ADVANCED CLINICAL TEACHING CHAPTER 1 MULTICULTURAL ASPECTS OF LEARNING Types of Culture Communitarianism - is found in traditional or conventional societies.

ies. Here, the community or societies views are regarded first, and then an individualistic perspective is considered. No decision is made without the concerned parties consent. Individualistic culture- is found most commonly in modern societies. Here, the individual makes all his decisions himself, and others do not affect these. He regards his opinion much higher than the society he lives in. Neutral cultures- are those, where feelings are controlled and are kept subdued. Right from the formative years, a child is taught to behave in a certain manner and control his emotions. Emotional cultures- feelings are expressed very openly. People are open about their happiness or sadness in a certain situation. They are usually open with one another about their problems and joys and tend to be surrounded by family or friends at most times. They are warm and personal Diffuse cultures- believe in customizing their response or approach when dealing with a particular person or situation. They take time out to know the person they are dealing with. They do keep a few rules in mind, but go out and to have personalized interactions with people.

Following points about Culture 1. 2. 3. 4. 5. Culture is learned and transmitted from one generation to another. Culture is localized and is created through specific interactions with specific individual. Culture is patterned. Culture is evaluative. Culture has continuity, with change.

Three approaches to promoting cultural knowledge and competency. 1 . the fact-centered approach,, which provides information about the health beliefs and behaviors of specific ethnic groups. 2 . Culture is attitude centered, emphasizing the importance of valuing and respecting all cultures. 3 . An ethnographic approach to cultural competence.
rd nd st

CULTURAL AWARENESS The process whereby the nurse becomes respectful, appreciative, and sensitive to the values, beliefs, practices, and problem-solving strategies of a client culture. a. b. Ethnocentrism- a behavior in which a person is totally unaware of others cultural beliefs and values. Ethno relativism- reflects an attitude of nurses who value, respect, and integrate cultural differences into their practice.

CULTURAL KNOWLEDGE Involves the process of seeking and obtaining factual information about different culture.

1. 2. 3. 4.

Unconscious incompetence is identified as an individuals being unaware that he or she lacks cultural knowledge. Conscious incompetence is the awareness that he or she lacks knowledge about another culture and is willing to seek and obtain the knowledge. Conscious competence is the act of learning about a clients culture, verifying generalization, and providing culturally responsive nursing intervention. Unconscious competence is the ability to automatically apply knowledge and the culturally congruent care to clients from diverse cultural backgrounds. The nurse who has unconscious competence interacts naturally and easily with clients from diverse cultures.

CULTURAL ENCOUNTERS Is the process whereby a nurse engages directly in cross-cultural interactions with the clients from culturally diverse backgrounds. One of the purposes of this encounter is to refine or modify ones belief about those groups to prevent possible stereotyping CULTURAL SKILLS The ability to collect relevant cultural data about a client health history and health problems, as well as to accurately perform culturally specific assessment. CULTURAL DESIRE The nurse motivation to engage in the process of cultural competence. Nurses need to want to work toward cultural competence as they individualized and self care to clients.

Four major themes emerged from the data; 1. 2. 3. Discomfort caused by lack of knowledge, skills, or exposure to groups members. Discomfort caused by disapproval or negative attitudes towards group members. Discomfort as a result of feeling threatened by feeling guilt, sympathy, or pity toward group members.

THE CULTURE OF TEACHERS AND LEARNERS Nurse educators who work with the multicultural students should consider the following: 1. 2. Become self-aware of your own cultural values, norms, and beliefs and the influence they have on your view of life, family, and relationship. Develop and maintain an attitude of respect for the broad range of cultural differences and their importance to individuals. Identify and value the strengths in different cultural values and beliefs rather than becoming critical of them. Develop strategy for continuing education about predominant cultures in a given community or institution. Explore the possibility of integrating the appropriate use of the teaching strategies and communications. Consider the use of other professionals and members of the community from other cultures to learn about the culture.

3. 4. 5.

ASSESSING THE CULTURALLY DIVERSE LEARNER

Educating culturally diverse learners presents a challenge to nurse educators. We must be aware of the fact there are varying cultural behaviors and that these behaviors are the result of past educational experiences, cultural beliefs, and cultural heritage. Cultural differences may have a significant impact on the way learners think and learn. COMMUNICATION Means by which culture transmitted and preserved through the generations. Nurse educators need to be aware of the complexity in communication, especially in learners whose primary language is other than English. Misunderstandings are not necessarily due to problems in translation. SPACE An individual level of comfort is related to personal space or distance, and discomfort is experienced when ones personal space is invaded. Personal space is an individual matter and varies with the situation. SOCIAL ORGANIZATION Cultural behavior, or how one act in certain situation, is socially acquired and learned. These patterns of cultural behavior are important to the teacher because they provide explanations for the peoples behavior. Individuals are not generally conscious of their cultural behavior. TIME Temporal orientation refers to how time is viewed. ENVIRONMENTAL CONTROL Refer to a person ability to plan activities that control nature. It also refers to the persons perception of his ability to direct factors in the environment. BIOLOGICAL VARIATION Educators know that the learners from different backgrounds have genetic biological difference that may affect their classroom performance. One such difference may be susceptibility to disease.

CROSS-CULTURAL ISSUES IN COMPUTER-BASED LEARNING Nurse educator in designing or using computers as a teaching strategy should consider the importance of using symbols and methods that users can recognize from their own cultural background experience. COMMUNICATION ISSUES Cross-cultural communication with Nursing Students communicating and writing effectively in a second language ha been identified as a major challenge facing nursing students. Cross-cultural communication and in-service education. Cross-cultural communication with the patients and clients. Gender differences in communication.

EFFECTIVE TEACHING IN NURSING What constitutes good teaching? Who should be asked about good teaching practices, teachers or students? Student surveys have inherent weaknesses. Although the majority of students may agree on the qualities of a good teacher, some students have different opinions based on their individual learning styles, goals, and personal needs.

Despite the weaknesses of survey methods, such research provides useful insights into the components of GOOD TEACHING. In 1966, Jacobson, in a classic article, delineated 6 MAJOR CATEGORIES of effective teaching in nursing

1. Professional competence -The teacher who enjoys nursing, shows genuine interest in patients, and displays confidence in his or her professional abilities is rated high. -The teacher who is creative and stimulating, can excite student interest in nursing, and can demonstrate clinical skills with expertise is also valued. -He or she maintains and expands this knowledge through: reading, research, clinical practice and continuing education. -Learners need to know that they can trust the teacher. =admit errors and admit weaknesses. -Excellent clinical skills, judgment, honesty =Role Model. 2. Interpersonal Relationship with students -Skillful in interpersonal relationships. DEMONSTRATED BY: taking a personal interest in learners, being sensitive to their feelings and problems, conveying respect, alleviating anxieties, accessible, fair, permits expression, sense of warmth. 3. Personal Characteristics -Desirable personal characteristics of teachers: authenticity , enthusiasm, cheerfulness, self-control, patience, flexibility, humor, good speaking voice, self-confidence, caring attitude. -Learning= Interesting, fun and pleasant. 4. Teaching Practices -Jacobson (1966) mechanics, methods, and skills in classroom and clinical teaching. -Students and colleagues value a teacher who has a thorough knowledge of the subject matter and can present material in an interesting, clear, and organized manner. -FACTORS affecting: teachers style, personality, personal interest, teaching strategies 5. Evaluation Practices -Clearly communicating expectations, providing timely feedback on student progress, correcting students tactfully, being fair in the evaluation process, giving tests that are pertinent to the subject matter. 6. Availability to Students -One of the great stressors for teachers- trying to be available to students or patients who need instruction, at the precise time they need it. -Learners should be told what they should do for an instance if the instructor may not be available at the time. -Backup plan. BARRIERS TO EDUCATION and OBSTACLES TO LEARNING BARRIERS TO EDUCATION- factors impeding the nurses ability to deliver educational services. Lack of time to teach; Traditionally ill prepared to teach; Personal characteristics-motivation; Low priority; Environmental settings-space; privacy; Absence of third-party reimbursement; Learners itself; Inconsistency-malfunction; Scope and depth of teaching OBSTACLES TO LEARNING- factors that negatively affect the ability of the learner to attend to and process information. Stress; Negative influence; Lack of time to learn; Personal characteristics-readiness; motivation; compliance; Behavioral changes needed; Lack of support; Psychological-denial; willingness Learning Systems Is an interdependent combination of people, media, and materials that interact to achieve a goal. In the systems approach to instruction, the teaching/learning process is planned to facilitate learning. A specific methodology is used to design, implement, and evaluate the teaching/learning process. This methodology is directed at achieving specified objectives and based on research in human learning and communication. Requirements for a Learning System A learner A learning goal A procedure for achieving the goal

Types of Learning Sytems 1. trial and error The least efficient way of learning, trying one approach and then another. With no guiding theory or principles. This is like reinventing the wheel every time the learner wants to progress. 2. deductive and inductive approaches Giving a definition and following it with examples; Giving examples of a concept and then following it with a definition. 3. Discovery social cognitive learning Self-efficacy theory is an important component of Albert Bandura's social cognitive theory, which suggests high interrelation between individual's behavior, environment, and cognitive factors. According to Bandura, a persons attitudes, abilities, and cognitive skills comprise what is known as the self-system. Self-efficacy plays an essential part of this self-system. People with a strong sense of self-efficacy: View challenging problems as tasks to be mastered. Develop deeper interest in the activities in which they participate. Form a stronger sense of commitment to their interests and activities. Recover quickly from setbacks and disappointments. People with a weak sense of self-efficacy: Avoid challenging tasks. Believe that difficult tasks and situations are beyond their capabilities. Focus on personal failings and negative outcomes. Quickly lose confidence in personal abilities (Bandura, 1994). How does self-efficacy develop? These beliefs begin to form in early childhood as children deal with a wide variety of experiences, tasks, and situations. However, the growth of self-efficacy does not end during youth, but continues to evolve throughout life as people acquire new skills, experiences, and understanding. (Bandura, 1992). Four major sources of self-efficacy 1. Mastery Experiences "The most effective way of developing a strong sense of efficacy is through mastery experiences," Bandura explained (1994). Performing a task successfully strengthens our sense of self-efficacy. However, failing to adequately deal with a task or challenge can undermine and weaken self-efficacy. 2. Social Modeling Seeing people similar to oneself succeed by sustained effort raises observers' beliefs that they too possess the capabilities master comparable activities to succeed (1994). Witnessing other people successfully completing a task is another important source of self-efficacy. 3. Social Persuasion Bandura also asserted that people could be persuaded to belief that they have the skills and capabilities to succeed. Consider a time when someone said something positive and encouraging that helped you achieve a goal. Getting verbal encouragement from others helps people overcome self-doubt and instead focus on giving their best effort to the task at hand. 4. Psychological Responses "it is not the sheer intensity of emotional and physical reactions that is important but rather how they are perceived and interpreted Bandura (1994). Our own responses and emotional reactions to situations also play an important role in self-efficacy. By learning how to minimize stress and elevate mood when facing difficult or challenging tasks, people can improve their sense of self-efficacy. Traditional Teaching Strategies 1. Lecturing a. Definition It is an oral presentation intended to present information or teach people about a particular subject These are used to convey critical information, history, background, theories and equations Usually the lecturer will stand at the front of the room and recite information relevant to the lecture's content. b. Purposes of Lecturing It can be an efficient means of introducing learners to new topics It can be used to stimulate students interest in a subject 4.

 It can be used to inspire people It helps to integrate and synthesize a large body of knowledge from several fields or sources Difficult concepts can be clarified in lectures It is valuable where knowledge is advancing rapidly and up-to-date textbooks are not available c. Advantages of Lecture Method It is economical The lecturer can supplement a textbook by enhancing a topic and making it come to life During a lecture, a teacher can serve as a role model for the students Learners have the advantage of watching a creative mind at work It can bring enjoyment to the learners as well It helps students develop their listening abilities d. Disadvantages of Lecture Method It places learners in the passive role of sponge Few teachers are good lecturers It lends itself to the teaching of facts while placing little emphasis on problem solving, decision making, analytical thinking or transfer of learning It often results in surface learning It is not conducive to meeting students individual needs It brings with it the problem of limited attention span on the part of learners e. Organizing the Lecture Classical Lecture - the most commonly used formed, especially in nursing. Comparative Lecture is used when the objective is to differentiate between two entities. Problem Centered Format is also popular. In this approach, a problem is posed, and various hypothesis and solutions are developed. Thesis Format this involves a lecturer taking a position on an issue or a particular viewpoint on a subject and then supporting and justifying that viewpoint with evidence. f. Characteristics of Disorganized Lecture Structure or outline is not obvious to the learner No mention of the objective or desired learning outcomes of the lecture Lecturer mentions same topic at different times for no apparent purpose other than failing to complete a thought at one time No transition between sections of the lecture No summary or tying of thoughts in the end g. Delivering the Lecture Controlling of Anxiety Spontaneity Voice Quality Body Language Speed of Delivery Getting off on the right foot Clarifying during the lecture Facilitating Retrieval from memory 2. Discussion a. Definition These method is effective in getting the students to think constructively while interacting with the rest of the group. A discussion is an oral exploration of a topic, object, concept or experience. All learners need frequent opportunities to generate and share their questions and ideas in small and whole class settings. Class discussions may be formal or informal. b. Purposes of Discussion Method to stimulate thought, wonder, explanation, reflection and recall to provide opportunities for students to clarify and expand their ideas and those of others to demonstrate questioning techniques c. Advantages of Discussions Students can learn the process of problem solving Helps students develop and evaluate their beliefs and positions

 Attitudes can be changed through discussions to promote positive group interaction and conversation d. Disadvantages of Discussions It take a lot of time It is effective only in small groups One person or few people can monopolized the discussion Discussions are valuable only if the participants come prepared with the necessary background information e. Discussion Techniques Make your expectations clear Set the ground rules Arrange the physical space Plan a discussion starter Facilitate, dont discuss Encourage quiet group members Dont allow monopolies Direct the discussion among group members Keep the discussion on track Clarify when confusion reigns Tolerate some silence Summarize when appropriate 3. Questioning a. Definition It is a major form of human thought and interpersonal communication The instructor employs a series of questions to explore an issue, an idea or something intriguing. It is the process of forming and wielding that series to develop answers and insight. b. Functions of Questioning It can be used to assess baseline of knowledge It can also be used to review content It can arouse learners curiosity It helps to guide learners thought process in a certain direction c. Question Classification using Blooms Taxonomy Level of Blooms Taxonomy 1. Knowledge 2. Comprehension 3. Application 4. Analysis 5. Synthesis 6. Evaluation Level of thinking Involves recall of memorized data Includes understanding and interpretation of information Requires using information in new situations Involves breaking the whole into parts and showing relationships Requires combining elements into a new structure Includes assessing a situation based on criteria

d. Types of Questions Factual Questions - it demand a simple recall answer Probing Questions it is used when a teacher wants a learner to further explain an answer Multiple Choice Questions it is a form of assessment in which respondents are asked to select the best possible answer (or answers) out of the choices from a list. Open Ended Questions this broad category encompasses all questions that require learners to construct an answer. Questions that guide problem solving proper sequencing of questions is a consideration when using this kind of question Rhetorical questions it is sometimes appropriate to ask questions for which you expect no answers at the time e. Questioning Techniques Prepare some questions ahead of time State questions clearly and specifically

 4.

Tolerate some silence Listen carefully to responses Use the beam, focus, build technique Provide feedback Handle wrong answers carefully

Using Audio-visuals a. Definition i. The term Audio-Visual (AV, or A/V) may refer to works with both a sound and a visual component. ii. Audio-visuals include any teaching tool used to focus attention, emphasize, clarify and reinforce key points. Visuals, in particular, are important presentation tools because humans are visual creatures we process visual information (pictures, graphs, etc.) 60,000 times faster than text and retain it up to five times longer. b. Advantages of Audio-visuals for the audience Capture attention and focus attention Reinforce the verbal message Clarify information Accelerate learning Increase retention c. Advantages of Audio-visuals for the presenter Help organize the presentation Increase presenter credibility Help manage time and help maintain control Help keep presenter/audience on the same track d. Types of Traditional Audio-visuals Hand-outs Chalkboards or whiteboards Overhead transparencies Slides Videotapes

ACTIVITY-BASED TEACHING STRATEGIES I. II. III. IV. Cooperative Learning Strategies Simulations Problem-based Learning Self-learning Modules

I.

COOPERATIVE LEARNING STRATEGIES A working definition of cooperative learning is that it involves structuring small groups of learners (usually groups of four or five) who work together toward achieving shared learning goals. Cooperative learning is based on the premise that learners work together and are responsible for not only their own learning but also for the learning of other group members (Lindauer & Petrie, 1997).

Types of Cooperative Learning Groups Formal Groups Purpose To complete a specific learning task consisting of concepts or skills Informal Groups To enhance understanding of a specific unit of information; to make Base Groups To provide encouragement and to monitor progress

connections learning Length of Existence One class to many weeks

to

prior

throughout the learning experience The length of the learning experience, usually long term

No more than one class, and perhaps for only a few minutes during a class

These three types differ in their length of existence and the specific purposes they address (Johnson, et.al, 1998). 1. 2. 3. Formal Groups are usually most effective or useful in the academic or classroom setting than in-service or patient education departments. Informal Groups can be used in any setting, even in the community. Base Cooperative Learning Groups could be most applicable to preceptorship programs or new staff orientation.

Advantages of Cooperative Learning o o o o Group members learn to function as part of a team. Working in a group for any length of time can teach or enhance social and communication skills. Cooperative learning groups can help to address individual learning needs and learning styles (Huff, 1997). Critical thinking is promoted (Zafuto, 1997).

Research on Cooperative Learning o o o o o o Cooperative learning produces higher achievement levels than do individualistic or competitive learning approaches. Outcome measures of achievement are knowledge gain, retention of knowledge, problem solving, reading, mathematics, and procedural tasks, all of which show increases with cooperative learning. Other outcomes found are increased self-esteem, improved attitude toward learning, social competence, and decreased anxiety in learning. Cooperative learning has been found to be a cost-effective strategy. Effectiveness of cooperative learning has been found in all ages and levels of education, both sexes, all nationalities studied, and all economic groups. Effects have been equally good for learners at all ability levels.

Why is Cooperative Learning so effective? o o o An effective way to learn something is to try to teach it to someone else. As learners listen to each other, they work to make sense of what each is saying and then they build on these ideas, thus adding to their cognitive schemata. As learners within a group disagree with each other, they seek to reduce cognitive dissonance and therefore end up synthesizing divergent ideas.

II.

SIMULATIONS

Simulation (Cooper, 1979; Rockler, 1978; Thiagaran & Stolovich, 1978) is an imitation, recreation or representation of the structure or dynamics of a real thing or situation with which the learner actively participates and interacts with persons or things in the environment, applies previously learned knowledge to solve a problem or situation and receives feedback about his or her responses without fear of adverse effects related to real-life consequences or results. Simulations are controlled representations of reality. They are exercises that learners engage in to learn about the real world without the risks of the real world.

Purpose and Uses of Simulations *Simulations are intended to help learners practice decision-making and problem-solving skills, to develop human interaction abilities, and to learn psychomotor skills in a safe and controlled setting. o o o o o Simulations can be used to achieve many learning objectives. Simulation is also an avenue for attitude change. Decision-making skills can be fostered by simulation. Simulation strategies can be applied to the teaching of psychomotor skills. Simulations can be used to evaluate learning and competence.

Roles of the Educator 1. 2. 3. o o o Planning begins with choosing or developing an appropriate simulation that will meet learning objectives. Facilitating you should function as a facilitator during the actual progress of the simulation. Debriefing should occur immediately following the simulation when the information is fresh in everyones mind. First, briefly summarize what has taken place. Second, it can be valuable to have the learners explain what they did and why. Third, you should point out how principles and concepts have been applied and how the experience ties in to the learning objectives.

Four Types of Simulations 1. Simulation Exercise A controlled representation of a piece of reality that learners can manipulate to better understand the corresponding real situation. It focuses on process learning. Participants learn how to make decisions or solve problems or apply theory.

Examples: Helmuth (1994) developed a mock convention to help nursing students apply leadership skills. The simulation is very involved and lengthy one in which students simulate a portion of a professional nursing organization convention. Lev (1998) conducted an exercise in which nursing students, acting as if they were from a variety of community agencies, competed for community grant monies designed to assist chronically ill people across the life span.

Wildman and Reeves (1997) used a simulation exercise to teach nursing students how to apply management theory to organizing the work of a hospital clinical unit. Simulation exercises designed to help learners apply and master psychomotor and clinical skills: Aronson, Rosa, Afinson, and Light (1997) arranged a laboratory simulation in which senior nursing students visited manikin patients who were outfitted with tubes, dressings, intravenous lines, and the like. Eaves & Flagg (2001) The U.S. Air Force developed an entire simulated hospital unit in which new graduates spent four hours providing care to nine manikins and two live actor patients.

2.

Simulation Game A game that represents real-life situations in which learners compete according to a set of rules in order to win or achieve an objective. It focuses either on content or on process learning. Content Games focus on teaching or reinforcing factual information.

Example: Crossword puzzles that aim to teach terminology or Bingo games that reinforce previously learned facts. Process Games emphasize problem solving or application of information.

Example: Simulation game such as SimCity Frame Games games that follow the format of established board games, television games, and word games (Bloom & Trice, 1994) because they provide a frame on which you can build new game applications.

Advantages of Simulation Games o o For most people, gaming is fun. It increases interaction among learners and allows even quiet and reserved class members to participate in a relatively lowrisk situation.

Disadvantages of Simulation Games o o o Games may be a waste of time. Games are unprofessional and dislike the competition that games promote. Time consuming to play and very labor-intensive to develop (Bloom & Trice, 1994).

Factors to Consider in Developing Simulation Games o o Validity of Games (Peters, Vissers, and Heijne 1998). Careful Planning (Gruending, Fenty, & Hogan, 1991).

3.

Role-playing A form of drama in which learners spontaneously act out roles in an interaction involving problems or challenges in human relations.

It is a simulation technique where one person portrays the role of another whose primary purpose is to help participants and observers obtain insights into the behaviors and feelings of people who are different from themselves by spontaneously acting out roles involving problems in human relations. This teaching method is effective in helping people gain skill in interpersonal and therapeutic relationships and in teaching them how to handle interpersonal conflicts. Role-playing may be a means of helping people develop the quality of empathy.

*In a staff development setting, Johnson (1997) used role-playing to teach home care nurses to assess patients, communicate with families and professionals, and to fill out paperwork accurately.

Mechanism of Role-Plays (de Tornyay, et.al. 1987): o o o o o Role plays usually last from 5 to 15 minutes. Upon termination of the play, the participants are asked to discuss their feelings about the roles they played and the feelings that the roles generated. Then the observers are asked to join in the discussion and to analyze what occurred, what feelings were generated and the insights that were gained. Criticism should focus more on the role that was played and the problem that was presented rather than on the person playing the role. Videotaping is highly recommended for precise recall of the incident to aid the analysis and discussion.

4.

Case Studies (De Young, 2003) It is an analysis of an incident or situation in which characters and relationships are described, factual or hypothetical events transpire, and problems need to be resolved or solved. Case studies provide learners with an open-ended problem where the student is expected to see the pros and cons, advantages/disadvantages of the presenting alternatives or options where there is more than one desirable outcome. After comparing the alternative solutions, the student must be able to make a decision and defend or justify the choice of actions. The students ability to see and appreciate more than one perspective or point of view is one of the primary objectives of case studies.

Steps in Constructing Case Studies: 1. 2. 3. 4. 5. Develop the objectives based on what you expect the students to achieve. Select a situation, topic or scenario that will meet your objectives and learning content you have chosen. Draw cases from real-life situations. Develop the characters by giving enough details about the patient and his/her family and health care providers so that the interpersonal aspects of the case will be an integral part of it. Develop the discussion questions which should promote application of principles and generation of possible interventions and outcomes. Lead the group discussion and keep the atmosphere of the class relaxed. Whether this is a group or individual case presentation, explain to the class that except for the factual questions, there is no one right answer to a case.

III.

PROBLEM-BASED TEACHING

Problem-based learning (PBL) is an approach to learning that involves exposing the students to real-life problems and working together in small groups, analyzing the case, deciding what information they need and then solving the problems. The chief differences between PBL and the case method are: 1. 2. 3. PBL is conducted with small groups, while case studies may be used by individuals or groups. Students using PBL have little background knowledge of the subject matter in the case, whereas in the case method, students already have most of the background knowledge they need to apply to the case. In PBL, the cases are usually brief and the presenting problems are ill structured, while in the case method, cases are often long and detailed and their problems are fairly well defined.

Facts about Problem-based Learning o o PBL began over 35 years ago at McMaster University School of Medicine in Canada and has spread to medical schools in the United States and all over the world. The first nursing application of PBL began in Australia, and the movement has spread to Africa, Asia, Europe, and the United States (Rideout, 2001).

Advantages of Problem-based Learning o o Helps the student to think critically. Sharing of new information.

Disadvantages of Problem-based Learning o o o o Takes a lot of time (Matthews-smith, Oberski, GrayCater & Smith, 2001). Students may feel unhappy and that of the teacher. Teachers have difficulty adjusting to their role. Students feel frustrated as they learn to direct to direct their own learning (Lunky-child et. al., 2001).

IV.

SELF-LEARNING MODULES Also called self-directed learning modules, self-paced learning modules, self-learning packets, and individualized learningactivity packages. A self-learning module can be defined as a self-contained unit or package of study materials for use by an individual (De Young, 2003). Most useful for adult learners in graduate and undergraduate levels. This can be produced in a hard copy, online or as CD-ROM.

Self-directed learning is based on some of the principles of adult learning such as: 1. 2. Adults are self-motivated to learn material for which they see relevance. Adults prior experience is a resource for further learning.

3.

Adults are problem focused and readily learn material they can use to solve problems (Herrick, Jenkins, & Carlson, 1998; Mast & Van Atta, 1986).

Components of Self-learning Modules The components are fairly standard: Introduction and Instruction the topic for a module is a single concept. A course may have several modules. Behavioral Objectives state what the learner will be able to do upon completion of the module. Pretest usually but not always included but modules for staff development and academic settings usually include pretests. The pretest helps learners evaluate which sections of the module they might skip over and which ones they need to study in depth. Learning Activities activities are designed that will help the learner achieve the objectives. The activities should also appeal to people with differing learning styles. Activities might include: o o o o o Reading textbook chapters, articles, or pamphlets Reviewing handouts, charts, pictures or diagrams Attending short lectures, speeches, or demonstrations Answering study questions and getting feedback Watching a video or slide presentation

Self-evaluations a self-test is usually included at the end of every lesson or subconcept. It is generally some form of quiz, either multiple choice questions or short-answer questions. Posttest used to determine whether learners have mastered the module objectives. It may be an objective-item test, a case study, a written assignment such as a care plan, or a demonstration of a psychomotor skill.

Advantages of Self-learning Modules o o o o The ability to learn independently and at ones own pace and in ones own time. In academic settings, faculty who are frustrated with not having the time to help students who are struggling with course material in a traditional learning system have that opportunity in the individualized approach. In staff development settings, self-learning modules can reduce travel time for conferences and reduce the amount of time that staff nurses have to be away from their units. They can also reduce the cost of in-service education.

Disadvantages of Self-learning Modules o o o Some learners may miss learning with other people and miss the interactions that take place in a classroom. For learners who tend to procrastinate, individualized learning may lead to further procrastination because of lack of structure and deadlines. In settings where the module posttest is taken without supervision, learners may be less than honest about their results and thus forego needed learning (Sugg et al., 1998).

COMPUTER TEACHING STRATEGIES

Computer use in nursing and patient education is increasing greatly due to: Hardware cost decrease Software proliferates The internet and the World Wide Web (WWW) expand Availability of grant funds for technology Growth of software companies Increasing sophistication of software Need to make education more cost effective

Computer technology and learning Computers are used to: Communicate information to students and nurses in a time-saving way Teach critical thinking and problem solving Provide simulations of reality Educate from a distance

In the clinical world, computers are used to: Communicate with other health care professionals Access patient records in real-time online Provide patient teaching Provide home-based care and support for the chronically ill

Advantages of computer use: Support mastery learning very well Can maximize time on task and can help develop overlearning Provide instant feedback Instructional consistency Interactivity Reduction of teachers repetitive tasks Individualized instruction Time efficiency Cost effectiveness

Drawbacks of computer instruction: Many nurse educators do not feel comfortable enough with computer instruction to jump into this medium. Cost Effect that computer use may have on personal and professional communication.

Ribbons (1998) discusses the cognitive effects of computer use. He suggests that there are: Cognitive effects with the technology those learning effects that take place during the use of the computer program. Cognitive effects of technology effects that remain after use of the computer. Cognitive residue skills the learner acquires during interaction with the computer that can be transferred to other situations.

Computer Assisted Instruction (CAI) Who can benefit? Patients Nursing Students Nursing Staff

To be effective, it requires that: The program be aimed toward instructional objectives and be of high quality Learners have sufficient access to computers There is sufficient technological support The computer is judged to be the best way to teach the given content.

Strategies 1. Drill and Practice Simplest level of CAI Students have already learned certain information, either through computer programs or teaching methods, and are now presented with repetition and application of information. Computer presents a series of questions or problems which the student must answer from recall. It may be used in any situation requiring memorization of facts, and concepts. Based on the principle of mastery through the use of repetitious practice or rehearsal of knowledge or skills.

2. Tutorials The program tutors or teaches the student a body of knowledge by presenting information and asking questions, giving hints if the student gets stuck. Most useful in teaching material at the rule and concept level.

Any information taught by means of lecture could potentially be written as a computer tutorial program. Take the form of an interactive lecture with built-in feedback and can be developed very creatively, especially if graphics are used.

3. Games Few nursing game programs have been written and marketed, probably because good games are not easy to devise and because software specialists have been concentrating their efforts on other modes. Computer games can involve either content or process. Both simulation and nonsimulation games can be used with the computer. The program is designed to: o o o 4. Simulations Simulations of real-world experiences provide students with the opportunity to learn how to solve clinical problems and make sound decisions. Computer simulations can provide students with all the details about a particular patients situation and then ask them to assess the patient, arrive at diagnoses, plan interventions, and evaluate care. Unexpected twists and turns can also be thrown in the course of the patients illness and ask for revisions of plans or quick decisions. Advantages: o o o Students can all be exposed to the same learning situation, which is not the case in the clinical setting. Students can take risks and make mistakes with no danger to the patient. The student is functioning in a controlled environment where pressures characteristics of the clinical area do not occur. Assess strategies Give results or effects of decisions made Introduce variables that alter the course of events

Disadvantage: o Educators find out only what students might do or are capable of doing in a situation, not how they actually would perform in reality.

A computer simulation might be formatted in the following way: o o o o o o o Description of a patient situation Student selects (from a list) which data should be collected Computer provides feedback about choices Student uses the correct data to arrive at nursing diagnoses Computer provides feedback on diagnoses Student selects (from a list) appropriate nursing goals Computer responds to each solution as to why it is or is not correct

o o o o

Student selects (from a list) appropriate nursing actions Computer responds with positive and negative effects of each action Student selects (from a list) evaluation criteria that indicate success of nursing actions Computer provides feedback on evaluation criteria.

5. Multimedia Presentations Sometimes called hypermedia, may incorporate texts, sound tracks, graphics, still photos, animation, video clips, and material from the World Wide Web (WWW).

Evaluating Software A manual or users guide accompanies programs. It is generally not made available to learners but should be available to the nurse educator. The manual should be: o o o o Clearly written Have an easy-to-use index Contain a trouble-shooting section Include information about the type and level of learner for whom the program is designed, objectives of the lesson material, and an estimate of the average amount of time it should take to complete the program.

Criteria for Evaluating Computer-Assisted Instruction Software o o o o o o Accuracy Ease of Use Design Appearance Feedback Cost Effectiveness

Computer Managed Instructions Teachers can use computers to manage, prepare, organize, and evaluate educational experiences. It may include test development programs, system of record keeping and authoring systems.

The Internet Is a mammoth complex of computer connections across the continents, connecting many millions of computers. The primary uses of the Internet in nursing are e-mail, news groups, and access to the WWW.

1. E-mail (electronic mail)

Can be used to provide greater collaboration between teachers and students and between students and students. Can be used as a means for patients to seek referrals, for consultations, and for post discharge follow-up. Listserv a group of people who have similar interests and want to share information and experiences regarding those interests in a type of discussion group.

2. News Groups Discussion groups of people with similar interests. Messages appear in a general mailbox that everyone views, compared to the individual mailbox messages in a listserv. Special programs called news reader software may be necessary for individuals to read e-mails sent to a news group. One example of a news group of interest to nurses is sci.med.nursing, a group discussing all kinds of nursing issues.

3. World Wide Web A collection of millions of documents found on Web pages that interface to the Internet. It can be a place to find specialized knowledge and multimedia presentations. Two problems exist in using the WWW and teaching others to use it: (1) difficulty in finding the Web sites pertinent to your purpose and (2) quality or lack of it, of many Web sites. To be efficient in a search for information on the Web, you must use a search engine that indexes Web pages for you and gives you the Uniform Resource Locator (URL) for each page. Criteria for Evaluating the Quality of WWW Sites o o o o o Virtual reality Computer-based, simulated three-dimensional environment in which the participant interacts with a virtual world. Advantages: o o Ability to practice invasive procedures in a lifelike scenario is an extraordinary advantage over previous simulation formats. The control that is built into the virtual reality simulation makes it a unique opportunity to practice complex and dangerous skills in a safe environment. Purpose Currency Credibility Content Accuracy Design

Disadvantage: o o The cost of developing, operating, and maintaining a virtual reality system is generally prohibitive unless grant funds are obtained. People may assume they if they learn a skill via virtual reality, they will automatically perform well in a real setting.

Technology in Nursing Education and Communication 1. Distance Learning Teacher and learner are separated from each other. Learning is achieved through online courses with the internet. Some techniques used: o o o o Online courses Correspondence courses Independent study Videoconferencing

2. E-Learning (Electronic Learning) Training modules can be accessed via the World Wide Web in a computer or laptop within the clinical unit. Modules are interactive and reality-based where patient simulation can be created to allow the participant to manage the care of a virtual patient.