in an infants
appearance, which trigger off caring behaviour in adults (Eibl-Eibesfeldt,
1971). Bowlby (1970) considered that the attachment behaviour of the
newborn infant towards a preferred figure is a form of imprinting.
Freudian psychoanalytic theory
Another theory that utilizes the concept of instinct is that of Sigmund
Freud. His psychoanalytic theory sees humans as being motivated by two
basic instincts or drives, Eros and Thanatos. The former are life drives and
are divided into ego drives, which are concerned with self-preservation,
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and libido, which is concerned with sexual drive and preservation of the
species. Thanatos is composed of self-destructive drives and aggressive
drives, and constraints imposed on these by self or society result in
their repression below the level of consciousness. According to Freud,
such repressed drives function as powerful unconscious motivators of
behaviour (Freud, 1923).
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Human
motivation
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Figure 2.2
Maslows Hierarchy of Needs
Self-actualization
Esteem
Belongingness and love
Safety
Physiological
Physiological needs are the most basic and include hunger, thirst,
sleep, maternal needs, etc. Individuals dominated by these needs see
everything else as being of secondary importance, and this can occur to
such an extent that they no longer see anything beyond the gratification
of those needs. The next class is the safety needs, which include
security, stability, protection, the need for order and structure, etc., and
above this come the belongingness and love needs, including affection,
friendship and sexual needs, although the latter can also be classified with
physiological needs.
Esteem needs are concerned with strength, achievement, mastery
and competence and also include reputation, prestige and dignity.
Self-actualization is the highest class of needs and is concerned with
the fulfilment of ones potential. This will vary greatly from person to
person, according to how the individual perceives that potential. There
are two further classes of need that Maslow originally included in the
hierarchy the need to know and understand and the aesthetic needs.
These are now seen to be interrelated with the basic needs, rather than
as separate classes. The order of these remains fixed for most people,
but there are exceptions. For example, some people prefer assertive selfesteem to love. There are examples in life where lack of basic needs seems
to be subjugated to the attainment of self-actualization, as with monks
who fast for lengthy periods.
Characteristics of self-actualizing individuals
Maslow examined the lives of well-known public figures and came
up with a list of shared characteristics, which are hallmarks of selfactualizing individuals:
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Learning
problem-centring;
quality of detachment, a need for privacy;
autonomy, independence of culture and environment;
continued freshness of appreciation;
peak experiences;
deeper, more profound interpersonal relations;
democratic character;
philosophical, non-hostile sense of humour;
creativeness;
transcendence of any culture.
Maslows theory is open to criticism on a number of counts. The
imperative to satisfy basic needs before becoming motivated at the
next level does not accord with the facts. There are many documented
incidents of individuals becoming highly creative despite a lack of basic
needs; for example, in concentration camps during the Second World
War. Martyrdom is another example which conflicts with the theory;
some individuals embrace the prospect of certain death as the ultimate
fulfilment of their purpose on earth. There is no convincing evidence for
the hierarchy of needs, but despite this the theory has influenced many
curricula in nurse education.
One of the major problems with conceptualizing motivation as needs
and drives is that it does not explain why animals or people try to achieve
things that are not associated with biological deficits, such as watching
television and reading books. It is likely that most real-life situations are
characterized by multiple motivations, where the individual is motivated
by a number of different motives. These may be in harmony, thereby
increasing the strength of motivation or they may be in conflict, with
some producing a positive incentive and others a negative incentive. This
has been described as approachavoidance conflict and there are three
types (Bourne and Ekstrand, 1985):
Learning
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Learning
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Approaches
to learning
Approaches
to learning
All qualified nurses are involved in teaching and learning. They live in
a constantly learning profession, in which the teaching and facilitation
of students features greatly in their day-to-day life. Whilst exploring
the theoretical underpinnings to teaching and learning, Dix and Hughes
(2004) demonstrate how they can be applied to teaching and learning
situations by discussing the strategies and approaches that can be adopted
by nurse teachers and nurses working in the clinical setting to support
students effectively. They presented four biographical vignettes of adult
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learners and described some of the strategies and approaches that might
assist these students to learn more effectively. An example of those
vignettes can be seen in Table 2.3.
Table 2.3
Four biographical vignettes
Katie
Katie is a 45-year-old nursing student with three grown-up children. She left school at the age
of 15 without any formal qualifications. She has 25 years experience as a health care assistant
on an acute surgical ward. In order to acquire the necessary academic qualifications for nurse
training, she has, for the past five years attended evening classes at her local FE College and
achieved five GCSEs and passed an access to nursing course. Katie is now in her second year of
the three-year programme, which leads to the award of Bachelor of Nursing. Although she was
apprehensive about returning to full-time education, as she would probably be older than most
of her colleagues and some of the lecturers, she is a popular student, who willingly contributes
openly to class discussion and is keen to share her life experiences. She also possesses excellent
interpersonal skills, which enable her to motivate other students and, overall, improve group
dynamics. The quality of Katies clinical work is exemplary, and her enthusiasm and motivation
are demonstrated and documented well within her clinical placement reports. However, Katie is
dyslexic and is particularly anxious about the continual theoretical assessments and examinations.
Although Katie has passed all of her college-based assignments to date, she still feels that she
is unable to demonstrate and apply her analytical thoughts and reflective skills adequately in a
theoretical context. Her objectives during the second year are to improve on her assessment
grades and achieve good passes instead of borderline passes. Factors that inhibit learning can
be described as internal or external in nature. The most common barriers have been identified
by numerous authors, and can include pressure of time and workload, lack of support from
work organization and family, underachievement at school with a fear of further learning, social
and family commitments, cultural and age (Ashcroft and Foreman-Peck, 1994; Huddleston and
Unwin, 1997; Reece and Walker, 2000). Factors likely to inhibit Katies learning are lack of selfbelief, age and exam anxiety and dyslexia.
Peter
Peter is a 28-year-old first year nursing student aiming for the award of Diploma (HE) Nursing.
He lives at home with his parents and has a son of 18 months, who lives with his girlfriend.
Peter takes his parental responsibilities seriously and hopes to be able to support his family when
he qualifies. His parents are very supportive of his career and encourage Peter to study in the
evenings to prevent him socializing with his friends. They think his friends are a bad influence on
his social behaviour and blame this for his persisting truancy in school. Peter reflects negatively
on his school years and states that his lack of educational qualifications is due to his boredom and
disinterest in class, and subconsciously highlights some of the consequences associated with the
hidden curriculum (Vallance, 1974). For the past 10 years Peter was employed as an operating
theatre assistant but felt restricted in his role. This led to him applying for nurse training but he
was advised to provide evidence of further education to support his application in order to satisfy
the entrance requirements. He enrolled on a part-time course based at his local college and
achieved a Diploma in Anatomy and Physiology, which led to his success in gaining a nurse-training
place. Initially, Peters enthusiasm was faultless; however, within the first four months, he had
accumulated six episodes of sickness and presented mostly unbelievable reasons for his absence.
On one occasion he was absent from lectures because he claimed that his best friend had died
the previous night, but a request for a compassionate leave day for the funeral was never made.
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Approaches
to learning
Peter is a pleasant student with a vibrant personality and is eager to please his mentors on clinical
placements. He also has many enduring qualities that have not gone unnoticed when caring for
patients. However, he has had recent difficulties meeting deadlines for assignment submission and
his personal tutor has noticed several inconsistencies in his style of writing, which is beginning to
raise concerns amongst academic staff. Although he appears to be achieving clinical competence,
oral questioning and written assessments confirm that knowledge is not evident. Peter is failing
to progress and achieve the required assessment standard. In line with the equal opportunities
of the college, Peters personal tutor has offered him assistance in terms of help and support
with academic writing skills in an attempt to overcome his learning difficulties but this has been
declined. Peter maintains that he is as motivated as ever to achieve professional registration.
Factors likely to inhibit Peters learning are social and family commitments, underachievement at
school and surface learning.
Melissa
Melissa is 32 years old and is a first-year nursing student. She is a recently separated parent
with two young children, one of whom has profound learning disabilities. Melissa has extremely
supportive parents who care for both children whilst she is at university but she is beginning
to feel guilty for leaving them and burdening her parents for up to nine hours per day on most
weeks. Prior to commencing the three-year nurse education programme, Melissa worked as a
health care assistant and undertook a nursing access course in the hope of realizing her childhood
dream. Although Melissa is enjoying the clinical aspect of the course, she is finding it increasingly
difficult to juggle her shifts and home life. Her academic assignments are also proving difficult
and she is just managing to achieve a borderline pass each time. The concept of adult learning
is becoming difficult to grasp and she is losing confidence in her academic ability. During recent
weeks, Melissa has contemplated the idea of leaving the course and becoming a full-time mum.
Her drive and determination to succeed in qualifying as a Registered Nurse are slowly diminishing.
Nathan
Nathan is also a first year student nurse, nine-weeks into training; with a plethora of GCSEs and
A levels, he is, as a result, following the degree pathway. Nathan is an only child and spent his
secondary education at an all-boys school. He is finding the transition from further education to
higher education quite difficult, and his quiet disposition and lack of self-confidence are inhibiting
his ability to form solid friendships. As nursing is a predominately female profession, Nathan is
also finding it difficult adjusting to this new culture of being surrounded by women, and feels
embarrassed during lectures when animated slides often depict the nurse in a feminine form.
As the only boy in his seminar group, Nathan is reluctant to participate in classroom discussion
and has missed several seminar presentations because of this. A general surgical ward is to
be Nathans first clinical placement and, although he is excited, he is also anxious about the
forthcoming six-week placement. Nathan is aware that he has a number of clinical competencies
to achieve during this time and is concerned as to whether these can be accomplished.
Adapted from Dix and Hughes (2004)
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Melissa
Lack of self-belief
Age
Exam anxiety and dyslexia
Lack of self-belief
Family commitments
Surface learning
Peter
Nathan
Lack of self-belief
Group participation
Gender issues
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Approaches
to learning
Gender issues
Nathan could be reluctant to participate in classroom discussion for a
number of reasons, although Rogers (1996) believes that the causes of
reticence are rarely clear. Rogers also suggests trying to persuade the
student to talk outside of the group session, to find out some opinions
that they hold, some skill or experience that they possess and then
try to guide the work of the group into these fields so that eventually
the student can fittingly (but never easily) make some contribution.
One possible reason for Nathans apparent shyness could be that he is
surrounded by female classmates and, as previously mentioned, is finding
it difficult to adjust to this predominantly female profession. The fact
that most of the animated visual aids used in teaching depict the nurse
as female is not helping; this is indicative of the hidden curriculum as
described by Jarvis (1995) who explains that some students may learn
values that may be unrecognized and unintended by those who formulate
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learning theory
them. Updating these teaching aids and depicting men as well as women
in the role of nurse could possibly help the situation, not just for Nathan
but for future male nurses.
Deep learning
Melissa is slowly losing her intrinsic motivation to continue with
her nurse training, which in turn could be affecting her approach to
learning. According to Ashcroft and Foreman-Peak (1994), there are deep
learners and surface learners, and an important role of the teacher is to
help students become aware of different approaches to learning. The
idea that a surface approach to learning is a less effective approach is
not necessarily true, as Ashcroft and Foreman-Peak (1994) point out
that not all learning tasks (e.g. learning keyboard skills) require a
deep approach. Melissas lack of motivation could be affecting her deeper
approach to learning, which could be the reason why she is finding her
academic work increasingly difficult. Obviously, this motivational factor
could be rooted in her social circumstances, and in such a situation
referral to a counselling service could possibly be of some help. Regular
positive reinforcement, providing encouragement and praise could help
to increase Melissas self-motivation; however, motivation depends as
much on the attitudes of the teacher as on the attitudes of the students
(Rogers, 1996).
Peter has also been demonstrating characteristics of surface learning,
so he might need encouragement to engage in applying his learning to
problem-based situations and in structuring his reflective skills.
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Summary
(2000b) explains that students will need help and guidance to reflect on
their experience and to record that experience, with advice often given
to the student by their mentors in clinical practice.
Time management
Owing to family and social commitments and his continual absence, Peter
is struggling to meet assignment deadlines. Melissa is also struggling with
juggling family and university life. Armitage et al. (1999) encourage the
use of an empathetic approach, to communicate an understanding of
students situations, and the use of probing to help students to clarify and
focus on issues of concern. A strategy to support and improve students
time management, using learning resources to develop appropriate study
skills, could enable them to assume responsibility for their own learning;
however, taking responsibility for their own learning may make students
feel threatened and insecure.
Summary
Adult learning theory has been strongly influenced by humanistic
psychology.
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All qualified nurses are involved in teaching and learning. They live in
a constantly learning profession, in which the teaching and facilitation
of students features greatly in their day-to-day life.
References
Armitage, A., Bryant, R., Dunnill, R., Hammersley, M., Hayes, D.,
Hudson, A. and Lawes, S. (1999) Teaching and Training in Postcompulsory Education. Open University Press, Buckingham.
Ashcroft, K. and Foreman-Peck, L. (1994) Managing Teaching and
Learning in Further and Higher Education. RoutledgeFalmer, London.
Atkinson, J.W. (1958) Motives in Fantasy, Action and Society. Van
Nostrand, Princeton.
Benner, P. (1984) From Novice to Expert: Excellence and Power in
Clinical Nursing Practice. Addison-Wesley, California.
Boud, D., Keogh, R. and Walker, D. (eds) (1985) Reflection: Turning
Experience into Learning. Kogan Page, London.
Bourne L. and Ekstrand B. (1985) Psychology: Its Principles and Meanings.
Holt, Rinehart & Winston, New York.
Bowlby, J. (1970) Attachment. Penguin, Harmondsworth.
Burns, S. and Bulman, C. (2000) Reflective Practice in Nursing, 2nd edn.
Blackwell Science, Oxford.
de Tornyay R. and Thompson, M.A. (1987) Strategies for Teaching
Nursing, 3rd edn. Delmar Publishers Inc., Albany, NY.
Dix, G. and Hughes, S.J. (2004) Strategies to help students learn
effectively. Nursing Standard, 18(32), 3942.
Eibl-Eibesfeldt, I. (1971) Love and Hate. Methuen, London.
Entwistle, N. (1981) Styles of Learning and Teaching. Wiley, Chichester.
Entwistle, N., Hanley, M. and Hounsell, D. (1979) Identifying distinctive
approaches to studying. Higher Education, 8, 365380.
Ewan, C. and White, R. (1996) Teaching Nursing: A Self-instructional
Handbook, 2nd edn. Chapman & Hall, London.
Fontana, D. (1972) What do we mean by a good teacher? In D. Chanan
(ed.) Research Forum on Teacher Education. National Foundation for
Educational Research, Windsor.
Freud, S. (1923) The Ego and the Id. Translated by J. Riviere (1962),
Norton, New York.
Hamachek, D. (1978) Humanistic psychology: theoreticalphilosophical
framework and implications for teaching. In D. Treffinger, J. Kent Davis
and R. Ripple (eds) Handbook on Teaching Educational Psychology.
Academic Press, New York.
Honey, P. (1982) The Manual of Learning Styles. Honey & Mumford,
Maidenhead.
Huddleston, P. and Unwin, L. (1997) Teaching and Learning in Further
Education: Diversity and Change. Routledge, London.
Jarvis, P. (1995) Adult and Continuing Education: Theory and Practice,
2nd ed. Routledge, London.
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References
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Perspectives
learning
on teaching and
Memory
Memory is the process that allows human beings to store experiences
from the past, and to use these in the present. There are three basic
aspects of memory function: encoding, storage and retrieval, and three
stages of memory: sensory, short-term and long-term.
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Memory
claimed that these networks can represent both perceptual and linguistic
information in long-term memory and that this single-code explanation
is more parsimonious than the dual-code theory.
Fibres in ground substance
Provides support and movement
CONNECTIVE TISSUE
ARELOAR
Widely dispersed
Basic support
ADIPOSE
CARTILAGE
LONG BONE
FEMUR
Longest bone
Hip to knee
Hyaline
Fibrous
Elastic
BONE
Intercellular
impregnation of
inorganic salts
Has shaft
Has two extremities
HUMERUS
Surgical neck
Condyles/epicondyles
Figure 3.1
Simple two-dimensional
network hierarchy in semantic
memory
A canary is a canary.
A canary is a bird.
A canary is an animal.
According to the theory, participants should take longer to verify the
third sentence because more nodes have to be traversed than in the first
or second sentences, and this indeed was the finding. However, later
work has shown that this is not always the case; for some concepts, the
search is faster for sentences with more nodes to traverse. The sentence
A dog is a mammal should be verified faster than A dog is an animal,
but participants found the latter more quickly, suggesting that familiarity
plays a part in the speed with which propositions are searched (Collins
and Quillian, 1969).
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Dual-code theory
The dual-code theory (Paivio, 1969) states that there are two different
kinds of knowledge representations in long-term memory: verbal and
imagery. If information is encoded in both modes, there is a much
better chance of remembering it; some words are easier than others to
encode with imagery, such as words that describe concrete concepts like
forceps.
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Memory
sit and think about things and their thoughts may trigger off a course of
action, with a flow of information through the system. This kind of
processing is termed knowledge-driven or top-down processing; the
processing of stimuli from the environment is termed data-driven or
bottom-up processing.
Remembering
An early pioneer of memory study was Ebbinghaus (1885) who used
himself as the subject of experiments in which he used nonsense
syllables to eliminate any interference from previous knowledge of
the words to be remembered. One group of very effective techniques
is called mnemonics. These make the subject think about the item to
be remembered by using some kind of scheme. The following offers a
selection of these techniques.
Method of loci
In this method, the student first imagines a familiar place such as home
or work and chooses a sequence of rooms to remember. The student then
pictures an item to be remembered in each room until the whole list of
items has been used. When the student wishes to recall the list, he or she
simply does a mental walkabout through the house or workplace to find
the items in their locations.
Natural language mediation
This mnemonic is useful for learning unfamiliar words, such as many of
those encountered in nursing; it consists of turning the strange word into
one that the student already knows and which relates to the new word.
For example, students trying to learn the name of the drug streptomycin
might think of strapped the mice in, which implies containment of the
spread of the pest.
Key word method
This can be helpful when learning the vocabulary of a foreign language;
the student first chooses a French word such as pain (bread) and then
makes a visual image of a loaf of French bread crying out in pain.
Acronyms
These are lists of letters arranged vertically to form a word, with each
letter itself forming the first letter of a horizontal word. For example, the
curriculum components might be remembered thus:
A (Aims)
C (Content)
M (Methods)
E (Evaluation)
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Forgetting
It was pointed out earlier in this section that there are three stages of
memory: encoding, storage and retrieval. Encoding involves putting
representations into the memory system, storage is maintaining these
in memory, and retrieval is the recovery of memories from the memory
system. There are a number of explanations for forgetting, but all of them
involve either the original memory trace not being available, or being
available but not accessible. The latter is termed the tip of the tongue
(TOT) phenomenon and is a familiar experience for most people.
Decay theory
Forgetting was originally ascribed to a simple process of fading or decay
over a period of time. However, this explanation is insufficient to explain
forgetting, as it takes no account of the influence of an individuals
experience of forgetting.
Interference
This states that forgetting is due to interference from other memories.
Retroactive interference (retroactive inhibition) occurs when new learning
material interferes with that previously learned. Student nurses may
attend two or three lectures during an afternoon, and the first one
may be forgotten due to retroactive interference from the ones that
followed it. Proactive interference (proactive inhibition) means the
opposite; the second lecture of the afternoon is largely forgotten due to
interference from the first.
Encoding specificity theory
The key point of this approach is that all forgetting occurs because the
cues that were present when the memory was encoded are not present
when it is retrieved. It is claimed that the best cues for remembering
something are the cues that were present when the memory was encoded.
It is well established that, when someone visits a place where he or she
lived as a child, the context cues the recall of memories long thought to
have been forgotten.
Consolidation theory
In this theory, the idea is that every experience sets up a trace in the
brain and this trace needs to be consolidated if the information is to be
remembered. Hence, the trace can be destroyed before it has had time to
be consolidated, as in electro-convulsive therapy and retrograde amnesia
following head injury.
Perception
In order to discuss the processes involved in perception, we need to refer
again to the diagram of the information-processing system in Figure 3.2.
It can be seen that sensory inputs from the environment are first registered
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Thinking
in the sensory receptors such as the cells of the retina in the eye. These
receptor cells transform the physical stimulus into electrical impulses and
transfer it to the brain. Sensation is the term given to the initial processes
of reception of the stimulus by the sense organ, whereas perception is
used for the processes that occur centrally in the information-processing
model. Perception can be defined as an organized process in which the
individual selects cues from the environment and draws inferences from
these in order to make sense of his or her experience.
Organization
When a particular stimulus such as the letter T impinges on the cells
of the retina, the information is transmitted to the cells of the visual
cortex and it is here that the process of perception begins. These
cortical neurones are designed to respond to particular types of stimuli
or patterns, with some responding to vertical lines, some to horizontal,
others to acute angles, and so on.
Thinking
Thinking is a cognitive process consisting of internal mental representations
of the world, and it includes a wide range of activities including problemsolving, reflecting and decision-making. Some mental representations
are in the form of pictures in the mind, while others are in the form of
propositions.
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Propositional thought
Propositions are assertions or claims that relate a subject and a predicate,
and they may or may not be true. For example, the proposition nursing
is a caring profession relates the subject (nursing) to the predicate (is
a caring profession). Propositional thinking is made up of symbolic
building blocks called concepts.
Concepts
Concepts can be defined as objects, events, situations or properties that
possess common criterial attributes and are designated by some sign or
symbol (Ausubel et al., 1978). A concept is thus a category or class of
objects, rather than an individual example, each member of that class
sharing one or more common characteristics.
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Critical
Critical
thinking
thinking
define a problem;
select relevant information for problem-solving;
draw inferences from observed or supposed facts;
recognize assumptions;
formulate relevant hypotheses;
make deductions, i.e. draw conclusions from premises;
make interpretations from data; and
evaluate arguments.
However, interpretations like these that equate critical thinking to a set
of generic cognitive skills or procedures have been criticized as unhelpful
(Bailin et al., 1999a). They point out that these are simply lists of what
people must be able to do (e.g. make deductions), and that they shed no
light on the psychological processes involved in critical thinking. They
also question the view that critical thinking is a generic skill that can be
applied to any situation, because this ignores the importance of context.
For example, the ability to evaluate arguments is included in the above
list of critical-thinking abilities, but in order to do this one needs to have
specific knowledge of the context in which it takes place. Nurses may be
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Critical
thinking
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Interpretation
This involves judging whether or not a conclusion follows, beyond a
reasonable doubt, from the facts given. Let us take a purely hypothetical
example: suppose a survey of professional misconduct within the
Barsetshire Region found that female nurses were involved in 34 cases of
complaints from patients, but male nurses were involved in only 22 cases
of complaint. The following conclusions might be drawn:
A There were more complaints by patients against female nurses than
male nurses in Barsetshire.
B Patients are generally more satisfied with male nurses than female
nurses.
Conclusion A follows beyond a reasonable doubt, since it is a factual
statement supported by the evidence of the numbers involved. However,
conclusion B does not follow beyond a reasonable doubt, as it makes
unwarranted generalizations from the given data; for example, it takes no
account of the number of male:female nurses 34 may represent 1 per cent
of female nurses, while 22 may represent 5 per cent of male nurses.
Evaluation of arguments
When attempting to make important decisions about an issue or
problem, it is necessary to be able to distinguish between strong and weak
arguments. Watson and Glaser use two criteria for a strong argument: it
must be important, and it must be directly related to the issue or problem.
If one of these is absent, then the argument is considered to be weak.
engaging students in dealing with tasks that call for reasoned judgement
or assessment;
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Critical
thinking
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Intuition
Intuition is an interesting cognitive phenomenon that has been largely
neglected in psychology this century (Claxton, 1998). In lay terms,
intuition is thought of as some sort of extra-sensory perception or
sixth sense, and was at one time thought to be a particularly female
characteristic, womens intuition. The essence of intuition is a sense of
knowing something almost unconsciously; it occurs without deliberation
and there appears to be no articulated reason for this feeling of
certainty.
However, intuitive learning, or learning intuitively, may actually be
superior in some cases to rational problem-solving; as an example of this,
Claxton cites childrens ability to solve the Rubiks cube puzzle. The cube
is notoriously difficult for adults to solve, yet children seem to be able
to solve it more readily, and the explanation may well lie in the different
approaches used by each. Adults tend to use a logical, problem-solving
approach, which is inappropriate for the complexity of the Rubiks cube,
whereas children rely on intuitive learning rather than on thinking about
it.
Problem-solving
and decision-making
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Problem-solving
and decision-making
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Problem-based learning
Gagn (1985) suggests that the most effective problems for student
learning are those that are novel to the students and within their
capabilities. Barrows and Tamblyn (1980) recommend problem-based
learning as a strategy in teaching health studies and define it as learning
that results from the process of working towards the understanding or
resolution of a problem. Problem-based learning is different from other
problem-solving teaching strategies, because the problem is given to the
student prior to any form of input; usually, traditional methods involve
the giving of information followed by the application of that information
to clinical problems. Problem-based learning starts with the problem, and
students have to find out what they need to know in order to solve it.
This approach is very much a discovery-type approach and can be very
motivating (Allen and Murrell, 1978).
Problem-based learning lends itself well to computer-assisted learning,
with the use of simulation and case method. Students are given basic data
about a patient and are then asked to produce a suitable care plan. Having
selected a series of interventions, the nurse can check to see whether, in
the real case, the ones chosen were actually selected for the patient.
Decision-making
Professional practitioners in nursing, midwifery and specialist community
public health nursing spend a significant part of their professional lives
making decisions: many are routine and predictable, and others are lifeor-death decisions.
Decision theory offers an explanation for how people decide to take
one kind of action rather than another. The theory assumes that people
choose the action that they think will have the most value or utility
for them. However, given that decisions are made before the outcomes
are known, the choice of action is based upon the probability that the
outcome will have the expected utility.
When faced with a range of possible actions, the decision about which
one to take is made by multiplying the utility by the probability,
which gives the expected utility of that action (Mook, 1996). However,
in real life this calculation takes the form of deciding how well we like the
outcome of each alternative action and how likely it is that the outcome
will follow that action. Let us take an example relating to student
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Motor Skills
Motor
skills
Earlier in this chapter (p. 58) the difference between declarative knowledge
and procedural knowledge was identified: the latter being
knowledge about how to do things. This procedural knowledge is an
essential part of motor skills, hence the preferred term psychomotor
skills. Motor skills are an extremely important aspect of the practice
of nursing, since nursing science is largely a practical endeavour, but
the notion of skill pervades the whole of society; indeed, the concept
of social class is very much influenced by the degree of skill of the
occupations in each category of the Registrar Generals classification.
Motor skills are concerned with movements and a skilled person exhibits
certain characteristics over a novice.
Human motor skills can be divided into three broad categories
(Oxendine, 1984):
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Cognitive
3. The autonomous phase, during which the skill becomes automatic and
can occur without the student thinking about it.
The frequency and distribution of practice can affect learning of motor
skills; distribution can be divided into massed practice and distributed
practice, the former having little or no rest from beginning to end
of practice, and the latter having practice sessions separated by rest
periods or by longer intervals of time. Distributed practice is generally
more effective for learning motor skills, possibly because of the avoidance
of boredom, fatigue or loss of attention. Simple tasks, however, are better
learned in one session, and short practice periods are preferable to long
ones. Of course, student motivational level will influence the amount of
practice that the student can accommodate.
As pointed out earlier, one of the key features of practice is that, in
order to help them improve, students must be receive feedback about
their performance. Thorndike (1931), in a classic experiment asked
participants to draw four-inch lines whilst blindfolded, and they were
not told how close to four inches their efforts were. There was much
variability in the lengths of the lines drawn, but no trend towards
improvement over the trials. Feedback can be classified as intrinsic or
extrinsic. Intrinsic feedback is feedback arising within the performer and
is further subdivided into reactive and operational feedback: reactive
feedback consists of the kinaesthetic feedback from the performers body
muscles and joints; and operational feedback is the observation of the
effect of the action by the performer, also termed knowledge of results
(KOR). Extrinsic feedback is external to the performer and is also termed
augmented feedback; it can be given by teachers, peers or coaches and
may be given concurrently during the performance, or terminally when
it is finished.
When student nurses learn a new skill, it is likely that there will be
some element of transfer from previously learned skills; transfer means
that a previously learned skill has a positive or negative influence on the
new one, and this is termed proactive transfer. It is also possible for
the new skill to influence the old one, a phenomenon called retroactive
transfer. Transfer of skill may be specific or non-specific; specific aspects
that are transferred in nursing are such things as lifting patients without
injuring oneself, whereas general transfer occurs less obviously, in areas
such as problem-solving ability.
Positive transfer of skills is enhanced by similarity between them
and also if well-learned responses can be used in the new skill. On the
other hand, well-learned habits may interfere with new responses, as in
driving a car with different controls. There is evidence to suggest that
an understanding of the underlying principles will enhance transfer to a
different activity.
Cognitive
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depend upon this basic form, which consists of the learning of single
words or what is represented by them.
Concept learning. Ausubel defines concepts as objects, events,
situations or properties that possess common criterial attributes and
are designated by some sign or symbol. He identifies two kinds of
concept acquisition: the first occurring in young children, called
concept formation; and the second occurring in school children and
adults, called concept assimilation.
Propositional learning. In this form of learning, it is not simply the
meaning of single words that is learned, but the meaning of sentences
that contain composite ideas. Syntax and grammatical rules must also
be understood.
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Cognitive variables:
the students previous knowledge of related ideas seen to be
important to the learning of new material and forms the basis of
the notion transfer of learning;
developmental readiness, which is the stage of cognitive development
the student has reached;
intellectual ability of the student;
practice;
arrangement of instructional materials in order to facilitate
learning.
Affective/social variables:
motivation and attitudes;
personality;
group and social factors;
teacher characteristics.
One of the key strategies for learning advocated by Ausubel is the
concept of advance organizer, a strategy introduced in advance of any
new material in order to provide an anchoring structure for it. This
strategy is based on assimilation theory, which, as we have seen, states
that new information is subsumed or incorporated into an anchoring
structure already present in the student. Typically, an advance organizer
consists of ideas that are similar to the material that is to be learned, but
are stated at a higher level of generality and inclusiveness, so that the
new material may then assume a subordinate relationship to the advance
organizer. The concept is similar to an overview (or summary), except
that the latter is presented at the same level of generality or inclusiveness.
Advance organizers form the link between the students previous
knowledge and what is needed to be known, before any meaningful
learning can take place. A further advantage is that it provides a highly
specific anchoring structure because the content is virtually identical to
the material that follows, although, to be effective, it must obviously be
potentially meaningful and capable of being understood.
The process of forgetting meaningfully learned material is also
explained by Ausubel in terms of assimilation theory. Learning, as we
have seen, consists of the interaction between new information and
knowledge already present in the cognitive structure of an individual.
During the process of assimilation, this new information gradually
loses its discrete identity as it becomes part of the modified anchoring
structure; this process is termed obliterative subsumption. This gradual
loss of separate identity ends with the meaning being forgotten when
the idea falls below the threshold of availability. This threshold forms a
level below which an idea cannot be retrieved, but the level is subject to
variation, for example due to anxiety.
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Figure 3.2
Example of a lesson plan with
advance organiser for the
circulatory system
Introduction
Good morning and welcome to this lecture on the circulatory system. Before we begin I would like
to include some introductory material to help you understand the lecture.
Advance organizer
You are all very familiar with the notion of transport systems in society; for example, road, rail, air and
sea transport. Any transport system has a number of basic components as follows:
Vehicles
Routes
lorry
train
plane
ship
Freight
origin
destination
Energy consumption
passengers
goods
Organization
Travel
medium
road
rail
air
sea
control centre
maintenance/repair
diesel oil
electricity
aviation fuel
The circulatory system in the body is another example of a transport system with the same basic
components. We can usefully examine the system using these components as follows:
Vehicles: In the bloodstream, certain cells act as vehicles for transporting substances, as does the liquid
part of the blood, called plasma.
Freight: Many goods are transported in the blood, including foodstuffs, oxygen, chemical messengers
and waste products.
Travel medium: The liquid part of the blood is the transport medium.
Routes: There are many routes involved in the circulation. For example, oxygen originates at the
lungs (the supplier) and its destination is the tissue cells (the consumer).
Organization: There is a complex organization of circulation, both from central control in the brain to
local control in the tissues.
Energy consumption: Like all other body systems, the circulation burns up glucose to make energy.
Main body of the lecture
1. Composition of the blood
Plasma
Cells
red
white
platelets
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Cognitive
Structure, then, involves the basic patterns and ideas of the subject
but not the details or specific facts. If students understand the structure,
they should be able to work out for themselves much of the fine detail.
The structure is made up of concepts or categories, and Bruner sees
learning as a process of categorization of objects. Classes of objects are
seen to be characterized by common properties, and it is these properties
that are used as a basis for identifying new objects that are encountered.
The new object is compared with the properties of a category, to see if
it belongs there. If the object fits a particular category, then we infer that
it possesses the characteristics of that category. A category has certain
distinguishing properties that differentiate it from other categories and
it also has a certain order in which the characteristics are combined.
For example, the category bed has the following components: frame,
legs, headboard, footboard, mattress, pillows, blankets and counterpane.
These characteristics are assembled in a certain order, such as the legs
underneath, the mattress on the frame, the pillows and blankets on top,
etc. There are also limits of acceptance for objects to fall within a category.
For instance, a bed would still be a bed if there were no headboard, but it
would not constitute a bed if there were no frame.
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Fractures
Caused by
sudden injury
Direct
violence
Simple
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Stress or
fatigue
Indirect
violence
Compound
Caused by
pathology
Infection
Simple
Tumor
Cyst
Compound
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Gagn:
Discovery learning
Discovery learning involves students in discovering the structure of
a subject through active involvement and can be divided into pure
discovery and guided discovery. The former is virtually impossible
to organize, since it involves no direction whatsoever, so the latter is
preferable. The role of the teacher is to pose questions or problems that
stimulate students to seek answers in an active discovery way. One of the
great obstacles to this kind of learning in nurse education is the pressure
on students always to produce the correct answers to questions; this runs
counter to the notion of intuitive thinking. Intuition involves making
an educated guess about phenomena before one has the complete data
and can be very motivating for students because they then have to check
whether or not their hypothesis was correct.
Implications for teaching and learning
One implication of Bruners ideas on the structure of subject matter is
that the nurse teacher must ensure that any new material being taught
is first explained in terms of its basic structures and principles. It is not
helpful to give lots of fine detail in the early stages of encountering a
new subject; it is much more sensible to give an outline only. Take the
example of microbiology, an important topic for nurses to understand so
that they can appreciate the need for asepsis and antibiotics. It would be
good practice if the teacher confined the lecture to a general overview
of the main principles and concepts of microbiology until the students
were well immersed in them. However, it is common to find lectures on
microbiology given to first-year students that contain very specific detail
about the classification of bacteria, a confusing experience for those
students who have not encountered the concepts before.
Discovery learning can be used to good effect in the context of guided
discovery; the nurse teacher can ask students to devise a series of questions
or problems related to the topic areas and then to try to find answers to
those using whatever resources are available. Another discovery approach
is to use practical laboratory sessions to generate activities and then to ask
students to try to explain why things happened.
Gagn:
Robert Gagn does not propose a theory of learning per se but focuses
on the conditions of learning. Using an information-processing model,
he analyses these conditions and develops a theory of instruction based
upon them. Learning is defined as a change in human disposition or
capability that persists over a period of time and is not simply ascribable
to processes of growth (Gagn, 1985). Thus growth is seen very much
as being genetically determined, whereas learning is seen as being mainly
under the control of environmental influences that interact with the
individual. Any learning situation can be viewed as having a number of
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elements, namely the student, the stimulus, the contents of the students
memory, and the response or performance outcome. Such a learning
situation or occurrence is described by Gagn (1985, p. 4) as follows:
A learning occurrence, then, takes place when the stimulus situation
together with the contents of memory affect the student in such a
way that his or her performance changes from a time before being in
that situation to a time after being in it. The change in performance
is what leads to the conclusion that learning has occurred.
Learning capabilities
Gagn believes that it is possible to make sense of all the different
learning outcomes that people make during a lifetime by organizing them
into five performance categories, each representing a different kind of
learning capability.
intellectual skills:
discrimination;
concrete concepts;
defined concepts;
rules;
higher-order rules;
cognitive strategies;
verbal information;
motor skills;
attitudes.
Prototypes of learning
The five varieties of learning capability include some elements that Gagn
terms prototypes of learning; these are commonly identified phenomena
of learning that constitute basic forms of learning by association. They
include:
classical conditioning;
operant conditioning;
verbal-association learning; and
chaining.
These are seen as basic forms because they comprise only parts of specific
capabilities and are insufficient to explain all aspects of complex learning.
Hence, association is seen as an important aspect, since its various forms
constitute some of the components of the five learning capabilities.
Having emphasized the importance of association learning as a basic
component of all types of learning, we now examine the five varieties of
learning capability in more detail.
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Gagn:
Intellectual skills
It is useful to think of intellectual skills as forming a hierarchy in which
any particular skill requires the prior learning of those skills below it in
the hierarchy, as illustrated in Figure 3.4.
Figure 3.4
Hierarchy of intellectual skills
Higher-order rules
Rules
Concepts
Discriminations
Prototypes (association and chaining)
The dependence of intellectual skills on the basic prototypes is shown;
each level consists of progressively more complex skills. These intellectual
skills are what is referred to as procedural knowledge (i.e. knowledge
about how to perform such things as mathematical calculations) and are
typified by rule-governed behaviour. Rules state relationships between
things and are composed of simpler components called concepts,
which in turn depend on the ability to discriminate between various
characteristics of things.
Discrimination
Young children learn to respond to collections of things by learning the
differences between them, a process called discrimination. Discrimination
learning involves perceiving differences in size, shape, colour, texture,
etc., and multiple discriminations have to be made when there is more
than one stimulus present. Student nurses and midwives may have to
learn to discriminate between the various kinds of tissue when using
a microscope. This is usually taught by presenting examples and nonexamples of a particular tissue, a process called contrast practice.
When the student is making multiple discriminations, there is a danger
of confusion between stimuli and of interference in the learning of
discriminations.
Concrete concepts
Discrimination learning is confined to specific stimuli, whereas concept
formation allows the student to respond to collections of things by
classifying them into categories sharing common abstract properties.
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Gagn:
A. Features
A container
(superordinate
thing-concept)
Figure 3.5
consisting of a
Components of the
definition of syringe
B. Functions
Injecting or aspirating
(relational-concept)
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Chapter 3 Perspectives
simpler rules forming prerequisites for more complex ones, and this
implies that there is a cumulative process involved in learning. Hence,
simpler rules are transferred to more complex rules, and these higher
order rules tend to be more generalizable in their application.
Cognitive strategies
These strategies exert control over the internal mental processes of learning
such as thinking, memory and problem-solving and are independent of
content. They are involved in the learning of intellectual skills and other
learning capabilities and are often referred to as metacognitive processes
or learning to learn. Students use cognitive strategies for attending to
stimuli, for encoding and retrieving information in memory and for
thinking and problem-solving, for example the use of mnemonics and
imagery. Cognitive strategies are easily acquired by students and become
better with practice, and there is some evidence to suggest that these skills
will transfer to other situations.
Verbal information learning
Verbal learning entails declarative knowledge, the kind of knowledge
involved in telling or verbalizing, and it utilizes sentences or propositions.
There are three forms of verbal learning: names (or labels), facts (or
single propositions) and organized verbal knowledge:
Names or labels. These are normally learned at the same time as the
concept is acquired; hence only one or two labels or names are learnt
at any one time. On occasions, however, it is necessary to learn several
names at one time, such as when a nurse teacher meets a new student
group and has to remember each name, which can be very difficult.
Facts or single propositions. It seems likely that facts are stored in
memory as meaningful propositions rather than as verbatim words in
some form of semantic network.
Organized verbal knowledge. This refers to collections of propositions
that are organized into connected discourse called prose. It is suggested
that a students previous knowledge is a major influence on the learning
of new information from prose texts, owing to the previous formation
of global schemata for particular situations or events.
Motor skills
Much human learning is to do with movements, and a practice discipline
like nursing centres around the learning of motor skills and procedures.
There are three dimensions of motor skills: fine/gross performance,
continuous/discrete movements, and closed/open looped tasks.
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Gagn:
the individual has about the beliefs that he or she holds about the
attitudinal object;
the behavioural aspect a predisposition to act in some way
although studies have shown poor correlation between attitudes and
behaviour.
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The
The
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Chapter 3 Perspectives
since this was the object of study in the other scientific disciplines. The
emphasis was to be on objective experimentation and replication of
results, leaving no place for subjective inquiry.
Most behaviour is learned by making an association between a
stimulus and a response, hence the term stimulusresponse (SR) theory.
Experiments in animals can be extrapolated to human beings, as the
former differ only in their degree of complexity from man. Watson
was convinced that even complex behaviour could be accounted for
by this association of stimuli and response, and the publication of
Pavlovs work on classical conditioning provided the confirmation that
he sought.
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The
Watson became famous for his work with Rosalie Rayner on conditioned
fear in humans (Watson and Rayner, 1920). By modern-day standards
Watson and Rayners experiments seem ethically dubious; however, they
believed that no permanent harm would be done to the subject of their
experiment, a nine-month-old boy called Albert B. (Little Albert!). Albert
showed no fear when presented with a range of stimuli, including a
white rat. He did, however, show a fear reaction to a stimulus consisting
of a loud noise behind him, which Watson made by striking a metal bar
with a hammer. The conditioning process involved presenting the rat
to Albert, then, when he reached towards it, the metal bar was struck
loudly behind him, causing him to startle and cry. After repeated pairings
of the rat and the noise, presentation of the rat alone caused the child to
cry immediately and to crawl away rapidly. His fear of the rat showed
generalization to other furry objects, such as a rabbit and a dog. This
demonstrated that the Albert had learned to be afraid of the rat through
the process of classical conditioning.
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The
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1.
2.
3.
4.
The subject or topic is divided up into a number of units, each of one or two weeks duration.
Learning objectives are prescribed for each of the units.
The subject matter of the unit is taught.
Formative tests are administered at the end of the unit and are used to identify the successful
and unsuccessful students.
5. If students do not achieve mastery, then remedial teaching is given.
6. When a student has completed all the units, a summative test is given to test mastery
of the course, which equals a grade A.
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Critique of behaviourism
Stimulusresponse theories of learning have come in for a great deal of
criticism over the years. For example, Skinners laboratory experiments
seem to have little ecological validity when generalized to human
beings, i.e. they ignore the importance of human relationships and the
social context in which behaviours occur. It is also difficult to see how
stimulusresponse connections can account for the infinitely complex
skills of language. Another difficulty arises when attempting to use SR
theory to explain how individuals learn by imitating the behaviour of
other people. Humanistic psychologists find SR theory distasteful, as it
makes the individual merely a puppet, the passive recipient of external
forces. In addition, the application of reinforcement theory may lead to a
situation where the learner will only consider doing something if there is
a reward associated with it, i.e. a whats in it for me? attitude. Another
objection concerns the ethical issues surrounding the manipulation of
human behaviour, in particular the problem of who has the right to
control and manipulate another individuals behaviour.
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Social
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Summary
Summary
The term cognition refers to the internal mental processes of human
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References
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References
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Skinner, B.F. (1971) Beyond Freedom and Dignity. Alfred Knopf, New
York.
Smythe, M., Morris, P., Levy. P. and Ellis, A. (1987) Cognition in Action.
Erlbaum, London.
Thorndike, E. (1911) Animal Intelligence: Experimental Studies.
Macmillan, New York.
Thorndike, E. (1931) Human Learning. Appleton Century Crofts, New
York.
Tulving, E. (1972) Episodic and semantic memory. In E. Tulving and W.
Donaldson (eds) Organization of Memory. Academic Press, New York.
Watson, G. and Glaser, E. (1961) WatsonGlaser Critical Thinking
Appraisal. Harcourt, Brace and World Inc., New York.
Watson J. and Rayner, R. (1920) Conditioned emotional reactions.
Journal of Experimental Psychology, 3, 114.
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Part Two
Learning,
teaching and
assessment
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Curriculum
in-house study days for qualified staff, for example intravenous drug
administration;
The
nature of curriculum
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Chapter 4 Curriculum
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Components
of curriculum
Components
of curriculum
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Chapter 4 Curriculum
Figure 4.1
Components of curriculum
Learning outcomes
Subject matter
Teaching and
learning process
Assessment
Models
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Educational aim
An aim is a broad, general statement of goal direction, which contains
reference to the worthwhileness of achieving it. The educational aim is
the most important part of the goal system, since all the other objectives
are derived from it. The following is an example of an educational aim
in nursing: Understands the nature of malignant disease, so that he or
she may perform skilled nursing care of the patient with such disease.
This statement gives a very general indication of the goal to be achieved,
namely the understanding of malignant disease. It does not give details
as to what this understanding should consist of, but it does stress the
value of achieving this goal, which is the skilled care of the patient. Some
authorities subdivide these general goals into immediate and long-term
goals and, in nursing, it is likely that teachers will need to state goals for
the learner that apply to practice after qualification and so are long-term
goals.
Learning outcome
This is the desired end-state of student learning, and describes the
knowledge, skills, attitudes and values that a student should acquire
as a result of the educational process. Learning outcomes are derived
from the educational aims of a programme but are stated in terms of the
capabilities that students should attain as a result of instruction. There is
a very specific type of learning outcome called a behavioural objective,
and this is described below.
Specific behavioural objectives
Also termed instructional objectives or terminal objectives, these are
highly specific statements that describe the changes in behaviour that
constitute learning. They must always contain a verb that indicates
exactly what the learner must do in order to achieve the objective, and
this verb should describe an observable action so that achievement can
be measured. Behavioural objectives are derived from the secondary
goals, for example: List five factors which predispose an individual to
malignant disease. The word list describes an observable action on the
learners part, which can be measured simply by asking the learner to
write down the list on paper.
If the curriculum uses a behavioural objectives approach to the
formulation of goals, then the following guidelines may be helpful:
1. Formulate the educational aims, ensuring that there is some indication
of the worthwhileness of achieving them.
2. Formulate the secondary-level goals, which will break down the
material into manageable sections for study.
3. Formulate specific behavioural objectives from the secondary-level
goals.
4. Formulate any experiential objectives from the secondary-level goals.
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Knowledge
Category
Subcategory
Table 4.1
1.10
1.11
of terminology
1.12
of specific facts
Taxonomy of educational
objectives: cognitive domain
1.21
of conventions
1.22
of trends and
sequences
1.23
of classifications and
categories
1.24
of criteria
1.25
of methodology
1.31
of principles and
generalizations
1.32
of theories and
structures
1.20
1.30
2.00
Comprehension
3.00
Application
4.00
Analysis
5.00
6.00
Synthesis
Evaluation
of specifics
of ways and means of
dealing with specifics
2.10
Translation
2.20
Interpretation
2.30
Extrapolation
4.10
of elements
4.20
of relationships
4.30
of organizational
principles
5.10
Production of a unique
communication
5.20
Production of a plan,
or a proposed set of
operations
5.30
Derivation of a set of
abstract relations
6.10
Judgements in terms of
internal evidence
6.20
Judgement in terms of
external criteria
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Level 1.00 Knowledge. At this, the most basic, level, all that is required
is the bringing to mind of such things as specific facts or terminology,
as stated in the subcategories. Typical verbs used to indicate this level
are define, describe, identify, label, name, state, list, etc. However, it is
important to remember that it is the context of the verb rather than the
verb itself that will decide the level, as some verbs can be used at more
than one level.
Level 2.00 Comprehension. This refers to understanding, which is usually
demonstrated by the learner making limited use of the information.
Such activities as paraphrasing a communication whilst maintaining the
intent of the original would constitute translation. Interpretation can
be observed by the learner summarizing or explaining information in
his or her own words, and extrapolation is involved when information
is projected beyond the given data. Typical verbs used at this level are
paraphrase, translate, convert, explain, give examples, etc.
Level 3.00 Application. The learner is required to apply rules, principles,
concepts, etc. to real situations. These should be sufficiently unfamiliar
to avoid the mere recall of previous behaviours. Typical verbs used at
this level are demonstrate, discover, prepare, produce, relate, use, solve,
show, etc.
Level 4.00 Analysis. This involves the ability to break down information
into its component parts, which may be elements of information,
relationships between elements, or organization and structure of
information. Its purpose is to separate the important aspects of
information from the less important, thus clarifying the meaning. Typical
verbs are differentiate, discriminate, distinguish, etc.
Level 5.00 Synthesis. At this level the learner is required to combine
various parts into a new kind of whole. Creativity is present because the
learner produces something unique, such as a plan or design. Typical
verbs are compile, compose, create, devise, plan, etc.
Level 6.00 Evaluation. This implies the ability to make judgements
regarding the value of material and involves the use of criteria. Typical
verbs are compare, contrast, criticize, justify, appraise, judge, etc.
Table 4.2 gives examples of nursing objectives for the cognitive
domain.
Table 4.2
Examples of nursing objectives
for the cognitive domain
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models
Level 5.00 Characterization. This is the highest level, and having attained
this level the learner has an internalized value system which has become
his or her philosophy of life. These are the values that characterize an
individual. Typical verbs are act, discriminate, listen, etc. Nurse
students, unlike schoolchildren, will have acquired mature attitudes and
values systems, because they enter nursing when mature. However, this
domain is still most applicable to nurse education, as the learner may
have to acquire new attitudes and values, or modify existing ones.
The psychomotor domain
Taxonomies in this domain have been developed by Harrow (1972) and
Simpson (1972), the latter having more application to the type of skilled
performance involved in nursing.
Level 1 Perception. This basic level is concerned with the perception of
sensory cues that guide actions and ranges from awareness of stimuli
to translation into action. Typical verbs are chooses, differentiate,
distinguish, identify, detect, etc.
Level 2 Set. This is concerned with cognitive, affective and psychomotor
readiness to act. Typical verbs are begin, move, react, show, start,
etc.
Level 3 Guided responses. These objectives refer to the early stages in
skills acquisition where skills are performed following demonstration by
the teacher. Typical verbs are carry out, make, perform, calculate,
etc.
Level 4 Mechanism. At this level, the performance has become habitual,
but the movements are not as complex as the next higher level. Typical
verbs are similar to the previous level.
Level 5 Complex overt response. This level typifies the skilled performance
and involves economy of effort, smoothness of action, accuracy and
efficiency, etc. Again, verbs are similar to Level 3.
Level 6 Adaptation. Here, the skills are internalized to such an extent
that the nurse can adapt them to cater for special circumstances. Typical
verbs are adapt, alter, modify, reorganize, etc.
Level 7 Origination. This is the highest level, and concerns the origination
of new movement patterns to suit particular circumstances. Typical verbs
are compose, create, design, originate, etc.
Table 4.3 gives examples of nursing objectives for the psychomotor
domain.
Level 1. Perception
Table 4.3
Detects the need for pharyngeal suction in a patient, by listening to the sound of his or her
breathing.
Level 2. Set
Demonstrates the correct bodily position for lifting a patient.
Level 3. Guided response
Performs urine testing as demonstrated by the instructor.
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Level 4. Mechanism
Sets a tray for an intramuscular injection.
Level 5. Complex overt response
Applies with skill a stump bandage to a lower-limb amputee.
Level 6. Adaptation
Modifies surgical dressing technique to suit a particular patients circumstances.
Level 7. Origination
Devises an original way of securing a dressing that has tended to come loose soon after
application.
Proponents
They provide the student with clear directions as to what must be learnt.
Their use encourages the teacher to examine his or her goals more carefully.
It is relatively easy to assess students achievements, as behaviours are observable.
They can aid self-instruction.
They are accessible to public scrutiny.
They offer a rational system for curriculum planning.
Students on the whole tend to welcome the clarity that behavioural objectives bring to learning.
They provide a basis for comparison between similar courses in different institutions.
They offer a system for evaluation the performance of the teacher.
Opponents
They act as a set of blinkers that narrow the learning field.
They are difficult to formulate for higher level outcomes and hence encourage trivialization of
learning by focusing on lower level outcomes.
They are almost impossible to formulate in the affective domain.
They ignore unanticipated outcomes of instruction.
It is impossible to state objectives for every learning outcome, even if this were desirable.
They are unsuitable for arts subjects such as music, poetry and drama.
They are unsuitable for science subjects, as they emphasize the learning of actual information
rather than scientific enquiry.
Their use reflects a training approach rather than an educational one.
They encourage conformity rather than diversity.
It is wrong for one individual, i.e. the teacher, to dictate how another individual, i.e. the student
should behave.
They are extremely time-consuming to formulate and require continuous updating.
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Models
of teaching
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development
Nursing
models
Nursing models are used to assess, plan, implement, and evaluate nursing
care in a wide range of practice settings and will therefore feature
significantly in curriculum documentation for nursing programmes.
Indeed, a nursing model may well function as the over-arching model
for an entire curriculum, and it is here that the boundary between
curriculum models and other models becomes blurred. The majority of
models originated in North America, with the notable Scottish exception
of the Roper, Logan and Tierney Model of Activities of Living. The
most commonly used American models are the Orem Self-Care model;
Roys Adaptation Model; Neumans Health Care Systems Model, and
Johnsons Behavioural Systems Model. Fraser (1996) advocates the use of
a multiple-model approach to practice, as no single model is capable
of covering all the problems experienced by clinical nurses.
Curriculum
development
The basic principles of curriculum development apply to both preregistration and post-registration provision, although there are some
differences in approach between these. Pre-registration courses or
programmes in nursing and midwifery tend to be offered in both
full-time and part-time modes, whereas post-registration continuing
education programmes are largely part time.
Since pre-registration programmes form the entry gate to the nursing
or midwifery professions they must meet the criteria laid down by the
NMC. Post-registration programmes and courses are, on the whole, less
constrained by such requirements and provide scope for curriculum
designers to be much more flexible and imaginative.
Curriculum development needs to be distinguished from curriculum
design at this point:
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Although nursing curricula within the UK will differ one from another,
there will be certain common aspects. For example, the now defunct
English National Board describes a documentary analysis of nursing
degree curricula undertaken by University College, Suffolk (ENB, 1999)
which sets out the similarities and differences between nursing degree
curriculum documents from 32 institutions. The ways in which the
documents were comparable included:
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Table 4.5
Typical components of
a course specification
Level
Credit level 1, 2, 3 or M
Code
Co-ordinator
Rationale
Aims
Learning outcomes
Course title
Department
Assessment
Indicative content
Indicative reading
The complete set of core and option courses will differ from student
to student, according to the option courses that they choose. The
basic criterion for the inclusion of an option course within a students
programme of study is that he or she must be able to demonstrate its
coherence and relevance to the overall programme.
Take the example of a nurse working within the field of sexually
transmitted diseases who is undertaking a post-registration degree in
nursing studies. This particular nurse may choose to study an option
course from a social science degree programme on human sexuality, since
this would be relevant to his or her particular professional needs and
interests. Similarly, an option course on personnel management from a
diploma in management studies may be undertaken so as to improve both
knowledge and skills as a departmental manager.
In credit schemes, a specified number of credit points are awarded to
the student on successful completion of appropriate learning, and these
can be gained in three ways:
=
=
=
level 1
level 2
level 3
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The system in Scotland differs from that in the three countries above,
in that there are four levels: SD1, SD2, SD3 and SD4. The first three
levels equate with the certificate, diploma and unclassified degree as
shown above, but the degree with honours requires 480 credit points,
120 at each of the four levels.
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Curriculum
design
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design
be included are the first draft of the validation document, the internal
validation event, and the printing of the document. A specimen critical
path analysis for curriculum development is shown in Figure 4.2
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Formation of
planning team
Curriculum development
Unit writing
Document writing
Internal
validation
Document
to panel
Validation
event
Response to
validation conditions
Start
intake
Figure 4.2
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programme title;
type of award;
rationale of the proposed programme;
name of designated programme organizer;
mode of study;
proposed commencement date;
name of professional accreditation (if applicable);
evidence of local, national, international demand;
staff resources to support the programme;
resources to support learning and teaching.
The proposal of a new programme of study is then scrutinized by a
number of committees. The School Board approves initial documentation
for further development and a proposal cannot proceed without the
approval of the Head of School and School Board. The proposal then
moves through a series of panels, including the School Advisory Panel,
Programme Approval Panel, Academic Standards and Quality Committee
before it is finally approved by the Academic Policy Committee.
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1. Programme title, type of award, programme manager, length and mode of study.
2. Introduction and rationale.
3. Admissions policy.
4. Level, aims and intended learning outcomes.
5. Programme structure, content and delivery.
6. Assessment strategy.
7. Academic standards and quality assurance.
8. Regulations and programme administration.
9. Support for students.
10. Financial, physical and human resources.
Adapted from Cardiff University (2005)
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design
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for academic standards in the university, who is not from the faculty
submitting the programme;
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design
one academic from the host school, who was not involved in the
development;
approval for a fixed length of time, for example five years, after which
the programme is then subject to review;
approval withheld.
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date by which the conditions must be met, and this can vary from a few
weeks to a whole year. The programme development team must make
a satisfactory response to the conditions, and this is sent to all panel
members. Once the panel has agreed that the conditions have been met,
the amendments are incorporated into the validation document, and this
then becomes the definitive programme document. This is housed in the
library for general access by students and anyone else who is interested
in the programme.
Equal
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Equal
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computational skills;
oral skills lack of logical structure in oral presentation, difficulties
with mispronunciation and word retrieval;
memory short-term memory may be less effective; inefficient
working/short-term memory can cause problems when following
instructions;
concentration high levels of distractibility; short attention span;
high levels of energy needed to concentrate;
organization poor awareness of time; problems with time
management.
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Educational
quality assurance
Are lecture theatres and other rooms allocated and timetabled with
Educational
quality assurance
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Educational
quality assurance
Quality assurance
Quality assurance (QA) was originally developed for the manufacturing
and service industries, and the approaches used in higher education are
derivations of these systems, with suitable modifications for educational
contexts. However, definitions of quality derived from manufacturing
industry do not necessarily transfer easily into the higher education
context. For example, if educational quality is seen as fitness for purpose,
the question then arises as to whose purpose we are talking about, i.e.
students, lecturers, employers, or the states? Similarly, if it is defined
as customer satisfaction, who are the customers of higher education?
Students, employers, or society at large?
The term assurance implies an action taken by one party towards
another in order to convey sureness or certainty about something. Hence,
quality assurance literally means that the provider of products or services
tells the consumers that they can be sure of the quality of such products
or services. In the industrial context, this is often given in the form of a
guarantee, warranty or customer charter. Ellis (1993) describes a set of
characteristics of quality assurance in whatever context it occurs:
1. The specification of standards for whatever is conceived as the product
or service.
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quality assurance
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Quality
Quality of teaching
In discussions about education, the words teaching and learning are
invariably linked together, the assumption being that teaching promotes
learning. In practice, however, a cause-and-effect relationship is difficult
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Table 4.7
Checklist for self- and
peer-evaluation of teaching
Item
Highly satisfactory
Lesson plan
1.
2.
3.
4.
5.
6.
7.
Delivery of lesson
8.
9.
Weak
1
1
1
1
1
1
1
2
2
2
2
2
2
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
Audibility of voice
Clarity of speech
1
1
2
2
3
3
4
4
10
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
Expressiveness of voice
Speed of delivery
Use of pauses
Confidence
Enthusiasm
Warmth
Psychological safety
Sense of humour
Non-verbal communication
Accuracy of content
Content up to date
Research quoted
Clarity of explanations
Level of lesson appropriate
Quality of media resources
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
25.
26.
27.
28.
29.
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
Peer-evaluation of teaching
Peer-evaluation of teaching remains a contentious issue in higher
education; lecturers have traditionally enjoyed complete autonomy in
the classroom, and when assessment has occurred it has largely been in
the form of written evaluation by students. However, the advent of staff
appraisal in higher education has raised the profile of teaching quality, as
it constitutes one aspect of the appraisal process for lecturing staff. Some
observational assessment takes place as part of both internal and external
audit, but only affects small numbers of staff and occurs infrequently.
The evaluation form shown in Table 4.8 is appropriate for either self- or
peer-evaluation of teaching.
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Table 4.8
Teacher evaluation form for
completion by students
The purpose of this questionnaire is to help me to adapt my teaching to your needs as a student. Please indicate your opinion of my
teaching during the course you have just completed by putting a tick in the appropriate box.
X
X applies
Marked
tendency
to X
Some
tendency
to X Y
Marked
tendency
to Y
Y applies
Presented in a confusing
manner
No student participation
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Quality
Quality of curriculum
The first check on the quality of curriculum occurs at the validation
event for the programme, and checks continue in the form of programme
monitoring and programme review. As stated earlier, the term curriculum
encompasses the four main aspects of educational provision that were
shown in Figure 4.1 (p. 110). These four components are intimately
related to each other and the model adopts a rational stance, in that the
curriculum design is seen to begin with the formulating of student learning
outcomes and then progresses to decisions about what outcomes-related
subject matter should be included. Teaching and learning processes
are then defined, for example lectures, laboratory work, group work,
discussions, debate, self-directed learning, etc. that will help the student
to achieve the learning outcomes, and, finally, the students achievement
of the learning outcomes is assessed using appropriate and relevant
assessment methods.
Ashworth and Harvey (1994) offer the following criteria for a quality
curriculum:
1. Relevance, relates to present and anticipated future needs.
2. Aims and objectives, explicit and carefully focused.
3. Time constraints, effective use of time for individual subjects and their
arrangements.
4. Content, a body of knowledge which offers breadth and depth and is
state of the art and well balanced.
5. Progression, cumulative knowledge and skills which allows for planned
progression.
6. Sequencing, coherent sequencing of subjects and subject matter.
7. Integration, different aspects of the curriculum allow for integrated
working.
8. Core skills, relevant balance of all core skills.
9. Accreditation, appropriate accreditation of the programme from
professional bodies, other colleges, NVQ, etc.
Programme evaluation
Programme evaluation needs to be distinguished from evaluation of
teaching, the latter being just one component of the former. Although
evaluation of teaching contributes useful information, it is insufficient
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Quality
are clear, accurate and consistent and accessible to all staff, students,
practice assessors and external examiners.
Assessment practices should be explicit, valid and reliable and
applied consistently across each institution. All staff involved in the
assessment of students must be competent to undertake their roles and
responsibilities and be offered opportunities to update and enhance
their expertise as assessors.
Boards of examiners and assessment panels have an important role
in overseeing assessment practices and maintaining standards, and
institutions should develop policies and procedures governing the
structure, operation and timing of their boards/panels.
Institutions should have effective mechanisms to deal with breaches
of assessment regulations, and the resolution of appeals against
assessment decisions.
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Quality
So far in this chapter the role of the individual lecturer and the programme
team in quality assurance has been examined. We now turn our attention
to the institutions overall quality-assurance system that impacts on all
aspects of the work of the institution.
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Quality
Inputs
1.
Quality of leadership
Institutional philosophy
Mission statement
Vision
Management structure
Relationships with staff
Financial management
Staff development policy
Public relations and publicity
Equal opportunities policy
Quality assurance systems
2.
Personnel
3.
4.
Enterprises
Teaching accommodation
Halls of residence
Security arrangements
Ground maintenance
Catering
Car parking
Recreation
Child care
5.
Students
Spectrum of institutional
quality assurance
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Processes
6.
Curriculum
Relevance
Employer-focus
Planning
Validation, monitoring and review
7.
Teaching
Preparation
Delivery
Assessment
Teacherstudent relationships
8.
External funding
Publication in refereed journals
Citations
Client satisfaction with consultancy
9.
Outputs
10.
Student achievement
11.
Course monitoring/evaluation
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Table 4.10
Considerations for annual or
periodic monitoring reports
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External
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External
Those who use and those who pay for higher education must have
ready access to reliable information about the performance of
universities and colleges across the extensive and diverse range
of programmes of study offered.
The Higher Education Funding Councils have statutory obligations to
secure the assessment of the quality of provision they fund. Information
must be provided and quality assurance arrangements undertaken by
the Agency in forms acceptable to the Councils.
A national quality assurance system must meet these needs in a manner
that is effective, efficient and economical.
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External examiners.
Approval, monitoring and review of award standards.
Academic infrastructure and other external reference points.
Assessment policies and regulations.
Progression and completion statistics.
Section 3: Institutional management of learning opportunities
The quality statement is the institution should make sure that the
learning opportunities for students help them make good use of those
opportunities.
External examiners.
Approval, monitoring and review of award standards.
Academic infrastructure and other external reference points.
Role of students in quality assurance.
Links between research or scholarly activity and learning
opportunities.
Modes of study.
Resources for learning.
Admissions policy.
Student support.
Staff support.
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External
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External
Whilst there is a one-off registration fee for all those wishing to join the
Academys register, applicants applying through the Individual Entry
Route for Experienced Staff need to pay an additional evaluation fee. All
registration routes are focused on the following:
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Chapter 4 Curriculum
Standard:
Approval/re-approval ensures NMC standards and requirements for programmes and practice
learning are met with due regard to the specific part of the register
Required activity criteria:
1. Schedule predicted approval/re-approval activity in advance of academic year.
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Open,
2. Ensure that:
The need for the programme has been established through consultation with the
commissioners.
Resources are in place to deliver the programme.
The standard and content as set out by the NMC have been met in the development of the
programme.
The structure and content of the programme have been developed in partnership between
education and service providers.
The programme outcomes satisfy the statutory requirements for a registrable and/or
recordable qualification.
The assessment strategy meets NMC requirements.
3. Institutions must demonstrate that they have the capacity and capability to provide practicebased programmes to meet the standards specified by the NMC to include:
sufficient teachers with relevant experience and expertise to deliver programmes effectively
(an adequate number of whom must hold an approved teaching qualification);
student support services;
physical and learning resources;
access to adequate practice experience and appropriate partnership arrangements to deliver
practice experience.
4. Country-specific quality indicators are mapped against and shown to meet all NMC approval
standards, principles and requirements.
5. Joint approval is undertaken with education provider with external representation.
6. NMC representation is with due regard to programmes being approved.
7. Registrants may act as specialist advisers with due regard; thereby providing the registrant
attending the approval event with profession-specific advice.
8. Programme may be conditionally approved but may not commence until all conditions are
met.
Adapted from NMC (2005a)
Open,
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Chapter 4 Curriculum
Figure 4.3
Higher education
Modes of delivery in
higher education
Attendance mode
Flexible mode
The left-hand box on the diagram shows the traditional delivery pattern
in higher education, i.e. students attend the university for their teaching.
The right-hand box shows the flexible mode of delivery, a broad category
that includes both the distance learning mode and the open learning
mode. Given the considerable degree of overlap between the three
concepts, it may be helpful to identify the critical attributes that each
must possess in order to warrant its title.
Distance learning
In order for a programme to count as distance learning, a significant
proportion must be delivered on the basis of a wide geographical
separation between the student and the teaching institution responsible
for the programme. Distance is normally defined in terms of a student
who is more than one hours travelling time from the institution. Distance,
however, is not the only critical attribute; distance learning is invariably
delivered by means of text-based learning materials and information and
communication technology (ICT), for example email, Internet, video,
etc. The Quality Assurance Agency (QAA) defines distance learning as:
a mode of provision of higher education that involves student
learning resources being transferred to the students location rather
than the student moving to the location of the resources.
(QAA, 1998b)
Open learning
In order for a programme to count as open learning, there must be a
significant element of openness in comparison with traditional attendance
programmes. By openness we mean a minimum of restrictions on such
things as students access to programmes, the teaching and learning
methods used, the assessment methods, the venue for study, and the
timing of study. In reality, absolute openness does not exist; open learning
programmes fall somewhere on a continuum, from more or less closed to
more or less open. There will always be some kind of restriction imposed
upon students in higher education by virtue of validation requirements,
quality assurance requirements, and other institutional imperatives.
Open learning is succinctly defined by Rogers (2001) as:
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Open,
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Chapter 4 Curriculum
Race (1993) cites a number of reasons for the move towards flexible
learning in higher education, including:
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Selecting,
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Designing materials
The design of flexible learning materials will depend to some extent on
their proposed use:
They may comprise the teaching and learning material for an entire
programme of study.
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Target population
Pre-requisite
Table 4.12
Typical components of a
flexible learning package
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Chapter 4 Curriculum
Learning outcomes
Choice of learning
activities
Optional activities
beyond the
package
Tests
Guidance
concerning the
next step
Teachers notes
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How will student monitor his or her own progress through the
package?
Outline the sequence of content but omit page numbers until final
draft completed.
Table 4.13
Planning sequence for producing
a flexible learning package
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Chapter 4 Curriculum
The
Tutoring at a distance
Depending upon the nature of the programme of study, distance learning
students may meet their tutors on a face-to-face basis every three or four
weeks, or as infrequently as once or twice per semester. In either case, the
main form of communication will be the telephone and postal service, or
electronic forms such as fax and email. The additional roles of the tutor
in relation to distance learning students include those described below.
Establishing initial contact with students
It is good practice to send out to students a personal letter of welcome,
containing some background details about the tutor, and also the
arrangements for contacting the tutor.
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Chapter 4 Curriculum
Computer-mediated tutoring
One of the most appropriate innovations in tutoring distance students is
computer-mediated tutoring, which is defined as:
The use of computers, telephone lines and specialist software to
facilitate interaction between students and tutors irrespective of
geographical location or time zone.
(Ryan, 1996)
This system uses Lotus Notes software to offer both electronic mail
and conferencing databases; email can be used for one-to-one messages
and questions, or for one-to-many notices and information. Computer
conferencing allows students and tutors to discuss issues in a virtual
group but does not take place in real time. Hence, a tutor may initiate
activities or ideas onto the server, and the students in the virtual group
can respond at any time of the day or night. Students and tutor may
initiate and respond to each others inputs just like a live seminar, but
with the advantage of not having to be in the same place at the same
time.
Managing
Editorial board
An editorial board is an essential component of the management structure,
and membership would normally consist of the flexible learning manager,
the materials editor, the design and layout technician, and representatives
of authors. The editorial board is responsible for the commissioning,
production scheduling, and review process; commissioning may be done
on the basis of payment to the author for the writing, or by including
the writing as part of the teachers normal timetable commitments. It is
important that the editorial board maintains oversight of the production
schedule, so that action can be taken if there is slippage of deadlines. One
of the major quality assurance aspects of the editorial board is organizing
the critical review process for materials.
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Managing
Staffing issues
If the students experience of flexible learning is to be a quality
experience, it requires motivated, committed and, above all, flexible
tutors. The staffing of such programmes raises issues not encountered
within traditional attendance mode programmes.
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Quality
Cost implications
The cost of development and production of flexible learning materials
should not be underestimated: an editorial board is required, writers
and critical readers need to be commissioned; permissions to reproduce
copyright materials that will be scanned into texts need to be obtained;
and materials need to be piloted, all of which have very substantial cost
implications. Also, decisions have to be made about design and quality of
the materials, as these will influence cost. Materials will not remain up to
date forever; therefore, review and updating will need to be scheduled
every three to five years, depending upon the nature of the materials.
There are also costs involved in the necessary staff development for
flexible learning tutors.
On the other side of the equation, there are potential savings to be
made from the implementation of flexible learning. The following are
examples of such savings:
Quality
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Chapter 4 Curriculum
Summary
The term curriculum is used to describe a plan or design upon which
educational provision is based.
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References
and services in todays society, and this includes the two large service
industries of higher education and the health service.
Quality assurance at individual lecturer level should consider two main
aspects; quality in relation to teaching and quality in relation to the
lecturers continuing professional development.
Validation ensures that courses or programmes are of a standard
comparable to similar awards elsewhere within higher education.
Internal quality audit is undertaken periodically by an institution
to assure itself and others that its quality assurance systems are
appropriate for maintaining the standard of its academic awards, and
that its development activities are enhancing the quality of teaching
and learning.
In order for a programme to count as distance learning, a significant
proportion must be delivered on the basis of a wide geographical
separation between the student and the teaching institution responsible
for the programme.
Open learning is any system where learners work alone, at their own
pace, on resources prepared by others, with minimal face-to-face
contact either with teachers or with other learners.
Flexible learning covers any strategy that helps to reduce restrictions
on students learning opportunities.
Ashworth, A. and Harvey, R. (1994) Assessing Quality in Higher
Education. Jessica Kingsley Publishers, London.
Beattie, A. (1987) Making a curriculum work. In P. Allan and M. Jolley
(eds) The Curriculum in Nursing Education. Croom Helm, London.
Bell, R. (1973) Thinking About the Curriculum. Open University Press,
Milton Keynes.
Bernstein, B. (1971) On the classification and framing of educational
knowledge. In M. Young (ed.) Knowledge and Control: New Directions
for the Sociology of Education. Collier Macmillan, London.
Bligh, D. (1998) Whats the Use of Lectures?, 5th edn. Intellect, Exeter.
Bloom, B. (1956) Taxonomy of Educational Objectives: The Classification
of Educational Goals, Handbook One: Cognitive Domain. McKay, New
York.
Boyle, P. and Bowden, J.A. (1997) Educational quality assurance in
universities: an enhanced model. Assessment and Evaluation in Higher
Education, 22(2), 111121.
Butterworth, C. (1992) More than one bite at the APEL: contrasting
models of accrediting prior learning. Journal of Further and Higher
Education, 16(3), 3951.
Butterworth, C. (1993) Introduction and Self-assessment Guide to Claiming
APEL by Distance Learning. University of Greenwich, London.
Cardiff University (2005) Programme Approval and Maintenance
Handbook. Cardiff University, Cardiff.
References
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References
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Planning
for teaching
Table 5.1
Title
Level/year
Full-time or part-time attendance
Course aims and learning outcomes
Indicative content
Assessment methods
C Details of students
1. Number of students
2. Full-time/part-time
3. Relevant prior knowledge and experience
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Chapter 5 Planning
for teaching
D Organizational factors
1.
2.
3.
4.
5.
E Psychological factors
1.
2.
3.
4.
Defining
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Defining
Modules, the standard of which is higher than GCSE or its equivalent, which would
prepare students for entry to an undergraduate degree
Level HE 1 Modules, the standard of which is higher than modules at level 0, and which are
appropriate to the award of a university Certificate of Higher Education
Level HE 2 Modules, the standard of which is higher than modules at level 1, and which are
appropriate to the award of a university Diploma of Higher Education
Level HE 3 Modules, the standard of which is higher than modules at level 2, and which are
appropriate to the award of an Honours degree
Level M
Modules, the standard of which is higher than modules at level 3, and which are
appropriate to the award of a Masters degree
Table 5.2
Definitions of credit levels
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Chapter 5 Planning
for teaching
Selecting
session
Concept mapping
In Chapter 3 (p. 64), the nature of concepts was discussed. When planning
teaching sessions, one of the most difficult decisions confronting the
teacher is deciding what must go in, what should go in, and what could
go in; concept sorting and mapping can be a helpful tool in this regard.
Lawless et al. (1998, p. 219) offer the following definition:
Concept sorting is a simple, yet powerful, way in which to generate,
sort, arrange and rearrange any set of elements, i.e. ideas, concepts,
events, statements or procedures, in a visually explicit manner,
namely a concept map.
Hence, the terms have largely the same meaning, but the writers
point out that the term concept sorting is used in business and
public administration, whereas concept mapping is the preferred
term in education because the emphasis is on the relationships between
concepts.
Concept mapping provides a way of prioritizing concepts in a
concrete, visual way. The simplest way of making a concept map is
to write each concept on a small square of paper and then place the
squares on a flat surface. The squares are then arranged in order of their
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Selecting
relationship to each other, with the most closely related concepts being
placed next to each other. This pattern is then transferred to a diagram,
and the relationships between concepts are shown by connecting lines,
usually annotated.
Figure 5.1 shows an example of a concept map for the topic coronary
heart disease; first-order, second-order and third-order concepts are
included. When making a decision about which concepts to include and
which to omit, the teacher will need to judge not only the appropriate
level of information for the learners in question but also the amount of
time available for the session.
Incidence
EPIDEMIOLOGY
Risk factors
Geographical distribution
Statistics
Age and gender
LDL
HDL
Primary
Secondary
Lipids
Hypertension
Diabetes
Lifestyle
CHD
PATHOLOGY
Atherosclerosis
Thrombosis
Pain
Shock
Pyschological effects
Fear
Employment
Self-image
Diagnosis
ECG
Angiography
Treatment
Drugs
CLINICAL FEATURES
PATIENT CARE
Diet
Smoking
Alcohol
Exercise
Ischaemia
Infarction
Sick role
Income
Relationships
Lipid-lowering
Nitrates
Beta blockers
Bypass
Angioplasty
Surgery
Nursing
Physical
Psychosocial
Figure 5.1
When sorting the concepts, lecturers draw upon the relevant literature
and their specialist knowledge and experience of the topic, and the end
result should be a prioritizing of concepts into key concepts (must be
included), second-order concepts (should be included) and third-order
concepts (could be included). At the level of the key concepts, selection
is usually fairly straightforward; it is at the level of the second- and thirdorder concepts that the danger of over-inclusion of information is most
likely to occur. There are all kinds of fascinating facts and anecdotes
attached to the key concepts of nursing and health, and as such these
can be important elements in the maintenance of students interest and
motivation.
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Chapter 5 Planning
for teaching
Problems may arise when the teacher perceives that there are so many
key concepts to include that no time is left for these interesting but nonessential aspects of the topic. This dilemma can be lessened if the aim
of the session is taken into account. Provided that sufficient book and
periodical resources are available in the college, there should seldom
be the need for the teacher to attempt to cover all aspects of a topic in
detail. By the judicious use of references and further reading, the teacher
can limit the number of concepts within the session, and in so doing will
free up time for inclusion of anecdotes and other interesting facets of the
topic.
Although the foregoing information has focused on the planning of
a single teaching session, concept mapping is equally appropriate for
planning a scheme of work for a series of sessions on a broad topic area.
It can actually be easier to make a selection from a concept map if more
than one session is available, as the time constraints may be less evident.
Selecting
There is a wide range of strategies available to the teacher and these are
discussed in detail in the relevant chapters of this book. Hence, for this
section, an overview of the basis on which teaching strategies might be
selected will be provided. The starting point for selection of teaching and
learning strategies is the broad purpose of the session(s). The strategies
must be compatible with the aims of the session; lecturing is very
commonly used as a vehicle for conveying subject matter to students,
but there may well be more effective ways involving individualized
instruction. If the intention of a session is to encourage discussion or
debate about issues, student-centred activities should predominate;
for skills teaching, demonstration followed by student practice is an
appropriate strategy.
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Planning
an explanation
The CNAA project makes the point that existing curricula need not
necessarily be abandoned but can be modified to include the above
strategies.
Planning
an explanation
Classification of explanations
Within the literature there are a number of ways in which explanations are
classified; for example, Bligh (1998) identifies 11 kinds of explanation,
but for everyday practice a much more useful classification is that of
Brown and Atkins (1988):
1. Interpretive, i.e. answers the question What?
2. Descriptive, i.e. answers the question How?
3. Reason-giving, i.e. answers the question Why?
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Designing
effective questions
Table 5.3
Step 2
Common bile duct conveys bile from liver to intestine via gall bladder
Obstruction to bile flow causes jaundice
Gallstones block the common bile duct
Gallstones cause jaundice
Hidden variable = gallstones do not always cause jaundice. Thus, the explanation must make
clear in what circumstances gallstones cause jaundice.
Step 3
Secretion of bile; storage and passage of bile; formation of gallstones; migration and
impaction of gallstone; results of obstruction to flow of bile.
Step 4
(a) Bile is secreted by hepatocyes and conveyed to the gall bladder via the hepatic duct
and cystic duct.
(b) Bile is stored and concentrated in the gall bladder, from whence it is ejected by
muscular contraction, and conveyed by peristalsis into small intestine via cystic duct
and common bile duct.
(c) In some people, gallstones form from precipitation of bile constituents, for example
cholesterol, in gall bladder.
(d) Small gallstones may be ejected during contraction of the gall bladder, passing by
peristalsis into the common bile duct, where they may impact in the lumen.
(e) This implication may cause obstruction to the flow of bile, with resultant rise in
back-pressure to the liver.
(f) This back-pressure will eventually cause reversal of flow of bile into the
bloodstream, raising the serum bilirubin and discolouring the skin and mucous
membranes, i.e. jaundice.
Designing
effective questions
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Chapter 5 Planning
for teaching
Classification of questions
There are many different ways of classifying questions, none of which is
entirely satisfactory because questions depend very much on the context
in which they are asked. Although none of the following examples
is particularly recent, they are probably the most useful ones in the
literature.
Blooms taxonomy classification
In Chapter 4 (p. 114) the work of Benjamin Bloom (1956) is discussed
in connection with educational objectives. The taxonomy of educational
objectives can be used to formulate questions at different intellectual
levels. Bloom classified intellectual or cognitive functions into a hierarchy
of levels of increasing complexity, from simple recall of facts to evaluation
and judgement of ideas.
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Designing
effective questions
Table 5.4
Blooms taxonomy
Knowledge
Comprehension
Application
Analysis
Synthesis
Evaluation
Recalling
information
Explaining
information
Solving open-ended
problems
Creating answers to
problems
List
Relate
Record
Underline
Define
Name
Repeat
Recognize
Label
Recall
Report
Review
Translate
Describe
Discuss
Express
Identify
Explain
Justify
Summarize
Illustrate
Schedule
Interpret
Demonstrate
Apply
Practise
Employ
Operate
Prepare
Verify
Criticize
Analyse
Question
Categorize
Test
Compare
Contrast
Debate
Appraise
Experiment
Manage
Collect
Propose
Compose
Prepare
Arrange
Construct
Plan
Create
Arrange
Making critical
judgements
based on a sound
knowledge base
Evaluate
Assess
Judge
Estimate
Compare
Conclude
Discriminate
Value
Rate
Defend
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Designing
effective questions
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Chapter 5 Planning
for teaching
Drafting
a teaching plan
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Drafting
a teaching plan
Reece and Walker (2000) believe that a lesson plan has two functions:
as a strategy or plan for teaching and as a series of cues to be used
during the lesson. They also believe that a lesson plan is intended to help
teachers to proceed with the teaching session logically; but, even with
detailed planning, every eventuality cannot be catered for. A lesson plan
is therefore essentially tentative and flexible. In addition to providing
structure to a lesson, a lesson plan should identify a sequence of events in
the form of an introduction, the progression of the subject material and a
conclusion. There are many reasons for the use of lesson plans, and, for
them to be effective, many key details should be present:
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Group Number: 60
Group: Cohort 1
Session Style: Lecture
9780748797660_Q_Nursing.indd 198
Duration
15 mins
5 mins
10 mins
20 mins
Time
13.30
13.40
13.45
13.50
Teacher
transmission with
direct questioning
Introduction to session
Aims and learning outcomes
Development 2:
What information does the
preoperative checklist comprise?
Practical exercise:
Circulation and
facilitation while
students on task
Teacher
transmission with
direct questioning
Quiz
Development 1: QUESTIONS
Why do we assess patients prior to
surgery?
Has anyone accompanied a patient
to theatre?
Can anyone talk us through the
process?
What information is required before
the patient leaves the ward area?
Method
Rationale
Student Participation
Group work to
document what
the preoperative
checklist consists of
(4 groups)
Student led
questions and
answering
Student activity
Feedback to the
group
Assessment of
prior knowledge
Acetates and
pens
Allows assessment
of prior knowledge
Allows assessment
of prior knowledge
Verbal feedback
to indicate prior
learning
Assessment
PowerPoint
Slides 1213
PowerPoint
Slides 811
PowerPoint
Slides 57
PowerPoint
Slides 14
AVA
Learning outcomes: at the end of the lesson the students will be able to:
Demonstrate correctly an understanding of the importance of maintaining a safe environment and ensuring patient safety during the preoperative phase
Critically examine the theory underpinning the pre-operative check list for surgical patients
Provide a sound rationale for nursing care which takes into account the social, legal and ethical influences within the peri-operative environment
Date: January 04
Table 5.5
Chapter 5 Planning
for teaching
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30 mins
15 mins
5 mins
14.10
14.40
14.50
Development 4:
Re-cap on todays session
Re-visit learning outcomes and
conclusion
Any questions or comments?
Development 3:
Examination of preoperative
checklist
Duration: 1 hr
Group Number: 20
Learning outcomes: at the end of the lesson the students will be able to:
Identify correctly common sites and types of fractures
Explain how to correctly recognise the signs and symptoms of a fracture
Describe the appropriate treatment of fractures
Demonstrate correctly an elevation sling, broad-arm sling and immobilization of lower limbs as per St John Ambulance first aid manual
Student activity
Rationale
Group: cohort 2
Teacher
transmission with
direct questioning
Teacher
transmission with
direct questioning
Teacher
transmission with
direct questioning
Method
Date: January 04
Table 5.6
Duration
Time
PowerPoint
Slides 4142
None
PowerPoint
Slides 1440
AVA
Verbal feedback
to demonstrate
knowledge and
understanding
Assessment
Drafting
a teaching plan
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10 mins
10 mins
5 mins
5 mins
20 mins
5 mins
5 mins
13.30
13.40
13.50
13.55
14.00
14.20
14.25
Development 6
Revisit learning outcomes and conclusion
Q8. Any questions or comments?
Development 5
Treatment of an open fracture
Q7. How do you think an open fracture should be
treated compare with tutor slide
Development 4
Immobilization of upper and lower limb fractures
Q6. Can anyone remember where these particular
bones are situated?
Students to demonstrate application of slings and
bandages in pairs
Development 3
Signs and symptoms of fractures
Q5. What are the signs and symptoms of a fracture?
Write student answers on flip chart compare with
tutor slide
Development 2
Types of fractures
Q4. Can anyone identify any types of fractures?
Draw identified fractures on flip chart compare
with tutor slide
Development 1
Common sites of fractures upper and lower limbs
Q3. Where are these bones situated in the body?
Identify bones on skeleton model
Note: Tables 5.5 and 5.6 from Nursing Standard, reproduced with permission.
Duration
Time
Teacher transmission
Teacher demonstration of
application of slings and
bandages
Students in pairs to
practise skill on each
other
Circulate and facilitate
Method
Demonstration enhances
transmission of information,
by the use of tangible
equipment. Students are
given the opportunity to
practise this psychomotor skill
in a safe environment
Visualization, aids to
retention of learning, better
than continuous teacher
transmission
Rationale
Slide 10
Slide 9
Slide 7 and 8
2nd teacher as a
model
Slings/bandages
Slide 6
Flip chart/pens
Slide 4 and 5
Flip chart/pens
Slide 2 and 3
Skeleton model
PowerPoint
Slide 1
AVA
Allows assessment of
what has been learnt
and retained during
the session
Allows assessment of
prior knowledge
By circulating around
the students, allows
for visual assessment
of the skill
Allows assessment of
prior knowledge
Allows assessment of
prior knowledge
Allows assessment of
prior knowledge
Verbal feedback
indicates prior level
of learning
Assessment
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Drafting
a scheme of work
Drafting
a scheme of work
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Session
Outcomes
Content
Teaching methods
Assessment
Introduction to research
Understand nature of
knowledge
Mutual knowledge,
formal knowledge,
informed consent,
confidentiality
Lecture
Issue-centred groups
Resource material
Multiple-choice test
Types of research
Understand principles of
experimental research
Describe the nature of
experimental research
Experimental research
Non-experimental
research
Lecture/discussion
Carousel exercise
Nil
Action research
Understand nature of
action research
Discuss potential projects
in own field
Principles: exploratory,
practical, problemcentred
Problem-centred groups
Case-study material
Basic statistics
Activity workshop
Handout material
Monitoring of activities
Research critique
Understanding of
providing a critique
Undertake and
elementary critique
Guidelines, academic
fraud
Lecture/discussion
Practical exercise
Assessment of critiques
Writing a research
proposal
Identify sources of
funding
Write a draft proposal
Sources of funding,
DoH, NHS, HEA, etc.
Guidelines
Lecture/discussion
Workshop on writing a
proposal
Assessment of draft
proposal
Essay assignment on
course outcomes
Table 5.7
Example of a scheme of work
Organizing
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Organizing
The standards also establish that this requires critical understanding and
essential knowledge of:
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Planning
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Information
Information
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is replete with terminology, and there are two other terms that nurses
will encounter in the literature, i.e. health informatics and nursing
informatics. Severs and Pearson (1999) define the former as follows:
Health informatics (HI) is the term used to describe the science
of information management in health care and its application to
support clinical research, decision-making and practice.
communication;
knowledge management;
data quality and management;
confidentiality and security;
secondary uses of clinical data and information;
clinical and service audit;
working clinical systems;
telemedicine and telecare.
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Information
The paper offers a number of key assumptions and issues for education
providers, including a pre-requisite requirement that participants possess
basic computer skills; advice about teaching informatics in a more creative
way than beginning with basic concepts; the availability of resources; and
the encouragement of multi- and interprofessional programmes.
The Use of Technology to Support Learning in Colleges (FEFC, 1998)
This document is the report of a national survey undertaken by the
Further Education Funding Council (FEFC) on a representative sample
of 44 colleges across nine FEFC regions. The aim of the survey was: to
investigate the use and effectiveness of technologies to support teaching
and learning in colleges and the factors influencing developments. The
findings of the survey include the following:
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Does the language used reflect all strata of society, or simply the
middle class?
Using
a whiteboard in teaching
The whiteboard or ink board is now the most common type of board in
use in higher education teaching rooms. When using a whiteboard for
teaching, it is important to have the correct type of marker pen. Most
boards use dry marker pens that can be wiped off with a dry cloth;
ordinary marker pens cannot be wiped off without the use of some form
of spirit. The purpose of the whiteboard is to record, in semi-permanent
form, the key points and explanations during a teaching session. This
enables the student to see as well as hear the points and to copy them
down as a source of reference for the future.
Teachers may feel uncomfortable with silences, so tend to write as
quickly as possible, with a resulting loss of legibility. The period spent
writing on the board can be used as a mini-break for the students, so that
their arousal will increase when the teacher faces them again. Remember,
if its worth writing down, its worth writing legibly.
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Using
an overhead projector
Using
flipcharts
Using
an overhead projector
The overhead projector (OHP) is one of the most useful and versatile
of educational media; it is a machine that projects large images of
clear acetate sheets, called overhead transparencies, onto a screen. The
overhead projector is designed for use in daylight, which saves the
inconvenience of blackout, and it has the advantage over the whiteboard,
in that the teacher faces the audience whilst using it. Transparencies can
be prepared from a variety of sources:
hand-written/hand-drawn by teachers;
computer-generated by teachers;
produced by teachers using a photocopier;
produced by commercial publishers.
Overhead projection has another advantage over the whiteboard, in
that transparencies can be prepared in advance of the teaching session.
They offer the facility for step-by-step presentations, using revelation
technique or overlays. On the downside, however, there may be some
glare from the bright light of the projector, and the noise of the projector
fan can be distracting. During the session, it is important to make full
use of the off switch; this should be done whenever a transparency
is changed and also if the teacher needs to give a detailed explanation
regarding one of the points on the transparency. Switching off the
machine will focus the students attention back to the teacher.
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Projection of silhouettes
The overhead projector will project a silhouette of any solid object on to
the screen, such as the shape of an organ or of instruments and drains.
For example, the teacher could drawn an outline of a leg onto acetate
and then add cardboard silhouettes of the two fragments of a fractured
femoral shaft to indicate the displacement and the effects of reduction.
Designing
Purposes of handouts
The purposes of handouts can be summarized, as follows:
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Designing
Design of handouts
Students should be encouraged to file handouts, so it is helpful to
use paper with punched holes for ease of filing. The actual layout of
text and diagrams will depend upon the nature of the topic, but in
general handouts should not be overcrowded with text. Handouts can
be designed in a very professional way by using desktop publishing
computer packages, which have the advantage of novel designs such as
newspaper columns or magazine format.
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Copyright
Copyright laws are designed to protect authors from the wholesale
copying of their works, a very real need in view of the ease with which
modern copying machines can reproduce materials. However, copying is
an important aspect of good teaching, and the licensing scheme operated
by the Copyright Licensing Agency (CLA) allows copying without
permission within clearly defined limits. In higher education institutions
the licence enables teaching, administrative and technician staff, librarians
and all students to copy for any one course of study in one academic year.
It is a condition of the licence that the number of multiple copies of any
one item of copyright material shall not exceed the number needed to
ensure that the tutor and each member of a class has one reproduction
only. The CLA produces Guidelines for Users of the CLA Licence, and a
copy must be kept beside the copying machine.
and
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Using audio-cassettes
Audio-cassettes can be a useful resource in teaching, provided that they
are used appropriately. They are used extensively for data collection in
research and are useful because a transcript of the material can be taken
for analysis. The use of audio-cassettes for long periods during lectures
or small-group sessions can become very boring, but it is useful to use
trigger-tapes to stimulate discussion. Audio-cassettes are also useful for
capturing the feelings and experiences of patients, which makes them a
good medium for adding interest to sessions on nursing care.
Sources of audio-cassette recordings
Audio-cassette recordings can be taken off-air from radio and television
programmes, or used with the integral microphone. The purpose of
making an audio-cassette recording is to capture specific content and
make it available to an audience. This does not imply, however, that the
quality of the recording is irrelevant, for, indeed, it is very important to
ensure that the recording is of the highest technical quality if people are
going to listen to it without distraction. A little attention to the technical
points can make all the difference between a good recording and a poor
one.
Universities have professional recording studies for audio and video,
but teachers may wish to make their own audio recordings.
Making amateur audio recordings
When reading a script for a recording session, the teacher should be
sitting comfortably at a table, with the integral microphone high enough
to avoid having to lower the head to speak. The script must not intervene
between the face and the microphone, and, to prevent the rustling of
paper being detected, it is useful to enclose each sheet in a polythene
sleeve so that it glides noiselessly to one side.
Recording requires an assistant to switch the machine on and to
monitor sound levels. It is important to position the cassette recorder at
some distance from the microphone so that amplifier hum is not picked
up. If the cassette recorder does not have automatic recording level, the
sound level must be monitored by watching the VU indicator on
the recorder, ensuring that this does not exceed 0 VU during the
recording. On the other hand, it is important to record the signal at a
high level, so the level should approach 0 VU but not exceed it.
Teachers who are new to recording often feel nervous or embarrassed
and this makes their delivery stilted. It is a good tip to have someone
sitting opposite the speaker, behind the microphone, to whom the
speaker addresses his or her words. This often makes the tone more
natural and conversational.
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Computer-assisted
learning
for presentations
Computer-assisted
learning
Courseware
Courseware, i.e. teaching materials, for CAL can use a single computer
or a computer can be used in combination with a range of other media as
in multimedia CAL. With a single-computer approach, the teacher either
develops appropriate courseware or it is purchased from manufacturers
of educational media. The courseware is selected by the student and
loaded into the computer, where it forms the learning experience for the
student in whichever mode is appropriate.
Computer-assisted learning is only as good as the courseware that
goes into it, but computers do have the potential to produce high-quality
graphic displays, data storage and retrieval and a host of other effects
that would be almost impossible for the individual teacher to emulate in
standard teaching situations. Single-computer CAL does have limitations
and these can be overcome by the use of multimedia CAL, which consists
of a range of media used in the same instructional program, for example
sound, pictures, video.
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It is cost-effective.
However, Hartley points out that these claims may not be justified, as
students may not have control over the pace of their learning, and the
quality of some programs is questionable.
The Internet
and
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Intranets
Intranets
Intranets
Intranets operate in much the same way as the Internet, but within an
institutions own internal computer network (inter = between; intra
= within). Hence, intranets are not accessible by the community at
large. There is a wide variety of information contained on an intranet,
including teaching and learning materials in the form of journal articles,
lecture handouts, assignments, revision tips, etc. Intranets are particularly
useful for students studying at a distance from the main site, as they can
easily access the materials without the need to travel.
Online campus
This is a Web-based, virtual university campus that supports students
on their programme of studies (Ryan and Culwick, 1997); it requires
students and staff to have access to the Internet and an Internet browser.
The online campus consists of three aspects:
ask questions, seek advice or share experiences, and teachers can set
up student activities in relation to their own courses. Students can
respond to each others contributions and to those of the teachers,
thus providing an environment similar to a face-to-face discussion.
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files to help students with their programme work, and also links to
other Web sites and pages.
Student common room. This is an area to which teachers do not
have access, and provides a point of informal social contact and chat.
It is particularly useful for students on open and distance learning
programmes that do not have regular face-to-face interaction with a
group.
The Web site and further information on Blackboard Academic Suite can
be obtained from: http://www.blackboard.com/products/as/contentsys/.
Summary
Nursing and midwifery incorporates a wide range of teaching contexts,
ranging from the delivery of lectures in a university through to one-toone teaching sessions with individual students, practitioners, patients
and clients.
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Summary
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References
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References
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Teaching
The
strategies
lecture method
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The
lecture method
information, but less effective for the promotion of thinking skills and
the changing of attitudes.
Compulsory attendance. Students who absent themselves from lectures
do less well in examinations and tests.
Time of day. Morning lectures seem superior to afternoon lectures for
the recall of information, but this may not apply to the evening-type
of learner, whose maximum physiological alertness occurs between
15.00 hours and midnight.
Length. Attention declines considerably after approximately 20
minutes, with a reduction in the amount of information assimilated
and noted.
Recall. Recall on information from lectures is relatively inefficient,
falling to something around 20% recall after one week.
Delivery. Speed of delivery is closely related to the level of difficulty
of the material, and evidence suggests that there is a critical level of
difficulty and speed, beyond which the material is delivered with a loss
of efficiency.
One common criticism of the lecture method is that the information
could have been obtained from textbooks just as easily; however, this
shows a lack of understanding of the purpose of lectures. Indeed, if they
are used only to convey information readily available in other forms
such as books, then they are likely to be simplistic or inaccurate due to
time constraints. However, used thoughtfully, lectures can complement
textbooks by providing:
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Advantages
Disadvantages
Lecturing techniques
Lecturing can be seen as analogous to acting, each requiring careful
scripting, polished presentational skills, and a certain personal charisma
for effective performance. This theatrical performance element may
not be present in other forms of teaching and can provide a source
of stimulation and job satisfaction for those teachers who enjoy the
challenge. The requirements of good lecturing are creativity, welldeveloped verbal-exposition skills, clarity of ideas, an ability to make a
subject interesting, enthusiasm and self-confidence. Verbal exposition is
the term given to the kinds of talking in which the teacher engages during
a lecture, or indeed in any other type of teaching, with the exception
of individualized instruction. This teacher-talk can be subdivided
into a number of modes, the commonest ones being the stating of
facts, the defining and classifying of material, asking and answering
questions, giving explanations, comparing and contrasting information,
and evaluating material.
Table 6.2 gives guidelines for planning and delivering lectures; it
uses an acrostic arrangement under the headings before, during
and after. In an acrostic, the initial letters of each of the horizontal
statements combine vertically to make another word, and this is a simple
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Table 6.2
Believe in yourself
Explaining
Focus on selected aspects
Over-learn your material
Rehearse
Excitement/anxiety
Commentary
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Recap
Recapitulation or repetition should be used frequently, so that the learner
is exposed to the information on more than one occasion. Provision
could also be made for this at the end of the lecture if time allows, as it
will help students to retain the information for a longer period of time.
Involve your audience
Adult students are never very happy just sitting listening to lectures; what
they like to have is some personal involvement in them. There is a wide
variety of strategies for involving students in lectures, even when faced
with a large number of students. One effective way is to use buzz groups,
in which students form groups of four to six without moving their seats,
for example by some swivelling around to face the people behind them.
These small buzz groups spend a couple of minutes discussing some
aspect of the topic and then feedback is invited. Incomplete handouts
offer another way of ensuring student participation; the handout
contains only key headings or diagrams and the student is required to
fill in the details gleaned from the presentation. A quiz or test given at
the end of the lecture may also serve to focus students attention on the
material presented!
Note-taking
This is discussed in detail in Chapter 8 (p. 323), but it is helpful to note
a few key points here. There are both advantages and disadvantages in
taking notes during a lecture. Taking notes provides a permanent record of
the information which is then available for review at a later date. Another
advantage is that the information is actively processed and encoded in the
students own words. Bligh (1998) summarizes 29 studies showing that
note-taking aids memory, and 20 studies showing that note-taking aids
revision. On the negative side, notes may be inaccurate, and students may
miss important points whilst writing down previous ones. On balance,
however, I favour note-taking if it is done effectively, i.e. recording the
key points rather than trying to write down everything word for word.
At degree level, it is more important to note key references given in the
lecture, so that the original source can be accessed later, avoiding reliance
on secondary sources.
Get out on time
It is quite common to find that lectures over-run their allotted time, and
this could be thought a cardinal offence! Students find it difficult enough
to maintain attention during the normal span of a lecture, and overrunning simply compounds the problem. There are also knock-on effects
on the students next class or lunch break, and it delays the next groups
access to the lecture room. One of the causes of over-running is an overambitious lecture plan for the time available. These lecture plans seem to
exert a powerful influence over teachers, who slavishly follow them until
the bitter end, often regardless of the time or circumstances. From the
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Variants
Variants
of the lecture
of the lecture
The demonstration
A demonstration can be defined as a visualized explanation of facts,
concepts and procedures. The purposes of demonstration can be broadly
classified into:
Table 6.3
1.
2.
3.
4.
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of the lecture
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Small-group
Small-group teaching
The term small group is difficult to define. Brown (1996) emphasizes
the importance of context in defining what constitutes a small group;
i.e. the term can apply equally to three or four students working on a
project, or the subdividing of a large lecture group into small groups of
twenty or more.
Group size
Clearly, the size of the group will have an effect on the processes
occurring within it, particularly with regard to the amount of face-to-face
interaction with other group members. With numbers greater than about
25, this becomes impossible and subgroups have to be formed in order
to allow for it.
Group size has another important bearing on learning: the larger
the group, the less time each individual member will have available for
contribution. Let us take a typical 1-hour group session: if there are
30 students, each will have a maximum possible contribution time of 2
minutes; with a group of only 10 students, the individual contribution
time becomes 6 minutes. If we assume that not all students contribute to
the same extent, it becomes quite probable that certain students will gain
at the expense of others; it is interesting to note that none of the above
timings includes any input from the teacher and the more the teacher
becomes involved, the less time there is for student participation.
Purpose of small groups
The concept of a small group is not defined solely by the numbers of
students involved; it also includes the purpose of the group. Broadly
speaking, the function of an educational small group is to put the student
at the centre of things; to allow opportunities for face-to-face interaction
with other group members in order to exchange ideas and feelings; to
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Small-group
Experiential learning
Although experiential learning is not confined to a single teaching or
learning method, small-group strategies do provide a major vehicle for
many aspects of it: hence the inclusion of both strategies in this chapter.
David Kolbs theory of experiential learning was discussed in Chapter
2 (p. 34), so the present chapter will focus on more practical aspects of
experiential learning. At its simplest, experiential learning is learning that
results from experience, but, since almost everything in life constitutes
experience, this becomes an impossibly global notion. Essentially,
experiential learning is learning by doing, rather than by listening to
other people or reading about it. This active involvement of the student
is one of the key characteristics of this form of learning, together with
student-centredness, a degree of interaction, some measure of autonomy
and flexibility, and a high degree of relevance.
Kolb (1984) identifies the characteristics of experiential learning:
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Group
dynamics
Social roles
In any given group, there are many social positions called social roles:
the family has roles called father and mother; nurse education has
roles called teacher and student; and the individual over time plays
many parts. A number of roles are played concurrently, as with a post-
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Group
dynamics
Group norms
Group norms are defined as required or expected behaviours and beliefs
of group members, which may be covert or overt. Covert or implicit
norms are usually typified by the phrase it just isnt done, whereas overt
norms are usually formulated as explicit rules of behaviour. In nursing,
there are explicit rules about the way in which uniform is worn, but, in
clinical settings, there may be implicit norms such as The ward manager
likes it done this way. It could be argued that norms are simply roles that
are applied to all group members rather than to different concepts.
Both roles and norms may be considered as either imposed or
emergent. Imposed roles are those that arise from outside the group,
such as the appointment of a new head of department; emergent
roles are those arising from within a group, such as the election of a
chairperson. Such norms may also arise from outside the group as when
a nurse teacher lays down the rules for conduct in a small-group session.
Alternatively, the group may itself develop norms for behaviour and these
are often termed group rules.
Belbin (1997) studied teamwork for many years; he famously
observed that people in teams tend to assume different team roles. He
defines a team role as a tendency to behave, contribute and interrelate
with others in a particular way and named nine such team roles that
underlie team success.
The nine team roles are identified in Table 6.4 and are categorized into
three groups: action-oriented, people-oriented, and thought-oriented.
Each team role is associated with typical behavioural and interpersonal
strengths.
Action-oriented roles
Table 6.4
People-oriented roles
Cerebral roles
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Action-orientated roles
Cerebral roles
Shaper
Implementer
Completer finisher
Co-ordinator
Acts as a chairperson
Teamworker
Encourages co-operation
Resource investigator
Plant
Monitor evaluator
Specialist
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Reflection
Reflection
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Planning
Taxonomic level
Description
1.0
2.0
3.0
4.0
5.0
Consciousness of an experience
Deciding to become part of an experience
Union of the learner with what is to be learned
Experience continues to influence lifestyle
Attempt to influence others
Exposure
Participation
Identification
Internalization
Dissemination
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Taxonomic level
Nursing applications
Table 6.7
1.0
Exposure
Nursing applications of
experiential taxonomy
2.0
Participation
3.0
Identification
4.0
Internalization
5.0
Dissemination
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
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S
S
S
S
S
S
S
S
S
T
S
S
S
S
S
S
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Re-arranging seating
One of the common errors that inexperienced teachers make is to
rearrange seating in the classroom without adequate explanation to the
group. Students of all ages tend to be quite sensitive about their personal
seat and usually sit in the same place for all sessions. If they suddenly
find that the seating arrangements have been altered, they may become
resentful; indeed, many an unwitting student teacher has entered a
classroom only to find that their carefully planned seating arrangement
has been returned to its normal state by the students.
The emotive nature of seating positions is such that the teacher must
ensure full and adequate explanation as to why he or she is wishing
to rearrange it. A few minutes spent in explaining ones philosophy of
teaching and the importance of the students contributions can save a great
deal of trouble later on by giving students rational, sincere reasons for
such a rearrangement. Students are usually tolerant of such innovation,
provided that they have been consulted before it is implemented. If a
group is particularly resistant to rearrangement, it may be wise to leave
the seating as it is, but to use a small group activity early in the lesson
that requires students to interact with others. This will encourage natural
pairing and movement, which can be capitalized on for the remainder of
the session.
Psychological environment
The ideal environment for small-group and experiential learning is
that which is termed a learning community. This is characterized by
a climate of acceptance, support and trust, where each member of the
team acknowledges that he or she is still learning and where the needs of
students are recognized. This notion of a learning community can apply
to the higher education institution and to the clinical or community
area and contains an implicit value judgement that students are equal
to trained staff in all respects other than those of age and experience.
In a learning-community approach, opportunities for learning are made
available and professional growth is encouraged by graded responsibility.
A large element of negotiation is typical of this approach, where students
can determine what they want to learn and the means by which this will
be achieved and evaluated.
Establishing trust
The establishment of trust among group members is fundamental to
successful small-group and experiential learning. The length of time
the small group is likely to be together is an important factor. For
example, small-group techniques may be used on a study day, and in this
short timescale it would be impossible to develop group identity. On a
programme of study, on the other hand, small groups may well remain
together for months or years, and it is therefore crucial that the group is
given the time and opportunity to foster interpersonal relationships and
trust. This means that the teacher must avoid the temptation of setting
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the group tasks and issues too early. Taking time to facilitate group
cohesion will pay dividends later on when the group is able to work
effectively without interpersonal conflict and competition.
Techniques
There are a great many ways in which small groups can be made aware
of individual members.
Pairs exercises
One technique is a pairs exercise that aims for maximum interaction.
Group members are asked to form pairs, choosing someone they do not
know. Each member spends two minutes introducing him- or herself to
the other. After this, group members are asked to find another partner
whom they do not know, and spend two minutes each on explaining what
they hope to gain from the group membership. This pairing continues
until all group members have met each other, using topics such as my
feelings about small group work, problems in my current job, etc.
In another example, group members are asked to form pairs, and
each member must choose a character from literature, theatre, films
or television whom they would most like to be. They must explain the
reason for their choice, taking up to two minutes to do this.
Developing trust
When members of a small group trust each other, they are able to
contribute without fear of being ridiculed if their suggestion seems
wrong; indeed, such suggestions may be seen as creative rather than
stupid and may lead the group in a new direction. Students need to
be able to try out their ideas, and this can only be encouraged in an
atmosphere of psychological safety. Where there is trust in a group, each
student is free to concentrate his or her energies on learning, rather than
wasting them on building up defensive barriers against attacks from other
group members. Trust may be developed using techniques which involve
the group members in such activities as being led around the room
blindfold. Yet another important way in which trust can be developed is
the use of group evaluation at the end of each session. The group is asked
to allow five minutes at the end for some spontaneous evaluation of the
groups performance.
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available close by, but out of sight, should group members feel that they
need assistance. If the teacher decides to be involved in the group, there
is always the danger that members will see the teacher as the leader, even
if it has been made clear that the teachers function is as facilitator only.
Importance of organization
Many of the dissatisfactions that are experienced with the use of small
groups stem from the fact that they have not been properly organized.
Because a small group is informal does not mean that it can be conducted
in an off-the-cuff manner, and it is sensible to indicate to the students
the goals to be achieved and the roles they must assume during the
discussion. Each member must be prepared to contribute something
to the group, and the importance of this should be explained at the
first meeting. The teacher must be aware of attempts to participate by
members and, if these are unsuccessful, should assist. A careful watch
of non-verbal communication will provide good feedback as to how the
students are feeling, and will also reveal such non-productive behaviour
as opting out, dominating and seeking sympathy.
Basic
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Seminar groups
In higher education, a seminar group is mainly concerned with academic
matters rather than with individual students and commonly involves
the reading of an essay or paper by one group member, followed by a
discussion of the topic by the total group. The teacher may decide to be
the leader or may delegate leadership to the group. It can be a motivating
strategy in nursing, where a student presents a paper on some aspect
of nursing and then participates in a discussion with the group. The
presentation of a seminar by the student can be counted as an assignment
for continuous assessment purposes and this may serve as a motivating
factor in ensuring a good-quality seminar.
Tutorial groups
Tutorial groups can take many different forms, and the term is often used
synonymously with seminar. It can also mean a one-to-one encounter
with a student, an encounter with three or four students and a teacher,
or can be synonymous with a controlled discussion. Clearly, the purpose
of the tutorial group will largely determine its organization; a one-to-one
tutorial is usually related to individual student progress and comments
upon specific aspects of the students work. The same kind of function
can be achieved with three or four students together, although this may
inhibit some individuals from speaking as freely as they might if they
were alone.
The term tutorial group is often used for convenience to describe the
collection of personal tutees for whom a teacher has responsibility, and
this is discussed in detail in Chapter 10 (p. 380).
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Problem-solving groups
In this form of small-group discussion, the students are given a problem
to solve and are usually provided with certain sources of information
from which to draw their solutions. The problem may be something
that requires a single correct answer, or it may involve a number of
correct answers, the students being required to decide which one is most
appropriate to the situation.
Brown and Atkins (1988) identify four main stages in problem-solving
that equate to the following questions:
1. What is the nub of the problem? This question gets at the core of the
problem, and may identify subproblems, conflicts and contradictions.
2. Have I met a similar problem before? By recalling similar problems
from past experience, the student may discover that the solution
arrived at then will apply to the current problem.
3. What approaches can I use? Students may have to resort to trial-anderror experimentation if the solutions in Stage 2 are not successful.
4. How should I check the solution? This stage involves checking whether
the solution feels right and also reflection upon the strategies used to
solve the problem, as part of the development of students problemsolving skills.
The main purpose of problem-solving groups is to encourage critical
thinking by the students, and this method has had considerable success
in the teaching of medicine. Nursing faculties have also developed a
problem-solving approach to nurse education, using real and simulated
patients. A common strategy for problem-solving groups is to present
a detailed case history of a patient and then to ask specific questions
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Learning-through-discussion groups
Learning-through-discussion (LTD) groups were described originally
by Fawcett-Hill in 1969 and are similar in some respects to the freediscussion groups described above. However, in an LTD group, the
topic is decided by the teacher rather than by the students. The teachers
roles in LTD are only those of resource person and group trainer; the
teacher does not take part as a group member. The roles normally taken
by a teacher or chairperson are seen to be the responsibility of each and
every group member. Fawcett-Hill maintains that students have little
preparation for involvement in small-group work and so need to have
a plan by which to proceed (Fawcett-Hill, 1969). The purpose of this
method is to enhance learning of course material by utilizing the skill of
each group member.
Syndicate groups
This type of group is valuable for putting students in a position for
discovery learning. The total class is given a major topic and then divided
into small groups of about six members. Each of these small groups
selects one aspect of the major topic and studies this over a period of
two weeks or so. Contact with the teacher is maintained intermittently to
report progress. When the work has been completed, each group reports
its findings to the total group, after which the findings are assessed and
interpreted by the teacher and a grade is awarded.
Project groups
The project method can be defined as a unit of purposeful experience in
which the educational needs and interests of the student determine the
aims and objectives of the activity and guide its process to a conclusion.
Characteristics
The main characteristics of the method are that the students are very much
involved in the formulation of the aims and objectives of the project and
that they are actively participating in the learning experience. Projects
may be done by individuals, but more commonly they are undertaken by
a small group of about six members. The main topics can be suggested
by the teacher or left completely to the students imagination, but in both
cases it is crucial for the teacher to ensure that the aims of the project are
clarified, so that the students are in no doubt as to the purpose of such an
exercise. The kinds of aims that a group project can foster are the ability
to work co-operatively in groups, collection of information, development
of confidence in decision-making and many others.
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the purpose of the project so that the enthusiasm and co-operation of the
groups are obtained, and it is equally necessary to allocate sufficient time
for the work to be accomplished.
When the groups have chosen, or have been allocated, a specific
subject area, they decide amongst themselves which objectives and
methods of inquiry they will use. The teacher must not control the
direction of approach, as this would stifle independence and enthusiasm.
The progress of each groups project should be monitored by the teacher,
but only to ensure that difficulties are being overcome and that the most
efficient techniques of data collection are being used.
The channels for obtaining information from personnel in the hospital
or community must be clearly understood by the group. It is important
to check that personnel who are likely to be approached by students are
willing to spend time talking to them. The form of presentation of the
projects should be decided before the students commence their work.
All projects should be written up regardless of the form of presentation,
and the teacher can negotiate with the group as to whether the projects
are presented to the total group or simply submitted to the teacher in
written form. Presenting the project to the total group can be seen as
the culmination of the students work and reinforces their feelings of
accomplishment and success. Assessment of project work is discussed in
Chapter 7 (p. 288).
Small-group projects, then give students the opportunity for more
intensive study of a topic, challenging them to seek more widely for
resources and giving experience in the skills of problem-solving and
decision-making, all of which are important for the changing role of the
nurse.
Experiential-learning groups
These groups are characterized by the use of experiential techniques to
develop greater expertise in a variety of fields, for example teaching in
clinical and community settings.
Focus groups
This is a qualitative research technique that is frequently used in nursing
and health research. Rees (2003) points out that a focus group can
be conducted with a small group of individuals who are prompted to
discuss certain topics and experiences. Focus groups have a degree of
acceptability because they tend to capitalize on the most natural form
of social communication, the conversation.
Techniques
learning
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help group members to achieve the purpose of the small group. Again,
it is useful to categorize them according to their main purpose, although
some techniques have a wide range of application. Table 6.8 identifies
the categories.
Category
Techniques
Table 6.8
1.
Categories of techniques
for small-group teaching
2.
3.
4.
5.
6
7.
Snowball groups
As the name implies, this technique involves group members in subgroups
of ever-increasing size until the total group is involved together. It begins
with each individual group member working on a problem and then
sharing this information with another student. Each pair then joins with
another pair for further work on the problem, and then these tetrads
join with each other to form groups of eight. Work continues in this
fashion until the entire group comes together to share its ideas in a
plenary session. The work can become progressively more detailed as the
snowball grows, and this technique is useful for getting every member
of the group involved in participation.
Buzz groups
Buzz groups consist of from two to six members and are most frequently
used to provide student involvement during a lecture or other teachercentred session. For example, during a lecture on post-operative nursing
care, the large class can be asked to form buzz groups for a three- or fourminute discussion of the complications of surgery. The group leaders then
feed back their contributions to the total group. It is often a good idea
simply to ask the first row to turn and face the second and the third to
turn and face the fourth, and so on. These rows can then be segmented
into groups of six students and this system minimizes the reorganization
of the room. Buzz groups can be used more than once in any given
lecture and provide the students with social activity and involvement,
helping to maintain their level of arousal during the lecture. It is often
useful to begin a session by asking the students to form buzz groups
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and write down everything they know about a subject, for example the
structure of the heart. This can be fed into the main group and forms
the basis of the lecture.
Brainstorming
This is another effective method of obtaining creative solutions to a
problem (Osborne, 1962). The idea is for each member to generate as
many ideas as he or she can about the problem in question. The emphasis
is on free expression of ideas, and no criticism is permitted, however
unlikely the suggestions. De Bono (1986) suggests that there are three
main features of a brainstorming session: cross-stimulation, suspended
judgement and a formal setting. Cross-stimulation refers to the effects
of other peoples ideas on an individual and the fact that these ideas may
interact with existing ones to produce creative solutions. As the name
implies, suspended judgement means that no criticism of suggestions is
allowed, however silly the ideas may seem. It is important that the leader
or chairperson be on the lookout for any evaluative comments and stops
them immediately. It is not vital to produce entirely new or novel ideas;
indeed, it may be that an old idea is the best solution to a difficulty in
certain situations.
A formal setting is important so that participants can feel that there is
something special about the group and thus be less inhibited about saying
things that might seem ridiculous. The organization of a brainstorming
group involves a leader or chairperson and someone to make notes of
the ideas as they arise; it is helpful to use audiotape recording to ensure
that no ideas are lost. The brainstorming activity can take any amount
of time up to a maximum of about 3040 minutes, and frequently lasts
only some 510 minutes.
The activity itself is only a means to an end, so there has to be an
evaluation session in order to see what the next steps should be.
This evaluation should take place some little time after the brainstorming
session itself, and involves the sifting out of all the useful ideas into three
categories: those ideas that are of immediate use; those that need further
exploration; and those that represent new approaches.
Synectics
Synectics is a system of problem-solving that aims to produce creative
solutions by making people view problems in new ways. Creative ideas
are seen as involving the making of new connections between ideas, and
one way of facilitating this is the use of the SES box steps method
(SES Associates, 1986). This method is based on the assumption that
all problems contain a paradox or contradiction that can only be solved
if new connections can be made. It uses the notions of analogy and
metaphor to create these new connections and there are four distinct
steps in the process:
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Eventually, the entire outer circle will have been interviewed by each of
the interviewers and the latter will have a sheet of different responses to
their question. These data can then be analysed to reveal the opinions of
those group members who were in the outer circle. It is desirable to then
exchange the roles, so that the outer group become the interviewers and
vice versa, thus generating twice as much data for analysis.
Simulations
A simulation is an imitation of some facet of life, usually in a simplified
form. It aims to put students in a position where they can experience
some aspect of real life by becoming involved in activities that are closely
related to it. Airline pilots spend time working in flight simulators,
which are identical to the flight deck of an aircraft and in which the
pilots can gain simulated experience of handling emergencies that cannot
(for reasons of safety and/or expense) be gained in any other way. For
example, they are able to practise emergency procedures for such things
as sudden depressurization, failure of engines, etc., and this experience
should transfer to the real-life setting, if it is ever required. The notion
of transfer of learning underpins all aspects of simulation, the aim being
to use the simulated experience to help the student to learn how to cope
with the real thing.
Using simulation in nurse education
In nurse education, a commonly used simulation is that of the cardiacarrest procedure or crash-call. The teacher organizes the simulation
by providing an authentic environment that simulates a ward setting,
with a patient in a bed, a locker, charts, etc. Certain staff or students
are designated roles such as anaesthetist, sister, relatives and nurses, and
the whole scenario of what happens when a patient has a cardiac arrest
is enacted. The scenario can be used to give student nurses an insight
into how the procedure operates and, in this instance, would serve as a
demonstration. Alternatively, students can be asked to take the part of the
student who discovers a patient with a cardiac arrest and to imitate
the procedures required following such detection. By this means it is
possible to give students experience of a situation, without the associated
anxiety of learning it initially in the real-life setting.
Transfer of learning
It is always debatable whether or not there is transfer of learning to
the real-life setting, but, at the very least, the students will have had an
opportunity to internalize the sequence of procedures required, and to
appreciate the urgency of the whole situation. One of the important
hallmarks of a simulation is that the students are not required to act out
any kind of script; they are expected to behave and react in any way they
feel is appropriate. In other words, a simulation involves the students in
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being themselves and dealing with situations using their normal, everyday
behaviour. Whatever the scenario of the simulation may be, the students
are expected to be themselves and to deal with the situations presented.
Simulations in first aid
One of the most valuable areas in which simulation can be used is that
of first aid. Although this topic has some theoretical basis, the main
emphasis is on practical techniques, so it is important to teach first aid
in a way that helps students to cope with real-life situations. The first
part of each session might introduce the concepts in question and then
demonstrate the techniques required. Volunteers are then invited to join
in with a simulation, in which they are required to give first-aid treatment
to a casualty, and the simulation should be as realistic as possible
within the limitations of the college setting. With a little imagination and
dramatic flair, it is quite possible to create a scenario that simulates to a
reasonable extent a first-aid emergency such as a head injury, a fracture,
poisoning, and the like. The aim is to create a simulation that is as near
as possible to the real-life situation that the student will encounter, so
that the established behaviours and procedures can be transferred easily
to the new setting.
Simulations and role-play
The term simulation is closely related to the concepts of role-play
and gaming; indeed, many simulations will involve an element of roleplaying by other people, even though the students in question remain
themselves. For example, a teacher may wish to do a simulation involving
the admission of a mentally disturbed patient to the admission ward. A
student is first identified who will be the admitting nurse, whilst another
student or teacher will undertake the role of the disturbed patient. In this
scenario, one nurse will be acting out the role of a disturbed patient, i.e.
he or she will indulge in role-play; the other nurse, however, will simply
behave and react in the way that he or she feels is appropriate in order
to carry out the admission, i.e. remaining as him- or herself throughout
the simulation.
When carrying out simulations, it is important that the teacher should
give full briefing beforehand and allow sufficient time for an adequate
debriefing at the end. These aspects are discussed in the next section on
role-play.
Role-play
Role-play is derived largely from the work of Moreno on psychodrama
(Marineau, 1989) and uses acting and imagination to create insights
into the students own behaviour, beliefs and values, and those of other
people. Students are required to take on someone elses identity and to
act as they think that person would behave. Although some scripting is
essential to delineate the role, this should be kept to a minimum so that
the student can act out the role in his or her own way.
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Counter-attitudinal role-play
Role-play can be an excellent way of creating empathy with other
peoples points of view, particularly if the student is given a role that
is opposite to the position or viewpoint currently held. This counterattitudinal role-play forces students to consider issues and feelings from
the other persons point of view and can help them to gain insight into
why that persons behaviour is occurring. One of the important points
about role-play is that the student, after some initial self-consciousness
about the role in question, then quickly settles down to project his or
her own character and values into the role. It is this identification with
the role that forms the basis for subsequent debriefing and experiential
learning. Role-play can be used for almost any social situation and is the
method par excellence for exploring interpersonal communication skills.
A checklist for organizing role-play is given in Table 6.9.
Table 6.9
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
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Gaming
Gaming is closely related to simulation and role-play, but gaming differs
from simulation in that it has very precise sets of rules and is usually
competitive in nature. Unlike simulation, games have no scenario, being
complete in themselves, and participants behave as their normal selves.
Educational games are simply extensions of recreational games, such as
board games, card games and quizzes, and the aim is to create a method
of learning that is both enjoyable and beneficial.
Case studies
Case studies are textual descriptions of specific situations that may either
be genuine or fictional and that provide a trigger for the discussion of
issues and the examination of real-life events. Case studies differ from
simulations in that they offer the student a cognitive view of the event
rather than an experiential one. However, it is possible to use a case study
as the basis for a simulation or role-play, with students taking the parts
of the characters involved.
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Debate
Although commonly thought of as a large-group technique, debate can
be used to good effect in small-group teaching. Debate is a formal way of
examining issues that can be very exciting to the participants as well as the
audience and it has the added advantage of not only raising the students
awareness of issues and values, but also giving them the opportunity to
formulate an argument and present it in a public arena.
Debate is quite easy to set up; the teacher can choose a number of
issues, or the group may come up with its own list. Four students are
required to present their views, two speaking for the motion and two
against it. Following the presentations, the issue is opened up to the
audience to contribute and then a vote is taken on whether the motion
is carried or defeated. Debate is particularly useful for topical, emotive
issues and can serve to make students examine their beliefs and values
about such issues.
Microteaching
Microteaching is a small-group activity that has many uses in nurse
education. Essentially, microteaching consists of a cycle of events. It can
be seen that the cycle consists of the performance of some microskill, i.e.
some aspect of a social or psychomotor skill such as asking questions,
which is recorded on videotape. This recording is then played back
to the small group; the performer firstly evaluates his or her own
performance, and then the group members contribute their evaluation.
The performer then replans the performance using the feedback gained
during the analysis. The performance is repeated, incorporating the
changes suggested in the analysis, and this is also videotaped. The video
is then replayed, further analysis takes place and the cycle is repeated as
often as is required until the performance is satisfactory. Microteaching
can be a very potent tool for the acquisition of skills, but it does need a
fair amount of time in order to allow students the chance to teach and
re-teach several times.
Field visits
A well-established technique in nurse education, field visits can provide
insight when extending students experience of nursing. Visits can be
clinical (to a hospice or specialist centre) or non-clinical (to museums or
public utilities). Within programmes for initial registration, it is common
to find that students are required to undertake field visits as part of a
neighbourhood study, for example to local government offices, sports
centres, supermarkets, etc. Briefing and debriefing are important if the
maximum learning value is to be gained from the visit.
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Exercises
Exercises are particularly common in experiential learning; consisting of
structured sequences in which students are actively involved, exercises
often contain written instructions. Exercises consist of dyadic, triadic
or small-group activities, usually ending in a discussion of participants
feelings about the exercise.
Body movements
Also extensively used in experiential learning, physical contact may
or may not be involved in this kind of experience but is common in
the various forms of warm-up exercises prior to interpersonal skills
sessions. Relaxation also comes under this heading.
Instrumentation
A variety of instruments are used to facilitate activities, the commonest
being questionnaires and inventories that direct the student to selfexploration.
Common
learning
The teacher may find that difficulties arise from time to time in a small
group, and these require sensitive handling. It is usually better to deal
with problems as they arise, but occasionally it may be necessary to have
a private word with a group member after the session has finished.
Multi-speak
Commonly in small-group discussion, all the members talk at once
(multi-speak), which leads to a chaotic situation where no progress is
made. The teacher should exert firm, friendly control to bring the session
to order, and a sense of humour is invaluable in keeping the atmosphere
informal, while at the same time maintaining order. Very often there is
a vocal member of a group who tends to monopolize the session, and
it is important not to squash that person, as motivation can easily be
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Conflict
Group discussions can become very heated, especially when debating an
issue that is emotionally charged, such as abortion. However, conflict
is not always undesirable, as productive conflict can be an effective aid
to learning. It is useful to reassure the group that disagreement is quite
in order, but that it should be the opinion of another group member
that is questioned and not that person as an individual. Each group
member is respected, but his or her opinions are open to challenge and
disagreement.
Emotional outbursts
Occasionally, the teacher may be confronted with an emotional outburst
by a group member. One of the most dramatic of all gestures is that of
a student walking out of the group, and it is always difficult to know
how best to handle such a situation. Resisting the temptation to follow
the individual, the teacher should stay with the group and attempt to
help them to realize that such behaviour (flight, rather than fight) is one
way that people have of coping with anxiety or anger; it is important
to convey to the group that this is not a major disaster. However, it is
extremely important for the welfare of the group as a whole that the
teacher make contact with the distressed student before the next group
meeting to discuss the incident with a view to deciding how best to raise
it with the group.
Whilst every student has the right to behave in this way when under
stress, the teacher cannot ignore the effects of such behaviour on the rest
of the group. It might be that at the next meeting the student concerned
in the incident should be invited to make a statement to the group about
his or her feelings at the time and thus use the incident as a positive
learning experience for all concerned.
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strategies
Unwillingness to participate
Another common problem in small groups is that of the student who
is unwilling to participate. Arguably, every individual has the right to
remain silent but this obviates the whole purpose of an educational
small group. However, the teacher must acknowledge that students
will differ in the degree of confidence they possess for making public
contributions, and that this may be due to a variety of factors including
basic personality, lack of knowledge, feelings of lack of personal worth
or inadequate preparation. On the other hand, it may be the teachers
own style that is inhibiting a student; if the climate of the group is not
conducive to psychological safety, then it is unlikely that students will
risk contributing to discussion, lest they be humiliated or made to feel
inadequate in some way.
The previous background and experience of students will also
influence their desire to contribute to group discussions; in certain
cultures, the teacher is seen very much as an expert who is not to be
questioned and this may be difficult to overcome. Childhood experience
of teachers who humiliated students may have left scars that ensure that
the student tries never again to be put in such a position. Some of these
factors may be impossible to change, although the teacher can do a great
deal to ensure that the group members are valued and respected. Students
can be invited into the discussion by gentle questioning, particularly in
areas that rely upon student opinion rather than hard fact, since there is
no likelihood of giving an incorrect answer.
It may well be that such reticent students require more specific help in
the building up of confidence in public, such as a systematic programme
of interaction that begins in pairs and gradually builds up to larger
numbers, but such provision has obvious resource implications for the
institution.
Summary
Lecturing is the most common teaching strategy in adult education,
but teachers opinions tend to be polarized: some love it; others loathe
it.
Over-reliance on lectures may lead to dependence on the part of the
students, who expect all the information to be handed to them on a
plate.
Lectures are often long, tedious and poorly organized, whereas with
careful planning and practice they can be an effective vehicle for
motivating students.
Lecturing can be seen as analogous to acting, each lecture requiring
careful scripting, polished presentational skills, and a certain personal
charisma for effective performance.
Recapitulation or repetition should be used frequently, so that the
learner is exposed to the information on more than one occasion.
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References
Adult students are never very happy just sitting listening to lectures;
they like to have some personal involvement in them.
References
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of learning
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Chapter 7Assessment
of learning
Purposes
selection;
maintenance of standards;
motivation of students;
feedback to students;
feedback to the teacher; and
preparation for life.
Assessment can provide valuable feedback to students about their
progress, and point out ways in which they could develop further. Also,
the successful achievement of a publicly recognized award can enhance
an individuals status, and may lead to employment opportunities or
confer eligibility to undertake further academic study.
There is no doubt that assessment can act as a powerful motivator
of study; students expect to be assessed, and they plan their studies
accordingly. Assessment also provides feedback to the higher education
funding bodies about the effectiveness of an institution, and in that sense
is a performance indicator of quality.
Regardless of the type, there are three basic aims of assessment:
These aims are set in a context of equality of opportunity and antiracism, and it is a fundamental tenet of higher education that no student
is assessed on the basis of their race, religion, politics, gender or sexual
orientation.
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The
The
Table 7.1
Terminology of assessment
Informal
Qualitative
Continuous
Summative
Student-centred
Criterion-referenced
Aptitude/personality
Practical/oral
Table 7.2
Dimensions of assessment
Formal assessment involves the use of tests to obtain data that are then
made available to the institution; the data are often subjected to statistical
analysis, and comparisons are drawn between students. Examples of
formal assessment in nurse education are modular or unit assessments,
unseen written components, and clinical practice assessments.
Informal assessment, in contrast, does not involve comparisons with
other students; it is essentially private and subjective to the teacher
concerned. Such informal assessment is gleaned from the day-to-day
observation of students behaviour, examination of students notes, and
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The
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Cardinal
Validity
This is the most important aspect of a test and is the extent to which the
test measures what it is designed to measure. In other words, validity is
the relevance of a test to its objectives.
Content validity
Assessments should sample adequately the content of the syllabus and, if
this is the case, then the examination is said to have content validity.
Predictive validity
If a test is designed to predict the future performance of a student and it
fulfils this function, then it is said to have predictive validity.
Concurrent validity
Concurrent validity is the extent to which the results of a test correlate
with those of other tests administered at the same time.
Construct validity
The fourth kind of validity is construct validity. A construct is a quality
that is devised by psychologists to explain aspects of human behaviour
that cannot be directly observed. For example, such things as attitudes,
values and intelligence are constructs. Construct validity is the extent to
which the results of a test are related to the data gained from observations
of individuals behaviour with regard to the construct in question.
Reliability
Reliability is the term used to indicate the consistency with which a test
measures what it is designed to measure. In other words, it should yield
similar results when used on two separate occasions, provided that the
other variables remain similar. The main way to assure reliability is to use
more than one type of assessment to measure student achievement.
Testretest reliability
If a test is administered to a group of students and then re-administered,
either immediately or after an interval of time, and the scores are
similar on both occasions, then the test is said to have high testretest
reliability.
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Cardinal
Parallel-form reliability
If the group is given a different test in the retest phase, but one that
measures the same thing, a positive correlation indicates parallel-form
reliability.
Split-half reliability
To ascertain split-half reliability, the test items are divided into two halves
and the correlation between the two sets of scores is calculated.
The importance of validity and reliability is self-evident, but it might
be helpful to give an example to show the inter-relationship between
them. One of the most common measuring instruments to be found in
the home is the bathroom scales. Just like any other assessment tool, the
measurement of human weight by the scales must be valid and reliable.
To check the validity (accuracy) of the measurement of an individuals
weight, it is necessary to record the weight as registered by the scales, and
then to check the weight again using different scales, such as can be found
in most chemist shops. If the two weights are identical, then the measure
is valid, i.e. it is demonstrating accuracy and fitness for purpose.
If the measurement of an individuals weight by the bathroom scales is
reliable (consistent) then the scales should register the same weight when
the individual weighs themselves again and again (provided, of course,
that their weight has remained constant since the last measurement).
It is possible, however, for an assessment test to be valid but not
reliable, or reliable but not valid. For example, the bathroom scales may
register the same weight each time (reliability), but that weight may be
several pounds above the actual weight of the individual (i.e. not valid).
Alternatively, the scales may register the correct weight of the individual
on some occasions (validity), but the incorrect weight on others (i.e. not
reliable).
Discrimination
The purpose of any test is to discriminate between those who answer
correctly and those who do not. The term discriminate is used in the
sense of distinguish between, and not in the equal opportunities sense. If
a test makes no discrimination between students, then it has no purpose.
The discrimination index will be examined later in this chapter (p.000).
Practicality or utility
It is important that a test is practical for its purpose. This implies such
factors as the time taken to conduct the test, the cost of using it and its
practicality for everyday use.
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of learning
Planning
assessments
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Assessing
Table 7.3
General aims of
higher education
Domains of learning
Some higher education institutions use Blooms (1956) taxonomy as
a basis for their definitions of the level of learning outcomes. The
taxonomy is discussed in detail in Chapter 4 (p. 114) in relation to
educational objectives.
Assessing
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Examples
of types of essays
Examples
of types of essays
Interpretive essay
Example: The accompanying table relates accidents at work to the type
of industry, i.e. manufacturing, construction, railways, coal mining and
agriculture. Comment on the relative risk of accidents for the types of
industry represented in the table.
When answering this type of question, the student has to interpret
the table in order to come up with the relative risk for each industry; this
requires high-level cognitive functioning.
Hypothesis-formation essay
Example: Imagine that you are the chair of a committee charged with
making recommendations for the siting of a new home for brain-injury
patients in a quiet suburban area of town. Speculate on the likely planning
objections to your proposal.
In this case, the student has to consider all the relevant facts and come
up with a hypothesis about the likely planning objections. This essay
cannot be written by a simple reliance on memorized facts; it requires
higher-order synthesis.
Questioning-assumptions essay
Example: Read this article from the Journal of Advanced Nursing and
comment on the authors underlying assumptions.
This assessment requires the student to explore the article thoroughly
and to search for the writers assumptions. These assumptions may not
be obvious, and the student may have to analyse the text deeply before
they become apparent.
Inquiry-based assessments
As the name suggests, this type of assessment requires the student to
undertake some form of enquiry, the results of which must be written up
in the form of a report.
Example: Carry out an investigation into the provision for disabled
people in terms of access to public buildings within the Cardiff Borough.
Write up your findings in the form of a report to go to the Cardiff
Borough Council.
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Marking
Marks and grades provide data for decisions about students fulfilment
of learning outcomes.
Comments
70+
6069
5059
4049
039
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Marking
Percentage
Degree as class
Degree award
Table 7.5
039%
4044%
4549%
5059%
Fail
Pass
3rd
2:2
6069%
2:1
1st
Fail
Pass Degree
Third Class Honours
Second Class Honours
Division II Second Division
Second Class Honours
Division I First Division
First Class Honours
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Pressure sores constitute one of the biggest challenges for nursing care. Critically discuss the role of the nurse in risk assessment and
prevention of pressure sores (3000 words)
ANALYTICAL MARKING SCHEME
Element
Marks allocated
(out of 100)
2
3
5
Factors implicated in pressure sore development, e.g. poor nutrition, immobility, incontinence, etc.
Nursing rationale for use of tools for risk assessment, e.g. Norton Scale, Waterlow Scale, etc.
Critique of tools, including criteria used for critique
10
10
10
10
10
10
3
7
10
10
Table 7.6
Example of an analytical marking
scheme for a credit level 3
module assessment
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Marking
were marked together, then the chances are that this would create an
impression, favourable or otherwise, that would influence the marking
of the remainder of the answers for that learner. It is thus important to
mark all the answers for one question before proceeding to the next. It
has been suggested that answers should be shuffled randomly after each
question has been marked, so that the position of any paper will not
consistently be affected by the quality of the preceding ones.
Anonymous marking helps to eliminate bias, by avoiding the use of
students names; a number is substituted instead.
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the need to provide feedback promptly so that the student has less
chance of forgetting what he or she has written in the answer.
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Using
objective tests
criticize but to suggest what the student could have done differently.
Turn a negative into a positive suggestion.
Own the feedback. It is important to own the feedback. Beginning the
feedback with I or in my opinion is a way of avoiding the impression
of being the giver of cosmic judgements about the other person.
Leave the student with a choice. A teacher may invite resistance if the
feedback given demands change. Skilled feedback will offer students
information about themselves in a way that leaves them with a
choice about whether or not to act on it. It can help to examine the
consequences of any decision to change or not to change, but it does
not involve making change mandatory.
Ask the student. It is often helpful to ask students how they think they
have performed; it will enable them to feel involved in the assessment
process.
Do not labour what went wrong. It is only necessary to get the student
to recognize and accept what went wrong and to identify how it can
be corrected.
Empathize. Be sensitive about how students feel about their performance
and try to put yourself in their position.
Variants
of essays
The seen-paper
Some essay examinations allow the candidates to see the paper some
weeks prior to the examination and may even allow them to bring notes
into the examination (up to 100 words). The test is used to evaluate the
candidates ability to select sources and to organize the information in a
meaningful way.
Using
objective tests
The limitations of the essay test led to the development of the objective
test, the word objective referring to the marking of the test, which is not
influenced by the subjective opinion of the marker. However, the actual
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Multiple-choice item
This consists of three parts; the stem containing the problem or
statement, the key, which is the correct response, and distracters,
or incorrect responses. There should be at least three options given, to
reduce the chances of guessing. Example:
(Stem)
The type of epithelium that lines the colon is called:
(Distractors) a squamous
b cuboidal
c transitional
(Key)
d columnar
The multiple-choice item is a very versatile test that can measure a variety
of levels of functioning. It is less susceptible to guessing, as there is only
a one-in-four chance of getting it correct.
Matching item
This consists of two lists in columns, and the learner is required to match
items from column A with responses in B. For example:
A
B
1 Yellow discolouration of skin
a Bile salts
2 Severe itching of skin
b Unconjugated bilirubin
3 Clay-coloured stools
c Bilirubinaemia
4 Dark urine with yellow foam
d Jaundice
e Haemolysis
f Obstruction
Matching items are useful for testing both knowledge of terminology and
specific relationships between facts.
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Guidelines
Truefalse item
Truefalse items are statements that the learner has to decide are true or
false. There is a large risk of guessing in this type of item, and it is often
difficult to select items that are categorically true or false. For example:
The commonest form of mental illness in Great Britain is schizophrenia.
True/false.
Assertionreason item
This test presents two statements, an assertion and a reason. The learner
is required to decide whether (a) each statement is true and (b) whether
the reason is a correct explanation of the assertion. For example:
Assertion
Reason
Pressure in the glomerular
The efferent arteriole has a
capillaries is 70 mm Hg
smaller calibre than the afferent.
Multiple-completion items
This involves the selection of more than one correct response, from a
choice of combinations. The learner is looking for the incorrect option,
so this item is often termed reverse multiple-choice. For example:
Which of the following would indicate occurrence of cardiac arrest?
a Apnoea
b Dilated pupils
c Chest pain
d Absence of pulse.
Guidelines
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Comments
Example 1
Vitamin B12:
a. contains iron
b. is absorbed by mouth
c. is stored in the liver
d. is given for haemolytic anaemia
Example 2
Vitamin B12, one of the water-soluble
B group of vitamins, is necessary for:
a. prevention of haemolytic anaemia
b. formation of haemoglobin
c. formation of thrombocytes
d. maturation of red corpuscles
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Guidelines
Example
Comments
Example 3
A female patient aged 60 is admitted
with history of fatigue, dyspnoea on
exertion, and fainting attacks. Her
Vitamin B12 is low and tests reveal
achlorhydria. The likely diagnosis is:
a. iron deficiency anaemia
b. haemolytic anaemia
c. pernicious anaemia
d. folic acid deficiency anaemia
Example 4
The normal range of haemoglobin
level for men (g/l) is:
a. 320380
b. 3080
c. 230280
d. 130180
Example 5
A patients blood pressure when
lying down is charted using:
a. 2 black dots joined by an interrupted
horizontal line
b. 2 black dots joined by a continuous
vertical line
c. 2 black dots joined by a continuous
horizontal line
d. 2 black dots joined by an
interrupted vertical line
Example 6
The inferior boundary of the thoracic
cavity is:
a. sternum
b. thoracic vertebrae
c. diaphragm
d. peritoneum
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Example
Comments
Example 7
Which of the following are not found
in normal urine:
a. urea
b. albumin
c. phosphate
d. chloride
Example 8
Which of the following is found in
dehydration:
a. inelastic skin
b. oliguria
c. constipation
d. all of these
Example 9
The secretion of the sebaceous glands
is called:
a. cerumen
b. sebum
c. semen
d. sweat
Option c. is implausible.
Example 10
A patient in the ward develops
diarrhoea.
The nurses first priority is to:
a. increase his fluids
b. isolate him
c. send stool to laboratory
d. commence fluid balance recordings
Example 11
Hypertension is a state of:
a. high blood sugar
b. high blood pressure
c. low blood sugar
d. low blood pressure
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Analysis
Example
of objective-test items
Comments
Example 12
Diaphragmatic breathing is usually
seen when a patient is:
a. running
b. standing
c. sleeping
d. in pain
Option d. is grammatically
inconsistent.
of objective-test items
Facility index
This is calculated by the following formula:
Number of students who answered correctly
Total number of students tested
100
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For example, if 40 students take the test, and 20 get the item correct,
then the facility index is
20/40 X 100 = 50%
Discrimination index
This is normally calculated by arranging the completed test papers in
order from the highest to lowest mark, and then putting them into high
and low groups. The top 27 per cent from the high group and the bottom
27 per cent of the low group are used to calculate the index, as follows.
First, work out the number of students in the top 27 per cent who
answered the item correctly and subtract the number of students in the
bottom 27 per cent who answered the item correctly. Then divide that
answer by 27 per cent of the total number of students tested.
The figure of 27 per cent is not rigidly fixed, and if the number of
students is less than about 40 it is better to use the top and bottom halves
of the group. The index range is from + 1.00 to 1.00.
Example: if a batch of 200 test papers is used and the number of
correct answers for the top 27 per cent is 40, and for the bottom 27 per
cent it is 20, then the calculation will be as follows:
40 20 = 0.37
54
Interpretation of indexes
The facility index is generally considered ideal when it is 50 per cent, but
the acceptable range is from about 25 to 75 per cent. It is often desirable
to include some easy items at the beginning of the test and then make it
progressively more difficult.
The index of discrimination ranges from +1.00 to 1.00 and zero
indicates no discrimination. Positive discrimination is accepted at 0.3
and above. If the index shows a negative figure, this implies that the less
knowledgeable students are getting more correct answers for an item
than the more knowledgeable ones and may indicate that the item is
ambiguous or that the wrong key has been chosen.
The writing of objective-test items is made easier if regular shredding
sessions are conducted, in which three or four lecturers look at new test
items to decide whether or not they are suitable for inclusion in pretesting.
Assessment
of group projects
Group projects can take many forms depending upon the subject being
studied, but the fundamental principle is that a small number of students
work collaboratively on a common problem or task, for example the
design and production of artefacts such as a computer program, with each
student in the group receiving the same overall grade. Group projects can
help students to experience teamwork at first hand, and also to develop
interpersonal communication skills and management skills. There are
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Student
self-assessment
Giving all students in the group the same grade creates the danger that
some students will opt out of the work.
self-assessment
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Chapter 7Assessment
of learning
and unbiased reporting, although the teacher may wish to negotiate with
the student about the final grade of work, taking into account these
self-assessments. Another method is to keep a self-assessment diary or
commentary about progress on a course; this involves the student writing
down reflections about his or her experiences and feelings.
Peer
assessment
Assessment
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Assessment
Individual-response evaluation
Reflective diary
Group members are invited to keep a diary of the events and feelings
that they have about the group meetings over a period of time. These
comments may be disclosed to the group or the tutor and can give much
insight into the group process. However, the fact that the diary may be
seen by other people may inhibit students from revealing some aspects
of their experiences.
Individual impressions
Students are asked to jot down two aspects of the group that they did
not like and two aspects that they did like, for feedback to the tutor, the
group or both.
Face-to-face interview
Here, the tutor spends time with a group member discussing his or her
perceptions of the group and the usefulness of the process. It can be time
consuming but is worthwhile, provided that both parties are sufficiently
trusting to be honest and open.
Sociometry
This technique involves individual group members privately writing
down the names of other group members with whom they would choose
to spend time on a particular activity.
Group-response evaluation
Nominal group technique
There are five stages in this technique as follows:
1. Each group member generates his or her own response.
2. Each group member feeds back his or her response to the group.
3. The group clarifies each members response.
4. Each group member votes on, and ranks, each response.
5. The groups consensus of opinion is discussed.
Do-it-yourself evaluation
This involves each group member in writing three statements about the
group and then snowball groups of two, four and eight people are
formed to modify and hone the statements. A plenary is called and the
group must edit the list, after which the finished statements are put up
on a notice board. Each group member then has to rate each statement
on a six-point scale ranging from strongly agree to strongly disagree
and record his or her rating in the form of large blobs that can easily be
seen. The whole exercise provides a forum for discussion and exchange
of feelings.
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Group consensus
Group members form buzz groups to ascertain whether they have
common likes or dislikes about the group and are required to reach a
consensus of opinion.
Group interview
Similar to the face-to-face interview with one group member, this involves
the total group in interview with the teacher. Again, this requires skilful
handling if it is to be effective and not just tokenism.
Sculpting
This is a technique for evaluation that uses physical position to indicate
group processes. One member is asked to volunteer to be the sculptor
and the rest of the group is asked to remain in any position the chosen
member would like to put them in. He or she is asked to sculpt the way
that they see relationships within the group; the leader is often put on a
chair to indicate elevation above the rest of the group. Trust is essential
among members if this is to work well, particularly as some may find
themselves in the role of outsider or isolate. Following the sculpting there
is group discussion and debriefing about the exercise.
Third-party evaluation
Observation
This can take place during normal group interaction, where a non-group
member observes the process of group interaction. The main problem
is the Hawthorne effect; i.e. the presence of an observer may alter the
natural behaviour of the group.
Video-recording
This can provide a good alternative to a live observer, since it will not
interpret the events, only record them. During the analysis playback,
group members comment on the process.
Assessment
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Assessment
Table 7.7
Example of an assessment
specification for student
presentations
Please note: the actual presentation of your lesson, although compulsory, does not count towards
your grade. You will be graded only on the written materials and accompanying rationale.
This decision is to help reduce the stress that inevitably accompanies a students first formal
presentation to a large group.
Assessment
Laboratory practicals
These are usually assessed by means of the students laboratory reports.
These reports are completed by the student after each practical activity,
using a standard format. Many laboratories now provide computers so
that students can input their reports at the time that they are undertaking
the practicals. There must be explicit criteria for assessing the laboratory
reports, and examinations should require the students to draw upon their
reports when answering examination questions.
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Fieldwork
Programmes in nurse education commonly require students to undertake
some kind of fieldwork. For example, students commencing a common
foundation programme may undertake a survey of food labelling in a
local supermarket. Fieldwork is normally assessed by means of students
fieldwork logs and reports, but other artefacts such as video, audio and
photography can be assessed.
Assessment
diaries
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Assessment
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Assessment
Assessment
in the workplace
in the workplace
Competence
The term competence has a range of meanings according to the context
within which it is discussed. The Further Education Curriculum Unit
defines it as follows:
Competence is the possession and development of sufficient skills,
knowledge, appropriate attitudes and experience for successful
performance in life roles.
(FEU, 1984)
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Chapter 7Assessment
of learning
Assessment by observation
By far the most common, and valid, method of assessment for work-based
learning is observation by the assessor. However, the mere presence of
an observer is often sufficient to raise students anxiety levels so that
the quality of their performance is adversely affected. On the other
hand, the presence of an observer can, in some circumstances, enhance
performance. One of the weaknesses of assessment by observation is the
subjectivity of the observer, so it is of paramount importance to have
specific assessment criteria in the form of a checklist or rating scale that
serves as a guide for the assessor and allows a second observer, when
present, to assess the same aspects as the first.
Checklists
A checklist is simply a list of student behaviours associated with a
particular aspect of practical work, with a space for the assessor to check
or tick off whether or not that particular behaviour occurred. There is
no means of indicating how well a behaviour was carried out, and this
limits the usefulness of checklists. A checklist normally contains only the
desired behaviours, but it can include the behaviours that constitute poor
performance. Table 7.8 shows an example of a checklist.
Table 7.8
Checklist for assessment of
admission of patients from
waiting list
Assessor should place a tick or a cross in each box depending upon whether or not the
behaviour was observed.
Prepares bed and locker area in advance
Greets patient (and companion)
Introduces him or herself
Conducts patient to bed
Ensures privacy whilst patient is unpacking
Introduces patient to adjacent patients
Shows patient the ward layout
Allows ample opportunity for questions
Gives only essential explanations initially
Makes appointments for further explanation and discussion
Employs appropriate procedures with regard to patients property
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Assessment
in the workplace
X applies
Marked
tendency
to X
Some
tendency to
XY
Y applies
Table 7.9
Examples of descriptive
rating scales
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B. Single-word category
Gives a full explanation to
patient prior to commencing
a procedure
Always
Usually
Occasionally
Never
C. Phrase description
Working in
partnership with
another nurse
Shares equal
responsibility with
partner
Allows partner to
lead most of the time
Some
The assessor
Accurate assessment requires care and effort if it is to be objective, and
there may be a lack of time and interest for this. An assessor may be
biased in his or her perception of the performance, and this bias can
take a number of forms. The halo effect occurs when the assessor is
influenced by the general characteristics of the student: if the assessor
forms a good impression of the student, the latter is likely to be rated
highly on the performance and if the impression is unfavourable, then
the reverse will occur. Another common factor is the central-tendency
error, in which the rater gives everybody an average mark.
The generosity error occurs when the rater gives a higher score
than is warranted; the explanation for this is the tendency to feel
that our nursing role is to care for students, so this the assessor does
unconsciously. In addition to the above factors, assessors will be subject
to the same influences on their interpersonal perception as everyone else,
namely past experience, motivation and personality.
The student
The main factors that influence assessment from the students point of
view are state of preparation, level of anxiety and the presence of others.
The first point is self-evident, in that the student must have prepared
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Some
adequately for the aspects that are being assessed. Anxiety has the effect
of degrading decision-making, which could make a difference to an
assessment in which decisions are required. The presence of others, i.e.
the assessor, may have the effect termed diffusion of responsibility (Latan
and Darley, 1968), which might account for a students indecision in the
assessment.
The methodology
The criteria chosen for the observation schedule will have implications
for reliability and validity, and it is exceedingly difficult to formulate
objective criteria for checklists or rating scales. The problem is that most
criteria are fairly general; this may be necessary because it is impractical
to state them in a more precise way.
These examples illustrate the dilemma referred to earlier about trying
to make accurate descriptions of nursing behaviours. One solution is to
give more detailed criteria; for example, Describes the action, dosage,
route of administration, unwanted side effects and contraindications of
a given drug, to the level indicated in the current edition of the British
National Formulary. This criterion is certainly more specific and does
give the student an idea as to the kind of level of questioning to expect.
However, it is rather lengthy, and one can imagine a checklist of skills
required for a medicine round being stated in several pages of text.
Another problem is that, although such objectives are reasonably
meaningful when applied to knowledge or motor skills, how do we go
about writing criteria for the interactional elements of a drug round? We
could try Displays warmth and friendliness towards patients during the
drug round. This is certainly an important aspect of nursing care, but
the difficulty lies in the assessors interpretation of the behaviours that
are considered to be warm and friendly. At first glance it may seem fairly
straightforward, until we begin to wonder what the borderline is between
friendliness and familiarity and between humour and offence.
One way round the problem would be to adopt a stance advocated
by Stenhouse (1975) who suggests that the teacher, as an expert in the
field of nursing, can judge the quality of what is observed without having
to define what that quality might consist of in advance. In other words,
a competent teacher-practitioner can tell whether a student has done a
satisfactory drug round or not without having to go through any kind
of checklist. The problem arises when different assessors hold different
views on competence, but perhaps it is naive to expect any real consensus
in nursing, or in any other social-science endeavour, since there are so
many variables to be considered. In the world of the arts, an art critic
makes judgements about the merits of a work of art without having to
specify in advance what the work of art should look like.
Many teachers are often asked by students: How should I approach
this topic in order to get an A grade for my assignment? All one can say
in reply is, I cant tell you in advance what an A assignment will look
like, but I will recognize one when I see it.
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of learning
Assessment
of attitudes
The term attitude is used in two senses within the nursing and teaching
professions: in one sense it is used to describe someone who exhibits
undesirable characteristics, as in he was giving me a lot of attitude, and,
in another sense, it describes a human psychological phenomenon.
According to Recommendation 16 of Fitness for Practice (UKCC,
1999), the balance between university- and practice-based study should
be planned not only to promote integration of knowledge and skills but
also to promote an integration of attitudes. The All Wales document
for pre-registration nursing highlights that appropriate action should
be taken if a student indicates unsatisfactory performance in terms of
professional behaviour/attitude (WAG, 2005). Consequently, consistent
or repeated unsatisfactory professional attitude will result in the students
discontinuation from the course. Professional attitudes are assessed in
terms of students individual needs, communication and teamwork and
rating scales are completed by both the student and mentor in clinical
practice. A scoring system is employed between 1 (lowest) and 7 (highest)
and students should achieve 3 or above in each criterion statement. A
score below 18 will require discussion with the students personal teacher
and referral to a senior educational manager. An example of an assessment
of professional attitudes in relation to teamwork is demonstrated in Table
7.10.
Table 7.10
Assessment of professional
attitudes team
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Assessment
of attitudes
Measurement of attitudes
A note of caution is required here; the methods of assessing attitudes
outlined below include a wide range of techniques, most of which require
a qualified psychologist to administer and interpret.
Self-report
In this approach, the students are asked to write down their attitudes
towards something, either anonymously or otherwise, depending on the
degree of trust and the honesty of the respondent.
Published inventories
These are standardized scales for measuring attitudes to various things,
such as attitudes towards college. They are more useful than home-made
tests because they claim to have high validity and reliability, but they may
not meet individual teachers exact requirements.
Likert scaling
In this technique, a pool of items is devised to cover the attitude in
question, and then a scale is drawn up that rates each item under
five points, ranging from strongly agree to strongly disagree. These five
points are scored from one to five, and the teacher can choose whether
the high score of five is to mean a favourable or unfavourable attitude
towards the statement in question. Once this has been decided, the
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Chapter 7Assessment
of learning
2.
3.
Strongly
agree
Agree
Uncertain
Disagree
Strongly
disagree
Management
All the foregoing discussion about ensuring the validity and reliability
of assessments can be rendered meaningless if the management of the
assessment system is inadequate.
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Management
Assessment regulations
One of the most important aspects of assessment is the assessment
regulations; these act as an absolute guide to the whole assessment system
for a given course or programme and should be followed meticulously.
Although assessment regulations will be specific to a given course or
programme, there are some generic aspects that apply to most:
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Submission of assessments
The handing-in procedures for unit assessments are very important.
Students must be made aware of the correct procedures for the handingin of assessments, and no deviations should be allowed. Programmes
will vary in their handing-in procedures; Table 7.12 shows a typical
example.
Table 7.12
Example of a handing-in
procedure for assessments
1. Assignments must be handed-in to the designated office by the close of day on the deadline
date for submission.
2. Assignments are not normally handed in to teaching staff.
3. A receipt is normally issued to the student as proof that the assessment has been handed in.
4. If assignments are posted, they should be sent by recorded delivery.
5. Students should keep a copy of all their assessments, in case of loss.
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Management
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Marking
Moderation
Internal moderation
Internal moderation can be carried out in a number of ways, but the
principles remain the same, i.e. to ensure fairness and consistency of
marking across the programme. Internal moderation normally consists of
the scrutiny of a sample of students work across the range of marks.
Internal moderation and double-marking (second-marking)
It is important to distinguish internal moderation from double marking.
Double or second marking is a process whereby two tutors independently
mark a students work and come to an agreement about the final mark
awarded. However, this process has limited value: as it focuses on the
work of individual students it does not tell us anything about the overall
consistency of a given marking tutor across their entire range of marking.
Moderation, on the other hand, involves one marker evaluating another
markers judgement.
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Moderation
External moderation
External moderation is undertaken by the external examiner, who will
inform the programme leader of the procedures that he or she would
like to adopt for this. Normally, the external examiner would receive all
referred papers and all papers awarded the highest grade, as well as a
sample of papers from each grade or percentage band. The programme
leader needs to ensure that the external examiner has a timescale
sufficient for adequate scrutiny of the papers.
Once the moderation system has been completed, assessment work
can be returned to students. Assessments are made available for collection
at the departmental office. Students should note that any mark awarded
is provisional at this stage. The final mark is determined when the board
of examiners meets, and a unit pass list is sent to each successful student
as soon as possible after that meeting. Students who were unsuccessful
are informed individually by letter.
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External
examiners
Boards
of examiners
Table 7.15
Typical responsibilities of
a board of examiners
1.
2.
3.
4.
5.
6.
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Boards
of examiners
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Chapter 7Assessment
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so that when they are collected back from board members at the end of
the meeting, the administrator can check that all have been returned. This
measure is designed to maintain the confidentiality of the proceedings.
In the event that a student is given a fail grade, the chair would
normally ask if there are any mitigating circumstances in relation
to the student concerned. If the board considers that the mitigating
circumstances were such that the students performance in the assessment
was adversely affected, the board has the authority to allow the student
to do the assessment again.
illness or other factors which the student claims affected his or her
performance, but which he or she was unable or unwilling, for
legitimate reasons, to make known to the board of examiners before it
made its decision;
the occurrence of an administrative error or other irregularity affecting
the assessment;
the assessment was not carried out in accordance with the regulations
for the programme.
Summary
Setting, marking and moderating students written assessment work
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References
References
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of learning
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References
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Teaching
study skills
Levels
Award
Credit levels
Characteristics
1, 2
1, 2, 3
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Masters degree
n/a
Students
Making
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Chapter 8Teaching
study skills
Classification systems
The Dewey classification scheme (Dewey decimal system) is the system
favoured by university libraries to classify resources. It is divided into ten
main classes:
000
100
200
300
400
500
600
700
800
900
Generalities;
Philosophy and related disciplines;
Religion;
Social sciences;
Language;
Pure sciences;
Technology;
Arts;
Literature;
General geography and history.
Within this main classification, there are more specific ones; for
example, nursing is classified at 610, anatomy and physiology at 612,
psychology at 150159, and education at 370. The Dewey classification
is used not only for the main book stock, but for reference books,
periodicals, oversize materials, pamphlets, and audio-visual media. When
searching for specific subjects, students tend to concentrate on books,
and they may need reminding to look at the other resources shelved in
different areas of the library
Author and title. This is the fastest search if both the author and the
title are known.
Subject. This is used to find the shelf mark, for example psychology.
Class. This is used to search for items within a Dewey decimal class
mark, for example 610, nursing.
Author and keyword. This is used if the author is known but only a
general idea of the subject is known.
Number. This is the ISBN, a number that is unique to each book and
the fastest way to search for a book.
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Making
The Web OPAC will also show details of loans, fines, and reservations.
Books
Although the majority of the book stock of a library is available for
loan, there are some categories that have restricted access. A short loan
collection consists of books that are in very great demand, and the
loan period for these is only one or two weeks in order to maximize their
availability to all readers. A counter text collection also contains popular
books, as well as other materials, and is available for use in the library
only. The reference collection contains materials that are not available
for loan, including statistical sources, encyclopaedias, dictionaries and
directories. If the library does not stock a particular book or other
resource, it can be obtained via the inter-library loan service; a charge
may be levied for this service.
Periodicals
The term periodical applies to any journal, newspaper or magazine,
and these are a valuable source of reference, particularly as they contain
material that is published long before it reaches the textbooks. Current
editions of periodicals are usually displayed prominently in the library,
with back copies stored under the appropriate classification.
Databases
Most libraries will have a range of computer databases stored on CDROM (Compact Disc Read Only Memory). A compact disc can hold
the equivalent of a quarter of a million pages of A4 text or pictures, with
very fast access to indexes and abstracts. One of the most frequently
used in nursing is the Cumulative Index of Nursing and Allied Health
Literature (CINAHL), which contains citations from a large number of
journals. MEDLINE is the database of the National Library of Medicine,
USA, and NERIS is a British educational database.
Other library resources
In addition to books, periodicals and databases, libraries hold syllabuses,
prospectuses from educational institutions, past examination papers,
student dissertations, and audio-visual materials such as videotapes.
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Table 8.2
Undertaking a literature search
Consult the Web OPAC for the material held by the library on your subject.
Consult the relevant CD-ROM databases on your subject.
Consult other relevant abstracts and indexes on your subject.
Consult other relevant biographies on your subject.
Locate each of the references, using inter-library loan as appropriate.
Read this material, noting the quality. For example, is there any obvious bias? Does it contain a
biography? What is the quality of the index? Have there been previous editions? It is easier to
start with the latest material first, proceeding to the earlier material.
9. Complete a separate reference card for each reference, using a standard format such as the
Harvard system.
10. Complete reference cards for further references which might be given in the sources you
locate.
Bibliographies
There are two main types of bibliography, each of which contains
references to work in a given subject area. The first kind is the
retrospective bibliography, which gives a list of references up to a
particular date, for example, Thompsons Bibliography of Nursing
Literature 196070. The second kind is the serial bibliography, which
is published at regular intervals; for example, Nursing Bibliography
(monthly) and Current Literature on Health Services (monthly). The
British National Bibliography is published weekly and contains every
publication in Britain since 1950.
Online information services are remote databases such as the
International Bibliography of the Social Science (IBSS).
Abstracts
These consist of summaries of publications in certain fields, for example
Hospital Abstracts, Nursing Research Abstracts, and Research into Higher
Education Abstracts.
Indexes
Indexes contain references for articles on a particular subject, culled
from a variety of journals; for example, International Nursing Index and
British Education Index.
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Making
Table 8.3
Year of publication
Title, in italics or underlined
Edition
Publisher
Place of publication
Example:
Quinn, F.M. (ed.) (1998) Continuing Professional Development in Nursing: A Guide for Practitioners
and Educators. Nelson Thornes, Cheltenham.
Chapter authors surname and initials
Table 8.4
Year of publication
Title of chapter
Book authors initials and surname
Year of publication
Title of book, in italics or underlined
Edition
Publisher
Place of publication
Example:
Hinchliff, S (1998) Lifelong learning in context. In F. M. Quinn (ed.) (1998) Continuing Professional
Development in Nursing: A Guide for Practitioners and Educators. Nelson Thornes, Cheltenham.
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Example
Quinn (7) suggests that the main purpose of problem-solving groups is
to encourage critical thinking. In the reference listing, the full reference
would appear as follows:
7. Quinn, F.M. (2000) The Principles and Practice of Nurse Education,
4th edn. Nelson Thornes, Cheltenham.
Journal articles
For journal articles, slightly different details are needed to help the
reader locate the information. The use of italics is also different from
the convention used for book references, as shown in Table 8.5.
Table 8.5
Harvard system for journal
references
Effective
reading skills
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Effective
note-taking
A glance at the bibliographical page will indicate the author, title and
date of publication; if the book is into a second or subsequent edition,
this may indicate success. The contents page can be scanned for an idea of
the main sequence of the book, and it is important to examine the index
to see the kind of content included.
Approaches to reading
Students will approach reading in different ways, depending upon its
purpose. Brown and Atkins (1988) identify six approaches:
1. Scanning. This approach is used to find a specific piece of
information.
2. Skimming. This is used to obtain an overall impression of an article or
chapter.
3. Surveying. This is used to ascertain the overall structure of an article
or chapter.
4. Light study reading. This is reading with no specific purpose other than
general background study.
5. Directed reading. This is focused reading for a specific purpose, for
example to grasp concepts, theories, etc.
6. Deep study reading. This is active reading in depth for example to
discover meanings, to consider and evaluate arguments, etc.
Effective
note-taking
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Chapter 8Teaching
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Table 8.6
Advantages and disadvantages
of note-taking
Advantages
Disadvantages
May be inaccurate
Student may miss part of lecture whilst writing
notes
May inhibit students own processing activities
if structured by teacher
Incidence
Aetiology
Pathology
Clinical features
Investigations
Management
Prognosis
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Participating
SOCIAL DEFINITION
Figure 8.1
Pattern system of note-taking:
labelling theory
CULTURE-DETERMINED
DEVIANCE
LABELLING THEORY
STIGMA e.g.
mad; gay
SELF-FULFILLING PROPHECY
Layout should be neat and flexible. Plan your notes so that information
from other sources can be added later.
Review notes immediately after the lecture and add any further
points.
Participating
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Not everyone likes group work, and students may feel that the same
few people always dominate the discussion, so that others cannot get a
word in. Unit leaders need to be alert to this and be prepared to take steps
to encourage the more silent members to contribute. Students must be
encouraged to participate in group discussions during the units; it really
is important that they experience the process of constructive criticism.
Seminar presentation involves speaking to the group on a particular
topic, either chosen by the student or allocated by the tutor. Students
may feel that this is a nerve-racking experience, especially if they have
not done anything like it before! Tutors can give guidance and tips to help
students with seminar presentations, as shown in Table 8.8.
Table 8.8
Guidance for students
seminar presentations
1. Prepare your material carefully, i.e. ensure that any visual materials are written large enough
to be seen.
2. Make a brief plan of the presentation so that you have the sequence in front of you (it is very
disconcerting for you to lose your place).
3. Ensure that you have thoroughly understood the content of your material; you may be
questioned about it by group members!
4. Prepare the classroom carefully beforehand, i.e. make sure that everyone can see the
chalkboard/screen, etc.; ensure that the overhead projector is aligned carefully, with a full-size
image on the screen (if unsure how to do this, ask your tutor).
5. Remember, the aim of the seminar is that the group learns something from your presentation,
i.e. do not bombard them with masses of information; use overhead projector or handouts
for key points; allow sufficient time for note-taking.
6. Allow opportunities for discussion, i.e. the seminar is not about giving information, but should
stimulate thinking and debate; keep formal information to a minimum; posing questions for
the group to answer can stimulate debate.
7. Try to make your presentation serve two purposes, i.e. for the seminar and also as the basis
of your unit assessment. This will ensure that you take the necessary care over the reading
and preparation of the topic.
Planning
to study
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Strategies
study must be seen as a natural part of the students life, just like meal
times and other routines. Another aspect is the temptation to escape
from the chore of study by using certain devices that may or may not be
unconscious. For example, daydreaming is a common occurrence during
study as are frequent trips to make coffee, or some other ploy that takes
one away from the unpleasant situation. Boredom is another problem
against which the student must fight, and it is good advice to suggest that
he or she uses a pencil to make notes at regular intervals, thus aiding
concentration and providing a feeling of getting somewhere. Joining
with a small group of students to examine a common problem can be a
motivating activity from time to time and gives different perspectives on
an aspect of study.
When planning for study it is important to include regular breaks
so that fatigue is avoided. Stretching ones legs every hour or so will
help keep concentration and make the subsequent study more efficient.
It is unlikely that a period of study longer than about three hours will
be useful at any one time and even this length may prove difficult.
An interesting suggestion is given by Bandura (1977), which he terms
self-reinforcement. It involves setting oneself certain study goals and
allocating a reward that is conditional upon attainment of these goals.
For example, students might decide to study a particular section of a
textbook until they could describe its content in their own words. The
reward that they allocate could be a walk in the park, which can be taken
only when the objective has been achieved.
Strategies
There are a number of strategies that can help students to study more
effectively, including rehearsal, mnemonics, and self-assessment.
Rehearsal
This is the silent repetition of sentences or words over and over again as
a way of remembering them. It is a particularly important metacognitive
strategy for retention of material, and there are two closely related
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concepts: review, which involves going back over material that one has
previously read, and recitation, which is actually saying the material out
loud.
Mnemonics
These are memory aids that involve mental strategies; the best-known
ones involve rhymes, such as Thirty days hath September, April, June
and November
Mnemonics can be visual, as in the case of imagery. Evidence suggests
that by forming a mental picture or image we can remember items much
better. For example, one can form a picture in which items for recall are
associated with aspects of the home; one item may be hanging in the
hall, another on the sofa. A more practical example in nursing is the use
of images of patients one has nursed in the past. The student should try
to recall a patient who had nursing problems and picture the care given.
Narrative is a closely related idea and consists of making up a story that
links all the words one wishes to remember.
Self-testing
Self-testing can be a useful strategy for increasing retention of material,
and evidence for this is offered by Rothkopf (1970) and Rothkopf and
Johnson (1971). Rothkopf maintains that learning from written materials
involves two processes, the first one being the study and inspection
behaviours of the student. He calls these mathemagenic behaviours, i.e.
behaviours that give birth to learning. The second process is the actual
acquisition of learning of the subject matter. Rothkopf maintains that the
study habits of students are fluid and can be constantly modified during
study. He tested these ideas in a series of experiments involving the use of
questions inserted into texts and found that the greatest facilitative effect
on learning occurred when the questions were inserted after the material
to which they related, i.e. post-questions. The implication for students
is that the regular testing of study materials by the use of post-questions
may well enhance learning.
Tackling
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Tackling
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Introduction
Expanded role of theatre nurse
Concept of accountability
NMC code of conduct
Aim of assignment
Figure 8.2
Spider diagram for assignment
Assignment title
Accountability
Legal/professional implications in the
perioperative area
Main body
Modes of accountability (professional, employer, civil, criminal)
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study skills
Table 8.9
Common terms used
in assessment
ANALYSE
ASSESS
Estimate the pros and cons of the issue and give a judgement
on these
DEFINE
DESCRIBE
DISCUSS
Give viewpoints from both sides and then round off with
own conclusion based on these
LIST
OUTLINE
STATE
1.
Title
Typical structure of an
essay assignment
2.
Introduction
Focus of assignment
Problem or issue
Context
Literature review
3.
Main body
Description
Analysis/argument
Synthesis/argument
Evaluation
4.
Conclusions
Review of issues
Students opinions in the light of the foregoing discussion
Recommendations if appropriate
5.
References
Use standard system of referencing, e.g. Harvard
6.
Appendix
Useful for documents that could not be included fully in the text for want of space, but
which would provide useful information for the reader
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Tackling
Word-processing
Word-processing is the answer to students problems when editing
the final draft for submission. With this technology, they can move
paragraphs around, or insert and delete until they are happy with the
result. Handwritten assignments do not easily allow for alterations
without a great deal of re-writing, so it might be worth students while
to acquire word-processing skills. Tutors can offer useful advice and tips
on editing, as shown in Table 8.11.
1. Check the number of words (do a spellcheck on word processor); it is normal to accept
plus or minus 10% of the required word length, i.e. if the assignment is 2500 words, then
an acceptable range would be 22502750 words. If you go outside these boundaries you
may well find that your marks are adversely affected. It is more difficult to write concisely, and
therefore students would be unfairly advantaged if they were allowed to exceed the word
length by a significant amount.
2. Avoid padding your assignment with materials that are not strictly relevant to the topic.
Students are often tempted to include material in the appendix just because it is readily
available from their institution. Any material in the appendix must be referred to in the main
text, and must have a substantial contribution to make to the assignment.
3. Carry out a final check against the unit assessment specification to ensure that all aspects have
been addressed.
4. It is imperative that careful attention is paid to the procedures for handing-in of your
assignment.
5. Always keep a copy of the assignment. In the very best systems there is always the possibility
of a mishap, and an assignment may occasionally go astray. It is heartbreaking if this occurs and
you have not kept a copy.
Table 8.11
Tips for students on
editing their assignments
Failing an assignment
Some students are likely to experience the failure of an assignment, and
one of the most common reasons is that the students have not tried as
hard and performed as well as they are able. Other reasons for failure
are likely to include illness, personal circumstances, learning difficulties
and plagiarism. Although all institutions have systems in place to support
students who fail, Mardell and Moore (2005) offer some very useful
advice on how actually to fail an assignment. Whilst by their own
admission it is relatively tongue-in-cheek, it is worth drawing students
attention to it as a reminder of the pitfalls associated with academic
writing. They identify key areas that students often dismiss when
studying, which include planning, plagiarism and referencing.
Plagiarism
There are now a number of Internet sites that offer to write students
assignments for them. Apart from the obvious plagiarism that occurs,
the issue relating to trustworthiness has huge implications for students
and qualified nurses. The NMC (2004) demands that we uphold the
reputation of the profession; if a nurse sees nothing wrong in paying for
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Summary
review of lecture notes will help. Again, planning is the key to effective
revision, with objectives and deadlines for each week, but, in the case of
examination revision, motivation is of paramount importance. Revising
in study groups can provide excellent motivation and, in addition,
the presence of other students who feel equally ignorant can be very
reassuring. Frequent changes of stimulus can help combat staleness,
and the use of a learning resources centre with audio-visual aids may
provide a welcome change from reading. It cannot be overemphasized
that cramming is a very inefficient and risky business, as the high levels
of stress that develop close to the examination act to impair the learning
performance.
Examination technique
Sitting for an examination requires a degree of self-control, since panic
can so easily undermine an otherwise well-prepared candidate. If the
examination consists of an unseen paper, the candidate will not be
allowed to take any resources into the examination room other than
those for writing and drawing. The instructions for filling in the answer
book should be noted. On the first scan of the paper, the student should
carefully note the number of questions to be answered, the parts from
which they should each be selected if relevant, and the amount of time to
be allocated to each. It is wise to allocate an equal amount of time to each
question, including an allowance at the end of the examination to go
back over and check the answers. The students should be advised to scan
the questions and to select the one that they feel most confident about.
Once writing begins anxiety levels should fall, and the students will be
able to choose subsequent questions in a more rational frame of mind.
Students should be advised to make a brief plan before commencing a
question, as this can ensure that all necessary elements of the answer have
been considered. This plan can then act as a prompt when the writing
begins to flow. It is important that a careful watch is kept on the time,
as it is all too easy to overrun on the easier questions, leaving a shortfall
for the more difficult ones. During the last five minutes or so, the student
should read through all answers, adding brief points that were missed the
first time. As a final check, the student should ensure that all papers are
properly identified according to the instructions.
Summary
The inclusion of study-skills training is now an important feature of
higher education.
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study skills
References
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References
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Part Three
Specific
teaching
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Group
The workplace does not simply provide an environment for learning the
knowledge and skills required for practice; it also serves as a vehicle for
pre-registration students socialization into the profession of nursing or
midwifery.
Socialization
From early infancy, individuals learn the values, knowledge and patterns
of behaviour that make them a member of their particular society; the
process by which an individual undergoes induction into these expected
behaviours or roles is termed socialization, and is a lifelong process
involving transmission of culture.
Primary socialization
This begins in infancy and is mediated through the immediate family;
sex roles, social class morals and manners are all part of this early
socialization process.
Secondary socialization
This begins once the child commences school and is influenced not only
by teachers but also by peers; the latter exert a powerful effect as the
child moves into adolescence, when peer-group pressure may result in
behaviour at variance with the childs family or society.
Occupational socialization
This is a particular kind of secondary socialization, which involves
induction into specific occupational roles after leaving school. Nursing
culture has a powerful influence on new members, socializing them into
the role of nurse, with all its attendant values and behaviours. In the past,
there was great emphasis on conformity and obedience to superiors and
a very rigid code of personal and professional behaviour.
Socialization may begin in anticipation of future rules, and this
anticipatory socialization is important in facilitating the eventual uptake
of such roles. Many girls are socialized into nursing from an early age
by means of play, especially that associated with hospitals and caring.
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Group
The mass media are a powerful influence on such socialization and may
well be responsible for sex-role stereotyping and racism. Television,
newspapers and even childrens books may portray nursing as being the
exclusive preserve of women; indeed, women are commonly depicted
in occupations such as nursing, teaching, domestic work and catering,
rather than in engineering or medicine.
medical
laboratory
It is very likely that much of the teaching will take place in this public
arena, so it may be helpful to explore the effects of an audience on
human performance. The mere presence of an audience may facilitate
or hinder behaviour, the so-called audience effect. For example, many
actors and athletes feel that they need an audience in order to perform to
their fullest ability. On the other hand, the presence of others can exert
an inhibitory effect on behaviour and this has been demonstrated in a
number of interesting studies.
Latan and Darley (1968) showed the effect of the presence of other
people on an individuals reaction to emergency situations. They conclude
that people are less likely to intervene in an emergency if other people
are present and that this can be explained by diffusion of responsibility.
If a person encounters an emergency when alone, that person is solely
responsible for his or her actions. If, however, other people are present,
each individual may feel that his or her own responsibility is reduced and
this makes the person less likely to become involved.
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evidence that norms may develop over a short period. In a classic study
on group norms, Sherif (1936) demonstrated the rapid convergence to
a group norm of individuals opinions regarding the extent of apparent
movement of a spot of light in a darkened room. Hence, individuals who
join a workplace setting will be expected to adhere to the norms, or risk
alienation or ostracism.
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The
a ward manager labels a student nurse as lazy and people begin to react
to him according to his label; eventually, the nurse begins to accept the
label and his behaviour becomes lazy. Obviously, there must have been
an initial episode that led to the label, but it may have been a one-off
incident entirely untypical of the individual.
The notion of self-fulfilling prophecy has been explored in education,
where it is known as teacher-expectancy effect. There is a good deal of
evidence about the effect of peoples expectations on certain outcomes;
experimenters have to be cautious when interpreting results because
such results may be due to the Hawthorne effect a variation in people
simply due to the fact that they are being observed. The presence of an
observer may have either positive or negative effects on the performance
of students that are totally unrelated to the style of teaching given.
In a classic study by Rosenthal and Jacobson (1968), carried out in
an American school, teachers were given false information about some
of the children in their classes; these children were purported to have
unusual academic potential and were called spurters, but in reality they
were randomly selected from the total class. The children were given
tests of non-verbal intelligence at the start of the experiment and again
at four months and eight months and results showed that the spurters
had gained significantly more in terms of IQ than the other children.
This was ascribed to the fact that teachers expectations of the spurters
had acted as a self-fulfilling prophecy, which made them achieve more.
The study has been criticized on methodological grounds, but there is
some support from other studies for the view that teacher-expectancy
can influence learning.
The
The qualified staff are a key factor influencing the learning environment
in hospital placements, the role of ward manager being particularly
influential. Not only do they have control of the management of the area,
but they also serve as role-models for nursing practice. The leadership
style and personality of the ward manager are important determinants of
an effective learning environment, as demonstrated in a series of classic
surveys in the 1980s (Pembrey, 1980; Orton, 1981; Ogier, 1982, 1986;
Fretwell, 1983).
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The
Stressors. These are events in our lives that threaten our physical or
mental well-being.
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The
volume of patients;
aggressive patients;
unpredictable workloads;
always in the public eye;
new technology;
lack of managerial supervision;
fluctuating shift times;
lack of time for training.
Coping with stress in the workplace
Many of the stressors encountered in the workplace will be beyond
the individual practitioners power to change. The organization carries
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a responsibility for the health and safety of its employees, and the
increasing incidence of litigation on the grounds of stress-induced illness
is forcing organizations to look more seriously at workplace stressors.
One of the most important elements of coping is being able to
recognize the signs of stress in oneself, and to attempt to identify the
main stressors involved. This enables coping strategies to be mobilized at
a relatively early stage before the stress gets to a more serious level. The
following coping strategies are commonly identified in the literature:
Avoid taking on more work than you can cope with, by developing
your assertive ability to say no to requests.
example, go to the staff dining room for coffee and go outside to the
shops at lunch time.
Undertake relaxation techniques, such as physical-relaxation techniques
and meditation, at appropriate times.
Suggest to management that stress-reduction programmes should be
made available for staff.
Try setting up a stress support group in the workplace, where
colleagues can share their experiences.
Use the individual performance review/appraisal system to bring to
the attention of management the workplace stressors that you have
identified, for example lack of staff development for your role;
inadequate resources, etc. This will ensure that they are formally
recorded with the organization, an important point if evidence is
needed at a later date.
Report to your GP if your symptoms of stress are severe; not only
may treatment be provided, but a formal record is made which may
be important evidence if needed at a later date.
Managing emotion in the workplace
Clinical and community settings are, by their very nature, places of intense
emotions. These encompass positive emotions, such as excitement, joy,
elation, and also negative emotions, such as anger, frustration and fear. It
is interesting to note that both positive and negative emotions can equally
disrupt normal functioning in an individual, including the persons
relationships with others and his or her ability to make judgements and
take decisions. It may be necessary for nurses, midwives and specialist
community public health nurses to manage other peoples disruptive
emotions in the workplace, be it those of colleagues, patients or clients,
and a number of principles of good practice for managing the emotions
of others are suggested by Ostell, Baverstock and Wright (1999):
1. Deal with the emotional reaction before attempting to resolve the
problem. The individuals disruptive level of emotion needs to be
reduced so that he or she can begin to consider the problem rationally,
and the authors suggest two approaches to this. Apologizing to the
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The
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The
Educational audit
Educational audit is a process that ensures collaboration between
higher education institutions and health care providers on an ongoing
basis. It is defined by NAfW (2002) as the assessment of a student
placement completed by the link lecturer for that clinical area. All audits
are undertaken every three years and generally serve to ensure that
placements are appropriate learning environments for student nurses.
The All Wales FfP audit document (NAfW, 2002) is completed by both
the link lecturer and the educational co-ordinator and presents itself in
five sections. An example in relation to the operating theatre is identified
below (Hughes, 2004):
Section 1 outlines the general details and skill mix within the
placement.
The audit document requires a named link lecturer who will provide
learning and educational support for students and staff in the practice
setting. It also requires a named clinician in theatre who will liaise with
the link lecturer to ensure that the relationship between the university
and the placement is effective.
The encouragement of continuing professional development must
be visible in the placement area and staff enabled to fulfil the
requirements of professional registration. There must also be evidence
of opportunities available for clinical supervision within the operating
theatre environment.
Sections 4 and 5 provide a summary of previous student evaluations of
the placement; an action plan is identified for any areas of improvement
with an appropriate timescale for completion.
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Placement
Fit for practice (professional legal and ethical outcomes) can fulfil the
needs of registration.
Fit for award (meeting academic standards) have the breadth and
depth of learning to be awarded a diploma or degree.
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Placement
Orientate the students to the ward, routine and staff that they are
likely to encounter during placement.
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Mentorship
Mentorship is seen by many writers as being a long-term relationship
that extends throughout a students programme, whereas others limit the
concept to a relationship within a specific placement. In some systems,
students are encouraged to choose their own mentors, and in others the
mentor is assigned to the student. The former is preferable if possible,
because it increases the likelihood of compatibility between mentor and
student, an important factor in the relationship.
One of the controversial issues in mentoring is whether or not mentors
should also act as assessors in relation to their students. Anforth (1992)
argues that the role of mentor is incompatible with that of assessor, as
it presents a moral dilemma between the guidance and counselling role
and the judgmental assessment role. However, Quinn (2000) finds it
difficult to understand why there should be a dilemma between these two
aspects, since assessment should constitute an important teaching and
learning strategy and not simply a punitive testing of achievement. If the
mentor has an open, honest and friendly relationship with the student,
assessment can provide a rich source of feedback and dialogue to further
the students development. Quinn adds that the term mentor is used to
describe a qualified and experienced member of the practice-placement
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Placement
Preceptorship
From the foregoing discussion it is apparent that there is much overlap
in the literature between the concepts of mentor and preceptor. Burke
(1994) sees preceptors and students as having a short-lived, functional
relationship for a specific purpose in a practice setting. Given the
definition of mentorship above, preceptorship can be seen as a specific
teaching and learning strategy rather than as a generic support system for
students. A definition of a preceptor, therefore, can be an experienced
nurse, midwife or specialist community public health nurse within a
practice placement who acts as a role model and resource for a student
who is attached to him or her for a specific timespan or experience
(adapted from Quinn, 2000).
Preceptorship uses the principle of learning by sitting next to Nelly
but in a more systematic and planned way. A student is attached to the
preceptor for a relatively long period of time, such as a day or a week,
and shadows the preceptor throughout. The students role is to observe
the various interactions and decisions that the preceptor is involved with
in the course of his or her work, and then time is made available for the
student and preceptor to meet privately to discuss the events that have
occurred. During these meetings, there is two-way dialogue about the
various approaches adopted and the decisions made by the preceptor,
and the student can ascertain the basis for such decisions. Clearly the
person chosen to be the preceptor needs to have the confidence and
interpersonal skills to be questioned about why one course of action
was taken rather than another, and equally the student needs to have
sufficient confidence not to be overawed by the power differential.
In management training, the preceptorship is often conducted in
an institution other than the one in which the trainee works, and this
has the advantage of avoiding a boss relationship between preceptor
and student. Preceptorship offers not only benefits to the students, but
also to the preceptors because the system helps the preceptors to clarify
their reasons for making particular decisions or taking certain courses of
action.
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The
At one time in nursing, there were two types of nurse teacher: the
nurse tutor, whose primary responsibility lay in classroom teaching,
and the clinical teacher, whose primary responsibility was teaching in
practice placement settings. These roles have been unified under the
title of lecturer-practitioner, a qualified teacher who has retained clinical
competence and whose responsibilities include teaching, supervision
and assessment of students. Additionally some lecturer-practitioners also
undertake part-time roles in the clinical practice and education settings
by acting as module leaders for post-registration modules.
The ENB commissioned a research project on the role of the
teacher/lecturer in practice (ENB, 1998), in relation to in nursing and
midwifery practice in both institutional and community contexts. The
aims of the project were to map the national range and variations in the
roles and responsibilities; to explore the factors promoting or inhibiting
the role, and to identify the most effective model to meet criteria for
clinical competence/credibility, promoting professional knowledge and
scholarship. The main findings included:
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Clinical supervision
Clinical supervision is peer-support for practitioners in clinical and
community settings; it is defined by the Department of Health (DoH)
as:
a formal process of professional support and learning which enables
the individual practitioner to develop knowledge and competence,
assume responsibility for their own practice and enhance consumer
protection and safety of care in complex clinical situations.
(DoH, 1993)
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Purpose
Professional support and learning
Development of knowledge and competence
Responsibility for own practice
Enhance consumer protection
Help practitioner to examine and validate his or her practice and feelings
Pastoral support
Formative assessment
Ensuring standards of clinical and managerial practice
Maintain and support standards of care
To help the client
Improve quality of patient care
Improve staff performance
Reduce stress and burn-out
Adapted from Grant and Quinn (1998)
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Process
A formal process
A practice-focused professional relationship
Should be developed according to local circumstances
Every practitioner should have access
Preparation for supervisors is important and should be included in pre- and post-registration
programmes
Evaluation is needed and should be determined locally
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many supervisors and supervisees prefer the end of the day, when patient/
client demand may be less. The frequency of meetings varies widely in
the literature, ranging from weekly to three-monthly.
Keeping records of supervision
It is important that both supervisor and supervisee keep records of
clinical supervision for their personal professional profile, as evidence
of professional development. Whilst these records are confidential to the
individuals concerned, it is also necessary to keep a managerial record of
clinical supervision which contains the minimum amount of information
required by management in order to be able to confirm that supervision
has occurred, and to enable the time to be costed. This would normally
be the names of the supervisor and supervisee, the dates on which
supervision took place, and the reasons for any cancellation. In cases of
litigation by patients or clients, such records can provide evidence of the
ongoing professional development of the practitioner involved.
Teaching
The principles of teaching and learning that have been expounded in this
book are applicable to teaching and learning in the workplace. However,
some teaching strategies are more appropriate for the workplace
environment than others, and this section will explore a range of these.
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Case conferences
Ideally these should involve all members of the nursing team in discussion
and evaluation of the nursing care of a particular patient. Medical staff
have long used the case-presentation method as a learning tool for
students and qualified doctors, and the same principles apply to the
use of nursing-care conferences. There is no standard format for such a
conference, but it is usual for one nurse to present the patients case and
then for the whole team to be involved in the discussion. This helps the
student to feel part of the nursing team, as well as providing the skills
required in a public presentation of self . Such conferences provide a
useful holistic view of the patient and his or her problems, together with
an opportunity to analyse critically the care that has been received, to the
mutual benefit of both nurses and patients.
Handover report
Many qualified practitioner nurses view the handover report as a valuable
opportunity to do some teaching. Handover is done normally in two
ways:
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Handover was quicker, and staff were available on the ward for other
patients if needed.
The study recommended that all qualified nurses should attend planning
workshops, that bedside handover should continue and that patients
should be included wherever possible, and that the role of the
support worker should be reviewed in relation to communication and
documentation.
Clinical rounds
Students can gain a great deal from accompanying a doctor or nurse on
a clinical round. The former is useful for gaining insight into the role
of the medical team in patient care, and it is interesting to listen to the
discussion with regard to treatment. Students may find it valuable to
accompany a nurse teacher on a similar round and to make comparisons
of the needs of patients with similar conditions, and also to look at the
difference in attitudes between such patients. Examples of pathology
can be pointed out, for example oedema or inflammation, and the
reasons discussed at the end of the round. Students should always carry a
notebook to write down any queries or observations, but single sheets of
paper must not be allowed, as they can easily be lost and other patients
may read the confidential details.
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the context;
a detailed description;
why the incident was critical to the participant;
what the participants concerns were at the time;
what he or she was thinking about during the incident;
what he or she felt about it afterwards;
what he or she found most demanding about it.
Learning contracts
Learning contracts are an effective tool for developing student autonomy
in practice placements. It is useful to meet with students prior to the
placement to begin the initial contract negotiation, and this can be
modified as required once the placement has commenced. The theory
and components of a learning contract are discussed in Chapter 2 (p. 30).
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Part-skills (tasks)
Elements*
1.2 Screening
1.3 Closing windows
1.4 Positioning patient
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2.0 Preparation of equipment
and trolley
2.1 Hand-washing
2.2 Cleaning trolley
2.3 Collecting equipment
2.4 Setting trolley
2.5 Taking to bedside
These motor skills are further subdivided into part-skills and elements,
and it can be seen that the elements consist of many previously learned
entry behaviours, such as moving the bed table and pulling curtains.
Determining the sequence of the procedure is important, and it may be
forgotten that students must remember this as well as the motor skills.
Entry behaviours need to be identified, because they are already learned
and hence do not need to be taught again.
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principles underlying the skill. Existing skills must have been well learned
if they are to transfer positively to the new skill, and the similarities need
to be pointed out to the students.
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Stage 3: competent
This stage is characterized by conscious, deliberate planning based upon
analysis and careful deliberation of situations. The competent nurse is
able to identify priorities and manage his or her own work, and Benner
suggests that the competent nurse can benefit at this stage from learning
activities that centre on decision-making, planning and co-ordinating
patient care.
Stage 4: proficient
Unlike the competent nurse, the proficient nurse is able to perceive
situations holistically and can therefore home in directly on the
most relevant aspects of a problem. According to Benner, proficient
performance is based upon the use of maxims and is normally found
in nurses who have worked within a specific area of nursing for several
years. Inductive teaching strategies, such as case-studies, are most useful
for nurses at this stage.
Stage 5: expert
This stage is characterized by a deep understanding and intuitive grasp
of the total situation; the expert nurse develops a feel for situations and
a vision of the possibilities in a given situation. Benner suggests that
critical incident technique is a useful way of attempting to evaluate expert
practice, but she considers that not all nurses are capable of becoming
experts.
Summary
Workplace settings in nursing and midwifery education provide the
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References
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References
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UKCC (1999) Fitness for Practice: The UKCC Commission for Nursing
and Midwifery Education. United Kingdom Central Council for Nursing,
Midwifery and Health Visiting, London.
UKCC (2000) Requirements for Pre-registration Nursing Programmes.
United Kingdom Central Council for Nursing, Midwifery and Health
Visiting, London.
Watson, S. (2000) The support that mentors receive in the clinical setting.
Nurse Education Today, 20, 585592.
Welsh I. and Swann, C. (2002) Partners in Learning: A Guide to Support
and Assessment in Nurse Education. Radcliffe Medical Press, Abingdon.
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support mechanisms
10
Mentorship
The concept of mentoring in nurse education is not a new one. The
original concept of mentoring is well documented and is said to have
originated in the US (Morle, 1990; Clutterbuck, 1991). It started to
appear in the nursing literature in the early 1980s, having traditionally
been linked to professions such as medicine, law and business, and
has resulted in a wealth of published literature in the 1990s (Andrews
and Wallis, 1999). Although mentorship has assumed respectability in
professional education, Jarvis and Gibson (1997) maintain that it remains
a term that is not easily defined, as numerous articles have debated
its meaning. However, evidence suggests that mentoring is primarily
associated with clinical settings and, to a lesser extent, educational
establishments (Sword et al., 2002).
The terms mentor and mentorship have received considerable
attention in the last decade within nurse education, and Lloyd Jones et
al. (2001) summarize the mentoring role as one that:
supports the student in the clinical area and acts as a role model;
facilitates the learning experiences on placements; and
undertakes clinical teaching and assesses the students practice.
Similarly, the process of mentorship, as defined by the Welsh National
Board (2001), is one that facilitates learning opportunities and supervises
and assesses students in the practice setting. Terminology frequently
used to describe a mentor includes teacher, supporter, coach, facilitator,
assessor, role model and supervisor (Darling, 1985; Jarvis and Gibson,
1997; Neary, 1997; Chow and Suen, 2001). Although there is substantial
variation in the meaning of these terms, Hagerty (1986) believes that
this is inevitable owing to the diverse contexts in which mentorship
functions.
Qualities of a mentor
The personal qualities of a mentor and the nature of the relationship
between the mentor and student are central to the success of the
mentorship process (Pulsford et al., 2002), and from the literature
(Darling, 1986; Davies et al., 1994) it can be surmised that the attributes
of a good mentor include:
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Approachable
Knowledgeable and motivated to teach
Supporting
Good listener and trustworthy
Patient and friendly
Experienced and enthusiastic
Demonstrates interest in students
Committed to the mentoring process
Intimidating to students
Promise breaker
Lacking in knowledge and expertise
Unapproachable
Poor communicator
Lacking in time for students
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Mentorship
Facilitation of learning in order to:
demonstrate sufficient knowledge of the students programme to identify current learning needs
demonstrate strategies that will assist with the integration of learning from practice and
educational settings
create and develop opportunities for students to identify and undertake experiences to meet
their learning needs
Assessment in order to:
demonstrate a good understanding of assessment and ability to assess
implement approved assessment procedures
Role modelling in order to:
demonstrate effective relationships with patients and clients
contribute to the development of an environment in which effective practice is fostered,
implemented, evaluated and disseminated
assess and manage clinical developments to ensure safe and effective care
Creating an environment for learning in order to:
ensure effective learning experiences, and the opportunity to achieve learning outcomes for
students, by contributing to the development and maintenance of a learning environment
implement strategies for quality assurance and quality audit
Improving practice in order to:
contribute to the creation of an environment in which change can be initiated and supported
A knowledge base in order to:
identify, apply and disseminate research findings within the area of practice
Course development that:
contributes to the development and/or review of courses
Adapted from NMC (2004b)
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Personal
tutoring
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Personal
tutoring
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preparing each student, prior to his or her first and subsequent clinical
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Personal
tutoring
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Personal
tutoring
for their students (Phillips, 1994), they are not expected to be constantly
available for students, and arrangements should exist for appointments
that are deemed urgent.
Individual tutorials give the personal tutor an idea of the students
achievements but there are instances when the student is failing to
achieve the required standard. Quinn (2000) identifies many barriers
to learning, so, when faced with this situation, it is important to identify
what aspects of the programme the student is experiencing difficulties
with. During this time, both personal tutor and student must agree a plan
of action to rectify the situation and negotiate an increase in meetings to
monitor progress more closely (Welsh and Swann, 2002).
Contract of supervision
A contract of supervision, although not legally binding, is a method
of setting ground rules between a student and personal tutor. It can
be instigated by the personal tutor and created on commencement
of the studentteacher relationship to identify the process of making
appointments and the number of meetings required per module; it can
also identify when draft assignments can and cannot be reviewed. The
supervision contract is then agreed and signed by both parties and a copy
retained by the student and personal tutor. Table 10.4 demonstrates an
example of a supervision contract.
Student/Personal Tutor Contract of Supervision
Table 10.4
Example of a supervision
contract
Students name
Contact details
Telephone number/email
Please make direct contact to book appointments at least 5 days in advance unless an
emergency situation arises.
My location is identified on my office door and is also available from the directorate secretary.
Please provide all relevant documentation including portfolios and draft assignments 48 hours
prior to any meeting draft assignments may be submitted by electronic mail and portfolios
may be left with the secretary in the general secretariat office.
Formal meetings will be required according to the course of study undertaken. Two meetings
are normally acceptable at the beginning and end of the module.
Additional support can be negotiated and agreed and any other conditions required by the
College will be included.
Draft assignments and extension requests for summative work will not be accepted during the
final week prior to submission unless mitigating circumstances are evident.
If all of the above statements are satisfactory to both student and personal teacher, please sign and
date the contract below.
Personal Tutors Signature:
Students Signature:
Date:
Date:
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Learning contracts
Neary (2002) endorses the use of learning contracts designed by
both teacher and student to specify what the student will learn, how
it will be achieved and the timescale and criteria for measuring its
success. Identifying learning objectives will bridge the theorypractice
gap and demonstrate the transfer of knowledge to clinical practice
(Rolfe, 1996). A learning contract could be perceived as a combined
andragogical/pedagogical approach, instigated by the personal tutor for
meeting learning needs, and which, as it stands, defeats the theory of
adult learning. Whilst acknowledging that, at the start of educational
programmes, the knowledge, and subsequently power, is with the tutor, it
is presumed that, over a period of time, the personal tutor will challenge
the boundaries to shift responsibility slowly to the student. Nolan and
Nolan (1997a) support this and believe that, when it comes to matters of
control, it seems that students, at least in the early stages of their training,
want the tutor to take the lead.
Andragogy has been depicted at the level of grand theory as being
universally applicable to all adult learners, yet Nolan and Nolan (1997b)
clearly point out that evidence suggests that there is a growing realization
that, in nurse education, this is not the case, and they argue for a cooperative model of tutoring. However, Derbyshire (1993) challenged
the need to reclaim a pedagogical approach to overcome the deficits of
andragogy, which is, he believes, divisive and fragmentary.
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The
The
clinical teacher;
teacher/practitioner;
lecturer/practitioner;
clinical facilitator;
practice educator.
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Educational
audit
Clinical
tutorials
Link
lecturer
role
Update on
curricular changes
Clinical
meetings
Review student
progress
Mentorship
preparation
Update on
current practice
Post-registration
education
Research
The link lecturers role is multi-faceted and within the clinical setting
most usually includes:
student support;
educational audit;
mentorship;
clinical credibility; and
research.
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Clinical credibility
What exactly is clinical credibility and how is it generally defined? In
terms of the critical care environment, does it mean that a lecturer should
be able to walk into an intensive care unit and prepare the environment
appropriately for a ventilated patient? Then act in a competent manner
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and assist the anaesthetist for the duration of the shift? Anecdotal
evidence suggests that six weeks away from any clinical area renders a
nurse deskilled (Hughes, 2004b).
A study by Aston et al. (2000), exploring the role of the link lecturer
in the practice setting, highlighted a lack of strategic management of
the practice role by educational institutions. Interestingly, whilst the
researchers found that clinical credibility was of great importance for
lecturers, both clinicians and lecturers felt that this was a broad term and
that clinical credibility was understood to mean an awareness of current
issues and changes in the practice setting.
To overcome the obstacles of maintaining clinical credibility, several
strategies have been adopted to enhance the link-lecturer role. The
experiences of Maslin-Prothero and Owen (2001) demonstrate that nurse
lecturers should consider their current knowledge, skills and expertise in
order to develop an individualized practice-based role that enables them
to keep in touch with current clinical developments. They suggest a
number of realistic, pragmatic approaches that nurse lecturers can use to
enhance both clinical competence and credibility, and to ensure that their
teaching is up to date and grounded in the realities of clinical practice.
Some of these include:
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References
Summary
Although mentorship has assumed respectability in professional
education, it remains a term that is not easily defined.
it is also a concept that has been adopted within the realms of nurse
education establishments.
Throughout their educational programmes, students are supported
by a range of professional and academic mentors and are allocated a
personal tutor who is able to guide, support and facilitate learning.
Being a personal tutor is a fundamental part of the academic role in
developing the students understanding and perception of clinical
practice.
The personal-tutor role tends to concentrate on activities in four key
areas: learning through reflective practice, conflict, learning contracts
and support for lecturers.
A personal tutor creates a climate and culture of support.
A link lecturer is allocated to a clinical placement area and liaises with
placement staff on student issues.
A link lecturer is the first point of contact for the health care provider
who assists the mentors in practice in the facilitation of a supportive,
creative learning environment and will provide support throughout
the clinical assessment.
There are four key elements of the clinical role of nurse teachers:
liaison, teaching, clinical practice and research.
Clinical credibility is understood to mean an awareness of current
issues and changes in the practice setting.
Andrews, M. and Wallis, M. (1999) Mentorship in nursing: a literature
review. Journal of Advanced Nursing, 29(1), 201207.
Armitage, P. and Burnard, P. (1991) Mentors or preceptors? Narrowing
the theorypractice gap. Nurse Education Today, 11, 225229.
Aspinall, L. and Siddiqui, J. (1996) Mentorship in the neonatal unit.
British Journal of Midwifery, 4, 121125.
Aston, L., Mallik, M., Day, C., Fraser, D., Cooper, M., Hall, C.,
Hallawell, R. and Narayanasamy, A. (2000) An exploration into the role
of the teacher/lecturer in practice: findings from a case study in adult
nursing. Nurse Education Today, 20(3), 178188.
Benner, P. (1984) From Novice to Expert: Excellence and Power in
Clinical Nursing Practice. Addison-Wesley, San Francisco, CA.
References
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11
Teaching
families
Issues
and context
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Issues
and context
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Students
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Patient-teaching
Patient-teaching
One of the interesting issues about teaching patients, clients and their
families is the extent to which such teaching can be considered to come
under the umbrella term of health promotion. The concept of health
can be viewed in various ways, as one individuals definition will differ
from anothers. Until a few years ago, health promotion used to be
called health education; indeed, the special health authority that advises
the Government on health promotion is called the Health Education
Authority! It may be helpful to look at a number of definitions of each
of these terms:
Ewles and Simnett (1999) believe that the main aim of health
promotion is for people to have more control over the health aspect of
their lives, essentially to empower them. Whilst Naidoo and Wills (1998)
and Kemm and Close (1995) share very similar views:
Health promotion refers to a group of activities that help to prevent
disease and improve health and well-being.
(Naidoo and Wills, 1998)
Health promotion is the name given to all those activities which are
intended to prevent disease and ill-health and to increase well-being
in the community.
(Kemm and Close, 1995)
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reducing the death rate from cancer by one-fifth in people under the
age of 75, saving some 100,000 lives;
reducing the death rate from accidents by at least one-fifth, and serious
injuries by at least one-tenth, saving some 12,000 lives;
reducing the mental illness death rate from suicide and undetermined
injury by at least one-fifth, saving some 4000 lives.
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Patient-teaching
NSFs are now in place for a variety of care settings, such as:
older people;
diabetes;
mental health;
chronic obstructive pulmonary disease;
cancer;
renal;
long-term conditions;
coronary heart disease;
children; and
paediatric intensive care.
The NHS Improvement Plan
The National Health Service (NHS) has made significant steps in
providing faster, more convenient access to care through increases in
capacity and changes in ways of working (DoH, 2005). Whilst it has
always been very patient centred and delivered excellent care, the NHS
Improvement Plan (DoH, 2004a) set out ways in which the NHS needed
to change in order to become patient led. It stated that the NHS needs
a change of culture to become truly patient led, i.e. as concerned with
health promotion as it is with sickness and injury.
The Wanless Report
Patients within patient-led services must have access to a range of services
and treatments to enable them to make informed choices about their
health. The Wanless Report (2002) Securing our Future Health: Taking a
Long-term View highlighted the benefits of giving patients choices, putting
them in control and helping them to be fully engaged in their health care.
Supporting the role of citizens in promoting their health, individually and
collectively underlies the principles of Designed for Life: Creating World
Class Health and Social Care for Wales in the 21st Century (WAG, 2005).
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Strategies
families
teaching that the nurse believes the family requires, for example
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Strategies
for teaching
that they do their exercises. This is not the only example of carer
education; some children are the sole carers for ill or disabled parents,
and in this case the child needs to be taught how to care for the parent.
The issue of confidentiality is important in terms of teaching the
carer; the nurse must ensure that the patient/client identifies what
information may be divulged to the carer, and that information must
remain confidential.
Ascertain what they already know about the subject or issue, and
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respond in any way they like and are particularly useful for ascertaining
the patients feelings.
Probing questions. These are used to follow up a previous response
by the patient and allow the teacher to explore the response in more
depth. However, their use requires skill and sensitivity on the part of
the teacher, as this type of question may provoke anger or distress in
some situations.
Factual questions. These are used to check whether patients have
understood the teachers points, and consist simply of asking them to
repeat back certain items of information.
A detailed discussion of questioning can be found in Chapter 5 (p.
191).
Advantages
Disadvantages
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for teaching
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The authors offer the following checklist for the content of patient
information materials:
1. Use patients questions as the starting point.
2. Ensure that common concerns and misconceptions are addressed.
3. Refer to all relevant treatment or management options.
4. Include honest information about benefits and risks.
5. Include quantitative information where possible.
6. Include checklists and questions to ask the doctor.
7. Include sources of further information.
8. Use non-alarmist, non-patronizing language in active rather than
passive voice.
9. Design should be structured and concise with good illustrations.
10. Be explicit about authorship and sponsorship.
11. Include reference to sources and strengths of evidence.
12. Include the publication date.
Examples
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Examples
Group teaching:
lack of privacy;
individual needs are not always addressed.
One-to-one teaching:
Time is required.
Specialist knowledge is required by the nurse.
Patient-support mechanisms should be ongoing to optimize the
session outcomes.
Facilities for the patient should be appropriate to his or her needs; for
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noting the condition of the mothers breasts, checking for the presence/
absence of milk and nipple damage;
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Examples
The authors also point out that the workshops encourage a fresh
approach by prioritizing and including user-led sessions and involvement
as a part of the training. The workshops were conducted over a two-day
period and facilitated by service-users, user development workers and
clinical psychologists. The content of the programme included:
such as listening, being friendly, and that these are easily forgotten but
are beneficial in assisting recovery.
The importance of small talk. Having conversations with service users
using everyday language was therapeutic.
Shrinking the gap between us and them. This theme stressed the need
to work collaboratively and to avoid distancing themselves from
service-users.
The value of user views. The distressing experiences of service-user
trainers were highlighted, and this was seen as inspirational by
participants.
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The authors maintain that collaboration between workers and serviceusers was well received by staff attending the programme as it helped
to learn about service-user involvement in the training process and also
assisted in creating conditions for a positive experience for the serviceuser. Houghton et al. (2006) emphasize that this approach to psychosis
sees learning from the service-user as vital in informing and developing
practice and that developing collaborative relationships encourages a
positive and more hopeful outlook towards recovery.
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Examples
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The
Looking after me
There is also an expert patient programme called Looking after me,
which is aimed at adults who care for someone with a long-term condition
or disability. This course is also free of charge and led by trained tutors
who have experience of caring for a friend/relative. Although the course
itself does not address topics such as carers rights and benefits, and
skills such as moving and lifting, this information is freely available on a
resource table.
Both courses are not time consuming, but a commitment of 2.5 hours
per week for six weeks is required.
Teaching
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Teaching
Carers UK
Carers UK is a registered charity that operates in Scotland, Wales,
Northern Ireland and England and was set up to improve the lives of
carers. According to Carers UK, the term carer:
is used to distinguish those who provide care for others on an
unpaid basis from those who are paid (care workers, home helps
and people employed by someone with a disability).
(Carers UK, 2004)
informing carers of their rights, the help available and how to challenge
injustice so that they can lead fulfilled lives.
Carers currently save the economy 57 billion each year in care costs,
which is the equivalent to a second National Health Service.
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There are more opportunities for carers to access learning and training
programmes.
There are more opportunities for carers to lead a more fulfilled life.
Benefits of home care
Home care can confer benefits on both the carer and the relative being
cared for (Voluntary Aid Societies, 1997):
1. For the relative:
Being cared for at home confers a degree of independence greater than
that in an institutional environment.
A much more personal type of care can be given, as the carer knows
the relatives personal likes and dislikes.
The home environment contains all the familiar home comforts, such
as favourite books, pictures and furniture.
2. For the carer:
Providing support for the relative may enhance a closer relationship.
There is pride and satisfaction in knowing that the relative is receiving
good care.
Looking after a relative develops organizational skills such as
prioritizing and time management.
Carers needs
Carers need to be helped to recognize emotions, such as anger and guilt,
and to identify the underlying reasons for them. They need also to be
aware of the dangers of becoming isolated and lonely, and the need to
make the effort to maintain friendships and outside activities. It is essential
that carers are made aware of the wide range of care professionals with
whom they may have contact, including GP, social services, community
nurses, chiropodist, and ambulance personnel. They will also need
information on the types of benefits available to home carers, including
Invalid Care Allowance (ICA), and disability benefits for the relative.
The majority of registered charities now produce information
booklets relating to specific diseases. For example, the Arthritis Research
Campaign (ARC, 2005) has produced a comprehensive guide for caring
for a person with arthritis. It explains how a carer can help someone with
arthritis; what arthritis means; how to communicate effectively with the
person who has arthritis; how to offer practical help with treatment, and
how a carer can access further information, advice and support.
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Teaching
groups
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Table 11.3
Support groups
UK Patient Support
Alzheimers Society
National Autistic Society
Cancer Backup
Diabetes UK
Downs Syndrome Association
KIDS (working for children with special needs)
MENCAP (Royal Society for Mentally
Handicapped Children and Adults)
Age Concern
CRUSE (bereavement care)
SANDS (Stillbirth and Neonatal Death Society)
British Heart Foundation
Carers UK
ARC (Arthritis Research Campaign)
Pain Concern
Gender Trust
Stroke Association
APEC (Action on Pre-eclampsia)
Mental Health Foundation
Cystic Fibrosis Trust
Asthma UK
Meningitis Research Foundation
Gingerbread
RNIB (Royal National Institute for the Blind)
Spinal Injuries Association
MIND
Parkinsons Disease Society
OUCH UK (cluster headache support)
Haemophilia Society
Positively Women (HIV/AIDS support)
Terrence Higgins Trust
Leonard Cheshire (disabled care and support)
www.patient.co.uk
www.alzheimers.org.uk
www.autism.org.uk
www.cancerbackup.org.uk
www.diabetes.org.uk
www.downs-syndrome.org.uk
www.kids.org.uk
www.mencap.org.uk
www.ageconcern.org.uk
www.crusebereavementcare.org.uk
www.uk-sands.org
www.bhf.org.uk
www.carersuk.org
www.arc.org.uk
www.painconcern.org.uk
www.gendertrust.org.uk
www.stroke.org.uk
www.apec.org.uk
www.mentalhealth.org.uk
www.cftrust.org.uk
www.asthma.org.uk
www.meningitis.org
www.gingerbread.org.uk
www.rnib.org.uk
www.spinal.co.uk
www.mind.org.uk
www.parkinsons.org.uk
www.clusterheadaches.org.uk
www.haemophilia.org.uk
www.positivelywomen.org.uk
www.tht.org.uk
www.leonard-cheshire.org
Summary
Health education is a subcomponent of health promotion and is the
term that is most appropriate for the teaching of patients, clients and
their families.
When teaching patients, clients and their families, the teaching can
either be planned in advance or spontaneous, depending upon the
context.
Teaching in small groups can be a very useful strategy for working with
patients, clients and their families, and it is used extensively in health
promotion in the community.
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References
Patients, clients, and their families are not students, and this needs to
References
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Part Four
Continuing
professional
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Preparation
12
Teaching and learning are subjects that involve all qualified nurses. They
live in a constantly learning profession where the teaching and facilitation
of students features greatly in their day-to-day working life. The Nursing
and Midwifery Council demands that registered nurses, midwives and
specialist community public health nurses maintain their professional
knowledge and competence by regularly taking part in learning activities
(NMC, 2004). They are also required to facilitate students of nursing and
midwifery and others to develop their clinical competence.
The main aim of this chapter is to focus on preparation for a nurse
education post in higher education; it will discuss the qualifications
necessary to become a nurse lecturer; gaining teaching experience,
setting probationary objectives once in an educational post; undertaking
a PGCE; compiling a portfolio of teaching evidence, and career pathway.
The terms teacher and lecturer will be used interchangeably but will
refer to the same position.
Criteria
Table 12.1
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Becoming
an ideal teacher
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The
The
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Chapter 12 Preparation
They also highlight that these factors include personal belief systems,
our own experience of being taught, our personality and our theoretical
understanding of the teaching and learning process. Learning to teach
is a complex, challenging, and, often, a painful experience, and student
teachers repeatedly begin their teaching experience with a simplistic
and idealistic understanding of their role, the relationship that they may
have with students and the nature of learning and teaching (Furlong and
Maynard, 1995).
Having taught in the clinical environment, most teachers would
report that it compares very little to the experiences and realities in a
higher education establishment. Approaches to teaching in practice are
seldom considered as it is often delivered on an ad hoc basis.
During a teaching career, all teachers will experience conflicting
feelings and emotions that are both negative and positive in nature.
Concerns are often associated with teaching a large audience and
controlling student behaviour.
It is probably fair to say that the above example and the issues associated
with it are often regarded as reality shocks and critical incidents. These
experiences can be meaningful because they are completely new, and
they can be both challenging and thought provoking; to some extent,
they bring home the reality of teaching adults. Student behaviour can be
poor at times, and their attitude is often fundamental in shaping a new
teachers approach to teaching. However it is the feeling of trepidation
when facing a larger audience that new teachers are likely to remember
most often, and finding a solution to managing such a situation is often
difficult. Concern about facing a large audience can stay with a new
teacher for some time, but there are some that might argue that this is
not a recurring feature associated with teaching. In other words, a fear
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The
Student behaviour
An aspect of teaching that is not often considered is identified by
Hinchliff (2001) who argues that, although teachers may be nervous
when teaching, the students may also be afraid to speak. Welsh and
Swann (2002) remind us not to underestimate the anxiety that students
may experience in learning situations; they say that care should be taken
to alleviate this and to assist students to progress towards their goals. A
possible reason for students reluctance to speak and ask questions in
class is addressed by Buckenham (1992), who found that increased group
size could often be intimidating and adversely affect communication.
Armitage et al. (1999) point out that students behaviour can
sometimes be irritating, disturbing or destructive, and that the kind
of behaviour that is acceptable in the classroom will depend on the
tolerance levels of the teacher on that particular day. They also point out
that teachers frequently establish a set of rules and set boundaries for
behaviour patterns but these rules are not often communicated because
of their association with the teaching of children.
Furlong and Maynard (1995) believe that a disruptive class or student
can be an extremely unsettling experience for student teachers and that
classroom control is essentially related to confidence. On the other
hand, Reece and Walker (2000) argue that careful planning of teaching
sessions ensuring that students are challenged appropriately with
relevant learning activities should increase motivation and reduce class
disruption. They do, however, acknowledge that some post-16 students
are not mature enough to respond fully to this situation; and, when this
happens, they suggest the use of a protocol.
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Table 12.2
Effective classroom management
In the classroom:
Try to avoid:
Try to:
Making
Making a step into higher education often proves difficult for many
nurses in practice for a variety of reasons. They do not know if they will
be suited to the environment or if the environment will be suited to them.
We have already established that teaching in practice differs greatly from
teaching in the education setting, but there are also many similarities.
Working in a team to ensure the best possible learning environment for
students is something with which all nurses are familiar, as is the necessity
to maintain professional development. To address areas of uncertainty
and to confirm the move is the right one, it might prove beneficial to
follow some or all of the following:
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Developing
probationary objectives
Developing
probationary objectives
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Table 12.3
Objectives for the probationary
period
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Achieving
Achieving
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Chapter 12 Preparation
and that new teachers were allocated what they regarded as the less
academic teaching and the teaching sessions that nobody else wanted
to teach.
PGCE curriculum
Whilst the PGCE provides both personal and professional development
at postgraduate level, it also enables new teachers to respond effectively
to the needs of adult learners in a rapidly changing higher education
sector. The knowledge and understanding that is usually gained during a
PGCE is clearly outlined by Neary (2002, p. 237) and relates to a number
of realistic learning opportunities that a PGCE can provide.
Table 12.4
The purpose of a PGCE
Make the transition from being an expert in a subject to becoming a professional teacher in the
post-16 sector
Acquire knowledge of relevant educational theories of the post-16 system
Study teaching within the social, psychological and philosophical context and relate these to
changes in the provision of education and training
Develop the strategies, tactics and expertise necessary for planning, preparing, implementing
and evaluating teaching and learning activities for the subjects and classes that he or she is
expected to teach
Identify barriers faced by learners in education and training, such as disability, age, race and
gender, and promote professional practice that recognizes and values diversity
Respond to the educational needs of the older adolescent and adult learner
Develop confidence in your professional knowledge; develop a personal philosophy of
education and commitment to and critical awareness of professional situations
Plan teaching and learning to meet students needs
Use a range of information technologies, media and methods to support teaching and promote
learning
Assess student learning and achievement, using an appropriate range of assessment techniques
Practise and develop a range of professional skills and techniques associated with an effective
teacher
Demonstrate effectiveness as a specialist teacher and reflective practitioner
Use opportunities to enhance own learning and develop skills and strategies to facilitate other
peoples learning
Investigate an aspect of an organization and understand the context in which education takes
place
Be enterprising and respond positively and effectively to change
Evaluate own effectiveness and students learning experiences
Adapted from Neary (2002)
Compiling
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Compiling
Section 2
Observed teaching activities
Lessons 1, 2, 3, 4, 5, 6
Lesson plans
Assessments of practical teaching
Reflections on teaching and assessment process
Lesson handouts
Section 3
Teaching evaluations
Section 4
Teaching environment
Section 5
Presentations
Teaching appraisals
Approaches to teaching and learning
Section 6
Assessment and marking
Table 12.5
Components of a teaching
portfolio
Section 8
Reflections
Section 9
Probationary objectives
Probationary objectives
Methods of achievement
Additional evidence to support teaching/learning activities
Section 10
Teaching curriculum
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Research activity
Increasingly, many lecturers are active in the field of research and are
also engaged in individual and departmental projects that enrich and
enliven their teaching; they are producing publications and developing a
profile in the research culture of the university (Hinchliff, 2001). There
is increasing pressure for nurse lecturers in higher education to become
research active, and the PGCE can often provide an ideal opportunity
to engage for the first time in a small research project. This can increase
motivation to incorporate research into teaching methods and can lead to
further involvement in research activity within education.
Professional
Career
pathway
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References
senior lecturer;
reader;
directorate manager;
deputy head of school;
head of school.
Having embarked on a career that ensures lifelong learning, teaching
in higher education can provide what can only be described as
emancipatory feelings. It appears that the more a person does and
achieves, the more that person is motivated and wants to progress, and
teaching in higher education offers opportunities to equip students with
the necessary tools for continued professional development and lifelong
learning.
Summary
It is evident from the literature and with hindsight from personal
experiences that planning for effective teaching and learning is the key
to a teachers success.
In order to achieve this, accessing an appropriate course of study
can ensure that novice teachers gain the necessary knowledge and
understanding of educational processes to influence their teaching
and learning strategies.
The PGCE can assist new teachers to develop key skills and
understanding of the theories of learning, curriculum planning,
lesson planning, preparation of the learning environment, and the
management of students in the classroom environment.
Teaching and learning is about flexibility; it is about learning how to
learn; it is about problem solving, and it is about growth.
Armitage, A., Bryant. R, Dunnill. R., Hammersley, M., Hayes, D.,
Hudson, A. and Lawes, S. (1999) Teaching and Training in Postcompulsory Education. Open University Press, Buckingham.
Buckenham, M. (1992) Academic and organisational change. In O. Slevin
and M. Buckenham (eds) Project 2000: The Teachers Speak Innovations
in the Nursing Curriculum. Campion Press, Edinburgh.
Burns, R. (1982) Self-concept Development and Education. Holt,
Rinehart & Winston, London.
Furlong, J. and Maynard, T. (1995) Mentoring Student Teachers: The
Growth of Professional Knowledge. Routledge, London.
References
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Lifelong
learning
13
Background
and context
The need for institutions to review, update and make available to all
staff their policies with regard to staff development.
and information technology on the role of staff, and ensure that the
necessary support and training is made available.
That an Institute for Learning and Teaching in Higher Education (ILT)
be established for the purpose of accrediting programmes of teachertraining, the commissioning of research into teaching and learning,
and the encouragement of innovation. All new full-time academic staff
should undertake an accredited teacher-training course as part of their
probationary period of employment.
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Chapter 13Lifelong
learning
This aim was welcomed by many people inside and outside the higher
education sector. Indeed, most members of the public would have been
unaware that higher education lecturers can be employed as teachers
without possessing a teaching qualification. Most higher education
institutions now require all newly appointed lecturers to undergo teacher
training as a condition of employment, the most common routes being a
postgraduate certificate in education. It is interesting to note that, in this
area, nurse education is leading the way; the UKCC, and more recently
the NMC, has always required teachers of nurses to hold a recognized
teaching qualification.
In 2003, the Department of Health published the White Paper,
The Future of Higher Education (DoH, 2003), which sets out the
Governments plans for radical reform and investment in universities and
higher education colleges. A year later saw the introduction of the Higher
Education Act 2004 intended to assist the implementation of a number
of policies set out in the above white paper. The Higher Education Act
2004 is divided into five sections as follows:
Section I refers to the new Arts and Humanities Research Council and
the funding of research.
and, provided that they have an approved plan, fees above the basic
rate.
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Lifelong
learning
Lifelong
learning
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Chapter 13Lifelong
learning
CPD programmes should meet local service needs and also those
of individual professionals. Higher education institutions and local
education agencies will have a key role in the development of CPD,
including innovative approaches to work-based learning (DoH, 1998).
The concept of clinical governance was also established within
this document, which identified a framework through which NHS
organizations are accountable for continuously improving the quality
of their services and safeguarding high standards of care by creating an
environment in which excellence in clinical care will flourish (DoH, 1998).
Clinical governance must be underpinned by a culture that values lifelong
learning and recognizes the key part that it plays in improving quality.
Gopee (2001) also recognizes the links between clinical governance and
lifelong learning, while being aware that lifelong learning is seen as an
inherent component of clinical effectiveness.
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Lifelong
learning and
CPD
learning and
CPD
Lifelong learning is also perceived as an essential aspect of postregistration education and practice, which according to Gopee (2001) is
seen as central to professional self-regulation in nursing. He claims that,
although lifelong learning is very much apparent in nurse education,
various other forms of informal learning occur all the time. Informal
learning can also take place in formal settings, such as modules and
courses at diploma, degree and higher degree level, study days and halfday shorter programmes (Gopee, 2001).
The Department of Health (1998) supports the identification of
professional and service needs in a personal development plan, which
should identify different learning preferences, highlight where team
or multi-professional learning offers the best solution and take full
advantage of opportunistic learning on the job. It emphasizes that CPD
does not necessarily mean going on a course.
Gopee (2001) points out that lifelong learning has evolved consistently
over the last few decades at conceptual level; however, obstacles remain,
and these are mainly at organizational level. Obstacles to lifelong learning
are identified in Table 13.1.
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Chapter 13Lifelong
learning
Table 13.1
Obstacles to lifelong learning
Lack of time
Lack of confidence
Negative effects of school experience
Distance from classes
Reluctance to go out at night
Adapted from Gopee (2001)
However, he does acknowledge that it may be necessary to assist selfdirected learners to be more effective in their quest for knowledge
because they may still need to acquire study skills. Study skills should be
an integral part of professional preparation in order that professionals
become lifelong learners.
What is interesting is that Jarvis (2005) explains how learners should
be given the opportunity to develop into self-directed learners rather
than become teacher dependent; they may then acquire a problemsolving attitude that would equip them better for their career. Following
this, nurse educators might see changes in their own role, moving away
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Lifelong
learning and
CPD
It appears from the study that the most influential factor for undertaking
CPD was to increase professional knowledge. The least influential factor
was the desire to achieve a higher educational qualification; students who
previously had poor education did not feel that this was a reason for
undertaking CPD. Other factors include:
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learning
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Reflection
Reflection
The concept of reflective practice is mainly associated with the idea
of reflection on experience (Johns, 1996); however, Watson (2002)
believes reflection to be an accurate representation of the students
practice and that gaps in knowledge and/or skill competence can be
identified quickly and rectified. According to Jasper (2003) reflective
practice has been identified as one of the key ways to learn from
experiences and education recognizes it as an essential tool for helping
health care students to make links between theory and clinical practice.
Spouse (2001) argues that for many years the theory-practice gap has
dominated approaches to preparing students for their future role, with
an increased emphasis on work-based learning. However, Jasper (2003)
further emphasizes how the learning that is achieved using reflective
strategies is different from the theory that provides the knowledge
underpinning practice. In other words, reflective practice bridges the gap
between theory and clinical practice by providing a strategy that helps to
develop both understanding and learning.
Dix and Hughes (2004) recognize that a considerable number of
learners benefit from reflective practice. Johns (1995) argued that, to
enable learners to understand and learn through lived experiences, they
should take congruent action towards developing increasing effectiveness,
within the context of what is understood as desirable practice. Many
nursing students are expected to keep reflective journals whilst on clinical
placements, and some are required to submit a reflective essay during
each module of the programme (Dix and Hughes, 2004).
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Chapter 13Lifelong
learning
(Schn, 1987) had considerable impact on both the teaching and the
nursing professions, providing, as the books do, an alternative rationale
for professional practice.
Schns focus is the relationship between academic knowledge as
defined in universities and the competence involved in professional
practice. He argues that professional practice is based upon a technical
rationality model that makes erroneous assumptions about the nature
of practice and in so doing reduces its importance in relation to theory.
Technical rationality views professional practice as the application of
general, standardized, theoretical principles to the solving of practice
problems; in other words, professional practice is problem-solving.
This top-down view puts general theoretical principles at the top of the
hierarchy of professional knowledge and practical problem-solving at the
bottom, leading to what Schn termed the pre-eminence of theory and
the denigration of practice.
Problem-setting
Within the technical rationality model, professional practice is viewed
as a process of instrumental problem-solving, with the assumption
that problems are self-evident. Schn, however, argues that in reality
practitioners are not presented with problems per se, but with problemsituations. These must be converted into actual problems by a process of
problem-setting, i.e. selecting the elements of the situation, deciding the
ends and means, and framing the context. Technical rationality also fails
to take account of the fact that problems encountered in professional
practice are rarely standard or predictable.
Knowing-in-action
Schn uses this term to describe the intuitive or tacit knowing that
is embedded in professional actions. Intuition is a mental process,
commonly termed the sixth sense, and refers to a process by which
an individual comes to a conclusion about something in the absence of
sensory inputs and without consciously thinking about it. For example,
skilled practitioners constantly make intuitive judgements about situations
without being able to specify exactly the criteria on which they base those
judgements; this is often termed thinking on your feet. Schn maintains
that, although this intuitive knowing is implicit within our actions, it
is possible for practitioners to access this by reflecting on what they are
doing while they are doing it.
Reflection-in-action
Reflection-in-action occurs when the practitioner is confronted by a
novel puzzle or problem-situation that he or she attempts to resolve. This
resolution occurs when the problem is re-framed, i.e. seen differently
during the actions. It is the process of reflecting upon the intuitive
knowing that is implicit in a practitioners actions, whilst at the same
time carrying out those actions, that constitutes reflection-in-action.
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Reflection
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Chapter 13Lifelong
learning
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reFleCtion
Stage 1: Return to experience
1. Describe the experience, recollect
what happened.
2. Notice what happened/how you felt/
what you did
Figure 13.1
Model of reflection
Stage 2: Attend to feelings
1. Acknowledge negative feelings but dont let
them form a barrier
2. Work with positive outcomes
Stage 4: Learning
(added by Johns, 1995)
1. How do I feel about this experience?
2. Could I have dealt better with the
situation?
3. What have I learnt from this experience?
Adapted from Boud et al. (1985); Johns (1995)
They go on to conclude:
Much as we may enjoy the intellectual chase, we cannot neglect
our full experience in the process. To do so is to fool ourselves into
treating learning from experience as a simple, rational process.
Whilst acknowledging the feelings of self and others enhances selfawareness and is an important aspect of health care, this stage could
be, and often is, incorporated within the experience/situation narrative,
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Chapter 13Lifelong
learning
Cue questions
Aesthetics
Personal
Ethics
Empirics
Reflexivity
The Johns model is more detailed than any of the models outlined,
and there are both advantages and disadvantages to this. The nursing
literature indicates that nurses need to be taught how to reflect, and the
detailed questions that practitioners are required to ask of themselves
in the Johns model certainly provide a comprehensive checklist for
reflection. The disadvantage of such a detailed structure is that it imposes
a framework that is external to the practitioner, leaving little scope for
inclusion of his or her own approach. It is also open to criticism on
the grounds of complexity, although other models can be criticized
on precisely the opposite grounds, i.e. that they may appear simplistic
and self-evident.
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Reflection
Table 13.3
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Interprofessional
education
Interprofessional
education
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Chapter 13Lifelong
learning
Shared learning
Much of the literature on multiprofessional teamwork has addressed
increasing collaborative practices through multiprofessional and sharedlearning programmes. Scholes and Vaughan (2001) explain that, whilst
this can occur in higher education settings, it also needs to centre on
learning from one another in practice if it is to be most effective.
Traditionally each profession has provided a different approach to
health care from a different educational base, and Masterson (2001)
notes that professional education and assessment of competence has
been traditionally uni-disciplinary. She also argues that service and role
developments require a readiness to cross traditional boundaries not only
in practice but also in education; as the work of health professionals
continues to change, significant changes will also be required in the
types of education and training that are provided. Following reforms in
education and service, Masterson (2001) expects to see greater emphasis
on work-based systems of learning, which aim to encourage the student
to be an autonomous learner (Chapman, 2006) and mean moving away
from a model in which the teacher imparts knowledge towards one where
the teacher is a facilitator of learning (Chapman and Howkins, 2003).
Educators and policy makers have argued that interprofessional
education breaks down some of the traditional and unhelpful demarcations
between the health and social care professions, facilitates cultural change
and promotes successful teamworking (Masterson, 2001). It is thought
to provide opportunities for health and social care professionals to
learn with, from and about each other, which, according to Masterson
(2001), includes developing knowledge, skills and attitudes required for
collaboration.
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Interprofessional
education
dentistry;
physiotherapy;
occupational therapy;
pharmacy;
social work;
psychology;
speech therapy;
dietetics;
audiology; and
chiropody.
Cooper et al. (2001) reported that the majority of educational
interventions occurred in non-clinical environments using academic
classrooms for teaching, although there was significant variation in both
the quality and the type of educational interventions used. The authors
point out that those educational interventions addressed a variety of
topics and that a range of teaching methods were utilized (see Table
13.4).
Topic
Teaching method
Table 13.4
Teamwork
Primary health care
Problem-solving
Chronic illness
Clinical skills
Communication skills
Health behaviour
Continuous improvement
Therapeutics
reaction;
learning;
behaviour; and
results.
Within each of these categories, a number of themes emerged. The reaction
category identified themes relating to evaluation of interprofessional
learning experiences, timing of courses and teaching methods. Each of
these themes demonstrated the value placed on the learning experience
with early learning experiences enhancing participation in interdisciplinary
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learning
Summary
The knowledge and skills of lecturers and practice educators are
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References
lifelong learning and recognizes the key part that it plays in improving
quality.
Lifelong learning is seen as an essential aspect of post-registration
education and practice and is central to professional self-regulation in
nursing.
Critical thinking and clinical actions empower the professional
nurse, and continuing education may be the key to promoting and
maintaining competency, strengthening the profession and improving
the quality of care.
Learners should be given the opportunity to develop into self-directed
learners rather than become teacher dependent.
Reflective practice has been identified as one of the key ways to learn
from experiences, and education recognizes it an as essential tool for
helping health care students to make links between theory and clinical
practice.
Reflection is essentially a psychological construct that is closely related
to a range of other internal mental (cognitive) processes, such as
thinking, reasoning, considering and deliberating.
Reflection-in-action occurs when the practitioner is confronted by a
novel puzzle or problem situation that he or she attempts to resolve.
The reflective practitioner is characterized by a range of personal
qualities and abilities, such as the ability to engage in self-assessment,
to criticize the existing state of affairs, to promote change and to adapt
to change, and the ability to practise as an autonomous professional.
A model by Boud et al. with a fourth stage added by Johns could be
acknowledged as one of the clearer models of reflection; with only
four stages, it allows less room for irrelevant material.
A short and clear model of reflection would allow for freedom of
expression and could incorporate three steps: the learning experience,
evaluation, and personal and professional development.
Atkins, S. and Murphy, K. (1993). Reflection: a review of the literature.
Journal of Advanced Nursing, 18, 11881192.
Borton, T. (1970) Reach, Touch and Teach. Hutchinson, London.
Boud, D., Cohen, R. and Walker, D. (eds) (1993) Using Experience for
Learning. Open University Press, Milton Keynes.
Boud, D., Keogh, R. and Walker, D. (eds) (1985) Reflection: Turning
Experience into Learning. Kogan Page, London.
Burnard, P. (2005) Reflections on reflection. Nurse Education Today, 25,
8586.
Castledine, G. (2001) Is pre-registration nurse education being ignored?
British Journal of Nursing, 10(20), 1371.
Chapman, L. (2006) Improving patient care through work-based
learning. Nursing Standard, 20(41), 4145.
References
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14
Continuing
professional
development: the university context
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CPD in
CPD
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teaching;
curriculum planning; and
administration.
Figure 14.1 illustrates the multi-faceted role of nurse lecturers.
Figure 14.1
Nurse lecturer roles in higher
education
Curriculum
Planning, implementing
and evaluating
Administration
Managing modules, timetables
and record- keeping
Assessor
Marking theory and
portfolio assessments
Personnel role
Recruitment and
selection of students
LECTURER
Research
Education research
and practice research
Teaching
Students in college and
clinical placement
Professional development
PREP, reflection, publish,
conference paper presentation
The standards for teaching and learning (FENTO, 2002) stipulate that
teachers need to contribute effectively to the continuous improvement
of quality by evaluating their own practice, by identifying opportunities
for personal and professional development, and by participating in
programmes of professional development. To do this, teachers should:
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Undertake
research
Write book/
journal paper
staFF
Team
teaching
Present paper
at conference
Continuing
Professional
Development
Undertake
international exchange
Figure 14.2
CPD activities for nurse lecturers
Take on new
responsibilities
Apply for
secondment
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Chapter 14 CPD:
Purposes of appraisal
Appraisal is used for a variety of purposes within educational management,
and these can be broadly classified into those that are aimed at the
person being appraised and those that are aimed at management. In
the former category, appraisal is used to encourage staff development,
self-evaluation, team awareness and review of performance. From the
management point of view, appraisal is used to clarify the organizations
objectives, to improve communication, to develop staff resources and to
evaluate the performance of the organization. An appraisal can be thought
of as a system in which staff can provide feedback to management and
management can provide feedback to staff, in terms of ambitions, growth
and development and perceived needs. The process of appraisal centres
around two questions:
There is one purpose that has been omitted, but which is commonly
suggested, namely discipline. Indeed, appraisal may be a euphemism for
a procedure that ends in disciplinary action, but it should not be used as
a system for disciplinary action, since this undermines the whole purpose
of appraisal, i.e. the development of the individual. Clearly, disciplinary
action may be required in some cases, but the procedure should be
distinct from appraisal. Equally, an appraisal interview should not form
the basis for an employers reference, as this may inhibit free and frank
discussion during appraisal.
Implementing appraisal
In order to have maximum benefit for both appraisee and appraiser, the
appraisal interview needs careful planning, and confidentiality must be
ensured. The following sequence may be useful:
Preliminary reflection
A week or two before the appraisal interview, each party should take time
to complete an initial form that focuses on key aspects of the appraisal
such as those illustrated in Table 14.1. This ensures that each party has
given consideration to the various aspects of appraisal and should mean
that the interview itself can be used to best advantage
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Staff
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Chapter 14 CPD:
This section of the appraisal should identify training or development activities, highlighting each
activity in priority order. This should then be agreed upon by both appraisee and appraiser.
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Table 14.2
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Chapter 14 CPD:
Professional values
Respect for individual learners
Commitment to incorporating the process and outcomes of relevant research, scholarship and/
or professional practice
Commitment to development of learning communities
Commitment to encouraging participation in higher education, acknowledging diversity and
promoting equality of opportunity
Commitment to continuing professional development and evaluation of practice
Adapted from HEA (2006b)
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research
Figure 14.3
Developing
distance learning
and flexible
learning study
materials
Writing books
Contributing
chapters in books
Writing journal
papers
Undertaking
research projects
research
assessment exercise
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Chapter 14 CPD:
The next research assessment exercise is scheduled for 2008 and is the
sixth in a series of exercises conducted nationally in order to:
assess the quality of UK research and to inform the selective
distribution of public funds for research by the four UK higher
education funding bodies; it will provide a flexible framework for
all forms of research to be assessed on an equitable basis.
(RAE, 2006a)
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Research
assessment exercise
Hence, panel criteria are also established for nursing and midwifery.
The criteria for the RAE in 2008 include submissions from all areas of
nursing, midwifery and specialist community public health nursing and
take account of the following themes:
research staff;
research outputs;
research environment:
research students and research studentships;
research income;
research structure;
staffing policy;
research strategy;
esteem indicators;
applied research and practice-based research;
individual staff circumstances;
working methods.
Example of RAE assessment criteria
The following is a brief summary of the 2008 RAE assessment criteria
for the unit of assessment (UOA) number 11, Nursing and Midwifery
(RAE, 2006b).
The panel will be looking for research of high quality that contains
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Chapter 14 CPD:
The definitions of quality levels, which will apply to the 2008 RAE,
are identified in Table 14.3.
Table 14.3
4*
3*
2*
1*
Unclassified
Work of a quality that does not meet the definition of one star, or which does
not meet the published definition of research for the purposes of the RAE.
The RAE mechanism has been criticized for separating teaching and
research, particularly in the classification of academic staff into research
active and non-research active staff. Nevertheless, the RAE is clearly
a significant aspect of continuing professional development in nurse
education, with important implications for career development. McNay
(1997) found that 43% of higher education staff felt that their career
planning had been significantly affected by the RAE. The Web site address
for the RAE is http://www.rae.ac.uk.
Research
governance
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Research
governance
Table 14.4
Defines mechanisms of delivering the principles, requirements and standards within the
framework
Describes monitoring and assessment arrangements
Improves research and safeguards the public by:
Enhancing ethical awareness and scientific quality
Promoting good practice
Reducing adverse incidents and ensuring lessons are learnt
Forestalling poor performance and misconduct
Is for all those who:
Design research studies
Participate in research
Host research in their organization
Fund research proposals or infrastructure
Manage research
Undertake research
Is for managers and staff in all professional groups, no matter how senior or junior
Is for those working in all health and social care research environments, including:
Primary care
Secondary care
Tertiary care
Social care
Public health
Research governance
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Chapter 14 CPD:
Writing
for publication
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Writing
for publication
a book under your belt! However, the reality is very different; most
authors would rather write a dozen sole-authored books than be the
editor of one multi-contributor text!
The editors job requires a combination of characteristics, including
vision, literary skills, administrative skills, and above all interpersonal
communication skills. Vision is required if one is to come up with
an idea for an edited book that will make a significant contribution
to professional knowledge or debate, and at the same time more or
less guarantee sufficient sales to meet the publishers targets. It is also
required when deciding the structure of the book and the decisions
about who should be invited to contribute a chapter or chapters. Editing
a book is a complex business, and good administrative skills are essential
to maintain communication with the contributing authors. The more
contributors one has in a book, the more difficult the task of editing
becomes. The very fact that contributors are chosen for their expertise
will inevitably mean that they have other priorities that get in the way of
manuscript deadlines, and one of the most frustrating aspects of editing
is the chasing-up of chapter drafts from contributors. This is where
interpersonal communication skills come in; a mixture of friendliness,
respect and assertiveness will go a long way in encouraging recalcitrant
authors to submit their manuscripts, but as a last resort the editor can
always enlist the assistance of the publisher to send a more formal
reminder to them.
Writers block
One of the problems encountered by professional writers from time to
time is the so-called writers block, a psychological state in which an
experienced writer becomes unable to write, sometimes for considerable
periods of time. This phenomenon is more likely to occur in the case of
sole-authored works, where the workload is considerably greater than
that involved in contributing one or two chapters to an edited volume.
The everyday workload of teachers in nurse education makes major
demands on their time and commonly spills over into their private time
in evenings and weekends. Hence, the added demands of authoring
a book can be very stressful, particularly as deadlines approach and
slippage occurs. This stress can be compounded by feelings of guilt about
neglecting family responsibilities, and the demands of writing may mean
that insufficient time is available for recreational pursuits that are so
important for re-charging the batteries.
There are a number of strategies that may help prevent or eliminate
writers block. It is important to ensure that, wherever possible, writing
is done when you are fresh and alert. Writing is a creative activity, and
it is very difficult to be creative if you are exhausted in the evening after
a heavy days work. Maintaining regularity of writing is also important,
because the more one slips behind in the writing schedule, the more
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Chapter 14 CPD:
pressure and guilt we feel; this in turn may cause further blocking, so
writers should try to do even a small amount of writing each day if
possible.
Some publishers prefer to meet with their authors on a regular basis
throughout the period of writing, so as to maintain contact and to
monitor the authors progress. Whilst this may not be welcomed by every
author, meetings with the publisher once per term serve as mini-deadlines
that help to maintain focus and ensure that the schedule is adhered to.
Writers rights
Given the ubiquity of photocopying, authors and editors of books need
to know their rights in relation to their intellectual property. Chapter
5 (p. 211) discusses the legal position with regard to photocopying of
books and journal articles and identifies the restrictions on the amount
and type of material that can be copied. The Authors Licensing and
Collecting Society (ALCS) exists to collect fees for photocopying and to
pass 50 per cent of these on to those authors who are members; the other
50 per cent goes to the publisher. Membership involves a small annual
fee. ALCS has issued a declaration of academic writers rights (ALCS,
1998) that covers the following areas:
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Writing
for publication
journals offer a guide for contributors that covers such aspects as word
length, a requirement for the manuscript to be both on hard copy and
disk, referencing format, illustrations and charts, and information about
the review process.
Trouble-shooters checklist for prospective authors
Alton-Lee (1998) offers the following checklist for prospective authors,
based upon the critical feedback given to authors by reviewers. The
checklist identifies 13 weaknesses demonstrated by prospective authors,
and these are given in rank order of occurrence, from most common to
least common, in the 142 studies researched.
1. Lack of methodological transparency, adequacy, or rationale:
insufficient information given.
2. Unjustified claims: based on insufficient evidence, or in spite of
evidence.
3. Shortcomings in format: title, abstract, presentation of data, style,
etc.
4. Theoretical shortcomings: failure to provide, articulate or develop
theoretical perspectives.
5. Data analysis problems: inadequate or lacking in substance.
6. Inadequacies in literature reviews: insufficient, dated, not linked to
subsequent studies.
7. Insufficient clarify of focus: focus not clear at outset, focus changed,
no statement of research question or purpose of study.
8. Conceptual confusion: need to take more care with definitions, and
use of metaphor.
9. Parochial blinkers: ensure that local contexts, policies and practices are
made meaningful to readers in different regions or countries.
10. Does not add to the international research literature: need to ensure
that the manuscript extends or develops the international literature in
the area of study.
11. Failure to link findings to the research literature: authors had not
linked their findings to the relevant research literature.
12. Lack of critical reflections on implicit assumptions: authors are
challenged to focus critically on unexamined issues implicit in their
manuscripts such as gender, political and economic resource issues,
etc.
13. Victory claims: reviewers rejected overly optimistic outcomes and
achievements as lacking in credibility.
An interesting study that surveyed the views of editors of nursing
journals about the process for submission and review of articles is
described by Wildman (1998). Data were received from 22 journals, 16
of which routinely submitted articles to referees or reviewers. In terms
of the quality of papers submitted, the data showed that there were two
main aspects that made a manuscript immediately appealing to editors:
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Chapter 14 CPD:
relevance and presentation. There were three main grounds that would
cause editors to immediately reject a manuscript: irrelevance, poor
presentation, and failure to adhere to guidelines.
The most common problems with manuscripts included poor academic
work, poor use of English, non-adherence to guidelines, inappropriate
references, poor presentation and unaltered coursework. The points most
frequently raised with authors about the suitability of their manuscripts
for publication included a requirement for better editing to improve
understanding, amendments to meet journal requirements, attention to
writing style, a need to be more critical, and an alteration of the title.
Based upon the study, and the literature, the author offers a checklist for
successful publication that includes the following helpful points.
Prospective authors should:
Celebrate when the article is accepted, but be prepared for a long wait
before it is published.
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Writing
for publication
The authors remind us that, like students, prospective authors are also
learning a craft, so reviewing journal papers should be a supportive and
encouraging process.
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Chapter 14 CPD:
consistently to the correct image. The rules include such aspects as the
institutions crest, logo and corporate colours; the corporate typeface,
front and back covers, and the corporate house style for letters,
memoranda and facsimile.
Issues relating to the writing of open, distance and flexible learning
materials are discussed in Chapter 4 (p. 167).
Summary
Within all sectors of education, continuing professional development
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References
References
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15
Continuing
professional
development: the workplace context
Post
The RCN (2002) emphasizes not only that all nurses must embrace and
engage in the principles of continuing professional development
and lifelong learning but also that professions that work together should
learn together. Standard 6 of the NMC Code of Professional Conduct
(2004) tells us that we must maintain our professional knowledge and
competence. It further states that all registrants:
Must keep your knowledge and skills up-to-date throughout your
working life. In particular, you should take part regularly in learning
activities that develop your competence and performance.
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Post
The PREP standard can be met in a variety of ways, and The PREP
Handbook (NMC, 2006a) provides a template for recording evidence
of CPD learning: i.e. evidence of where the registrant was working;
the nature of the learning activity; a description of the learning activity
and how the learning activity informed and influenced the work of
the registrant. Table 15.1 outlines a suggested template for recording
evidence of PREP.
CPD PERIOD the three year period to which this learning applies
Table 15.1
From:
To:
WORKPLACE where you were working when the learning activity took place
Name of organization:
Brief description of your work/role:
NATURE OF THE LEARNING ACTIVITY
Date:
Briefly describe the learning activity, for example, reading a relevant clinical article, attending a
course, observing practice:
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All nurses should receive some assistance from their employers for
CPD, but the primary responsibility for maintaining competence to
practice remains with the individual. Continuing professional development
ensures that the practitioner remains not only fit to practise but also
develops the knowledge and competence needed to advance practice
and progress through clinical and other career pathways (RCN, 2004).
However, the RCN (2004) acknowledges realistically that employers
wanting to access government finance and individual nurses seeking
CPD support from their employers face many obstacles. In an attempt
to overcome this, the RCN suggests an increase in collaboration between
clinicians and nurse teachers to facilitate work-based learning, which
should be research focused and educationally grounded.
The DoH (2001) fosters the belief that post-registration education
and CPD should be grounded in clinical governance and draw on
clinical audit. Clinical effectiveness findings enable the development of
a research-aware workforce. The clinical governance framework is an
umbrella term for everything that helps to maintain and improve high
standards of care for patients and the RCN (2003) emphasizes how
education, training and development are an integral component of this
framework. Hinchliff (1998) puts this quite succinctly and claims that
CPD is potentially a key tool in maintaining standards.
resOurces
FOr
cPd
There are many different ways in which CPD can be accomplished and
not just through undertaking post-registration courses. Figure 15.1 shows
how CPD can be achieved; Figure 15.2 gives examples of self-directed
CPD, and Figure15.3 shows CPD activities that require support.
Figure 15.1
Examples of CPD activities
Self-directed
study
Formal
study
Continuing
Professional
Development
Conference
attendance
Clinical
supervision
Organizing
study days
Clinical
activities
Professional
activities
Policy/standard
development
Reading nursing
journal articles
Research
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Selfevaluation
Selfdirected
CPD
Present a paper at
conference
Review
research
Self-appraisal
Distance
learning course
Conduct
research
Clinical
teaching
Reflect on a
critical incident
Annual mandatory
training
Assisted
CPD
Job
rotation
Figure 15.2
Examples of self-directed CPD
activities
Shadow a student
and/or teacher
Maintain professional
portfolio
Develop
information board
for students/staff
Read a book/
journal article
Figure 15.3
Examples of assisted CPD
activities
Take on new
responsibilities
Apply for
secondment
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Chapter 15 CPD:
Staff
appraisal
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Personal
development planning
Table 15.2
Personal
development planning
The implementation of Agenda for Change (DoH, 2003) and the process
of personal development review are becoming the accepted means of
turning learning into improvements in care and services. Harding and
Salmon (2005) recognize that most activities in the workplace can be
regarded as opportunities for self-directed learning, for teaching others,
or for strengthening and enhancing knowledge and skills. The authors
maintain that most professional learning is experiential or reflective in
nature, occasioned by events and experiences at work. They define onthe-job learning and development as follows:
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Chapter 15 CPD:
The DoH (2004) emphasizes that the KSF is designed to form the basis
of a development review process; it is intended to be an ongoing cycle
of review, planning, development and evaluation for all staff that makes
links between the needs of the organization and the development needs
of individual staff members. Figure 15.4 demonstrates the development
review process.
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Figure 15.4
Development review process
Joint review of
individuals work
against the NHS KSF
outline for the post
Joint evaluation of
applied learning and
development
Jointly produce
personal development
plan identify needs
and agree goals
Individual
undertakes supported
learning and
development
the demands of their current post and identifying whether they have
any development needs;
developing a personal development plan for the individual outlining
the learning and development to take place;
learning and development for the individual supported by the
reviewer;
evaluating the learning and development and reflecting on how it has
been applied to work.
The DoH (2004) explains that the review process benefits individuals
by:
enabling them to be clear about the knowledge and skills that they
need to apply in their post;
identifying the knowledge and skills that they need to learn and
develop throughout their careers;
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Chapter 15 CPD:
Clinical
education co-ordinator/facilitator
teacher/practitioner;
clinical teacher;
education facilitator;
practice educator;
practice development nurse/facilitator; and
educator/practitioner (Hughes, 2006).
These education co-ordinators plan practice placements, allocate
students to appropriate learning situations and provide personal support
to students, mentors and all qualified and unqualified staff. Practicebased teaching is not new, and Koh (2002) believes that it is often seen
as a means of enhancing student learning and enriching the clinical
learning environment. To support students and qualified staff in practice,
effective educational activities within the clinical environment should be
available.
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Clinical
education co-ordinator/facilitator
Table 15.3
Identify competence, skill, learning or knowledge required, which may be simple or require a
complex level of research.
Stage 2:
Identify key people or stakeholders involved, which will include staff, patients, managers,
purchasers, providers or those commissioning services.
Stage 3:
Consider the best means of ascertaining the knowledge of the key people in stage 2; identify what
they need to know, or do, to achieve stage 1.
Stage 4:
Consult all groups identified in stage 2 and check their understanding.
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Chapter 15 CPD:
Stage 5:
Analyse data, using valid systematic methods and match against what needs to be known or what
skills are required to find the gaps in the present knowledge or skill this will identify a training
need.
Stage 6:
Present to management with a plan of how to meet identified need.
Adapted from Pedder (1998)
Benefits
Drawbacks
Clinical
governance
The Government White Paper The New NHS: Modern, Dependable (DoH,
1997) introduced a new quality initiative called clinical governance,
which has important implications for professional practice and teaching.
Clinical governance is a framework that unites a range of quality
initiatives including clinical effectiveness, evidence-based practice,
reflective practice, and quality improvement processes such as clinical
audit. The aim of clinical governance is to assure and improve clinical
standards at local level throughout the NHS.
The White Paper also created a new quality body called the National
Institute of Clinical Excellence, whose purpose is to appraise new and
existing interventions, and to disseminate evidence-based guidance.
It may be helpful at this stage to offer a range of definitions of the
term clinical governance, in order to identify its key components.
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Clinical
governance
professional self-regulation;
strong leadership;
effective communication;
being patient focused;
a commitment to quality;
valuing each other; and
continuing professional development.
Activities relating to clinical governance
The main activities relating to clinical governance are outlined by Cook
(1999) and the NMC (2006b):
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Chapter 15 CPD:
Risk management:
health and safety assessment;
clinical risk assessment;
staff training;
policy/procedure/protocol development.
Quality initiatives:
continuous professional development;
standard setting;
complaints handling and critical incident reporting;
user/patient involvement;
evidence-based practice;
clinical supervision.
Clinical effectiveness:
standard setting;
evidence reviews;
identification/production of clinical guidelines.
Clinical audit:
criterion-based audit;
significant-event audit.
Cook points out that all nurses will need to acquire the skills to
carry out these elements of clinical governance, including auditing skills,
disseminating good practice, and appraising research findings. The
application of these principles provides an environment in which clinical
excellence can flourish and high standards of patient care can be provided
(NMC, 2006b).
The implementation of clinical governance differs somewhat between
NHS trusts and primary care groups (PCGs). In the former, the chief
executive is responsible for ensuring that the trust is meeting its quality
responsibilities; in the latter, a senior professional member takes
responsibility for planning and implementation throughout the PCG.
As mentioned earlier, the clinical governance framework brings
together a number of quality initiatives, some of which are already well
established, and others that are new. The following sections will address
a selection of these initiatives.
National Institute
for
Clinical Excellence
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Clinical
Clinical
Table 15.5
Stage 2:
Stage 3:
Stage 4:
Stage 5:
Clinical effectiveness
Adams (1999) outlines the requirements for clinical effectiveness:
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Chapter 15 CPD:
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Clinical
Clinical audit
NICE (2002) defines clinical audit as:
a quality improvement process that seeks to improve patient care
and outcomes through systematic review of care against explicit
criteria and the implementation of change. Aspects of the structure,
processes and outcomes of care are selected and systematically
evaluated against explicit criteria.
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Chapter 15 CPD:
Self-assessment
Self-assessment is the process of identifying your strengths, weaknesses,
opportunities and threats (SWOT); it can also identify your interests,
personality, traits and values and can be used in order to make an
informed career choice or to assess your current career role.
The most common personality inventory is the Myers-Briggs, which
identifies attitudes, needs, individual traits and motivation (available
from the Myers-Briggs Foundation: www. myersbriggs.org). However,
for the purposes of this chapter, we will focus on self-assessment and
SWOT analysis of professional development.
A SWOT analysis is aimed at discovering certain characteristics
about you and/or your job. By recognizing your strengths, weaknesses,
opportunities and threats, you are in a position to uncover your talents
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Self-assessment
and abilities and put your weaknesses and threats into perspective. A
SWOT analysis can be undertaken for a number of reasons, for example,
within the change management process when considering a change
in current practice. It is also used for assessing ones suitability for
promotion or a career change.
Self-assessment and SWOT analysis have many benefits, allowing each
individual to:
Weaknesses
Table 15.6
Opportunities
Threats
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Chapter 15 CPD:
Strengths
Weaknesses
Bachelor degree
Specialist practitioner NMC
Excellent interpersonal skills and works well
within a team
Outstanding organizational skills
Adapts well to change
High standard of achievement
Ability to build relationships
Very supportive, approachable, reliable,
trustworthy, competent, confidential and
professional.
Honesty (can also be a weakness)
Sense of humour
Motivated and good motivator
Works well under pressure
Enjoys challenges
Experience of teaching in practice
Some experience of teaching students in
university
Identifies own limitations need for support
Summary
All nurses must embrace and engage in the principles of continuing
professional development and lifelong learning.
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Summary
All nurses should receive some assistance from their employers for
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Chapter 15 CPD:
References
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References
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Index
Page reference in italics indicate
tables or figures.
Beattie, A.
fourfold model of curriculum
1234
Behaviour modification 95, 98
Behavioural objectives model of
curriculum 95, 11121
behavioural objectives
components 113
critique of 1201, 120
educational goal statements
11112
Stenhouse on 121, 122
taxonomy of educational
objectives 11419, 115,
11618, 11920, 1923,
193
Behaviourism 22, 23, 91
approach to learning 918, 99
approach to motivation 367
Belbin, R.M.
on teamwork 2378, 237, 238
Benner, Patricia
model of skill acquisition
3712
Bias in assessment 279, 300
Bibliographies 320
Blackboard Academic Suite
218
Bloom, Benjamin
mastery learning 96
taxonomy of educational
objectives 11415, 115
taxonomy and question
formulation 1923, 193
Boards of examiners 151,
31012, 310
Books 319, 329
citing references 3212, 321
photocopying 474
reading skills 3223
writing and editing 4723
Boud, D. et al
model of reflection 4468,
447
Brainstorming 252, 330
Branching programmes of
learning 956
Breastfeeding 4089
Brown, G. & Edmondson, R.
classification of questions 194
Bruner, Jerome
and discovery learning 813
Buzz groups 229, 2512, 292
502
9780748797660_Q_Nursing.indd 502
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Index
clinical effectiveness 493,
4935
evidence-based practice 493,
493
National Institute for Clinical
Settings (NICE) 4923
Clinical practice placements see
Workplace settings
Clinical rounds 365
Clinical supervision 35961,
3601
group 361
one-to-one 361, 3623, 362
for personal tutors 386
Closed-circuit television 214,
232
CMT (computer-mediatedtutoring) 174, 217
Code of Professional Conduct
(NMC, 2004) 378, 397, 458
Coding systems 82, 82
Cognition 56
memory 5662
perception 623
thinking 639
Cognitive development, Piagets
theory of 1819
Cognitive domain of educational
objectives 11516, 115,
11618
Cognitive strategies 88
Cognitive styles see Learning
styles
Collection curricula 135
Communication
lecturer-student 2278
nurse-patient 396, 397
Community health nursing
learning environment in 347
standards of proficiency
78, 8
Competence 2978, 354
Comprehension 115, 116, 117,
193, 193
Computer-assisted learning
(CAL) 21516
Computer-mediated tutoring
(CMT) 174, 217
Concepts 64, 85, 858
Ausubel on 76
demonstrating 2334
difficult 205
mapping 1868, 187
rules and 878
teaching 189, 201
Concrete concepts 64, 84, 856,
87, 201
Concrete experience (CE) 35,
42, 43
Concrete operational stage of
cognitive development 19
Concurrent validity 270
Conditioning 91
classical 84, 912, 923, 97
operant 84, 935, 978
Conferences, presenting papers
at 477
Confidentiality, patient 397, 403
Conjoint validation of curricula
136
Conservation 19
Consolidation theory of
forgetting 62
Databases 319
Dearing Report (1997) 157,
4356
Debate 259
Decay theory of forgetting 62
Decision-making 723
Declarative knowledge 58, 73, 88
Deduction 67
Deductive teaching of concepts
189
Deep approach to learning 434,
50, 1889, 317
Definitions 867, 87
Demonstrations 231
of principles or concepts 2334
of psychomotor skills 2313,
2312
Development, human 17
adult 20
ageing 202
intellectual 1819
Development review 10, 4867,
487
Development, staff see Continuing
professional development
Developmental model and APEL
130
Deviance 344
Dewey classification scheme 318
Diaries 294
reflective 291, 3656
Disabilities, provision for students
with 13941
Disability Rights Commission 141
Disciplinary action 462
Discovery learning 76, 813, 248
Discrimination
and assessment 271
and learning 85, 856
Discrimination index of objectivetest items 288
Discussion groups 2468
Distance learning
context 1656
and continuing professional
development 459
defining 1634, 164
delivery systems 1667
managing 1747
materials for 16771, 16970,
1712, 4778
quality assurance 1778
role of tutor 1724
Diverger learning style 42
Dix, G. and Hughes, S.J.
strategies to help students to
learn effectively 4551
Domain-referenced assessment
269
Double-marking 308
Driscoll, J.
model of reflection 449, 449
Drives, motivation as 3841
Dual-code theory of memory 60
Dyslexia 139, 140
Ebbinghaus, H.
on memory 61
Editorial boards and flexible
learning 174
Editors 4723
Education co-ordinators 48890
Educational audit of student
placements 353
Educational objectives 11112
taxonomy of 11419, 115,
11618, 11920, 1923, 193
Email 21617
Emap Healthcare Open Learning
167
Emotions
managing in the workplace
3501
and motivation 389
in small groups 261
Empowerment 23
Encoding specificity theory of
forgetting 62
English National Board (ENB)
354, 358
Environments, learning see
Learning environments
Episodic assessment 268
Episodic knowledge 58
EPP (expert patient programme)
412
Equal opportunities 138
curriculum provision 13940
student support mechanisms
1401
Equilibration 18
Eros 378
Essays 273
composing 3303, 331, 332,
333
feedback and 27981
marking and grading
2769, 276, 277, 278
students marking own 289
types of 2756
variants of 281
weaknesses 2745
Ethology 37
Evaluation 141
503
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Index
see also Assessment; Quality
assurance
of arguments 68
educational objective 115, 116,
118, 193, 193
formative and summative 2689
Evidence-based practice 493, 493
Examinations
see also Essays
conduct of 307
examination technique 335
open-book 281
revising for 3345
seen papers 281
and student fatigue 274
Examiners, boards of 151,
31012, 310
Examiners, external 152, 309,
310, 310
Exercises 260
Expectancy effect 345
Experience and adult learning 31,
32, 51
Experiential learning 33, 2356,
341
Accreditation of Prior 35,
12931, 2956, 460
common difficulties 2602
groups 250
Jarviss typology of learning
356
Kolbs theory 345, 34, 235
learning styles and 423
planning and implementing
2404, 240, 241
reflection in 23940
Rogers and 24
and small-group teaching
234, 235
techniques 25060
as therapy 236
Experimentation 346
Expert patient programme (EPP)
412
Explanations 189
classification of 18990
sequence for planning 1901,
191
to patients, clients and
families 403
External examiners 152, 309,
310, 310
Gagn, Robert
conditions of learning 72,
8391
theory of instruction 901
Gaming 257
Gender issues when learning 49
General adaptation syndrome
348
Gestalt psychology and insight
learning 70, 701
Gestures during lectures 228
Global method of marking 278
Grades and grading 2767, 276,
278, 305
Grammar 279
Groups
see also Small-group teaching
clinical supervision 361
dynamics of 2369, 237, 238
dynamics and the workplace
3425
participation in group
discussion 3256
Jarvis, P.
typology of learning 356
Johns, C.
model of structured reflection
448, 448
504
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Index
Joint Information Systems
Committee (JISC) 334
Journals 319, 329
citing journal articles 322, 322
photocopying 474
refereeing journal papers
4767
writing for 4746
Kerry, T.
classification of questions 194
Key words (mnemonics) 61
Knowing-in-action 444
Knowledge
declarative and procedural 58,
73, 85, 88
educational objective 115,
116, 116, 193, 193
episodic and semantic 58
representation in memory
5860
transmission of 124, 222, 223
Knowledge and Skills
Framework (KSF) 10, 486
Knowledge-in-action 445
Knowles, M. S
on teaching of adults 2732
Khler, W.
insight learning experiments
701
Kolb, D.
learning style inventory 423
theory of experiential learning
345, 34, 235
KSF (Knowledge and Skills
Framework) 10, 486
505
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Index
New NHS, The: Modern,
Dependable (DoH, 1997) 490
NHS
developments in 810
Knowledge and Skills
Framework 10, 486
NHS Improvement Plan 8, 401
NICE (National Institute of
Clinical Excellence) 490,
4923
NMC see Nursing Midwifery
Council
Non-verbal communication
during lectures 228
Norm-referenced assessment 269
Norms
group 237
in the workplace 3434
Note-taking 229, 3234, 324
systems for 3245, 324, 325
Notes, teachers 196
NSFs (National Service
Frameworks) 401
Nurse lecturers see lecturers
Nursing Midwifery Council
(NMC) 2
and assessment 265
Code of Professional Conduct
(2004) 378, 397, 458
and educational programmes
133, 134, 162, 1623
post-registration education
and practice (PREP)
standards (2006) 34, 459,
4802, 481
principles for clinical
supervision 360
principles for practice learning
351, 352
standards for mentors 378,
3789
Standards for the Preparation
of Teachers of Nurses,
Midwives and Specialist
Community Public Health
Nurses (2004a) 45
Standards of Proficiency for
Pre-registration Midwifery
Programmes of Education
(2004c) 67, 7
Standards of Proficiency for
Pre-registration Nursing
Education (2004b) 56,
6, 297
Standards of Proficiency for
Specialist Community
Public Health Nurses
(2004d) 78, 8
Nursing Midwifery Order
(2001) 2, 133, 162
Nursing models 110, 125
Nursing profession,
developments in 28
Nursing Standard 483
NVQs (National Vocational
Qualifications) 130, 298, 341
Object permanence 18
Objective tests 2812
analysis of objective-test items
2878
classification of 2823
guidelines for writing 2837
Objectives
behavioural objectives model
of curriculum 11121
curriculum as 107
Objects, categorization of 812
Observation, assessment by
298301, 345
Observational learning theory
98100
Occupational socialization
3423
OHPs (overhead projectors)
20910
OLF (Open Learning
Foundation) 168
One-to-one clinical supervision
361, 3613, 362
One-to-one teaching
opportunistic 2045
with patients and clients 404,
404
in the workplace 3634
Online campus 21718
Online public access catalogue
(OPAC) 31819
Open learning
context 1656
and continuing professional
development 459
defining 1634, 1645, 164
delivery systems 1667
managing 1747
materials for 16771, 16970,
1712, 4778
quality assurance 1778
tutors role 1724
Open Learning Foundation
(OLF) 168
Open University 165, 167
Open-book examinations 281
Operant conditioning 935
educational applications 978
prototype of learning 84
Opponent-process theory 389
Opportunistic teaching 2045,
363
Overhead projectors (OHPs)
20910
506
9780748797660_Q_Nursing.indd 506
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Index
Psychosis, supporting patients
with 40910
Publication, writing for see
Writing for publication
Punctuation 279
507
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Index
and small-group teaching 243,
2602
with special needs 13941,
306
support for 25463, 37780,
3889
in the workplace 341, 3456,
348
Study guides 169
Study leave 459
Study skills 316, 440
assignments 32834
citing and listing references
3212, 321, 322
examinations 3345
group discussion and seminars
3256
learning styles 317
levels of study 316, 31617
library use 31719
literature search and review
31920, 320
note-taking 229, 3235
planning to study 3267
reading skills 3223
strategies for effective study
3278
Subject assessment panels 311
Subject matter 186
curriculum and 107, 109, 110
notes 196
selection for teaching session
1868
sequencing 201
structure of 812
teachers knowledge of 186,
226
Subject-centred groups 247
Submission of assessments 305,
3067, 306
Summative assessment 268, 269
Summative feedback to students
2801
Supervision see clinical
supervision
Supervision contracts
clinical supervision 362, 362
student-personal tutor 385,
385
Support groups 415, 416
Support mechanisms
clinical supervision 35963
link lecturers 358, 38790
mentorship 359, 37780
personal tutoring 3807
placement support systems
3547
for students with disabilities
1401
Surface approach to learning
434, 50, 317
SWOT analysis 4968, 497, 498
Syllabus-bound and syllabus-free
students 445
Syndicate groups 246, 248
Synetics 2523
Syntax 279
Synthesis
assessments requiring 2756
educational objective 115,
116, 117, 193, 193
Systematic desensitization 97
Thinking 63
see also Reflection
concepts 64
critical thinking 659, 247,
325
intuition 70
problem-solving and decisionmaking 703
propositional thought 64
Time management, students 51,
3267
TLC (Teachable Language
Comprehender) 59
TNA (training needs analysis)
48990, 489, 490
Token economy 95
TQEC (Teaching Quality
Enhancement Committee) 160
Training needs analysis (TNA)
48990, 489, 490
Transfer of skills/learning 75,
81, 2545
Transmission model of teaching
124, 222, 223
True-false item tests 283, 287
Trust and small-group teaching
243, 244, 292
Tuckman, Bruce
on group development 2389
Turnitin 334
Tutorial groups 246
Tutors
see also Lecturers; Personal
tutoring
and email 217
open, distance and flexible
learning 167, 1724, 175,
176, 178
Tyler, Ralph
on curriculum 111
Validation
of curriculum 134, 1368
of programmes and courses
1545
Validation submission documents
1345, 134
Validity and assessment 270, 271
essays 274
objective tests 282
Value added 145, 146
Values 118, 119
Verbal exposition 224, 228
Verbal learning 88
Vicarious learning 98100
Video-conferencing 214
Video-recordings 214, 292
Vocabulary learning 76
voice, lecturers 227
508
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