New Directions in Teaching and
Learning Within Nursing
Education
New Mexico Statewide Nursing Faculty Conference
June 3-4, 2009
Jean Giddens, PhD RN, Professor
Interim Senior Associate Dean for Academic Affairs
College of Nursing, University of New Mexico
Student Centered Learning
Decades of educational research have shown
that learning is most effective when…….
• Students are engaged
• Learning incorporates emotion
• Learning activities are purposeful and
perceived by students as useful
Integrative Teaching
• Integrative Teaching is practice of
minimizing the distance between
theory and clinical instruction.
• Benner calls integrative teaching a
“signature pedagogy” of excellent
instructors
Emergence of New Paradigms
• Student centered
learning
• Integrative teaching
• Conceptual Approaches
to Teaching and
Learning
• Virtual Experiential
Communities
TEACHING AND LEARNING
DIFFERENTLY: THE CONCEPTUAL
APPROACH
Example: Concepts as Categories
 What concepts do
the shapes below
represent?
 What other concepts
can you identify?
Example: Concepts as Categories
What is Conceptual Teaching and
Learning?
The difference between concept- and contentfocused learning is… “the difference between
facts of the Alaska oil spill and an
understanding of the importance of
environmental sustainability” (Erickson, 1998 p. 50).
Conceptual teaching means….
 Focusing on big ideas – students anchor to specifics.
 Fostering deep learning, and deep understanding
through connections and reflection (as opposed to
surface learning).
 Developing student-centered learning with a
purpose.
Pulmonary
Edema
Anemia
RDS
Pnuemothorax
PE
AMI
Pneumonia
RSV
COPD
Asthma
Oxygenation
Oxygenation
Other
Exemplars
RSV
Asthma
COPD
Pneumonia
Other
Concepts
Teaching Conceptually
Focus on Concept
Exemplars provide content knowledge
Application of content to interrelated concepts
Application of other content to the concept
Concepts for Nursing Education
• In nursing education, a concept should be
clinically useful to guide student learning and
clinical practice.
• What are the Concepts for Nursing Practice?
• Concepts vs. Exemplars
• Concepts vs. Medical Diagnoses
Additional Thoughts on Conceptual
Teaching
 A focus on concepts in itself does not
guarantee conceptual learning.
 Faculty must adopt active learning strategies
to enhance conceptual learning.
 Ideally, concepts are woven throughout the
curriculum - incorporated into clinical and
didactic courses.
Example:
Long-term complications of DM
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Hypertension
ASHD
Renal Failure
Diabetic
Retinopathy
• Peripheral
Neuropathy
• Peripheral Artery
Disease
• How could you teach
this so students can
understand the
underlying concept
or concepts could
explain this?
Example:
Skill AcquisitionSecuring an IV Catheter
• After starting an IV,
what steps are
necessary to
properly secure
the IV?
• What concept(s) apply?
• How could you apply this to
your skills lab teaching?
What is a concept-based curriculum?
Concepts provide organizational structure
for the curriculum and courses.
Concepts represent nursing practice.
Concepts drive content through selection of
exemplars.
INSTITUTION
Mission Statement
Goals
Philosophy
NURSING PROGRAM
Mission Statement
Goals
Philosophy
Level Objectives/Competencies
Courses and Course Objectives
Class Sessions
Class Session Objectives
Class Learning Activities
CURRICULM FRAMEWORK
Knowledge, Concepts & Theory
• Knowledge is represented through concepts
• Concepts are building blocks of theory
THEORY
Concept
Concept
Concept
Concept
Concept
Knowledge
Concept
Concept
Hallmarks of “Good” Concepts for
Curriculum and Teaching?
• Represent important spectrum of conditions
or situations representing nursing practice
• Logical and used consistently
• Useful for education
• Application across multiple courses and
contexts
Benefits
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Content management
Focus on concepts as opposed to content
Emphasis on learning
Focus is on Nursing
Concepts cut across disease
categories and populations
• Emphasis on recognition of concepts across
populations and practice settings
Drawbacks
• Resistance to change
• Requires a different level of
organization
• Students may be resistant (at first)
• Lack of literature detailing steps
• What about NCLEX?
VIRTUAL EXPERIENTIAL
COMMUNITIES
Mr. Ocampo
• Mr. Ocampo is short of
breath, experiences
intermittent chest pain,
and is fatigued.
• He obviously should
seek medical attention,
but he won’t.
• Why won’t he seek
medical care?
Anthony Martin
• Anthony Martin has been
arrested for indecent
exposure at a local park.
• He is taken to the ED
because he is combative
and disoriented.
• What is causing Anthony
to act this way?
Kelsey Young
• Kelsey Young has a
new baby sister.
• What is Kelsey's family
like? Does she have
adequate support
systems?
• What things trouble
her?
What is a Virtual Experiential
Community?
• Extension of technology-enhanced learning
• Representation of individuals in context of
community setting – with impact to group and
individuals.
• In health care, focus on individuals and health
related issues and health care providers.
• Examples:
• The Neighborhood (USA)
• Stillwell (UK)
Giddens - ODU, 2008
Household Characters
– 34 characters who live in 11 households within
The Neighborhood.
– Character stories reflect health-related situations
based on incidence and prevalence.
– Stories reflect individual and family responses to
health-related problems over time.
– Stories told from the perspective of the
character.
Nurse Characters
• 6 featured nurse characters that work in 4 healthcare agencies
– 3 Hospital Nurses, School Nurse, Midwife, Geriatric Nurse
in senior center
• Stories reflect contemporary issues in nursing
practice and issues within the local community.
• Stories of household characters interwoven into
nurse stories as applicable.
Biographical
Information


Each character has
biographical
information that
serves as an
introduction.
Updated each
semester to reflect
previous semester
story.
Weekly
Story
Each character has
a story update
each week.
Stories unfold
weekly over 3
academic
semesters.
Photos &
Video Clips


Stories are
extended with
photos, and
video clips as
applicable.
These media
enhance
understanding
beyond text.
Medical
Record
• Abbreviated medical
records included to
provide an
understanding of
health care.
Newspaper
•
•
The newspaper
links individual
characters to
the community
Is reflective of
contemporary
social, ethical,
and health
related issues.
BENEFITS OF LEARNING WITH VIRTUAL
EXPERIENTIAL COMMUNITIES
Changing the Focus and Context
• Focus shifts away from content and toward the
characters’ lived experiences
• Context is story of individual and relationships within
the home, community, and health care settings.
• Enhanced understanding of issues associated with
vulnerable populations and individuals with complex,
chronic conditions.
• Enhanced understanding of diversity (i.e. cultural,
age, socioeconomic, sexual orientation).
Comparisons – Heart Failure
Traditional Approach
-
A&P
Pathophysiology
Signs/Symptoms
Dx tests
Treatment
Nursing Interventions &
patient teaching
Context = acute phase;
perspective of the
nurse
Virtual Experiential Communities
- Story of individual with HF
- Story depicts issues associated
with disease management and
navigating health care system
- Multimorbidity
- Changes in status depicted time
over weeks; acute exacerbation
not primary focus of story – just
an event within the story.
Context = daily life;
perspective of individual
What is the Link to Nursing
PHASE OF NURSING CARE
• Clinical Judgment Model (Tanner)
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Notice (potential for problem)
Recognize (problem has developed or is developing)
Respond (nurse knows what to do)
Reflection-in-action
Reflection-on-action
• Health Promotion Model
– Primary Prevention
– Secondary Prevention
– Tertiary Care
Common Teaching Strategies
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Incorporated in Lecture
Case Study
Role Play
Games
Care Plan
Creative Writing
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Simulation
Compare and Contrast
Concept Map
Debate
Concept Analysis
Policy Analysis
What Do You Want Students To Do?
Learning Activities that are Purposeful
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Individual Assessment
Family Assessment
Community Assessment
Calculate medication dosages
Analyze medication or treatment
plan
Develop a Care Plan
Develop a Teaching Plan
Identify Risk Factors
Identify Interventions
Evaluate Interventions
Hold a Team Meeting
Analyze a Medical Record
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Plan a Home Visit
Analyze payment structures
Develop a Policy or Protocol
Propose a Community Health
Plan
Identify a researchable problem
Apply principles of ethics to an
ethical dilemma
Apply evidence-based standards
to situation
Develop Discharge Instructions
Plan a Health Fair
Identify Safety Hazards
FUTURE DIRECTIONS
Outcomes and Evidence
• Research conducted at pilot sites Fall 08
– Perceived engagement
– Perceived benefits (students)
– Perceived benefits (faculty)
• Future research ???
– Faculty work-life
– Enhance cultural competence
– Differences in health care delivery
Alternative Applications
• Population specific virtual communities
• Application for multidisciplinary health care
education
• Application for other disciplines
– K-12
– Social Work
– Construction Management